reglab/statecodes huggingface dataset:
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter X - Records › Part 240 - Confidentiality Of Information Furnished By Social Services Agencies › Section 240.1 - Guidelines

Current through Register Vol. 46, No. 28, July 10, 2024
The following guidelines are established with respect to
				  preserving the confidentiality of information furnished by social services
				  agencies to entities subject to the provisions of section 4311 or
				  320  of the Insurance Law:
(a) No such entity shall request of the New
				York State Social Services Department or of any local social services district
				any information pertaining to an applicant for or recipient of medical
				assistance other than is necessary to identify the records or information
				requested by said social services agency concerning such applicant or
				recipient.
(b) No such entity, nor
				any officer, agent, or employee thereof, shall make any use of information
				furnished by a social services agency concerning an applicant for or recipient
				of medical assistance other than for the purpose of identifying the records it
				may have pertaining to such individual and of transmitting information
				contained therein to the requesting agency.
(c) Every such entity shall designate in
				writing to the Superintendent of Insurance the officer who shall be primarily
				responsible for maintaining the security and confidentiality of information
				received in effectuation of the mandate of sections 4311 and
				320  of the Insurance Law.
(d) Said designated officer shall maintain a
				register of those persons authorized to receive or have access to information
				furnished by the social services agencies aforesaid, and the date on which
				authorization was conferred.
(e) No
				person shall be authorized to have access to or make use of the information
				furnished by the social services agencies aforesaid unless that person shall
				first have been advised that violation of the strictures herein set forth may
				result in criminal prosecution, pursuant to section 109  of the Insurance Law.
(f) The instruction required by subdivision
				(e) of this section shall be given orally to prospective authorized persons by
				the designated officer aforesaid, who shall also furnish a copy of this
				regulation to each such person and secure from each such person written
				acknowledgment that such person has received said copy and has read the
				same.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter X - Records › Part 241 - Availability Of Department Records (Repealed)

Current through Register Vol. 46, No. 28, July 10, 2024
Statutory authority: Insurance Law, §§ 201,
				  301;  Public Officers Law, art. 6; Financial
				  Services Law, §§
										202, 
				  302
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter X - Records › Part 242 - Access To Personal Information › Section 242.1 - Purpose and scope

Current through Register Vol. 46, No. 28, July 10, 2024
(a) It is the
				responsibility and the intent of the agency to fully comply with the provisions
				of article 6-A of the Public Officers Law, the Personal Privacy Protection
				Law.
(b) The agency shall maintain
				in its records only such personal information that is relevant and necessary to
				accomplish a purpose of the agency that is required to be accomplished by
				statute or executive order, or to implement a program specifically authorized
				by law.
(c) Personal information
				will be collected, whenever practicable, directly from the person to whom the
				information pertains.
(d) The
				agency seeks to ensure that all records pertaining to or used with respect to
				individuals are accurate, relevant, timely and complete.
(e) This Part provides information regarding
				the procedures by which members of the public may assert rights granted by the
				Personal Privacy Protection Law.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter X - Records › Part 242 - Access To Personal Information › Section 242.2 - Designation of privacy compliance officer

Current through Register Vol. 46, No. 28, July 10, 2024
(a) The privacy compliance officer and deputy
				privacy compliance officers shall be designated by the general counsel from
				among the counsels, associate attorneys and attorneys in the office of general
				counsel in the department's Albany and New York City offices and shall be
				responsible for ensuring that the department complies with the provisions of
				the Personal Privacy Protection Law and the regulations herein and for
				coordinating the agency's response to requests for records and amendment of
				records.
(b) The address and
				telephone number of the privacy compliance officer is:
Office of General Counsel
Insurance Department
One Commerce Plaza
Albany, NY 12257
(518) 473-0785
and
Office of General Counsel
Insurance Department
25 Beaver Street
New York, NY 10004
(212) 480-5259
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter X - Records › Part 242 - Access To Personal Information › Section 242.3 - Proof of identity

Current through Register Vol. 46, No. 28, July 10, 2024
(a) When a
				request is made in person, or when records are made available in person
				following a request made by mail, the agency may require appropriate
				identification, such as a driver's license, an identifier assigned to the data
				subject by the agency, a photograph, or similar information that confirms that
				the record sought pertains to the data subject.
(b) When a request is made by mail, the
				agency may require verification of a signature or inclusion of an identifier
				generally known only by a data subject, or similar appropriate
				identification.
(c) Proof of
				identity shall not be required regarding a request for a record accessible to
				the public pursuant to article 6 of the Public Officers Law.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter X - Records › Part 242 - Access To Personal Information › Section 242.4 - Location

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Records shall
				be made available at the main office of the agency, which is located at:
Insurance Department
One Commerce Plaza
Albany, NY 12257
(b) Whenever practicable, records shall be
				made available at a regional office most convenient to a data subject. The
				regional office is located at:
New York City Office
25 Beaver Street
New York, NY 10004
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter X - Records › Part 242 - Access To Personal Information › Section 242.5 - Hours for public inspection and copying

Current through Register Vol. 46, No. 28, July 10, 2024
The agency shall accept requests for records and produce
				  records during regular business hours, which are 9:30 a.m. to 3:30
				  p.m.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter X - Records › Part 242 - Access To Personal Information › Section 242.6 - Requests for records

Current through Register Vol. 46, No. 28, July 10, 2024
(a) A request
				shall reasonably describe the record sought. Whenever possible, the data
				subject should supply identifying information that assists the agency in
				locating the record sought.
(b)
				Requests based upon categories of information described in a notice of a system
				of records or a privacy impact statement shall be deemed to reasonably describe
				the record sought.
(c) Within five
				business days of the receipt of a request, the agency shall provide access to
				the record, deny access in writing explaining the reasons therefor, or
				acknowledge the receipt of the request in writing, stating the approximate date
				when the request will be granted or denied, which date shall not exceed 30 days
				from the date of the acknowledgment.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter X - Records › Part 242 - Access To Personal Information › Section 242.7 - Amendment of records

Current through Register Vol. 46, No. 28, July 10, 2024
Within 30 business days of a request from a data subject for
				  correction or amendment of a record or personal information that is reasonably
				  described and that pertains to the data subject, the agency shall:
(a) make the amendment or correction in whole
				or in part and inform the data subject that, on request, such correction or
				amendment will be provided to any person or governmental unit to which the
				record or personal information has been or is disclosed pursuant to paragraph
				(d), (i) or (l) of subdivision 1 of section 96  of the Public Officers Law; or
(b) inform the data subject in writing of its
				refusal to correct or amend the record, including the reasons
				therefor.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter X - Records › Part 242 - Access To Personal Information › Section 242.8 - Denial of request for record or amendment or correction of record or personal information

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Denial
				of a request for records or amendment or correction of a record or personal
				information:
(1) shall be in writing,
				explaining the reasons therefor; and
(2) shall identify the person to whom an
				appeal may be directed.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter X - Records › Part 242 - Access To Personal Information › Section 242.9 - Appeal

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Any person
				denied access to a record or denied a request to amend or correct a record or
				personal information pursuant to section
				242.8 
				of this Part may, within 30 days of such denial, appeal to the deputy
				superintendent and general counsel.
(b) The time for deciding an appeal shall
				commence upon receipt of an appeal that identifies:
(1) the date and location of a request for a
				record or amendment or correction of a record or personal
				information;
(2) the record that is
				the subject of the appeal; and
(3)
				the name and return address of the appellant.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter X - Records › Part 242 - Access To Personal Information › Section 242.10 - Statement of disagreement by data subject

Current through Register Vol. 46, No. 28, July 10, 2024
(a) If correction or amendment of a record or
				personal information is denied in whole or in part upon appeal, the
				determination rendered pursuant to the appeal shall inform the data subject of
				the right to:
(1) file with the agency a
				statement of reasonable length setting forth the data subject's reasons for
				disagreement with the determination;
(2) request that such a statement of
				disagreement be provided to any person or governmental unit to which the record
				has been or is disclosed pursuant to paragraph (d), (i) or (l) of subdivision 1
				of section 96  of the Public Officers Law.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter X - Records › Part 242 - Access To Personal Information › Section 242.11 - Fees

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Unless
				otherwise prescribed by statute, there shall be no fee charged for:
(1) inspection of records;
(2) search for records; or
(3) any certification pursuant to this
				Part.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter X - Records › Part 242 - Access To Personal Information › Section 242.12 - Severability

Current through Register Vol. 46, No. 28, July 10, 2024
If any provision of this Part or the application thereof to
				  any person or circumstance is adjudged invalid by a court of competent
				  jurisdiction, such judgment shall not affect or impair the validity of the
				  other provisions of this Part or the application thereof to other persons and
				  circumstances.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter X - Records › Part 243 - Standards Of Records Retention By Insurance Companies › Section 243.0 - Purpose

Current through Register Vol. 46, No. 28, July 10, 2024
The purpose of this Part is to clarify and provide minimum
				  recordkeeping requirements regarding the origin, maintenance and reproduction
				  of information by insurers doing business in this state and certain other
				  entities.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter X - Records › Part 243 - Standards Of Records Retention By Insurance Companies › Section 243.1 - Definitions

Current through Register Vol. 46, No. 28, July 10, 2024
For the purposes of this Part, the following terms shall
				  apply:
(a) Insurer means an authorized
				insurer, as such term is defined in Insurance Law, section
				107(a)(10); a joint
				underwriting association; the State insurance fund; the medical malpractice
				insurance plan; the New York property insurance underwriting association; the
				New York automobile insurance plan; the motor vehicle accident indemnification
				corporation; a health maintenance organization subject to Public Health Law,
				article 44; an employee welfare fund; a charitable annuity society, pension
				fund, retirement system, fraternal benefit society, or other entity exempt from
				the doing of an insurance business pursuant to Insurance Law, section
				1108 or other section of the Insurance Law
				and which is subject to examination by the superintendent; a viatical
				settlement company; or a licensed rate service organization.
(b) Records means books, records, files,
				securities, data compilations and other documents.
(c) Durable medium means a medium for
				maintaining a record where the properties of such medium provide reasonable
				assurances against tampering with the information contained in the original and
				degradation of any reproduction generated, and where the reproduction is an
				exact copy of the original. The medium may include paper; facsimile; or
				photographic, micrographic, magnetic, optical, mechanical or electronic
				media.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter X - Records › Part 243 - Standards Of Records Retention By Insurance Companies › Section 243.2 - Records required for examination purposes and retention period

Current through Register Vol. 46, No. 28, July 10, 2024
(a) In addition to any other requirement
				contained in Insurance Law, section
				325, any other section of the Insurance Law
				or other law, or any other provision of this Title, every insurer shall
				maintain its claims, rating, underwriting, marketing, complaint, financial, and
				producer licensing records, and such other records subject to examination by
				the superintendent, in accordance with the provisions of this Part.
(b) Except as otherwise required by law or
				regulation, an insurer shall maintain:
(1) A
				policy record for each insurance contract or policy for six calendar years
				after the date the policy is no longer in force or until after the filing of
				the report on examination in which the record was subject to review, whichever
				is longer. Policy records need not be segregated from the policy records of
				other states as long as they are maintained in accordance with the provisions
				of this Part. A separate copy need not be maintained in an individual policy
				record, provided that any data relating to a specific contract or policy can be
				retrieved pursuant to section
				243.3(a) 
				of this Part. A policy record shall include:
(i) the policy term, basis for rating, and
				return premium amounts, if any;
(ii) the application, including any
				application form or enrollment form for coverage under any insurance contract
				or policy;
(iii) the contract or
				policy forms issued including the declaration pages, endorsements, riders, and
				termination notices of the contract or policy. Binders shall be retained if a
				contract or policy was not issued; and
(iv) other information necessary for
				reconstructing the solicitation, rating, and underwriting of the contract or
				policy.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter X - Records › Part 243 - Standards Of Records Retention By Insurance Companies › Section 243.3 - Standards for maintenance and reproduction of records

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
(1)
				Records and indices of records required to be maintained under this Part may be
				maintained in any durable medium.
(2) Where the original record was not a paper
				document, an insurer shall be able to produce information or data which
				accurately represents a record of communications between a person or entity and
				the insurer or accurately reflects a transaction or event.
(3) Upon transfer of an original record to a
				durable medium, the insurer may destroy the original record after assuring that
				all information contained in the original record, including signatures,
				handwritten notations, or pictures, is contained in the durable
				medium.
(4) If the insurer does not
				retain the original paper record, or if there was no original paper record, a
				duplicate or back-up system sufficient to permit reconstruction of the record
				shall be established at a separate location. The record may be retained in any
				form permitted by this Part.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter X - Records › Part 244 - CONFIDENTIALITY PROTOCOLS FOR VICTIMS OF DOMESTIC VIOLENCE AND ENDANGERED INDIVIDUALS › Section 244.0 - Preamble

Current through Register Vol. 46, No. 28, July 10, 2024
Individuals experiencing actual or threatened violence
				  frequently establish new addresses and telephone numbers to protect their
				  health and safety. Insurance Law section 2612 requires the Superintendent of
				  Financial Services, in consultation with the Commissioner of Health, Office of
				  Children and Family Services, and Office for the Prevention of Domestic
				  Violence, to promulgate rules to guide and enable insurers to guard against the
				  disclosure of information protected by Insurance Law section 2612. This Part
				  establishes requirements with which insurers shall comply to enable them to
				  effectively respond to requests to keep records and information confidential in
				  conformance with Insurance Law section 2612.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter X - Records › Part 244 - CONFIDENTIALITY PROTOCOLS FOR VICTIMS OF DOMESTIC VIOLENCE AND ENDANGERED INDIVIDUALS › Section 244.1 - Applicability

Current through Register Vol. 46, No. 28, July 10, 2024
(a) This Part shall
				apply to a policy issued pursuant to the Insurance Law.
(b) With respect to an insurer authorized to
				write kinds of insurance in addition to accident and health insurance or salary
				protection insurance, any section of this Part that establishes rules with
				regard to a requestor or covered individual shall apply only with respect to a
				policy of accident and health insurance or a policy of salary protection
				insurance.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter X - Records › Part 244 - CONFIDENTIALITY PROTOCOLS FOR VICTIMS OF DOMESTIC VIOLENCE AND ENDANGERED INDIVIDUALS › Section 244.2 - Definitions

Current through Register Vol. 46, No. 28, July 10, 2024
As used in this Part:
(a)
Accident and health
				insurance
shall have the meaning set forth in Insurance Law section
				1113(a)(3) and with regard to a fraternal benefit society, also shall have the
				meaning set forth in Insurance Law section 4501(i)-(k), (m), (o) and
				(p).
(b)
Address
means a street address, mailing address, or e-mail address.
(c)
Claim related
				information
shall have the meaning set forth in Insurance Law section
				2612(h)(1)(A).
(d)
Covered
				individual
means an individual covered under a policy issued by a
				health insurer who could be endangered by the disclosure of all or part of
				claim related information by the health insurer.
(e)
Fraternal benefit
				society
shall have the meaning set forth in Insurance Law section
				4501(a).
(f)
Health
				insurer
shall have the meaning set forth in Insurance Law section
				2612(h)(1)(B).
(g)
Insured
means an individual who is covered under an individual
				or a group policy.
(h)
Insurer
shall have the meaning set forth in Insurance Law
				section 2612(c)(2) and shall include a fraternal benefit society.
(i)
Person
means an
				individual or legal entity, including a partnership, limited liability company,
				association, trust, or corporation.
(j)
Policy
means a policy,
				contract, or certificate of insurance, an annuity contract, a child health
				insurance plan issued pursuant to title 1-A of Public Health Law article 25,
				medical assistance or health care services provided pursuant to title 11 or
				11-D of Social Services Law article 5, or any certificate issued under any of
				the foregoing.
(k)
Policyholder
means a person to whom a policy has been
				issued.
(l)
Reasonable
				request
means a request that contains a statement that disclosure of
				all or part of the claim related information to which the request pertains
				could endanger an individual, and the specification of an alternative address,
				telephone number, or other method of contact.
(m)
Requestor
means a
				covered individual, or the individual's legal representative, or with regard to
				a covered individual who is a child, the child's parent or guardian, who makes
				a reasonable request to the health insurer.
(n)
Salary protection
				insurance
shall have the meaning set forth in Insurance Law section
				1113(a)(31).
(o)
Victim of
				domestic violence
or
victim
shall have the meaning
				set forth in Social Services Law section 459-a(1).
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter X - Records › Part 244 - CONFIDENTIALITY PROTOCOLS FOR VICTIMS OF DOMESTIC VIOLENCE AND ENDANGERED INDIVIDUALS › Section 244.3 - Confidentiality protocol

Current through Register Vol. 46, No. 28, July 10, 2024
(a) An
				insurer shall develop and implement a confidentiality protocol whereby, except
				with the express consent of the individual who delivers to the insurer a valid
				order of protection, the insurer shall keep confidential and shall not disclose
				the address and telephone number of the victim of domestic violence, or any
				child residing with the victim, and the name, address, and telephone number of
				a person providing covered services to the victim, to a policyholder or another
				insured covered under the policy against whom the victim has a valid order of
				protection, if the victim, the victim's legal representative, or if the victim
				is a child, the child's parent or guardian, delivers to the insurer at its home
				office a valid order of protection pursuant to Insurance Law section 2612(f)
				and (g).
(b) In addition to the
				requirements of subdivision (a) of this section, a health insurer shall develop
				and implement a confidentiality protocol whereby the health insurer shall
				accommodate a reasonable request made by a requestor for a covered individual
				to receive communications of claim related information from the health insurer
				by alternative means or at alternative locations. Except with the express
				consent of the requestor, a health insurer shall not disclose to the
				policyholder or another insured covered under the policy:
(1) the address, telephone number, or any
				other personally identifying information of the covered individual or any child
				residing with the covered individual;
(2) the nature of the health care services
				provided to the covered individual;
(3) the name, address, and telephone number
				of the provider of the covered health care services; or
(4) any other information from which there is
				a reasonable basis to believe the foregoing information could be
				obtained.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter X - Records › Part 244 - CONFIDENTIALITY PROTOCOLS FOR VICTIMS OF DOMESTIC VIOLENCE AND ENDANGERED INDIVIDUALS › Section 244.4 - Notice

Current through Register Vol. 46, No. 28, July 10, 2024
(a) An insurer
				shall post conspicuously on its website and, with regard to a health insurer,
				also annually provide all its participating health service providers with:
(1) a description of Insurance Law section
				2612;
(2) the information required
				by section
				244.3(c)(1),
				(2) and (6); and
(3) the phone number for the New York State
				Domestic and Sexual Violence Hotline.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter XI - Prepaid Legal Services Plans And Legal Services Insurance › Part 261 - Prepaid Legal Services Plans › Section 261.0 - Preamble

Current through Register Vol. 46, No. 28, July 10, 2024
(a) This Part
				implements, interprets, and clarifies chapter 65 of the Laws of 1998, as
				amended by chapter 28 of the Laws of 2003. Prior to the enactment of chapter
				65, section 1116  of the Insurance Law authorized
				insurers to offer experimental plans of prepaid legal services insurance, and
				except in connection with such a plan, the Insurance Law did not authorize
				insurers to provide legal services insurance.
(b) Chapter 65 added a new paragraph (29) to
				subsection (a) of section 1113  of the Insurance Law effective April
				1, 1999, to set forth a new kind of insurance entitled legal services insurance
				(defined to mean insurance providing legal services or reimbursement of the
				cost of legal services) and also amended section 1116  of the Insurance Law (retitled as
				prepaid legal services plans and legal services insurance).
(c) Section 1116(a)(3), as amended effective
				April 1, 1999, provides that legal services insurance may not be written
				except:
(1) in conjunction with prepaid legal
				services plans as authorized in section 1116; or
(2) pursuant to a regulation promulgated by
				the superintendent permitting legal services insurance to be written as part of
				a policy of liability insurance covering related risks and, provided further,
				that legal services for defense only coverages for commercial or other business
				related lawsuits or arbitration proceedings commenced against the business
				entity that purchased the policy is not more than an incidental part of such
				liability insurance.
Section 1116(a)(2), as amended, provides that a prepaid legal
				  services plan may include legal services insurance as part of the plan,
				  provided however, not more than an incidental amount of the premium with
				  respect to such prepaid legal services plan shall be attributable to legal
				  services for defense only coverages for commercial or other business related
				  lawsuits or arbitration proceedings commenced against the business entity that
				  purchased the policy.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter XI - Prepaid Legal Services Plans And Legal Services Insurance › Part 261 - Prepaid Legal Services Plans › Section 261.2 - Applicability

Current through Register Vol. 46, No. 28, July 10, 2024
(a) This Part shall
				apply to any prepaid legal services plan policy or certificate issued or
				delivered in this State, or issued or delivered by an authorized insurer on
				risks or operations in this State, on or after April 1, 1999.
(b) Provided that the transaction does not
				violate section 1102  of the Insurance Law, this Part shall
				not apply to:
(1) an attorney retainer
				agreement as defined in section
				261.1(b) 
				of this Part;
(2) a referral
				service as authorized by Judiciary Law, section
				498;
(3) the furnishing of legal assistance by a
				labor union or other employee organization to its members in matters relating
				to employment;
(4) an employee
				welfare benefit plan to the extent that state laws are preempted by the
				Employee Retirement Income Security Act of 1974,
				29
				U.S.C. 1144; or
(5) an access plan as defined in section
				261.1(a)
				of this Part, unless provided by an authorized insurer.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter XI - Prepaid Legal Services Plans And Legal Services Insurance › Part 261 - Prepaid Legal Services Plans › Section 261.3 - Prepaid legal services plan policy and certificate provisions

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Every policy
				and certificate shall be subject to the filing and approval requirements of
				article 23 of the Insurance Law and shall not qualify as a special risk
				pursuant to Part 16 of this Title (Regulation 86).
(b) Every policy and certificate shall be
				written in a readable and understandable manner in accordance with section 3102  of the Insurance Law.
(c) Every policy and certificate shall
				contain the provisions specified in section 1116  of the Insurance Law and shall be
				subject to the requirements of that section.
(d)
(1)
				Every policy and certificate shall contain a detailed list and description of
				the legal services to be supplied or the legal matters for which expenses are
				to be covered or reimbursed and any limits on the amounts covered or
				reimbursed.
(2) Every policy and
				certificate shall indicate the name of the insurer and the full address of its
				principal place of business, the telephone number of the place where services
				can be requested, and the full address and telephone number of the place where
				the insured may file a claim.
(3)
				Every policy and certificate shall contain a provision that nothing in the plan
				shall be construed to limit the right of an insured to retain any attorney
				admitted to practice in the state where the legal service is being provided.
				The policy shall state that compensation by the plan for attorneys not
				participating in the plan shall be subject to the schedule of benefits and fee
				structure set forth in the applicable contract. The policy shall not prohibit
				an attorney who is not participating in the plan from charging a fee for
				services provided in excess of the schedule of benefits or fee structure set
				forth in the applicable contract.
(4) Every policy and certificate shall
				provide a procedure for prompt resolution of grievances concerning
				benefits.
(5) Every policy and
				certificate shall provide that nothing in the plan shall be construed to
				prevent an insured from making a complaint to the appropriate Appellate
				Division or other body designated by the Appellate Division to investigate
				complaints in accordance with Judiciary Law section 90, or to the appropriate
				disciplinary body in the state where the legal service is being
				provided.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter XI - Prepaid Legal Services Plans And Legal Services Insurance › Part 261 - Prepaid Legal Services Plans › Section 261.4 - Attorney compensation

Current through Register Vol. 46, No. 28, July 10, 2024
No insurer shall compensate an attorney on a capitated fee
				  basis in connection with a prepaid legal services plan.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter XI - Prepaid Legal Services Plans And Legal Services Insurance › Part 261 - Prepaid Legal Services Plans › Section 261.6 - Prepaid legal services plans; mass merchandising basis

Current through Register Vol. 46, No. 28, July 10, 2024
(a) In addition to marketing to individuals,
				individual prepaid legal services plan policies may be issued through a mass
				merchandising program where the program is marketed to:
(1) cardholders of a credit card, charge card
				or payment card which can be used to buy goods or services, and such card is
				issued by a bank, retailer or other issuer of such cards;
(2) depositors, account holders or members of
				a bank, savings and loan association, credit union, mutual fund, money market
				fund, stock broker or other similar financial institution regulated by state or
				Federal law, that has agreed to facilitate such coverage from an insurer to
				such persons; or
(3) a policy
				issued to an association or the trustee or trustees of a trust established, or
				participated in, by one or more associations, to cover association members,
				where each association shall have:
(i) been
				organized and maintained in good faith for purposes principally other than that
				of obtaining insurance;
(ii) been
				in active existence for at least two years; and
(iii) a constitution and by-laws which
				provide that:
(a) the association hold regular
				meetings not less than annually to further the purposes of the
				association;
(b) the association
				collect dues or solicit contributions from members; and
(c) the members have voting privileges and
				representation on the governing board and committees;
(4) any of the groups specified in
				section
				261.5 
				of this Part.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter XI - Prepaid Legal Services Plans And Legal Services Insurance › Part 261 - Prepaid Legal Services Plans › Section 261.7 - Applicability of article 21

Current through Register Vol. 46, No. 28, July 10, 2024
Nothing in this Part in connection with group or mass
				  merchandising policies shall be interpreted as exempting any person from the
				  applicable licensing requirements of Insurance Law article
				  21.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter XI - Prepaid Legal Services Plans And Legal Services Insurance › Part 262 - Legal Services Insurance › Section 262.0 - Preamble

Current through Register Vol. 46, No. 28, July 10, 2024
(a) This Part
				implements, interprets, and clarifies chapter 65 of the Laws of 1998, as
				amended by chapter 28 of the Laws of 2003, as it pertains to legal services
				insurance. This Part should be read in conjunction with Part 261 of this Title
				(Regulation 161) which was being promulgated at the same time. The preamble of
				Part 261 (section
				261.0  of this
				Title) more fully explains the background, legislative history and intent of
				chapter 65.
(b) Section 1116 (a)(3)  of the
				Insurance Law, as amended effective April 1, 1999, provides that legal services
				insurance may not be written except:
(1) in
				conjunction with prepaid legal services plans as authorized in section 1116;
				or
(2) pursuant to a regulation
				promulgated by the superintendent permitting legal services insurance to be
				written as part of a policy of liability insurance covering related risks,
				provided that legal services for defense-only coverages for commercial or other
				business related lawsuits or arbitration proceedings commenced against the
				business entity that purchased the policy is not more than an incidental part
				of such liability insurance.
Section 1116(a)(2), as amended, provides that a prepaid legal
				  services plan may include legal services insurance as part of the plan,
				  provided, however, that not more than an incidental amount of the premium with
				  respect to such prepaid legal services plan shall be attributable to legal
				  services for defense-only coverages for commercial or other business related
				  lawsuits or arbitration proceedings commenced against the business entity that
				  purchased the policy.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter XI - Prepaid Legal Services Plans And Legal Services Insurance › Part 262 - Legal Services Insurance › Section 262.1 - Definitions

Current through Register Vol. 46, No. 28, July 10, 2024
For purposes of this Part, the following definitions shall
				  apply:
(a) Criminal proceeding means a
				proceeding commenced in the supreme court, county court, a district court, a
				city court, a town court, a village court, the criminal court of the city of
				New York, or an equivalent tribunal in another jurisdiction, including the
				courts of the United States, in which it is alleged a person has violated any
				provision of the Penal Law or any other statute of this State or another
				jurisdiction, including statutes of the United States, that specifies a
				violation thereof is a misdemeanor, felony or other criminal act. Such term
				shall not include proceedings concerning traffic infractions, as that term is
				defined in Vehicle and Traffic Law section 155.
(b) Issue includes issue for
				delivery.
(c) Legal services
				insurance has the meaning ascribed in section 1113 (a)(29)  of the
				Insurance Law.
(d) Policy means an
				insurance policy, including a contract issued in connection with a prepaid
				legal services plan.
(e) Prepaid
				legal services plan has the meaning ascribed in section
				261.1(m) 
				of this Title (Regulation 161).
(f)
				Related risk means a risk exposure that is related to the kind of risk exposure
				covered under the liability insurance policy of which the legal services
				insurance is a part.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter XI - Prepaid Legal Services Plans And Legal Services Insurance › Part 262 - Legal Services Insurance › Section 262.2 - Applicability; general requirements

Current through Register Vol. 46, No. 28, July 10, 2024
(a) This Part shall apply to any policy that
				includes legal services insurance issued or delivered in this State, or issued
				or delivered by an authorized insurer on risks or operations in this State, on
				or after April 1, 1999.
(b) No
				policy that includes legal services insurance may be issued or delivered except
				by an insurer authorized to write such insurance and as provided in this
				Part.
(c) Notwithstanding any other
				provision of this Part, legal services insurance may be issued or delivered
				only:
(1) as part of a prepaid legal services
				plan, provided, however, that not more than an incidental amount of the premium
				with respect to the plan shall be attributable to legal services for
				defense-only coverages for commercial or other business related lawsuits or
				arbitration proceedings commenced against the business entity that purchased
				the policy; or
(2) as part of a
				policy of liability insurance covering related risks, provided, however, that
				legal services for defense-only coverages for commercial or other business
				related lawsuits or arbitration proceedings commenced against the business
				entity that purchased the policy is not more than an incidental part of such
				liability insurance.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter XI - Prepaid Legal Services Plans And Legal Services Insurance › Part 262 - Legal Services Insurance › Section 262.3 - Coverage in an administrative proceeding or involving a non-pecuniary remedy or relief

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Subject to
				the provisions of subdivision (b) of this section, legal services insurance may
				provide coverage for the insured's costs of legal representation:
(1) in an administrative proceeding or other
				non-judicial dispute resolution forum; or
(2) in litigation where the remedies or
				relief sought are non-pecuniary in nature.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter XI - Prepaid Legal Services Plans And Legal Services Insurance › Part 262 - Legal Services Insurance › Section 262.4 - Permitted defense-only coverages involving claims of legal liability

Current through Register Vol. 46, No. 28, July 10, 2024
(a) No policy may
				provide defense-only coverage for a legal liability of the insured if the legal
				liability may permissibly be covered under a policy of liability insurance in
				this State.
(b) Legal services
				insurance may provide for the payment of defense-only costs in relation to a
				claim of legal liability where a liability insurance policy cannot provide
				coverage for the legal liability of the insured because the coverage is against
				public policy or otherwise not permitted under the Insurance Law, such as a
				claim relating to dishonest or fraudulent acts, intentional violation of
				statute, or the intentional gaining of profits to which the insured was not
				legally entitled.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter XI - Prepaid Legal Services Plans And Legal Services Insurance › Part 262 - Legal Services Insurance › Section 262.5 - Defense of criminal proceedings

Current through Register Vol. 46, No. 28, July 10, 2024
(a) No policy of legal services insurance may
				provide defense coverage in a criminal proceeding, except as provided in
				subdivision (b) of this section.
(b)
(1) For
				the purposes of this subdivision, a corporation shall mean a corporation
				subject to the provisions of Business Corporation Law, section
				726, Not-for-Profit Corporation Law, section
				726, or Banking Law, section
				7023, or a corporation that, if it were a
				New York corporation, would be subject to one of said sections.
(2) A directors and officers liability
				insurance policy that provides indemnification for the acts of an officer or
				director of a corporation, as such term is defined in paragraph (1) of this
				subdivision, may provide legal services insurance coverage in a criminal
				proceeding, to the extent permitted by the applicable corporate
				statute.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter XI - Prepaid Legal Services Plans And Legal Services Insurance › Part 262 - Legal Services Insurance › Section 262.6 - Directors and officers insurance limitations

Current through Register Vol. 46, No. 28, July 10, 2024
A directors and officers liability insurance policy that
				  provides coverage for the acts of an officer or director of a corporation, as
				  such term is defined in section
				  262.5(b)(1) 
				  of this Part, shall not provide coverage where indemnification is not permitted
				  pursuant to the Business Corporation Law, Not-for-Profit Corporation Law,
				  Banking Law or other applicable corporate statute.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter XI - Prepaid Legal Services Plans And Legal Services Insurance › Part 262 - Legal Services Insurance › Section 262.7 - Coverage trigger

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Coverage
				for legal services insurance may be provided only where the event that is the
				basis for the action occurs during the policy period, notwithstanding when the
				action is brought, except as provided in subdivision (b) of this
				section.
(b) If legal service
				insurance is written as part of a liability insurance policy, and the policy
				may be written on a claims-made basis pursuant to Part 73 of this Title
				(Regulation 121), then the legal services insurance may be provided on a
				claims-made basis, in accordance with the provisions of that Part.
(c) Coverage for legal services insurance
				shall continue until the matter is adjudicated or settled, except that:
(1) coverage provided under section
				262.4(b) 
				of this Part may be provided only until either the final adjudication of the
				claim adverse to the insured or until the insured is found to have in fact
				committed the alleged wrongful act; and
(2) if legal service insurance is written as
				part of a liability insurance policy, and the policy provides that the limits
				of liability may be exhausted by defense costs, in accordance with the
				provisions of Part 71 of this Title (Regulation 107), then the legal services
				insurance coverage shall cease when the limits of liability are
				exhausted.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter XI - Prepaid Legal Services Plans And Legal Services Insurance › Part 262 - Legal Services Insurance › Section 262.8 - Policy limits

Current through Register Vol. 46, No. 28, July 10, 2024
(a) A policy
				providing legal services insurance may establish separate dollar limits for
				services provided under the coverage.
(b) Legal services insurance that is written
				as part of a policy of liability insurance may not reduce the limits of
				liability under the liability insurance coverage except as permitted by the
				provisions of Part 71 of this Title (Regulation 107).
(c) A policy providing legal services
				insurance may include a reasonable deductible for such services but when the
				coverage is written as part of a policy of liability insurance, the deductible
				shall be separate and apart from any deductible under any liability insurance
				policy of which it is part. To the extent that the legal services provided
				under the coverage relate to legal services for a claim under the liability
				coverage for which a deductible applies, then the services shall be applied to
				both deductibles.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter XI - Prepaid Legal Services Plans And Legal Services Insurance › Part 262 - Legal Services Insurance › Section 262.9 - Minimum provisions for legal services insurance written as part of a legal services plan

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Legal
				services insurance that is written as part of a legal services plan shall
				comply with the provisions of Part 261 of this Title (Regulation
				161).
(b) An insurer may offer, as
				part of a legal services plan, types of legal services insurance coverage other
				than those specifically addressed by this Part, provided that the
				superintendent is satisfied that the criteria in section 1116 (b)  of the Insurance
				Law have been met and that providing such coverage would not be against the
				public policy of this State.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter XI - Prepaid Legal Services Plans And Legal Services Insurance › Part 262 - Legal Services Insurance › Section 262.10 - Minimum provisions for legal services insurance written as part of a policy of liability insurance

Current through Register Vol. 46, No. 28, July 10, 2024
Legal services insurance that is written as part of a policy
				  of liability insurance:
(a) may be
				written on a group basis, only if the underlying liability insurance policy is
				written on a group basis in accordance with Part 153 of this Title (Regulation
				135);
(b) shall be subject to the
				filing and approval requirements of article 23 of the Insurance Law, except
				that such coverage may qualify as a special risk coverage pursuant to Part 16
				of this Title (Regulation 86) only if the coverage of the policy of liability
				insurance of which it is a part also qualifies as a special risk coverage
				pursuant to that Part, and the policy is written on such basis;
(c) shall be subject to section 3102  of the Insurance Law if the underlying
				liability insurance policy is subject to that section;
(d) shall be written on a "pay on behalf"
				basis, except for a policy of directors and officers insurance, which may be
				written on an "indemnification" basis; and
(e) shall provide that nothing in the policy
				shall be construed to prevent an insured from making a complaint to the
				appropriate Appellate Division or other body designated by the Appellate
				Division to investigate complaints in accordance with Judiciary Law section 90,
				or to the appropriate disciplinary body in the state where the legal service is
				being provided.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter XII - Group Property/casualty Insurance › Part 301 - Purchasing Groups › Section 301.1 - Definitions

Current through Register Vol. 46, No. 28, July 10, 2024
In this Part, the following definitions shall apply:
(a) Doing an insurance business has the
				meaning ascribed to it by section 1101  of the Insurance Law.
(b) Doing business in this State includes,
				with respect to a purchasing group, where there is:
(1) a member which has a risk resident or
				located in this State;
(2) any
				solicitation, negotiation, issuance or delivery in this State of a policy by,
				to or on behalf of such group or any of its members; or
(3) an office of such group in this
				State.