Utah Administrative Code
Topic - Insurance
Title R590 - Administration
Rule R590-191 - Unfair Life Insurance Claims Settlement Practices Rule
Section R590-191-4 - File and Record Documentation
Universal Citation: UT Admin Code R 590-191-4
Current through Bulletin 2024-06, March 15, 2024
(1) An insurer's claim file is subject to examination by the commissioner.
(2) To aid in an examination, an insurer shall maintain:
(a) claim data that is
accessible and retrievable for examination, including:
(i) the policy number;
(ii) the certificate number, if any;
(iii) a duplicate of the policy, as
issued;
(iv) the claim number;
(v) the date of loss;
(vi) the date the notice of loss was
received;
(vii) the date the proof
of loss was received;
(viii) the
date an investigation began and was complete;
(ix) the date of the settlement of the claim;
(x) the type of settlement, indicated as:
(A) payment, including the amount
paid;
(B) settled without payment;
or
(C) denied;
(xi) documentation supporting how the claim
was settled and how any payments were calculated; and
(xii) other documentation relied upon for
claim settlement;
(b)
detailed documentation in each claim file permitting the reconstruction of the
insurer's activities relative to the claim; and
(c) the claim file record in a hard copy file
or other format that has the capability of duplication to hard copy.
(3) The data in Subsection (2) shall:
(a) be available for each open and
closed file for at least the most recent three-year period; or
(b) for a Utah domiciled insurer, be
available from the date of the previous examination by the
department.
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