230 R.I. Code R. 230-RICR-20-40-1.3

Current through December 3, 2024

Section 230-RICR-20-40-1.3 - Definitions

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.

230 R.I. Code R. 230-RICR-20-40-1.3