§ 22:2055 — Definitions

§2055. Definitions
As used in this Part:
(1) "Affiliate" means a person who directly or indirectly, through one or more
intermediaries, controls, is controlled by, or is under common control with another person.
(2) "Association" means the Louisiana Insurance Guaranty Association created under
R.S. 22:2056.
(3) "Association similar to the association" means any guaranty association, security
fund or other insolvency mechanism that affords protection similar to that of the association.
The term shall also include any property and casualty insolvency mechanism that obtains
assessments or other contributions from insurers on a pre-insolvency basis.
(4) "Commissioner" means the commissioner of insurance of this state.
(5) "Control" means the possession, direct or indirect, of the power to direct or cause
the direction of the management and policies of a person, whether through the ownership of
voting securities, by contract other than a commercial contract for goods or non-management
services, or otherwise, unless the power is the result of an official position with or corporate
office held by the person. Control shall be presumed to exist if a person, directly or
indirectly owns, controls, holds with the power to vote, or holds proxies representing, ten
percent or more of the voting securities of any other person. This presumption may be
rebutted by a showing that control does not exist in fact.
(6) "Covered claim" means the following:
(a) An unpaid claim, including one for unearned premiums that arises out of and is
within the coverage and not in excess of the applicable limits of an insurance policy to which
this Part applies issued by an insurer, if such insurer becomes an insolvent insurer after
September 1, 1970, and the policy was issued by such insurer and any of the following:
(i) The claimant or insured is a resident of this state at the time of the insured event,
provided that, for entities, the residence of a claimant or insured is the state in which its
principal place of business is located at the time of the insured event.
(ii) The claimant is a self-insurer, including an arrangement or trust formed under
R.S. 23:1191 et seq., and is principally domiciled in this state at the time of the insured event.
(iii) The claim is a first party claim for damage to property with a permanent location
in this state.
(b) "Covered claim" does not include the following:
(i) Any amount awarded as penalties or punitive or exemplary damages, including
but not limited to those in the provisions of R.S. 22:1892 and 1892.2.
(ii) Any amount sought as a return of premium under any retrospective rating plan.
(iii) Any amount due any reinsurer, insurer, insurance pool or underwriting
association, health maintenance organization or plan, preferred provider organization or plan,
hospital plan corporation, professional health service corporation, employee retirement fund
including but not limited to plans subject to the Employee Retirement Income Security Act
of 1974, Medicare or Medicare Advantage, Medicaid, or the self-insured portion due any
self-insurer as subrogation recoveries, reinsurance recoveries, contribution, indemnification,
or otherwise. In addition, any person insured under a policy issued by an insolvent insurer
shall likewise not be liable for any subrogation claim or any contractual indemnity claim
asserted by any reinsurer, insurer, insurance pool, underwriting association, health
maintenance organization or plan, hospital plan corporation, professional health service
corporation, preferred provider organization or plan, employee retirement fund including but
not limited to plans subject to the Employee Retirement Income Security Act of 1974,
Medicare or Medicare Advantage, Medicaid, self-insurer, or any other person with an interest
in the claim, other than to the extent the claim exceeds the association's obligation
limitations.
(iv) Any claims excluded due to the high net worth of an insured as defined in this
Part.
(v) Any first party claims by an insured that is an affiliate of the insolvent insurer.
(vi) Any fee or other amount relating to goods or services sought by or on behalf of
any attorney or other provider of goods or services retained by the insolvent insurer or an
insured prior to the date it was determined to be insolvent.
(vii) Any fee or other amount sought by or on behalf of any attorney or other
provider of goods or services retained by any insured or claimant in connection with the
assertion or prosecution of any claim, covered or otherwise, against the association.
(viii) Any claim for interest.
(ix) Any claim filed with the association or a liquidator for protection afforded under
the insured's policy for incurred-but-not-reported losses.
(x) Any claim the payment of which exceeds the powers and duties of the association
in R.S. 22:2058(A)(1) or is outside the scope of coverage in R.S. 22:2053(A).
(xi) Any claim by a group self-insurance fund for the amount within the self-insured
retention, deductible, co-pay, or any other obligation or liability of the group self-insurance
fund, stated in the policy of the insolvent insurer, or for the first three hundred thousand
dollars of each claim, whichever is greater.
(xii) Any claim by any agency or program of the federal government or of any state
or political subdivision thereof.
(7) "Insolvent insurer" means an insurer who meets both of the following criteria:
(a) Is licensed and authorized to transact insurance in this state, either at the time the
policy was issued or when the insured event occurred.
(b) Against whom an order of liquidation with a finding of insolvency has been
entered by a final judgment of a court of competent jurisdiction in the insurer's state of
domicile or of this state, and which order of liquidation has not been stayed or been the
subject of a perfected suspensive appeal or other comparable order.
(8) "Insurance policy" means an insurance contract as defined in R.S. 22:864, and
shall not include an agreement in which an insurer agrees to assume and carry out directly
with the policyholder any of the policy obligations of another insurer, such as cut-through
endorsements, reinsurance endorsements, facultative reinsurance agreements, treaty
reinsurance agreements, and other such agreements, when either insurer is an affiliate of the
other.
(9) "Insured" means any named insured, any additional insured, any vendor, lessor,
or any other party identified as an insured under the policy.
(10)(a) "Member insurer" means any person who meets both of the following
criteria:
(i) Is licensed and authorized to transact insurance in this state.
(ii) Since September 1, 1970, has written at least one policy of insurance to which
this Part applies.
(b) An insurer shall cease to be a member insurer effective on the day following the
termination or expiration of its license to transact the kinds of insurance to which this Part
applies; however, the insurer shall remain liable as a member insurer for any and all
obligations, including obligations for assessments levied prior to the termination or
expiration of the insurer's license.
(11) "Net direct written premiums" means direct gross premiums written in this state
on insurance policies to which this Part applies, including policy and membership fees, less
return premiums thereon, premiums on policies not taken, and dividends paid or credited to
policyholders on such direct business. "Net direct written premiums" does not include
premiums on contracts between insurers or reinsurers. Notwithstanding any law to the
contrary, no assuming reinsurer shall be required to pay or otherwise contribute to any fund
or assessment of the association except for any insurance that the reinsurer directly writes in
the state.
(12) "Ocean marine insurance" shall have the same meaning as that term is defined
in R.S. 22:46.
(13) "Person" means any natural or juridical person, company, insurer, association,
organization, reciprocal or inter-insurance exchange, partnership, business, trust, corporation,
or other entity, including governmental entities.
(14) "Receiver" means liquidator, rehabilitator, conservator or ancillary receiver, as
the context requires.
(15) "Self-insurer" means a person that covers its liabilities through a qualified
individual or group self-insurance program created for the specific purpose of covering
liabilities typically covered by insurance. A group self-insurance fund formed under R.S.
23:1191 et seq. shall not be deemed to be an insurer with respect to this Chapter.
NOTE: Former R.S. 22:2055 redesignated as R.S. 22:415 by Acts 2008, No.
415, §1, eff. Jan. 1, 2009.

Legislative History

Added by Acts 1970, No. 81, §1. Amended by Acts 1980, No. 486, §1; Acts 1987, No. 172, §1, eff. June 19, 1987; Acts 1989, No. 620, §1; Acts 1989, No. 688, §1; Acts 1990, No. 105, §1; Acts 1990, No. 129, §1; Acts 1990, No. 254, §1; Acts 1992, No. 835, §1; Acts 1997, No. 1340, §1, eff. July 15, 1997; Acts 1999, No. 475, §1, eff. June 18, 1999; Acts 1999, No. 476, §1, eff. June 18, 1999; Acts 1999, No. 477, §1, eff. June 18, 1999; Acts 2004, No. 109, §1; Acts 2008, No. 109, §1; Redesignated from R.S. 22:1379 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009; Acts 2010, No. 959, §1, eff. July 6, 2010; Acts 2012, No. 271, §1; Acts 2017, No. 183, §2; Acts 2020, No. 287, §1, eff. July 1, 2020; Acts 2023, No. 444, §1, eff. June 28, 2023; Acts 2024, No. 3, §3, eff. July 1, 2024.