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New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 2 - INSURANCE GROUP › Subchapter 13 - GROUP COVERAGE DISCONTINUANCE AND REPLACEMENT › Section 11:2-13.3 - Effective date of discontinuance for nonpayment of premium or subscription charges

Current through Register Vol. 56, No. 14, July 15, 2024
(a) If a policy or contract provides for automatic discontinuance after a premium or subscription charge has remained unpaid through the grace period allowed for such payment, the carrier shall be liable for valid claims for covered losses incurred and services or supplies provided prior to the end of the grace period. For all charges incurred with respect to hospitalization, the loss is considered incurred on the date of admission for all services and supplies provided through date of discharge.
(b) If the actions of the carrier after the end of the grace period indicate that it considers the policy or contract as continuing in force beyond the end of the grace period (such as, by continuing to recognize claims subsequently incurred or continuing to provide services or supplies), the carrier shall be liable for valid claims for losses beginning, and services or supplies provided, prior to the effective date of written notice of discontinuance to the policyholder, contractholder or other entity responsible for making premium payments or submitting subscription charges to the carrier. The effective date of the discontinuance shall be no earlier than midnight at the end of the third scheduled business day after the date that the notice is received.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 2 - INSURANCE GROUP › Subchapter 13 - GROUP COVERAGE DISCONTINUANCE AND REPLACEMENT › Section 11:2-13.4 - Requirements for notice of discontinuance

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Any written notice of discontinuance provided pursuant to 11:2-13.3 by the carrier to the group policy holder or contractholder shall include a statement that, unless otherwise provided in the policy or contract, the carrier shall not be liable for claims for losses incurred, or services or supplies provided, after the effective date of such discontinuance. Where a plan involves member contributions, the notice of discontinuance shall state that if the policyholder, contractholder or other entity continues to collect contributions for the coverage beyond the date of discontinuance, the policyholder, contractholder or other entity may be held solely liable for the benefits, services or supplies for which the contributions have been collected.
(b) At the same time written notice of discontinuance is given pursuant to (a) above, the carrier shall provide the policyholder, contractholder or other entity with a notice form to be distributed to the members indicating the effective date of such discontinuance, and urging the members to refer to their certificates, contracts or evidence of coverage to determine their rights, if any, including, but not limited to, privileges of conversion.
(c) Discontinuance of the group policy or contract shall not reduce the required time limit for providing notice of claim or proof of loss.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 2 - INSURANCE GROUP › Subchapter 13 - GROUP COVERAGE DISCONTINUANCE AND REPLACEMENT › Section 11:2-13.5 - Extension of benefits

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Every group policy or other contract subject to these rules hereafter issued, or under which the level of benefits is hereafter altered, modified or amended, shall provide a reasonable provision for extension of benefits in the event of total disability which exists as of the date of discontinuance of the group policy or contract, as required by (b) through (e) below.
(b) In case of a group life plan which contains a disability benefit extension of any type (for example, premium waiver extension, extended death benefit in event of total disability or payment of income for a specified period during total disability), the discontinuance of the group policy shall not operate to terminate such extension.
(c) In the case of a group plan providing benefits for loss of time from work or specified indemnity during hospital confinement, discontinuance of the policy during a disability shall have no effect on benefits payable for that disability or confinement.
(d) In the case of hospital, medical, dental expense, dental plan organization, dental service corporation or health maintenance organization coverages, a reasonable extension of benefits or accrued liability provision is required. Such a provision shall be considered reasonable if:
1. Under major medical, comprehensive medical and HMO coverages, it provides an extension of at least 12 months.
2. Under other types of hospital, medical or dental expense coverages, other than for maternity, it provides either an extension of at least 90 days or an accrued liability for expenses incurred during a period of disability or during a period of at least 90 days starting with a specific event which occurred while coverage was in force (such as, an accident).
3. Under hospital or medical expense or health maintenance organization coverages related to maternity, any extension of benefits or accrued liability shall be considered reasonable if benefits for expenses incurred or services or supplies are provided in connection with maternity resulting from conception prior to the date of discontinuance of the group policy or contract.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 2 - INSURANCE GROUP › Subchapter 14 - PROCEDURES FOR THE CONDUCT OF VOTING ON A PLAN OF REORGANIZATION OF A DOMESTIC MUTUAL LIFE INSURER › Section 11:2-14.1 - Purpose and scope

Current through Register Vol. 56, No. 14, July 15, 2024
(a) This subchapter establishes procedures pursuant to N.J.S.A. 17:17C-5a for the conduct of the vote of the policyholders of a domestic mutual life insurer on a proposal to approve a plan of reorganization to convert from a domestic mutual life insurance company to a domestic stock life insurance company.
(b) This subchapter shall apply to any domestic mutual life insurer that seeks to reorganize into a domestic stock life insurer pursuant to 17:17C-1 et seq.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 2 - INSURANCE GROUP › Subchapter 14 - PROCEDURES FOR THE CONDUCT OF VOTING ON A PLAN OF REORGANIZATION OF A DOMESTIC MUTUAL LIFE INSURER › Section 11:2-14.2 - Definitions

Current through Register Vol. 56, No. 14, July 15, 2024
The following words and terms, as used in this subchapter, shall have the following meanings, unless the context clearly indicates otherwise.
"Ballot" means the instrument by which a policyholder indicates his approval or disapproval of the plan of reorganization, including, but not limited to, a paper ballot.
"Commissioner" means the Commissioner of Banking and Insurance of the State of New Jersey.
"Demutualization" means the conversion of a domestic mutual insurer into a stock insurer.
"Department" means the New Jersey Department of Banking and Insurance.
"IVR" means interactive voice response.
"Notice" means a notice of the policyholder meeting as required by N.J.S.A. 17:17C-5c.
"Policyholder meeting" means the meeting of the policyholders held to conduct the vote on the plan of demutualization pursuant to 17:17C-5.
"Voting policyholders" means those policyholders of the insurer who are eligible to vote on the plan of reorganization pursuant to 17B:18-13 or 17B:18-23, as applicable.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 2 - INSURANCE GROUP › Subchapter 14 - PROCEDURES FOR THE CONDUCT OF VOTING ON A PLAN OF REORGANIZATION OF A DOMESTIC MUTUAL LIFE INSURER › Section 11:2-14.3 - Policyholders entitled to notice and vote and manner of giving notice

Current through Register Vol. 56, No. 14, July 15, 2024
The insurer shall prepare, in electronic format, a list of policyholders eligible to vote on the plan of reorganization, which list shall be subject to review by the Department. The insurer, acting directly or through one or more agents (as specified in 11:2-14.1 0), shall mail to voting policyholders a notice, an appropriate form of ballot with a postage-paid (first class) return envelope. The notice shall set forth the time, place and date of the policyholder meeting, and the notice or other material shall include instructions on all forms of voting, including interactive voice response (IVR) and internet, if applicable, as well as the procedure for requesting substitute or duplicate ballot forms. Substitute or duplicate ballot forms shall be mailed by the insurer or its agent as promptly as possible after receipt of the request. Upon conclusion of the vote, the insurer shall provide a certificate of mailing to the Commissioner.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 2 - INSURANCE GROUP › Subchapter 14 - PROCEDURES FOR THE CONDUCT OF VOTING ON A PLAN OF REORGANIZATION OF A DOMESTIC MUTUAL LIFE INSURER › Section 11:2-14.4 - Policyholder communication

Current through Register Vol. 56, No. 14, July 15, 2024
The insurer shall operate a toll free telephone center ("Demutualization Call Center") to answer questions from policyholders on the plan, including, but not limited to, questions on the method of voting. The insurer shall submit to the Department for its approval, in advance of the establishment of the Demutualization Call Center, a copy of responses that will be given to anticipated policyholder questions. The insurer shall establish appropriate procedures acceptable to the Department for providing oral and written responses to questions that do not have an approved response. Such procedures shall be developed, taking into consideration the insurer's need to respond promptly to policyholder inquiries. The insurer shall not provide any oral or written response that was not specifically approved or prepared in accordance with such procedures.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 2 - INSURANCE GROUP › Subchapter 14 - PROCEDURES FOR THE CONDUCT OF VOTING ON A PLAN OF REORGANIZATION OF A DOMESTIC MUTUAL LIFE INSURER › Section 11:2-14.5 - Mailing, receipt, custody, and safeguarding of ballots

Current through Register Vol. 56, No. 14, July 15, 2024
The insurer shall file with the Department its procedures for the printing, mailing, receipt, custody, safeguarding, verification and tabulation of ballots, and measures to prevent ballot tampering. The insurer shall also file with the Department its procedures for IVR and internet voting.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 2 - INSURANCE GROUP › Subchapter 14 - PROCEDURES FOR THE CONDUCT OF VOTING ON A PLAN OF REORGANIZATION OF A DOMESTIC MUTUAL LIFE INSURER › Section 11:2-14.7 - Voting on the plan

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Voting on the plan shall be in accordance with 17:17C-5 under the supervision of the Department or its designee(s). At the conclusion of the policyholder meeting, the insurer shall verify and tabulate such votes separately from those received other than in person and shall execute and deliver to the Commissioner a certificate setting forth the number of valid ballots received, and broken down into the following categories:
1. Paper ballot received by mail;
2. Paper ballot cast at the policyholder meeting;
3. Votes cast by IVR;
4. Votes cast by internet; and
5. A new vote included as part of a revocation of a ballot pursuant to 11:2-14.6(g)2.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 2 - INSURANCE GROUP › Subchapter 14 - PROCEDURES FOR THE CONDUCT OF VOTING ON A PLAN OF REORGANIZATION OF A DOMESTIC MUTUAL LIFE INSURER › Section 11:2-14.8 - Assistance with voting

Current through Register Vol. 56, No. 14, July 15, 2024
The Demutualization Call Center shall be equipped to respond to questions from policyholders concerning the voting procedures, but shall not advise policyholders whether to vote in favor of or against the plan.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 2 - INSURANCE GROUP › Subchapter 14 - PROCEDURES FOR THE CONDUCT OF VOTING ON A PLAN OF REORGANIZATION OF A DOMESTIC MUTUAL LIFE INSURER › Section 11:2-14.9 - Vote confirmation

Current through Register Vol. 56, No. 14, July 15, 2024
The insurer shall establish a mechanism to be filed with the Department which permits policyholders to verify by telephone whether their votes have been received.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 2 - INSURANCE GROUP › Subchapter 14 - PROCEDURES FOR THE CONDUCT OF VOTING ON A PLAN OF REORGANIZATION OF A DOMESTIC MUTUAL LIFE INSURER › Section 11:2-14.10 - Agents

Current through Register Vol. 56, No. 14, July 15, 2024
In performing any duty set forth in this subchapter or any duty incidental to such tasks, the insurer may utilize the services of a firm that is professionally engaged in the business of mailing materials to shareholders or policyholders and/or soliciting and tabulating shareholder or policyholder votes, to act as agent for the insurer in providing such services in connection with the policyholder meeting. Such firms may employ the services of subcontractors. Any agent of the insurer that conducts activities involving the policyholder vote, and its subcontractors, shall act under the supervision and direction of the Department in the conduct of all activities pursuant to this subchapter. The use of an agent shall not relieve the insurer from any obligations imposed under this subchapter.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 2 - INSURANCE GROUP › Subchapter 14 - PROCEDURES FOR THE CONDUCT OF VOTING ON A PLAN OF REORGANIZATION OF A DOMESTIC MUTUAL LIFE INSURER › Section 11:2-14.11 - Penalties

Current through Register Vol. 56, No. 14, July 15, 2024
Failure to comply with the provisions of this subchapter shall result in the imposition of penalties as authorized by law.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 2 - INSURANCE GROUP › Subchapter 15 - INSOLVENT INSURERS › Section 11:2-15.1 - Cancellation of property and liability policies

Current through Register Vol. 56, No. 14, July 15, 2024
Whenever an insurer is declared insolvent by a court of competent jurisdiction, or its business is suspended under the laws of its state of incorporation, or its certificate of authority is revoked by this State, the company's insurance policies shall be deemed cancelled by said insurer if the policy is terminated at the request of the policyholder. The insurer thereupon shall be obligated to return the unearned premiums including the unearned commissions to the policyholder.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 2 - INSURANCE GROUP › Subchapter 16 - GUARANTEED ARREST BOND CERTIFICATES OF AUTOMOBILE CLUB UNDERTAKING › Section 11:2-16.1 - General provisions

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Whenever a domestic or foreign surety company which has qualified to transact surety business in this State, in any year, becomes surety in an amount not to exceed $500.00 with respect to any guaranteed arrest bond certificates issued in such year by an automobile club or association by filing with the Commissioner of Banking and Insurance an undertaking thus to become surety, such undertaking shall state:
1. The name and address of the automobile club or clubs or automobile association or associations with respect to guaranteed arrest bond certificates of which the surety company undertakes to be surety;
2. The unqualified obligation of the surety company to pay the fine or forfeiture in an amount not to exceed $500.00 of any person who, after posting a guaranteed arrest bond certificate with respect to which the surety company has undertaken to be surety, failed to make the appearance for which the guaranteed arrest bond certificate was posted.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 2 - INSURANCE GROUP › Subchapter 17 - UNFAIR CLAIMS SETTLEMENT PRACTICES › Section 11:2-17.1 - Purpose

Current through Register Vol. 56, No. 14, July 15, 2024
17:29B-4(9)  and 17B:30-13.1 prohibit insurers from engaging in unfair claims settlement practices. The purpose of this subchapter is to promote the fair and equitable treatment of claimants by defining certain minimum standards for the settlement of claims which, if violated with such frequency as to indicate a general business practice, would constitute unfair claims settlement practices in the business of insurance.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 2 - INSURANCE GROUP › Subchapter 17 - UNFAIR CLAIMS SETTLEMENT PRACTICES › Section 11:2-17.2 - Scope

Current through Register Vol. 56, No. 14, July 15, 2024
This subchapter applies to all persons and all policies except the following: ocean marine, fidelity and surety, boiler and machinery and workers' compensation. It shall also not apply to commercial property and liability policies for which the annual premium is more than $ 10,000 and where the claim is made by the commercial insured. This subchapter is not exclusive, and other acts, not herein specified, may also be found to constitute unfair claims settlement practices. This subchapter is not intended to supersede any other rule or regulation.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 2 - INSURANCE GROUP › Subchapter 17 - UNFAIR CLAIMS SETTLEMENT PRACTICES › Section 11:2-17.4 - Miscellaneous rules

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Every insurer shall distribute copies of this subchapter to every person directly responsible for the handling and settlement of claims subject to this subchapter. Every insurer shall satisfy itself that all such responsible persons are thoroughly conversant with and are complying with this subchapter.
(b) All correspondence to a claimant required of an insurer pursuant to this subchapter shall be written in easy to read and understandable terms. This subsection shall not apply to correspondence to a claimant's legal representative.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 2 - INSURANCE GROUP › Subchapter 17 - UNFAIR CLAIMS SETTLEMENT PRACTICES › Section 11:2-17.5 - Misrepresentation of policy provisions

Current through Register Vol. 56, No. 14, July 15, 2024
(a) No insurer shall fail to fully disclose to first party claimants all pertinent benefits, coverages or other provisions of an insurance policy or insurance contract under which a claim is presented.
(b) No agent, broker, or insurer shall conceal from first party claimants benefits, coverages or other provisions of any insurance policy or insurance contract when such benefits, coverages or other provisions are pertinent to a claim.
(c) No insurer shall, except where there is a time limit specified in the policy, make statements, written or otherwise, requiring a claimant to give written notice of loss or proof of loss within a specified time limit and which seek to relieve the company of its obligations if such time limit is not complied with unless the failure to comply with such time limit prejudices the insurer's rights.
(d) No insurer shall request a claimant to sign a release that extends beyond the subject matter that gave rise to the claim payment.
(e) No insurer shall issue checks or drafts in partial settlement of a loss or claim using language which releases the insurer or its insured from its total liability.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 2 - INSURANCE GROUP › Subchapter 17 - UNFAIR CLAIMS SETTLEMENT PRACTICES › Section 11:2-17.6 - Rules for replying to pertinent communications

Current through Register Vol. 56, No. 14, July 15, 2024
(a) All claims must be reported to the designated insurer by a broker no later than three working days following receipt of notification of claim by the broker. For the purposes of this subsection, "broker" shall include a producer of record with respect to any residual market mechanism created by statute.
(b) Every insurer, upon receiving notification of claim shall, within 10 working days, acknowledge receipt of such notice unless payment is made within such period of time. This acknowledgement shall include the address and telephone number of the insurer claims office or authorized claims representative which will handle the claim. Notification given to an agent of an insurer shall be considered notice to the insurer.
(c) Every insurer, upon receiving notification of claim, shall promptly provide first party claimants with necessary claim forms, instructions, and reasonable assistance so that such claimants can comply with the policy conditions and the insurer's reasonable requirements. Compliance with this subsection (c) within 10 working days of notification of a claim shall constitute compliance with (b) above.
(d) Every insurer, upon receipt of any inquiry from the Department respecting a claim shall, within 15 working days of receipt of such inquiry, furnish the Department with, based on the information available to the insurer, a complete and accurate written response to the inquiry.
(e) An appropriate reply shall be made within 10 working days on all other pertinent communications from a claimant which reasonably suggest that a response is expected.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 2 - INSURANCE GROUP › Subchapter 17 - UNFAIR CLAIMS SETTLEMENT PRACTICES › Section 11:2-17.7 - Rules for prompt investigation and settlement of claims

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Every insurer shall commence an investigation on all claims other than auto physical damage within 10 working days of receipt of notification of claim.
(b) The maximum payment period for all personal injury protection (PIP) claims shall be 60 calendar days after the insurer is furnished written notice of the fact of a covered loss and of the amount of same; provided, however, that an insurer may secure a 45-day extension in accordance with 39:6A-5.
(c) Unless a clear justification exists, or unless otherwise provided by law, the maximum payment periods for property/liability claims shall be as follows:
1. For all first party claims other than personal injury protection (PIP) and auto physical damage (see 11:3-10.5(a)  ), 30 calendar days from receipt by the insurer of properly executed proofs of loss.
2. For all third party property damage claims, 45 calendar days from receipt by the insurer of notification of claim.
3. For all third party bodily injury claims, 90 calendar days from receipt by the insurer of notification of claim.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 2 - INSURANCE GROUP › Subchapter 17 - UNFAIR CLAIMS SETTLEMENT PRACTICES › Section 11:2-17.11 - Written notice by insurers of payment of claims

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Upon payment of $ 5,000 or more in settlement of any third-party liability claim, where the claimant is a natural person, the insurer or its representative (including the insurer's attorney) shall mail to the third-party claimant written notice of payment at the same time payment is made to the third-party claimant's attorney or other representative.
(b) Upon payment of $ 5,000 or more in settlement of any first-party property claim, the insurer or its representative (including the insurer's attorney) shall mail to the first-party claimant written notice of payment at the same time payment is made to the first-party claimant's public adjuster or other representative.
(c) The written notice referred to in (a) or (b) above shall be mailed to the claimant by regular mail at the claimant's last known address, and shall include at least the following information:
1. The amount of the payment;
2. The party or parties to whom the check is made payable;
3. The party to whom the check was mailed; and
4. The address of the party to whom the check was mailed.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 2 - INSURANCE GROUP › Subchapter 17 - UNFAIR CLAIMS SETTLEMENT PRACTICES › Section 11:2-17.12 - Examinations

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Each insurer's claim files are subject to examination and inspection by the Commissioner or by his duly appointed designees pursuant to 17:23-20 et seq., 17:29B-5, and 17B:30-16.
(b) Detailed documentation and/or evidence shall be contained in each claim file in order to permit the Commissioner or his designated examiners or investigators to reconstruct the company's activities relative to the claims settlement. Such documentation shall include but is not necessarily limited to all investigative reports, payment vouchers, transactions, notices, memoranda and work papers. With respect to automobile damage claims, file documentation also shall include the name, address, telephone number and license number of any auto body repair facility that has been utilized by the insurer in the adjustment of the loss or repair of the automobile. All such documentation shall be properly dated and, for investigative reports, notes, memoranda and work papers, the parties preparing such documents shall be identified.
(c) Every insurer shall maintain records of all pertinent communications relating to a claim. The records must identify the date of the communication and the parties, and describe the substance of the communication.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 2 - INSURANCE GROUP › Subchapter 17 - UNFAIR CLAIMS SETTLEMENT PRACTICES › Section 11:2-17.13 - Special claims reports

Current through Register Vol. 56, No. 14, July 15, 2024
(a) If the Department observes that an insurer's claims settlement practices are not meeting the standards established by statute or by this subchapter, the Department may require such insurer to file periodic reports. Depending on the nature and extent of an insurer's deviations from such standards and with due consideration of the insurer's data capabilities, the Commissioner in his discretion may require the report to include some or all of the statistics listed below:
1. The total number of claims submitted;
2. The original amount claimed;
3. The classification by line or insurance of each individual claim;
4. The total number of claims denied;
5. The total number of claims paid;
6. The total number of claims compromised;
7. The amount of each settlement;
8. The total number of claims for which lawsuits are instituted against the insurer, the reason for the lawsuit, and the amount of the final adjudication; and
9. An individual listing showing the disposition and other information for each claim.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 2 - INSURANCE GROUP › Subchapter 17 - UNFAIR CLAIMS SETTLEMENT PRACTICES › Section 11:2-17.14 - Separability

Current through Register Vol. 56, No. 14, July 15, 2024
If any provision of this subchapter or the application thereof to any person or circumstance is for any reason held to be invalid, the remainder of the subchapter and the application of such provision to other persons or circumstances shall not be affected thereby.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 2 - INSURANCE GROUP › Subchapter 17 - UNFAIR CLAIMS SETTLEMENT PRACTICES › Section 11:2-17.15 - Penalties

Current through Register Vol. 56, No. 14, July 15, 2024
(a) If, after notice and hearing, the Commissioner finds that a person has violated this subchapter, he shall make his findings in writing and shall issue and cause to be served upon the person charged with the violation an order requiring such person to cease and desist from engaging in such violation. The Commissioner may order payment of a penalty not to exceed $ 1,000 for each and every violation unless the person knew or reasonably should have known he was in violation of this subchapter, in which case the penalty shall not be more than $ 5,000 for every violation. The Commissioner shall collect the penalty in the name of the State in a summary proceeding in accordance with "the penalty enforcement law" (N.J.S.A. 2A:58-1 et seq.).
(b) Any person who violates a cease and desist order of the Commissioner under (a) above, after it has become final, and while such order is in effect, shall be liable to a penalty not exceeding $ 5,000 for each violation, which may be recovered in a civil action. In determining the amount of the penalty the question of whether the violation was willful shall be taken into consideration.
(c) The penalties provided herein shall be in addition to any other penalties authorized by law.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 2 - INSURANCE GROUP › Subchapter 18 - READABLE POLICIES › Section 11:2-18.1 - Purpose

Current through Register Vol. 56, No. 14, July 15, 2024
The Plain Language Law, N.J.S.A. 56:12-1et seq., requires certain insurance policies to be written in a "simple, clear, understandable and easily readable way." N.J.S.A. 39:6A-23.g requires that each buyer's guide and coverage selection form required by that section to be issued to insureds and prospective insureds for automobile insurance be written in plain language. This subchapter provides rules for the implementation of these provisions.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 2 - INSURANCE GROUP › Subchapter 18 - READABLE POLICIES › Section 11:2-18.2 - Scope

Current through Register Vol. 56, No. 14, July 15, 2024
(a) This subchapter applies to all insurance policies which are issued to individuals to provide coverage for personal, family, or household purposes except life, health and annuity policies defined in N.J.S.A. 17B:17-19a, the "Life and Health Policy Language Simplification Act." Examples of coverage for personal, family or household purposes are:
1. Policies used solely to provide homeowners insurance, dwelling fire insurance on one to four family units, or individual fire insurance on dwelling contents;
2. Policies principally used to provide primary insurance on private passenger automobiles which are individually owned and used for personal or family needs; and
3. Policies of personal inland marine, personal theft, residence glass, and personal liability insurance.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 2 - INSURANCE GROUP › Subchapter 18 - READABLE POLICIES › Section 11:2-18.3 - Definitions

Current through Register Vol. 56, No. 14, July 15, 2024
The following words and terms, as used in this subchapter, shall have the following meanings, unless the context clearly indicates otherwise:
"Buyer's Guide" means part of a written notice required to be given to insureds and prospective insureds for automobile insurance, pursuant to 39:6A-23, which provides a brief description of all available policy coverages and benefit limits, identifies which coverages are optional and mandatory, and identifies all options offered by the insurer.
"Commissioner" means the Commissioner of Banking and Insurance.
"Coverage Selection Form" means part of a written notice required to be given to insureds and prospective insureds for automobile insurance, pursuant to 39:6A-23, which provides information required by the Commissioner pursuant to 11:3-15.6.
"Insurer" means any person, corporation, company, association, partnership, title insurance company, eligible authorized surplus lines insurer, or any other legal entity issuing a contract of insurance subject to this subchapter. In this subchapter, "insurer" also includes rating organizations.
"Policy" means any contract of insurance subject to this subchapter and includes, but is not limited to, all policies, contracts, certificates, riders and endorsements that provide insurance coverage to individuals. "Policy" also includes applications to be signed by the applicant and all other writings required to complete the insurance transaction.
"Text" means all printed matter in a policy, except the name and address of the insurer; the name, number and title of the policy; the table of contents or index, captions or subcaptions; applications; specification or declarations pages; and schedules or tables. "Text" does not include the Coverage Selection Form or specific language required, permitted or approved by a law, regulation, rule or published interpretation of a State or Federal agency.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 2 - INSURANCE GROUP › Subchapter 18 - READABLE POLICIES › Section 11:2-18.4 - Minimum readability standards

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The Plain Language Law provides, at 56:12-10, certain "examples of guidelines" that the Commissioner may consider in determining whether a contract complies with the Act. The readability standards in this section are in addition to the standards enumerated in the Act.
(b) A policy, Buyer's Guide, and Coverage Selection Form shall be printed in legible type style with adequate contrast between paper and ink. Captions, headings, and spacing shall be used to increase overall readability.
(c) A policy and Buyer's Guide shall be printed in not less than 10 point type, one point leading. This rule shall not apply to schedules and tables; specification or declaration pages; or applications.
(d) Applications to be signed by the applicant shall be printed in not less than 8-point type, one point leading. Provided, however, that conditions or exceptions to the main promise of the agreement contained in an application shall be printed in at least 10-point type. (See N.J.S.A. 56:12-10.b(3).)
1. The 8 point type, one point leading standard set forth in (d) above shall become operative on July 1, 1983.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 2 - INSURANCE GROUP › Subchapter 18 - READABLE POLICIES › Section 11:2-18.6 - Enforcement

Current through Register Vol. 56, No. 14, July 15, 2024
The Commissioner may seek injunctive relief to enforce this subchapter. The court may authorize reasonable attorney's fees and costs in such a proceeding.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 2 - INSURANCE GROUP › Subchapter 18 - READABLE POLICIES › Section 11:2-18.7 - Separability

Current through Register Vol. 56, No. 14, July 15, 2024
If any provision of this subchapter, or its application to any person or circumstances, is held invalid, the remainder of this subchapter and its application to other persons or circumstances shall be affected.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 2 - INSURANCE GROUP › Subchapter 19 - DESIGNATION OF THIRD PARTY FOR CERTAIN NOTIFICATIONS BY SENIOR CITIZEN INSUREDS › Section 11:2-19.1 - Purpose and scope

Current through Register Vol. 56, No. 14, July 15, 2024
(a)
									17:29C-1.1 and 1.2 allow senior citizen insureds of policies of personal lines insurance to designate a third party to whom the insurer must transmit a copy of important notices affecting insurance coverage. This subchapter provides rules for the implementation of those provisions.
(b) This subchapter applies to all insurance policies or contracts of insurance that are issued or issued for delivery in this State for personal, family or household purposes, as determined by the Commissioner, by an insurer on a risk located or resident in this State for which the premiums are paid directly to the insurer by the senior citizen insured.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 2 - INSURANCE GROUP › Subchapter 19 - DESIGNATION OF THIRD PARTY FOR CERTAIN NOTIFICATIONS BY SENIOR CITIZEN INSUREDS › Section 11:2-19.2 - Definitions

Current through Register Vol. 56, No. 14, July 15, 2024
The following words and terms, as used in this subchapter, shall have the following meanings, unless the context clearly indicates otherwise:
"Commissioner" means the Commissioner of the Department of Banking and Insurance.
"Insurer" means those entities defined at 17:29C-1.1.
"Lapse" means default in premium or any other required payment, and the termination of insurance for any reason, including, but not limited to, nonpayment of premium, excessive debt, and expiration of policy term.
"Personal lines insurance" means insurance policies issued for personal, family or household purposes, and includes:
1. Under property/casualty coverage:
i. The policies set forth at 11:13-1.2(a)2  i; and
ii. Policies principally used to provide primary insurance on private passenger automobiles that are individually owned or leased for over six months and used for personal or family needs; and
2. Under life and health coverage:
i. All individual life, health and credit insurance policies;
ii. Annuity contracts;
iii. Health maintenance organization contracts;
iv. Medicare + Choice plans as defined at 11:4-23.3; and
v. Any group policies of life, health or credit insurance, group annuity contracts and group health maintenance organization contracts where the individual insured pays premiums directly to the insurer.
"Policy of personal lines insurance" means any policy or contract of insurance issued or issued for delivery in this State for personal, family or household purposes, as defined in this subchapter, by an insurer on a risk located or resident in this State for which the premiums are paid directly to the insurer by the senior citizen insured.
"Senior citizen insured" means any named insured, or certificate holder, or, with respect to life insurance, the owner of the policy or certificate, if other than the insured, pursuant to a policy of personal lines insurance who is an individual and is at least 62 years of age.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 2 - INSURANCE GROUP › Subchapter 19 - DESIGNATION OF THIRD PARTY FOR CERTAIN NOTIFICATIONS BY SENIOR CITIZEN INSUREDS › Section 11:2-19.3 - Designation third party to receive copies of certain notices

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Every insurer shall permit its senior citizen insureds to designate a third party to whom the insurer shall transmit a copy of notices of cancellation, lapse, nonrenewal and conditional renewal with respect to a policy of personal lines insurance. The senior citizen insured shall notify the insurer that a third party has been so designated. Such notification shall be delivered to the insurer by certified mail, return receipt requested, and shall be effective not later than 10 business days from the date of receipt by the insurer. The notification shall contain, in writing, an acceptance by the third party designee to receive copies of notices of cancellation, lapse, nonrenewal and conditional renewal from the insurer.
(b) Designation as a third party shall not constitute acceptance of any liability on the part of the third party for services provided to the senior citizen insured, nor on the part of the insurer.
(c) The transmission to the third party designee of a copy of any notice of cancellation, lapse, nonrenewal or conditional renewal shall be in addition to the original document transmitted to the senior citizen insured. When a third party is so designated, all such notices and copies shall be mailed in an envelope clearly marked on its face with the following: "IMPORTANT INSURANCE POLICY INFORMATION: OPEN IMMEDIATELY."
(d) The copy of the notice of cancellation, lapse, nonrenewal or conditional renewal transmitted to the third party shall be governed by the same law and policy provisions which govern the notice being transmitted to the senior citizen insured.
(e) The insurer shall notify its senior citizen insureds annually in writing, except in cases in which the age of the senior citizen insured is unknown to the insurer, of the availability of the third party designee notice procedures and provide information on how the insured can commence this procedure, except that notice need not be provided once a senior citizen insured has made a designation. An insurer may provide this required annual notice to its senior citizen insureds in any manner that it determines.
(f) Should the third party designee desire to terminate the status as a third party designee, the designee shall provide written notice to both the insurer and the senior citizen insured. Should the senior citizen insured desire to terminate the third party designation, the insured shall provide written notice to the insurer.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 2 - INSURANCE GROUP › Subchapter 19 - DESIGNATION OF THIRD PARTY FOR CERTAIN NOTIFICATIONS BY SENIOR CITIZEN INSUREDS › Section 11:2-19.4 - Penalties

Current through Register Vol. 56, No. 14, July 15, 2024
Failure to comply with this subchapter shall result in the imposition of penalties as set forth in 17:33-2 and 17B:21-2.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 2 - INSURANCE GROUP › Subchapter 23 - ADVERTISEMENT OF LIFE INSURANCE AND ANNUITIES › Section 11:2-23.1 - Purpose

Current through Register Vol. 56, No. 14, July 15, 2024
The purpose of this subchapter is to implement 17B:30-1 et seq. through guidelines intended to assure a full and truthful disclosure to the public of all material and relevant information in the advertising of life insurance policies and annuity contracts.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 2 - INSURANCE GROUP › Subchapter 23 - ADVERTISEMENT OF LIFE INSURANCE AND ANNUITIES › Section 11:2-23.2 - Applicability

Current through Register Vol. 56, No. 14, July 15, 2024
(a) This subchapter shall apply to any life insurance or annuity advertisement distributed in this State.
(b) Every insurer shall establish and at all times maintain a system of control over the content, form and method of dissemination of all advertisements of its policies. All such advertisements, regardless of by whom written, created, designed, or presented, shall be the responsibility of the insurer.
(c) This subchapter shall also apply to agents and brokers to the extent that they are responsible for the advertisements of any policy.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 2 - INSURANCE GROUP › Subchapter 23 - ADVERTISEMENT OF LIFE INSURANCE AND ANNUITIES › Section 11:2-23.4 - Form and content of advertisements in general

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Advertisements shall be truthful and not misleading in fact or by implication. Words or phrases the meaning of which is clear only by implication or by familiarity with insurance terminology shall not be used. The form and content of an advertisement of a policy shall be sufficiently complete and clear so as to avoid deception. The advertisement shall not have the capacity or tendency to mislead or deceive.
(b) Whether an advertisement has the capacity or tendency to mislead or deceive shall be determined by the Commissioner from the overall impression that the advertisement may be reasonably expected to create upon a person of average education or intelligence within the segment of the public to which it is directed.
(c) No advertisement shall use the terms "investment," "investment plan," "founder's plan," "charter plan," "savings," "savings plan," or other similar terms in connection with a policy when they have the tendency to mislead a purchaser or prospective purchaser into believing that he will receive something other than a policy or some benefit not available to other persons of the same class and equal expectation of life.
(d) The fact that the policy offered is made available to a prospective insured prior to consummation of the sale or that an offer is made to refund the premium if the purchaser is not satisfied does not remedy misleading statements.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 2 - INSURANCE GROUP › Subchapter 23 - ADVERTISEMENT OF LIFE INSURANCE AND ANNUITIES › Section 11:2-23.5 - Disclosure requirements

Current through Register Vol. 56, No. 14, July 15, 2024
(a) All information required to be disclosed by this subchapter shall be set out conspicuously and in close conjunction with the statements to which such information relates or under appropriate captions of such prominence that it shall not be minimized, rendered obscure, or presented in an ambiguous fashion, or intermingled with the context of the advertisements so as to be confusing or misleading.
(b) No advertisement shall omit material information or use words, phrases, statements, references, or illustrations if such omission or such use has the capacity, tendency, or effect of misleading or deceiving purchasers or prospective purchasers as to the nature or extent of any policy benefit payable, loss covered, premium payable, or State or Federal tax consequences.
(c) An advertisement for a policy containing graded or modified benefits shall prominently display any limitation of benefits. If the premium is level and coverage decreases or increases with age or duration, such fact shall be prominently disclosed.
(d) An advertisement for a policy with non-level premiums shall prominently describe the premium changes.
(e) Advertisements referring to dividends must comply with the following requirements:
1. An advertisement shall not utilize or describe dividends in a manner which is misleading or has the capacity or tendency to mislead;
2. An advertisement shall not state or imply that the payment or amount of dividends is guaranteed. If dividends are illustrated, they must be based on the insurer's current dividend scale and the illustration must contain a statement to the effect that they are not to be construed as guarantees or estimates of dividends to be paid in the future; and
3. An advertisement shall not state or imply that illustrated dividends under a participating policy and/or pure endowments will be or can be sufficient at any future time to assure, without the further payment of premiums, the receipt of benefits, such as a paid-up policy, unless the advertisement clearly and precisely explains:
i. What benefits or coverage would be provided at such time; and
ii. Under what conditions this would occur.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 2 - INSURANCE GROUP › Subchapter 23 - ADVERTISEMENT OF LIFE INSURANCE AND ANNUITIES › Section 11:2-23.6 - Identification of insurer, plan and number of policies

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The name of the insurer shall be clearly identified, and if any specific individual policy is advertised it shall be identified either by form number or other appropriate description. An advertisement shall not use a trade name, an insurance group designation, name of a parent company of the insurer, name of a particular division of the insurer, service mark, slogan, symbol, or other device or reference without disclosing the name of the insurer, if the advertisement would have the capacity or tendency to mislead or deceive as to the true identity of the insurer or create the impression that a company other than the insurer would have any responsibility for the financial obligation under a policy.
(b) No advertisement shall use any combination of words, symbols, or physical materials which by their content, phraseology, shape, color or other characteristics are so similar to a combination of words, symbols, or physical materials used by a governmental program or agency or otherwise appear to be of such a nature that they tend to mislead prospective insureds into believing that the solicitation is in some manner connected with such governmental program or agency.
(c) When a choice of the amount of benefits is referred to, an advertisement shall disclose that the amount of benefits provided depends upon the plan selected and that the premium will vary with the amount of the benefits.
(d) When an advertisement refers to various benefits which may be contained in two or more policies, other than group master policies, the advertisement shall disclose that such benefits are provided only through a combination of such policies.