reglab/statecodes huggingface dataset:
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 04 - CONSUMER SERVICES DIVISION › Section .0100 - GENERAL PROVISIONS › Section 04 .0121 - PREMIUM PAYMENT RECEIPTS

Current through Register Vol. 39, No. 2, July 15, 2024
All premium payment receipts and copies issued by an agent,
				  broker, or limited representative, shall be dated and contain the printed or
				  stamped name and address of the agency or agent, broker, or limited
				  representative, and the name of the insurer. Receipts shall be signed by the
				  person accepting the payment.
Authority
				  G.S.
				  58-2-40;
				  58-2-185;
				  58-2-195;
Eff.
				  February 1, 1993;
Amended Eff. February 1, 1996;
Readopted Eff. October 1, 2021.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 04 - CONSUMER SERVICES DIVISION › Section .0100 - GENERAL PROVISIONS › Section 04 .0122 - POWER-OF-ATTORNEY

Current through Register Vol. 39, No. 2, July 15, 2024
Except for authorizations given in accordance with
				  G.S.
				  58-45-35(a) or
				  G.S.
				  58-46-15, no agent, broker, or limited
				  representative shall solicit a power-of-attorney from a consumer that
				  authorizes the agent, broker, or limited representative to sign
				  insurance-related forms.
Authority
				  G.S.
				  58-2-40;
				  58-2-195;
Eff.
				  February 1, 1993;
Readopted Eff. October 1,
				  2021.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 04 - CONSUMER SERVICES DIVISION › Section .0100 - GENERAL PROVISIONS › Section 04 .0123 - USE OF SPECIFIC COMPANY NAME IN RESPONSES

Current through Register Vol. 39, No. 2, July 15, 2024
When an insurer makes a written response to an inquiry by the
				  Division or complaint made by a consumer, the insurer shall identify on its
				  response:
(1) its mailing
				address;
(2) official corporate
				name of the company against which the complaint is made;
(3) the NAIC company code; and
(4) specific corporate name if the insurer is
				part of a group of companies.
Authority
				  G.S.
				  58-2-40;
				  58-2-190;
				  58-3-50;
				  58-63-65;
Eff. April
				  1, 1995;
Amended Eff. February 1, 1996;
Readopted Eff.
				  November 1, 2021.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 04 - CONSUMER SERVICES DIVISION › Section .0100 - GENERAL PROVISIONS › Section 04 .0124 - INSURANCE COMPANY CONTACT PERSONS

Current through Register Vol. 39, No. 2, July 15, 2024
(a) Every
				insurer shall provide the Division with company contact information using a
				form provided by the Division, which shall include the name, title, address,
				and telephone number, including a toll-free number, of a designated person to
				whom any person may send a complaint or inquiry, and the company president's
				name, address, and telephone number for the Division's use.
(b) The form shall be completed, signed by a
				corporate officer, and returned to the Division by every insurer.
(c) A new form must be filed with the
				Division within 15 business days after any change in the information on the
				form.
Authority
				  G.S.
				  58-2-40;
				  58-2-190;
				  58-63-65;
Eff. April
				  1, 1995;
Amended Eff. February 1, 1996;
Readopted Eff.
				  November 1, 2021.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 04 - CONSUMER SERVICES DIVISION › Section .0200 - MARKET CONDUCT EXAMINATION › Section 04 .0201-0202

Current through Register Vol. 39, No. 2, July 15, 2024
Filed as an Emergency
				  Repeal Eff. April 25, 1979, for a Period of 120 Days to be Reinstated on August
				  23, 1979;
Authority
				  G.S.
				  57-10;
				  57A-18;
				  58-7.3;
				  58-9;
				  58-9.2;
				  58-18;
				  58-25;
				  58-16;
				  58-16.2;
				  58-63;
				  58-25.1;
				  58-26;
				  58-27;
				  58-296;
Eff. February
				  1, 1976;
Readopted Eff. March 16, 1979;
Repealed Eff.
				  August 23, 1979;
Transferred Eff. August 14,
				  1986.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 04 - CONSUMER SERVICES DIVISION › Section .0200 - MARKET CONDUCT EXAMINATION › Section 04 .0205 - FUNCTION OF SECTION

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
				  G.S.
				  57-10;
				  57A-18;
				  58-7.3;
				  58-9;
				  58-9.2;
				  58-16;
				  58-25;
				  58-25.1;
				  58-26;
58-27;
				  58-296;
Eff. December 15, 1979;
Transferred to T11.11G;
				  Eff. August 14, 1986.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 04 - CONSUMER SERVICES DIVISION › Section .0200 - MARKET CONDUCT EXAMINATION › Section 04 .0206 - REPORT AND COLLECTION PROCEDURES

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
				  G.S.
				  57-10;
				  58-16;
				  58-16.2;
				  58-18;
				  58-63;
Eff. December
				  15, 1979;
Transferred to T11.11G; Eff. August 14,
				  1986.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 04 - CONSUMER SERVICES DIVISION › Section .0200 - MARKET CONDUCT EXAMINATION › Section 04 .0207 - MAINTENANCE OF RECORDS

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
				  G.S.
				  57-10;
				  58-9;
				  58-9.2;
				  58-15;
				  58-25;
				  58-25.1;
				  58-26;
				  58-27;
Eff. December
				  15, 1979;
Transferred to T11.11G; Eff. August 14,
				  1986.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 04 - CONSUMER SERVICES DIVISION › Section .0200 - MARKET CONDUCT EXAMINATION › Section 04 .0208 - COMPLAINT RECORDS

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
				  G.S.
				  57-10;
				  58-9;
				  58-16;
				  58-25.1;
				  58-26;
				  58-27;
				  58-54.5;
				  58-54.6;
Eff. December
				  15, 1979;
Transferred to T11.11G; Eff. August 14,
				  1986.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 04 - CONSUMER SERVICES DIVISION › Section .0300 - LIFE: ACCIDENT AND HEALTH › Section 04 .0301-0309

Current through Register Vol. 39, No. 2, July 15, 2024
Filed as an Emergency
				  Repeal Eff. April 25, 1979, for a Period of 120 Days to be Reinstated on August
				  23, 1979;
Authority
				  G.S.
				  57-1;
				  57-4;
				  57-10;
				  58-9;
				  58-25.1;
				  58-26;
				  58-27;
				  58-42.1;
				  58-207;
				  58-251.1;
				  58-251.4;
				  58-260.1;
Eff.
				  February 1, 1976;
Readopted Eff. March 16, 1979;
Repealed Eff. August 23, 1979.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 04 - CONSUMER SERVICES DIVISION › Section .0300 - LIFE: ACCIDENT AND HEALTH › Section 04 .0310 - REPEALED - CLAIM PRACTICES: PROCEDURES: LIFE: ACCIDENT: HEALTH

Current through Register Vol. 39, No. 2, July 15, 2024
Filed as an Emergency
				  Repeal Eff. April 25, 1979, for a Period of 120 Days to be Reinstated on August
				  23, 1979;
Authority
				  G.S.
				  57-1;
				  57-4;
				  58-9;
				  58-54.3;
Eff. March
				  16, 1979;
Repealed Eff. August 23,
				  1979.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 04 - CONSUMER SERVICES DIVISION › Section .0300 - LIFE: ACCIDENT AND HEALTH › Section 04 .0311 - REPEALED - FUNCTION OF SECTION

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
				  G.S.
				  57-1, -4; 58-9, -262.4;
Eff.
				  December 15, 1979;
Repealed Eff. July 1,
				  1988.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 04 - CONSUMER SERVICES DIVISION › Section .0300 - LIFE: ACCIDENT AND HEALTH › Section 04 .0312 - INFORMATION USED IN CLAIM SETTLEMENTS

Current through Register Vol. 39, No. 2, July 15, 2024
(a) Any
				information, including medical information, used in whole or in part as the
				basis of settling a life, accident, health, or disability claim shall be
				provided to the Division as requested in connection with a complaint or injury.
				The delivery method may include a secure electronic portal provided by the
				Division.
(b) To the extent
				permitted by law, the Department shall treat medical information as
				confidential.
Authority
				  G.S.
				  58-2-40;
				  58-2-190;
				  58-2-195;
				  58-2-200;
				  58-63-20;
				  58-65-105;
				  58-67-65;
				  58-67-150;
Eff.
				  December 15, 1979;
Amended Eff. April 1, 1989;
Readopted Eff. November 1, 2021.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 04 - CONSUMER SERVICES DIVISION › Section .0300 - LIFE: ACCIDENT AND HEALTH › Section 04 .0313 - PROVISIONS OF CONTRACTS

Current through Register Vol. 39, No. 2, July 15, 2024
The following phrases and provisions, found in life,
				  accident, health, and disability contracts, if not defined in the contracts,
				  shall be construed by the Department in the following manner:
(1) Regular Care and Attendance of a
				Physician. As used in life, accident, health, and disability policies, "regular
				care and attendance of a physician" shall not be construed to require insureds
				to see or be under the care of a physician on a regular basis if it can be
				shown that the insured has reached his or her maximum point of recovery yet is
				still disabled under the terms of the insurance contract. This requirement
				shall not restrict the right of the insurer, at its own expense, to examine or
				cause to have examined the insured according to the terms of the contract of
				insurance.
(2) Premature Baby. A
				premature baby shall not be considered a well baby. The protection afforded
				newborn infants under
				G.S.
				58-51-30 shall be provided to premature
				babies.
(3) Medical Necessity.
				"Medical necessity" shall be construed as including treatment that restores not
				only the insured's physical but also his or her mental well-being. As used in
				this Item, "restoration of mental well-being" does not require coverage of
				psychiatric disorders when those disorders are excluded under the express terms
				of the contract.
(4) Sound Health.
				The question, "Are you in sound health?" shall be considered ambiguous, and
				therefore answers to that question on an insurance application shall not be
				used as the basis for rescission of a policy or denial of a claim.
Authority
				  G.S.
				  58-2-40;
				  58-3-150;
				  58-51-1;
				  58-63-15;
				  58-63-65;
				  58-65-1;
				  58-65-40;
				  58-67-65;
				  58-67-150;
Eff.
				  December 15, 1979;
Amended Eff. July 1, 2012; April 8, 2002; April
				  1, 1989;
Readopted Eff. November 1,
				  2021.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 04 - CONSUMER SERVICES DIVISION › Section .0300 - LIFE: ACCIDENT AND HEALTH › Section 04 .0314 - PREMIUM NOTICES: PAYMENTS AND REFUNDS

Current through Register Vol. 39, No. 2, July 15, 2024
The Commissioner shall consider an unfair trade practice the
				  failure by an insurer to adhere to any of the following procedures concerning
				  premium notices, payments and refunds on life, accident, health, or disability
				  policies pursuant to
				  G.S.
				  58-63-15:
(1) Premium Notices. Any insurer that makes a
				practice of sending premium notices shall maintain records to show that it
				mailed or otherwise delivered the notice to an individual insured or policy
				owner.
(2) Timely Remittance.
				Insurance companies shall use date of mailing, rather than date of receipt, to
				determine whether the insured has made timely remittance of premium, provided
				the premium payment is received within seven days after either the termination
				date of the policy or the last day of its grace period, whichever is
				later.
(3) Right to Return Policy.
				When this right is given by contract or statute, no insurer shall abridge or
				frustrate the right of the insured to return a policy within 10 days after he
				or she receives it for a full refund of premiums paid. Evidence of such
				delivery shall be signed statements from the policyowner of the date of
				delivery, copies of signed certified mail receipt, certification of mailing, or
				firm mailing book entry.
(4)
				Unearned Premium Refund. When this right is given by contract or statute, no
				insurer shall abridge or frustrate the right of the insured to receive a refund
				of unearned premium.
(5) Unearned
				Premium on Health Policies. When an insured covered by an accident, health or
				disability policy dies during the term of the policy, his or her insurer shall
				refund the unearned premium.
(6)
				Commingling. No licensed person may commingle premiums, insurance deposits or
				other such funds. These funds are received in a fiduciary capacity on behalf of
				policyowner and must be immediately forwarded to the proper insurers or be
				deposited into an authorized account that is separate and distinct from the
				person's operating or personal accounts. The account shall be used to receive
				and disburse premiums paid for insurers, return premiums to policyowner, pay
				bank charges for the account, and transfer of earned commissions or
				fees.
Authority
				  G.S.
				  58-2-40;
				  58-2-195;
				  58-51-10;
				  58-51-15;
				  58-63-65;
				  58-65-40;
				  58-67-50;
				  58-67-65;
				  58-67-150;
				  58-63-40;
Eff.
				  December 15, 1979;
Amended Eff April 1, 1989;
Readopted
				  Eff. December 1, 2021.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 04 - CONSUMER SERVICES DIVISION › Section .0300 - LIFE: ACCIDENT AND HEALTH › Section 04 .0315 - ISSUANCE OF CONTRACTS

Current through Register Vol. 39, No. 2, July 15, 2024
The Commissioner shall consider an unfair trade practice the
				  failure by an insurer to adhere to any of the following procedures with respect
				  to the issuance of life, accident, health, or disability policies pursuant to
				  G.S.
				  58-63-15:
(1) Policies to Cover Newborn Infants. No
				health application or requirements of insurability shall be used to circumvent
				the requirements of North Carolina
				General
				Statute 58-51-30.
(2) Rating of Guaranteed Issue Coverages.
				There shall be no rating of policies where guaranteed issue at a specified rate
				is to the public. When only guaranteed issue is presented for sale, the insurer
				shall disclose in writing to any applicant subjected to individual rating
				because the applicant did not qualify for guaranteed issue, the fact that his
				or her rate deviates from the specified rate for the guaranteed issue coverage.
				This Item shall not apply to individual policies issued to employees under a
				contract between their employer and his or her insurer.
(3) Replacement of Existing Coverage. With
				respect to individual accident, health and disability coverages, when an
				insurer's agent, by misrepresenting the new policy as a supplement or addition
				to the existing policy, induces an insured to consent to the replacement of his
				or her existing policy with a new policy, new waiting periods shall be
				decreased by the amount of time coverage was afforded under the existing
				policy.
(4) Continuous Coverage
				Under Credit Life, Accident and Health Policies. In a series of credit life or
				credit accident and health insurance transactions where the insured, the
				lender, and the insurer are the same and there is no lapse in coverage between
				transactions, the waiting periods of the insurance agreements shall run from
				the date of the first insurance contract, at least to the extent of the amount
				and term of the indebtedness outstanding at the time of renewal or
				refinancing.
Authority
				  G.S.
				  58-2-40;
				  58-3-125;
				  58-3-150;
				  58-33-75;
				  58-51-30;
				  58-63-40;
				  58-65-40;
				  58-67-50;
				  58-67-65;
				  58-67-150;
Eff.
				  December 15, 1979;
Amended Eff. April 8, 2002; April 1, 1989;
				  December 15, 1979;
Readopted Eff. December 1.
				  2021.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 04 - CONSUMER SERVICES DIVISION › Section .0300 - LIFE: ACCIDENT AND HEALTH › Section 04 .0316 - CONTESTABILITY CLAUSE AND RESCISSION

Current through Register Vol. 39, No. 2, July 15, 2024
If an insurer does not attempt to rescind an accident,
				  health, or disability policy upon becoming aware that the insured's application
				  contained false statements, the insurer may not subsequently use such false
				  statements as a basis for attempted rescission or alteration of the policy. The
				  Commissioner shall consider failure to adhere to this principle an unfair trade
				  practice pursuant to
				  G.S.
				  58-63-15.
Authority
				  G.S.
				  58-2-40;
				  58-63-40;
				  58-65-1;
				  58-63-15;
				  58-65-40;
Eff.
				  December 15, 1979;
Readopted Eff. December 1,
				  2021.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 04 - CONSUMER SERVICES DIVISION › Section .0300 - LIFE: ACCIDENT AND HEALTH › Section 04 .0317 - SEX DISCRIMINATION: LIFE: ACCIDENT AND HEALTH INSURANCE

Current through Register Vol. 39, No. 2, July 15, 2024
(a) Prohibited Practices. The Commissioner
				shall consider unfair discrimination the denial of life, accident, health or
				disability insurance on the basis of the insured's or prospective insured's sex
				or marital status. The amount of benefits payable on any term, condition or
				type of coverage shall not be restricted, modified, excluded or reduced on the
				basis of the sex or marital status of the insured or prospective insured. All
				underwriting criteria shall be applied in all instances of similar
				circumstances without regard to the sex or marital status of the insured or
				prospective insured, except to the extent that the amount of the benefits,
				terms, conditions or type of coverage vary as a result of the application of
				rate or premium differentials not prohibited under this Chapter, such as
				differentials for life insurance or annuities derived from sex-based life
				expectancy tables. Nothing in this Paragraph shall prohibit an insurer from
				taking marital status into account for the purpose of determining persons
				eligible for dependent benefits. Examples of the practices prohibited by this
				Section include:
(1) denying coverage to
				females employed at home, employed part-time or employed by relatives when
				coverage is offered to males similarly employed;
(2) denying policy riders to females when the
				riders are available to males;
(3)
				denying maternity coverage to unmarried females covered under a policy or
				contract if maternity coverage is available to married females covered under
				that policy or contract;
(4)
				denying, under group contracts, dependent coverage to husbands of female
				employees, when dependent coverage is available to wives of male
				employees;
(5) denying disability
				income contracts to employed women when coverage is offered to men similarly
				employed;
(6) treating
				complications of pregnancy differently from any other illness or sickness under
				the contract;
(7) restricting,
				reducing, modifying, or excluding benefits payable for disorders of the genital
				organs of only one sex;
(8)
				offering lower maximum monthly benefits to women than to men who are in the
				same classification under a disability income contract;
(9) offering more restrictive benefit periods
				and more restrictive definitions of disability to women than to men in the same
				classifications under a disability income contract;
(10) establishing different conditions by sex
				under which the policyholder may exercise benefit options contained in the
				contract; and
(11) limiting the
				amount of coverage an insured or prospective insured may purchase based upon
				the insured's or prospective insured's marital status unless such limitation is
				for the purpose of defining persons eligible for dependent benefits.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 04 - CONSUMER SERVICES DIVISION › Section .0300 - LIFE: ACCIDENT AND HEALTH › Section 04 .0319 - CLAIMS PRACTICES: LIFE: ACCIDENT AND HEALTH INSURANCE

Current through Register Vol. 39, No. 2, July 15, 2024
The Commissioner shall consider as prima facie violative of
				  G.S.
				  58-63-15(11) the failure by
				  an insurer to adhere to the following procedures concerning settlement of life,
				  accident, health and claims:
(1)
				Examining Physician's Opinion. When the patient's health is in question, an
				insurer shall give greater weight to the opinion of a physician who has
				examined the patient than to the opinion of a physician who has not examined
				the patient and whose opinion is based solely on a review of the examining
				physician's notes or reports. As used in this Item, "examination of the
				patient" shall include the interpretation by a specialist of the results of
				diagnostic tests performed on the patient by others.
(2) Settlement Offers. Initial offers of
				settlement or compromise made by an insurer or its representative shall remain
				open for a period of time of not less than 30 calendar days.
(3) Multiple Health Impairments. When an
				insured is confined to the hospital with multiple health impairments some of
				which are excluded from coverage, the insurer or its representative shall make
				pro rata payments where treatment for excluded conditions can be
				separated.
(4) Assignment of
				Benefits. If an accident, health, or disability contract does not prohibit
				assignment of benefits and an assignment including notice to the insurer prior
				to the payment of the claim, is made, the insurer shall honor the assignment,
				even though it may have erroneously paid the insured. Submission of a completed
				claims form indicating that an assignment is on file shall be treated as though
				it were submission of the actual assignment.
(5) Claim Status Reports. Health insurance
				claims subject to 58-3-225 shall be processed in accordance with the provisions
				of that statute. Otherwise, if benefits claimed under an accident, health, or
				disability contract have not been paid within 45 days after receipt of the
				initial claim by the insurer, the insurer shall at that time mail a claim
				status report to the insured.
Authority
				  G.S.
				  58-2-40;
				  58-3-225;
				  58-63-15;
				  58-63-65;
				  58-65-1;
				  58-65-40;
				  58-65-125;
				  58-67-65;
				  58-67-150;
Eff.
				  December 15, 1979;
Amended Eff. July 1, 2012; April 8, 2002; April
				  1, 1989;
Readopted Eff. December 1,
				  2021.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 04 - CONSUMER SERVICES DIVISION › Section .0300 - LIFE: ACCIDENT AND HEALTH › Section 04 .0320 - REPEALED - STUDENT LOANS

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
				  G.S.
				  58-2-40;
				  58-3-135;
				  58-3-150;
Eff. July 1,
				  1986;
Amended Eff. April 8, 2002; April 1, 1989;
Repealed Eff. November 1, 2021.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 04 - CONSUMER SERVICES DIVISION › Section .0400 - PROPERTY AND LIABILITY › Section 04 .0401-0404

Current through Register Vol. 39, No. 2, July 15, 2024
Filed as an Emergency
				  Repeal Eff. April 25, 1979, for a Period of 120 Days to be
				  Reinstated
on August 23, 1979;
Authority
				  G.S.
				  58-9;
				  58-30.3;
				  58-30.4;
				  58-32;
				  58-72(4) through
				  -72(22); 58-131.56;
58-131.57; 58-248.26; 58-248.31; 58-248.32;
				  58-248.36; 20-310;
Eff. February 1, 1976;
Readopted
				  Eff. March 16, 1979;
Repealed Eff. August 23,
				  1979.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 04 - CONSUMER SERVICES DIVISION › Section .0400 - PROPERTY AND LIABILITY › Section 04 .0405-0413

Current through Register Vol. 39, No. 2, July 15, 2024
Filed as an Emergency
				  Repeal Eff. April 25, 1979, for a Period of 120 Days to be
				  Reinstated
on August 23, 1979;
Authority
				  G.S.
				  58-9;
				  58-30.3;
				  58-30.4;
				  58-39;
				  58-44.3;
				  58-54;
				  58-54.4;
				  58-131.37;
Eff. March
				  16, 1979;
Repealed Eff. August 23,
				  1979.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 04 - CONSUMER SERVICES DIVISION › Section .0400 - PROPERTY AND LIABILITY › Section 04 .0414 - REPEALED - FUNCTION OF SECTION

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
				  G.S.
				  58-7.3, -9, -72;
Eff. December
				  15, 1979;
Repealed Eff. July 1,
				  1988.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 04 - CONSUMER SERVICES DIVISION › Section .0400 - PROPERTY AND LIABILITY › Section 04 .0415 - SAFE DRIVER INCENTIVE PLAN

Current through Register Vol. 39, No. 2, July 15, 2024
The following are Department of Insurance provisions
				  regarding the Safe Driver Incentive Plan ("SDIP"):
(1) License revocation for refusal to submit
				to chemical tests shall not be considered conviction of a moving traffic
				violation.
(2) A conviction for
				driving the wrong way on a one-way street is not a conviction for driving on
				the wrong side of the road.
(3) The
				revocation or suspension of a driver's license solely because of the
				accumulation of motor vehicle points shall not be considered a
				conviction.
(4) When new operators
				are added to an automobile policy, their SDIP points may be added to the policy
				at the same time coverage is extended to them.
(5) SDIP points for an operator whose license
				has been suspended or revoked may be added only at the date the operator again
				becomes eligible for license. However, SDIP points may be charged at the
				inception date of the current policy if the operator has previously been
				convicted of a moving traffic violation while his or her license was suspended
				or revoked or if there is evidence that the operator does operate a motor
				vehicle.
(6) If an operator dies or
				permanently leaves an insured's household during the policy period, the
				operator's SDIP points shall be removed at the time of his or her death or
				departure.
Authority
				  G.S.
				  58-2-40;
				  58-36-65;
				  58-36-75;
Eff.
				  December 15, 1979;
Amended Eff. February 1, 1993;
Readopted Eff. December 1, 2021.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 04 - CONSUMER SERVICES DIVISION › Section .0400 - PROPERTY AND LIABILITY › Section 04 .0416 - BILLING PROCEDURES FOR AUTOMOBILE INSURANCE

Current through Register Vol. 39, No. 2, July 15, 2024
(a) With
				respect to new business, an insurer shall take no more than 90 days from the
				effective date of the policy to make any investigation other than review of the
				initial application and to bill the insured for proper rate classification or
				sub-classification.
(b) With
				respect to renewal business, an insurer shall not bill for any additional
				premium after the renewal quotation is made for any condition that existed at
				the time of renewal and is on the driver's motor vehicle record.
(c) With respect to renewal business, if the
				insured does not provide updated and complete rating information necessary to
				underwrite the policy or makes an effort to withhold rating information, the
				insurer shall take no more than 90 days from the effective date of the renewal
				to make inquiry of the insured, to make any other investigation, and to bill
				the insured for proper rate classification and sub-classification.
(d) When an insurer obtains information from
				sources other than the Department of Motor Vehicles for use in underwriting an
				automobile policy and the insured alleges that the information is incorrect,
				the insurer shall verify the accuracy of such information.
(e) Unearned premium refunds shall be
				determined from the later of either the date the consumer gives direct notice
				to a company or an agent of the company of the cancellation or the effective
				date of cancellation requested by the insured. In the case of physical damage
				insurance where there is a loss payee, the effective date of cancellation for
				the purposes of determining unearned premium refund shall be 10 days from the
				date cancellation notice was given to a company or a company's agent.
(f) If the consumer can show proof that
				within the 10 day period in this Rule where cancellation involves a loss payee,
				and the consumer had obtained replacement physical damage coverage that
				included the loss payee, then the cancellation date for purposes of determining
				unearned premium refund shall be the last date of any lapse in coverage for the
				loss payee during the 10 day time set out in this Rule. In the case of no
				lapse, shall be determined as if no loss payee was involved.
Authority
				  G.S.
				  58-2-40;
				  58-63-65;
Eff.
				  December 15, 1979;
Amended Eff. April 1, 1989; July 1,
				  1986;
Readopted Eff. November 1,
				  2021.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 04 - CONSUMER SERVICES DIVISION › Section .0400 - PROPERTY AND LIABILITY › Section 04 .0417 - DRIVE-IN CLAIM SERVICE FACILITIES

Current through Register Vol. 39, No. 2, July 15, 2024
No insurer shall require any claimant to use a drive-in claim
				  service operated by the insurer. The claimant's voluntary utilization of a
				  drive-in claim service or preferred repair shop shall not prejudice the right
				  of either party to obtain independent appraisals and negotiate settlement on
				  the basis of such appraisals.
Authority
				  G.S.
				  58-2-40;
				  58-63-65;
Eff.
				  December 15, 1979;
Amended Eff. July 1, 2012;
Readopted
				  Eff. October 1, 2021.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 04 - CONSUMER SERVICES DIVISION › Section .0400 - PROPERTY AND LIABILITY › Section 04 .0418 - TOTAL LOSSES ON MOTOR VEHICLES

Current through Register Vol. 39, No. 2, July 15, 2024
(a) The
				Commissioner shall consider as prima facie violative of
				G.S.
				58-63-15(11) the failure by
				an insurance company to adhere to the procedures in this Rule concerning the
				settlement of covered "total loss" motor vehicle claims when the failure is so
				frequent as to indicate a general business practice.
(b) For the purposes of this Rule, the
				following terms shall mean:
(1) "Licensed
				Motor Vehicle Dealer" means a person who is licensed by the North Carolina
				Department of Transportation Division of Motor Vehicles pursuant to Chapter 20,
				Article 12 of the N.C. General Statutes.
(2) "Local Market Area" means an area within
				a 100-mile radius of the place where the motor vehicle is principally garaged.
				If a substantially similar motor vehicle is unavailable within a 100-mile
				radius, the insurance company may increase the radius in increments of 50 miles
				until a substantially similar motor vehicle can be found.
(3) "Published Regional Average Values" means
				values derived from printed or electronically published motor vehicle pricing
				guides recognized in the motor vehicle industry, including National Automobile
				Dealers Association Pricing Guide Book or Kelley Blue Book that analyze current
				and historical motor vehicle sales data taking into consideration the year,
				make, model and condition of the motor vehicle, motor vehicle market
				conditions, and geographic area to reach an average retail value of the motor
				vehicle.
(4) "Substantially Similar
				Motor Vehicle" means a motor vehicle of the same make, model, and year of the
				damaged motor vehicle.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 04 - CONSUMER SERVICES DIVISION › Section .0400 - PROPERTY AND LIABILITY › Section 04 .0419 - MOTOR VEHICLE REPAIR ESTIMATES

Current through Register Vol. 39, No. 2, July 15, 2024
(a) The
				Commissioner shall consider as prima facie violative of
				G.S.
				58-63-15(11) the failure by
				an insurance company to adhere to the procedures in this Rule concerning repair
				estimates on covered motor vehicle damage claims when the failure is so
				frequent as to indicate a general business practice.
(b) For the purposes of this Rule, the
				following terms shall mean:
(1) "Digital
				Inspection" means an inspection of a damaged motor vehicle conducted by using
				digital photographs, videos, or other digital evidence through an electronic
				processing system authorized by an insurer.
(2) "Licensed Motor Vehicle Damage Appraiser"
				means an individual who is licensed as a motor vehicle damage appraiser
				pursuant to Article 33 of Chapter 58 of the N.C. General Statutes or is
				licensed in another state whose licensing requirements are substantially
				similar to or exceed those established under that Article.
(3) "Physical Inspection" means an inspection
				of a damaged motor vehicle conducted in person by an insurer's
				representative.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 04 - CONSUMER SERVICES DIVISION › Section .0400 - PROPERTY AND LIABILITY › Section 04 .0420 - WRITTEN CONFIRMATION OF ORAL AGREEMENTS

Current through Register Vol. 39, No. 2, July 15, 2024
(a) Once
				an insurer accepts liability or advises a claimant to have damaged property
				repaired with the understanding that the insurer will pay or reimburse the
				claimant, the insurer shall, if requested by the claimant, confirm the
				understanding in writing. Such writing shall clearly state the responsibility
				assumed by the insurer for payment of incurred costs.
(b) If so requested by the claimant, the
				insurer or its representative shall confirm in writing all other oral
				agreements between itself or its representative and the claimant.
Authority
				  G.S.
				  58-2-40;
				  58-3-100;
				  58-63-15;
Eff.
				  December 15, 1979;
Readopted Eff. November 1,
				  2021.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 04 - CONSUMER SERVICES DIVISION › Section .0400 - PROPERTY AND LIABILITY › Section 04 .0421 - HANDLING OF LOSS AND CLAIM PAYMENTS

Current through Register Vol. 39, No. 2, July 15, 2024
(a) The
				Commissioner shall consider the failure by an insurer to adhere to the
				procedures in this Rule concerning loss and claim payments as prima facie
				evidence violation of
				G.S.
				58-63-15(11) when such
				failure is so frequent as to indicate a general business practice.
(b) When a motor vehicle is damaged and the
				claim is covered by an insurer, the insurer shall adhere to the following
				procedures concerning loss and claim payments.
(1) Loss and claim payments shall be mailed
				or delivered within 10 business days after the claim is settled.
(2) Unless the insured consents, no insurer
				shall deduct premiums owed by the insured on a policy from a loss or claim
				payment made under another policy.
(3) No insurer shall withhold the entire
				amount of a loss or claim payment because the insured owes premium or other
				monies in an amount less than the loss or claim payment.
(4) If a release or full payment of claim is
				executed by a claimant involving a repair to a motor vehicle, it shall not bar
				the right of the claimant to assert a claim for property damages unknown to
				either the claimant or to the insurance carrier prior to the repair of the
				motor vehicle if the damages were caused by the accident and could not be
				determined or known until after the repair or attempted repair of the motor
				vehicle. This claim shall be asserted within the statute of limitations set
				forth in G.S.
				1-52(16).
(5) If a release or full payment of claim is
				executed by a third-party claimant involving a repair to a motor vehicle, it
				shall not bar the right of the third-party claimant to assert a claim for
				diminution in fair market value pursuant to
				G.S.
				20-279.21(d1) caused by the
				accident and could not be determined or known until after the repair or
				attempted repair of the motor vehicle. This claim shall be asserted within the
				statute of limitations set forth in
				G.S.
				1-52(16).
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 04 - CONSUMER SERVICES DIVISION › Section .0400 - PROPERTY AND LIABILITY › Section 04 .0422 - CANCELLATION OF INSURANCE

Current through Register Vol. 39, No. 2, July 15, 2024
The Commissioner shall consider an unfair trade practice the
				  cancellation by an insurer of any personal lines insurance policy for which the
				  premium has been paid because there is another policy in force for which the
				  premium has not been paid.
Authority
				  G.S.
				  58-2-40;
				  58-63-40;
Eff.
				  December 15, 1979;
Amended Eff. February 1, 1996;
Readopted Eff. November 1, 2021.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 04 - CONSUMER SERVICES DIVISION › Section .0400 - PROPERTY AND LIABILITY › Section 04 .0423 - ETHICAL STANDARDS

Current through Register Vol. 39, No. 2, July 15, 2024
(a) Every agent,
				limited representative, broker, adjuster, appraiser, or other insurer's
				representative shall, when conducting insurance business with a member of the
				public:
(1) identify himself or herself and
				his or her occupation; and
(2)
				provide his or her National Producer Number and the Department's website
				address and phone number for verification of licensure status when requested to
				show proof of licensure by any claimant, any repairer while he or she is
				investigating a claim or loss, any Department representative, or any other
				person with whom he or she has contact while performing his or her insurance
				business.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 04 - CONSUMER SERVICES DIVISION › Section .0400 - PROPERTY AND LIABILITY › Section 04 .0424 - REPEALED - PURPOSE

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
				  G.S.
				  58-9;
Eff. April 1,
				  1989;
Repealed Eff. April 1,
				  1993.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 04 - CONSUMER SERVICES DIVISION › Section .0400 - PROPERTY AND LIABILITY › Section 04 .0425 - DEFINITIONS

Current through Register Vol. 39, No. 2, July 15, 2024
As used in this Section the following terms shall be
				  construed as follows:
(1) "After
				market part" means a part made by a nonoriginal manufacturer.
(2) "Claimant" means a first-party or
				third-party claimant.
(3)
				"Diminution in Fair Market Value," as that term is used in
				G.S.
				20-279.21, means the difference in the fair
				market value of the vehicle immediately before the accident and after any
				repairs made to the vehicle as a result of the accident have been
				completed.
(4) "Disinterested
				appraiser," as that term is used in
				G.S.
				20-279.21, means a motor vehicle damage
				appraiser who:
(a) Is not employed by either
				the claimant or the insurer;
(b)
				Has no financial interest in the outcome of the appraisal; and
(c) Did not participate in the original
				appraisal.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 04 - CONSUMER SERVICES DIVISION › Section .0400 - PROPERTY AND LIABILITY › Section 04 .0426 - LIKE KIND AND QUALITY

Current through Register Vol. 39, No. 2, July 15, 2024
No insurer shall require the use of an aftermarket part in
				  the repair of a motor vehicle unless the aftermarket part is at least equal to
				  the original part in terms of fit, quality, performance, and warranty. Insurers
				  specifying the use of aftermarket parts shall include in the estimate the costs
				  of any modifications made necessary by the use of aftermarket
				  parts.
Authority
				  G.S.
				  58-2-40;
Eff. April 1,
				  1989;
Readopted Eff. November 1,
				  2021.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 04 - CONSUMER SERVICES DIVISION › Section .0400 - PROPERTY AND LIABILITY › Section 04 .0427 - DISCLOSURE REQUIREMENTS

Current through Register Vol. 39, No. 2, July 15, 2024
Every insurer that writes motor vehicle insurance in this
				  State and that intends to require or specify the use of after market parts must
				  disclose to its policyholders in writing, either in the policy or on a sticker
				  attached thereto, the following information in all capital letters and font
				  size no smaller than ten-point:
IN THE REPAIR OF YOUR COVERED AUTO UNDER THE PHYSICAL DAMAGE
				  COVERAGE PROVISIONS OF THIS POLICY, WE MAY REQUIRE OR SPECIFY THE USE OF
				  AUTOMOBILE PARTS NOT MADE BY THE ORIGINAL MANUFACTURER. THESE PARTS ARE
				  REQUIRED TO BE AT LEAST EQUAL IN TERMS OF FIT, QUALITY, PERFORMANCE AND
				  WARRANTY TO THE ORIGINAL MANUFACTURER PARTS THEY REPLACE.
All after market parts installed on a motor vehicle shall be
				  identified on the estimate and invoice for such repair.
Authority
				  G.S.
				  58-2-40;
Eff. April 1,
				  1989;
Amended Eff. March 1, 2004;
Readopted Eff.
				  December 1, 2021.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 04 - CONSUMER SERVICES DIVISION › Section .0400 - PROPERTY AND LIABILITY › Section 04 .0428 - REPEALED - ENFORCEMENT

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
				  G.S.
				  58-9;
Eff. May 1,
				  1989;
Repealed Eff. May 3, 1993.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 04 - CONSUMER SERVICES DIVISION › Section .0400 - PROPERTY AND LIABILITY › Section 04 .0429 - COMMINGLING

Current through Register Vol. 39, No. 2, July 15, 2024
The accounting records maintained by agents, brokers, and
				  limited representatives shall be separate and apart from any other business
				  records and demonstrate at all times that collected funds due to insurers and
				  return premiums due to policyholders are available at all
				  times.
Authority
				  G.S.
				  58-2-40;
				  58-2-195;
Eff.
				  February 1, 1993;
Amended Eff. February 1, 1996;
Readopted Eff. December 1, 2021.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 04 - CONSUMER SERVICES DIVISION › Section .0400 - PROPERTY AND LIABILITY › Section 04 .0430 - PROOF OF MAILING; AUTOMOBILE INSURANCE

Current through Register Vol. 39, No. 2, July 15, 2024
As used in
				  G.S.
				  58-36-85, "proof of mailing" means a
				  certificate issued by and bearing the date stamp of the United States Postal
				  Service or an official United States Postal Service tracking number or similar
				  proof of mailing.
Authority
				  G.S.
				  58-2-40;
				  58-36-85;
Eff.
				  February 1, 1993;
Amended Eff. July 1, 2012; February 1,
				  1996;
Readopted Eff. October 1,
				  2021.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 04 - CONSUMER SERVICES DIVISION › Section .0400 - PROPERTY AND LIABILITY › Section 04 .0431 - DEFINITION OF CLAIMANT

Current through Register Vol. 39, No. 2, July 15, 2024
As used in this Section, unless the context indicates
				  otherwise, "claimant" means a first party claimant or a third party
				  claimant.
Authority
				  G.S.
				  58-2-40(1);
				  58-63-15;
Eff. April
				  1, 1993;
Readopted Eff. November 1,
				  2021.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 04 - CONSUMER SERVICES DIVISION › Section .0400 - PROPERTY AND LIABILITY › Section 04 .0432 - REFUND OF EXCESS PREMIUM ON SCHEDULED ITEMS

Current through Register Vol. 39, No. 2, July 15, 2024
If an insured has any scheduled item listed for additional
				  insurance covered by a homeowner's or personal inland marine insurance policy,
				  and that item is replaced for less than the scheduled amount of coverage, the
				  insurer shall refund the insured the difference in premium charged between the
				  scheduled amount of coverage and the actual amount of the loss paid by the
				  insurer, if the refund per policy term is greater than five dollars ($5.00).
				  Any refund shall be computed from the date of issuance of the policy or five
				  years, whichever is less.
Authority
				  G.S.
				  58-2-40;
				  58-63-65;
Eff. April
				  1, 1995;
Amended Eff. July 1, 2012;
Readopted Eff.
				  December 1, 2021.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 04 - CONSUMER SERVICES DIVISION › Section .0400 - PROPERTY AND LIABILITY › Section 04 .0433 - REFUND OF AUTO INSURANCE PREMIUM ON NEW BUSINESS

Current through Register Vol. 39, No. 2, July 15, 2024
If an insured asks an insurer to cancel a newly issued motor
				  vehicle insurance policy on or before the premium billing due date, the
				  unearned premium refund made by the insurer shall be made on a pro rata rather
				  than a short rate basis, and the refund shall be based on the premium initially
				  quoted by the insurer if both of the following conditions are met:
(1) The insured provided the insurer with
				accurate and complete rating information.
(2) The insurer subsequently calculated the
				premium to be greater than the premium initially quoted.
Authority
				  G.S.
				  58-2-40;
				  58-36-85;
				  58-63-65;
Eff. April
				  1, 1995;
Readopted Eff. December 1,
				  2021.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 04 - CONSUMER SERVICES DIVISION › Section .0500 - LIFE INSURANCE ILLUSTRATIONS › Section 04 .0502 - ASSUMED EXPENSES AND CURRENT SCALE

Current through Register Vol. 39, No. 2, July 15, 2024
(a) An insurer
				may choose to designate each year the method of determining assumed expenses
				for all policies from the following:
(1)
				Fully allocated expenses.
(2)
				Marginal expense.
(3) A table of
				fully allocated expenses developed by the Actuarial Standards Board and
				approved by the National Association of Insurance Commissioners.
Marginal expenses may be used only if greater than a
				  generally recognized expense table. If no generally recognized expense table is
				  approved, fully allocated expenses must be used.