New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 1 - HOSPITAL WORKERS' COMPENSATION GROUP SELF-INSURANCE › Section 11:15-1.2 - 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.
"Act" means the provisions of the New Jersey Workers' Compensation Law regarding self-insurance as contained in 34:15-77, as amended and supplemented by P.L. 1983, c.376.
"Actuary" means a person who is a fellow in good standing of the Casualty Actuarial Society with three years recent experience in loss reserving or an associate in good standing of the Casualty Actuarial Society with five years recent experience in loss reserving.
"Administrator" means an individual, partnership, or corporation engaged by a group to carry out the policies established by the group and to provide day-to-day management of the group.
"Bona fide hospital association" means any association of more than 10 hospitals which has been in existence for more than five years.
"Commissioner" means the Commissioner of the New Jersey Department of Banking and Insurance or an employee of the Department designated by him or her to act on his or her behalf.
"Contribution" means the amount contributed by each member of a group.
"Department" means the New Jersey Department of Banking and Insurance.
"Excess insurance" means insurance, purchased from an insurance company appropriately licensed in the State of New Jersey or qualified by the Commissioner as a surplus lines insurer, covering losses in excess of an amount established between the group and the insurer up to the limits of coverage set forth in the insurance or indemnity agreement on a specific per occurrence or per accident or annual aggregate basis.
"Group" means a self-insurance group organized by 10 or more hospitals which enter into agreements to pool their liabilities for worker's compensation benefits and employer's liability obligations in a manner approved by the Commissioner under the authority of the Act and these regulations.
"Hospital" means a health care facility licensed as a hospital by the New Jersey Department of Health pursuant to 26:2H-1 et seq.
"Indemnity and trust agreement" means a written contract signed by the members of the group under which each agrees to jointly and severally assume and discharge the liabilities of each and every party to such agreement for workers' compensation benefits, which agreement shall also create a trust and govern the operation thereof under which monies shall be held by one or more trustees as fiduciaries for the benefit of persons qualifying to receive workers' compensation awards or payments from employers participating in the group.
"Insolvent" or "Insolvency" means the inability of a hospital workers' compensation self-insurance group to pay its outstanding lawful obligations as they mature in the regular course of business, as may be shown either by an excess of its required reserves and other liabilities over its assets or by its not having sufficient assets to reinsure all its outstanding liabilities after paying all accrued claims owed by it.
"Service organization" means a person, partnership, corporation or other legal entity which provides services to a group not provided by the administrator, including but not limited to:
1. Claims adjustment,
2. Safety engineering,
3. Compilation of statistics and the preparation of contribution, loss expense and tax reports,
4. Preparation of other required self-insurance reports, and
5. Development of any member's contribution and fees.
"Workers' compensation", when used as a modifier of "benefits", "liabilities", or "obligations", means both workers' compensation and employer's liability.