210 Neb. Admin. Code, ch. 60, § 003

Current through September 17, 2024
Section 210-60-003 - Definitions

All definitions contained in the Unfair Insurance Claims Settlement Practices Act are hereby incorporated by reference. As otherwise used in this regulation:

003.01 Agent

"Agent" means any individual, corporation, association, partnership or other legal entity authorized to represent an insurer with respect to a claim;

003.02 Automobile

"Automobile" means a four wheel motor vehicle of the private passenger, station wagon, pickup, panel or delivery type;

003.03 Claim file

"Claim file" means any retrievable electronic file, microfilm/microfiche file, paper file, or any combination thereof;

003.04 Claimant

"Claimant" means either a first party claimant, a third party claimant, or both and includes the claimant's designation legal representative or a member of the claimant's immediate family designated by the claimant;

003.05 Days

"Days" means working days;

003.06 Documentation

"Documentation" includes, but is not limited to, all pertinent communications, transactions, notes, work papers, claim forms, bills and explanation of benefits forms relative to the claim;

003.07 First party claimant

"First party claimant" means an individual, corporation, association, partnership or other legal entity asserting a right to payment under an insurance policy or insurance contract arising out of the occurrence of the contingency or loss covered by the policy or contract;

003.08 Investigation

"Investigation" means all activities of an insurer directly or indirectly related to the determination of liabilities under coverages afforded by an insurance policy or insurance contract;

003.09 Notification of claim

"Notification of claim" means any notification by a claimant, whether in writing or by other means acceptable under the terms of an insurance policy, business custom or statute, to an insurer or its agent which reasonably apprises the insurer of the facts pertinent to a claim;

003.10 Third party claimant

"Third party claimant" means any person asserting a claim against any person under a policy or certificate of an insurer; and

003.11 Written communications

"Written communications" includes all correspondence, regardless of source or type, that is related to the handling of the claim. Written communications shall be effectively communicated when placed in the mail with adequate first class postage.

210 Neb. Admin. Code, ch. 60, § 003