reglab/statecodes huggingface dataset:
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 41 - Conservation, Rehabilitation and Liquidation › Section 59A-41-54 - Summary proceedings; seizure under court order.

A. Upon filing by the superintendent in the district court for Santa Fe county or the county in which the insurer has its principal office of his verified petition alleging any ground for a formal delinquency proceeding against an insurer under this article and that the interests of the insurer's policyholders or creditors or the public will be jeopardized by delay, and setting forth the order deemed necessary by the superintendent, the court shall, ex parte and without notice or hearing, issue the requested order. The requested order may:
(1) direct the superintendent to take possession and control of all or part of the property, books, accounts and records of the insurer and the premises occupied by it for transaction of its business in this state; and
(2) until further order of the court, enjoin the insurer and its officers, managers, agents and employees from removal, concealment or other disposition of its property, and from transaction of its business, except with the superintendent's written consent.
B. The court's order shall be for such duration, specified in the order, as the court deems necessary to enable the superintendent to ascertain the insurer's condition. On motion of any party or on its own motion, the court may hold such hearings as it deems desirable after such notice as it deems appropriate, and extend or shorten the duration or modify the terms of the order. The court shall vacate the seizure order if the superintendent fails to commence a formal proceeding under this article after reasonable opportunity to do so; and a seizure order is automatically terminated by issuance of the court's order pursuant to formal delinquency proceedings under this article.
C. Entry of a seizure order under this section does not constitute an anticipatory breach of any contract of the insurer.
History:
Laws 1984, ch. 127, § 746.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 41 - Conservation, Rehabilitation and Liquidation › Section 59A-41-55 - Summary proceedings; seizure under superintendent's order.

A. If it appears to the superintendent that the interests of policyholders, creditors or the public will be jeopardized by delay incident to requesting a court seizure order, then on any ground which would justify a court seizure order under Section 59A-41-54 NMSA 1978, and without notice and without applying to the court, the superintendent may issue a seizure order which must contain a statement verified by him of the grounds for his action. As directed by the seizure order, the superintendent's representatives shall forthwith take possession and control of all or part of the property, books, accounts and records of the insurer and of the premises in this state occupied by the insurer for transaction of its business. The superintendent shall retain possession and control until the order is vacated or is replaced by an order of court pursuant to Subsection B of this section, or pursuant to a formal proceeding under Chapter 59A, Article 41 NMSA 1978.
B. At any time after seizure under Subsection A of this section, the insurer may apply to the district court for Santa Fe county. The court shall thereupon order the superintendent to appear forthwith and shall thereafter proceed as if the order were a court seizure order issued under Section 59A-41-54 NMSA 1978.
C. Every peace officer of this state shall assist the superintendent in making and enforcing any such seizure, and every sheriff and police department shall furnish the superintendent with such deputies, patrolmen or officers as may be necessary for the purpose.
D. Entry of a seizure order under this section does not constitute an anticipatory breach of any contract of the insurer.
History:
Laws 1984, ch. 127, § 747; 1987, ch. 259, § 26.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 41 - Conservation, Rehabilitation and Liquidation › Section 59A-41-56 - Summary proceedings; conduct of administrative and judicial hearings.

A. The superintendent shall hold all hearings in summary proceedings privately unless the insurer requests a public hearing, in which case the hearing shall be public.
B. The court may hold all hearings in summary proceedings and judicial reviews thereof privately in chambers, and shall do so on request of the insurer proceeded against.
C. In all summary proceedings and judicial reviews thereof, all records of the insurer, other documents, and all insurance department files and court records and papers, so far as they pertain to or are part of the record of the summary proceedings, shall be and remain confidential except as necessary to obtain compliance therewith, unless the court after hearing arguments by the parties in chambers, orders otherwise, or unless the insurer requests that the matter be made public. Until the court otherwise orders, all papers filed with the clerk of the court in the matter shall be held by him in a confidential file.
D. If at any time it appears to the court that any person whose interest is or will be substantially affected by an order did not appear at the hearing and has not been served, the court may order that notice be given and the proceedings be adjourned to give such person an opportunity to appear, on such terms as may be reasonable.
History:
Laws 1984, ch. 127, § 748.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 41 - Conservation, Rehabilitation and Liquidation › Section 59A-41-57 - Summary proceedings; penalty for refusal to deliver property, records.

Any person having possession or custody of and refusing to deliver to the superintendent or his representative upon request any of the property, books, accounts, documents or other records of an insurer against which a seizure order has been issued by the superintendent or by the court, as provided in Sections 743 through 748 [59A-41-51 to 59A-41-56 NMSA 1978] of this article, unless a greater monetary or other applicable penalty is provided by other law, is upon conviction thereof guilty of a misdemeanor punishable by a fine not to exceed five hundred dollars ($500).
History:
Laws 1984, ch. 127, § 749.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 42 - Life and Health Insurance Guaranty Association › Section 59A-42-1 - Short title.

Chapter 59A, Article 42 NMSA 1978 may be cited as the "Life and Health Insurance Guaranty Association Act".
History:
Laws 1984, ch. 127, § 750; 2012, ch. 9, § 4.
ANNOTATIONS
The 2012 amendment,
effective July 1, 2012, deleted "This Article" and added "Chapter 59A, Article 42 NMSA 1978"; and after "Insurance Guaranty", deleted "Law" and added "Association Act".
Am. Jur. 2d, A.L.R. and C.J.S. references. —
43 Am. Jur. 2d Insurance §§ 1, 9, 103, 173; 44 Am. Jur. 2d Insurance §§ 1653, 2038.
44 C.J.S. Insurance §§ 111, 126.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 42 - Life and Health Insurance Guaranty Association › Section 59A-42-2 - Purpose.

The purpose of the Life and Health Insurance Guaranty Association Act is to provide a mechanism to facilitate continuation of coverage and the payment of covered claims under certain insurance policies, to avoid excessive delay in payment and avoid financial loss to claimants or policyholders because of insolvency of an insurer, to assist in detection and prevention of insurer insolvencies and to provide an association to assess the cost of such protection among insurers.
History:
Laws 1984, ch. 127, § 751; 2012, ch. 9, § 5.
ANNOTATIONS
The 2012 amendment,
effective July 1, 2012, after "The purpose of", deleted "this article" and added "the Life and Health Insurance Guaranty Association Act".
Temporary provisions.
Laws 2012, ch. 9, § 21, provided that:
A. The accounts maintained pursuant to the Life and Health Insurance Guaranty Law and in effect on July 1, 2012 shall continue in full force as the accounts maintained pursuant to the Life and Health Insurance Guaranty Association Act, modified as necessary to comply with that act.
B. The life insurance guaranty association existing pursuant to the Life and Health Insurance Guaranty Law on July 1, 2012 is the life and health insurance guaranty association organized pursuant to the Life and Health Insurance Guaranty Association Act, subject to the provisions of that act.
C. The insurer members of the board of directors of the life insurance guaranty association serving pursuant to the Life and Health Insurance Guaranty Law on July 1, 2012 shall serve as the insurer members of the board of directors of the life and health insurance guaranty association pursuant to the provisions of the Life and Health Insurance Guaranty Association Act.
D. The plan of operation in effect pursuant to the Life and Health Insurance Guaranty Law on July 1, 2012 shall serve as the plan of operation required pursuant to the Life and Health Insurance Guaranty Association Act, modified as necessary to comply with that act.
E. An action, including an assessment, or an obligation of the life insurance guaranty association, board of directors of the life insurance guaranty association or superintendent of insurance initiated or created but not completed pursuant to the Life and Health Insurance Guaranty Law prior to July 1, 2012, shall continue until completed pursuant to the provisions of the Life and Health Insurance Guaranty Law.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 42 - Life and Health Insurance Guaranty Association › Section 59A-42-5 - Organization of association; participation.

A. All insurers shall organize and remain members of the association as a condition of their authority to transact insurance business covered by Section 59A-42-4 NMSA 1978. The association may take any appropriate form of legal entity available under the laws of this state and approved by the superintendent. The association shall perform its functions under the plan of operation established and approved pursuant to Section 59A-42-9 NMSA 1978 and shall exercise its powers through the board. For purposes of assessment and administration, the association shall maintain two accounts:
(1) the life insurance and annuity account, which includes the following subaccounts:
(a) a life insurance account;
(b) an annuity account, which includes annuity contracts owned by a governmental retirement benefit plan, or its trustee, established pursuant to Section 401, 403(b) or 457 of the federal Internal Revenue Code of 1986, but otherwise excludes unallocated annuities; and
(c) an unallocated annuity account, which excludes contracts owned by a governmental retirement benefit plan, or its trustee, established pursuant to Section 401, 403(b) or 457 of the federal Internal Revenue Code of 1986; and
(2) the health insurance account.
B. The association shall be supervised by the superintendent and shall be subject to the applicable provisions of the insurance laws of New Mexico. Meetings or records of the association may be opened to the public upon majority vote of the board of the association.
History:
Laws 1984, ch. 127, § 754; 2012, ch. 9, § 8.
ANNOTATIONS
Cross references.
— For Sections 401, 403(b) and 457 of the federal Internal Revenue Code of 1986,
see
26 U.S.C.§§ 401, 403(b) and 457, respectively.
The 2012 amendment,
effective July 1, 2012, created the accounts of the association; provided for the supervision of the association; provided for the opening of meetings and records to the public; in Subsection A, in the third sentence, after "approved pursuant to", deleted "this article" and added "Section 59A-42-9 NMSA 1978"; and in the fourth sentence, after "shall maintain", deleted "three (3)" and added "two"; after "accounts", deleted "A. the health insurance account", "B. the life insurance account; and", and "C. the annuity account" and added Paragraph (1), including Subparagraphs (a) through (c), and Paragraph (2); and added Subsection B.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 42 - Life and Health Insurance Guaranty Association › Section 59A-42-6 - Board of directors.

A. The board of directors of the association shall consist of not less than five nor more than nine member insurers serving terms as established in the plan of operation. The insurer members of the board shall be selected by member insurers subject to the approval of the superintendent. In addition, two persons who are public representatives shall be appointed by the superintendent to the board. A public representative shall not be an officer, director or employee of an insurance company or a person engaged in the business of insurance. Vacancies on the board shall be filled for the remaining period of the term by a majority vote of the remaining board members for member insurers, subject to approval of the superintendent, and by the superintendent for public representatives.
B. In approving insurer member selections, the superintendent shall consider among other things whether all member insurers are fairly represented.
C. Members of the board may be reimbursed from the assets of the association for reasonable and necessary expenses incurred by them as members of the board, but the amount of that reimbursement shall not exceed the guidelines provided by the approved plan of operation.
History:
Laws 1984, ch. 127, § 755; 1993, ch. 320, § 100; 2012, ch. 9, § 9.
ANNOTATIONS
The 2012 amendment,
effective July 1, 2012, required the appointment of two public members of the board of directors, one of whom must be associated with an insurance company or engaged in the insurance business; in Subsection A, in the first sentence, after "nor more than nine", deleted "persons" and added "member insurers", in the second sentence, after "The", added "insurer", added the third and fourth sentences, in the fifth sentence, after "remaining board members", added "for member insurers", and after "approval of the superintendent", added the remainder of the sentence; and in Subsection B, after "In approving", added "insurer member".
The 1993 amendment,
effective June 18, 1993, in Subsection A, made stylistic changes in the first sentence, and inserted "board" preceding "members" in the second sentence; and, in Subsection C, substituted "approved plan of operation" for "Per Diem and Mileage Act (10-8-1 to 10-8-7 NMSA 1978)".
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 42 - Life and Health Insurance Guaranty Association › Section 59A-42-10 - Duties and powers of the superintendent.

A. The superintendent shall:
(1) notify the association of the existence of an insolvent insurer not later than three days after the superintendent receives notice of the determination of the insolvency;
(2) upon request of the board, provide the association with a statement of the premiums in this or another state of each member insurer; and
(3) when an impairment is declared and the amount of the impairment is determined, serve a demand upon the impaired insurer to make good the impairment within a reasonable time. Notice to the impaired insurer shall constitute notice to its shareholders, if any. The failure of the insurer to promptly comply with the demand shall not excuse the association from the performance of its powers and duties pursuant to the Life and Health Insurance Guaranty Association Act.
B. The superintendent may:
(1) suspend or revoke, after notice and hearing, the certificate of authority to transact insurance in this state of a member insurer that fails to pay an assessment when due or that fails to comply with the plan of operation. As an alternative, the superintendent may levy a fine on a member insurer that fails to pay an assessment when due. The fine shall not exceed five percent of the unpaid assessment a month, except that no fine shall be less than one hundred dollars ($l00) a month; and
(2) revoke the designation of a servicing facility if the superintendent finds that claims are being handled unsatisfactorily.
History:
Laws 1984, ch. 127, § 759; 2012, ch. 9, § 13.
ANNOTATIONS
The 2012 amendment,
effective July 1, 2012, permitted the superintendent to give notice to an impaired insurer requiring the insurer to cure the impairment; eliminated the superintendent's authority to require the association give notice of a determination of insolvency to interested parties; in Subsection A, in Paragraph (2), after "a statement of the", deleted "net direct written" and after "premiums", added "in this or another state", and added Paragraph (3); and in Subsection B, deleted former Paragraph (1), which authorized the superintendent to require the association to notify insureds of an insolvent insurer and other interested parties of the determination of insolvency and their rights by mail or newspaper publication.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 42 - Life and Health Insurance Guaranty Association › Section 59A-42-12 - Appeals.

A. A member insurer may appeal to the superintendent from an action of the board by filing with the superintendent a notice of appeal within thirty days after that action.
B. A final order of the superintendent on appeal is subject to judicial review by an action in the district court pursuant to the provisions of Section 39-3-1.1 NMSA 1978.
History:
Laws 1984, ch. 127, § 761; 1998, ch. 55, § 66; 1999, ch. 265, § 69; 2012, ch. 9, § 15.
ANNOTATIONS
Cross references.
— For procedures governing administrative appeals to the district court,
see
Rule 1-074 NMRA.
Compiler's notes.
— For scope of review of the district court,
see
Zamora v. Village of Ruidoso Downs, 120 N.M. 778, 907 P.2d 182 (1995).
The 2012 amendment,
effective July 1, 2012, in Subsection A, after "board", deleted "of directors of the association" and after "thirty days after", changed "the action appealed from" to "that action", and made minor stylistic changes.
The 1999 amendment,
effective July 1, 1999, substituted "Section 39-3-1.1" for "Section 12-8A-1" in Subsection B.
The 1998 amendment,
effective September 1, 1998, in Subsection A, deleted "(30)" following "thirty"; rewrote Subsection B, and made minor stylistic changes throughout the section.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 42 - Life and Health Insurance Guaranty Association › Section 59A-42-14 - Examination of association; annual report.

The association is subject to examination and regulation by the superintendent. The board shall submit to the superintendent, not later than May 1 each year, a financial report for the preceding calendar year in form approved by the superintendent and a report of its activities during the preceding calendar year. Upon the request of a member insurer, the association shall provide the member insurer with a copy of the report.
History:
Laws 1984, ch. 127, § 763; 2012, ch. 9, § 17.
ANNOTATIONS
The 2012 amendment,
effective July 1, 2012, permitted member insurers to request a copy of the annual report and added the last sentence.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 42 - Life and Health Insurance Guaranty Association › Section 59A-42-15 - Immunity.

There shall be no liability on the part of, and no cause of action shall arise against, a member insurer or its agents or employees, the association or its agents or employees, members of the board or the superintendent or the superintendent's representatives for an act or omission by them in the performance of their powers and duties pursuant to the Life and Health Insurance Guaranty Association Act. This immunity shall extend to the participation in an organization of one or more other state associations with similar purposes and to that organization and its agents or employees.
History:
Laws 1984, ch. 127, § 764; 2012, ch. 9, § 18.
ANNOTATIONS
The 2012 amendment,
effective July 1, 2012, extended the immunity from liability to participation in other state organizations and to those other state organizations and their agents and employees; in the first sentence, after "the superintendent's representatives for", deleted "any action taken" and added "an act or omission", and after "their powers and duties", deleted "under this article", added the reminder of the sentence and added the last sentence.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 42 - Life and Health Insurance Guaranty Association › Section 59A-42-16 - Stay of proceedings; reopening default judgments.

A proceeding in which an insolvent insurer is a party in a court in this state shall be stayed one hundred eighty days from the date an order of liquidation, rehabilitation or conservation is final to permit proper legal action by the association on matters germane to its powers or duties. As to a judgment under a decision, order, verdict or finding based on default, the association may apply to have the judgment set aside by the same court that made the judgment and shall be permitted to defend against the suit on the merits.
History:
Laws 1984, ch. 127, § 765; 2012, ch. 9, § 19.
ANNOTATIONS
The 2012 amendment,
effective July 1, 2012, expanded the time period of the stay and in the first sentence, after "shall be stayed", deleted "sixty (60)" and added "one hundred eighty".
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 42A - Provider Service Networks › Section 59A-42A-1 - Short title.

Sections 1 through 10 [59A-42A-1 to 59A-42A-9 NMSA 1978] of this act may be cited as the "Provider Service Network Act".
History:
Laws 1997, ch. 107, § 1.
ANNOTATIONS
Compiler's notes.
— There is no Section 10 of this article; Section 10 of Laws 1997, ch. 107 enacted new 59A-5-11.1 NMSA 1978.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 42A - Provider Service Networks › Section 59A-42A-2 - Definitions.

As used in the Provider Service Network Act:
A. "association" means the provider service network guaranty association;
B. "board" means the provider service network guaranty board;
C. "health care facility" means an institution providing health care services, including a hospital or other licensed inpatient center, an ambulatory surgical or treatment center, a skilled nursing center, a residential treatment center, a home health agency, a diagnostic, laboratory or imaging center and a rehabilitation or other therapeutic health setting;
D. "health care insurer" means a person that has a valid certificate of authority in good standing under the New Mexico Insurance Code to act as an insurer, health maintenance organization, nonprofit health care plan or prepaid dental plan;
E. "health care professional" means a physician or other health care practitioner, including a pharmacist, who is licensed, certified or otherwise authorized by the state to provide health care services consistent with state law;
F. "health care services" includes physical health services or community-based mental health or developmental disability services, including services for developmental delay;
G. "person" means an individual or other legal entity;
H. "provider" means a person that is licensed or otherwise authorized by the state to furnish health care services, including health care professionals and health care facilities; and
I. "provider service network" means two or more providers affiliated for the purpose of providing health care services on a capitated or similar prepaid, flat-fee basis.
History:
Laws 1997, ch. 107, § 2.
ANNOTATIONS
Cross references.
— For the Insurance Code,
see
59A-1-1 NMSA 1978 and notes thereto.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 42A - Provider Service Networks › Section 59A-42A-3 - Provider service networks; insurance code applicability.

A. Except as provided otherwise in this section, a provider service network shall obtain and maintain a certificate of authority under the New Mexico Insurance Code.
B. A provider service network is not required to obtain or maintain a certificate of authority in connection with health care coverage for which the risk of loss is directly and fully underwritten by a health care insurer, subject to any applicable deductible, coinsurance or copayment provisions.
C. A provider service network that obtains and maintains a certificate of authority as a health care insurer may contract directly with government agencies to provide goods and services to persons receiving public assistance, including medicare and medicaid.
D. A provider service network that does not obtain or maintain a certificate of authority as a health care insurer may contract in appropriate circumstances, including membership and participation in the association, directly with government agencies to provide goods and services to persons receiving public assistance, including medicare and medicaid. The contract shall incorporate and be subject to specific financial, quality-of-service and consumer-protection standards that the contracting agency shall specify by regulation.
E. This section does not abrogate any other New Mexico Insurance Code requirements that may be applicable to provider service networks, including requirements relating to third-party administrators and examinations. This section does not bar or restrict the right of a provider service network to obtain and maintain a certificate of authority.
History:
Laws 1997, ch. 107, § 3.
ANNOTATIONS
Cross references.
— For the Insurance Code,
see
59A-1-1 NMSA 1978 and notes thereto.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 42A - Provider Service Networks › Section 59A-42A-5 - Plan of operation.

A. The board shall submit to the superintendent of insurance for approval a plan of operation and any subsequent amendments necessary or suitable to assure proper and fair operation of the association.
B. After notice and hearing, the superintendent of insurance shall approve or disapprove the plan of operation or any subsequent amendments. The superintendent shall approve the plan or an amendment only if he finds that it provides for administering the association on a fair, reasonable and equitable basis and for sharing the association's losses on an equitable basis. The plan of operation or amendment shall become effective upon the superintendent's written approval.
C. If the board fails to submit a plan of operation satisfactory to the superintendent of insurance within ninety days after the initial board is appointed or fails in a timely manner to submit any amendment the superintendent deems necessary at any time thereafter, the superintendent shall adopt and promulgate such plan of operation or amendment by rule. Any such rule shall continue in force until the superintendent modifies it or approves a plan of operation or an amendment submitted by the board that he deems to supersede the rule.
D. The plan of operation submitted to the superintendent of insurance shall:
(1) establish procedures for handling and accounting of the association's money, other assets and property;
(2) provide for payment of claims or provision of alternative health care services to public assistance recipients;
(3) establish regular times and places for board meetings;
(4) establish procedures for records to be kept of all financial transactions and for annual fiscal reporting to the superintendent;
(5) establish procedures for the determination and collection of assessments from members to pay claims or to provide alternative health care services and administrative expenses incurred or estimated to be incurred during the period for which the assessment is made;
(6) establish penalties for nonpayment or late payment of assessments; and
(7) contain any additional provisions necessary and proper for the execution of the association's powers and duties.
History:
Laws 1997, ch. 107, § 5.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 42A - Provider Service Networks › Section 59A-42A-6 - Board; powers and duties.

The board has the power and authority to:
A. enter into contracts necessary or proper to carry out the provisions and purposes of the Provider Service Network Act, including contracts with independent contractors for the performance of the association's administrative functions;
B. sue or be sued;
C. determine and pay the association's obligations, including its obligation to pay claims or to provide alternative health care services to public assistance recipients on behalf of an insolvent or financially troubled provider service network;
D. borrow money to satisfy the association's obligations;
E. assess association members in accordance with the provisions of the Provider Service Network Act and make initial and interim assessments as may be reasonable and necessary for organizational or interim operating expenses. Interim expense assessments shall be credited as offsets against any regular assessments due following the close of the calendar year;
F. recoup expenditures on behalf of an insolvent or financially troubled provider service network from that provider service network or any other available source, including a governmental agency, and be subrogated to that provider service network's rights to payment to the extent of such expenditures;
G. employ or contract with appropriate legal, actuarial, clerical and other personnel as necessary to provide assistance in the operation of the association;
H. conduct periodic audits to assure the general accuracy of the financial data submitted to the association. The board shall cause the association to undergo an annual audit on a calendar-year basis of its financial records and operations by an independent certified public accountant;
I. take all other actions, whether like or unlike the foregoing, necessary or appropriate to carry out the board's or the association's duties;
J. reinsure any or all of the risk of the association; and
K. assess each original and new provider service network an initial administrative fee of five thousand dollars ($5,000) times the number of providers in the provider service network. If a provider service network adds new members to increase the number of providers, then that provider service network shall pay an additional administrative fee of five thousand dollars ($5,000) for each additional provider. An employee of a provider shall not be used in computing the administrative fee due under this subsection.
History:
Laws 1997, ch. 107, § 6.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 42A - Provider Service Networks › Section 59A-42A-7 - Examination; annual statement.

A. The association is subject to and responsible to pay the cost of examination by the superintendent on a periodic basis, pursuant to Chapter 59A, Article 4 NMSA 1978.
B. Not later than March 1 of each year, the board shall submit to the superintendent an annual statement in accordance with the requirements of Section 59A-5-29 NMSA 1978 and a risk-based capital report in accordance with the requirements of Section 59A-5A-3 NMSA 1978.
History:
Laws 1997, ch. 107, § 7; 2014, ch. 59, § 50.
ANNOTATIONS
The 2014 amendment,
effective July 1, 2014, required the provider service network guarantee board to submit annual statements and risk-based capital reports to the superintendent; and in Subsection B, after "submit to the superintendent an", deleted "audited financial report for the preceding calendar year in a form approved by the superintendent" and added the remainder of the sentence.
Severability.
— Laws 2014, ch. 59, § 54 provided that if any part or application of the provisions of Laws 2014, ch. 59 is held invalid, the remainder or its application to other situations or persons shall not be affected.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 42A - Provider Service Networks › Section 59A-42A-8 - Assessments; fund created.

A. The "provider service network guarantee fund" is created in the state treasury. The fund shall be administered by the board and money in the fund is appropriated to the board to carry out the provisions of the Provider Service Network Act. Money in the fund shall be invested by the state treasurer as other state funds are invested; provided that interest on the fund shall be credited to the fund. Any unexpended or unencumbered balance remaining in the fund at the end of any fiscal year shall not revert.
B. The secretary of human services shall report to the board within thirty days of the close of each calendar quarter the amounts paid each member for services to public assistance recipients during that calendar quarter.
C. The proportion of participation of each member shall be determined annually by the board based on the secretary of human services' report, together with members' annual statements and other reports deemed necessary by the board.
D. The assessment for each member shall be determined by multiplying the member's income from services to public assistance recipients pursuant to Subsection D of Section 3 [59A-42A-3 NMSA 1978] of the Provider Service Network Act for the preceding calendar quarter by a percentage set by the board not to exceed five percent.
E. The board shall notify each member of the amount of the assessment within forty-five days of the close of a calendar quarter. The member shall pay the assessment within sixty days of the close of a calendar quarter.
F. The board may abate or defer, in whole or in part, the assessment of a member if, in the opinion of the board, payment of the assessment would endanger the ability of the member to fulfill its contractual obligations. In the event an assessment against a member is abated or deferred in whole or in part, the amount by which such assessment is abated or deferred may be assessed against the other members in a manner consistent with the basis for assessments set forth in Subsection A of this section. The member receiving the abatement or deferment shall remain liable to the association for the deficiency for four years.
G. If assessments exceed actual expenses in any year, the excess shall be held at interest and used by the board to offset future expenses. Any deficit incurred shall be recouped by assessments apportioned among the association's members pursuant to the assessment formula provided by Subsection D of this section.
H. If it appears that the maximum assessment available, together with unencumbered money and other assets, will be insufficient in any year to make all necessary payments, the association's obligations shall be paid pro rata. The unpaid portion shall be paid as soon as additional assessment proceeds or other assets become available. Notwithstanding the foregoing, the association may pay its obligations in any order it deems reasonable.
History:
Laws 1997, ch. 107, § 8.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 42A - Provider Service Networks › Section 59A-42A-9 - Notification to pay claims or provide services.

A. The association shall be liable to pay claims or to provide alternative health care services for insolvent or financially troubled members who are not fulfilling obligations to provide such services to public assistance recipients under contracts pursuant to Subsection D of Section 3 [59A-42A-3 NMSA 1978] of the Provider Service Network Act. The association's obligation shall commence on the date the secretary of human services gives the association notice that a member is failing, because of insolvency or financial difficulties, to provide some or all of such services.
B. Nothing [in] the Provider Service Network Act shall be deemed to authorize or obligate the association to pay or otherwise assume any obligation of a provider service network prior to the date of notification, or any obligation thereafter other than the obligation to provide services to public assistance recipients under a contract pursuant to Subsection D of Section 3 of the Provider Service Network Act. In no event shall the association be liable to the creditors of a provider service network.
History:
Laws 1997, ch. 107, § 9.
ANNOTATIONS
Bracketed material.
— The bracketed material was inserted by the compiler and it is not part of the law.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 43 - Property and Casualty Insurance Guaranty Fund › Section 59A-43-1 - Short title.

This article [Chapter 59A, Article 43 NMSA 1978] may be cited as the "Property and Casualty Insurance Guaranty Law".
History:
Laws 1984, ch. 127, § 767.
ANNOTATIONS
Compiler's notes.
— Laws 1984, ch. 127, § 785, provided that this article shall be liberally construed to carry out its purposes.
Am. Jur. 2d, A.L.R. and C.J.S. references. —
43 Am. Jur. 2d Insurance § 103.
Products liability insurance coverage as extending only to product-caused injury to person or other property, as distinguished from mere product failure, 91 A.L.R.3d 921.
Running of statute of limitations on products liability claim against manufacturer as affected by plaintiff's lack of knowledge of defect allegedly causing personal injury or disease, 91 A.L.R.3d 991.
Property damage insurance: what constitutes "contamination" within policy clause excluding coverage, 72 A.L.R.4th 633.
Products liability of endorser, trade association, certifier, or similar party who expresses approval of product, 1 A.L.R.5th 431.
Liability policy coverage for insured's injury to third party's investments, anticipated profits, goodwill, or the like, unaccompanied by physical property damage, 18 A.L.R.5th 187.
44 C.J.S. Insurance §§ 111, 126.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 43 - Property and Casualty Insurance Guaranty Fund › Section 59A-43-2 - Purpose.

The purpose of this article is to provide a mechanism for payment of covered claims under certain insurance policies to avoid excessive delay in payment and financial loss to claimants or policyholders because of insolvency of an insurer, to assist in detection and prevention of insurer insolvencies and provide an association to assess the cost of such protection among insurers.
History:
Laws 1984, ch. 127, § 768.
ANNOTATIONS
Am. Jur. 2d, A.L.R. and C.J.S. references. —
6 Am. Jur. 2d Associations and Clubs § 2.
7 C.J.S. Associations § 1.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 43 - Property and Casualty Insurance Guaranty Fund › Section 59A-43-3 - Scope.

A. This article applies to all kinds of direct insurance except life, health, annuities, title guaranty, surety (other than fidelity), credit, mortgage guaranty, ocean marine, surplus line and other coverages written by insurers other than authorized insurers or written by Mexican casualty insurers pursuant to Article 40 [Chapter 59A, Article 40 NMSA 1978] of the Insurance Code.
B. This article also does not apply as to motor club coverages or services nor as to any coverage issued by any person not organized under laws providing expressly for formation of insurers nor engaged in business as such an insurer.
History:
Laws 1984, ch. 127, § 769.
ANNOTATIONS
Self-insured employer claiming against insolvent insurer.
— A self-insured employer who has a claim against an insolvent insurer may qualify such claim as a covered claim within the scope of this article.
In re Mission Ins. Co.
, 1991-NMSC-080, 112 N.M. 433, 816 P.2d 502.
Excess workers' compensation insurance policies
are not reinsurance policies or indemnity policies excluded from the Property and Casualty Insurance Guaranty Law (this article).
In re Mission Ins. Co.
, 1991-NMSC-080, 112 N.M. 433, 816 P.2d 502.
Excess workers' compensation policies are not excepted from coverage under 59A-43-4C NMSA 1978.
In re Mission Ins. Co.
, 1991-NMSC-080, 112 N.M. 433, 816 P.2d 502.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 43 - Property and Casualty Insurance Guaranty Fund › Section 59A-43-5 - Organization of association.

All member insurers shall remain members of the association as a condition of their authority to transact insurance in this state. The association may take any appropriate form of legal entity available under the laws of this state and approved by the superintendent. For purposes of administration and assessment, the association shall be divided into three (3) separate accounts:
A. the workmen's compensation insurance account;
B. the automobile insurance account; and
C. the account for all other insurance to which this article applies.
History:
Laws 1984, ch. 127, § 771.
ANNOTATIONS
Am. Jur. 2d, A.L.R. and C.J.S. references. —
43 Am. Jur. 2d Insurance § 52.
44 C.J.S. Insurance § 15 et seq.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 43 - Property and Casualty Insurance Guaranty Fund › Section 59A-43-6 - Board of directors.

A. The board of directors of the association shall consist of not less than five (5) nor more than nine (9) persons serving terms as established in the plan of operation. The members of the board shall be selected by member insurers subject to the approval of the superintendent. Vacancies on the board shall be filled for the remaining period of the term by a majority vote of the remaining board members, subject to the approval of the superintendent.
B. In approving selections to the board, the superintendent shall consider among other things whether all member insurers are fairly represented.
C. Members of the board of directors may be reimbursed from the assets of the association for expenses incurred by them as members of the board of directors.
History:
Laws 1984, ch. 127, § 772.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 43 - Property and Casualty Insurance Guaranty Fund › Section 59A-43-8 - Plan of operation.

A. The association shall submit to the superintendent a plan of operation and any amendments thereto necessary or suitable to assure the fair, reasonable and equitable administration of the association. The plan of operation and any amendments thereto shall become effective upon approval in writing by the superintendent. If at any time the association fails to submit suitable amendments to the plan, the superintendent shall, after notice and hearing, adopt rules necessary or advisable to effectuate the provisions of this article. The rules shall continue in force until modified by the superintendent or superseded by a plan or amendments submitted by the association and approved by the superintendent.
B. All member insurers shall comply with the plan of operation.
C. The plan of operation, among other things, shall establish all procedures for conducting the business of the association, for handling its assets, for receiving claims, for keeping records and for the conduct of other activities necessary for execution of the powers and duties of the association.
D. The plan of operation may provide that any or all powers and duties of the association, except those under Paragraph (3) of Subsection A and Paragraph (2) of Subsection B of Section 773 [59A-43-7 NMSA 1978] of this article, are delegated to a corporation, association or other organization which performs or will perform functions similar to those of the association, or its equivalent, in two (2) or more states. Such a corporation, association or organization shall be reimbursed as a servicing facility would be reimbursed and shall be paid for its performance of any other functions of the association. A delegation under this subsection shall take effect only with the approval of both the board of directors and the superintendent, and may be made only to a corporation, association or organization which extends protection not substantially less favorable and effective than that provided by this article.
History:
Laws 1984, ch. 127, § 774.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 43 - Property and Casualty Insurance Guaranty Fund › Section 59A-43-9 - Duties and powers of superintendent.

A. The superintendent shall:
(1) serve on the association a copy of any complaint seeking an order of liquidation with a finding of insolvency against a member insurer at the same time that such complaint is filed with a court of competent jurisdiction;
(2) notify the association of the existence of an insolvent insurer not later than three (3) days after he receives notice of the determination of the insolvency; and
(3) upon request of the board of directors, provide the association with a statement of the net direct written premiums of each member insurer.
B. The superintendent may:
(1) require that the association, and agents of the insurer in New Mexico as to policyholders of the insurer in this state, notify the insureds of the insolvent insurer and any other interested parties of the determination of insolvency and of their rights under this article. Such notification shall be by mail at their last known address, where available, but if sufficient information for notification by mail is not available, notice by publication in a newspaper of general circulation shall be sufficient;
(2) suspend or revoke, after notice and hearing, the certificate of authority to transact insurance in this state of any member insurer which fails to pay an assessment when due or fails to comply with the plan of operation. As an alternative, the superintendent may levy a civil penalty on any member insurer which fails to pay an assessment when due. The civil penalty shall not exceed five percent of the unpaid assessment per month, except that no civil penalty shall be less than one hundred dollars ($100) a month; and
(3) revoke the designation of any servicing facility if he finds claims are being handled unsatisfactorily.
History:
Laws 1984, ch. 127, § 775.
ANNOTATIONS
Am. Jur. 2d, A.L.R. and C.J.S. references. —
43 Am. Jur. 2d Insurance § 52.
44 C.J.S. Insurance § 15 et seq.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 43 - Property and Casualty Insurance Guaranty Fund › Section 59A-43-10 - Effect of paid claims.

A. Any person recovering under Chapter 59A, Article 43 NMSA 1978 shall be deemed to have assigned his rights under the policy to the association to the extent of his recovery from the association. Every insured or claimant seeking the protection of that article shall cooperate with the association to the same extent as he would have been required to cooperate with the insolvent insurer. The association shall have no cause of action against the insured of the insolvent insurer for any sums it has paid out except such causes of action as the insolvent insurer would have had if such sums had been paid by the insolvent insurer. In the case of an insolvent insurer operating on a plan with assessment liability, payments of claims of the association do not operate to reduce the liability of the insured to the receiver, liquidator or statutory successor for unpaid assessments.
B. The receiver, liquidator or statutory successor of an insolvent insurer is bound by settlements of covered claims by the association or a similar organization in another state. The association may make application to the court for reimbursement of such claims and expenses and upon proper application the court shall order appropriate disbursements to be made in accordance with the provisions of Chapter 59A, Article 41 NMSA 1978 in effect at the time the application is acted upon by the court.
C. The association shall, within the time set by the receivership court, file with the receiver or liquidator of the insolvent insurer, statements of the covered claims paid by the association and estimates of anticipated claims on the association.
History:
Laws 1984, ch. 127, § 776; 1993, ch. 320, § 101.
ANNOTATIONS
The 1993 amendment,
effective June 18, 1993, in Subsection A, substituted "Chapter 59A, Article 43 NMSA 1978" for "this article" and made a stylistic change; and in Subsection B, deleted the former second sentence, relating to the priority of claims and expenses of the association in another state, and added the language beginning "in accordance with" at the end of the subsection.
Am. Jur. 2d, A.L.R. and C.J.S. references. —
44 Am. Jur. 2d Insurance § 1820.