New Jersey Administrative Code
Title 11 - INSURANCE
Chapter 25 - OFFICE OF THE INSURANCE CLAIMS OMBUDSMAN
Subchapter 2 - INTERNAL APPEALS PROCEDURE
Section 11:25-2.2 - Definitions
The following words and terms, when used in this subchapter, shall have the following meanings, unless the context clearly indicates otherwise.
"Claim" means any claim filed under a policy of insurance issued pursuant to 17:17-1 et seq., 39:6A-1 et seq., or any policy of life insurance issued pursuant to Title 17 or Title 17B of the New Jersey Statutes.
"Claimant" means a first-party claimant, a third-party claimant, or a designated representative.
"Claims settlement" means all activities of an insurer relating directly or indirectly to the determination of the extent of liabilities due or potentially due under the coverage afforded by the policy, and which can or does result in a claim payment or acceptance, compromise or rejection.
"Insured" means any individual, policyholder, or entity who has purchased a policy of property and casualty insurance or any policy of life insurance issued pursuant to Title 17 or Title 17B of the New Jersey Statutes.
"Insurer" means any entity authorized or admitted to transact the business of a property/casualty and life insurance in accordance with Titles 17 and 17B of the New Jersey Statutes.
"Internal appeals" means any notification, in written form which is received either by mail, electronic mail, facsimile or by delivery to the insurer that advises the insurer that the final offered claim settlement remains unacceptable to the claimant.
