Mich. Admin. Code R. 550.301 - Definitions

Current through Vol. 22-05, April 1, 2022

Rule 1. As used in these rules:

(a) "Appeal" means an appeal by a policyholder or other claimant of a claim denial by an insurer. It includes appeals to administrative agencies, arbitrators, courts, and mediators.
(b) "Commissioner" means the commissioner of the office of financial and insurance services.
(c) "Discretionary clause" is a provision in a form that purports to bind the claimant to or grant deference in subsequent proceedings to the credit insurer's decision, denial, or interpretation on terms, coverage, or eligibility for benefits including, but not limited to, a form provision that does any of the following:
(i) Provides that a policyholder or other claimant may not appeal a denial of a claim.
(ii) Provides that the insurer's decision to deny policy coverage is binding upon a policyholder or other claimant.
(iii) Provides that on appeal the insurer's decision-making power as to policy coverage is binding.
(iv) Provides that the insurer's interpretation of the terms of a form is binding upon a policyholder or other claimant.
(v) Provides that on appeal the insurer's interpretation of the terms of a form is binding.
(vi) Provides that or gives rise to a standard of review on appeal that gives deference to the original claim decision.
(vii) Provides that or gives rise to a standard of review on appeal other than a de novo review.
(d) "Form" means a form identified in section 13 of the credit insurance act, 1958 PA 173, MCL 550.613.
(e) Terms defined in the credit insurance act, 1958 PA 173, as amended, MCL 550.601 to MCL 550.624, and R 550.201 to R 550.216 have the same meanings when used in these rules.

Notes

Mich. Admin. Code R. 550.301
2007 AACS

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