reglab/statecodes huggingface dataset:
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 3 - AUTOMOBILE INSURANCE › Subchapter 29 - MEDICAL FEE SCHEDULES: AUTOMOBILE INSURANCE PERSONAL INJURY PROTECTION AND MOTOR BUS MEDICAL EXPENSE INSURANCE COVERAGE › Appendix - APPENDIX

Current through Register Vol. 56, No. 14, July 15, 2024
Exhibit 1
Physicians' & Ambulatory Surgical Center (ASC) Facility Fee Schedule
Click here to view Physicians' & Ambulatory Surgical Center (ASC) Facility Fee Schedule.
Exhibit 2
Dental Fee Schedule
Click here to view Dental Fee Schedule.
Exhibit 3
Home Care Fees
Click here to view Home Care Fees.
Exhibit 4
Ambulance Services Fee Schedule
Click here to view Ambulance Services Fee Schedule.
Exhibit 5
Durable Medical Equipment Prosthetics, Orthotics & Supplies
Click here to view Durable Medical Equipment Prosthetics, Orthotics & Supplies.
Exhibit 6
Codes Subject to the Daily Maximum
Click here to view Codes Subject to the Daily Maximum.
Exhibit 7
Hospital Outpatient Surgical Facility (HOSF) Fees
Click here to view Hospital Outpatient Surgical Facility (HOSF) Fees.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 3 - AUTOMOBILE INSURANCE › Subchapter 30 - MOTOR VEHICLE SELF-INSURANCE › Section 11:3-30.1 - Purpose

Current through Register Vol. 56, No. 14, July 15, 2024
This subchapter sets forth the filing requirements for motor vehicle self-insurers pursuant to 39:6-50.1, and 39:6-52 to 39:6-54.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 3 - AUTOMOBILE INSURANCE › Subchapter 30 - MOTOR VEHICLE SELF-INSURANCE › Section 11:3-30.2 - Scope

Current through Register Vol. 56, No. 14, July 15, 2024
The provisions of this subchapter apply to any person seeking to qualify as a motor vehicle self-insurer in New Jersey, except public entities pursuant to 39:6-54.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 3 - AUTOMOBILE INSURANCE › Subchapter 30 - MOTOR VEHICLE SELF-INSURANCE › Section 11:3-30.3 - Definitions

Current through Register Vol. 56, No. 14, July 15, 2024
The following words and terms, when used in this subchapter, shall have the following meanings, unless the context clearly indicates otherwise.
"Applicant" means a person applying for a certificate of self-insurance who does not currently possess a valid certificate.
"Association" means the New Jersey Automobile Full Insurance Underwriting Association created pursuant to 17:30E-1 et seq.
"Certificate" means certificate of self-insurance.
"Certificate holder" means a person who currently possesses a valid certificate of self-insurance.
"Certified public accountant" means an independent certified public accountant or accounting firm in good standing with the American Institute of Certified Public Accountants and in all states in which they are licensed to do business.
"Commissioner" means the Commissioner of Banking and Insurance.
"Motorized bicycle" means a pedal bicycle having a helper motor characterized in that either the maximum piston displacement is less than 50 cubic centimeters (cc.) or said motor is rated at no more than 1.5 brake horsepower and said bicycle is capable of a maximum speed of no more than 25 miles per hour on a flat surface.
"Motor vehicle" means all vehicles propelled otherwise than by muscular power, excepting such vehicles as run upon rails or tracks and motorized bicycles.
"Person" means a natural person, firm, co-partnership, association or corporation.
"Public entity" means this State, any political subdivision of this State or any municipality therein.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 3 - AUTOMOBILE INSURANCE › Subchapter 30 - MOTOR VEHICLE SELF-INSURANCE › Section 11:3-30.4 - General requirements

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Any person in whose name more than 25 motor vehicles are registered or in whose name more than 25 motor vehicles are leased may qualify as a self-insurer by obtaining a certificate of self-insurance issued at the discretion of the Commissioner as provided in this subchapter.
(b) All filings for certificates of self-insurance, renewals, and any other filings deemed necessary by the Commissioner pursuant to this subchapter shall be sent to:
New Jersey Department of Banking and Insurance
Financial Exams Division
20 West State Street
PO Box 325
Trenton, New Jersey 08625-0325
Attention: Self-insurers
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 3 - AUTOMOBILE INSURANCE › Subchapter 30 - MOTOR VEHICLE SELF-INSURANCE › Section 11:3-30.5 - Certificate of self-insurance

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Any person applying for a certificate of self-insurance shall submit the following to the Commissioner:
1. A completed application form on forms to be provided by the Commissioner;
2. The most current financial statement and financial statements for the two years immediately preceding the date of such current financial statement:
i. All financial statements shall be certified by a Certified Public Accountant;
ii. If the applicant is a subsidiary of a corporation, the applicant shall also submit the financial statements of the subsidiary's ultimate parent corporation;
iii. If the applicant is a corporation, the Commissioner may also include the name of any subsidiary corporation under the control of that corporation in the certificate of self-insurance if the ultimate parent corporation guarantees that it will discharge the subsidiary's liability as evidenced by the filing of an indemnity agreement. If the ultimate parent corporation does not provide such a guarantee, the subsidiary shall make a separate application and receive independent qualification as a self-insurer. If the name of the subsidiary is included in the certificate of self-insurance of the ultimate parent corporation and ownership of the ultimate parent or subsidiary corporation changes, the ultimate parent or subsidiary shall reapply for a certificate of self-insurance within 30 days of the ownership change; and
3. A $ 1,000 filing fee.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 3 - AUTOMOBILE INSURANCE › Subchapter 30 - MOTOR VEHICLE SELF-INSURANCE › Section 11:3-30.6 - Renewals

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Any certificate holder applying for renewal shall submit the following so that it is received by the Commissioner not later than June 1 of the year of the expiration date of such certificate:
1. An accident and claim activity report on forms to be provided by the Commissioner;
2. A financial statement for the calendar year immediately preceding the expiration date of the certificate of self-insurance certified by a Certified Public Accountant;
3. An updated vehicle listing which shall include a listing of the vehicles subject to any applicable policy constant or RMEC pursuant to 17:29A-37.1 and 17:30E-1 et seq., respectively;
4. A $ 1,000 renewal fee; and
5. Any other information that is substantially different from the information provided in the original application form or from the information provided in the last renewal period.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 3 - AUTOMOBILE INSURANCE › Subchapter 30 - MOTOR VEHICLE SELF-INSURANCE › Section 11:3-30.7 - Surety bond requirement

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The Commissioner may require the furnishing of a surety bond and/or evidence of excess insurance.
(b) If the applicant or certificate holder is required to furnish a surety bond, the surety bond shall be in an amount of not less than $ 300,000, with an additional $ 10,000 for each vehicle registered or leased in the applicant's or certificate holder's name over the minimum required to qualify as self-insurer under this subchapter, up to a maximum amount of $ 1,000,000.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 3 - AUTOMOBILE INSURANCE › Subchapter 30 - MOTOR VEHICLE SELF-INSURANCE › Section 11:3-30.8 - Audits and examinations

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The Commissioner may make or cause to be made audits or examinations as may be necessary to determine the ability of the applicant or the certificate holder to discharge its financial obligations as a self-insurer.
(b) The applicant or certificate holder shall pay the reasonable expenses of the audit or examination.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 3 - AUTOMOBILE INSURANCE › Subchapter 30 - MOTOR VEHICLE SELF-INSURANCE › Section 11:3-30.9 - Public entities

Current through Register Vol. 56, No. 14, July 15, 2024
(a) This subchapter does not apply to any motor vehicle owned by the United States, this State, any political subdivision of this State or any municipality therein; nor to any motor vehicle which is subject to the requirements of law requiring insurance or other security on certain types of vehicles, other than the requirements of 39:6A-1 et seq. or 39:6B-1 et seq.
(b) Notwithstanding the provisions in (a) to the contrary, any public entity that currently has or will establish in the future a self-insurance program or plans to discontinue a self-insurance program currently in effect, shall notify the Commissioner in writing that it currently has, will establish or discontinue such a program.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 3 - AUTOMOBILE INSURANCE › Subchapter 30 - MOTOR VEHICLE SELF-INSURANCE › Section 11:3-30.10 - Cancellation of certificate of self-insurance

Current through Register Vol. 56, No. 14, July 15, 2024
After a hearing conducted pursuant to the Administrative Procedure Act, 52:14B-1 et seq., and the Uniform Administrative Procedure Rules, N.J.A.C. 1:1, upon not less than five days' notice, the Commissioner may cancel a certificate of self-insurance upon reasonable grounds including, but not limited to, failure to pay any judgment within 30 days after such judgment has become final.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 3 - AUTOMOBILE INSURANCE › Subchapter 32 - CERTIFICATION OF COMPLIANCE: MANDATORY LIABILITY COVERAGES › Section 11:3-32.1 - Purpose and scope

Current through Register Vol. 56, No. 14, July 15, 2024
(a) This subchapter establishes the procedures and requirements for automobile or motor vehicle insurers to certify that automotive or motor vehicle insurance liability policies issued outside of New Jersey provide coverage pursuant to 39:6A-3, 39:6A-4, 39:6B-1a, 17:28-1.3 and 17:28-1.1, as required under 17:28-1.4, whenever the automotive or motor vehicle insured under such a policy is used or operated in this State.
(b) This subchapter applies to each insurer authorized to transact automobile or motor vehicle insurance business in the State pursuant to 17:28-1.4.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 3 - AUTOMOBILE INSURANCE › Subchapter 32 - CERTIFICATION OF COMPLIANCE: MANDATORY LIABILITY COVERAGES › Section 11:3-32.2 - Definitions

Current through Register Vol. 56, No. 14, July 15, 2024
The following words and terms, when used in this subchapter, shall have the following meanings, unless the context clearly indicates otherwise:
"Certification" means a written statement certified or sworn to be true and signed by a duly authorized officer of the insurer.
"Commissioner" means the Commissioner of the New Jersey Department of Banking and Insurance.
"Control" (including the terms "controlling," "controlled by" and "under common control") means the possession, direct or indirect, of the power to direct or cause the direction of the management and policies of a person, whether through the ownership of voting securities, by contract other than a commercial contract for goods or nonmanagement services, or otherwise, unless the power is the result of an official position with or corporate office held by the person. Control shall be presumed to exist if any person, directly or indirectly, owns, controls, holds with the power to vote, or holds proxies representing 10 percent or more of the voting securities of any other person, provided that no such presumption of control shall of itself relieve any person so presumed to have control from any requirement of this subchapter.
"NAIC" means the National Association of Insurance Commissioners.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 3 - AUTOMOBILE INSURANCE › Subchapter 32 - CERTIFICATION OF COMPLIANCE: MANDATORY LIABILITY COVERAGES › Section 11:3-32.3 - Certification compliance requirements

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Each insurer authorized to transact automobile or motor vehicle insurance business in this State pursuant to 17:28-1.4 shall file a certification of compliance with the Department on its own behalf and on behalf of:
1. Any insurer that is controlled by the insurer authorized to transact insurance business in this State, which sells a policy providing automobile or motor vehicle liability insurance coverage;
2. Any insurer that controls the insurer authorized to transact automobile or motor vehicle liability insurance in this State, which sells a policy providing automobile or motor vehicle liability insurance coverage; and
3. Any insurer under common control by or with the insurer authorized to transact automobile or motor vehicle liability insurance in this State.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 3 - AUTOMOBILE INSURANCE › Subchapter 32 - CERTIFICATION OF COMPLIANCE: MANDATORY LIABILITY COVERAGES › Section 11:3-32.4 - Requests for copies of certifications

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Any person requesting a copy of a certification on file with the Department shall make the request in writing and include the complete name of the company or companies for which the certification is requested.
(b) Requests for copies of certification on file with the Department shall be directed to:
New Jersey Department of Banking and Insurance
Division of Property and Casualty
20 West State Street
PO Box 325
Trenton, New Jersey 08625-0325
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 3 - AUTOMOBILE INSURANCE › Subchapter 33 - APPEALS FROM DENIAL OF AUTOMOBILE INSURANCE › Section 11:3-33.1 - Purpose; scope

Current through Register Vol. 56, No. 14, July 15, 2024
(a) This subchapter sets forth an appeal procedure for a person who has been either denied personal private passenger automobile insurance or nonrenewed in the voluntary market by an insurer on the basis that they are not an eligible person as defined in 11:3-34.4. This subchapter applies to such persons, agents and insurers required to write personal private passenger automobile insurance pursuant to State statutes and rules.
(b) This subchapter shall become inoperative on and after January 1, 2009, unless and until the Commissioner by Order makes the requirements of N.J.S.A. 17:33B-15a and b operative pursuant to the limited circumstances set forth in N.J.S.A. 17:33B-15d(3), upon a determination made after a hearing conducted pursuant to the Administrative Procedure Act, 52:14B-1 et seq., and Uniform Administrative Procedure Rules, N.J.A.C. 1:1, that a competitive market does not exist among insurers authorized to write private passenger automobile insurance in this State, or the Commissioner certifies by Order that the Personal Automobile Insurance Plan is insuring 10 percent or more of the aggregate number of private passenger automobile non-fleet exposures being written in this State. A notice of the issuance by the Commissioner of such an Order shall be published in the New Jersey Register.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 3 - AUTOMOBILE INSURANCE › Subchapter 33 - APPEALS FROM DENIAL OF AUTOMOBILE INSURANCE › Section 11:3-33.3 - Right to appeal

Current through Register Vol. 56, No. 14, July 15, 2024
Any eligible person who has been denied automobile insurance in the voluntary market by an insurer shall be entitled to appeal the denial in the manner provided by this subchapter.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 3 - AUTOMOBILE INSURANCE › Subchapter 33 - APPEALS FROM DENIAL OF AUTOMOBILE INSURANCE › Section 11:3-33.4 - Duties of insurer or insurance agent

Current through Register Vol. 56, No. 14, July 15, 2024
(a) If the application or request for coverage was made in writing, the insurer or agent shall provide the applicant with an explanation of the reasons for the denial in writing. If the application or request for coverage was made orally, the insurer or agent may provide the applicant with an oral explanation instead of a written explanation but shall provide a written explanation if the applicant requests a written explanation within 90 days of the oral denial.
(b) Within 10 working days of a determination to deny automobile insurance in the voluntary market (from either a written application or from the date that an oral request is made for a written determination), an insurer or agent shall notify an applicant, in writing, of each specific reason for the denial. The reasons provided by an insurer or insurance agent shall be comprehensive and written in plain language. The reasons shall identify the specific basis for which the applicant fails to qualify as an "eligible person."
(c) An insurer or agent who has issued a written denial shall notify an applicant of his or her right to appeal the denial to the Department, pursuant to the provisions of this subchapter. That insurer or agent shall also advise the applicant of his or her obligation to obtain insurance coverage as a condition of operation of the vehicle. As part of this notification, an insurer or agent shall provide an applicant with the letter and appeal form which comprise Appendices A and B to this subchapter set forth and incorporated as part of this rule. For nonrenewals, the insurer shall provide the notice set forth in 11:3-8.3 together with the letter and appeal form when nonrenewing an applicant pursuant to 11:3-8.4.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 3 - AUTOMOBILE INSURANCE › Subchapter 33 - APPEALS FROM DENIAL OF AUTOMOBILE INSURANCE › Section 11:3-33.5 - Procedure for filing an appeal

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Appeals from a denial of automobile insurance in the voluntary market shall be submitted to the Department, on a form prescribed by the Department (Appendix B to this subchapter, which is incorporated herein by reference as part of this rule), within 90 days of the date of a written denial from an insurer or insurance agent. Notwithstanding an insurer's or agent's obligation to provide a person with this form upon a denial of initial coverage (see N.J.A.C. 11:3-33.4(c)), copies can also be obtained by contacting the Department by telephone (609) 984-2426 or by mail at the address below:
Department of Banking and Insurance
Division of Enforcement and Consumer Protection
Attn: Auto Insurance Denial
20 West State Street
PO Box 471
Trenton, New Jersey 08625-0471
(b) The form prescribed by the Department shall be completed and submitted to the address above and shall include, at a minimum, the following information:
1. A copy of the written denial obtained from the insurer or agent pursuant to N.J.S.A. 17:33B-16 and N.J.A.C. 11:3-33.4. When an applicant receives an oral denial, he or she shall request a written denial as provided by N.J.A.C. 11:3-33.4; and
2. A statement from the applicant who has received a denial of coverage, including supporting documentation, if any, indicating the reasons why the denial is improper.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 3 - AUTOMOBILE INSURANCE › Subchapter 33 - APPEALS FROM DENIAL OF AUTOMOBILE INSURANCE › Section 11:3-33.6 - Processing appeals

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Upon receipt of an appeal submitted in accordance with 11:3-33.5, the Department shall send to the insurer or insurance agent (the "respondent") who provided the written denial, a copy of all pertinent documents which have been submitted by applicant (the "appellant"), and shall require a final written reply from the respondent within 30 days of the receipt of these documents.
(b) Upon the Department's receipt of the respondent's reply to the appeal, and upon a review of the papers, the Department shall render its decision on the appeal. The decision shall be in writing and shall set forth the reasons why the denial was appropriate or inappropriate under law. Copies of the Department's decision shall be mailed by certified mail to the appellant and the respondent. The Department's decision shall also include a written notice explaining the procedures to appeal the decision pursuant to 11:3-33.7.
(c) A respondent's failure to timely reply pursuant to (a) above shall result in a decision by the Department based solely upon the papers submitted by the appellant, together with any other information available to the Department at that time, pursuant to this subchapter. A respondent's failure to timely reply pursuant to (a) above shall be deemed a violation of this subchapter and may result in the assessment of penalties provided in 11:3-33.8.
(d) Upon a determination by the Department that a denial was improper, the insurer shall be required to offer the applicant the requested coverage effective as of the date of the declination. The Department may, however, determine to require the insurer to offer coverage effective on a later date upon a finding that the applicant failed to maintain insurance on an automobile as required by 39:6B-1 or obtained replacement coverage. In the event the insured obtained comparable replacement coverage at a higher cost than the denied coverage, the Department may require the insurer to reimburse the insured for the difference.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 3 - AUTOMOBILE INSURANCE › Subchapter 33 - APPEALS FROM DENIAL OF AUTOMOBILE INSURANCE › Section 11:3-33.7 - Contested case hearings; pleadings

Current through Register Vol. 56, No. 14, July 15, 2024
(a) An appeal from a decision of the Department made pursuant to 11:3-33.6 shall be heard as a contested case pursuant to the Administrative Procedure Act, 52:14B-1 et seq., as implemented by the Uniform Administrative Procedure Rules, N.J.A.C. 1:1.
(b) The procedure for filing an appeal from the Department's decision pursuant to 11:3-33.6(c)  shall be as follows:
1. Upon receipt of the Department's decision, the insurer or agent denying coverage or the applicant denied automobile insurance coverage shall, within 20 calendar days of receipt of the decision, file with the Department a written request that the matter be heard as a contested case. Failure to file an appeal within the time required by this section shall result in the Department's decision becoming the final agency action. The written request for a hearing as a contested case shall contain the following information.
i. The name and address of the appellant;
ii. The Department's case or file number;
iii. If the appellant is the person denied insurance, the name and address of the insurance company and/or insurance agent which issued the denial of automobile insurance. If the appellant is the insurance company, the name and address of the insurance agent who issued the denial of coverage, if any, and the name and address of the person to whom automobile insurance was denied;
iv. A detailed statement explaining the reasons why the Department's determination is improper together with supporting documentation, if any; and
v. A statement as to whether the appellant is represented by legal counsel, or another person pursuant to 1:1-5.1, and the name, address and telephone number of said person.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 3 - AUTOMOBILE INSURANCE › Subchapter 33 - APPEALS FROM DENIAL OF AUTOMOBILE INSURANCE › Section 11:3-33.8 - Penalties

Current through Register Vol. 56, No. 14, July 15, 2024
Any insurer or insurance producer who violates any provision of this subchapter shall be subject to the penalties provided by law, including, but not limited to, the suspension or revocation of a certificate of authority or licensure and a civil penalty in an amount of up to $ 2,000 for the first violation and up to $ 5,000 for the second and each subsequent violation, pursuant to 17:33B-15 and 21.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 3 - AUTOMOBILE INSURANCE › Subchapter 33 - APPEALS FROM DENIAL OF AUTOMOBILE INSURANCE › Section 11:3-33.9 - Compliance

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Pursuant to 39:6A-3 and 17:33B-15, compliance with the provisions of this subchapter shall be effected in the following manner:
1. Appeals from denials concerning new policies on or after April 1, 1992 may be filed in the manner prescribed by this subchapter; and
2. Appeals from denials concerning policy renewals which take effect on or after April 1, 1992, may be filed in the manner prescribed by this subchapter.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 3 - AUTOMOBILE INSURANCE › Subchapter 34 - ELIGIBLE PERSONS QUALIFICATIONS AND AUTOMOBILE INSURANCE ELIGIBILITY POINTS SCHEDULE › Section 11:3-34.1 - Purpose

Current through Register Vol. 56, No. 14, July 15, 2024
The purpose of this subchapter is to set forth the requirements for determining who can qualify as an "eligible person," and to provide the schedule for "automobile insurance eligibility points" pursuant to 17:33B-13 and 14.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 3 - AUTOMOBILE INSURANCE › Subchapter 34 - ELIGIBLE PERSONS QUALIFICATIONS AND AUTOMOBILE INSURANCE ELIGIBILITY POINTS SCHEDULE › Section 11:3-34.2 - Scope

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The provisions of this subchapter apply to all insurers which write personal private passenger automobile insurance and all persons who are required to procure automobile insurance coverage in this State.
(b) Except to the extent that the definition of eligible and ineligible persons at 11:3-34.4 is utilized for nonrenewals pursuant to N.J.A.C. 11:3-8, this subchapter shall become inoperative on or after January 1, 2009, unless and until the Commissioner by Order makes the requirements of N.J.S.A. 17:33B-15a and b operative pursuant to the limited circumstances set forth in N.J.S.A. 17:33B-15d(3), upon a determination made after a hearing conducted pursuant to the Administrative Procedure Act, 52:14B-1 et seq., and Uniform Administrative Procedure Rules, N.J.A.C. 1:1, that a competitive market does not exist among insurers authorized to write private passenger automobile insurance in this State, or the Commissioner certifies by Order that the Personal Automobile Insurance Plan is insuring 10 percent or more of the aggregate number of private passenger automobile non-fleet exposures being written in this State. A notice of the issuance by the Commissioner of such an Order shall be published in the New Jersey Register.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 3 - AUTOMOBILE INSURANCE › Subchapter 34 - ELIGIBLE PERSONS QUALIFICATIONS AND AUTOMOBILE INSURANCE ELIGIBILITY POINTS SCHEDULE › Section 11:3-34.5 - Automobile insurance eligibility points

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Automobile insurance eligibility points shall be accumulated as a result of convictions, suspensions, revocations and determinations of responsibility for civil infractions in accordance with the schedule set forth in the Appendix to this subchapter herein incorporated by reference.
(b) Automobile eligibility points are cumulative and accrue for all violations and occurrences set forth on Schedules 1 and 2. Automobile insurance eligibility points shall be deemed to accrue as follows:
1. Points for an at-fault accident shall accrue on the date that total payment by the insurer equals or exceeds $ 1,000 or such other amount as may be prescribed by Order of the Commissioner issued pursuant to 17:33B-14. The amount under such Order shall be reflected in this paragraph through a notice of administrative change published in the New Jersey Register. An insurer may, at its option, use the date of the accident or date of first payment provided, however, that the insurer shall not underwrite or rate any policy based on the accident until total payment by the insurer equals or exceeds $ 1,000, and further provided that the insurer shall use the optional date consistently in all cases.
2. Points for conviction of motor vehicle violations and other events that are set forth on an abstract of drivers license records available from the New Jersey Motor Vehicle Commission, or a comparable agency of another state, shall accrue when the event is recorded in the agency's records as evidenced by an abstract.
3. When an eligible person is involved in an at-fault accident and has not accrued any eligibility points during the three-year period immediately preceding the date of that accident, no eligibility points for a two- or three-point violation, as set forth in Schedule 2 of the Appendix, shall accrue along with the points assessed in accordance with Schedule 1 for the at-fault accident, when the violation arises out of the same incident which results in the assessment of points for the at-fault accident. However, violations that arise out of the same incident may be considered by insurers for purposes of tier placement pursuant to N.J.A.C. 11:3-19A.
4. Points for each full year of court-imposed driver's license suspension within the preceding three years and points for each full year within the immediately preceding three years that a person has not held a driver's license shall accrue on the date of application for insurance. However, in accordance with Schedule 1, eligibility points assessed for failure to hold a drivers' license in the previous three years are not cumulative to points assessed for the suspension of a drivers license.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 3 - AUTOMOBILE INSURANCE › Subchapter 36 - AUTOMOBILE PHYSICAL DAMAGE INSURANCE INSPECTION PROCEDURES › Section 11:3-36.1 - Purpose and scope

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The purpose of this subchapter is to provide rules for the inspection of automobiles in connection with the issuance of physical damage insurance coverage by insurers pursuant to 17:33B-33 through 17:33B-40.
(b) The provisions of this subchapter apply to all insurers which write private passenger automobile insurance in this State.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 3 - AUTOMOBILE INSURANCE › Subchapter 36 - AUTOMOBILE PHYSICAL DAMAGE INSURANCE INSPECTION PROCEDURES › Section 11:3-36.3 - Mandatory inspection requirements

Current through Register Vol. 56, No. 14, July 15, 2024
(a) No insurer shall provide automobile physical damage insurance coverage prior to conducting an insurance inspection in accordance with this subchapter, under the following circumstances:
1. When a new policy or endorsement adding physical damage coverage insuring a private passenger automobile is effected; and
2. When coverage is effected for an additional or replacement private passenger automobile.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 3 - AUTOMOBILE INSURANCE › Subchapter 36 - AUTOMOBILE PHYSICAL DAMAGE INSURANCE INSPECTION PROCEDURES › Section 11:3-36.4 - Waivers of mandatory inspection

Current through Register Vol. 56, No. 14, July 15, 2024
(a) An insurer shall waive a mandatory inspection when a new automobile is purchased from a franchised automobile dealership and the insurer is provided with the following documents in accordance with 11:3-36.7(e):
1. A copy of the bill of sale which contains a full description of the automobile, including all options and accessories;
2. A copy of the window sticker or advanced dealer shipping notice (invoice) showing the itemized options and equipment, the total retail price of the automobile, and any dealer installed option purchased by the customer; or
3. Vehicle buyer's order (contract) and/or the dealership invoice to the buyer, including all options and accessories.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 3 - AUTOMOBILE INSURANCE › Subchapter 36 - AUTOMOBILE PHYSICAL DAMAGE INSURANCE INSPECTION PROCEDURES › Section 11:3-36.5 - Deferral of inspections

Current through Register Vol. 56, No. 14, July 15, 2024
(a) An insurer, by itself or through its authorized producers, may defer the mandatory inspection required by 11:3-36.3 for seven calendar days following the effective date of coverage, upon an insured's requests for coverage for automobile physical damage insurance on an additional or replacement automobile.
(b) An insurer may defer the mandatory inspection under any of the following circumstances:
1. On new business for seven calendar days following the effective date of coverage. For purposes of this paragraph, the calculation of seven days shall commence the day after coverage becomes effective; and
2. On replacement automobiles, an insurer may provide the same type and level of physical damage coverage which covered the replaced automobile, without a request for coverage by the insured. Such automatic coverage prior to the insured's request for coverage shall be for a period of three days, including the day on which the automobile is acquired. The three-day period shall be extended by one day for each Saturday, Sunday or any New Jersey State legal holiday falling within the period. The insurer's election shall apply only to automobiles replacing covered automobiles which were insured by the insurer for physical damage coverage for at least the 12-month period preceding the replacement date and such election once made shall apply to all the insurer's private passenger automobile insurance. An insurer which makes an election pursuant to this clause shall file an appropriate policy endorsement with the Commissioner and furnish a copy of such endorsement to all of its insureds who have physical damage coverage.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 3 - AUTOMOBILE INSURANCE › Subchapter 36 - AUTOMOBILE PHYSICAL DAMAGE INSURANCE INSPECTION PROCEDURES › Section 11:3-36.6 - Standards and procedures for inspection

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Inspections shall be made by an authorized representative of the insurer at a time and place reasonably convenient to the insured. A reasonably convenient time shall include, in addition to customary business hours, sufficient early morning, evening and weekend hours. A reasonably convenient place shall not be more than 10 miles from the city or town where automobile is principally garaged.
(b) If the insured acquires an additional or replacement automobile outside of New Jersey, and such automobile will be located outside New Jersey until after the expiration of the deferral period permitted by 11:3-36.5(a) or (b), the insurer shall arrange to conduct the inspection by an authorized representative during the deferral period at a place which shall not be more than 50 miles from the temporary location.
(c) If the insured automobile required to be inspected upon renewal is temporarily located outside of New Jersey when the required notice of inspection is mailed to the insured, and such automobile will continue to be located outside of New Jersey until the expiration of the deferral period required by 11:3-36.5(e)1, the insurer shall arrange to conduct the inspection by an authorized representative before the expiration of the deferral period at a place which shall not be more than 50 miles from the temporary location.
(d) Whenever an insurer requires an automobile to be inspected pursuant to this subchapter, the insurer by itself or through its authorized producer shall provide the insured with a Notice of Inspection in the form set forth in Appendix B or an Acknowledgement of Requirement for Insurance Inspection as set forth in Appendix A. Any form so provided shall not contain the vehicle identification number (VIN) of the automobile to be inspected.
(e) The inspection shall include the following:
1. Completion of the Automobile Insurance Inspection Report as set forth in Appendix C incorporated herein by reference;
2. Two color photographs of the automobile, taken as directed on the inspection report (Appendix C), which shall be a part of the report;
3. A third close-up color photograph showing the VIN located on the Environmental Protection Agency/Federal Certification Label (EPA sticker) affixed to the driver's side door jamb. The photograph must be of sufficient clarity that the information contained on the EPA sticker and VIN is legible. If the EPA sticker is damaged, faded, missing or otherwise not legible, a photograph of the EPA sticker, or of the area of the door jamb where the sticker is normally located, is still required;
4. The authorized representative may take additional photographs showing any damaged areas, which shall also be a part of the report; and
5. The authorized representative shall provide a copy of the report, without photographs, to the insured at the time of inspection.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 3 - AUTOMOBILE INSURANCE › Subchapter 36 - AUTOMOBILE PHYSICAL DAMAGE INSURANCE INSPECTION PROCEDURES › Section 11:3-36.7 - Suspension of physical damage coverages

Current through Register Vol. 56, No. 14, July 15, 2024
(a) If the inspection is not conducted prior to the expiration of the deferral period or the expiration of the policy in the case of renewals, the insurer shall suspend automobile physical damage coverage on the automobile at 12:01 A.M. of the day following the last day for inspection. Suspension of coverage shall apply to all insureds, owners and lienholders.
(b) Whenever physical damage coverage is suspended, the insurer shall:
1. No later than the 30th calendar day after the effective date of the suspension, mail to the insured, the producer of record and any lienholders a Notice of Suspension of physical damage coverage (as set forth in Appendix D incorporated herein by reference);
2. Obtain a certificate of mailing or other evidence of mailing of the Notice of Suspension to the insured and shall retain the certificate and copy of the Notice in the insurer's file on the insured; and
3. Make a pro-rata premium adjustment (premium refund or credit) whenever there is a suspension of physical damage coverage for more than 10 days. A refund of premium, if applicable, shall be sent to the insured within 45 days of the effective date of suspension.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 3 - AUTOMOBILE INSURANCE › Subchapter 36 - AUTOMOBILE PHYSICAL DAMAGE INSURANCE INSPECTION PROCEDURES › Section 11:3-36.8 - Enforcement

Current through Register Vol. 56, No. 14, July 15, 2024
(a) A violation of any provision of this subchapter by an insurer shall be punishable by a $ 500.00 fine pursuant to 17:33B-39.
1. Insurers shall be responsible for the conduct of their authorized representatives with respect to all duties imposed by this subchapter.
2. Each issuance, procurement, or negotiation of a policy of insurance, or maintenance of a record in violation of this subchapter shall be deemed a separate offense.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 3 - AUTOMOBILE INSURANCE › Subchapter 36 - AUTOMOBILE PHYSICAL DAMAGE INSURANCE INSPECTION PROCEDURES › Section 11:3-36.9 - Results and audits

Current through Register Vol. 56, No. 14, July 15, 2024
Insurers shall maintain records as to the costs and savings related to this subchapter and make such records available to the Department upon request.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 3 - AUTOMOBILE INSURANCE › Subchapter 36 - AUTOMOBILE PHYSICAL DAMAGE INSURANCE INSPECTION PROCEDURES › Section 11:3-36.10 - Severability

Current through Register Vol. 56, No. 14, July 15, 2024
If any section or portion of a section of this subchapter or its application to any person, entity or circumstance is held invalid by any court, the remainder of this regulation or the applicability of such provisions to other persons, entities or circumstances shall not be affected thereby.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 3 - AUTOMOBILE INSURANCE › Subchapter 36 - AUTOMOBILE PHYSICAL DAMAGE INSURANCE INSPECTION PROCEDURES › Section 11:3-36.11 - Required amendatory endorsements

Current through Register Vol. 56, No. 14, July 15, 2024
(a) For all policies providing automobile physical damage coverage issued on or after June 1, 1991, or renewed on or after July 1, 1991, insurers may adopt any one of the following procedures:
1. Amend the policy by adding thereto the endorsements as set out in (c) below, which may include the option set forth in (d) below and which is hereby deemed approved upon filing with the Department;
2. Submit for Department approval the insurer's own similar endorsement; or
3. Submit for Department approval the insurer's basic policy form incorporating the substance of the endorsements set out in (c) below, which may include the option set forth in (d) below.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 3 - AUTOMOBILE INSURANCE › Subchapter 37 - ORDER OF BENEFIT DETERMINATION BETWEEN AUTOMOBILE PERSONAL INJURY PROTECTION AND HEALTH INSURANCE › Section 11:3-37.1 - Purpose and scope

Current through Register Vol. 56, No. 14, July 15, 2024
The purpose of this subchapter is to establish guidelines for the order of benefit determination between a plan of health insurance and personal injury protection provided through an automobile policy pursuant to 39:6A-4, when a named insured elects to have his or her personal injury protection become secondary coverage for the provision of benefits for medical expenses incurred due to injuries sustained in an automobile accident. This subchapter also sets forth the requirements for the order of benefit determination between a plan of health insurance and personal injury protection provided pursuant to 39:6A-4 or 39:6A-3.1, when personal injury protection is primary coverage. The provisions of this subchapter shall apply to all automobile policies, as that term is defined at N.J.S.A. 39:6A-2a, issued to New Jersey residents, or renewed on or after January 1, 1991, and to all health benefits plans which have been or will be delivered or issued for delivery in this State.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 3 - AUTOMOBILE INSURANCE › Subchapter 37 - ORDER OF BENEFIT DETERMINATION BETWEEN AUTOMOBILE PERSONAL INJURY PROTECTION AND HEALTH INSURANCE › Section 11:3-37.3 - Health benefits providers

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Nothing in this subchapter shall be construed as requiring any health benefits provider to offer, provide, or continue coverage to or for any individual or group, except as may be set forth by other laws of this State, or of the Federal government.
(b) Nothing in this subchapter shall be construed as requiring any health benefits provider to provide coverage for any treatment or service not otherwise covered under the terms of the applicable health benefits plan.
(c) No health benefits contract or policy delivered or issued for delivery in this State, or renewed, continued or converted on or after January 1, 1991, shall contain any provision, rider, waiver of endorsement or other instrument which restricts, limits or excludes coverage, directly or indirectly, of services or expenses otherwise eligible under the policy or contract on the grounds that such expenses or services would be covered under an automobile policy PIP provision for which the insured would be eligible had the named insured on the automobile policy not selected the PIP-as-secondary coverage option.
(d) No health benefits contract or policy delivered or issued for delivery in this State, or renewed, continued or converted on or after January 1, 1991, shall contain any provision, rider, waiver or endorsement, or other instrument which restricts, limits or excludes coverage, directly or indirectly, of services or expenses otherwise eligible under the policy or contract on the grounds that:
1. Such expenses arise from an automobile-related injury;
2. Such expenses are covered or paid by PIP; or
3. Such expenses are covered or paid by OSAIC except for reductions in benefits when the health benefits contract provides secondary coverage as defined in and permitted by this rule.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 3 - AUTOMOBILE INSURANCE › Subchapter 37 - ORDER OF BENEFIT DETERMINATION BETWEEN AUTOMOBILE PERSONAL INJURY PROTECTION AND HEALTH INSURANCE › Section 11:3-37.4 - Application of the PIP-as-secondary coverage option

Current through Register Vol. 56, No. 14, July 15, 2024
(a) When a named insured elects the PIP option, whereby the named insured intends that medical expenses incurred for treatment of an injury are to be covered by a health benefits provider or providers, as evidenced on the Coverage Selection Form, then the medical expense provisions of the PIP coverage shall be considered to be secondary coverage for the purposes of the order of benefit determination, and all health benefits plans of an insured subject to the PIP option elected shall be considered to be primary coverage.
(b) The election by the named insured to make PIP medical expense provisions secondary coverage shall apply to only the named insured and family members of the named insured who reside in the named insured's household and are not named insureds under other automobile policies.
(c) The election by the named insured to make PIP medical expense provisions secondary coverage shall continue in force as to subsequent renewal or replacement policies until the automobile policy insurer or its authorized representative receives a properly executed written request revoking the selection of this option.
(d) In the event that an insured is ineligible for health plan coverage of medical expenses, or is eligible for coverage under a dental expense or dental service plan only when an injury occurs, despite the selection of the PIP-as-secondary coverage option by the named insured, benefits shall be provided to the insured through PIP coverage in accordance with 11:3-37.8.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 3 - AUTOMOBILE INSURANCE › Subchapter 37 - ORDER OF BENEFIT DETERMINATION BETWEEN AUTOMOBILE PERSONAL INJURY PROTECTION AND HEALTH INSURANCE › Section 11:3-37.5 - Health benefit plan standards and the PIP premium reduction

Current through Register Vol. 56, No. 14, July 15, 2024
(a) An automobile insurer may eliminate the premium reduction on the base rate applicable to the amount of medical expense benefit chosen in conjunction with the PIP-as-secondary coverage option election if the automobile insurer complies with (b) below, and verifies that the coverage specified by the named insured:
1. Excludes the provision of benefits for treatment of injuries of an eligible insured when expenses incurred in relation to treatment of those injuries are eligible expenses under an automobile policy's PIP provisions; or
2. Provides that it is always secondary, or otherwise will not be a primary provider of benefits;
3. Provides benefits only for dental expenses or dental services; or
4. Provides benefits only for prescription drugs.