N.Y. Comp. Codes R. & Regs. tit. 11 § 86.2

Current through Register Vol. 46, No. 43, October 23, 2024

Section 86.2 - Definitions

The following shall govern the construction of the terms used in this Part:

(a) Claimant means any person who attempts to obtain a benefit from an insurer or self- insurer.

(b) Commercial insurance means insurance other than personal insurance.

(c) Insurance policy has the meaning assigned to insurance contract by section 1101 of the Insurance Law, except it shall also include reinsurance contracts, purported insurance policies, self-insurance plans and purported reinsurance contracts.

(d) Insured means the named insured, as defined in the policy, or an applicant for insurance.

(e) Insurer means an insurer authorized to do an insurance business in this State, including any organization exempted from compliance with the licensing requirements by the Insurance Law which is engaged in the business of insurance in this State. For the purposes of this Part, all health maintenance organizations, the Motor Vehicle Accident Indemnification Corporation, the New York Automobile Insurance Plan, the New York Property Insurance Underwriting Association and the Medical Malpractice Insurance Plan shall be deemed insurers.

(f) Person includes any individual, firm, association or corporation.

(g) Personal insurance means a policy of insurance insuring a natural person against any of the following contingencies:

(1) loss of or damage to real property used predominantly for residential purposes and which consists of not more than four dwelling units, other than hotels, motels and rooming houses;

(2) loss of or damage to personal property which is not used in the conduct of a business;

(3) losses or liabilities arising out of the ownership, operation or use of a motor vehicle, predominantly used for nonbusiness purposes;

(4) other liabilities for loss of, damage to or injury to persons or property, not arising from the conduct of a business; and

(5) death, including death by personal injury, or the continuation of life, or personal injury by accident, or sickness, disease or ailment, including insurance providing disability benefits pursuant to article 9 of the Workers' Compensation Law.

A policy of insurance which insures any of the contingencies listed in paragraphs (1) through (5) of this subdivision, as well as other contingencies, shall be personal insurance if that portion of the annual premium attributable to the listed contingencies exceeds that portion attributable to other contingencies.

(h) Statement includes, but is not limited to, any notice, proof of loss, bill of lading, invoice, account, estimate of property damages, bill for services, diagnosis, prescription, hospital or medical provider records, X-ray, test result and other evidence of loss, injury or expenses.

(i) Claim form includes any document supplied by an insurer or self-insurer, directly or indirectly, to a claimant and which the claimant is required to complete or submit in support of a claim for benefits.

N.Y. Comp. Codes R. & Regs. Tit. 11 § 86.2