R590-191-4. File and Record Documentation

(1) An insurer's claim file is subject to examination by the commissioner. (2) To aid in an examination, an insurer shall maintain: (a) claim data that is accessible and retrievable for examination, including: (i) the policy number; (ii) the certificate number, if any; (iii) a duplicate of the policy, as issued; (iv) the claim number; (v) the date of loss; (vi) the date the notice of loss was received; (vii) the date the proof of loss was received; (viii) the date an investigation began and was complete; (ix) the date of the settlement of the claim; (x) the type of settlement, indicated as: (A) payment, including the amount paid; (B) settled without payment; or (C) denied; (xi) documentation supporting how the claim was settled and how any payments were calculated; and (xii) other documentation relied upon for claim settlement; (b) detailed documentation in each claim file permitting the reconstruction of the insurer's activities relative to the claim; and (c) the claim file record in a hard copy file or other format that has the capability of duplication to hard copy. (3) The data in Subsection (2) shall: (a) be available for each open and closed file for at least the most recent three-year period; or (b) for a Utah domiciled insurer, be available from the date of the previous examination by the department.