Terms Used In Montana Code > Title 33 > Chapter 19 - Insurance Information and Privacy Protection

• Adverse underwriting decision: means any of the following actions with respect to insurance transactions involving insurance coverage that are individually underwritten:

  (i)a declination of insurance coverage;

  (ii)a termination of insurance coverage;

  (iii)failure of an insurance producer to apply for insurance coverage with a specific insurance institution that the insurance producer represents and that is requested by an applicant;

  (iv)in the case of a property or casualty insurance coverage:

  (A)placement by an insurance institution or insurance producer of a risk with a residual market mechanism, an unauthorized insurer, or an insurance institution that specializes in substandard risks; or

  (B)the charging of a higher rate on the basis of information that differs from that which the applicant or policyholder furnished;

  (v)in the case of a life, health, or disability insurance coverage, an offer to insure at higher than standard rates. See Montana Code 33-19-104

• Amendment: A proposal to alter the text of a pending bill or other measure by striking out some of it, by inserting new language, or both. Before an amendment becomes part of the measure, thelegislature must agree to it.
• Applicant: means a person who seeks to contract for insurance coverage other than a person seeking group insurance that is not individually underwritten. See Montana Code 33-19-104
• Consumer report: means any written, oral, or other communication of information bearing on a natural person's credit worthiness, credit standing, credit capacity, character, general reputation, personal characteristics, or mode of living that is used or expected to be used in connection with an insurance transaction. See Montana Code 33-19-104
• Consumer reporting agency: means a person who:

  (a)regularly engages, in whole or in part, in the practice of assembling or preparing consumer reports for a monetary fee;

  (b)obtains information primarily from sources other than insurance institutions; and

  (c)furnishes consumer reports to other persons. See Montana Code 33-19-104

• Contract: A legal written agreement that becomes binding when signed.
• Corporation: A legal entity owned by the holders of shares of stock that have been issued, and that can own, receive, and transfer property, and carry on business in its own name.
• Damages: Money paid by defendants to successful plaintiffs in civil cases to compensate the plaintiffs for their injuries.
• Declination of insurance coverage: means a denial, in whole or in part, by an insurance institution or insurance producer of requested insurance coverage. See Montana Code 33-19-104
• Discovery: Lawyers' examination, before trial, of facts and documents in possession of the opponents to help the lawyers prepare for trial.
• Docket: A log containing brief entries of court proceedings.
• 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}
• Fair Credit Reporting Act: A federal law, established in 1971 and revised in 1997, that gives consumers the right to see their credit records and correct any mistakes. ^{Source: OCC}
• Fraud: Intentional deception resulting in injury to another.
• Guardian: A person legally empowered and charged with the duty of taking care of and managing the property of another person who because of age, intellect, or health, is incapable of managing his (her) own affairs.
• Individual: means a natural person who:

  (a)regarding property or casualty insurance, is a past, present, or proposed named insured or certificate holder;

  (b)regarding life, health, or disability insurance, is a past, present, or proposed principal insured or certificate holder;

  (c)is a past, present, or proposed policyowner;

  (d)is a past or present applicant;

  (e)is a past or present claimant; or

  (f)derived, derives, or is proposed to derive insurance coverage under an insurance policy or certificate subject to this chapter. See Montana Code 33-19-104

• Institutional source: means a person or governmental entity that provides information about an individual to an insurance producer, insurance institution, or insurance-support organization, other than:

  (a)an insurance producer;

  (b)the individual who is the subject of the information; or

  (c)a natural person acting in a personal capacity rather than a business or professional capacity. See Montana Code 33-19-104

• Insurance function: means claims administration, claims adjustment and management, fraud investigation, fraud prevention, underwriting, loss control, ratemaking functions, reinsurance, risk management, case management, disease management, quality assessment, quality improvement, provider credentialing verification, utilization review, peer review activities, subrogation, grievance procedures, insurance transactions, internal administration of compliance and policyholder service functions, and technical, administrative, or professional services related to the provision of the functions described in this subsection. See Montana Code 33-19-104
• Insurance institution: means a corporation, association, partnership, reciprocal exchange, interinsurer, Lloyd's insurer, fraternal benefit society, or other person engaged in the business of insurance, including health maintenance organizations, and health service corporations as defined in 33-30-101. See Montana Code 33-19-104
• Insurance producer: means an insurance producer as defined in 33-17-102 and 33-30-311. See Montana Code 33-19-104
• Insurance transaction: means a transaction involving insurance primarily for personal, family, or household needs, rather than for business or professional needs, that entails:

  (a)the determination of an individual's eligibility for an insurance coverage, benefit, or payment; or

  (b)the servicing of an insurance application, policy, contract, or certificate. See Montana Code 33-19-104

• Insurance-support organization: means a person who assembles or collects information about natural persons for the purpose of providing the information to an insurance institution or insurance producer for insurance transactions, including:

  (i)the furnishing of consumer reports or investigative consumer reports to an insurance institution or insurance producer for use in connection with an insurance transaction; or

  (ii)the collection of personal information from insurance institutions, insurance producers, or other insurance-support organizations for the purpose of detecting or preventing fraud, material misrepresentation, or material nondisclosure in connection with insurance underwriting or insurance claim activity. See Montana Code 33-19-104

• Investigative consumer report: means a consumer report or portion of a consumer report containing information about a natural person's character, general reputation, personal characteristics, or mode of living obtained through personal interviews with the person's neighbors, friends, associates, acquaintances, or others who may have knowledge concerning this type of information. See Montana Code 33-19-104
• Judicial officers: means justices of the supreme court, judges of the district courts, justices of the peace, municipal judges, and city judges. See Montana Code 1-1-202
• 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.
• Knowingly: means only a knowledge that the facts exist which bring the act or omission within the provisions of this code. See Montana Code 1-1-204
• Licensee: means :

  (a)an insurance institution, insurance producer, or other person who is licensed or required to be licensed, authorized or required to be authorized, or registered or required to be registered pursuant to this title; or

  (b)a surplus lines insurer. See Montana Code 33-19-104

• Medical care institution: means a facility or institution that is licensed to provide health care services to natural persons, including but not limited to health maintenance organizations, home health agencies, hospitals, medical clinics, public health agencies, rehabilitation agencies, and skilled nursing facilities. See Montana Code 33-19-104
• Medical professional: means a person who is licensed or certified to provide health care services to natural persons, including but not limited to a chiropractor, clinical dietitian, clinical psychologist, dentist, nurse, occupational therapist, optometrist, pharmacist, physical therapist, physician, podiatrist, psychiatric social worker, or speech-language pathologist. See Montana Code 33-19-104
• Medical record information: means personal information that:

  (a)relates to an individual's physical or mental condition, medical history, medical claims history, or medical treatment; and

  (b)is obtained from a medical professional or medical care institution, from the individual, or from the individual's spouse, parent, or legal guardian. See Montana Code 33-19-104

• Mortgagee: The person to whom property is mortgaged and who has loaned the money.
• Partnership: A voluntary contract between two or more persons to pool some or all of their assets into a business, with the agreement that there will be a proportional sharing of profits and losses.
• Person: means a natural person, corporation, association, partnership, or other legal entity. See Montana Code 33-19-104
• Person: includes a corporation or other entity as well as a natural person. See Montana Code 1-1-201
• Personal information: means any individually identifiable information gathered in connection with an insurance transaction from which judgments can be made about an individual's character, habits, avocations, finances, occupation, general reputation, credit, health, or any other personal characteristics. See Montana Code 33-19-104
• Policyholder: means a person who:

  (a)in the case of individual property or casualty insurance, is a present named insured;

  (b)in the case of individual life, health, or disability insurance, is a present policyowner; or

  (c)in the case of group insurance that is individually underwritten, is a present group certificate holder. See Montana Code 33-19-104

• Pretext interview: means an interview during which a person, in an attempt to obtain information about a natural person, performs one or more of the following acts:

  (a)pretends to be someone else;

  (b)pretends to represent a person not in fact being represented;

  (c)misrepresents the true purpose of the interview; or

  (d)refuses to provide identification upon request. See Montana Code 33-19-104

• Privileged information: means any individually identifiable information that:

  (a)relates to a civil or criminal proceeding involving an individual; and

  (b)is collected in connection with or in reasonable anticipation of a claim for insurance benefits or civil or criminal proceeding involving an individual. See Montana Code 33-19-104

• Process: means a writ or summons issued in the course of judicial proceedings. See Montana Code 1-1-202
• Property: means real and personal property. See Montana Code 1-1-205
• 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.
• Residual market mechanism: means an association, organization, or other entity defined or described in 61-6-144. See Montana Code 33-19-104
• Service of process: The service of writs or summonses to the appropriate party.
• Subpoena: A command to a witness to appear and give testimony.
• Unauthorized insurer: means an insurance institution that has not been granted a certificate of authority by the commissioner to transact the business of insurance in this state. See Montana Code 33-19-104
• under common control with: means the possession, direct or indirect, of the power to direct or cause the direction of the management and policies of a person, whether through the ownership of voting securities, by contract other than a commercial contract for goods or nonmanagement services, or otherwise, unless the power is the result of an official position with or corporate office held by the person. See Montana Code 33-19-104
• United States: includes the District of Columbia and the territories. See Montana Code 1-1-201
• Usual: means according to usage. See Montana Code 1-1-206
• Willfully: when applied to the intent with which an act is done or omitted, means a purpose or willingness to commit the act or make the omission referred to. See Montana Code 1-1-204
• Writing: includes printing. See Montana Code 1-1-203