reglab/statecodes huggingface dataset:
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter V - Rates And Rating Organizations › Subchapter B - Commercial And Industrial Risks › Part 152 - Physicians And Surgeons Professional Insurance Merit Rating Plan › Section 152.9 - Excess medical malpractice risk insurance coverage eligibility requirements

Current through Register Vol. 46, No. 28, July 10, 2024
(a) In order to be
				  eligible for participation in the Excess Medical Malpractice Insurance Program
				  effective July 1st of any policy year, a physician must complete all of the
				  requirements for the excess medical malpractice basic or follow-up course, as
				  applicable, prior to that date. For example, in order for a physician to be
				  eligible for the Excess Medical Malpractice Insurance Program effective July 1,
				  2005 through June 30, 2007, the physician must have completed the required
				  basic or follow-up course requirements, as appropriate, by July 1,
				  2005.
(b) A physician that has not
				  satisfactorily completed all the excess medical malpractice risk management
				  requirements as provided in subdivision (a) of this section may not be eligible
				  for the Excess Medical Malpractice Insurance Program until, and effective as
				  of, the date the requirements are completed. The physician must also complete
				  any required excess medical malpractice follow-up course during the following
				  policy year in order to be eligible for the Excess Medical Malpractice
				  Insurance Program effective July 1st of the next succeeding two policy years.
				  For example, a physician who does not complete the basic or follow-up course,
				  which is required for eligibility beginning July 1, 2005, until August 1, 2005,
				  becomes eligible for excess medical malpractice insurance on August 1, 2005.
				  The physician continues to be eligible for the policy year beginning July 1,
				  2006. In order to continue to be eligible for excess medical malpractice
				  insurance effective July 1, 2007, the physician must complete the excess
				  medical malpractice risk management follow-up course requirements by July 1,
				  2007.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter V - Rates And Rating Organizations › Subchapter B - Commercial And Industrial Risks › Part 152 - Physicians And Surgeons Professional Insurance Merit Rating Plan › Section 152.10 - Coordination of excess medical malpractice risk management program with qualified risk management program

Current through Register Vol. 46, No. 28, July 10, 2024
In recognition of the fact that some physicians are also
					 participating in a qualified risk management program filed by their insurer
					 pursuant to section
					 152.6 
					 of this Part, and in order to facilitate participation in the Excess Medical
					 Malpractice Risk Management Program, the following rules shall apply:
(a) The excess medical malpractice risk
				  management basic course must be successfully completed even if the
				  participating physician has previously completed the basic risk management
				  course described in section
				  152.6(c) 
				  of this Part.
(b) For a physician
				  who has not previously participated in a qualified risk management program,
				  satisfactory completion of the five-hour Excess Medical Malpractice Risk
				  Management Program basic course will also qualify for completion of the
				  qualified risk management program basic course if the physician's insurer has
				  an approved qualified risk management program pursuant to section
				  152.6 
				  of this Part.
(c) A physician also
				  participating in a qualified risk management program who would otherwise be
				  required to complete both the three-hour qualified risk management program
				  follow-up course pursuant to section
				  152.6(e) 
				  of this Part and the five-hour Excess Medical Malpractice Risk Management
				  Program basic course in the same year may satisfy both requirements by
				  successfully completing the five-hour excess medical malpractice risk
				  management basic course.
(d) A
				  physician also participating in a qualified risk management program who would
				  otherwise be required to complete both the three-hour qualified risk management
				  follow-up course pursuant to section
				  152.6(e) 
				  of this Part and the three-hour Excess Medical Malpractice Risk Management
				  Program follow-up course in the same year may satisfy both requirements by
				  successfully completing the three-hour excess medical malpractice risk
				  management follow-up course.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter V - Rates And Rating Organizations › Subchapter B - Commercial And Industrial Risks › Part 152 - Physicians And Surgeons Professional Insurance Merit Rating Plan › Section 152.11 - Implementation of excess medical malpractice risk management programs

Current through Register Vol. 46, No. 28, July 10, 2024
(a) An insurer that
				  writes medical malpractice insurance for physicians must submit a proposed
				  Excess Medical Malpractice Risk Management Program to the superintendent and
				  obtain approval prior to the participation of any insured in the
				  program.
(b) The risk management
				  program must specify:
(1) the length of the
				  basic and follow-up courses;
(2)
				  the specific basic and follow-up courses;
(3) the qualifications required for
				  developers of the internet-based program and instructors in each subject
				  area;
(4) the methodology for
				  monitoring attendance during the lecture course format and for assuring that
				  the eligible insured physician is the person who has taken and completed the
				  internet-based course;
(5) a
				  description of the required project;
(6) the methodology for verifying
				  satisfactory completion of all components of the program prior to the
				  certifying of an insured physician to be eligible to participate in the Excess
				  Medical Malpractice Insurance Program;
(7) the identity of the entity, if any,
				  designated by the insurer to administer the risk management program on its
				  behalf, the qualifications of that entity, and the steps the insurer will take
				  to monitor the program;
(8) the
				  methodology for informing insureds of the availability of the risk management
				  course and the dates, locations, and if applicable, the internet address of
				  each risk management course offered by the insurer;
(9) for internet-based components, a
				  description of the type of interaction required of the insured physician, and
				  the basis for the insurer's determination that the component is equivalent to
				  the time and content of the lecture component; and
(10) evidence from an entity accredited to
				  grant continuing medical education credit that the basic course qualifies for
				  Category 1 continuing medical education credit.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter V - Rates And Rating Organizations › Subchapter B - Commercial And Industrial Risks › Part 152 - Physicians And Surgeons Professional Insurance Merit Rating Plan › Section 152.12 - Records maintenance, audits and reporting requirements

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Every insurer
				  that offers a risk management premium credit shall maintain loss and expense
				  statistics separately for those insureds receiving and not receiving the
				  credit, and such statistics shall be made available to the superintendent upon
				  request.
(b) At least once every
				  two years, an insurer shall conduct a risk management audit of all insured
				  physicians participating in its excess medical malpractice risk management
				  programs pursuant to this Part. Such audit may be in the form of a self-review
				  survey completed by each insured physician.
(c) An insurer that utilizes a self-review
				  survey in lieu of a physical audit shall develop self- review procedures
				  specific to the type of practice, varying by specialty type and size of the
				  practice engaged in by the insured, and any other criteria it determines
				  appropriate to evaluating the effectiveness of the Excess Medical Malpractice
				  Risk Management Program.
(d) The
				  self-review procedures shall be designed to provide information to the insurer
				  to determine that participants are properly following the procedures and
				  principles presented in the course, to assist the insurer in developing
				  revisions and improvements to its excess medical malpractice risk management
				  programs and to provide for the establishment of best practices in risk
				  management methods.
(e) An insurer
				  offering a risk management premium credit or an insurer offering a risk
				  management program for the purpose of eligibility in the Excess Medical
				  Malpractice Insurance Program shall annually, no later than March 1st, submit
				  to the superintendent a report indicating, by territory and medical specialty:
(1) total number of insureds;
(2) number of insureds receiving the premium
				  credit; and
(3) number of insureds
				  participating in risk management programs qualifying for excess medical
				  malpractice insurance coverage.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter V - Rates And Rating Organizations › Subchapter B - Commercial And Industrial Risks › Part 153 - Property/casualty Insurance Group And Quasi-group Standards › Section 153.0 - Preamble

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Omnibus
				  legislation embodied in Chapters 220 and 221 of the Laws of 1986, enacted in
				  response to affordability and availability problems experienced in connection
				  with commercial risk, professional liability and public entity insurance
				  markets, added section
				  3435 to the Insurance Law, enabling
				  property/casualty insurance group policies to be underwritten in connection
				  with public entities and non-profit organizations.
(b) Prior to section 3435, group policies for
				  property/casualty risks had not been permitted in this State, requiring all
				  such risks to be underwritten on an individual basis. In appropriate areas,
				  however, quasi-group approaches such as mass merchandising and safety group
				  programs have been allowed in this State for certain property/casualty risks.
				  While utilizing distribution efficiencies or emphasizing risk management in a
				  group context, these quasi-group approaches actually underwrite and issue
				  policies to participants on an individual, rather than a collective group,
				  basis.
(c) In addition, the Federal
				  Liability Risk Retention Act of 1986 (LRRA),
				  15
				  U.S.C. §
											3901 et seq., authorizes the
				  purchase of commercial liability insurance by purchasing groups,
				  notwithstanding State laws that would otherwise preclude such group purchase.
				  As set forth in Part 301 (Regulation No. 134) of this Title, authorized
				  insurers dealing with Federal purchasing groups remain subject to rate and
				  policy form requirements under the Insurance Law and regulations, such as this
				  Part, enforcing such requirements.
(d) If properly structured, operated and
				  regulated, group and quasi-group approaches can enhance availability and
				  affordability of these types of coverages by recognizing legitimate advantages,
				  based on loss and expense experience of the group and its members, not afforded
				  to other persons with respect to rates, policy forms, coverages and other
				  matters. The purpose of this Part is to encourage properly structured, operated
				  and regulated group and quasi-group approaches where permitted in the
				  property/casualty area.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter V - Rates And Rating Organizations › Subchapter B - Commercial And Industrial Risks › Part 153 - Property/casualty Insurance Group And Quasi-group Standards › Section 153.1 - Definitions

Current through Register Vol. 46, No. 28, July 10, 2024
For purposes of this Part, the following definitions shall
					 apply:
(a) Certificate means any
				  policy, contract or other evidence of insurance, or rider or endorsement
				  thereto, issued to a group member under a property/casualty or liability
				  insurance group master policy.
(b)
				  Commercial risk insurance has the meaning ascribed by section 107 (a)(47)  of the Insurance
				  Law.
(c) Family member means a
				  person, related to the insured by blood, marriage, adoption or operation of
				  law, who resides in the same household (including a ward or foster child) or
				  who is a dependent child away at school.
(d) Group member means a person or entity to
				  whom a policy or certificate has been issued in connection with a
				  property/casualty or liability insurance group policy or master policy, and may
				  include the group master policyholder.
(e) Group master policy means a group policy
				  issued to a group master policyholder and under which certificates are issued
				  to group members, but does not include such certificates.
(f) Group master policyholder means the
				  person or entity to whom a property/casualty or liability insurance group
				  master policy is issued.
(g) Group
				  policy means:
(1) a policy underwritten and
				  issued on a collective basis of:
(i)
				  property/casualty insurance insuring the interests of two or more persons or
				  entities; or
(ii) liability
				  insurance insuring a Federal purchasing group or its members;
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter V - Rates And Rating Organizations › Subchapter B - Commercial And Industrial Risks › Part 153 - Property/casualty Insurance Group And Quasi-group Standards › Section 153.2 - Scope

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
				  Property/casualty or liability insurance may be issued or renewed in this State
				  on a group or quasi-group basis only in compliance with this Part.
(b) This Part sets forth standards,
				  requirements and procedures governing:
(1)
				  group policies and certificates under section 3435  of the Insurance Law;
(2) group policies and certificates in
				  connection with a Federal purchasing group; and
(3) quasi-group policies, through a mass
				  merchandising, safety group or similar program, in connection with State law or
				  a Federal purchasing group.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter V - Rates And Rating Organizations › Subchapter B - Commercial And Industrial Risks › Part 153 - Property/casualty Insurance Group And Quasi-group Standards › Section 153.3 - General requirements

Current through Register Vol. 46, No. 28, July 10, 2024
(a) No
				  group policy shall be issued or renewed in this State with respect to personal
				  risk liability or any coverage subject to section 3425  of the Insurance Law.
(b) No quasi-group policy shall be issued or
				  renewed in this State with respect to personal risk liability or any coverage
				  subject to section 3425  of the Insurance Law, except to the
				  extent permitted pursuant to Part 13 (Regulation No. 58) of this
				  Title.
(c) Except in connection
				  with a Federal purchasing group, no group policy shall be issued or renewed in
				  this State, unless:
(1) the group is
				  homogeneous in nature, based upon standards acceptable to the
				  superintendent;
(2) the group is
				  formed for purposes other than obtaining insurance;
(3) the group consists of at least ten group
				  members engaged in similar activities giving rise to similar risks, based upon
				  standards acceptable to the superintendent, except that a smaller number of
				  members, but not less than five, may be covered on a group basis where each
				  such member generates at least $5 million in annual revenues or annual premiums
				  for such group total at least $500,000;
(4) group members are either public entities
				  or nonprofit organizations; and
(5)
				  coverage includes any kind of property/casualty insurance, but not a kind
				  specified by section 1113 (a)(16) (17) (21) (22) (23) or (25)  of the Insurance Law.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter V - Rates And Rating Organizations › Subchapter B - Commercial And Industrial Risks › Part 153 - Property/casualty Insurance Group And Quasi-group Standards › Section 153.4 - Group policy minimum standards

Current through Register Vol. 46, No. 28, July 10, 2024
Every group policy issued or renewed in this State on risks
					 or operations in this State, under section 3435 or in connection with a Federal
					 purchasing group, shall comply with the following minimum policy
					 standards:
(a) Certificates issued
				  under a group master policy shall contain all material terms and conditions of
				  coverage affecting a group member, unless the group master policy is
				  incorporated by reference, in which event a copy of such master policy shall
				  accompany the certificate or shall be promptly provided to a group member upon
				  request.
(b) No group policy,
				  master policy or certificate shall contain any deductible or self-insured
				  retention shared among group members or applicable to the group itself, and
				  certificates under a master policy may provide for a deductible or self-insured
				  retention only if applicable to a group member strictly on an individual
				  basis.
(c) No group policy, master
				  policy or certificate shall be subject to a group or sub-group aggregate
				  liability limit of any kind at any time, and any liability limit applicable to
				  a group member shall:
(1) be separate and
				  apart from any liability limit to which any other group member insured under
				  the group policy may be subject; and
(2) operate unaffected by the experience of
				  any other group member or the overall experience of the group itself.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter V - Rates And Rating Organizations › Subchapter B - Commercial And Industrial Risks › Part 153 - Property/casualty Insurance Group And Quasi-group Standards › Section 153.5 - Premium collection and payment

Current through Register Vol. 46, No. 28, July 10, 2024
(a) The premium for coverage:
(1) under a group policy shall be paid by
				  each group member, and shall not be paid by the group or group master
				  policyholder from the group's general funds or other source; and
(2) under a quasi-group policy shall be paid
				  by each participant, and shall not be paid by the sponsoring entity from
				  general funds or other source.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter V - Rates And Rating Organizations › Subchapter B - Commercial And Industrial Risks › Part 153 - Property/casualty Insurance Group And Quasi-group Standards › Section 153.6 - Form and rate filing requirements

Current through Register Vol. 46, No. 28, July 10, 2024
Every authorized insurer issuing or renewing in this State
					 any group policy or (except for subdivision [e] of this section) any
					 quasi-group policy on risks or operations in this State, in connection with
					 State law or a Federal purchasing group, shall comply with the following
					 requirements:
(a) All such policy
				  forms, rating classifications and territories shall be approved by the
				  superintendent pursuant to section 2307  of the Insurance Law.
(b) All such rates, rating plans or rating
				  rules shall be submitted to the superintendent pursuant to the applicable
				  provisions of article 23 of the Insurance Law.
(c) No group or quasi-group policy shall
				  qualify for exemption from filing under section 6301  of the Insurance Law.
(d) In complying with subdivisions (a) and
				  (b) of this section, the insurer shall describe the nature and all material
				  components of the group or quasi-group approach for which the forms, rating
				  classifications, territories, rates, rating plans or rating rules are proposed
				  for use.
(e) Subject to the
				  superintendent's approval, pursuant to section 2307  of the Insurance Law, of:
(1) an enrollment period, a group policy may
				  provide for a stated enrollment period; and
(2) an options plan, a group policy may be
				  based upon a plan that precludes or otherwise restricts individual selection of
				  insurance coverages and limits by group members.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter V - Rates And Rating Organizations › Subchapter B - Commercial And Industrial Risks › Part 153 - Property/casualty Insurance Group And Quasi-group Standards › Section 153.7 - Group and quasi-group dividend plans

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Dividends may be declared and paid by the
				  insurer confined to group members or quasi-group participants, or for
				  distribution of such dividends by the group or the group master policyholder to
				  group members or by the sponsoring entity to quasi-group participants, pursuant
				  to a dividend plan approved by the superintendent.
(b) No group or quasi-group dividend plan
				  shall be approved, unless:
(1) the
				  declaration of dividends remains within the discretion of the insurer, which
				  shall not obligate itself to return to a group member or quasi-group
				  participant any portion of the premium through dividends;
(2) the method of determining and declaring
				  dividends is fair and equitable, not unfairly discriminatory, and disclosed to
				  group members or quasi-group participants; and
(3) records documenting financial and loss
				  experience for the group or quasi-group, and every dividend declaration or
				  distribution, are maintained subject to the superintendent's
				  inspection.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter V - Rates And Rating Organizations › Subchapter B - Commercial And Industrial Risks › Part 153 - Property/casualty Insurance Group And Quasi-group Standards › Section 153.8 - Compulsory participation prohibited

Current through Register Vol. 46, No. 28, July 10, 2024
No insurer shall provide coverage in regard to a group or
					 quasi-group program that:
(a) requires
				  the purchase of insurance as a condition of group membership or quasi-group
				  participation; or
(b) imposes any
				  penalty upon a group member or quasi-group participant if insurance is not
				  purchased.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter V - Rates And Rating Organizations › Subchapter B - Commercial And Industrial Risks › Part 153 - Property/casualty Insurance Group And Quasi-group Standards › Section 153.9 - Tie-in sales prohibited

Current through Register Vol. 46, No. 28, July 10, 2024
No insurer shall provide coverage in regard to a group or
					 quasi-group program if:
(a) the
				  purchase of any good or service from the group or sponsoring entity is a
				  condition of purchasing insurance by a group member or quasi-group participant;
				  or
(b) the purchase of insurance by
				  a group member or quasi-group participant is a condition of purchasing any good
				  or service from the group or sponsoring entity.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter V - Rates And Rating Organizations › Subchapter B - Commercial And Industrial Risks › Part 153 - Property/casualty Insurance Group And Quasi-group Standards › Section 153.10 - Group insurance producers

Current through Register Vol. 46, No. 28, July 10, 2024
No person shall act as an insurance agent or broker in
					 regard to any group or quasi-group program, unless duly licensed under article
					 21 of the Insurance Law, consistent with section 5911 (c)  of the Insurance
					 Law in connection with a federal purchasing group.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter V - Rates And Rating Organizations › Subchapter B - Commercial And Industrial Risks › Part 153 - Property/casualty Insurance Group And Quasi-group Standards › Section 153.11 - Exemptions

Current through Register Vol. 46, No. 28, July 10, 2024
This Part shall not apply to:
(a) ocean marine cargo open policies issued
				  or renewed to a foreign freight forwarder or custom house broker, as referred
				  to in section 2101 (c)(3)  of the
				  Insurance Law, covering the ongoing shipment of goods;
(b) credit unemployment policies, as
				  specified by section 1113 (a)(24)  of the
				  Insurance Law; or
(c) channeling,
				  as specified in section 3436 (a)  of the Insurance
				  Law, if and only to the extent that such program has been previously permitted
				  by the superintendent prior to July 1, 1986.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter V - Rates And Rating Organizations › Subchapter B - Commercial And Industrial Risks › Part 154 - Private Passenger Motor Vehicle Insurance Multi-tier Programs › Section 154.0 - Introduction and purpose

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Section 2349  of the Insurance Law, effective May
				  28, 1995, pursuant to chapter 9 of the Laws of 1995, and further amended by
				  chapter 287 of the Laws of 1995, signed into law by Governor George E. Pataki
				  on July 26, 1995 and also effective May 28, 1995, explicitly permits insurers
				  in the voluntary private passenger motor vehicle authorized insurance market to
				  establish multi-tier programs that encourage depopulation of the New York
				  Automobile Insurance Plan (AIP). A multi-tier program is one in which there is
				  more than one rate level or tier in the same company, and associated with each
				  rate level or tier there is a complete rating system. The placement of insureds
				  in the various rating tiers is based on underwriting rules.
(b) The purpose of this Part is to establish
				  the rules that each insurer's multi-tier program shall comply with as mandated
				  by section 2349. These rules encompass, among other items, the placement and
				  rating of insured in the various tiers, and the application of sections 2349
				  and 3425 with regard to multi-tier program nonrenewals.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter V - Rates And Rating Organizations › Subchapter B - Commercial And Industrial Risks › Part 154 - Private Passenger Motor Vehicle Insurance Multi-tier Programs › Section 154.1 - General rules governing multi-tier programs

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Each multi-tier program shall be filed
				  with the superintendent for approval. The rating systems associated with the
				  various rate levels shall comply with all existing statutes and regulations
				  governing private passenger motor vehicle insurance in this state. A policy of
				  private passenger motor vehicle insurance for the purpose of this Part shall
				  mean a covered policy of automobile insurance, as defined in section 3425  of the Insurance Law, providing
				  liability or physical damage insurance or both. The various required private
				  passenger motor vehicle premium credits and surcharges shall be part of, and
				  applied to insureds in, each and every rating tier. Such credits and surcharges
				  may vary by tier.
(b) Each
				  multi-tier program filing shall contain a general overview of the insurer's
				  business plan that considers:
(1) the
				  insurer's multi-tier marketing objectives (e.g., appointing producers, or
				  directly soliciting business, in territories with higher than average AIP
				  populations);
(2) the insurer's
				  multi-tier underwriting objectives (e.g., changes in underwriting guidelines
				  that will enable the insurer to offer coverage to risks that previously did not
				  meet the insurer's underwriting guidelines); and
(3) the interaction of the previous two
				  paragraphs with the various Insurance Department initiatives to depopulate the
				  AIP (e.g., the territorial credit program).
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter V - Rates And Rating Organizations › Subchapter B - Commercial And Industrial Risks › Part 154 - Private Passenger Motor Vehicle Insurance Multi-tier Programs › Section 154.2 - Multi-tier program underwriting rules

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
(1) The
				  underwriting rules governing initial tier placement for qualifying applicants
				  (i.e., applicants the insurer has decided to write) shall be, to the extent
				  feasible, mutually exclusive per tier and shall be objective and shall not be
				  applied so as to result in a rate that would violate article 23.
(2) Insurers shall maintain the underwriting
				  rules governing initial tier placement, and a record of all changes thereto, in
				  writing at company offices, and the rules shall be made available to the
				  superintendent upon request. Each insurer shall submit an affirmation under
				  penalty of perjury, signed by an officer of the company, that the underwriting
				  rules exist, are mutually exclusive to the extent feasible, are objective and
				  are not applied so as to result in a rate that would violate article 23. Such
				  affirmation shall be submitted every three years and any time the rules are
				  changed.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter V - Rates And Rating Organizations › Subchapter B - Commercial And Industrial Risks › Part 154 - Private Passenger Motor Vehicle Insurance Multi-tier Programs › Section 154.3 - Application of section 3425 of the insurance law

Current through Register Vol. 46, No. 28, July 10, 2024
(a) The number of policed moved from higher
				  rated tiers to lower rated tiers shall not be considered in the calculation of
				  nonrenewals pursuant to section 3425(f).
(b) At least 30 days, but not more than 60
				  days, in advance of the end of the required policy period, an insurer shall
				  mail or deliver a notice of intent to uptier to each first named insured that
				  the insurer intends to move to a higher rated tier. Pursuant to section 2349,
				  the number of policies moved from lower rated tiers to higher rated tiers in
				  each of the insurer's rating territories for each calendar year shall be
				  limited to three percent of the total number of private passenger automobile
				  policies in force in that territory at last year-end. The three percent
				  limitation shall be in addition to the two percent limitation provided for in
				  section 3425(f).
(c)
(1) Each insurer shall keep a record of the
				  following, on a territorial basis:
(i) the
				  number of new polices issued;
(ii)
				  the number of polices for which a notice of intent to uptier was issued and
				  which continue after policy expiration;
(iii) the number of polices for which a
				  notice of intent to uptier was issued and do not continue after policy
				  expiration; and
(iv) the number of
				  all other nonrenewals and conditional renewals.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter V - Rates And Rating Organizations › Subchapter B - Commercial And Industrial Risks › Part 154 - Private Passenger Motor Vehicle Insurance Multi-tier Programs › Section 154.4 - Disclosure requirements

Current through Register Vol. 46, No. 28, July 10, 2024
(a) The
				  notice of intent to uptier shall specify the reasons underlying the insured's
				  placement in the higher rated tier and the premium that will be charged as a
				  result of uptiering.
(b) Upon
				  issuance of the policy or upon the annual policy renewal, the insurer shall
				  mail or deliver a notice to the first named insured, at the address contained
				  in the policy, explaining the multi-tier program. All such notices shall
				  contain the name and a toll free telephone number of a person that the insured
				  may call to obtain a more detailed explanation of the insured's tier
				  assignment.
(c) Every private
				  passenger motor vehicle policy, either on the declarations page or the renewal
				  notice, shall indicate the insured's designated tier.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter V - Rates And Rating Organizations › Subchapter B - Commercial And Industrial Risks › Part 154 - Private Passenger Motor Vehicle Insurance Multi-tier Programs › Section 154.5 - Monitoring requirements

Current through Register Vol. 46, No. 28, July 10, 2024
Every insurer shall submit a plan for monitoring the
					 effectiveness of its multi-tier program in depopulating the
					 AIP.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter V - Rates And Rating Organizations › Subchapter B - Commercial And Industrial Risks › Part 154 - Private Passenger Motor Vehicle Insurance Multi-tier Programs › Section 154.6 - Use of Education Level Attained and/or Occupational Status in Multi-Tier Programs

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
				  Background.
(1) Insurance Law section
				  2301 provides
				  that the purpose of Insurance Law Article 23, in relevant part, is to "promote
				  the public welfare by regulating insurance rates to the end that rates shall
				  not be excessive, inadequate, unfairly discriminatory ... ." As a corollary,
				  Insurance Law section
				  2303 requires, in relevant part, that rates
				  not be excessive, inadequate, or unfairly discriminatory. In applying this
				  rule, accepted actuarial standards and New York law require that a reasonable
				  relationship exist between the characteristics of a class and the hazard
				  insured against, and that the insurer bear the burden of establishing whether
				  the se requirements have been met.
(2) Pursuant to Insurance Law section
				  308,
				  the superintendent initiated an investigation of the use of an insured's
				  education level attained and/or occupational status within the voluntary market
				  by certain private passenger motor vehicle insurers in their underwriting rules
				  governing initial tier placement. During this investigation, the superintendent
				  learned that some, but not all, insurers in the state use an individual's
				  education level attained and/or occupational status in establishing initial
				  tier placement. The insurers' consideration of these factors has resulted in
				  cases where classes of insureds have been placed in less favorably rated tiers,
				  which may lead to higher premiums, without adequate substantiation that an
				  individual's level of education attained and/or occupational status relates to
				  his or her driving ability or habits such th at the insurer would suffer a
				  greater risk of loss. The insurers failed to provide sufficient support for the
				  existence of the necessary relationship for the use of occupational status or
				  any convincing evidence to support the necessary relationship for the use of an
				  insured's level of education attained, whether alone or in combination with
				  occupational status. As a result, the insurers failed to establish that their
				  use of education and/or occupation in establishing initial tier placement was
				  not unfairly discriminatory.
(3) To
				  ensure that use of education level attained and/or occupational status in
				  initial tier placement, tier movement, or the establishment of the rates shall
				  not result in a rate that violates Article 23, the use of such variables by an
				  insurer shall comply with the rules in this section or shall not be used to
				  determine initial tier placement, tier movement, or premium rate for private
				  passenger automobile insurance in the voluntary market in the State.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter V - Rates And Rating Organizations › Subchapter D - Rate Regulation And Promotion Of Competition › Part 160 - Responsibilities In Construction And Application Of Rates › Section 160.0 - Preamble

Current through Register Vol. 46, No. 28, July 10, 2024
(a) The purpose of
				  this regulation is to interpret and implement the purposes and provisions of
				  article 23 of the Insurance Law, and set forth the responsibilities of insurer
				  managements in the construction and application of rates. The regulation
				  provides rules for the establishment and maintenance of property and casualty
				  insurance rates.
(b) Insurer
				  managements are responsible to policyholders; to those dependent upon the
				  insurance enterprise for their livelihood; to shareholders in the case of stock
				  companies; and to the public generally. Ordinarily, the legitimate interests
				  and reasonable expectations of these groups are consistent. Sometimes they
				  conflict. It is the duty of insurer managements to take cognizance of the
				  interests and expectations of all and to make decisions which fairly and
				  rationally balance the interests of all.
(c) In constructing and applying rates, it is
				  the responsibility of insurer managements:
(1) to exercise competency in the evaluation
				  of technical factors;
(2) to foster
				  a competitive insurance market, to respond to competition, and to enhance the
				  ability of insurance consumers to give meaning to competition by the exercise
				  of free and informed choices;
(3)
				  to seek reasonable levels of profits in the case of stock companies or surplus
				  in the case of mutual companies;
(4) to provide equitable rate treatment among
				  insureds and classes of insureds and to avoid unfair discrimination;
(5) to consider the need to create an
				  adequate fund from which to pay losses and expenses and to foster an adequate
				  supply of insurance;
(6) to
				  consider the need of insurance consumers for rates which are reasonable and not
				  excessive;
(7) to avoid predatory
				  trade practices and anticompetitive behavior;
(8) to promote efficiencies and economies in
				  operations and to share the benefits of such with insurance
				  consumers;
(9) to recognize the
				  public necessity that each insurer do its part in attaining the objective of
				  making needed insurance coverages readily available to all eligible risks, and
				  to this end to construct its rate structure and to pursue underwriting
				  practices which maximize its ability to assist in meeting this need.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter V - Rates And Rating Organizations › Subchapter D - Rate Regulation And Promotion Of Competition › Part 160 - Responsibilities In Construction And Application Of Rates › Section 160.1 - Definitions

Current through Register Vol. 46, No. 28, July 10, 2024
For the purposes of this Part:
(a) Except where the context or circumstances
				  clearly indicate otherwise the word insurer as used in article 23 of the
				  Insurance Law and in these regulations includes two or more insurers:
(1) under common management; or
(2) under common controlling ownership or
				  under other common effective legal control and in fact engaged in joint or
				  cooperative underwriting, investment management, marketing, servicing or
				  administration of their business and affairs as insurers.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter V - Rates And Rating Organizations › Subchapter D - Rate Regulation And Promotion Of Competition › Part 160 - Responsibilities In Construction And Application Of Rates › Section 160.3 - Premium adjustments; when required

Current through Register Vol. 46, No. 28, July 10, 2024
(a) The decision as to whether an order
				  rendered after a hearing as provided in section 2320  of the Insurance Law will include
				  provision for retroactive premium adjustment is a matter to be determined
				  within the sound discretion of the superintendent, exercised in consideration
				  of all the facts and circumstances of the particular case with the primary
				  objective of effecting an equitable adjustment between the insurer and its
				  policyholders. Premium adjustment is not a penalty and the fact that premium
				  adjustment is ordered does not necessarily imply that the insurer has violated
				  the law.
(b) Where a rate has been
				  constructed and applied in the good faith exercise of reasonable judgment and
				  competence and in fair consideration of the relevant factors and interests and
				  in accordance with the procedures prescribed in the law and these regulations,
				  retroactive premium adjustment will not be ordered merely because the rate is
				  determined to be excessive by reason of actual loss or expense experience more
				  favorable than anticipated nor merely because the rate is determined to be
				  inadequate by reason of actual loss or expense experience less favorable than
				  anticipated.
(c) If an insurer has
				  established and pursues an adequate procedure to minimize the occurrence of
				  improperly charged rates as described in section
				  160.2(g) 
				  of this Part, the superintendent will limit himself to a request for
				  appropriate premium adjustment in cases of improperly charged rates which may
				  be discovered. If the insurer has not established and pursued such procedures,
				  improperly charged rates may be treated as violations of the law within the
				  meaning of section 2320  of the Insurance Law.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter V - Rates And Rating Organizations › Subchapter D - Rate Regulation And Promotion Of Competition › Part 160 - Responsibilities In Construction And Application Of Rates › Section 160.4 - Rates not in accordance with law

Current through Register Vol. 46, No. 28, July 10, 2024
Penalties. The adoption and charging of a rate will not be
					 deemed to be a violation of law within the meaning of section 2320 (c)  of the Insurance
					 Law where it has been constructed and applied in the good faith exercise of
					 reasonable judgment and competence and in fair consideration of the relevant
					 factors and interests and in accordance with the procedures prescribed in the
					 law and these regulations, even though it may subsequently be determined by the
					 superintendent that the rate does not comply with the standards of section 2303  of the Insurance
					 Law.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter V - Rates And Rating Organizations › Subchapter D - Rate Regulation And Promotion Of Competition › Part 160 - Responsibilities In Construction And Application Of Rates › Section 160.5 - Prohibition of informal discussion of rate changes

Current through Register Vol. 46, No. 28, July 10, 2024
Since both the overall policy and specific provisions of
					 the new law provide for a system under which there is to be no prior review of
					 rates or rate changes, it is essential, in order to preclude later question
					 about the legality of rate on purely procedural grounds, that there be no such
					 prior review. Accordingly, department and industry personnel shall not discuss
					 contemplated rates or rate changes in advance of their taking effect. The only
					 exception would be in situations where the consideration of novel questions of
					 law, policy or statistical method is involved and then only if an insurer or
					 rating organization has made a written request to the superintendent for prior
					 consultation and the request has been granted in writing by the
					 superintendent.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter V - Rates And Rating Organizations › Subchapter D - Rate Regulation And Promotion Of Competition › Part 160 - Responsibilities In Construction And Application Of Rates › Section 160.6 - Premium reductions for loss prevention measures

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
(1)
				  Insurers may provide for a reduction in the rates of homeowners insurance
				  premiums where all entrances leading to the insured residence premises from
				  commonly accessible areas are equipped with dead bolt locks. The amount of
				  reduction shall be determined in accordance with the standards set forth in
				  section
				  160.2  of this
				  Part.
(2) In order to qualify for a
				  premium reduction, the locks shall be installed in accordance with the
				  manufacturer's specifications, and shall meet the applicable operational and
				  security standards for such devices prevailing in the building hardware
				  manufacturing industry for a Grade 3 lock. A Grade 3 lock is described in
				  Appendix A of ANSI/BHMA A156.5-1992 as generally adequate to withstand an
				  attack of opportunity and where the attack is expected to be of short
				  duration.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter V - Rates And Rating Organizations › Subchapter D - Rate Regulation And Promotion Of Competition › Part 161 - Flexible-rating System; Rating Plans; Tort Reform Refiling Requirements › Section 161.2 - Tort reform refiling requirements

Current through Register Vol. 46, No. 28, July 10, 2024
(a) To alleviate affordability and
				  availability problems affecting commercial risk, professional liability and
				  public entity insurance, the omnibus and companion laws contain a number of
				  significant measures in the nature of tort reform:
(1) modification of the joint and several
				  liability doctrine;
(2) new
				  appellate standard for review of verdicts;
(3) credit for collateral sources;
(4) itemized verdicts required in tort
				  actions;
(5) periodic payment of
				  substantial future damages;
(6)
				  penalties for frivolous litigation;
(7) immunity for uncompensated nonprofit
				  directors and officers; and
(8)
				  modification of toxic tort statute of limitations.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter V - Rates And Rating Organizations › Subchapter D - Rate Regulation And Promotion Of Competition › Part 161 - Flexible-rating System; Rating Plans; Tort Reform Refiling Requirements › Section 161.3 - Exempt markets

Current through Register Vol. 46, No. 28, July 10, 2024
(a) As a
				  general proposition, markets that have experienced recent sharp swings in rate
				  level will not be exempted from flex-rating. Designed to promote stability over
				  the long range in the interests of insureds, insurers, consumers and the
				  public-at-large, the flex-rating system envisions broad rate change flexibility
				  coupled with increased regulatory scrutiny of substantial rate changes, whether
				  in an upward or downward direction.
(b) Following public hearings, market surveys
				  and other information analyzed by the department, the superintendent has
				  determined the identity of those commercial risk, professional liability and
				  public entity insurance markets that should be exempted from flex-rating.
				  Because competition is sufficient to assure that rates will not be excessive in
				  the particular market or such market is conducted in a manner not resulting in
				  inadequate rates, not destructive of competition or detrimental to the solvency
				  of insurers, the superintendent at this time exempts the following markets from
				  flex-rating:
(1) Lines of insurance, as
				  reported on page 14 of the annual statement blank, as follows:
(i) fire and allied lines;
(ii) farmowners;
(iii) ocean marine;
(iv) inland marine;
(v) earthquake;
(vi) fidelity;
(vii) surety;
(viii) aircraft;
(ix) glass;
(x) burglary and theft;
(xi) boiler and machinery; and
(xii) credit (including credit unemployment);
				  and