Rhode Island Code of Regulations
Title 230 - Department of Business Regulation
Chapter 20 - Insurance
Subchapter 40 - Claims
Part 1 - Unfair Life, Accident and Health Claims Settlement Practices (230-RICR-20-40-1)
Section 230-RICR-20-40-1.3 - Definitions

Universal Citation: 230 RI Code of Rules 20 40 1.3

Current through September 18, 2024

A. All definitions contained in R.I. Gen. Laws Chapter 27-9.1. The Unfair Claims Settlement Practices Act are hereby incorporated by reference. As otherwise used in this part:

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

2. "Beneficiary" means the party entitled to receive the proceeds or benefits occurring under the policy in lieu of the insured;

3. "Claim file" means any retrievable electronic file, paper file or combination of both;

4. "Claimant" means an insured, the beneficiary or legal representative of the insured, including a member of the insured's immediate family designated by the insured, making a claim under a policy;

5. "Days" means calendar days;

6. "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;

7. "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;

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

9. "Proof of loss" means written proofs, such as claim forms, medical bills, medical authorizations or other reasonable evidence of the claim that is ordinarily required of all insureds or beneficiaries submitting the claims;

10. "Reasonable explanation" means information sufficient to enable the insured or beneficiary to compare the allowable benefits with policy provisions and determine whether proper payment has been made;

11. "Written communications" includes all correspondence, regardless of source or type, that is materially related to the handling of the claim.

Disclaimer: These regulations may not be the most recent version. Rhode Island may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.