Title 31A, Insurance Code

31A-23b-404. Penalties. (1)(a) If, after notice and opportunity to be heard, the commissioner finds that the navigator or any other person has not materially complied with this part, or any rule made or order issued under this chapter, the commissioner may order the navigator or …

31A-25-102. Scope and purposes. (1) This chapter applies to all third party administrators. (2) The purposes of this chapter include: (a) encouraging disclosure of contracts between insurers and third party administrators, both to potential insureds and to the commissioner; (b) p…

31A-25-201. License and authority from insurers required. (1) A person may not perform, offer to perform, or advertise any service as a third party administrator in Utah, without a valid license under Section 31A-25-203 and express authority from all insurers it represents. A per…

31A-25-202. Application for license. (1)(a) An application for a license as a third party administrator shall be: (i) made to the commissioner on forms and in a manner the commissioner prescribes; and (ii) accompanied by the applicable fee, which is not refundable if the applicat…

31A-25-203. General requirements for license issuance. (1) The commissioner shall issue a license to act as a third party administrator to a person who: (a) satisfies the character requirements under Section 31A-25-204; (b) satisfies the financial responsibility requirement under…

31A-25-204. Character requirements. Each applicant for a license under this chapter shall show to the commissioner all of the following: (1) that the applicant has the good faith intent to engage in the type of business the license applied for would permit; (2)(a) if a natural pe…

31A-25-205. Financial responsibility. (1) Every person licensed under this chapter shall maintain an insurance policy or surety bond: (a)(i) while licensed; and (ii) for one year after the person is licensed; and (b) issued: (i) by an authorized insurer; (ii) in an amount specifi…

31A-25-206. Nonresident jurisdictional agreement. (1)(a) If a nonresident license applicant has a valid license from the nonresident license applicant's home state or designated home state and the conditions of Subsection (1)(b) are met, the commissioner shall: (i) waive any lice…

31A-25-207. Form and contents of license. (1) Licenses issued under this chapter shall be in the form the commissioner prescribes and shall set forth: (a) the name, address, and telephone number of the licensee; (b) the date of license issuance; and (c) any other information the …

31A-25-208. Revoking, suspending, surrendering, lapsing, limiting, or otherwise terminating a license -- Rulemaking for renewal and reinstatement. (1) A license type issued under this chapter remains in force until: (a) revoked or suspended under Subsection (4); (b) surrendered t…

31A-25-209. Probation -- Grounds for revocation. (1) The commissioner may place a licensee on probation for a period not to exceed 24 months as follows: (a) after an adjudicative proceeding under Title 63G, Chapter 4, Administrative Procedures Act, for any circumstances that woul…

31A-25-210. License lapse and voluntary surrender. (1)(a) A license issued under this chapter shall lapse if the licensee fails to: (i) pay when due a fee under Section 31A-3-103; (ii) submit a completed renewal application as required by Section 31A-25-202; (iii) produce, when d…

31A-25-301. Written agreements required. (1) Every third party administrator shall have a written agreement with each insurer and with each group policyholder represented. (2) The agreements required by Subsection (1) shall contain provisions which include the requirements of thi…

31A-25-302. Books and records required -- Access. (1) Any insurer contracting with an administrator for administrator services has the right of continuing access to those records maintained by the third party administrator which permit the insurer to fulfill all of its contractua…

31A-25-302.5. Place of business and residence address. (1) A third-party administrator licensed under this chapter shall register and maintain with the commissioner: (a) the address and one or more telephone numbers of the licensee's principal place of business; (b) a valid busin…

31A-25-303. Standards pertaining to advertising and underwriting. (1) A third party administrator may use advertising pertaining to the business underwritten by the insurer only to the extent it has been approved in writing by the insurer in advance. (2) The agreement required un…

31A-25-304. Liability of the insurer if administrator receives premium. If an insurer utilizes the services of a third party administrator under the terms of a written agreement, as required under this chapter, the payment to the third party administrator of any premiums for insu…

31A-25-305. Fiduciary requirements for third party administrators. (1) All money received by a third party administrator in that capacity shall be held by the third party administrator as a fiduciary. The money shall be paid in a timely manner to the persons entitled to it. While…

31A-25-306. Payments by administrator. An administrator shall pay a claim from money collected on behalf of the insurer on drafts or checks as authorized by the insurer.

31A-25-307. Delivery by administrator of policies and communications from insurer. Any policies, certificates, booklets, termination notices, or other written communications delivered by the insurer to the administrator for delivery to its policyholders shall be delivered by the …

31A-25-401. Compensation not to be contingent on claims expense. The compensation paid to a third party administrator for any policies under which the third party administrator adjusts or settles claims may be contingent on claims experience only if the third party administrator …

31A-25-402. Notice to insureds regarding administration of policies. (1) If the services of a third party administrator are utilized, the third party administrator shall provide a written notice to the insureds, advising them of the identity of and relationship among the third pa…

31A-26-101. Purposes. The purposes of this chapter are: (1) to promote the professional competence of those engaged in claims adjusting; (2) to encourage fair and rapid settlement of claims; (3) to protect claimants under insurance policies from unfair claims adjustment practices…

31A-26-102. Definitions. As used in this chapter, unless expressly provided otherwise: (1) "Company adjuster" means a person employed by an insurer who negotiates or settles claims on behalf of the insurer or an affiliated insurer. (2) "Designated home state" means the state or t…

31A-26-103. Workers' compensation claims. In addition to being subject to this and other chapters of this title, insurers writing workers' compensation insurance in this state are subject to the Labor Commission with respect to claims for and payment of compensation and benefits.…

31A-26-201. Requirement of license. (1) Except as provided in Subsection (2): (a) a person may not perform, offer to perform, or solicit the opportunity to perform an act of insurance adjusting without a valid license under Section 31A-26-203; and (b) a person may not use the ins…

31A-26-202. Application for license. (1)(a) The application for a license as an independent adjuster or public adjuster shall be: (i) made to the commissioner on forms and in a manner the commissioner requires; and (ii) except as provided in Subsection (4), accompanied by the app…

31A-26-203. Adjuster's license required. (1) The commissioner shall issue a license to act as an independent adjuster or public adjuster to a person who, as to the license classification applied for under Section 31A-26-204: (a) satisfies the character requirements under Section …

31A-26-204. License classifications. A resident or nonresident license issued under this chapter shall be issued under the classifications described under Subsections (1), (2), and (3). A classification describes the matters to be considered under a prerequisite education or exam…

31A-26-205. Character requirements. Each applicant for a license under this chapter shall show to the commissioner that: (1) the applicant has the good faith intent to engage in the type of business the license or licenses applied for would permit; (2)(a) if a natural person, the…

31A-26-206. Continuing education requirements. (1) Pursuant to this section, the commissioner shall by rule prescribe continuing education requirements for each class of license under Section 31A-26-204. (2)(a) The commissioner shall impose continuing education requirements in ac…

31A-26-207. Examination requirements. (1) The commissioner may require applicants for a particular class of license under Section 31A-26-204 to pass an examination as a requirement to receiving a license. The examination shall reasonably relate to the specific license class for w…

31A-26-208. Nonresident jurisdictional agreement. (1)(a) If a nonresident license applicant has a valid license from the nonresident license applicant's home state or designated home state and the conditions of Subsection (1)(b) are met, the commissioner shall: (i) waive any lice…

31A-26-209. Form and contents of license. (1) Licenses issued under this chapter shall be in the form the commissioner prescribes and shall set forth: (a) the name, address, and the one or more telephone numbers of the licensee; (b) the license classifications under Section 31A-2…

31A-26-210. Reports from organizations licensed as adjusters. (1) An organization licensed as an adjuster under Section 31A-26-203 shall designate an individual who has an individual adjuster license to act on the organization's behalf in order for the licensee to do business for…

31A-26-211. Claims liaison. Authorized insurers with employees engaged in insurance adjusting may be required by the commissioner to designate one or more natural persons to whom the commissioner or the commissioner's staff may direct inquiries concerning the insurer's claims adj…

31A-26-212. Emergency license. In the event of a catastrophe or emergency which arises out of a disaster, act of God, riot, civil commotion, conflagration, or other similar occurrence, the commissioner shall, upon application, issue emergency licenses to persons who are not licen…

31A-26-213. Revoking, suspending, surrendering, lapsing, limiting, or otherwise terminating a license -- Forfeiture -- Rulemaking for renewal or reinstatement. (1) A license type issued under this chapter remains in force until: (a) revoked or suspended under Subsection (5); (b) …

31A-26-214. Probation -- Grounds for revocation. (1) The commissioner may place a licensee on probation for a period not to exceed 24 months as follows: (a) after an adjudicative proceeding under Title 63G, Chapter 4, Administrative Procedures Act, for any circumstances that woul…

31A-26-214.5. License lapse and voluntary surrender. (1)(a) A license issued under this chapter shall lapse if the licensee fails to: (i) pay when due a fee under Section 31A-3-103; (ii) complete continuing education requirements under Section 31A-26-206 before submitting the lic…

31A-26-215. Temporary license -- Appointment of trustee for terminated licensee's business. (1)(a) The commissioner may issue a temporary insurance adjuster license: (i) to a person listed in Subsection (1)(b): (A) if the commissioner considers that the temporary license is neces…

31A-26-216. Portable electronics adjusting. (1) As used in this section, "automated claims adjudication system" means a preprogrammed computer system designed for the collection, data entry, calculation, and final resolution of a portable electronics insurance claim that: (a) may…

31A-26-301. Timely payment of claims. (1)(a) Unless otherwise provided by law, an insurer shall timely pay every valid insurance claim made by an insured. (b) By rule the commissioner may prescribe: (i) the kinds of notice and proof of loss that will establish validity; (ii) the …

31A-26-301.5. Health care claims practices. (1)(a) Except as provided in Section 31A-8-407, an insured retains ultimate responsibility for paying for health care services the insured receives. (b) If a health care service is covered by one or more individual or group health insur…

31A-26-301.6. Health care claims practices. (1) As used in this section: (a) "Health care provider" means a person licensed to provide health care under: (i) Title 26B, Chapter 2, Part 2, Health Care Facility Licensing and Inspection; or (ii) Title 58, Occupations and Professions…

31A-26-301.7. Dental claim transparency and practices. (1) As used in this section: (a) "Bundling" means the practice of combining distinct dental procedures into one procedure for billing purposes. (b) "Dental plan" means the same as that term is defined in Section 31A-22-646. (…