Md. Code Regs. 31.02.01.02

Current through Register Vol. 51, No. 10, May 17, 2024

Section 31.02.01.02 - Definitions

A. In this chapter, the following terms have the meanings indicated.

B. Terms Defined.

(1) "Administration" means the Maryland Insurance Administration.

(2) "Administrative complaint" means a document that:

(a) Is received by the Commissioner from any person; and

(b) Alleges a violation of:

(i) A law or regulation enforced by the Commissioner; or

(ii) An order issued by the Commissioner.

(3) Contested Case.

(a) "Contested case" has the meaning stated in State Government Article, § 10-202(d), Annotated Code of Maryland.

(b) "Contested case" includes a proceeding:

(i) Arising out of a determination made by the Commissioner;

(ii) Arising out of a charging document, order, or notice issued by the Commissioner;

(iii) Regarding a license, certificate, registration, or special permit;

(iv) On a proposed examination report; or

(v) Arising out of any other act of, threatened act of, or failure to act by the Commissioner that aggrieves a person.

(c) "Contested case" does not include:

(i) A hearing on the approval or disapproval of a rate filing or a form filing; or

(ii) Any other quasi-legislative hearing.

(4) Determination.

(a) "Determination" means a decision by the Commissioner that requires the Commissioner to provide the opportunity for a hearing to a person aggrieved by the decision under Insurance Article, § 2-210, Annotated Code of Maryland.

(b) "Determination" includes:

(i) A decision as to whether a person against whom an administrative complaint has been received violated a law, regulation, or order; and

(ii) An order issued under Insurance Article, § 2-204, Annotated Code of Maryland.

(5) Examination Report.

(a) "Examination report" means a report of the examination of:

(i) An authorized insurer, management company of an authorized insurer, subsidiary owned or controlled by an authorized insurer, rating organization, or authorized health maintenance organization that is subject to examination under Insurance Article, § 2-205, Annotated Code of Maryland;

(ii) An insurance producer, surplus lines broker, general agent, adjuster, public adjuster, adviser, or other person that is subject to examination under Insurance Article, § 2-206, Annotated Code of Maryland;

(iii) An accredited reinsurer that is subject to examination under Insurance Article, Title 5, Subtitle 9, Annotated Code of Maryland;

(iv) A third party administrator that is subject to examination under Insurance Article, § 8-319, Annotated Code of Maryland;

(v) A fraternal benefit society that is subject to examination under Insurance Article § 8-461 or 8-462, Annotated Code of Maryland;

(vi) An accepted fronting reinsurer that is subject to examination under Insurance Article, § 13-116, Annotated Code of Maryland;

(vii) A nonprofit health service plan that is subject to examination under Insurance Article, § 14-125, Annotated Code of Maryland;

(viii) A dental plan organization that is subject to examination under Insurance Article, § 14-411, Annotated Code of Maryland;

(ix) A private review agent that is subject to examination under Insurance Article, § 15-10 B-19, Annotated Code of Maryland;

(x) A premium finance company that is subject to examination under Insurance Article, § 23-103, Annotated Code of Maryland;

(xi) A managed care organization that is subject to examination under Health-General Article, §15-102.3, Annotated Code of Maryland;

(xii) A provider-sponsored organization that is subject to examination under Health-General Article, Title 19, Subtitle 7A, Annotated Code of Maryland;

(xiii) The Chesapeake Employers' Insurance Company, which is subject to examination under Insurance Article, § 24-304(e)(1), Annotated Code of Maryland; or

(xiv) Any other person that is subject to examination by the Commissioner under any other provision of law.

(b) "Examination report" includes:

(i) A financial examination report; and

(ii) A market conduct examination report.

(6) "Hearing officer" means:

(a) The Maryland Insurance Commissioner or the Commissioner's authorized designee under Insurance Article, § 2-210(d), Annotated Code of Maryland; or

(b) An administrative law judge.

(7) "Licensee" means a person holding a certificate of authority, license, registration, or special permit issued by the Administration or who has other similar authority to operate under the regulatory authority of the Administration.

(8) "Office" means the Office of Administrative Hearings.

(9) "Proposed examination report" means an examination report that:

(a) The Commissioner mails to the person examined:

(i) At the conclusion of an examination; and

(ii) Before filing the examination report; and

(b) Informs the person being examined of the person's right to request a hearing pursuant to Regulation .04C of this chapter.

Md. Code Regs. 31.02.01.02

Amended effective 43:2 Md. R. 128, eff.2/1/2016