2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 11 - The Insurance Contract (§§ 1101 — 1137) › § 1111 - Approval of forms

(1) No person shall issue, deliver or use any basic insurance policy form or application form where a written application is required or printed rider or endorsement form, unless previously filed before and approved by the Commissioner. In order to achieve the greatest uniformity possible in the approval of policy forms, the Commissioner shall take into consideration the recommendations of the National Association of Insurance Commissioners.
This requirement shall not apply to the following:
(a) Bond forms.— Notwithstanding the above, the Commissioner, through regulations adopted pursuant to this title, may require that a specific bond form be filed for his/her consideration and approval when the public interest so warrants.
(b) Policies, printed riders or endorsements that are exclusive by nature, designed and used in connection with insurance for a risk in particular, or which refer to the method whereby benefits are to be distributed or to the reserve of rights and benefits in conformance with life and disability insurance policies, and are used at the request of the holder of the particular policy, contract or certificate.
(c) Wireless communications equipment policies, which shall mean policies which provide insurance coverage for wireless communications equipment, issued to vendors of this equipment as master or group policies under which consumers may be designated as certificate holders or additional insured parties. As used in this clause, “wireless communications equipment” shall mean all wireless earpieces, beepers, personal digital assistants, wireless telephones or wireless telephone batteries, and other related wireless devices and accessories used to access wireless communications services, including wireless services.
These wireless communications equipment policies and related forms do not have to be submitted to the Insurance Commissioner for his/her approval, nor comply with the rate filing obligations imposed under § 1205 of this title, provided the rates are established pursuant to an adequate rates plan, appear in the insurer’s records and meet the following requirements:
(i) The insurer shall submit the policy form before the Commissioner for informational purposes only. This policy form shall be accompanied by certification by an authorized officer of the insurer attesting to the compliance with that which is provided herein concerning the wireless communications equipment policies.
(ii) An insurer shall neither terminate nor modify in any way the terms and conditions of a wireless communications equipment policy, except when previous notice is given to the policyholders, additional insured parties and certificate holders thus affected. This notice shall be made in writing and given at least sixty (60) days in advance of the termination or modification of the terms and conditions of the policy. If the insurer were to modify the terms and conditions, the insurer shall be under the obligation to provide the master or group policyholder with a revised policy or an endorsement, and to provide each additional insured party or certificate holder with a revised certificate or an endorsement, an updated brochure or facsimile thereof and an explanation of the modifications made.
(iii) Notwithstanding the provisions of paragaph (i) of this clause, an insurer may terminate coverage, provided notice is given to the policyholders, additional insured parties and certificate holders thus affected, at least fifteen (15) days in advance, on the following grounds:
(I) Default in the payment of the premium, or
(II) having incurred fraud or misrepresentation of material information when applying for and obtaining coverage or when presenting a claim thereunder.
(iv) Notwithstanding the provisions of paragraph (i) of this clause, an insurer may immediately and automatically terminate the coverage of a certificate holder or additional insured party who:
(I) Ceases or cancels the active communications service with the vendor of wireless communications equipment, or
(II) exhausts the aggregate liability limit, if any, and the insurer remits a termination notice to the policyholder, certificate holder or additional insured party thus affected within fifteen (15) work days following exhaustion of the limit.
However, if notice is not sent within the term hereby established, coverage shall continue despite the aggregate liability limit, until the insurer remits notice of termination to the policyholder, certificate holder or additional insured party thus affected.
(v) Notwithstanding the provisions of paragraph (iii)(II) of this clause, at the request of a policyholder, a certificate holder or an additional insured party thus affected, coverage under the policy shall be eligible for reinstatement for a term not greater than twelve (12) months following the date on which the coverage limit was exhausted under policy terms and subject to the registration criteria at the time and which are generally applicable to policyholders, certificate holders and additional insured parties.
(vi) If the policyholder were to terminate the policy, he/she shall remit or deliver a written notice to each additional insured party or coverage certificate holder, advising them as to the termination of the policy and providing the date on which the same shall become effective. The written notice shall be remitted or delivered to each additional insured party or certificate holder at least thirty (30) days in advance of the date of termination.
(vii) The certificate holder or additional insured party shall be entitled to terminate the policy within a term of thirty (30) days of having acquired the same and to a refund of the premium, provided he/she has made no claims during said period.
(2) Every such filing shall be made not less than sixty days in advance of any such issuance, delivery, or use. At the expiration of such sixty days the form so filed shall be deemed approved unless prior thereto it has been affirmatively approved or disapproved by order of the Commissioner. The Commissioner may extend by not more than an additional sixty days the period within which he may affirmatively approve or disapprove any such form, by giving notice of such extension before expiration of the initial sixty-day period. At the expiration of any such period as so extended, and in the absence of such prior affirmative approval or disapproval, any such form shall be deemed approved. Approval of a form by the Commissioner shall constitute a waiver of the unexpired portion of the waiting period. The Commissioner may for cause, after a hearing, withdraw a previous approval.
(3) The Commissioner’s order disapproving a form or withdrawing a previous approval shall state the grounds therefor.
(4) No person shall knowingly issue or deliver any such form as to which the Commissioner’s approval does not then exist.
(5) The Commissioner may exempt from the requirements of this section, for the time he/she deems convenient, any insurance document or form or type thereof, as specified in said order, to which, in his/her opinion, this section cannot be practicably applied, or the filing and approval of which are not, in his/her opinion, desirable or necessary to protect the public.
Likewise, the Commissioner may exempt from the requirements of this section, any policy form or document related to those referred to in the preceding subsection (1), if said form or document has been approved by the home state of the insurer that intends to use it, or by a federal regulatory agency, and if said form or document contains the uniform clauses required by this Code.
(6) This section shall apply also to any form used by domestic insurers for delivery in a jurisdiction outside Puerto Rico, if the insurance supervisory official of such jurisdiction informs the Commissioner that such form is not subject to approval or disapproval by such official, and upon the Commissioner’s order requiring the form to be submitted to him for the purpose. The applicable same standards shall apply to such forms as apply to forms for use in Puerto Rico.
History —Ins. Code § 11.110; July 23, 1974, No. 133, Part 1, p. 598, § 3; Sept. 6, 2000, No. 382, § 8; Aug. 9, 2008, No. 232, § 1.