Utah Code 31A-22-1102. Policy and certificate forms
Current as of: 2024 | Check for updates
|
Other versions
(1) Legal expense insurance may be written as individual, group, blanket, or franchise insurance. Each contractual obligation for legal expense insurance shall be evidenced by a policy. Each person insured under a group policy shall be issued a certificate of coverage.
Terms Used In Utah Code 31A-22-1102
- Certificate: means evidence of insurance given to:(23)(a) an insured under a group insurance policy; or(23)(b) a third party. See Utah Code 31A-1-301
- Contract: A legal written agreement that becomes binding when signed.
- Filing: when used as a noun, means an item required to be filed with the department including:
(70)(a) a policy;(70)(b) a rate;(70)(c) a form;(70)(d) a document;(70)(e) a plan;(70)(f) a manual;(70)(g) an application;(70)(h) a report;(70)(i) a certificate;(70)(j) an endorsement;(70)(k) an actuarial certification;(70)(l) a licensee annual statement;(70)(m) a licensee renewal application;(70)(n) an advertisement;(70)(o) a binder; or(70)(p) an outline of coverage. See Utah Code 31A-1-301- 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- Franchise insurance: means an individual insurance policy provided through a mass marketing arrangement involving a defined class of persons related in some way other than through the purchase of insurance. See Utah Code 31A-1-301
- Individual: means a natural person. See Utah Code 31A-1-301
- 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 company: means a person doing an insurance business as a principal including:
(104)(a)(i) a fraternal benefit society;(104)(a)(ii) an issuer of a gift annuity other than an annuity specified in Subsections31A-22-1305 (2) and (3);(104)(a)(iii) a motor club;(104)(a)(iv) an employee welfare plan;(104)(a)(v) a person purporting or intending to do an insurance business as a principal on that person's own account; and(104)(a)(vi) a health maintenance organization. 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- Legal expense insurance: includes an arrangement that creates a reasonable expectation of an enforceable right. See Utah Code 31A-1-301
- 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.
- 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(2) Policies and certificates of legal expense insurance are subject to Section 31A-21-201.(3) The commissioner may not approve any form that does not meet all of the following requirements:(3)(a) Policies shall contain a list and description of the legal services promised or the legal matters for which expenses are to be reimbursed, and any limits on the amounts to be reimbursed.(3)(b) Certificates issued under group policies shall contain a full statement of the benefits provided, but may summarize the other terms of the master policy.(3)(c) Policies promising legal services to be provided by a limited number of attorneys who have concluded provider contracts with the insurer, whether the attorney in an individual case is to be selected by the insured or by the insurer, shall provide for alternative benefits in case the insured is unable to find a participating attorney willing to perform the promised services or the attorney selected by the insurer is disqualified or otherwise unable to perform the promised services. The alternative benefit may consist of furnishing the services of an attorney selected and paid by the insurer or paying the fee of an attorney selected by the insured. The policy shall also provide a procedure that includes impartial review for settling disagreements about the grounds for demanding an alternative benefit.(3)(d) No policy, except one issued by a mutual insurance company, may provide for assessments on policyholders or for reductions of benefits to maintain the insurer’s solvency.(4) The commissioner may disapprove a policy or certificate form if he finds that it:(4)(a) is unfair, unfairly discriminatory, misleading, or encourages misrepresentation or misunderstanding of the contract;(4)(b) provides coverage or benefits or contains other provisions that would endanger the solidity of the insurer; or(4)(c) is contrary to law.(5) The commissioner may require the submission of relevant information he considers to be reasonably necessary in determining whether to approve or disapprove a filing.