Alabama Administrative Code
Title 482 - ALABAMA DEPARTMENT OF INSURANCE
Chapter 482-1-124 - STANDARDS FOR LIFE, ACCIDENT AND HEALTH INSURANCE CLAIMS
Section 482-1-124-.03 - Definitions
Current through Register Vol. 42, No. 5, February 29, 2024
In addition to the definitions contained in the Trade Practices Act and Section 27-1-2, Code of Ala. 1975, which are incorporated by reference, the following definitions shall apply for purposes of this chapter:
(a) Beneficiary. The party entitled to receive the proceeds or death benefits occurring under the policy in lieu of the insured.
(b) Claim file. Any retrievable electronic file, paper file or combination of both relative to the claim, that may contain:
(c) Claimant. An insured, any beneficiary or legal representative of the insured or beneficiary, including an adult member of the insured's or beneficiary's immediate family, designated in writing by the insured or beneficiary making a claim under a policy, subject, however, to the following provisions regarding a minor beneficiary as set forth in Sections 26-1-1, 27-14-5, and 27-14-25, Code of Ala. 1975.
(d) Days. Calendar days, calculated as set forth in the Alabama Rules of Civil Procedure.
(e) Documentation. All pertinent communications, transactions, notes, work papers, claim forms, bills, explanation of benefits forms, and all other records relative to the claim.
(f) Insurer. As set forth in Sections 27-1-2 and 27-1-17, Code of Ala. 1975.
(g) INSURANCE POLICY. As set forth in Section 27-14-1(1), Code of Ala. 1975.
(h) Investigation. All activities of an insurer directly or indirectly related to the determination of liabilities under coverages afforded by an insurance policy, insurance certificate or insurance contract.
(i) NOTICE OR Notification of A claim. Any notice or notification, whether in writing or other means acceptable under the terms of an insurance policy to an insurer by a claimant, which reasonably apprises the insurer of the facts pertinent to a claim.
(j) Proof of loss. Written evidence, including but not limited to claim forms, medical bills, medical authorizations, death certificates or other reasonable evidence of the claim or its circumstances that is ordinarily required by the insurer of all insureds or beneficiaries submitting the claims.
(k) PRODUCER. A person required to be licensed under the laws of this state to sell, solicit or negotiate insurance.
(l) REASONABLE EXPLANATION. Information sufficient to enable the insured or beneficiary to compare the allowable benefits with policy provisions and determine whether proper payment has been made.
(m) WRITTEN COMMUNICATIONS. All correspondence, regardless of source or type, that is materially related to the handling of the claim.
Author: Commissioner of Insurance
Statutory Authority: Code of Ala. 1975, §§ 27-2-17, 27-1-17, 27-1-19, 27-12-21, 27-12-24, 27-15-13, 27-16-10, 27-17-11, 27-19-11, 27-19-12.