W. Va. Code R. § 114-14-2

Current through Register Vol. XLI, No. 45, November 8, 2024

Section 114-14-2 - Definitions

For the purposes of this regulation, the following definitions shall apply:

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

2.2. "Claimant" means either a first-party claimant, a third-party claimant, or both.

2.3. "First-party claimant" or "Insured" 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 such policy or contract.

2.4. "Person" includes any individual, company, insurer, association, organization, society, reciprocal, business trust, corporation or any other legal entity, including agents, adjusters and brokers.

2.5. "Insurer" means a person licensed to issue or who issues any insurance policy or insurance contract covering risks resident, located or to be performed in this state.

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

2.7. "Notification of claim" means any notification, whether in writing or other means acceptable under the terms of an insurance policy or insurance contract, to an insurer or its agents, by a claimant, which reasonably apprises the insurer or agent of the existence of an occurrence which might give rise to liability under a policy or contract of insurance.

2.8. "Third-party claimant" means any individual, corporation, association, partnership or other legal entity asserting a claim against any individual, corporation, association, partnership or other legal entity insured under an insurance policy or insurance contract of an insurer.

2.9. "Settlement of claims" means all activities of the insurer or its agent which are related directly or indirectly to the determination of the compensation that is due under coverage afforded by the insurance policy or insurance contract. This includes, but is not limited to, the requiring or preparing of repair estimates.

2.10. "Insurance policy" or "Insurance contract" means the contract effecting insurance, or the certificate thereof, by whatever name called, and includes all clauses, riders, endorsements and papers issued under the terms of the policy or contract.

2.11. "Claim" means any communication by a claimant to an insurer or its agent which reasonably apprises the insurer or agent of an occurrence which might give rise to liability under a policy or contract of insurance.

2.12. "Commissioner" means the West Virginia Insurance Commissioner.

2.13. "Licensee" means any person that holds a license or certificate of authority from the Commissioner, or any other entity for whom the Commissioner's consent is required before transacting business in the State of West Virginia or with residents of West Virginia.

W. Va. Code R. § 114-14-2