(1) As used in this section, “claim” means a demand for payment pursuant to Section 31A-27a-601 under the terms and conditions of a contract issued by the insurer as a result of a known accident, casualty, disaster, loss, event, or occurrence.
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Terms Used In Utah Code 31A-27a-605

  • Contract: A legal written agreement that becomes binding when signed.
  • Disability: means a physiological or psychological condition that partially or totally limits an individual's ability to:
         (51)(a) perform the duties of:
              (51)(a)(i) that individual's occupation; or
              (51)(a)(ii) an occupation for which the individual is reasonably suited by education, training, or experience; or
         (51)(b) perform two or more of the following basic activities of daily living:
              (51)(b)(i) eating;
              (51)(b)(ii) toileting;
              (51)(b)(iii) transferring;
              (51)(b)(iv) bathing; or
              (51)(b)(v) dressing. See Utah Code 31A-1-301
  • Filed: means that a filing is:
              (69)(a)(i) submitted to the department as required by and in accordance with applicable statute, rule, or filing order;
              (69)(a)(ii) received by the department within the time period provided in applicable statute, rule, or filing order; and
              (69)(a)(iii) accompanied by the appropriate fee in accordance with:
                   (69)(a)(iii)(A) Section 31A-3-103; or
                   (69)(a)(iii)(B) rule. See Utah Code 31A-1-301
  • 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
  • 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
  • insurer: means a person who:
         (23)(a) is doing, has done, purports to do, or is licensed to do the business of insurance;
         (23)(b) is or has been subject to the authority of, or to rehabilitation, liquidation, reorganization, supervision, or conservation by an insurance commissioner; or
         (23)(c) is included under Section 31A-27a-104. See Utah Code 31A-27a-102
  • Long-term care insurance: includes :
              (121)(b)(i) any of the following that provide directly or supplement long-term care insurance:
                   (121)(b)(i)(A) a group or individual annuity or rider; or
                   (121)(b)(i)(B) a life insurance policy or rider;
              (121)(b)(ii) a policy or rider that provides for payment of benefits on the basis of:
                   (121)(b)(ii)(A) cognitive impairment; or
                   (121)(b)(ii)(B) functional capacity; or
              (121)(b)(iii) a qualified long-term care insurance contract. 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.
  • 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 all clauses, riders, endorsements, and papers that are a part of a policy. See Utah Code 31A-27a-102
  • Proceeding: includes an action or special statutory proceeding. See Utah Code 31A-1-301
  • Property: includes both real and personal property. See Utah Code 68-3-12.5
  • receivership: means a rehabilitation, liquidation, or ancillary receivership. See Utah Code 31A-27a-102
  • receivership court: refers to the court in which a delinquency proceeding is pending. See Utah Code 31A-27a-102
  • Reinsurance: means a transaction or contract under which an assuming insurer agrees to indemnify a ceding insurer against all, or a part, of a loss that the ceding insurer may sustain under the one or more policies that the ceding insurer issues or will issue. See Utah Code 31A-27a-102
  • Reinsurer: means a person licensed in this state as an insurer with the authority to assume reinsurance. See Utah Code 31A-1-301
(2)

     (2)(a) A claim of an insured or third party may be allowed under Section 31A-27a-603, regardless of the fact that it is contingent or unliquidated if:

          (2)(a)(i) any contingency is removed in accordance with Subsection (3); and
          (2)(a)(ii) the value of the claim is determined in accordance with Subsection (4).
     (2)(b) A claim is contingent if:

          (2)(b)(i) the accident, casualty, disaster, loss, event, or occurrence insured, reinsured, or bonded against occurs on or before the date fixed under Section 31A-27a-401; and
          (2)(b)(ii) the act or event triggering the insurer’s obligation to pay has not occurred as of that date.
     (2)(c) A claim is unliquidated if the insurer’s obligation to pay is established, but the amount of the claim has not been determined.
(3)

     (3)(a) Unless the receivership court directs otherwise, a contingent claim may be allowed if:

          (3)(a)(i) the claimant presents proof of the insurer’s obligation to pay reasonably satisfactory to the liquidator; or
          (3)(a)(ii) subject to Subsection (3)(b), the claim is based on a cause of action against an insured of the insurer, and:

               (3)(a)(ii)(A) it may be reasonably inferred from proof presented upon the claim that the claimant would be able to obtain a judgment; and
               (3)(a)(ii)(B) the person furnishes suitable proof.
     (3)(b) A contingent claim may not be allowed under Subsection (3)(a)(ii)(B) if the receivership court for good cause shown shall otherwise direct that no further valid claims can be made against the insurer arising out of the cause of action other than those already presented.
(4)

     (4)(a) An unliquidated claim may be allowed if its amount has been determined.
     (4)(b) If the amount of an unliquidated claim filed pursuant to Section 31A-27a-601 remains undetermined, the valuation of the unliquidated claim may be made by estimate whenever the liquidator determines that:

          (4)(b)(i) liquidation of the claim would unduly delay the administration of the liquidation proceeding; or
          (4)(b)(ii) the administrative expense of processing and adjudicating the claim or group of claims of a similar type would be unduly excessive when compared with the property that is estimated to be available for distribution with respect to the claim.
     (4)(c) Any estimate shall be based on an accepted method of valuing a claim with reasonable certainty at the claim’s net present value, such as an actuarial evaluation.
(5)

     (5)(a) Notwithstanding the other provisions of this section, a claim for the value or breach of a life insurance policy, disability income insurance policy, long-term care insurance policy, or annuity may not result in or serve as the basis of any liability of a reinsurer of the insurer.
     (5)(b) A reinsurer’s liability to the insurer shall be determined exclusively on the basis of its contracts of reinsurance and Section 31A-27a-513.
(6)

     (6)(a) The liquidator may petition the receivership court to set a date certain before which all claims under this section shall be final.
     (6)(b) In addition to the notice requirements of Section 31A-27a-107, the liquidator shall give notice of the filing of the petition to all claimants with claims that remain contingent or unliquidated under this section.
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