Fla. Admin. Code Ann. R. 69O-166.021 - Definitions

As used in this part:

(1) "Person" means any individual, association, organization, partnership, business, trust, or corporation.

(2) "Agent" means any person, as defined herein, authorized to represent an insurer with respect to a claim, including adjusters.

(3) "Claimant" means a first-party claimant, a third-party claimant, and, where the claimant is an individual, a member of the claimant's family designated by the claimant.

(4) "First-party claimant" means any person asserting a right to payment as an insured as provided by the insurance policy, arising out of the occurrence of the contingency or loss covered by that policy.

(5) "Insurer" means a person authorized to issue or which issues an insurance policy in this state, or otherwise transacts insurance in this state, including reciprocal and interinsurance exchanges, fraternal benefit societies, stock and mutual insurance companies, mutual fire insurance companies, grants and annuities societies, insurers holding certificates of exemption, motor clubs, medical and health service and related service plans, or the agents of any of the above-designated persons. The term "insurer," for purposes of this part, shall not include surplus lines brokers.

(6) "Insurance policy" and "policy" refer to the written instrument in which any certificate of insurance, contract of insurance, hospital service plan or motor club service is set forth.

(7) "Investigation" means any activities of an insurer or its agent, directly or indirectly related to the determination of liabilities under coverages afforded by an insurance policy, and other obligations or duties arising from an insurance policy.

(8) "Notification of a claim" means any notice to an insurer or its agent by a claimant or an insured that reasonably apprises the insurer that a loss has occurred.

(9) "Notice of loss" means:

(a) Written notice, such as claim forms, medical bills, medical authorizations or other reasonable evidence of the claim that is ordinarily required of a claimant; or

(b) Any notice by or on behalf of a claimant that reasonably apprises the insurer that a loss has occurred and that the claimant wishes to make a claim under an insurance policy or against a person insured under an insurance policy for such loss.

(10) "Tender" shall include mailing to the last known address or designated address of the last known recipient, or otherwise effecting delivery.

(11) "Third-party claimant" means any person asserting a claim against any other person insured under an insurance policy or insurance contract of an insurer.

(12) "Office" means the Office of Insurance Regulation.

Notes

Fla. Admin. Code Ann. R. 69O-166.021

Rulemaking Authority 624.308 FS. Law Implemented 624.307(1), 624.3161 FS.

New 11-2-92, Formerly 4-166.021.

New 11-2-92, Formerly 4-166.021.