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New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 1 - HOSPITAL WORKERS' COMPENSATION GROUP SELF-INSURANCE › Section 11:15-1.16 - Deficits

Current through Register Vol. 56, No. 14, July 15, 2024
(a) If the assets of a group are at any time insufficient to enable the group to discharge its legal liabilities and other obligations and to maintain the reserves required of it under the Act and these regulations, it shall forthwith make up the deficiency or levy an assessment upon its members for the amount needed to make up the deficiency.
(b) In the event of a deficiency in any fund year, such deficiency shall be made up immediately.
(c) If the group fails to assess its members or to otherwise make up such deficit within 30 days, the Commissioner shall order it to do so.
(d) If the group fails to make the required assessment of its members within 30 days after the Commissioner orders it to do so, or if the deficiency is not fully made up within 60 days after the date on which such assessment is made, or within such longer period of time as may be specified by the Commissioner, the group shall be deemed to fall within the condition in N.J.S.A. 34:15-77.1c.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 1 - HOSPITAL WORKERS' COMPENSATION GROUP SELF-INSURANCE › Section 11:15-1.17 - Revocation of certificate of approval

Current through Register Vol. 56, No. 14, July 15, 2024
(a) After notice and opportunity for a hearing as in a contested case (52:14B-9 ), the Commissioner may revoke a group's certificate of approval if it is found that:
1. There has been deterioration of the financial condition of the group to such an extent that such deterioration would have an adverse affect on the ability of the group to pay expected losses;
2. The group has failed to pay any regulatory fee or assessment, or special fund contribution imposed upon it;
3. The group has failed to comply with any of the provisions of the Act, any regulations promulgated thereunder, or with any lawful order of the Commissioner within the time prescribed;
4. Any certificate of approval that was issued to the group was obtained by fraud;
5. There was a material misrepresentation in the application for the certificate of approval; or
6. The group or its administrator has misappropriated, converted, illegally withheld or refused to pay over, upon proper demand, any monies that belong to a member, an employee of a member, or a person otherwise entitled thereto and that have been entrusted to the group or its administrator.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 1 - HOSPITAL WORKERS' COMPENSATION GROUP SELF-INSURANCE › Section 11:15-1.18 - Public record

Current through Register Vol. 56, No. 14, July 15, 2024
Any document filed with the Commissioner pursuant to the Act or these regulations shall be deemed a public record and available for inspection at the New Jersey Department of Insurance during usual business hours.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 2 - JOINT INSURANCE FUNDS FOR LOCAL GOVERNMENTAL UNITS PROVIDING PROPERTY AND LIABILITY COVERAGES › Section 11:15-2.1 - Purpose and scope

Current through Register Vol. 56, No. 14, July 15, 2024
(a)
									40A:10-36 et seq. authorizes two or more local units of government to join together to establish a joint insurance fund for the purpose of insuring against liability, property damage, workers' compensation, and loss or theft of money or securities, providing blanket bond coverage, the sole purpose of insuring against bodily injury and property damage claims arising from environmental impairment liability and legal representation therefor to the extent and for coverage approved by the Commissioner, and insuring against loss from liability associated with sick leave payment for service connected disability as provided by 18A:30-2.1. A fund may also provide its members with safety and loss control programs and may jointly purchase, on behalf of its membership, safety and loss control services, training equipment and apparatus, in connection with the provision of the coverages set forth above. This subchapter provides rules for the establishment, operation, oversight, modification and dissolution of such funds.
(b) No local unit of government shall join together with any local unit or units to act as a joint insurance fund except as authorized by the Commissioner in accordance with the provisions of 40A:10-36 et seq. and this subchapter.
(c) Except as otherwise specifically provided, all of the requirements of this subchapter shall apply to any joint insurance fund formed to insure against liability, property damage, loss or theft of money or securities, providing blanket bond coverage, or workers' compensation, or for the sole purpose of insuring against bodily injury and property damage claims arising from environmental impairment liability and legal representation therefor.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 2 - JOINT INSURANCE FUNDS FOR LOCAL GOVERNMENTAL UNITS PROVIDING PROPERTY AND LIABILITY COVERAGES › Section 11:15-2.3 - Agreement to join joint insurance fund; duration

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Pursuant to 40A:10-36, the governing body of any local unit of government may by resolution agree to join together with any other local unit or units to establish a joint insurance fund as defined in this subchapter. The resolution shall provide for execution of a written agreement specifically providing for acceptance of the fund's bylaws as approved and adopted pursuant to 40A:10-39. The agreement shall specify the extent of the local unit's participation in the fund with respect to the types of insurance coverage to be provided by the fund and shall include the duration of fund membership, which in no event shall exceed three years, pursuant to 40A:11-15(6). The agreement shall also specify that the fund members have never defaulted on claims if self-insured and have not been cancelled for non-payment of insurance premiums for a period of at least two years prior to application.
1. Pursuant to 40A:10-36.3 et seq., non-profit housing entities as defined by 40A:10-36.3 may establish a joint insurance fund comprised only of other non-profit housing entities. Any such joint insurance fund so established shall comply with the provisions of N.J.A.C. 11:15-6.
2. Non-profit housing entities, as defined by 40A:10-36.3, may join a joint insurance fund comprised either of other non-profit housing entities, housing authorities, or a combination thereof. No such joint insurance fund shall, however, have as its members local units that are municipalities, counties, boards of education, or fire districts. Any joint insurance fund comprised solely of non-profit housing entities shall comply with the provisions of N.J.A.C. 11:15-6.
3. Notwithstanding any provision of law to the contrary, a joint insurance fund established pursuant to 40A:10-36.3 that includes non-profit housing entities as members shall not join together with other local units as otherwise provided in 40A:10-36.3 for the purpose of providing contributory or non-contributory group health insurance or group term insurance, or both, to employees or their dependents or both.
4. Notwithstanding any provision of law to the contrary, a joint insurance fund established pursuant to 40A:10-36.3 that includes non-profit housing entities as members may participate in joint insurance funds:
i. Where the membership is exclusively comprised of other joint insurance funds and whose purpose is to provide excess levels of coverage;
ii. Where the membership is exclusively comprised of other joint insurance funds and whose purpose is to accept the transfer of residual claims liabilities; or
iii. Whose purpose is to provide environmental impairment liability insurance.
5. A joint insurance fund that has as its members non-profit housing entities shall operate pursuant to the provisions of 40A:10-36 et seq.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 2 - JOINT INSURANCE FUNDS FOR LOCAL GOVERNMENTAL UNITS PROVIDING PROPERTY AND LIABILITY COVERAGES › Section 11:15-2.6 - Bylaws and plan of risk management; contents

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The commissioners of a joint insurance fund shall prepare and, after the approval, by resolution, of the governing body of each participating local governmental unit, shall adopt bylaws for the joint insurance fund. The bylaws shall include, but not be limited to:
1. Procedures for the organization and administration of the joint insurance fund, the insurance fund commissioners and alternates and, if appropriate, the executive committee of the fund and alternates. The procedures may include the designation of one member local unit to serve as the lead agency;
2. Procedures for the assessment of members for their contributions to the fund and for the collection of contributions in default;
3. Procedures for the establishment, maintenance and administration of appropriate reserves in accordance with sound actuarial principles;
4. Procedures for the purchase of direct insurance or reinsurance if any;
5. Contingency plans for paying losses in the event that the fund is exhausted, including provision for supplemental assessments as provided at 11:15-2.1 6;
6. Procedures governing loss adjustment and legal fees;
7. Procedures for the joining of the fund by a non-member local unit;
8. Procedures in compliance with 11:15-2.1 0 for the withdrawal or expulsion from the fund by a local unit, including any requirement that a terminated or withdrawing member provide security in a form and amount acceptable to the Commissioner and fund commissioners as applicable, as a guarantee for the continued payment of the member's obligations pursuant to 11:15-2.1 0(c);
9. Procedures for the termination and liquidation of the joint insurance fund and the payment of its outstanding obligations; and
10. Procedures governing trust fund accounts, including transfers, withdrawals and distribution of surplus therefrom and supplemental assessments.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 2 - JOINT INSURANCE FUNDS FOR LOCAL GOVERNMENTAL UNITS PROVIDING PROPERTY AND LIABILITY COVERAGES › Section 11:15-2.7 - Disapproval of bylaws and plan of risk management

Current through Register Vol. 56, No. 14, July 15, 2024
If the Commissioner determines that the bylaws or plan of risk management of the fund or any subsequent amendments thereto do not contain all of the information set forth in 11:15-2.6, are not submitted in the proper format set forth in 11:15-2.5, or otherwise do not meet the requirements of 40A:10-36 et seq. or this subchapter, the Commissioner shall disapprove the bylaws or plan of risk management and notify the fund in writing, which notice shall contain the specific reasons for disapproval, and the requirements to be met before approval may be granted. If not disapproved by the Commissioner within 30 working days of receipt of the bylaws and plan of risk management or any amendments or changes thereto, which contain all of the information and documentation set forth in N.J.A.C. 11:15-2.6, in the format set forth in N.J.A.C. 11:15-2.5, and which meet the requirements of 40A:10-36 et seq. and this subchapter, the bylaws and plan shall be deemed approved.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 2 - JOINT INSURANCE FUNDS FOR LOCAL GOVERNMENTAL UNITS PROVIDING PROPERTY AND LIABILITY COVERAGES › Section 11:15-2.8 - Revocation of approval

Current through Register Vol. 56, No. 14, July 15, 2024
(a) After notice and opportunity for a hearing, the Commissioner may suspend or terminate the authority of any fund, or direct or take any action deemed necessary for good cause, to enable a fund to meet its obligations, cover its expected losses, or to liquidate, rehabilitate or otherwise modify its affairs if a fund:
1. Is found to be insolvent or has experienced a deterioration in financial condition to the extent that it causes or may cause an adverse affect upon the ability of the fund to pay expected losses;
2. Fails to pay any fee or assessment;
3. Fails to pay any claim within 30 days after a final judgment is rendered against the fund or the fund's obligation for such claim otherwise becomes final;
4. Fails to comply with any of the provisions of 40A:10-36 et seq. or this subchapter, or with any lawful order of the Commissioner with the time prescribed; or
5. Fails to follow its approved bylaws or plan of risk management.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 2 - JOINT INSURANCE FUNDS FOR LOCAL GOVERNMENTAL UNITS PROVIDING PROPERTY AND LIABILITY COVERAGES › Section 11:15-2.9 - Approval of nonmembers

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Prospective new members of the fund shall submit an application for membership to the fund's commissioners, or executive committee, as applicable, on a form acceptable to the Commissioner. Such application shall include a copy of the resolution of participation and executed indemnity trust agreement. The commissioners or executive committee may approve or disapprove the application for additional members, pursuant to the bylaws of the fund.
(b) Any application approved by the fund shall within 15 days of approval by the fund be filed with the Department and the Department of Community Affairs and shall be accompanied by a revised budget with assessment detail, if otherwise required pursuant to 11:15-2.4(f)6, an actuarial statement regarding the adequacy of the member's assessment to cover anticipated losses; and any amendments to the fund's bylaws and plan of risk management as may be necessary. The fund shall file only the specific changes to the bylaws or risk management program in effect for the current fund year. Where a fund purchases direct insurance, or where an actuary has determined a "per capita" rate for the member's assessment to cover anticipated losses which has been previously filed with the Department, actuarial certification of the adequacy of these same rates for each new member is not required. The Commissioner may nevertheless require actuarial certification of a per capita rate for the new member's assessment to cover anticipated losses if, in his or her opinion, the new member will impose an extraordinary impact on the exposure of the fund. In addition, the fund shall file the following information in the form of Exhibit D in the Appendix incorporated herein by reference with the Department and Department of Community Affairs within 15 days after approval of a new member:
1. The name and address of the new member;
2. The effective date of coverage;
3. The name of the new member's risk manager;
4. The name of the new member's fund commissioners and alternates in accordance with 11:15-2.6(a);
5. The lines of coverage for which the new member participates;
6. The amount of assessment, if not otherwise provided; and
7. An affirmative statement from the fund that in accepting the new member, an application has been filed, the fund has adhered to its bylaws and plan of risk management and the agreement to participate and indemnity and trust agreement have been filed with the fund.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 2 - JOINT INSURANCE FUNDS FOR LOCAL GOVERNMENTAL UNITS PROVIDING PROPERTY AND LIABILITY COVERAGES › Section 11:15-2.10 - Termination and/or withdrawal of fund members

Current through Register Vol. 56, No. 14, July 15, 2024
(a) A member of the fund must remain a member for the full term of membership, as provided in the fund's bylaws, unless earlier terminated by the fund for nonpayment of assessments, noncompliance with risk management or underwriting standards, or for other reasons subject to prior approval by the Commissioner as reasons for termination. However, such member shall not be deemed terminated for any reason until:
1. After 30 days written notice of the intention to terminate the member has been given by the fund to the member, which notice shall state the reasons for termination and shall be given by registered mail or certified mail, return receipt requested;
2. Like notice shall have been filed with the Department, together with a certified statement that the notice provided for by (a)1 above has been given; and
3. Thirty days have elapsed after the filing required by (a)2 above has been made.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 2 - JOINT INSURANCE FUNDS FOR LOCAL GOVERNMENTAL UNITS PROVIDING PROPERTY AND LIABILITY COVERAGES › Section 11:15-2.11 - Insolvency and/or bankruptcy of fund members

Current through Register Vol. 56, No. 14, July 15, 2024
The insolvency or bankruptcy of a member does not relieve the fund or any other member of joint and several liability for the payment of any claims incurred by the member during the period of its membership, including, but not limited to, being subject to and liable for supplemental assessments.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 2 - JOINT INSURANCE FUNDS FOR LOCAL GOVERNMENTAL UNITS PROVIDING PROPERTY AND LIABILITY COVERAGES › Section 11:15-2.12 - Voluntary dissolution of a fund

Current through Register Vol. 56, No. 14, July 15, 2024
(a) A fund may not voluntarily dissolve or otherwise cease to do business and distribute its assets to its members, unless and until it satisfies the following requirements:
1. A majority of the fund's members must have voted in favor of a resolution to dissolve the fund, pursuant to a written plan adopted pursuant to the procedures set forth in the fund's bylaws, at a meeting duly called for such purposes;
2. The plan of dissolution must provide for the payment of all unpaid losses of the fund and its members, including all incurred but not reported losses, as certified by an actuary, before any assets of the fund or the trust fund accounts may be used for any other purpose;
3. The plan of dissolution shall contain a statement of the fund's current financial condition computed both on a statutory basis and according to generally accepted accounting principles as attested to by any independent certified public accountant; and
4. The plan of dissolution, and such other information as may be required, must be filed with and approved in writing by the Commissioner and the Commissioner of the Department of Community Affairs. The plan shall be filed with the Commissioner and the Commissioner of the Department of Community Affairs not later than 90 days prior to the proposed effective date of dissolution.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 2 - JOINT INSURANCE FUNDS FOR LOCAL GOVERNMENTAL UNITS PROVIDING PROPERTY AND LIABILITY COVERAGES › Section 11:15-2.13 - Establishment of trust fund accounts; transfers or withdrawals prohibited

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Pursuant to the terms of the indemnity and trust agreement, each fund shall establish a separate trust fund account in accordance with 11:15-2.6(b)10  from which monies shall be disbursed solely for the payment of claims, allocated claim expenses and excess insurance or reinsurance premiums for each type of liability or risk retained jointly on a self-insured basis. Such accounts shall be designated as claims or loss retention fund accounts.
1. Other than for the purposes specified in (a) above, or as otherwise authorized by this subchapter, no withdrawals may be effected for a claim or loss retention fund without prior written approval of the Commissioner, except for intertrust fund transfers. Intertrust fund transfers, within a fund's fiscal year, may be conducted by the fund at any time, by providing 30 days prior written notification to the Commissioner and the Commissioner of the Department of Community Affairs. If the Commissioner does not disapprove of the transfer, in writing, within 30 days after receiving such written notification, the request for intertrust fund transfer(s) shall be deemed approved. Any intertrust fund transfer request must be supported by appropriate assessment and claim and expense documentation, and be accompanied by a certification signed by an actuary that the amount remaining in the trust fund account after the intertrust fund transfer will be at a level which is reasonable in relation to that account's unpaid losses, along with all documentation in support of such certification. Intertrust fund transfers may be conducted only where each member participates in each and every claim or loss retention fund account during that fund year. The Commissioner may waive the full participation requirement provided the fund demonstrates to the Department that it maintains records of each member's pro rata share of each claim or loss retention fund account for that fund year, and that the transfer shall be made so that any potential dividend shall not be reduced for a member that did not participate in the account receiving the transfer. Notwithstanding anything in this subsection to the contrary, an environmental impairment liability fund may not transfer any monies from the account established for purpose of paying the debt on any bonds issued pursuant to 40A:10-38.1.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 2 - JOINT INSURANCE FUNDS FOR LOCAL GOVERNMENTAL UNITS PROVIDING PROPERTY AND LIABILITY COVERAGES › Section 11:15-2.14 - Administrative account

Current through Register Vol. 56, No. 14, July 15, 2024
Each fund shall establish an administrative account for each fund year which shall be utilized for payment of the fund's general operating expenses, including, but not limited to, loss prevention activities, data processing services and general legal expenses. A fund shall not be required to establish a separate administrative account by fund year, provided the fund provides a plan in its bylaws which provides for the recording and accounting of all transactions by fund year.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 2 - JOINT INSURANCE FUNDS FOR LOCAL GOVERNMENTAL UNITS PROVIDING PROPERTY AND LIABILITY COVERAGES › Section 11:15-2.16 - Supplemental assessments

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Each fund shall levy upon its members an additional assessment whenever needed or so ordered by the Commissioner, to supplement the fund's claim or loss retention or administrative accounts to assure payment of the fund's obligations, including payment of benefits under the workers' compensation law.
1. The fund shall assess each participating member an additional proportionate amount, as provided in the fund's bylaws and plan of risk management or as directed by the Commissioner, to replenish claims or loss retention or administrative accounts.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 2 - JOINT INSURANCE FUNDS FOR LOCAL GOVERNMENTAL UNITS PROVIDING PROPERTY AND LIABILITY COVERAGES › Section 11:15-2.17 - Failure or refusal to provide required assessments

Current through Register Vol. 56, No. 14, July 15, 2024
Should any member of a fund fail or refuse to pay as directed its assessment(s) to the fund or to pay as directed any supplemental assessment(s), or should the fund commissioners fail to assess funds required to meet the obligations of the fund, the chairman of the fund commission or in the event of his or her failure to do so, the custodian of the fund's assets, shall notify in writing the Commissioner and the Commissioner of the Department of Community Affairs.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 2 - JOINT INSURANCE FUNDS FOR LOCAL GOVERNMENTAL UNITS PROVIDING PROPERTY AND LIABILITY COVERAGES › Section 11:15-2.18 - Individual loss reserve funds

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Whenever the risk management plan of a joint insurance fund requires the fund's members to individually retain a specific amount of risk, potential liability, or incurred losses, the participant shall provide for such liability, or incurred loss:
1. As a deductible to be charged to the operating expenses of the incurring department or agency;
2. Through a separate item of appropriation for the fund year in its annual budget; or
3. Through establishment of an insurance fund pursuant to 40A:10-1 et seq.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 2 - JOINT INSURANCE FUNDS FOR LOCAL GOVERNMENTAL UNITS PROVIDING PROPERTY AND LIABILITY COVERAGES › Section 11:15-2.19 - Certification of funds

Current through Register Vol. 56, No. 14, July 15, 2024
Prior to any commitment or agreement requiring the expenditures of funds by the fund, the custodian of the fund's assets shall certify the availability of sufficient unencumbered funds in the account to fully pay all charges or commitments to be accepted.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 2 - JOINT INSURANCE FUNDS FOR LOCAL GOVERNMENTAL UNITS PROVIDING PROPERTY AND LIABILITY COVERAGES › Section 11:15-2.20 - Investments; application of investment income

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The free balance of any account maintained by a fund, whether for claim or loss retention, administrative, contingency, or, in the case of an environmental impairment liability fund, the contingency account to be funded by bond proceeds pursuant to 11:15-2.1 3(b), shall be invested to obtain the maximum interest return practicable. All investments shall be in accordance with the fund's cash management plan and consistent with the requirements set forth in 40A:10-38. In addition, the fund commissioners may transfer monies held to the Director of the Division of Investment in the Department of the Treasury for investment on behalf of the fund in accordance with the requirements set forth in 40A:10-38.
(b) The investment and interest income earned by the investment of the assets of each claim or loss retention fund account shall be allocated to each such account by fund year.
(c) The investment and interest income earned by investment of the assets of administrative and contingency accounts shall be credited to that account.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 2 - JOINT INSURANCE FUNDS FOR LOCAL GOVERNMENTAL UNITS PROVIDING PROPERTY AND LIABILITY COVERAGES › Section 11:15-2.22 - Disbursements and/or payment of claims

Current through Register Vol. 56, No. 14, July 15, 2024
(a) All disbursements, payments of claims settlements or other expenditures of funds of the fund whether for administrative expenses or for claims purposes must be approved by a majority of the fund commissioners or the executive committee thereof, unless approved pursuant to (b) below.
(b) To allow the expeditious resolution of certain claims, the fund commissioners may designate the fund's administrator, lead agency or servicing organization as a "certifying and approving officer" pursuant to 40A:5-17. The certifying and approving officer may be authorized by the fund commissioners to approve for payment of any or specified types of claims in an amount not to exceed an amount approved by the Commissioner in the plan of risk management. The authority of the certifying and approving officer may be conditioned or restricted by the fund commissioners to require prior consultation, limitation as to the types or total amount of claims or payments which may be approved, or such other procedures or restrictions as the fund commissioners may deem appropriate. The authority of the certifying and approving officer may be revoked or modified at any time by the fund commissioners.
1. Upon approval, the certifying and approving officer shall certify the amount and particulars of such approved claims to the official having custody of the fund's assets, directing that a check for payment be prepared.
2. The certifying and approving officer shall prepare a report of all claims approved by him or her since the last such report, detailing the nature and amount of the claim, the payee, the reasons supporting payment and any other pertinent information. This report shall be submitted to the fund commissioners at their next scheduled meeting. The fund commissioners shall review and approve the actions of the certifying and approving officer. In the event a claim approved and paid by the certifying and approving officer is not approved by the fund commissioners, they shall direct appropriate action to be taken.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 2 - JOINT INSURANCE FUNDS FOR LOCAL GOVERNMENTAL UNITS PROVIDING PROPERTY AND LIABILITY COVERAGES › Section 11:15-2.23 - Excess insurance and/or reinsurance

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Consistent with 11:15-2.6(a)6, each fund providing primary or underlying coverage on a self-insured or commercially insured basis shall secure excess insurance or reinsurance in a form, in an amount and by an insurer, or other entity authorized to provide such coverage in this State pursuant to law, acceptable to the Commissioner, if commercially available and not unreasonably priced, as determined by the fund's executive committee for each fund year, and as approved by the Department and the Department of Community Affairs.
1. Any approval by the Department pursuant to (a) above shall be for a period not to exceed either the longer of 12 months from the date of approval or the end of the current fund year. Any fund seeking to extend the period of the approval shall notify the Department not later than 45 days prior to the expiration of the term of the approval. The notification shall specify the basis upon which the executive committee has determined that excess insurance or reinsurance required pursuant to (a) above is not commercially available or is not reasonably priced, and shall include all actions taken by the fund to obtain required excess insurance or reinsurance.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 2 - JOINT INSURANCE FUNDS FOR LOCAL GOVERNMENTAL UNITS PROVIDING PROPERTY AND LIABILITY COVERAGES › Section 11:15-2.24 - Financial statement and reports

Current through Register Vol. 56, No. 14, July 15, 2024
(a) An annual certified report in a form acceptable to the Commissioner shall be prepared by each fund, filed concurrently with the Department and Department of Community Affairs and made available to each fund member on or before June 30 of each year. The report shall include:
1. An annual audited statement of the financial condition of the fund prepared by an independent certified public accountant or registered municipal accountant and performed in accordance with generally accepted accounting principles and 40A:10-46, which shall include a statement of the organization of the fund indicating the persons who perform each function for the fund and the relationship and interdependency of each function, and including its balance sheet and revenue and expense for the preceding year;
2. Reports of outstanding liabilities by line of coverage showing the number of claims, amounts paid to date and current reserves for unpaid losses, claims and unearned assessments as certified by an actuary;
3. A certification by the chairman or administrator that periodic reports were made to fund members in the form and manner required by 11:15-2.4(i);
4. Any material changes in information from that previously submitted; and
5. Such other information, as may be required by the Department upon request from a particular fund.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 2 - JOINT INSURANCE FUNDS FOR LOCAL GOVERNMENTAL UNITS PROVIDING PROPERTY AND LIABILITY COVERAGES › Section 11:15-2.25 - Examination of funds possibly in financial condition detrimental to the public

Current through Register Vol. 56, No. 14, July 15, 2024
(a) In addition to any examination conducted pursuant to 11:15-2.6(f), the Commissioner may conduct an examination of any fund as he or she deems necessary, or at any time the Commissioner has reasonable cause to believe the fund may be insolvent or in a financial condition detrimental to its members or to the public. It shall be the duty of the fund members, commissioners, executive committee, administrator and chairman to notify the Commissioner of any information indicating that any fund may be insolvent or in a financial condition detrimental to the fund's members or the public.
(b) The fund's members, commissioners or executive committee, if any, may, upon majority vote, request that the Commissioner order an examination of the fund, or any fund member, which they, in good faith, believe may be in a financial condition detrimental to the fund's members or to the public.
(c) Any examination made pursuant to 40A:10-36 et seq. and this subchapter shall be conducted in accordance with the procedures set forth in 11:15-2.6(f).
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 2 - JOINT INSURANCE FUNDS FOR LOCAL GOVERNMENTAL UNITS PROVIDING PROPERTY AND LIABILITY COVERAGES › Section 11:15-2.26 - Servicing organizations; administrator

Current through Register Vol. 56, No. 14, July 15, 2024
(a) No servicing organization of a fund, or producer that may be appointed pursuant to 11:15-2.6(c)10, or their employees, officers or directors shall have either a direct or indirect financial interest in the administrator of that fund or be an employee, officer or director of the administrator, unless notice of such interest has been provided to the fund commissioners and members.
(b) No administrator of a fund, or its employees, officers or directors shall be an employee, officer or director of, or have either a direct or indirect financial interest in, a servicing organization of that fund, or the insurance producer that may be appointed by that fund pursuant to 11:15-2.6(c)10, unless notice of such interest has been provided to the fund commissioners and members.
(c) Each service contract shall include a clause stating, "Unless the fund commissioners otherwise permit, the servicing organization shall handle to their conclusion all claims and other obligations incurred during the contract period."
(d) The fund commissioners shall notify the Department and the Department of Community Affairs within 10 days of any determination to terminate or nonrenew any agreement with a servicing organization. The notification shall include a detailed statement that sets forth the manner and method by which claims handling and other obligations performed by the servicing organization will be provided or a statement that sets forth the reasons why the fund commissioners believe that the particular service is no longer necessary.
(e) The fund commissioners or the executive committee, if any, may designate an administrator or lead agency to carry out the policies established by the commissioners or the executive committee, if any, and to provide day-to-day management of the fund. The minutes of the commissioners or executive committee meetings, if any, shall detail the areas of authority delegated to the administrator or lead agency.
(f) Any employee, officer or director of an administrator, servicing organization or insurance producer that may be appointed pursuant to 11:15-2.6(c)10  shall disclose to the fund commissioners or executive committee, as applicable, any direct or indirect financial interest such employee, officer or director has in any other administrator, servicing organization or insurance producer.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 2 - JOINT INSURANCE FUNDS FOR LOCAL GOVERNMENTAL UNITS PROVIDING PROPERTY AND LIABILITY COVERAGES › Section 11:15-2.27 - Conflict of interest

Current through Register Vol. 56, No. 14, July 15, 2024
All officials or employees of a participating local unit or any members of the family of such officials or employees shall comply with 40A:9-22.1 et seq. (the "Local Government Ethics Law").
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 2 - JOINT INSURANCE FUNDS FOR LOCAL GOVERNMENTAL UNITS PROVIDING PROPERTY AND LIABILITY COVERAGES › Section 11:15-2.28 - Notice and hearings

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The Commissioner shall give prior written notice of any proposed suspension or revocation of authority, cease and desist order, or other enforcement action to the fund commissioners, executive committee, or member local unit as the case may be, or to any person to whom the proposed enforcement action applies specifically. Such notice shall be served personally or by certified or registered mail upon all interested parties, shall set forth the grounds for the proposed enforcement action, and shall inform the interested party of its right to request a hearing on the proposed enforcement action. A copy of such written notice shall also be provided to the Commissioner of the Department of Community Affairs.
(b) The interested party involved shall have 20 days from the mailing of the notice to request a hearing, on the proposed enforcement action. Such a hearing shall be conducted in accordance with the Administrative Procedure Act, 52:14B-1 et seq. and the Uniform Administrative Procedure Rules, N.J.A.C. 1:1. Failure to mail a request for hearing within the time prescribed shall result in the suspension, revocation, monetary penalty or cease and desist order becoming effective 30 days from issuance of the original notice. In no event shall any revocation become effective prior to the date that a hearing is scheduled.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 2 - JOINT INSURANCE FUNDS FOR LOCAL GOVERNMENTAL UNITS PROVIDING PROPERTY AND LIABILITY COVERAGES › Section 11:15-2.29 - Orders

Current through Register Vol. 56, No. 14, July 15, 2024
(a) After notice and opportunity for a hearing, as provided in 11:15-2.2 8, the Commissioner may issue an order revoking or suspending a fund's authority or requiring a person or fund to cease and desist from engaging in an act or practice to be in violation of any provision of 40A:10-36 et seq. or this subchapter.
(b) Upon a finding, after notice and opportunity for a hearing, as provided at 11:15-2.2 8, that a fund has violated any cease and desist order, the Commissioner may revoke his or her approval of the fund.
(c) Upon a finding, after notice and opportunity for a hearing, as provided at 11:15-2.2 8, the Commissioner may issue an order requiring the fund commissioners, or the executive committee, if any, to dismiss an administrator or servicing organization or terminate the service contract of an administrator or servicing organization because of any fraud, material misrepresentation, incompetence or untrustworthiness, misappropriation or conversion of monies or violation of any fiduciary responsibility by such administrator or servicing organization, or any of the employees, officers or directors thereof.
(d) A copy of any notice issued pursuant to this section shall be furnished to the Commissioner of the Department of Community Affairs.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 2 - JOINT INSURANCE FUNDS FOR LOCAL GOVERNMENTAL UNITS PROVIDING PROPERTY AND LIABILITY COVERAGES › Section 11:15-2.30 - Severability

Current through Register Vol. 56, No. 14, July 15, 2024
The rules contained in this subchapter and any of the provisions thereof shall be severable, and if any of its provisions shall be held to be unconstitutional or otherwise invalid, the decision of the court shall not affect the validity of the remaining rules and regulations or any of the provisions thereof.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 3 - JOINT INSURANCE FUNDS FOR LOCAL GOVERNMENT UNITS PROVIDING GROUP HEALTH AND TERM LIFE BENEFITS › Section 11:15-3.1 - Purpose and scope

Current through Register Vol. 56, No. 14, July 15, 2024
(a) This subchapter sets forth the requirements for the establishment, operation, oversight, modification and dissolution of joint insurance funds formed by two or more local units for the purpose of providing contributory or non-contributory group health insurance or group term life insurance, or both, to employees or their dependents, and to any other person eligible for coverage by a member local unit pursuant to 40A:10-36 et seq.
(b) This subchapter shall apply to all local units seeking to form a joint insurance fund for the purpose of providing contributory and non-contributory group health or group term life insurance and all joint insurance funds formed for such purpose pursuant to 40A:10-36 et seq. and this subchapter.
(c) No local unit of government shall join together with any other local unit or units to act as a joint insurance fund for the purpose of providing contributory or non-contributory group health or group term life insurance except as authorized by the Commissioner in accordance with the provisions of 40A:10-36 et seq. and this subchapter.
(d) The authority of a joint insurance fund formed for the purpose of providing contributory and non-contributory group health insurance or group term life insurance, or both, shall be limited solely to those coverages.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 3 - JOINT INSURANCE FUNDS FOR LOCAL GOVERNMENT UNITS PROVIDING GROUP HEALTH AND TERM LIFE BENEFITS › Section 11:15-3.3 - Agreement to join joint insurance fund; duration

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Pursuant to 40A:10-36, the governing body of any local unit of government may by resolution agree to join together with any other local unit or units to establish a joint insurance fund as defined in this subchapter. The resolution shall provide for execution of a written agreement specifically conditioning membership on acceptance of the fund's bylaws as approved and adopted pursuant to 40A:10-36 et seq. The agreement shall specify the extent of the local unit's participation in the fund with respect to the types of insurance coverage to be provided by the fund and shall include the duration of fund membership, which in no event shall exceed three years, pursuant to 40A:11-15(6)  and subject to 11:15-3.1 0. The agreement shall also specify that the fund members have never defaulted on claims if self-insured, and, if not self-insured, have not been cancelled for non-payment of insurance premiums for a period of at least two years prior to application.
(b) A joint insurance fund formed pursuant to 40A:10-36 et seq. and this subchapter shall have the power to insure, contract, or provide for any insurable interest of the member solely for benefits pursuant to contributory or non-contributory group health insurance or group term life insurance, or both, for employees or their dependents, or both, through self-insurance, the purchase of commercial insurance or reinsurance, or any combination thereof. The maximum risk to be retained for group term life insurance by a joint insurance fund on a self insured basis shall not exceed a face amount of $ 5,000 per covered employee or dependent or such greater amount as approved by the Commissioners of the Departments of Banking and Insurance and Community Affairs.
(c) Members may renew their participation by the execution of a new agreement to rejoin the joint insurance fund. If the existing resolution did not specify the duration of fund membership, the member shall affirm the new membership agreement by resolution. If the existing resolution specified the duration for fund membership, the membership shall either amend the existing resolution, or adopt a new resolution, as appropriate, to authorize the continued participation in the joint insurance prior to the execution of the new membership agreement. In lieu of filing copies of the new agreement and new indemnity and trust agreement referred to in 11:15-3.6(b)6  for each member's renewal of membership, the fund shall file a notice with the Department which sets forth the members that have renewed membership and the respective durations of such membership, as well as the members that have not rejoined.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 3 - JOINT INSURANCE FUNDS FOR LOCAL GOVERNMENT UNITS PROVIDING GROUP HEALTH AND TERM LIFE BENEFITS › Section 11:15-3.5 - Bylaws and plan of risk management; filing requirements

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Each joint insurance fund shall file with the Department for approval by the Commissioners of Banking and Insurance and Community Affairs, as provided in 40A:10-41, its bylaws and plan of risk management and any subsequent amendments thereto. In addition, the initial filing shall contain and be accompanied by the information and documentation specified at N.J.A.C. 11:15-3.6, and such other information the Commissioner may request. All filings shall be in loose-leaf form inserted into standard two-ring or three-ring binders tabbed or otherwise indexed to correspond to the requirements set forth in N.J.A.C. 11:15-3.6. The loose-leaf sheets used shall be eight and one-half inches wide and 11 inches long and punched for two-ring and three-ring binders, as appropriate. The fund shall submit five copies of a filing in the format set forth in this section. All information shall be submitted completely and accurately.
1. All filings and accompanying documents shall be submitted to the Department and the Department of Community Affairs.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 3 - JOINT INSURANCE FUNDS FOR LOCAL GOVERNMENT UNITS PROVIDING GROUP HEALTH AND TERM LIFE BENEFITS › Section 11:15-3.6 - Bylaws and plan of risk management; contents

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The prospective commissioners of a joint insurance fund shall prepare and, after the approval by resolution of the governing body of each participating local governmental unit, adopt bylaws for the joint insurance fund. The bylaws shall include, but not be limited to:
1. Procedures for the organization and administration of the joint insurance fund, the insurance fund commission and alternate commissioners and, if appropriate, the executive committee of the fund and alternates. The procedures may include the designation of one member local unit to serve as the lead agency;
2. Procedures for the assessment of members for their contributions to the fund and for the collection of contributions in default;
3. Procedures for the establishment, maintenance and administration of appropriate reserves in accordance with sound actuarial principles, including the assumptions and methodology to be used for the calculation of policy and claim reserves;
4. Procedures for the purchase of direct insurance, or reinsurance, if any;
5. Contingency plans for paying losses in the event that the fund is exhausted, including provision for supplemental assessments as provided at 11:15-3.1 6;
6. Procedures governing loss adjustment and legal fees;
7. Procedures and admissions criteria for the joining of the fund by a non-member local unit;
8. Procedures in compliance with 11:15-3.1 0 for the withdrawal from the fund by a local unit;
9. Procedures for the expulsion of a member local unit;
10. Procedures for the termination and liquidation of the joint insurance fund and the payment of its outstanding obligations; and
11. Procedures governing trust fund accounts, including transfers, withdrawals and distribution of surplus therefrom and supplemental assessments.