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New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 1 - ADMINISTRATION › Subchapter 7 - MEDICAL MALPRACTICE REPORTING REQUIREMENTS › Section 11:1-7.2 - Definitions

Current through Register Vol. 56, No. 14, July 15, 2024
The following words and terms, as used in this subchapter, shall have the following meanings, unless the context clearly indicates otherwise.
"Commissioner" means the Commissioner of the New Jersey Department of Banking and Insurance.
"Medical malpractice liability insurance" means insurance coverage against the legal liability of the insured and against loss, damage or expense incident to a claim arising out of the death or injury of any person as the result of negligence or malpractice in rendering professional services by any licensed medical practitioner or health care facility or a claim arising out of ownership, operation or maintenance of the practitioner's or facility's business premises, including primary and excess coverages.
"Medical Practitioner Review Panel" or "Panel" means the panel established pursuant to 45:9-19.8.
"Practitioner" means any person licensed to practice medicine and surgery under 45:9-1 et seq., podiatry under 45:5-1 et seq., or a medical resident or intern.
"State Board of Medical Examiners" means the board established pursuant to 45:9-1.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 1 - ADMINISTRATION › Subchapter 7 - MEDICAL MALPRACTICE REPORTING REQUIREMENTS › Section 11:1-7.3 - Medical malpractice reporting requirements

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Any insurer or insurance association authorized to issue medical malpractice liability insurance in the State shall notify the Medical Practitioner Review Panel in writing of the following:
1. Any medical malpractice claim settlement, judgment or arbitration award involving any practitioner licensed by the State Board of Medical Examiners and insured by an insurer or insurance association.
i. The notification requirement set forth in (a)1 above shall not apply to payments made under agreements for minimum and maximum payments irrespective of the verdict (commonly referred to as high/low agreements) where there is a finding by an arbitrator or a verdict in a civil action of no liability on the part of the practitioner;
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 1 - ADMINISTRATION › Subchapter 7 - MEDICAL MALPRACTICE REPORTING REQUIREMENTS › Section 11:1-7.4 - Confidentiality

Current through Register Vol. 56, No. 14, July 15, 2024
All information or documentation submitted to the Panel pursuant to this subchapter is confidential, except for release to a government agency under certain circumstances and conditions as set forth at N.J.S.A. 45:9- 19.10.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 1 - ADMINISTRATION › Subchapter 7 - MEDICAL MALPRACTICE REPORTING REQUIREMENTS › Section 11:1-7.5 - Penalties

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Any insurer, insurance association or practitioner failing to notify the Medical Malpractice Review Panel pursuant to the requirements of this subchapter shall be subject to such penalties as the Commissioner may determine in accordance with 17:30D-12. Additionally, the Commissioner may assess a fine not to exceed $ 1,000 for the first violation and $ 2,000 for the second and each subsequent violation, which may be recovered in a summary proceeding pursuant to N.J.S.A. 2A:58-1 et seq.
(b) Any practitioner failing to notify the Medical Practitioner Review Panel pursuant to the requirements of this subchapter shall be subject to disciplinary action and civil penalties in accordance with 45:1-21, 22 and 25.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 1 - ADMINISTRATION › Subchapter 10 - ADMISSION REQUIREMENTS FOR FOREIGN AND ALIEN PROPERTY AND CASUALTY INSURERS › Section 11:1-10.1 - Purpose

Current through Register Vol. 56, No. 14, July 15, 2024
This subchapter establishes the procedures, requirements and standards which govern the application of foreign and alien companies engaged in the business of property and casualty insurance for a Certificate of Authority to transact the business of insurance in the State of New Jersey.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 1 - ADMINISTRATION › Subchapter 10 - ADMISSION REQUIREMENTS FOR FOREIGN AND ALIEN PROPERTY AND CASUALTY INSURERS › Section 11:1-10.2 - Scope

Current through Register Vol. 56, No. 14, July 15, 2024
This subchapter applies to any foreign and alien company engaged in the business of property and casualty insurance that applies for a Certificate of Authority to transact the business of insurance in the State of New Jersey. The filing requirements contained in this subchapter shall not apply to the continuation, renewal or timely reinstatement of existing Certificates of Authority except where the Commissioner, pursuant to law, shall otherwise so require.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 1 - ADMINISTRATION › Subchapter 10 - ADMISSION REQUIREMENTS FOR FOREIGN AND ALIEN PROPERTY AND CASUALTY INSURERS › Section 11:1-10.5 - Letter of intent

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Prior to the acceptance of a final application for a Certificate of Authority in the State of New Jersey, all foreign and alien insurers engaged in the business of property and casualty insurance who desire to transact the business of insurance in the State of New Jersey shall submit, as a preliminary application, a letter of intent, which shall include the information required in (a)1 through 7 below.
1. The name of the applicant;
2. Where applicable, the name of any person, as defined in this subchapter, or other entity, by whom the applicant is controlled;
3. The applicant's current insurance holding company systems chart;
4. The type(s) of insurance proposed to be written by the applicant in the State of New Jersey;
5. A certified copy of the applicant's most recent Annual Statement, prepared on the NAIC annual and quarterly statements forms used by New Jersey domestic insurers;
6. A certified copy of the applicant's current Certificate of Authority from its state, district, commonwealth, territory, possession or country of domicile; and
7. The most recent report(s) from rating agencies, including, but not limited to, A.M. Best, Moody's, Standard and Poor's, Duff and Phelps, and Dun and Bradstreet.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 1 - ADMINISTRATION › Subchapter 10 - ADMISSION REQUIREMENTS FOR FOREIGN AND ALIEN PROPERTY AND CASUALTY INSURERS › Section 11:1-10.7 - Review procedures; appeals

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Upon receipt of a final application, the Commissioner shall conduct a thorough background investigation and review which shall include the information contained in 11:1-10.4, 10.5 and 10.6, inquiries regarding claims settlement practices and any other information which, in the opinion of the Commissioner, may be necessary to make an appropriate decision on an application.
(b) Applicant companies shall ensure that all filings submitted to the Department are current. Any amendments, changes or replacements to constituent documents on file shall be timely updated.
(c) Applications accepted after November 15 of each year shall have their review deferred until the Annual Statement for the current year is available and received for review. The review of the filings of the prior year shall begin after the receipt by the Department of the latest annual statement and the latest financial information of the applicant is available in electronic format from the NAIC database.
(d) Before a decision on an application is made, the Department may request from an applicant, in writing, any additional information it may require. Failure by an applicant to respond to written inquiries by the Department within 45 days shall result in an application being deemed withdrawn.
(e) Application reviews shall be conducted by the Department on a monthly basis. The Committee on Admissions shall make a recommendation to the Commissioner concerning each application which has been reviewed. The Commissioner shall consider the recommendation and make his or her decision on the application within 10 working days from receipt of the recommendation. Written notice of the decision shall be mailed to the applicant by registered mail within 10 working days of the date of the Commissioner's decision.
(f) When the Commissioner rejects an application, the notice of rejection shall include a statement specifying the reasons for the rejection.
1. Such notice shall further inform the applicant of the right to request an informal Departmental review of the rejection within 20 days of receipt of the notice of rejection.
2. Such notice shall further inform the applicant of the right to provide to the Department a written statement, with supporting documentation, if any, disputing with specificity the reasons for rejection within 30 days of the receipt of the notice of rejection.
3. Upon the timely receipt of the request for Departmental review and the written statement of the company, if any, the Department shall promptly review the application, attached documents, department records and the written statement. In appropriate circumstances, the Commissioner may provide the applicant with an opportunity to present its position in person.
4. If, after reviewing the record, the Commissioner determines that the applicant has failed to qualify, the Commissioner shall promptly so inform the applicant.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 1 - ADMINISTRATION › Subchapter 10 - ADMISSION REQUIREMENTS FOR FOREIGN AND ALIEN PROPERTY AND CASUALTY INSURERS › Section 11:1-10.8 - Requirements upon admission

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Applicants contemplating the writing of homeowners or comprehensive personal liability polices in the State of New Jersey shall be required to afford coverage against liability for the payment of any obligation which the policyholder may incur to an injured domestic servant, or household employee, or the dependents thereof, pursuant to the provisions of the Workers' Compensation Law of the State of New Jersey. The Compensation, Rating and Inspection Bureau shall be informed by the Department accordingly.
(b) Applicants who wish to have their Certificate of Authority limited to "reinsurance" only, may disregard the regulatory requirements concerning membership in the Compensation, Rating and Inspection Bureau identified in 11:1-10.6(d).
(c) In clarification of 11:2-29.5(a)1  i, if an applicant is granted authority to transact private passenger automobile insurance, the approval shall provide that if the applicant (insurer) later seeks to withdraw from transacting such business pursuant to N.J.A.C. 11:2-29, the period of time which such insurer must seek to place its business with a replacement carrier, which shall begin on the date of the Commissioner's approval of the plan of orderly withdrawal, shall be based on the time between the date of issuance of the certificate of authority and the date of the filing of a complete plan of orderly withdrawal as set forth in 11:2-29.4, as follows:
1. For insurers authorized to transact business up to two years, the period shall not exceed one year;
2. For insurers authorized to transact business beyond the period in (c)1 above up to four years, the period shall not exceed two years;
3. For insurers authorized to transact business beyond the period set forth in (c)2 above up to five years, the period shall not exceed three years;
4. For insurers authorized to transact business beyond the period set forth in (c)3 above up to six years, the period shall not exceed four years; and
5. For insurers authorized to transact business beyond the period set forth in (c)4 above, the period shall be established by the Commissioner pursuant to 11:2-29.5(a)1  i, but shall not exceed five years.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 1 - ADMINISTRATION › Subchapter 10 - ADMISSION REQUIREMENTS FOR FOREIGN AND ALIEN PROPERTY AND CASUALTY INSURERS › Section 11:1-10.9 - Severability

Current through Register Vol. 56, No. 14, July 15, 2024
If any provision of this subchapter or the application thereof to any person or circumstance is held invalid, the remainder of the subchapter and the application of such provision to other persons or circumstances shall not be affected thereby.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 1 - ADMINISTRATION › Subchapter 11 - CONDUCT CONSTITUTING VIOLATIONS BY BROKERS AND AGENTS › Section 11:1-11.1 - Scope

Current through Register Vol. 56, No. 14, July 15, 2024
This rule does not purport to describe all conduct within the proscription of the statute. Such other conduct found by the commissioner to constitute violation prior to this rule remains as a reason for sanctions under the statute. Nor is it possible to describe herein all forms of conduct which may in future be found to fall under the prohibition of the statutes.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 1 - ADMINISTRATION › Subchapter 11 - CONDUCT CONSTITUTING VIOLATIONS BY BROKERS AND AGENTS › Section 11:1-11.2 - Fraudulent, coercive or dishonest practices, or incompetence, untrustworthiness or financial irresponsibility under N.J.S.A 17:22A-40(8)

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Any licensed insurance producer who is a shareholder or who is serving as an officer of record of a corporate licensee which declares insolvency, dissolves, ceases to do business or does not renew its insurance licenses primarily to avoid payment of fines or debts to insolvent insurers, other insurance licensees, insureds, guaranty associations or governmental entities is engaging in conduct demonstrating fraudulent, coercive or dishonest practices, or incompetence, untrustworthiness or financial irresponsibility under 17:22A-40(8).
(b) Any licensee engaging in the above conduct shall be subject to the usual penalties and may be prohibited from licensing of or association with any other incorporated licensee.
(c) A showing that the licensee has placed 10 per cent or more of the book of business of the moribund corporate licensee into a new corporation controlled by one or more persons associated with the prior corporation shall raise a presumption of violative conduct.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 1 - ADMINISTRATION › Subchapter 11 - CONDUCT CONSTITUTING VIOLATIONS BY BROKERS AND AGENTS › Section 11:1-11.3 - Disciplinary action; restitution

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Violation of any of the rules of the Department of Banking and Insurance, or of any insurance statute, shall be sufficient cause for any disciplinary action permitted by statute.
(b) In accordance with the provisions of 17:22A-27 et seq., the Commissioner in appropriate circumstances will exercise his or her authority to impose restitution of moneys owed to others as a condition to the issuance of a license or to the reinstatement of a license after revocation or suspension, including revocation or suspension in states other than New Jersey.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 1 - ADMINISTRATION › Subchapter 12 - CORPORATE AND PARTNERSHIP LICENSEE REQUIREMENTS › Section 11:1-12.2 - Responsibility of active officers of corporate licensees

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Active officers shall be held individually responsible for all insurance related conduct of the corporate licensee.
(b) Every license application, amended application and renewal must be accompanied by a sworn statement signed by each active officer listed thereon that he consents to being an active officer and that he has read and is fully aware of the meaning of the departmental regulations relevant thereto.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 1 - ADMINISTRATION › Subchapter 15 - PETITIONS FOR RULES; RULEMAKING NOTICE › Section 11:1-15.1 - Scope

Current through Register Vol. 56, No. 14, July 15, 2024
11:1-15.2 and 15.3 shall apply to all petitions made by interested persons for the promulgation, amendment or repeal of any rule by the Department of Banking and Insurance, pursuant to 52:14B-4(f). 11:1-15.5 applies to requirements for extension of a public comment period, or holding a public hearing, on a proposal when sufficient public interest is established.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 1 - ADMINISTRATION › Subchapter 15 - PETITIONS FOR RULES; RULEMAKING NOTICE › Section 11:1-15.2 - Procedure for petitioner

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Any person who wishes to petition the Department to promulgate, amend or repeal a rule must submit to the Commissioner, in writing, the following information:
1. Name of the petitioner;
2. The substance or nature of the rulemaking which is requested;
3. The reasons for the request and the petitioner's interest in the request;
4. References to the statutory authority for the Department to take the requested action; and
5. A caption at the top of the document identifying it as a petition for rulemaking pursuant to 52:14B-4(f)  and this subchapter.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 1 - ADMINISTRATION › Subchapter 15 - PETITIONS FOR RULES; RULEMAKING NOTICE › Section 11:1-15.3 - Procedure of the Department

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Upon receipt of a petition in compliance with 11:1-15.2, the Department will file a notice of petition with the Office of Administrative Law for publication in the New Jersey Register. The notice will include:
1. The name of the petitioner;
2. The substance or nature of the rulemaking action which is requested;
3. The problem or purpose which is the subject of the request; and
4. The date the petition was received.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 1 - ADMINISTRATION › Subchapter 15 - PETITIONS FOR RULES; RULEMAKING NOTICE › Section 11:1-15.4 - Rulemaking activity

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The Department shall provide notice of new rules, amendments, repeals or adoptions by posting these rules on its website at
http://www.state.nj.us/dobi/legsregs.htm
and to the news media maintaining a press office in the State House Complex.
(b) The Department shall post its proposals in the Department's Library, which is located on the 1st Floor, 20 West State Street, Trenton, NJ 08625. The Department shall also distribute its proposals to the Department's list of "interested persons" by e-mail or hard copy. Interested persons are those who have informed the Department in writing that they wish to receive notice of its proposed regulations.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 1 - ADMINISTRATION › Subchapter 15 - PETITIONS FOR RULES; RULEMAKING NOTICE › Section 11:1-15.5 - Sufficient public interest for the purposes of extending the comment period or granting a public hearing

Current through Register Vol. 56, No. 14, July 15, 2024
(a) In determining whether sufficient public interest has been demonstrated for the purposes of extending the comment period pursuant to 1:30-5.4, the Commissioner shall consider the following criteria:
1. Whether comments received indicated a previously unrecognized impact on regulated entities or persons; or
2. Whether comments received raise unanticipated issues related to the notice of proposal.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 1 - ADMINISTRATION › Subchapter 16 - REQUIREMENTS FOR FILING A DOWNWARD DEVIATION IN CURRENTLY APPROVED RATES › Section 11:1-16.1 - Purpose and scope

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The purpose of this subchapter is to promote competition among insurers for the benefit of the insurance consuming public by permitting insurers subject to 17:29A-1 et seq. to effect expeditiously certain decreases in rates currently approved by the Department when, in an insurer's judgment, economic or competitive reasons or conditions warrant such a decrease.
(b) A further purpose is to enable an insurer to return to its previously approved rate level without delay or regulatory review when, in its judgment, the conditions or reasons for the decrease no longer pertain.
(c) This subchapter shall apply to every property and liability insurer which makes its own rates and to every member or subscriber of a rating organization on whose behalf rate filings are made pursuant to the provisions of 17:29A-1 et seq. For the purpose of this subchapter, the term "insurer" shall include all such independent insurers and rating organization members or subscribers who are subject to the provisions of 17:29A-1 et seq.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 1 - ADMINISTRATION › Subchapter 16 - REQUIREMENTS FOR FILING A DOWNWARD DEVIATION IN CURRENTLY APPROVED RATES › Section 11:1-16.2 - Filing requirements

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Any insurer, subject to the provisions of 17:29A-1 et seq., to effect a decrease in rates currently approved by the Commissioner, shall comply with the following filing requirements:
1. The insurer by a rate filing shall notify the Commissioner of Banking and Insurance at least 30 days prior to the date it wants to put into effect a decrease in rates currently approved for it by the Commissioner. In such rate filing, the insurer shall state the basis for the decrease in rates and its agreement that the decrease in rates shall remain in effect for at least six months from the effective date. Within 15 days of receipt of a filing of such a proposed decrease in rates, the Commissioner will notify the insurer of any finding as to the unacceptability of the filing for a decrease in rates. The Commissioner will only find unacceptable a decrease rate filing if, in his or her opinion, the decrease in rates may have a tendency or capacity to imperil the financial condition of the filing insurer.
2. The decrease in rates may be up to 20 percent from the rates currently approved for use by the insurers and must apply to all policyholders either by coverage or line of insurance.
3. After a filing has been in effect for six months or more, an insurer may automatically withdraw its decrease or any portion thereof by so notifying the Commissioner of Banking and Insurance at least 30 days prior to the withdrawal date.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 1 - ADMINISTRATION › Subchapter 20 - RENEWAL, CANCELLATION AND NONRENEWAL OF COMMERCIAL AND HOMEOWNERS INSURANCE POLICIES › Section 11:1-20.1 - Scope

Current through Register Vol. 56, No. 14, July 15, 2024
(a) This subchapter shall apply to all commercial insurance policies that are in force, issued, or renewed by companies licensed to do business in this State except workers' compensation insurance, employers liability, fidelity, surety, performance and forgery bonds, ocean marine and aviation insurance, and accident and health insurance and any policy written by a surplus lines insurer. With the exception of N.J.A.C. 11:1 -20.3 and 11:1 -20.4(d), this subchapter shall not be applicable to multi-state location risks or policies subject to retrospective rating plans.
(b) This subchapter shall also apply to all policies of homeowners insurance as defined at N.J.A.C. 11:2-42.2.
(c) These rules are not exclusive, and the Commissioner may also consider other provisions of statutes and regulations to be applicable to the circumstances or situations addressed herein. Policies may provide terms more favorable to policyholders than are required by these rules. The rights provided by these rules are in addition to and do not prejudice any other rights policyholders may have at common law, or under statutes and regulations.
(d) In addition to these rules, the Commissioner may implement a market assistance plan providing for a voluntary group of insurers in order to aid insureds in obtaining commercial insurance coverages specified therein.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 1 - ADMINISTRATION › Subchapter 20 - RENEWAL, CANCELLATION AND NONRENEWAL OF COMMERCIAL AND HOMEOWNERS INSURANCE POLICIES › Section 11:1-20.3 - Policy provisions relating to cancellation or nonrenewal

Current through Register Vol. 56, No. 14, July 15, 2024
(a)All commercial insurance policy forms and all homeowners' insurance policy forms must contain a provision setting forth the following statement:
Pursuant to New Jersey law, this policy cannot be cancelled or nonrenewed for any underwriting reason or guideline which is arbitrary, capricious or unfairly discriminatory or without adequate prior notice to the insured. The underwriting reasons or guidelines that an insurer can use to cancel or nonrenew this policy are maintained by the insurer in writing and will be furnished to the insured and/or the insured's lawful representative upon written request.
This provision shall not apply to any policy that has been in effect for less than 60 days at the time notice of cancellation is mailed or delivered, unless the policy is a renewal policy.
1. The policy provision language set forth at (a) above is mandatory and, notwithstanding any other law to the contrary, need not be submitted to the Department for approval.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 1 - ADMINISTRATION › Subchapter 20 - RENEWAL, CANCELLATION AND NONRENEWAL OF COMMERCIAL AND HOMEOWNERS INSURANCE POLICIES › Section 11:1-20.5 - Cancellation or nonrenewal based on loss of or reduction in available insurance capacity

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Every cancellation or nonrenewal based upon loss of or reduction in available insurance capacity shall be supported by the following documentation:
1. A narrative description of the specific facts underlying the insurer's loss of or reduction in capacity.
2. Identification of the individual risk(s) or line, class or subclass of insurance, as applicable, proposed for termination and an explanation of the basis for the selection, which shall demonstrate that the insurer's selection is not arbitrary, capricious or unfairly discriminatory. An unsupported statement, such as "underwriting judgment", shall not constitute a valid explanation.
3. With respect to terminations subject to N.J.A.C. 11:1-22, an explanation of how the loss of or reduction in capacity affects the insurer's risks throughout the line, class or category of insurance proposed for cancellation and/or nonrenewal.
4. An explanation of why cancellation or nonrenewal is necessary to cure the capacity problem and why other measures, including but not limited to cessation of new business writings, do not present a viable alternative to termination of existing business; and
5. With respect to terminations subject to N.J.A.C. 11:1-22, an explanation of how the cancellation or nonrenewals will be implemented with respect to individual risks and the steps that will be taken to ensure that the cancellation/nonrenewal decisions will not be applied in an arbitrary, capricious or unfairly discriminatory manner.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 1 - ADMINISTRATION › Subchapter 20 - RENEWAL, CANCELLATION AND NONRENEWAL OF COMMERCIAL AND HOMEOWNERS INSURANCE POLICIES › Section 11:1-20.6 - Cancellation and nonrenewal based on changes in statutory or case law

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Every cancellation or nonrenewal based on material increase in exposure resulting from changes in statutory or case law subsequent to issuance of the insurance contract shall be supported by the following documentation:
1. Copies of or appropriate references to the applicable statute or case;
2. A narrative description of the changes resulting from the statute or case and how the changes affect the coverages provided under the contract to increase the insurer's exposure in a material fashion. The narrative should also document that the modification to policy coverages arising from the change in statutory or case law was such that it could not have been reasonably foreseen by the insurer;
3. Identification of the individual risk(s), line(s), class(es) or subclass(es) of insurance affected by the change in statutory or case law;
4. If all risks within the lines, classes or subclasses identified in item 3 above are not to be cancelled or nonrenewed, an explanation of the basis for selection of individual risk(s) or lines, classes or subclasses, as applicable, which shall demonstrate that such selection is not arbitrary, capricious or unfairly discriminatory;
5. Explanation of why cancellation and/or nonrenewal is necessary to cure the insurer's increased exposure and why other measures, including but not limited to, premium modification or revision of coverage limits or terms, do not present a viable alternative to termination.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 1 - ADMINISTRATION › Subchapter 20 - RENEWAL, CANCELLATION AND NONRENEWAL OF COMMERCIAL AND HOMEOWNERS INSURANCE POLICIES › Section 11:1-20.7 - Cancellation or nonrenewal based on loss of or substantial changes in applicable reinsurance

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Every cancellation or nonrenewal based on loss of or substantial changes in applicable reinsurance shall be supported by the following documentation:
1. All information set forth at 11:1-22.2(b)1;
2. Copy of termination notice or other notice reflecting substantial changes in applicable reinsurance;
3. Copy of order issued by insurance department or court of competent jurisdiction, where applicable; and
4. Name, address and telephone number of each reinsurer contacted by the insurer in its effort to obtain replacement coverage, name and title of each company representative contacted and the outcome.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 1 - ADMINISTRATION › Subchapter 20 - RENEWAL, CANCELLATION AND NONRENEWAL OF COMMERCIAL AND HOMEOWNERS INSURANCE POLICIES › Section 11:1-20.8 - Cancellation and nonrenewal based on agency termination

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Every cancellation or nonrenewal based on agency termination shall be supported by the following documentation:
1. Explanation of the basis for the insurer's termination of the agency contract;
2. Explanation of why the individual risk(s) or line, class or subclass, as applicable, of insurance must be cancelled or nonrenewed as a result of the agency termination and why coverage cannot or should not be continued through referral to another active agent of the insurer or written by the insurer on a direct basis;
3. Evidence of the provision of replacement coverage to the insured, where applicable;
4. Copy of the insured's statement consenting to the termination of coverage, where applicable; and
5. Copy of the written notice issued by the insurer advising the insured of his or her right to continue coverage with the insurer.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 1 - ADMINISTRATION › Subchapter 20 - RENEWAL, CANCELLATION AND NONRENEWAL OF COMMERCIAL AND HOMEOWNERS INSURANCE POLICIES › Section 11:1-20.9 - Policy provisions

Current through Register Vol. 56, No. 14, July 15, 2024
No policy shall contain provisions which are inconsistent with the requirements of this subchapter.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 1 - ADMINISTRATION › Subchapter 20 - RENEWAL, CANCELLATION AND NONRENEWAL OF COMMERCIAL AND HOMEOWNERS INSURANCE POLICIES › Section 11:1-20.10 - Separability

Current through Register Vol. 56, No. 14, July 15, 2024
If any provision of this subchapter or the application thereof to any person or circumstance is for any reason held to be invalid, the remainder of the subchapter and the application of such provision to other persons or circumstances shall not be affected thereby.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 1 - ADMINISTRATION › Subchapter 20 - RENEWAL, CANCELLATION AND NONRENEWAL OF COMMERCIAL AND HOMEOWNERS INSURANCE POLICIES › Section 11:1-20.11 - Penalties

Current through Register Vol. 56, No. 14, July 15, 2024
(a) In addition to any other penalty authorized by law, the Commissioner may, after notice and a hearing, impose penalties as prescribed by 17:29A-1 et seq., 17:29AA-1 et seq., 17:29B-7 and 11, 17:30C-1 et seq., 17:32-1 et seq. and 17:33-2.
(b) As an alternative or in addition to the penalties set forth in (a) above, the Commissioner, where he or she deems such action will further the purposes of this subchapter, may require immediate reinstatement without lapse of any policy that has been cancelled or nonrenewed in violation of the provisions of this subchapter.
1. The Commissioner shall not order any reinstatement more than one year after the effective date of the nonrenewal or cancellation, provided, however, that the one year period shall be tolled during the course of any administrative proceedings initiated by the Department and any subsequent judicial review of those proceedings.
2. Nothing herein shall be deemed to create any right or cause of action on behalf of any insured to enforce the penalties set forth in this subsection.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 1 - ADMINISTRATION › Subchapter 21 - LOSS RESERVE OPINIONS › Section 11:1-21.1 - Purpose and scope

Current through Register Vol. 56, No. 14, July 15, 2024
(a) This subchapter sets forth the requirements for the filing of loss reserve actuarial opinions, actuarial opinion summary, and actuarial report and workpapers by property casualty insurers.
(b) This subchapter shall apply to all property and casualty insurers authorized or admitted to transact business in this State.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 1 - ADMINISTRATION › Subchapter 21 - LOSS RESERVE OPINIONS › Section 11:1-21.2 - Definitions

Current through Register Vol. 56, No. 14, July 15, 2024
The following words and terms, as used in this subchapter, shall have the following meanings, unless the context clearly indicates otherwise.
"Commissioner" means the Commissioner of the New Jersey Department of Banking and Insurance.
"Department" means the New Jersey Department of Banking and Insurance.
"NAIC" means the National Association of Insurance Commissioners.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 1 - ADMINISTRATION › Subchapter 21 - LOSS RESERVE OPINIONS › Section 11:1-21.3 - Statement of actuarial opinion

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Every property and casualty insurer authorized or admitted to transact business in this State shall annually submit the opinion of an appointed actuary entitled "Statement of Actuarial Opinion."
(b) The opinion required pursuant to (a) above shall be filed in accordance with the appropriate NAIC Property and Casualty Annual Statement Instructions.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 1 - ADMINISTRATION › Subchapter 21 - LOSS RESERVE OPINIONS › Section 11:1-21.4 - Actuarial opinion summary

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Every property and casualty insurance company domiciled in this State that is required to annually submit a statement of actuarial opinion shall also annually submit an actuarial opinion summary, written by the company's appointed actuary. This actuarial opinion summary shall be filed in accordance with the appropriate NAIC Property and Casualty Annual Statement Instructions and considered a document supporting the actuarial opinion required by this subchapter.
(b) A company licensed but not domiciled in this State shall provide the actuarial opinion summary upon request.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 1 - ADMINISTRATION › Subchapter 21 - LOSS RESERVE OPINIONS › Section 11:1-21.5 - Actuarial report and workpapers

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Every property and casualty insurance company domiciled in this State that is required to annually submit a statement of actuarial opinion shall annually file, by May 1 of each year, an actuarial report and underlying workpapers that are required to be prepared by the appropriate NAIC Property and Casualty Annual Statement Instructions to support each actuarial opinion. A company licensed but not domiciled in this State shall provide the actuarial report and workpapers upon request.
(b) If any insurer fails to provide a supporting actuarial report and/or workpapers as set forth in (a) above, or the Commissioner determines that the supporting actuarial report and/or workpapers provided by the insurance company are otherwise unacceptable, the Commissioner shall so notify the insurer. If the insurer fails to provide the requested information within 30 days of the date of the request, the Commissioner may, pursuant to 17:23-20 et seq., engage a qualified actuary at the expense of the company to review the opinion and the basis for the opinion and prepare the supporting actuarial report and/or workpapers.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 1 - ADMINISTRATION › Subchapter 21 - LOSS RESERVE OPINIONS › Section 11:1-21.6 - Confidentiality

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The statement of actuarial opinion shall be provided with the annual statement in accordance with the appropriate NAIC Property and Casualty Annual Statement Instructions and shall be treated as a public document.
(b) Documents, materials or other information in the possession or control of the Department that are considered an actuarial report, workpapers or actuarial opinion summary provided in support of the opinion, and any other material provided by the company to the Commissioner in connection with the actuarial report, workpapers or actuarial opinion summary, shall be confidential pursuant to N.J.S.A. 17:23-24f and shall not be considered a public record for purposes of the Open Public Records Act, 47:1A-1 et seq.
(c) This section shall not be construed to limit the Commissioner's authority to release the documents to the Actuarial Board for Counseling and Discipline (ABCD) so long as the material is required for the purpose of professional disciplinary proceedings and that the ABCD establishes procedures satisfactory to the Commissioner for preserving the confidentiality of the documents, nor shall this section be construed to limit the Commissioner's authority to use the documents, materials or other information in furtherance of any regulatory or legal action brought as part of the Commissioner's official duties.
(d) In order to assist in the performance of the Commissioner's duties, the Commissioner may:
1. Share documents, materials or other information, including the confidential and privileged documents, materials or information subject to (b) above with other state, federal and international regulatory agencies, with the National Association of Insurance Commissioners and its affiliates and subsidiaries, and with state, federal and international law enforcement authorities, provided that the recipient agrees to maintain the confidentiality and privileged status of the document, material or other information and has the legal authority to maintain confidentiality;
2. Receive documents, materials or information, including otherwise confidential and privileged documents, materials or information, from the National Association of Insurance Commissioners and its affiliates and subsidiaries, and from regulatory and law enforcement officials of other foreign or domestic jurisdictions, and shall maintain as confidential or privileged any document, material or information received with notice or the understanding that it is confidential or privileged under the laws of the jurisdiction that is the source of the document, material or information; and
3. Enter into agreements governing the sharing and use of information consistent with (b) and (c) above and this subsection.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 1 - ADMINISTRATION › Subchapter 21A - ACTUARIAL OPINION AND MEMORANDUM FOR LIFE/HEALTH INSURERS › Section 11:1-21A.1 - Purpose and scope

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The purpose of these rules is to prescribe:
1. Requirements for statements of actuarial opinion and for memoranda in support thereof;
2. Rules applicable to the appointment of an appointed actuary; and
3. Guidance as to the meaning of "adequacy of reserves."
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 1 - ADMINISTRATION › Subchapter 21A - ACTUARIAL OPINION AND MEMORANDUM FOR LIFE/HEALTH INSURERS › Section 11:1-21A.2 - Definitions

Current through Register Vol. 56, No. 14, July 15, 2024
The following words and terms, as used in this subchapter, shall have the following meanings, except where the context clearly indicates otherwise.
"Actuarial opinion" means the opinion of an appointed actuary regarding the adequacy of the reserves and related actuarial items based on an asset adequacy analysis in accordance both with 11:1-21A.4 and with actuarial standards applicable at the time of rendering the opinion;
"Actuarial Standards Board" means the board established by the American Academy of Actuaries to develop and promulgate standards of actuarial practice.
"Alien company" means a company formed under the laws of any country other than the United States, its states, districts, territories, commonwealths, and possessions.
"Annual Statement" means that statement required by 17:23-1, 17B:21-1 and 17:44B-25, as applicable, to be filed by the company with the Commissioner annually.
"Appointed actuary" means an individual who is appointed or retained in accordance with the requirements set forth in 11:1-21A.3(d)  to provide the actuarial opinion and supporting memorandum as required by this subchapter.
"Asset adequacy analysis" means an analysis that meets the standards and other requirements referred to in 11:1-21A.3(e).
"Commissioner" means the Commissioner of the New Jersey Department of Banking and Insurance.
"Company" means an insurer, fraternal benefit society or reinsurer subject to the provisions of this subchapter.
"Foreign company" means a company formed under the laws of a jurisdiction of the United States, other than this State.
"Fraternal benefit society" is as defined at 17:44B-2.
"Insurer" means any person or entity authorized to transact life, accident or health, or annuities business in this State or authorized to reinsure such business in this State in accordance with Title 17 or 17B of the New Jersey Statutes.
"NAIC" means the National Association of Insurance Commissioners.
"Qualified actuary" means any individual who meets the requirements set forth in 11:1-21A.3(c).
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 1 - ADMINISTRATION › Subchapter 21A - ACTUARIAL OPINION AND MEMORANDUM FOR LIFE/HEALTH INSURERS › Section 11:1-21A.3 - General requirements

Current through Register Vol. 56, No. 14, July 15, 2024
(a) There shall be included on or attached to Page 1 of the annual statement for each year, beginning with 1995, and with respect to the amendments to this subchapter effective April 17, 2006 (see 38 N.J.R. 101(a) and 1737(a)), 2006, the statement of an appointed actuary, entitled "Statement of Actuarial Opinion," setting forth an opinion relating to reserves and related actuarial items held in support of policies and contracts, in accordance with 11:1-21A.4.
(b) Upon written request by the company, the Commissioner may grant an extension of the date for submission of the statement of actuarial opinion.
(c) For purposes of this subchapter, a "qualified actuary" is an individual who:
1. Is a member in good standing of the American Academy of Actuaries;
2. Is qualified to sign statements of actuarial opinion for life and health insurance company annual statements in accordance with the American Academy of Actuaries qualification standards for actuaries signing such statements;
3. Is familiar with the valuation requirements applicable to life and health insurance companies;
4. Has not been found by the Commissioner (or if so found has subsequently been reinstated as a qualified actuary), following notice and opportunity for a hearing, to have:
i. Violated any provision of, or any obligation imposed by, the insurance laws or other law in the course of his or her dealings as a qualified actuary;
ii. Been found guilty of fraudulent or dishonest practices;
iii. Demonstrated his or her incompetency, lack of cooperation, or untrustworthiness to act as a qualified actuary;
iv. Submitted to the Commissioner during the past five years, pursuant to this subchapter, an actuarial opinion or memorandum that the Commissioner rejected because it did not meet the provisions of this subchapter, including standards set by the Actuarial Standards Board; or
v. Resigned or been removed as an actuary within the past five years as a result of acts or omissions indicated in any adverse report on examination or as a result of failure to adhere to generally acceptable actuarial standards; and
5. Has not failed to notify the Commissioner of any action taken by any commissioner of any other state similar to that under (c)4 above.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 1 - ADMINISTRATION › Subchapter 21A - ACTUARIAL OPINION AND MEMORANDUM FOR LIFE/HEALTH INSURERS › Section 11:1-21A.4 - Statement of actuarial opinion based on an asset adequacy analysis

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The statement of actuarial opinion submitted in accordance with this section shall consist of:
1. A paragraph identifying the appointed actuary and his or her qualifications in the format set forth in (b)1 below;
2. A scope paragraph identifying the subjects on which an opinion is to be expressed and describing the scope of the appointed actuary's work, including a tabulation delineating the reserves and related actuarial items that have been analyzed for asset adequacy and the method of analysis in the format set forth in (b)2 below, and identifying the reserves and related actuarial items covered by the opinion that have not been so analyzed;
3. A reliance paragraph describing those areas, if any, where the appointed actuary has deferred to other experts in developing data, procedures or assumptions (for example, anticipated cash flows from currently owned assets, including variation in cash flows according to economic scenarios as set forth in (b)3 below, supported by a statement of each such expert in the form prescribed in (e) below);
4. An opinion paragraph expressing the appointed actuary's opinion with respect to the adequacy of the supporting assets to mature the liabilities in the format set forth in (b)6 below; and
5. One or more additional paragraphs as may be needed in individual company cases as follows:
i. If the appointed actuary considers it necessary to state a qualification of his or her opinion;
ii. If the appointed actuary must disclose an inconsistency in the method of analysis or basis of asset allocation used at the prior opinion date with that used for this opinion;
iii. If the appointed actuary must disclose whether additional reserves of the prior opinion date are released as of this opinion date, and the extent of the release; and
iv. If the appointed actuary chooses to add a paragraph briefly describing the assumptions that form the basis for the actuarial opinion.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 1 - ADMINISTRATION › Subchapter 21A - ACTUARIAL OPINION AND MEMORANDUM FOR LIFE/HEALTH INSURERS › Section 11:1-21A.6 - Penalties

Current through Register Vol. 56, No. 14, July 15, 2024
Failure to comply with the provisions of this subchapter may result in the imposition of penalties as authorized by law.