New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 6 - JOINT INSURANCE FUNDS FOR NONPROFIT CORPORATIONS AND KEYS AMENDMENT FACILITIES › Section 11:15-6.2 - 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.
"Actuary" means a person who is a Fellow in good standing of the Casualty Actuarial Society with three years recent experience in loss reserving; an Associate in good standing of the Casualty Actuarial Society with five years recent experience in loss reserving; or a Member in good standing of the American Academy of Actuaries who has been approved as qualified for signing casualty loss reserve opinions by the Casualty Practice Council of the American Academy of Actuaries and who has seven years experience in loss reserving.
"Administrator" means a person, partnership, corporation or other legal entity engaged by the joint insurance fund commissioners, as defined in this section, to act as executive director to carry out the policies established by the joint insurance fund commissioners and to otherwise administer and provide day-to-day management of the joint insurance fund. The administrator may also be an employee of the fund, a fund member, or an independent contractor.
"Automobile and equipment liability" means liability resulting from the use or operation of motor vehicles, equipment or apparatus owned by or controlled by the member.
"Board" means the board of trustees or the group of persons vested with management of the business and affairs of a nonprofit corporation regardless of the name by which the group or persons is designated.
"Chairman" means the chairman of the insurance fund commission as may be elected or designated by the fund commissioners.
"Commissioner" means the Commissioner of the Department of Banking and Insurance.
"Department" means the New Jersey Department of Banking and Insurance.
"Employers' liability" means the legal liability of a public employer to pay damages because of bodily injury or death by accident or disease at any time resulting therefrom sustained by an employee arising out of and in the course of his or her employment by the employer, which is not covered by a workers' compensation law.
"Excess carrier" means an insurer that provides excess insurance or reinsurance to a fund.
"Excess insurance" means insurance, purchased from an insurance company authorized or admitted in the State of New Jersey or deemed eligible by the Commissioner as a surplus lines insurer, covering losses in excess of an amount established between the joint insurance fund and the insurer up to the limits of coverage set forth in the insurance contract on a specific per occurrence, per accident, or annual aggregate basis.
"Executive committee" means the committee of the insurance fund commissioners, as provided in 17:49A-5.
"Fiscal year" or "fund year" means the calendar year January 1 through December 31.
"General liability" means any and all liability which may be insured under the laws of the State of New Jersey, excluding automobile liability, workers' compensation and employers' liability.
"Hazardous financial condition" means that, based on its present or reasonably anticipated financial condition, a fund, although not yet financially impaired or insolvent, is unlikely to be able:
1. To meet obligations to claimants with respect to known claims and reasonably anticipated claims; or
2. To pay other obligations in the normal course of business.
"Indemnity and trust agreement" means a written contract signed by the members of the joint insurance fund under which each agrees to jointly and severally assume and discharge the liabilities of each and every party to such agreement arising from their participation in the fund.
"Insolvent fund" means a joint insurance fund which has been determined by a court of competent jurisdiction to be unable to pay its outstanding lawful obligations as they mature in the regular course of business, as may be shown either by an excess of its required reserves and other liabilities over its assets or by its not having sufficient assets to reinsure all of its outstanding liabilities after paying all accrued claims owed by it, or for which, or for the assets of which, a receiver or liquidator, however entitled, has been appointed by a court of competent jurisdiction and authority, after (the effective date of this subchapter).
"Insurer" means any corporation, association, partnership, reciprocal exchange, interinsurer, Lloyd's insurer or other person engaged in the business of insurance pursuant to Subtitle 3 of Title 17 of the Revised Statutes.
"Intertrust fund transfer" means an actual transfer of funds from one claim or loss retention fund account in a fiscal year to another account within the same fiscal year.
"Interyear fund transfer" means the transfer of funds from a claim or loss retention trust account for a fiscal year, to a claim or loss retention trust account of similar risk or liability for a different fiscal year.
"Joint insurance fund" or "Fund" means a group organized by two or more nonprofit corporations or two or more Keys amendment facilities to establish an insurance fund for the purposes of insuring and/or self-insuring against liability, property damage, and workers' compensation.
"Joint insurance fund commissioners" means the representatives chosen to represent those members in the fund, as provided in 17:49A-1 et seq.
"Keys amendment facility" means a medical or non-medical residential setting designated by the State as a facility that meets the requirements of the "Social Security Act", 42 U.S.C. §
										1382e, as implemented by 45 C.F.R. 1397.1 et seq.
"Member" means a nonprofit corporation or Keys amendment facility which is a member of an insurance fund.
"Net current surplus" or "surplus" means that amount of monies in a trust account established pursuant to 11:15-6.6(b)10, including earned investment income, that is in excess of all costs, refunds made pursuant to 11:15-6.2 0 incurred losses and loss adjustment expenses and incurred but not reported reserves, including the associated loss adjustment expenses attributed to the fund net of any recoverable per occurrence or aggregate excess insurance or reinsurance for a particular year.
"Nonprofit corporation" means any corporation organized under the "New Jersey Nonprofit Corporation Act", 15A:1-1 et seq., any corporation as defined by N.J.S.A. 15A:1-2e or any corporation organized pursuant to Title 16 of the Revised Statutes.
"Owner" means the person or group vested with ownership and management of a Keys amendment facility, regardless of the name by which the person or group is designated.
"Plan of risk management" means a plan and activities carried out under the plan, binding upon the participants in a joint insurance fund, to reduce risk of loss with respect to a particular line of insurance protection or coverage provided by a fund pursuant to 17:49A-1 et seq. Plan of risk management also includes the administration of one or more funds, including the processing and defense of claims brought against or on behalf of members of the fund.
"Producer" means any person engaged in the business of an insurance agent, insurance broker, or insurance consultant as defined in N.J.S.A. 17:22A-1 et seq.
"Property damage" means any loss or damage, however caused, on property, motor vehicles, equipment or apparatus owned by the member.
"Recoverable" insurance or reinsurance means the sum of:
1. All monies due from insurance or reinsurance contracts and not yet received for losses paid in excess of the attachment point of such insurance or reinsurance;
2. All monies that would be expected to be recoverable from insurance or reinsurance contracts for unpaid losses in excess of the attachment point of such insurance or reinsurance should those losses be settled at the values set in the reported reserves;
3. That portion of the incurred but not reported reserves that is expected to be recoverable from insurance or reinsurance contracts; and
4. All monies that would be recoverable from aggregate excess insurance or reinsurance should all losses be as reserved for including IBNR reserves.
"Secretary" means the secretary of the fund commission elected by the commission pursuant to 17:49A-5.
"Servicing organization" means an individual, partnership, association or corporation, other than the administrator, that has contracted with the fund to provide, on the fund's behalf, any function as designated by the trustees including, but not limited to, actuarial services, claims administration, cost containment services, loss prevention/safety engineering services, legal services, auditing services, financial services, compilation and maintenance of the fund's underwriting file, coordination and preparation of coverage documents, risk selection and pricing, excess insurance or reinsurance producer services, which include producer negotiations on behalf of the fund for excess insurance or reinsurance from an insurer, member assessment and fee development, report preparation pursuant to 17:49A-1 et seq., and this subchapter, and such other duties as designated by the fund.
"Unpaid claims" or "unpaid losses" means case reserves and reserves for incurred but not reported claims attributed to the fund net of any recoverable per occurrence or aggregate excess insurance or reinsurance for a particular year.
"Workers' compensation law" means the provisions of 34:15-7 et seq.