{"data":{"id":"us-va/14vac5-400-20","jurisdiction":"us-va","citation":"14VAC5-400-20","heading":"Definitions","body":"The  following words and terms when used in this chapter shall have the following meanings unless the context clearly indicates otherwise:\n\n\"Agent\" means any  person authorized to represent an insurer with respect to a claim.\n\n\"Claim\" means a demand for payment by a claimant and does not mean an inquiry concerning coverage.\n\n\"Claimant\" means  a first party claimant, a third party claimant,  a designated legal representative, or  a member of the claimant's immediate family designated by the claimant.\n\n\"Commission\" means the State Corporation Commission.\n\n\"Documentation\" includes all pertinent communications, including electronic communications and transactions, data, notes, work papers, claim forms, bills, and explanation of benefits forms relative to the claim.\n\n\"Estimate\" means a written statement of the cost of repairs to an automobile or to property, including any supplements.\n\n\"Explanation of benefits\" means any form provided by any insurer that explains the amounts covered under a policy or plan and shows the amounts payable by a covered person to a health care provider.\n\n\"First party claimant\" means an  insured, a beneficiary, a policy owner, or an annuitant who asserts a right to payment under an insurance policy  arising out of the occurrence of the contingency or loss covered by such policy.\n\n\"Insured\" means a person covered by an insurance policy with legal rights to the benefits provided by the policy.\n\n\"Insurer\" means a person licensed to issue or  that issues any insurance policy  in this Commonwealth. Insurer shall also include surplus lines brokers.\n\n\"Investigation\" means all activities of an insurer  used to make a determination that the claim should be paid, denied, or closed.\n\n\"Person\" has the same meaning as defined in § 38.2-501 of the Code of Virginia.\n\n\"Policy\" means insurance policy, contract, certificate of insurance, evidence of coverage, or annuity.\n\n\"Proof of loss\" means all necessary documentation reasonably required by the insurer to make a determination of benefit or coverage.\n\n\"Provider\" means any person providing  services pursuant to any accident and sickness policy.\n\n\"Third party claimant\" means any  person asserting a claim against  an insured or a provider filing a claim on behalf of an insured under an insurance policy.","path":["Title 14. Insurance","Agency 5. State Corporation Commission, Bureau of Insurance","Chapter 400. Rules Governing Unfair Claim Settlement Practices"],"source_url":"https://law.lis.virginia.gov/admincode/title14/agency5/chapter400/section20/","current_through":"2026 Regular Session (effective July 1, 2026)","vintage":"","retrieved_at":"2026-09-14T04:52:02Z","sha256":"8fcae69d0b19f2ea79e544787979beadd830a6bdb12133e7112e3e0c2d0c05e6","source_id":"us-va-vac","stale":false,"prev":"us-va/14vac5-400-10","next":"us-va/14vac5-400-25"},"notice":"GroundRules: Original legal text. Not legal advice."}