28 Tex. Admin. Code § 21.202 - Definitions
The following words or phrases, as used in these regulations, shall have the meanings placed opposite them unless the explicit wording of a regulation shall otherwise direct.
(1) Business day--A day other than a
Saturday, Sunday, or holiday recognized by this state.
(2) Claim--A request or demand reduced to
writing and filed by a Texas resident with an insurer for payment of funds or
the providing of services under the terms of a policy, certificate, or binder
of insurance.
(3) Claimant--A
person making or having made a claim.
(4) Complaint--Any written communication to
an insurer, not solicited by such insurer, primarily expressing a grievance
relating to an unfair claims settlement practice as defined in §
21.203 of this title (relating to
Unfair Claims Settlement Practices). For purposes of this subchapter, any
written communication to an insurer by the same person which relates to the
same claim, issue or question and requests or demands the same kind of relief
and which arises out of the same transaction or transactions is considered to
be part of the same complaint. A complaint is not a misunderstanding or a
problem of misinformation that is resolved promptly by clearing up the
misunderstanding and/or supplying the appropriate information to the
satisfaction of the person submitting the written communication, as
applicable.
(5) First-party
coverage--Benefits and other rights provided by an insurance contract to an
insured.
(6) Insurer--Stock and
mutual life, health, accident, fire, casualty, fire and casualty, hail, storm,
title, and mortgage guarantee companies; mutual assessment companies; local
mutual aid associations; local mutual burial associations; statewide mutual
assessment companies; stipulated premium companies; fraternal benefit
societies; group hospital service organizations; county mutual insurance
companies; Lloyds; reciprocal or interinsurance exchanges; and farm mutual
insurance companies.
(7)
Policyholder--The owner of a policy, certificate, or binder of insurance, and
any insured, named insured, or obligee under a bond.
(8) Third-party coverage--Benefits and other
rights provided by an insurance contract to any person other than the
insured.
(9) Written
communication--Any communication that is documented by publication or otherwise
being written onto a medium which is capable at the point of receipt of being
viewed, stored, retrieved and reproduced by the recipient without any
transcription. Such communication expressly includes, but is not limited to,
facsimile transmissions and electronic mail transmissions.
Notes
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