28 Tex. Admin. Code § 21.2502 - Definitions

The following words or phrases, as used in these sections, shall have the meanings placed opposite them unless the explicit wording of a section or part of a section shall otherwise direct.

(1) Complainant--A person making or having made a complaint.

(2) Complaint--Any written communication to an insurer, not solicited by such insurer, concerning coverage offered or issued by such insurer in this state and primarily expressing a grievance. 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.

(3) Complaint record--An electronic or hard copy record maintained by an insurer on a calendar-year basis and consisting of all complaints it has received during the preceding three years or since the date of its most recent financial examination, whichever time period is shorter.

(4) 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.

(5) Person--Any natural or artificial entity, including but not limited to, an individual, an association, or a partnership, trust or corporation.

(6) 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 insurer without any transcription. Such communication expressly includes facsimile transmissions and electronic mail transmissions.

Notes

28 Tex. Admin. Code § 21.2502

The provisions of this §21.2502 adopted to be effective December 7, 1998, 23 TexReg 12398.