Utah Code 31A-26-301. Timely payment of claims
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Terms Used In Utah Code 31A-26-301
- 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
- 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
- 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- 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- 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- 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
(1)(a) Unless otherwise provided by law, an insurer shall timely pay every valid insurance claim made by an insured.(1)(b) By rule the commissioner may prescribe:(1)(b)(i) the kinds of notice and proof of loss that will establish validity;(1)(b)(ii) the manner in which an insurer may make a bona fide denial of a claim;(1)(b)(iii) the periods of time within which payment is required to be made to be timely; and(1)(b)(iv) the reasonable interest rates to be charged upon late claim payments.(2)(2)(a) Notwithstanding Subsection (1) and subject to Subsection (2)(b), the payment of a claim is not overdue during any period in which:(2)(a)(i) the insurer is unable to pay the claim because there is no recipient legally able to give a valid release for the payment; or(2)(a)(ii) the insurer is unable to determine who is entitled to receive the payment.(2)(b) Subsection (2)(a) applies only if the insurer:(2)(b)(i) promptly notifies the claimant of the inability to pay the claim; and(2)(b)(ii) offers in good faith to pay the claim promptly when the inability to pay the claim is removed.(3) This section applies only to a claim for first party benefits made by a person who is:(3)(a) named or defined as an insured under the terms of an insurance policy;(3)(b) described as a covered person under the terms of a policy of health care insurance as defined in Section 31A-1-301; or(3)(c) named, defined, or described:(3)(c)(i) as:(3)(c)(i)(A) an insured;(3)(c)(i)(B) a beneficiary;(3)(c)(i)(C) a policyholder; or(3)(c)(i)(D) otherwise covered person; and(3)(c)(ii) under the terms of:(3)(c)(ii)(A) a life insurance policy; or(3)(c)(ii)(B) an annuity. - Insurance: includes :