OFFICE OF THE
[Filed November 24, 2020, 1:12 p.m., effective December 25, 2020]
Effective Date of Rule: Thirty-one days after filing.
Purpose: Amend one current regulation and create a new regulation to provide guidance on the limitations and use of implementation credits. The amended regulation is WAC 284-30-320 concerning definitions in trade practices and the new regulation is WAC 284-30-595 concerning unfair trade practices in the use of implementation credits. The anticipated effect of the proposed rules is to provide reference and guidance to insurers and implement the legislative amendments made to RCW 48.30.140
through passage of SHB 1075.
Citation of Rules Affected by this Order: New WAC 284-30-595; and amending WAC 284-30-320.
Adopted under notice filed as WSR 20-20-119 on October 6, 2020.
A final cost-benefit analysis is available by contacting Tabba Alam, P.O. Box 40260, Olympia, WA 98504-0260, phone 360-725-7170, email TabbaA@oic.wa.gov, website www.insurance.wa.gov.
Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 1, Amended 1, Repealed 0.
Number of Sections Adopted at the Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.
Number of Sections Adopted on the Agency's own Initiative: New 0, Amended 0, Repealed 0.
Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 0, Repealed 0.
Number of Sections Adopted using Negotiated Rule Making: New 0, Amended 0, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 0, Amended 0, Repealed 0.
Date Adopted: November 24, 2020.
AMENDATORY SECTION(Amending WSR 09-11-129, filed 5/20/09, effective 8/21/09)
When used in this regulation, WAC 284-30-300 through 284-30-400:
(1) "Actual cash value" means the fair market value of the loss vehicle immediately prior to the loss.
(2) "Claimant" means, depending upon the circumstance, either a first party claimant, a third-party claimant, or both and includes a claimant's designated legal representative and a member of the claimant's immediate family designated by the claimant.
(3) "Comparable motor vehicle" means a vehicle that is the same make and model, of the same or newer model year, similar body style, with similar options and mileage as the loss vehicle and in similar overall condition, as established by current data. To achieve comparability, deductions or additions for options, mileage or condition may be made if they are itemized and appropriate in dollar amount.
(4) "Current data" means data within ninety days prior to or after the date of loss.
(5) "Documented expenses" means specific incurred expenses which are either paid by the group policyholder or paid on behalf of the group policyholder and for which documentation is obtained by the insurer. Such documented expenses include, but are not limited to, training, marketing, consumer awareness, information technology and computer programming and operations and administration. Such expenses must be specifically disbursed and actually incurred within the limits set forth in the policy or policy addendum.
(6) "File" means a record in any retrievable format, and unless otherwise specified, includes paper and electronic formats.
(((6)))(7) "First party claimant" means an individual, corporation, association, partnership or other legal entity asserting a right as a covered person to payment under an insurance policy or insurance contract arising out of the occurrence of the contingency or loss covered by a policy or contract.
(((7)))(8) "Group policyholder" means a policy owner under a group policy which provides coverage to an entire group of fifty-one or more individuals.
(9) "Insurance policy" or "insurance contract" mean any contract of insurance, indemnity, suretyship, or annuity issued, proposed for issuance, or intended for issuance by any insurer.
"Insurer" means any individual, corporation, association, partnership, reciprocal exchange, interinsurer, ((Lloyds insurer,
)) fraternal mutual insurer, fraternal mutual life insurer, and any other legal entity engaged in the business of insurance, authorized or licensed to issue or who issues any insurance policy or insurance contract in this state. "Insurer" does not include health care service contractors, as defined in RCW 48.44.010
, and health maintenance organizations, as defined in RCW 48.46.020
(((9)))(11) "Investigation" means all activities of the insurer directly or indirectly related to the determination of liabilities under coverages afforded by an insurance policy or insurance contract.
(((10)))(12) "Loss vehicle" means the damaged motor vehicle or a motor vehicle that the insurer determines is a "total loss."
"Motor vehicle" means any vehicle subject to registration under chapter 46.16
(((12)))(14) "Notification of claim" means any notification, whether in writing or other means acceptable under the terms of an insurance policy or insurance contract, to the insurer or its agent, by a claimant, which reasonably apprises the insurer of the facts pertinent to a claim.
(((13)))(15) "Principally garaged area" means the place where the loss vehicle is normally kept, consistent with the applicable policy of insurance.
(((14)))(16) "Shall describe any such payment" means the specific expenses that are described in the group policyholder's contract or subsequent contract addendum with the insurer and which establish the limits of acceptable expenses under the contract.
(17) "Third-party claimant" means any individual, corporation, association, partnership or other legal entity asserting a claim against any individual, corporation, association, partnership or other legal entity insured under an insurance policy or insurance contract of the insurer.
(((15)))(18) "Total loss" means that the insurer has determined that the cost of parts and labor, plus the salvage value, meets or exceeds, or is likely to meet or exceed, the "actual cash value" of the loss vehicle. Other factors may be considered in reaching the total loss determination, such as the existence of a biohazard or a death in the vehicle resulting from the loss.
(((16)))(19) "Written" or "in writing" means any retrievable method of recording an agreement or document, and, unless otherwise specified, includes paper and electronic formats.
WAC 284-30-595Unfair practices regarding documented expenses for implementation credits.
Under RCW 48.30.140
, an insurer may issue payment to offset a documented expense that is incurred by a group policy holder while transferring from one policy to another policy provided that the insurer maintains evidence of the documented expense for three years from the date of the expense. An insurer will describe in the policy or in any such filing with the commissioner that the payment made to the group policy holder will not exceed the amount of the documented expenses.
(1) The failure to maintain and document an expense incurred by a group policy holder constitutes an unfair trade practice and is a violation of this chapter.
(2) Upon the commissioner's request, the insurer must provide proof of a documented expense in the form of paper or electronic copy.