Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 123.00 - Direct Payment Of Motor Vehicle Collision And Comprehensive Coverage Claims And Referral Repair Shop Programs › Section 123.04 - Procedure for Approval of Plans

Current through Register 1525, July 5, 2024
(1)
Who May File
: Any insurer may file a direct payment
			 plan for approval by the Commissioner. Any licensed insurance rating
			 organization may file a direct payment plan on behalf of its members ("industry
			 plan"), provided that each insurer member of the rating organization which
			 intends to implement such plan shall individually file notice of its intention
			 to adopt the industry plan before actively implementing the plan. Any insurer
			 may file for approval a plan which adopts some provisions of an industry plan
			 without adopting the entire plan, but to the extent such individual plan
			 deviates from the industry plan by omitting, adding or changing any particular
			 provision, it shall require separate approval by the Commissioner. Any insurer
			 filing a plan which deviates from an industry plan shall specify in detail the
			 differences between the plans.
(2)
Time for Filing
: Any plan which is intended to be
			 effective on January 1, 1989, shall be filed on or before December 15, 1988.
			 Any plan which is intended to be effective after January 1, 1989 shall be filed
			 at least 60 days prior to its effective date. Any notice of an insurer's
			 intention to adopt an industry plan shall be filed at least 14 days prior to
			 the insurer's implementation of the said plan, but in no event shall the
			 insurer's implementation of the plan take place prior to the effective date of
			 the industry plan, provided such plan has been approved.
(3)
Method of
			 Filing
: An insurer or rating organization seeking approval of a
			 plan shall file five copies of the proposed plan with the Commissioner. Any
			 form intended to be used in connection with a proposed plan and which is to be
			 delivered to consumers shall be included in the filing.
(4)
Consideration of Proposed
			 Plan
: Upon receipt of a proposed plan, the Commissioner shall
			 promptly schedule a hearing to determine whether the plan is consistent with
			 M.G.L. c. 90, § 34O and M.G.L. c. 175, § 113O, as amended, with 211
			 CMR 123.000, and with other applicable laws and regulations, and whether the
			 plan would carry out the purposes of M.G.L. c. 90, § 34O and M.G.L. c.
			 175, § 113O . No hearing shall be required in connection with an insurer's
			 plan which the Commissioner determine s d o e s not substantially deviate from
			 a previously approved plan. The Commissioner may schedule more than one plan to
			 be considered at any given hearing. The Commissioner may require an insurer or
			 any other party to the hearing to submit other or further information for
			 purposes of considering the plan. The insurer or rating organization which
			 filed the plan, and any other interested person, may file written materials in
			 support of or in opposition to the plan.
(5)
Timing of
			 Hearing
: With respect to any plan for which a hearing is required
			 and which is filed to be effective on January 1, 1989, the Commissioner shall
			 schedule the hearing thereon for such date as will allow a full and fair
			 consideration of the plan, and as will allow the issuance of a decision
			 approving or disapproving the plan prior to January 1, 1989. With respect to
			 any other plan for which a hearing is required, the Commissioner shall schedule
			 the hearing thereon to begin no less than 21 days after the plan is filed. The
			 party filing the plan and other persons affected shall be notified of the date
			 of the hearing at least ten days in advance.
(6)
Approval or Disapproval of
			 Plan
: After a hearing, the Commissioner shall approve or
			 disapprove the plan in writing and if the plan is disapproved or modified,
			 shall state the reasons for the decision. Approval of a plan may be conditioned
			 upon its modification, including a change in its effective date. The
			 Commissioner may, prior to approving or disapproving a plan, request the party
			 filing it to supplement or modify it.
(7)
Effective Date of
			 Plan
: The benefits of an approved plan shall be made available to
			 all claimants submitting claims arising from accidents or other losses
			 occurring on or after the effective date of the plan, unless and until the
			 approval of the plan is revoked or the plan is otherwise terminated in
			 accordance with 211 CMR 123.04(9), or unless and until the insurer implementing
			 such plan ceases to do so in accordance with 211 CMR 123.04(10).
(8)
Reconsideration
:
			 Within ten days after the disapproval of a plan, any affected person may
			 request reconsideration. Such request may be allowed only if the person
			 submitting such request presents new and previously unavailable information
			 which the Commissioner determines should be considered in evaluating the
			 plan.
(9)
Revocation of
			 Approval
: At any time after approval of a plan, the Commissioner
			 may, after due investigation, commence proceedings to revoke or suspend such
			 approval if he or she determines the insurer is not complying with the terms of
			 the plan or that the plan does not carry out the intent of 108 CMR 123.00. He
			 or she shall commence such proceedings by issuing an order to show cause why
			 the approval of such plan should not be revoked or suspended, which shall
			 briefly set forth the asserted grounds for revocation or suspension. The party
			 which filed the plan, any insurer which has filed a notice that it intends to
			 adopt or has adopted an industry plan, and any interested person may appear at
			 the hearing. The Commissioner may schedule the revocation of more than one plan
			 to be considered at any given hearing. After such hearing, the Commissioner
			 shall issue a written decision, stating reasons for any determination to revoke
			 or suspend approval of the plan. Non-revocation may be conditioned upon
			 modification of the plan or other means of compliance with
			 211 CMR 123.00. Unless the
			 Commissioner for good cause orders otherwise, the institution of revocation
			 proceedings shall not act to enjoin or suspend the operation of the plan as
			 originally approved. The Commissioner may, instead of or in addition to
			 revocation or suspension, impose fines or other appropriate sanctions under
			 M.G.L. c. 175 and 176D for any violations of law or of 108 CMR
			 123.00.
(10)
Voluntary
			 Withdrawal of Plan
: Any party which has filed or adopted a plan
			 may voluntarily withdraw such plan, or voluntarily withdraw its notice of
			 intention to implement an industry plan, prior to the Commissioner's final
			 approval of the plan. After that date, no insurer intending to implement or
			 actively implementing such plan shall cease implementing the plan without first
			 notifying the Commissioner of its intent to do so at least 60 days in advance.
			 The Commissioner may make any orders reasonably necessary to prevent such
			 cessation from causing undue hardship to consumers or disruption to the
			 automobile repair market, but in no event shall such cessation be delayed,
			 without the consent of the insurer, for more than six months, unless the
			 insurer fails to comply with orders of the Commissioner relating to the
			 cessation.