Terms Used In Utah Code > Title 31A > Chapter 26 > Part 3 - Claim Practices

• Accident and health insurance: means insurance to provide protection against economic losses resulting from:
            (1)(a)(i) a medical condition including:

                 (1)(a)(i)(A) a medical care expense; or

                 (1)(a)(i)(B) the risk of disability;
            (1)(a)(ii) accident; or
            (1)(a)(iii) sickness. See Utah Code 31A-1-301
• adjusting: means directing or conducting the investigation, negotiation, or settlement of a claim under an insurance policy, on behalf of an insurer, policyholder, or a claimant under an insurance policy. See Utah Code 31A-26-102
• Administrator: means the same as that term is defined in Subsection (187). See Utah Code 31A-1-301
• Administrator: includes "executor" when the subject matter justifies the use. See Utah Code 68-3-12.5
• Agency: means :
       (6)(a) a person other than an individual, including a sole proprietorship by which an individual does business under an assumed name; and
       (6)(b) an insurance organization licensed or required to be licensed under Section 31A-23a-301, 31A-25-207, or 31A-26-209. See Utah Code 31A-1-301
• Application: means a document:
       (10)(a)

            (10)(a)(i) completed by an applicant to provide information about the risk to be insured; and

            (10)(a)(ii) that contains information that is used by the insurer to evaluate risk and decide whether to:

                 (10)(a)(ii)(A) insure the risk under:

                      (10)(a)(ii)(A)(I) the coverage as originally offered; or

                      (10)(a)(ii)(A)(II) a modification of the coverage as originally offered; or

                 (10)(a)(ii)(B) decline to insure the risk; or
       (10)(b) used by the insurer to gather information from the applicant before issuance of an annuity contract. See Utah Code 31A-1-301
• Assets: (1) The property comprising the estate of a deceased person, or (2) the property in a trust account.
• authorized insurer: means an insurer:
            (191)(b)(i) holding a valid certificate of authority to do an insurance business in this state; and
            (191)(b)(ii) transacting business as authorized by a valid certificate. See Utah Code 31A-1-301
• Beneficiary: A person who is entitled to receive the benefits or proceeds of a will, trust, insurance policy, retirement plan, annuity, or other contract. ^{Source: OCC}
• Case action plan: means a document developed by the Department of Corrections that identifies:
       (2)(a) the program priorities for the treatment of the offender, including the criminal risk factors as determined by risk, needs, and responsivity assessments conducted by the department; and
       (2)(b) clearly defined completion requirements. See Utah Code 64-13-1
• Contract: A legal written agreement that becomes binding when signed.
• Conviction: A judgement of guilt against a criminal defendant.
• Correctional facility: means any facility operated to house offenders in a secure or nonsecure setting:
       (4)(a) by the department; or
       (4)(b) under a contract with the department. See Utah Code 64-13-1
• Credit bureau: An agency that collects individual credit information and sells it for a fee to creditors so they can make a decision on granting loans. Typical clients include banks, mortgage lenders, credit card companies, and other financing companies. (Also commonly referred to as consumer-reporting agency or credit-reporting agency.) ^{Source: OCC}
• Credit Score: A number, roughly between 300 and 800, that measures an individual's credit worthiness. The most well-known type of credit score is the FICO score. This score represents the answer from a mathematical formula that assigns numerical values to various pieces of information in your credit report. ^{Source: OCC}
• Creditor: means a person, including an insured, having a claim, whether:
       (39)(a) matured;
       (39)(b) unmatured;
       (39)(c) liquidated;
       (39)(d) unliquidated;
       (39)(e) secured;
       (39)(f) unsecured;
       (39)(g) absolute;
       (39)(h) fixed; or
       (39)(i) contingent. See Utah Code 31A-1-301
• Criminal risk factors: means an individual's characteristics and behaviors that:
       (5)(a) affect the individual's risk of engaging in criminal behavior; and
       (5)(b) are diminished when addressed by effective treatment, supervision, and other support resources, resulting in a reduced risk of criminal behavior. See Utah Code 64-13-1
• Department: means the Insurance Department. See Utah Code 31A-1-301
• Department: means the Department of Corrections. See Utah Code 64-13-1
• Dependent: A person dependent for support upon another.
• Direct supervision: means a housing and supervision system that is designed to meet the goals described in Subsection 64-13-14(5) and has the elements described in Subsection 64-13-14(6). See Utah Code 64-13-1
• Discovery: Lawyers' examination, before trial, of facts and documents in possession of the opponents to help the lawyers prepare for trial.
• Employee: means :
       (57)(a) an individual employed by an employer; or
       (57)(b) an individual who meets the requirements of Subsection (55)(b). See Utah Code 31A-1-301
• Enrollee: includes an insured. See Utah Code 31A-1-301
• Entitlement: A Federal program or provision of law that requires payments to any person or unit of government that meets the eligibility criteria established by law. Entitlements constitute a binding obligation on the part of the Federal Government, and eligible recipients have legal recourse if the obligation is not fulfilled. Social Security and veterans' compensation and pensions are examples of entitlement programs.
• Equal: means , with respect to biological sex, of the same value. See Utah Code 68-3-12.5
• Equitable: Pertaining to civil suits in "equity" rather than in "law." In English legal history, the courts of "law" could order the payment of damages and could afford no other remedy. See damages. A separate court of "equity" could order someone to do something or to cease to do something. See, e.g., injunction. In American jurisprudence, the federal courts have both legal and equitable power, but the distinction is still an important one. For example, a trial by jury is normally available in "law" cases but not in "equity" cases. ^{Source: U.S. Courts}
• Evidence: Information presented in testimony or in documents that is used to persuade the fact finder (judge or jury) to decide the case for one side or the other.
• Evidence-based: means a program or practice that has had multiple randomized control studies or a meta-analysis demonstrating that the program or practice is effective for a specific population or has been rated as effective by a standardized program evaluation tool. See Utah Code 64-13-1
• Executive director: means the executive director of the Department of Corrections. See Utah Code 64-13-1
• Fiscal year: The fiscal year is the accounting period for the government. For the federal government, this begins on October 1 and ends on September 30. The fiscal year is designated by the calendar year in which it ends; for example, fiscal year 2006 begins on October 1, 2005 and ends on September 30, 2006.
• Form: means one of the following prepared for general use:
            (74)(a)(i) a policy;
            (74)(a)(ii) a certificate;
            (74)(a)(iii) an application;
            (74)(a)(iv) an outline of coverage; or
            (74)(a)(v) an endorsement. See Utah Code 31A-1-301
• Habeas corpus: A writ that is usually used to bring a prisoner before the court to determine the legality of his imprisonment. It may also be used to bring a person in custody before the court to give testimony, or to be prosecuted.
• Health care: means any of the following intended for use in the diagnosis, treatment, mitigation, or prevention of a human ailment or impairment:
       (83)(a) a professional service;
       (83)(b) a personal service;
       (83)(c) a facility;
       (83)(d) equipment;
       (83)(e) a device;
       (83)(f) supplies; or
       (83)(g) medicine. See Utah Code 31A-1-301
• Health care provider: means the same as that term is defined in Section 78B-3-403. See Utah Code 31A-1-301
• health insurance: means insurance providing:
            (84)(a)(i) a health care benefit; or
            (84)(a)(ii) payment of an incurred health care expense. See Utah Code 31A-1-301
• Independent adjuster: means an insurance adjuster required to be licensed under Section 31A-26-201, who engages in insurance adjusting as a representative of one or more insurers. See Utah Code 31A-26-102
• Individual: means a natural person. See Utah Code 31A-1-301
• Inmate: means an individual who is:
       (12)(a) committed to the custody of the department; and
       (12)(b) housed at a correctional facility or at a county jail at the request of the department. See Utah Code 64-13-1
• Insurance: includes :
            (96)(b)(i) a risk distributing arrangement providing for compensation or replacement for damages or loss through the provision of a service or a benefit in kind;
            (96)(b)(ii) a contract of guaranty or suretyship entered into by the guarantor or surety as a business and not as merely incidental to a business transaction; and
            (96)(b)(iii) a plan in which the risk does not rest upon the person who makes an arrangement, but with a class of persons who have agreed to share the risk. See Utah Code 31A-1-301
• Insurance adjuster: means a person who directs or conducts the investigation, negotiation, or settlement of a claim under an insurance policy other than life insurance or an annuity, on behalf of an insurer, policyholder, or a claimant under an insurance policy. See Utah Code 31A-1-301
• Insured: means a person to whom or for whose benefit an insurer makes a promise in an insurance policy and includes:
            (103)(a)(i) a policyholder;
            (103)(a)(ii) a subscriber;
            (103)(a)(iii) a member; and
            (103)(a)(iv) a beneficiary. See Utah Code 31A-1-301
• Interest rate: The amount paid by a borrower to a lender in exchange for the use of the lender's money for a certain period of time. Interest is paid on loans or on debt instruments, such as notes or bonds, either at regular intervals or as part of a lump sum payment when the issue matures. ^{Source: OCC}
• Jurisdiction: (1) The legal authority of a court to hear and decide a case. Concurrent jurisdiction exists when two courts have simultaneous responsibility for the same case. (2) The geographic area over which the court has authority to decide cases.
• License: includes a certificate of authority issued to an insurer. See Utah Code 31A-1-301
• Life insurance: means :
            (114)(a)(i) insurance on a human life; and
            (114)(a)(ii) insurance pertaining to or connected with human life. See Utah Code 31A-1-301
• Litigation: A case, controversy, or lawsuit. Participants (plaintiffs and defendants) in lawsuits are called litigants.
• Medicare: means the "Health Insurance for the Aged Act" Title XVIII of the federal Social Security Act, as then constituted or later amended. See Utah Code 31A-1-301
• Month: means a calendar month, unless otherwise expressed. See Utah Code 68-3-12.5
• Mutual: means a mutual insurance corporation. See Utah Code 31A-1-301
• Obligation: An order placed, contract awarded, service received, or similar transaction during a given period that will require payments during the same or a future period.
• Offender: means an individual who has been convicted of a crime for which the individual may be committed to the custody of the department and is at least one of the following:
       (13)(a) committed to the custody of the department;
       (13)(b) on probation; or
       (13)(c) on parole. See Utah Code 64-13-1
• Order: means an order of the commissioner. See Utah Code 31A-1-301
• Organization: includes a sole proprietorship by which a natural person does business under an assumed name. See Utah Code 31A-26-102
• Participating: means a plan of insurance under which the insured is entitled to receive a dividend representing a share of the surplus of the insurer. See Utah Code 31A-1-301
• Person: includes :
       (146)(a) an individual;
       (146)(b) a partnership;
       (146)(c) a corporation;
       (146)(d) an incorporated or unincorporated association;
       (146)(e) a joint stock company;
       (146)(f) a trust;
       (146)(g) a limited liability company;
       (146)(h) a reciprocal;
       (146)(i) a syndicate; or
       (146)(j) another similar entity or combination of entities acting in concert. See Utah Code 31A-1-301
• Policy: includes a service contract issued by:
            (150)(b)(i) a motor club under Chapter 11, Motor Clubs;
            (150)(b)(ii) a service contract provided under Chapter 6a, Service Contracts; and
            (150)(b)(iii) a corporation licensed under:

                 (150)(b)(iii)(A) Chapter 7, Nonprofit Health Service Insurance Corporations; or

                 (150)(b)(iii)(B) Chapter 8, Health Maintenance Organizations and Limited Health Plans. See Utah Code 31A-1-301
• Policyholder: means a person who controls a policy, binder, or oral contract by ownership, premium payment, or otherwise. See Utah Code 31A-1-301
• Probable cause: A reasonable ground for belief that the offender violated a specific law.
• Probation: A sentencing alternative to imprisonment in which the court releases convicted defendants under supervision as long as certain conditions are observed.
• Probation officers: Screen applicants for pretrial release and monitor convicted offenders released under court supervision.
• Process: means a writ or summons issued in the course of a judicial proceeding. See Utah Code 68-3-12.5
• Property: includes both real and personal property. See Utah Code 68-3-12.5
• Public adjuster: means a person required to be licensed under Section 31A-26-201, who engages in insurance adjusting as a representative of insureds and claimants under insurance policies. See Utah Code 31A-26-102
• Rate: means :
            (163)(a)(i) the cost of a given unit of insurance; or
            (163)(a)(ii) for property or casualty insurance, that cost of insurance per exposure unit either expressed as:

                 (163)(a)(ii)(A) a single number; or

                 (163)(a)(ii)(B) a pure premium rate, adjusted before the application of individual risk variations based on loss or expense considerations to account for the treatment of:

                      (163)(a)(ii)(B)(I) expenses;

                      (163)(a)(ii)(B)(II) profit; and

                      (163)(a)(ii)(B)(III) individual insurer variation in loss experience. See Utah Code 31A-1-301
• Recidivism: means a return to criminal activity after a previous criminal conviction. See Utah Code 64-13-1
• Remainder: An interest in property that takes effect in the future at a specified time or after the occurrence of some event, such as the death of a life tenant.
• Rescission: The cancellation of budget authority previously provided by Congress. The Impoundment Control Act of 1974 specifies that the President may propose to Congress that funds be rescinded. If both Houses have not approved a rescission proposal (by passing legislation) within 45 days of continuous session, any funds being withheld must be made available for obligation.
• Risk and needs assessment: means an actuarial tool validated on criminal offenders that determines:
       (16)(a) an individual's risk of reoffending; and
       (16)(b) the criminal risk factors that, when addressed, reduce the individual's risk of reoffending. See Utah Code 64-13-1
• Sentencing guidelines: A set of rules and principles established by the United States Sentencing Commission that trial judges use to determine the sentence for a convicted defendant. ^{Source: U.S. Courts}
• Service of process: The service of writs or summonses to the appropriate party.
• Settlement: Parties to a lawsuit resolve their difference without having a trial. Settlements often involve the payment of compensation by one party in satisfaction of the other party's claims.
• Sex: means , in relation to an individual, the individual's biological sex, either male or female, at birth, according to distinct reproductive roles as manifested by:
       (34)(a) sex and reproductive organ anatomy;
       (34)(b) chromosomal makeup; and
       (34)(c) endogenous hormone profiles. See Utah Code 68-3-12.5
• State: when applied to the different parts of the United States, includes a state, district, or territory of the United States. See Utah Code 68-3-12.5
• Statute: A law passed by a legislature.
• United States: includes each state, district, and territory of the United States of America. See Utah Code 68-3-12.5
• Utah Code: means the 1953 recodification of the Utah Code, as amended, unless the text expressly references a portion of the 1953 recodification of the Utah Code as it existed:
       (42)(a) on the day on which the 1953 recodification of the Utah Code was enacted; or
       (42)(b)

            (42)(b)(i) after the day described in Subsection (42)(a); and

            (42)(b)(ii) before the most recent amendment to the referenced portion of the 1953 recodification of the Utah Code. See Utah Code 68-3-12.5
• Victim Impact Statement: A written or spoken statement by the victim or his or her representative about the physical, emotional, and financial impact of a crime on the victim. The statement is given to the court before sentencing.
• Writing: includes :
       (48)(a) printing;
       (48)(b) handwriting; and
       (48)(c) information stored in an electronic or other medium if the information is retrievable in a perceivable format. See Utah Code 68-3-12.5