58-12-31. Definitions regarding standards for claims processing.
Terms used in §§58-12-31 to 58-12-37, inclusive, mean:
(1)"Director," the director of the South Dakota Division of Insurance;
(2)"Insured," the party named on a policy or certificate as the individual with legal rights to the benefits provided by the policy;
(3)"Insurer," a person, reciprocal exchange, interinsurer, Lloyd's insurer, fraternal benefit society, and any other legal entity engaged in the business of insurance, including claim agents, brokers, adjusters, and third party administrators. The term also includes medical service plans, hospital service plans, health maintenance organizations, prepaid limited health care service plans, dental plans, and optometric plans. This term does not include any insurance producer licensed pursuant to chapter 58-30, unless an insurance producer is directly involved in the adjudication of claims;
(4)"Person," a natural or artificial entity, including individuals, partnerships, associations, trusts, or corporations;
(5)"Policy," or "certificate," a contract of insurance, indemnity, medical, health, or hospital service, or annuity issued. The term does not include contracts of workers' compensation, fidelity, suretyship, or boiler and machinery insurance.
Source: SL 2014, ch 235, §1.
Structure South Dakota Codified Laws
Chapter 12 - Insurance Claims And Benefits
Section 58-12-1 - Forms for proof of loss--Furnishing by insurer on request.
Section 58-12-2 - Acts of insurer not constituting waiver of policy provision or defense.
Section 58-12-4 - Life and health insurance--Exemption of benefits and proceeds from execution.
Section 58-12-5 - "Annuity contract" defined.
Section 58-12-8 - Maximum amount of annuity exemption--Excess subject to levy.
Section 58-12-9 - Application of excess annuities to judgment--Factors considered.
Section 58-12-12 - Use of uniform health insurance claim forms.
Section 58-12-13 - Use of claim forms required by federal law excepted.
Section 58-12-14 - Promulgation of rules for uniform health insurance claim forms.
Section 58-12-15 - "Paintless dent repair" defined.
Section 58-12-18 - Compliance with § 58-12-16.
Section 58-12-19 - Clean claim defined.
Section 58-12-25 - Reimbursement to department for cost of services.
Section 58-12-26 - Insurer defined.
Section 58-12-27 - Department defined.
Section 58-12-28 - Provisions of chapter 1-27 not applicable to insurer records.
Section 58-12-31 - Definitions regarding standards for claims processing.
Section 58-12-32 - Application of standards for claims investigation and disposition.
Section 58-12-34 - Acts constituting unfair claims practices.
Section 58-12-35 - Notice of hearing.
Section 58-12-36 - Cease and desist order--Monetary penalty--Suspension or revocation of license.
Section 58-12-37 - Promulgation of rules regarding definitions and records.