Terms Used In Montana Code > Title 33 > Chapter 19 > Part 2 - Information Gathering

• 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
• 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.
• 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

• 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
• 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 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

• Person: means a natural person, corporation, association, partnership, or other legal entity. See Montana Code 33-19-104
• 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

• State: when applied to the different parts of the United States, includes the District of Columbia and the territories. See Montana Code 1-1-201
• Writing: includes printing. See Montana Code 1-1-203