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RULE §21.202Definitions

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.

Source Note: The provisions of this §21.202 adopted to be effective January 1, 1976; amended to be effective September 9, 1982, 7 TexReg 3148; amended to be effective August 19, 1992, 17 TexReg 5458; amended to be effective December 7, 1998, 23 TexReg 12397.

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