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New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 6 - JOINT INSURANCE FUNDS FOR NONPROFIT CORPORATIONS AND KEYS AMENDMENT FACILITIES › Section 11:15-6.25 - Servicing organizations; administrator

Current through Register Vol. 56, No. 14, July 15, 2024
(a) No servicing organization of a fund or producer appointed pursuant to 11:15-6.6(d)10, or their employees, officers or directors shall have either a direct or indirect financial interest in the administrator of that fund, or be an employee, officer or director of the administrator, unless notice of such interest has been provided to the fund commissioners and members.
(b) No administrator of a fund, or its employees, officers or directors shall be an employee, officer or director of, or have either a direct or indirect financial interest in, a servicing organization of that fund, or an insurance producer appointed by that fund pursuant to 11:15-6.6(d)10, unless notice of such interest has been provided to the fund commissioners and members.
(c) Each contract with a servicing organization providing claims adjustment and administration services shall include a clause stating: "Unless the fund commissioners otherwise permit, the servicing organization shall handle to their conclusion all claims and other obligations incurred during the contract period."
(d) The fund commissioners shall notify the Department within 10 days of any determination to terminate or nonrenew any agreement with a servicing organization. The notification shall include a detailed statement that sets forth the manner and method by which claims handling and other obligations performed by the servicing organization will be provided or a statement that sets forth the reasons why the fund commissioners believe that the particular service is no longer necessary.
(e) The fund commissioners or the executive committee, if any, may designate an administrator to carry out the policies established by the fund commissioners and to provide day-to-day management of the fund. The minutes of the commissioners' or executive committee meetings shall detail the areas of authority delegated to the administrator.
(f) Any employee, officer or director of an administrator, servicing organization, or producer appointed pursuant to 11:15-6.6(d)10  shall disclose to the fund commissioners or executive committee any direct or indirect financial interest such employee, officer or director has in any other administrator, servicing organization or insurance producer.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 6 - JOINT INSURANCE FUNDS FOR NONPROFIT CORPORATIONS AND KEYS AMENDMENT FACILITIES › Section 11:15-6.26 - Conflict of interest

Current through Register Vol. 56, No. 14, July 15, 2024
The fund shall adopt a written conflict of interest policy, which shall be provided to each fund member, and shall include such provisions as the fund commissioners deem appropriate, including, but not limited to, a conflict of interest questionnaire. A copy of the conflict of interest policy shall be made available for review and inspection by the Department as part of an examination of the fund or upon request.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 6 - JOINT INSURANCE FUNDS FOR NONPROFIT CORPORATIONS AND KEYS AMENDMENT FACILITIES › Section 11:15-6.27 - Notice and hearing

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The Commissioner shall give prior written notice of any proposed suspension, revocation of authority, cease and desist order, or other enforcement action to the fund commissioners, executive committee, or member as the case may be, or to any person to whom the proposed enforcement action applies specifically. Such notice shall be served personally or by certified or registered mail upon all interested parties, shall set forth the grounds for the proposed enforcement action, and shall inform the interested party of its right to request a hearing on the proposed enforcement action.
(b) The interested party involved shall have 20 days from the mailing of the notice to request a hearing on the proposed enforcement action. Such a hearing shall be conducted in accordance with the Administrative Procedure Act, 52:14B-1 et seq., and Uniform Administrative Procedure Rules, N.J.A.C. 1:1. Failure to mail a request for a hearing within the time prescribed shall result in the suspension, revocation, monetary penalty or cease and desist order becoming effective 30 days from issuance of the original notice. In no event shall any revocation become effective prior to the date that a hearing is scheduled.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 6 - JOINT INSURANCE FUNDS FOR NONPROFIT CORPORATIONS AND KEYS AMENDMENT FACILITIES › Section 11:15-6.28 - Orders

Current through Register Vol. 56, No. 14, July 15, 2024
(a) After notice and opportunity for a hearing, as provided in 11:15-6.2 7, the Commissioner may issue an order revoking or suspending a fund's authority or requiring a person or fund to cease and desist from engaging in an act or practice found to be in violation of any provision of 17:49A-1 et seq., or this subchapter.
(b) Upon a finding, after notice and opportunity for a hearing, as provided at 11:15-6.2 7, that a fund has violated any cease and desist order, the Commissioner may revoke his or her approval of the fund.
(c) Upon a finding, after notice and opportunity for a hearing, as provided at 11:15-6.2 7, the Commissioner may issue an order requiring the fund commissioners, or the executive committee, if any, to dismiss an administrator or servicing organization or terminate the contract of an administrator or servicing organization because of any fraud, material misrepresentation, incompetence or untrustworthiness, misappropriation or conversion of monies or violation of any fiduciary responsibilities by such administrator or servicing organization, or any of the employees, officers or directors thereof.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 6 - JOINT INSURANCE FUNDS FOR NONPROFIT CORPORATIONS AND KEYS AMENDMENT FACILITIES › Section 11:15-6.29 - Compliance dates

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Except as otherwise specifically provided in this subchapter, funds subject to this subchapter shall comply with all of the requirements contained in this subchapter commencing with the fund year immediately following April 7, 1997, or October 4, 1997, whichever is later.
(b) Unless otherwise provided by this subchapter, all information and documents and any amendments thereto required by this subchapter shall be filed within 30 days from the date such information or document is due or such change or amendment has occurred.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 6 - JOINT INSURANCE FUNDS FOR NONPROFIT CORPORATIONS AND KEYS AMENDMENT FACILITIES › Section 11:15-6.30 - Severability

Current through Register Vol. 56, No. 14, July 15, 2024
The rules contained in this subchapter and any of the provisions thereof shall be severable, and if any of its provisions shall be held to be unconstitutional or otherwise invalid, the decision of the court shall not affect the validity of the remaining rules or any of the provisions thereof.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 7 - STATE COLLEGE RISK MANAGEMENT GROUPS › Section 11:15-7.1 - Purpose and scope

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The subchapter sets forth the filing requirements and approval procedures for joint liability funds established by State college risk management groups and for such groups established pursuant to 18A:64-86 et seq.
(b) This subchapter applies to all State college joint liability funds established by State college risk management groups and to such groups established pursuant to 18A:64-86 et seq.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 7 - STATE COLLEGE RISK MANAGEMENT GROUPS › Section 11:15-7.3 - Agreement to join risk management group; duration

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Any two or more State colleges may form or become members of a State college risk management group. A State college may take this action by resolution of the board of trustees of the State college.
(b) The resolution shall provide for execution of a written agreement with the group specifically conditioning membership on acceptance and adoption of the group's bylaws. The agreement shall specify the extent of the member's participation in the group with respect to the types of insurance coverage to be provided by the group and shall include the duration of group membership if applicable. The agreement shall specify that the group members have not been cancelled for nonpayment of insurance premiums for a period of at least two years prior to application. Members may renew their participation by the execution of a new agreement to join the risk management group. In lieu of filing copies of the new agreement and indemnity and trust agreement referred to in 11:15-7.6(c)10  for each member's renewal of membership, the group shall file a notice with the Department which sets forth the members that have renewed membership and the respective durations of such membership renewal, as well as the members that have not rejoined.
(c) A risk management group formed pursuant to 18A:64-86 et seq. and this subchapter shall have the power to insure, contract or provide for any insurable interest of the member solely for the following:
1. Any loss or damage to the member's property, real or personal, motor vehicles, equipment or apparatus;
2. Any loss or damage from liability as established by the New Jersey Contractual Liability Act, 59:13-1 et seq.;
3. Loss or damage from liability as established by 34:15-1 et seq.; and
4. Expenses of defending any claim against the State college, trustee, officer, employee or servant arising out of and in the course of performance of their duties, whether or not liability exists on the claim, not eligible for defense and indemnification by the State of New Jersey in accordance with the New Jersey Tort Claims Act, 59:1-1 et seq.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 7 - STATE COLLEGE RISK MANAGEMENT GROUPS › Section 11:15-7.6 - Bylaws and risk management program; contents

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The trustees shall prepare and, after the approval by resolution of the governing body of each participating member, shall adopt bylaws for the risk management group. The bylaws shall:
1. Set forth a statement of purposes of the group;
2. Set forth provisions for organization of the group, including governance by a board of trustees;
3. Provide for the delivery of a risk management program in conjunction with any joint liability fund or funds which the board of trustees shall establish;
4. Set forth procedures to enforce the collection of any contributions or payments in default;
5. Set forth membership standards as required in 18A:64-88;
6. Require that, for each joint liability fund, a contract or contracts of specific and aggregate excess insurance or reinsurance is maintained, if available, unless otherwise recommended by the trustees upon the advice and report of an independent actuary, or otherwise required pursuant to 18A:64-86 et seq. or this subchapter;
7. Set forth procedures for:
i. Withdrawal from the group and a fund by a member, including any requirement that a terminated or withdrawing member provide security in a form and amount acceptable to the Commissioner or trustees, as applicable, as a guarantee for the continued payment of the member's obligations pursuant to 11:15-7.1 0(c);
ii. Termination of the group or fund and disposition of assets; and
iii. Determining the obligations, if any, of a member in the event that the group is unable to pay indemnification obligations and expenses payable from a fund administered by it;
8. Require an annual certified audit and an actuarial opinion statement on loss reserves pursuant to the Loss Reserve Opinions rules, N.J.A.C. 11:1-21, to be prepared and filed with the Commissioner;
9. Require an annual, supplemental semi-annual, and quarterly financial reporting schedule, as applicable, to be filed pursuant to 11:15-7.2 4;
10. Require that any joint liability fund or funds be developed and operated in accordance with accepted and sound actuarial principles;
11. Provide that any expenditure of moneys in a fund be in furtherance of the purpose of the fund;
12. Provide for expulsion of a member;
13. Provide procedures governing trust fund accounts, including transfers, withdrawals and distribution surplus therefrom and supplemental assessments; and
14. Set forth other provisions as desired for operation and governance of the group.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 7 - STATE COLLEGE RISK MANAGEMENT GROUPS › Section 11:15-7.7 - Disapproval of bylaws and risk management program

Current through Register Vol. 56, No. 14, July 15, 2024
If the Commissioner determines that the bylaws or risk management program of the group or any subsequent amendments thereto do not contain all of the information set forth in 11:15-7.6, are not submitted in the proper format set forth in 11:15-7.5, or otherwise do not meet the requirements of 18A:64-86 et seq. or this subchapter, the Commissioner shall disapprove the bylaws or risk management program and notify the group in writing, which notice shall contain the specific reasons for disapproval, and the requirements to be met before approval may be granted. If not disapproved by the Commissioner within 60 days of receipt of the bylaws and risk management program or any amendments or changes thereto, which contain all of the information and documentation set forth in N.J.A.C. 11:15-7.6, in the format set forth in N.J.A.C. 11:15-7.5, and which meet the requirements of 18A:64-86 et seq. and this subchapter, the bylaws and program shall be deemed approved.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 7 - STATE COLLEGE RISK MANAGEMENT GROUPS › Section 11:15-7.8 - Revocation of approval

Current through Register Vol. 56, No. 14, July 15, 2024
(a) After notice and opportunity for a hearing, the Commissioner may suspend or terminate the authority of any group, or direct or take any action deemed necessary for good cause, to enable a group to meet its obligations, cover its expected losses, or to liquidate, rehabilitate or otherwise modify its affairs if a group:
1. Is found to be insolvent or has experienced a deterioration in financial condition to the extent that it causes or may cause an adverse affect upon the ability of the group to pay expected losses;
2. Fails to timely pay any fee or assessment;
3. Fails to pay any claim within 30 days after a final judgment is rendered against the group or the group's obligation for such claim otherwise becomes final;
4. Fails to comply with any of the provisions of 18A:64-86 et seq. or this subchapter, or with any lawful order of the Commissioner within the time prescribed; or
5. Fails to follow its approved bylaws or risk management program.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 7 - STATE COLLEGE RISK MANAGEMENT GROUPS › Section 11:15-7.9 - Approval of non-members

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Prospective new members of the group shall submit an application for membership to the group's board of trustees on a form acceptable to the Commissioner. The application shall include a copy of the resolution of participation and executed indemnity and trust agreement. The trustees may approve or disapprove the application for additional members, pursuant to the bylaws of the group.
(b) Any application approved by the group shall, within 15 days of approval by the group, be filed with the Department and shall be accompanied by a revised budget with assessment detail, if otherwise required pursuant to 11:15-7.4(e), an actuarial statement regarding the adequacy of the member's assessment to cover anticipated losses, and any amendments to the group's bylaws and risk management program as may be necessary. The group shall file only the specific changes to the bylaws or risk management program in effect for the current fund year. Where a group purchases direct insurance, or where an actuary has determined a "per capita" rate for the member's assessment to cover anticipated losses which has been previously filed with the Department, actuarial certification of the adequacy of these same rates for each new member is not required. The Commissioner may nevertheless require actuarial certification of a per capita rate for the new member's assessment to cover anticipated losses if, in his or her opinion, the new member will impose an extraordinary impact on the exposure of the group. In addition, the group shall file the following information in the form of Exhibit D in the chapter Appendix incorporated herein by reference with the Department within 15 days after approval of a new member:
1. The name and address of the new member;
2. The effective date of coverage;
3. The name of the new member's risk manager;
4. The name of the new member's trustee;
5. The lines of coverage for which the new member participates;
6. The amount of assessment, if not otherwise provided; and
7. An affirmative statement from the group that in accepting the new member, an application has been filed, the group has adhered to its bylaws and risk management program, and the agreement to participate and indemnity and trust agreement have been filed with the group.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 7 - STATE COLLEGE RISK MANAGEMENT GROUPS › Section 11:15-7.10 - Termination and/or withdrawal of group members

Current through Register Vol. 56, No. 14, July 15, 2024
(a) A member of the group must remain a member for the full term of membership, as provided in the group's bylaws, unless earlier terminated by the group for nonpayment of assessments, noncompliance with risk management or underwriting standards, or for other reasons subject to prior approval by the Commissioner as causes for expulsion. However, such member shall not be deemed terminated for any reason until:
1. Thirty days after written notice of the intention to terminate the member has been given by the group to the member, which notice shall state the reasons for termination and shall be given by registered mail or certified mail, return receipt requested;
2. Like notice shall have been filed with the Department, together with a certified statement that the notice provided for by (a)1 above has been given; and
3. Thirty days have elapsed after the filing required by (a)2 above has been made.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 7 - STATE COLLEGE RISK MANAGEMENT GROUPS › Section 11:15-7.11 - Insolvency and/or bankruptcy of group members

Current through Register Vol. 56, No. 14, July 15, 2024
The insolvency or bankruptcy of a member does not relieve the group or any other member of joint and several liability for the payment of any claims incurred by the member during the period of its membership, including, but not limited to, being subject to and liable for supplemental assessments.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 7 - STATE COLLEGE RISK MANAGEMENT GROUPS › Section 11:15-7.12 - Voluntary dissolution of a group

Current through Register Vol. 56, No. 14, July 15, 2024
(a) A group may not voluntarily dissolve or otherwise cease to do business and distribute its assets to its members, unless and until it satisfies the following requirements:
1. A majority of the group's members must have voted in favor of a resolution to dissolve the group, pursuant to a written plan adopted pursuant to the procedures set forth in the group's bylaws, at a meeting duly called for such purposes;
2. The plan of dissolution must provide for the payment of all unpaid losses of the group and its members, including all incurred but not reported losses, as certified by an actuary, before any assets of the group or the trust fund accounts may be used for any other purpose;
3. The plan of dissolution shall contain a statement of the group's current financial condition computed both on a statutory basis and according to generally accepted accounting principles as attested to by an independent certified public accountant; and
4. The plan of dissolution, and such other information as may be required, must be filed with and approved in writing by the Commissioner. The plan shall be filed with the Commissioner not later than 90 days prior to the proposed effective date of dissolution.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 7 - STATE COLLEGE RISK MANAGEMENT GROUPS › Section 11:15-7.13 - Establishment of trust fund accounts; transfers or withdrawals prohibited

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Pursuant to the terms of the indemnity and trust agreement, each group shall establish a separate trust fund account in accordance with 11:15-7.6(c)10  from which monies shall be disbursed solely for the payment of claims, allocated claim expenses and excess insurance or reinsurance premiums for each type of liability or risk retained jointly on a self-insured basis. Such accounts shall be designated as claims or loss retention fund accounts.
1. Other than for the purposes specified in (a) above, or as otherwise authorized by this subchapter, no withdrawal may be effected from a claim or loss retention fund without the prior written approval of the Commissioner, except for intertrust fund transfers. Intertrust fund transfers, within a fund's fiscal year, may be conducted by the group at any time, by providing 30 days prior written notification to the Commissioner. If the Commissioner does not disapprove of the transfer, in writing, within 30 days after receiving such written notification, the request for intertrust fund transfer(s) shall be deemed approved. Any intertrust fund transfer request must be supported by appropriate assessment and claim and expense documentation, and be accompanied by a certification signed by an actuary that the amount remaining in the trust fund account after the intertrust fund transfer will be at a level which is reasonable in relation to that account's unpaid losses, along with all documentation in support of such certification. Intertrust fund transfers may be conducted only where each member participates in each and every claim or loss retention fund account during that fund year. The Commissioner shall waive the full participation requirement provided the group demonstrates to the Department that it maintains records of each member's pro rata share of each claim or loss retention fund account for that year, and that the transfer shall be made so that any potential dividend shall not be reduced for a member that did not participate in the account receiving the transfer.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 7 - STATE COLLEGE RISK MANAGEMENT GROUPS › Section 11:15-7.14 - Administrative account

Current through Register Vol. 56, No. 14, July 15, 2024
Each group shall establish an administrative account for each fund year which shall be utilized for payment of the group's general operating expenses, including, but not limited to, loss prevention activities, data processing services and general legal expenses. A group shall not be required to establish a separate administrative account by fund year, provided the fund provides a plan in its bylaws which provides for the recording and accounting of all transactions by fund year.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 7 - STATE COLLEGE RISK MANAGEMENT GROUPS › Section 11:15-7.15 - Assessments

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Each participating member of a risk management group shall appropriate and pay to the group its assessments as required by the risk management group. During the first year of operation of a risk management group these contributions shall be paid in two equal installments, the first installment payable no later than July 15 and the second installment payable no later than November 15 or in any other manner that the Commissioner in his or her discretion may direct. Subsequent years' assessments may be paid in such installments as shall be provided in the group's bylaws, provided, however, that the full assessment shall be paid by each member no later than February 1, or in such other manner as provided in the group's bylaws as approved by the Commissioner.
(b) Each member's annual assessment shall consist of amounts allocated for the administrative account, contingency trust fund account where appropriate, plus a specific assessment to establish and/or replenish the claim or loss retention trust fund account for each type of coverage provided by the group and in which such member participates.
(c) The total amount of each member's annual assessments to the group shall be certified by the trustees to the governing body of each participant at least one month prior to the beginning of the next fiscal year. As a condition of continued participation in the group, each member shall pay the amount certified at such time and in such manner provided in the group's bylaws.
(d) Unless otherwise approved by the Commissioner, the annual assessment of each group member providing for the self-insurance of workers' compensation and employers' liability coverages shall be based upon the Experience Rating Plan provided for in the New Jersey Workers' Compensation and Employers' Liability Insurance Manual on file with the Commissioner. The Commissioner may withdraw his or her approval of any assessment if he or she finds that such assessment is unreasonable or inadequate for the members of the group to which it applies. In taking any action under this section, the Commissioner may require that the trustees, administrator, any servicing organization or agent of the group provide such information as he or she deems necessary.
(e) Nothing contained in this section shall preclude the assessment and payment of supplemental assessments as provided in 11:15-7.1 6.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 7 - STATE COLLEGE RISK MANAGEMENT GROUPS › Section 11:15-7.16 - Supplemental assessments

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Each group shall levy upon its members an additional assessment whenever needed or so ordered by the Commissioner, to supplement the group's claim or loss retention or administrative accounts to assure payment of the group's obligations, including payment of benefits under the workers' compensation law.
1. The group shall assess each participating member an additional proportionate amount, as provided in the group's bylaws and risk management program or as directed by the Commissioner, to replenish claims or loss retention or administrative accounts.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 7 - STATE COLLEGE RISK MANAGEMENT GROUPS › Section 11:15-7.17 - Failure or refusal to provide required assessments

Current through Register Vol. 56, No. 14, July 15, 2024
Should any member of a group fail or refuse to pay as directed its assessment(s) to the group or to pay as directed any supplemental assessment(s), or should the trustees fail to assess funds required to meet the obligations of the group, the chairman of the board of trustees, if any, or in the event of his or her failure to do so, the custodian of the group's assets, shall notify the Commissioner in writing. Upon such notification, the Commissioner shall order the group or member to take such remedial action as he or she deems necessary.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 7 - STATE COLLEGE RISK MANAGEMENT GROUPS › Section 11:15-7.18 - Individual loss reserve funds

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Whenever the risk management program of a group requires any members of the group to retain individually a specified amount of risk, potential liability, or incurred losses, the participant shall provide for such liability, or incurred losses:
1. As a deductible to be charged to the operating expenses of the incurring member; or
2. Through a separate item of appropriation for the loss year in its annual budget.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 7 - STATE COLLEGE RISK MANAGEMENT GROUPS › Section 11:15-7.19 - Certification of funds

Current through Register Vol. 56, No. 14, July 15, 2024
Prior to any commitment or agreement requiring the expenditure of funds by the risk management group, the custodian of the group's assets shall certify the availability of sufficient unencumbered funds in the account to fully pay all charges or commitments to be accepted.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 7 - STATE COLLEGE RISK MANAGEMENT GROUPS › Section 11:15-7.20 - Investments; application of investment income

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The free balance of any account maintained by a risk management group, whether for claim or loss retention, administrative, or contingency, shall be invested to obtain the maximum interest return practicable. All investments shall be made in accordance with the group's cash management plan and consistent with the statutes and regulations of the State Investment Council governing the investment of surplus public monies of the State.
(b) The investment and interest income earned by the investment of the assets of each claim or loss retention fund account shall be allocated to each such account by fund year.
(c) The investment and interest income earned by investment of the assets of the administrative account shall be credited to that account.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 7 - STATE COLLEGE RISK MANAGEMENT GROUPS › Section 11:15-7.21 - Refunds; interyear fund transfers

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Any monies for a fund year in excess of the amount necessary to fund all obligations for that fund year as certified by an actuary may be declared to be refundable by the group not less than 24 months after the end of the fund year.
(b) The group may seek approval from the Commissioner to make initial refund payments from a claims or loss retention fund account remaining from any year which has been completed at least 24 months by submitting a written notification to the Department, with accompanying documentation as set forth in this subsection, at least 30 days prior to the proposed refund. If the Commissioner does not disapprove, in writing, the request to make the refund within the 30 day period, the request shall be deemed approved. The Commissioner may also affirmatively approve the request prior to the expiration of the 30 day period. The written notification shall be accompanied by appropriate documentation including, but not limited to, assessment, claims and expense detail; actuarial certification that the loss and loss expense reserves are adequate for the group to have an overall surplus for that fiscal year; and such other information that the Commissioner may require. The initial and any subsequent refund for any year from a claim or loss retention trust account may be in any amount subject to the limitation that after the refund, the remaining net current surplus in the account from which the refund is made must equal or exceed the surplus retention requirement to be calculated as follows:
1. Fund year paid losses shall be multiplied by the appropriate paid loss factor for the line of coverage and duration of maturity set forth in Exhibit E in the chapter Appendix incorporated herein by reference;
2. Fund year unpaid claim reserves, excluding reserves for incurred but not reported claims, shall be multiplied by the appropriate unpaid claim factor for the line of coverage and duration of maturity set forth in Exhibit E in the chapter Appendix incorporated herein by reference. Unpaid claim reserves, excluding reserves for incurred but not reported claims, shall be established at full value and not discounted; and
3. The greater of the results from the calculation set forth in (b)1 and 2 above shall then be reduced by the amount of outstanding losses reported, including incurred but not reported claims, as certified by an actuary. The result of this calculation, but not less than zero, shall be the surplus retention requirement for that fund year.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 7 - STATE COLLEGE RISK MANAGEMENT GROUPS › Section 11:15-7.22 - Disbursements and/or payment of claims

Current through Register Vol. 56, No. 14, July 15, 2024
(a) All disbursements, payment of claims settlements or other expenditure of funds of the risk management group whether for administrative expenses or for claims purposes must be approved by a majority of the board of trustees, unless approved pursuant to (b) below.
(b) To allow the expeditious resolution of certain claims, the board of trustees may designate the group's administrator or servicing organization as a "certifying and approving officer." The certifying and approving officer may be authorized by the board of trustees to approve for payment of any or specified types of claims in an amount not to exceed an amount approved by the Commissioner in the risk management program. The authority of the certifying and approving officer may be conditioned or restricted by the board of trustees to require prior consultation, limitation as to the types or total amount of claims or payments which may be approved, or such other procedures or restrictions as the board of trustees may deem appropriate. The authority of the certifying and approving officer may be revoked or modified at any time by the trustees.
1. Upon approval, the certifying and approving officer shall certify the amount and particulars of such approved claims to the official having custody of the group's assets, directing that a check for payment be prepared.
2. The certifying and approving officer shall prepare a report of all claims approved by him or her since the last such report, detailing the nature and amount of the claim, the payee, the reasons supporting payment and any other pertinent information. This report shall be submitted to the board of trustees at their next scheduled meeting. The board of trustees shall review and approve the actions of the certifying and approving officer. In the event a claim approved and paid by the certifying and approving officer is not approved by the board of trustees, it shall direct appropriate action to be taken.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 7 - STATE COLLEGE RISK MANAGEMENT GROUPS › Section 11:15-7.23 - Excess insurance and/or reinsurance

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Consistent with 11:15-7.6(a)6, each group providing primary or underlying coverage on a self-insured or commercially insured basis shall secure excess insurance or reinsurance in a form, in an amount and by an insurer, or other entity authorized to provide such coverage in this State pursuant to law, acceptable to the Commissioner, if commercially available and not unreasonably priced, as determined by the trustees for each fund year, and as approved by the Department.
1. Any approval by the Department pursuant to (a) above shall be for a period not to exceed the longer of 12 months from the date of approval or the end of the current fund year. Any group seeking to extend the period of the approval shall notify the Department not later than 45 days prior to the expiration of the term of the approval. The notification shall specify the basis upon which the trustees have determined that excess insurance or reinsurance required pursuant to (a) above is not commercially available or is not reasonably priced, and shall include all actions taken by the group to obtain required excess insurance or reinsurance.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 7 - STATE COLLEGE RISK MANAGEMENT GROUPS › Section 11:15-7.24 - Financial statement and reports

Current through Register Vol. 56, No. 14, July 15, 2024
(a) An annual certified report in a form acceptable to the Commissioner shall be prepared by each group, filed with the Department, and made available to each group member on or before December 31 of each year. The report shall include:
1. An annual audited statement of the financial condition of the group prepared by an independent certified public accountant and performed in accordance with generally accepted accounting principles, which shall include a statement of the organization of the group indicating the persons who perform each function for the group and the relationship and interdependency of each function, and including the group's balance sheet and receipts and disbursements for the preceding year;
2. Reports of outstanding liabilities by line of coverage showing the number of claims, amounts paid to date and current reserves for unpaid losses, claims and unearned assessments as certified by an actuary;
3. A certification by the presiding officer of the board of trustees that periodic reports were made to group members in the form and manner required by 11:15-7.4(h);
4. Any material changes in information from that previously submitted; and
5. Such other information as may be requested by the Department from a particular group.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 7 - STATE COLLEGE RISK MANAGEMENT GROUPS › Section 11:15-7.25 - Examination of groups

Current through Register Vol. 56, No. 14, July 15, 2024
(a) In addition to any examination conducted pursuant to 11:15-7.6(g), the Commissioner may conduct an examination of any group as he or she deems necessary, or at any time the Commissioner has reasonable cause to believe the group may be insolvent or in a financial condition detrimental to its members or the public. It shall be the duty of the group members, trustees, and administrator to notify the Commissioner of any information indicating that any fund may be in a financial condition detrimental to the group's members or the public.
(b) The group's members or trustees may, upon majority vote, request that the Commissioner order an examination of the group, or any group member, which they, in good faith, believe may be in a financial condition detrimental to other group members or to the public.
(c) Any examination made pursuant to N.J.S.A. 18A:64-91c and this subchapter shall be conducted in accordance with the procedures set forth in 11:15-7.6(g).
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 7 - STATE COLLEGE RISK MANAGEMENT GROUPS › Section 11:15-7.26 - Servicing organizations; administrator

Current through Register Vol. 56, No. 14, July 15, 2024
(a) No servicing organization of a fund or producer appointed pursuant to 11:15-7.6(d)10, or their employees, officers or directors shall have either a direct or indirect financial interest in the administrator of that group, or be an employee, officer or director of the administrator, unless notice of such interest has been provided to the trustees and members.
(b) No administrator of a group, or its employees, officers or directors shall be an employee, officer or director of, or have either a direct or indirect financial interest in, a servicing organization of that group, or an insurance producer appointed by that fund pursuant to 11:15-7.6(d)10, unless notice of such interest has been provided to the trustees and members.
(c) Each contract with a servicing organization providing claims adjustment and administration services shall include a clause stating: "Unless the trustees otherwise permit, the servicing organization shall handle to their conclusion all claims and other obligations incurred during the contract period."
(d) The trustees shall notify the Department within 10 days of any determination to terminate or nonrenew any agreement with a servicing organization. The notification shall include a detailed statement that sets forth the manner and method by which claims handling and other obligations performed by the servicing organization will be provided or a statement that sets forth the reasons why the trustees believe that the particular service is no longer necessary.
(e) The trustees may designate an administrator to carry out the policies established by the trustees and to provide day-to-day management of the group. The minutes of the trustees' meetings shall detail the areas of authority delegated to the administrator.
(f) Any employee, officer or director of an administrator, servicing organization, or producer appointed pursuant to 11:15-7.6(d)10  shall disclose to the trustees any direct or indirect financial interest such employee, officer or director has in any other administrator, servicing organization or insurance producer.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 7 - STATE COLLEGE RISK MANAGEMENT GROUPS › Section 11:15-7.27 - Notice and hearing

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The Commissioner shall give prior written notice of any proposed suspension, revocation of authority, cease and desist order, or other enforcement action to the trustees or member as the case may be, or to any person to whom the proposed enforcement action applies specifically. Such notice shall be served personally or by certified or registered mail upon all interested parties, shall set forth the grounds for the proposed enforcement action, and shall inform the interested party of its right to request a hearing on the proposed enforcement action.
(b) The interested party involved shall have 20 days from the mailing of the notice to request a hearing on the proposed enforcement action. Such a hearing shall be conducted in accordance with the Administrative Procedure Act, 52:14B-1 et seq. and 52:14F-1 et seq., and Uniform Administrative Procedure Rules, N.J.A.C. 1:1. Failure to mail a request for a hearing within the time prescribed shall result in the suspension, revocation, monetary penalty or cease and desist order becoming effective 30 days from issuance of the original notice. In no event shall any revocation become effective prior to the date that a hearing is scheduled.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 7 - STATE COLLEGE RISK MANAGEMENT GROUPS › Section 11:15-7.28 - Orders

Current through Register Vol. 56, No. 14, July 15, 2024
(a) After notice and opportunity for a hearing, as provided in 11:15-7.2 7, the Commissioner may issue an order revoking or suspending a group's authority or requiring a person or fund to cease and desist from engaging in an act or practice found to be in violation of any provision of 18A:64-86 et seq. or this subchapter.
(b) Upon a finding, after notice and opportunity for a hearing, as provided at 11:15-7.2 7, that a group has violated any cease and desist order, the Commissioner may revoke his or her approval of the group.
(c) Upon a finding, after notice and opportunity for a hearing, as provided at 11:15-7.2 7, the Commissioner may issue an order requiring the trustees to dismiss an administrator or servicing organization or terminate the contract of an administrator or servicing organization because of any fraud, material misrepresentation, incompetence or untrustworthiness, misappropriation or conversion of monies or violation of any fiduciary responsibilities by such administrator or servicing organization, or any of the employees, officers or directors thereof.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 7 - STATE COLLEGE RISK MANAGEMENT GROUPS › Section 11:15-7.29 - Compliance dates

Current through Register Vol. 56, No. 14, July 15, 2024
Unless otherwise provided by this subchapter, all information and documents and any amendments thereto required by this subchapter shall be filed within 30 days from the date such information or document is issued or such change or amendment has occurred.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 7 - STATE COLLEGE RISK MANAGEMENT GROUPS › Section 11:15-7.30 - Severability

Current through Register Vol. 56, No. 14, July 15, 2024
The rules contained in this subchapter and any of the provisions thereof shall be severable, and if any of its provisions shall be held to be unconstitutional or otherwise invalid, the decision of the court shall not affect the validity of the remaining rules and regulations or any of the provisions thereof.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 16 - FRAUD PREVENTION AND DETECTION › Subchapter 1 - CLAIM FORM STATEMENTS › Section 11:16-1.1 - Scope; definitions

Current through Register Vol. 56, No. 14, July 15, 2024
(a) This subchapter applies to all insurers in the State of New Jersey.
(b) For the purpose of this subchapter:
"Commissioner" means the Commissioner of the New Jersey Department of Banking and Insurance.
"Insurer" means any person, corporation, association, partnership, company, fraternal benefit society, eligible unauthorized surplus lines insurer and other legal entity engaged as an indemnitor or contractor in the business of insurance or any hospital service corporation as defined at 17:48-1, medical service corporation as defined at 17:48A-1, health service corporation defined at section 1 of P.L. 1985, chap. 236, dental service corporation as defined at 17:48C-2 and dental plan organization as defined at 17:48D-2. "Insurer" shall also include any individual, corporation, association, partnership or other legal entity authorized to represent an insurer with respect to a claim.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 16 - FRAUD PREVENTION AND DETECTION › Subchapter 1 - CLAIM FORM STATEMENTS › Section 11:16-1.2 - Statement of liability for fraud on claim and application forms

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Insurers shall either place on or attach to all claim forms the following warning:
"Any person who knowingly files a statement of claim containing any false or misleading information is subject to criminal and civil penalties."
(b) Pursuant to 17:33A-6, all applications for insurance shall prominently and clearly contain the following statement:
"Any person who includes any false or misleading information on an application for an insurance policy is subject to criminal and civil penalties."
(c) In lieu of the statement in (a) and (b) above, insurers may use a substantially similar statement with the prior approval of the Commissioner.
1. The Commissioner may approve the use of a statement substantially similar to that set forth above upon finding that the statement properly describes the prohibited conduct and references both criminal and civil penalties.
2. Requests for approval of substantially similar statements shall be directed to the Department at the following address:
Division of Anti Fraud Compliance
New Jersey Department of Banking and Insurance