reglab/statecodes huggingface dataset:
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 16 - FRAUD PREVENTION AND DETECTION › Subchapter 2 - REPORTS TO THE NATIONAL INSURANCE CRIME BUREAU › Section 11:16-2.1 - Purpose and scope

Current through Register Vol. 56, No. 14, July 15, 2024
This subchapter governs the reporting of motor vehicle theft or salvage and related transactions between insurers and the National Insurance Crime Bureau ("NICB") or its successor, in implementation of 17:23-19. This subchapter applies to all insurers transacting motor vehicle insurance in New Jersey.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 16 - FRAUD PREVENTION AND DETECTION › Subchapter 2 - REPORTS TO THE NATIONAL INSURANCE CRIME BUREAU › Section 11:16-2.2 - Definitions

Current through Register Vol. 56, No. 14, July 15, 2024
The following words and terms, when used in this subchapter, shall have the following meanings, unless the context clearly indicates otherwise.
"Insurer" means any corporation, company, partnership, association, society, order, individual or combination of individuals transacting automobile insurance in New Jersey.
"Major component part" means the engine, transmission, front end assembly, hood, doors, trunk lid, rear clip or any other part of a motor vehicle on which a unique vehicle identifying number has been placed.
"Motor vehicle" means all vehicles propelled other than by muscular power, excepting such vehicles as are run only upon rails or tracks.
National Insurance Crime Bureau ("NICB") means that corporate entity, or its successor in interest, that is referred to in 17:23-19 that operates and maintains a data base for the data referred to 11:16-2.4.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 16 - FRAUD PREVENTION AND DETECTION › Subchapter 2 - REPORTS TO THE NATIONAL INSURANCE CRIME BUREAU › Section 11:16-2.3 - NICB membership or service company requirement

Current through Register Vol. 56, No. 14, July 15, 2024
(a) By December 20, 1989, every insurer transacting motor vehicle insurance in New Jersey that is not already a member or a service company of the NICB, shall make application to become either a member or a service company of the NICB. An insurer shall pay all assessments for membership or service company status as may be required by the NICB in the manner prescribed by the NICB.
(b) An insurer shall become and remain either a member or a service company of the NICB as a condition of maintaining its authorization to conduct the business of motor vehicle insurance in New Jersey.
(c) Applications for membership and service company status and related information can be secured from:
NICB
10330 South Roberts Road--3A
Palos Hills, Illinois 60465-1998
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 16 - FRAUD PREVENTION AND DETECTION › Subchapter 2 - REPORTS TO THE NATIONAL INSURANCE CRIME BUREAU › Section 11:16-2.4 - Insurer reporting requirements

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Insurers shall report to the NICB all motor vehicles involved in losses as follows:
1. All thefts of a motor vehicle, or any of its major component parts, shall be reported within two working days from the receipt of sufficient information from the insured. The NICB shall acknowledge the receipt of each theft report received from an insurer within 10 working days. If the insurer has not received any acknowledgment or communication from the NICB within 10 working days following its submission to the NICB of the report, the insurer shall immediately communicate with the NICB to determine the status of its report.
2. All losses involving motor vehicle salvage, however sustained, including salvage retained by either an insured or a third party claimant, shall be reported to the NICB within five working days after the sale of salvage; or, if the insured is permitted to retain salvage, within five working days after the date of loss payment.
3. All insurers required to submit reports to the NICB in compliance with this subchapter shall be bound by all of the reporting requirements of the NICB.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 16 - FRAUD PREVENTION AND DETECTION › Subchapter 2 - REPORTS TO THE NATIONAL INSURANCE CRIME BUREAU › Section 11:16-2.5 - Insurer cooperation with NICB

Current through Register Vol. 56, No. 14, July 15, 2024
Insurers shall cooperate with the NICB and shall release information in their possession to the NICB upon its reasonable request.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 16 - FRAUD PREVENTION AND DETECTION › Subchapter 2 - REPORTS TO THE NATIONAL INSURANCE CRIME BUREAU › Section 11:16-2.6 - NICB cooperation with insurers

Current through Register Vol. 56, No. 14, July 15, 2024
The NICB shall cooperate with insurers in the resolution of errors and the investigation of claims suspected to be fraudulent.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 16 - FRAUD PREVENTION AND DETECTION › Subchapter 2 - REPORTS TO THE NATIONAL INSURANCE CRIME BUREAU › Section 11:16-2.7 - Deferred claim processing and payment

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Notwithstanding any provision of Title 11 of the New Jersey Administrative Code to the contrary, an insurer shall defer the processing and payment of a claim filed under comprehensive or other coverage in accordance with the following:
1. No insurer shall pay a claim filed by an insured under comprehensive or other coverage for the theft of a motor vehicle or its major component parts unless said claim has first been reported to and acknowledged by the NICB.
2. An insurer shall defer the payment of a claim for five calendar days following receipt of the acknowledgment from the NICB of the insurer's report. If no further communication is received from the NICB during this five-day period indicating unresolved questionable circumstances, the insurer shall continue with the processing of the claim in accordance with the provisions of this section and other provisions of Title 11 of the New Jersey Administrative Code.
3. If the NICB indicates in its response to the insurer that coverage is in effect by more than one insurer for the same motor vehicle or that the motor vehicle has been previously reported as stolen and unrecovered, or that previous claims on the vehicle have been reported, the insurer shall promptly investigate and resolve such discrepancy.
4. If the NICB discovers an erroneous vehicle identification number (VIN) and the NICB is unable to clear up such discrepancy internally, the NICB shall send a questionnaire to the insurer. This questionnaire shall be returned within five working days of receipt by the insurer. If the NICB and insurer are unsuccessful, after due diligence, in resolving the VIN error after a 30-day period from the date of the receipt by the insurer of sufficient information from the insured, the insurer shall proceed with the processing of the loss claim.
5. If the NICB indicates in its response to the insurer or the insurer finds that it has reasonable cause to believe that the loss may have been caused by the criminal or fraudulent act of any person, the insurer shall suspend the processing of the claim and promptly begin an investigation. The insurer shall promptly provide such information to the NICB and shall cooperate fully with the NICB in its investigation of criminal or fraudulent acts.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 16 - FRAUD PREVENTION AND DETECTION › Subchapter 2 - REPORTS TO THE NATIONAL INSURANCE CRIME BUREAU › Section 11:16-2.8 - NICB record retention

Current through Register Vol. 56, No. 14, July 15, 2024
Such reports as may be required to be filed with the NICB by an insurer pursuant to P.L. 1989, c.65, this subchapter and the operating procedures of the NICB, shall be maintained by the NICB for at least a period of five years from the date of entry into the NICB system, except that in the case of motor vehicle salvage, such reports shall be maintained for a period of at least two years from such entry.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 16 - FRAUD PREVENTION AND DETECTION › Subchapter 2 - REPORTS TO THE NATIONAL INSURANCE CRIME BUREAU › Section 11:16-2.9 - Penalties

Current through Register Vol. 56, No. 14, July 15, 2024
Failure of an insurer to abide by the requirements of this subchapter may lead to the imposition of sanctions or penalties as provided by law.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 16 - FRAUD PREVENTION AND DETECTION › Subchapter 6 - FRAUD PREVENTION AND DETECTION PLANS › Section 11:16-6.1 - Purpose and scope

Current through Register Vol. 56, No. 14, July 15, 2024
(a) This subchapter sets forth the standards for a plan for the prevention and detection of fraudulent insurance applications and claims filed for approval pursuant to 17:33A-15 by insurers which transact the business of private passenger automobile insurance or health insurance in this State. These provisions apply to all insurers that transact the business of private passenger automobile insurance in New Jersey, including both personal and commercial coverage; and to all insurers transacting the business of health insurance as set forth in 17:33A-3 and N.J.A.C. 11:16-6.2.
(b) The subchapter also sets forth the reporting standards and forms necessary to refer insurance fraud matters to the Bureau of Fraud Deterrence and the Office of Insurance Fraud Prosecutor (OIFP) in accordance with 17:33A-1 et seq., as amended by P.L. 2010, c. 32. These provisions apply to all insurers as defined by 17:33A-3 and 11:16-6.2 including those with PAIP and CAIP assignments.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 16 - FRAUD PREVENTION AND DETECTION › Subchapter 6 - FRAUD PREVENTION AND DETECTION PLANS › Section 11:16-6.3 - General requirements and filing format

Current through Register Vol. 56, No. 14, July 15, 2024
(a) All insurers shall file for approval a fraud prevention and detection plan ("plan") in accordance with 17:33A-15 and this subchapter. No insurer shall use or implement any plan that is not filed and approved.
(b) Insurers shall submit their plan on 81/2 by 11-inch paper. The first page shall show the filer's company name, the filer's identifying number for this filing, National Association of Insurance Commissioners (NAIC) company number(s), and NAIC group name and number. The plan shall include page numbering, a table of contents, and the insurer's anti-fraud prevention and detection training program, protocol, and procedure manual. Subsequent amendments to the plan shall include the effective date, page number, location, and explanation of the amendments.
1. Insurers shall include a brief description of their business model or company profile in the front of the anti-fraud prevention and detection protocol for analysis by the Department in determining compliance with fraud prevention and detection.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 16 - FRAUD PREVENTION AND DETECTION › Subchapter 6 - FRAUD PREVENTION AND DETECTION PLANS › Section 11:16-6.4 - Special Investigations Unit (SIU)-duties, qualifications, and composition

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Except for automobile insurers that insure fewer than 2,500 New Jersey automobile policies, and health insurers that insure fewer than 10,000 lives, the plan filed in accordance with 11:16-6.3 shall establish a full-time Special Investigations Unit ("SIU").
(b) The SIU shall be responsible for the following:
1. Conducting investigations of claims referred by the claim personnel or applications referred by underwriting personnel whenever the adjuster, processor, or underwriter identifies specific facts and circumstances which, upon further SIU investigation, may lead to a reasonable conclusion that a violation of 17:33A-4 has occurred;
2. Providing liaison with OIFP, other law enforcement personnel and the MCEAFC;
3. Providing in-service training to claims personnel, underwriting personnel, and adjusters in accordance with the provisions of 11:16-6.5;
4. Maintaining a database of fraudulent claims and application fraud which shall contain, at a minimum, the names, addresses and other identifying information regarding all parties to the investigation referred to in (b)1 above;
5. Informing insurance underwriters of ineligible risks by reason of prior fraudulent activities from the database in (b)4 above;
6. Identifying persons and organizations that are involved in suspicious claim activity and application fraud, as described in (b)1 above;
7. Referring matters to OIFP in accordance with 11:16-6.6(b)  and 6.7 and providing notice of suspicious claims in accordance with N.J.A.C. 11:6-6.6(c); and
8. Ensuring that all evidence on matters referred to the SIU including, but not limited to, checks issued in payment of claims, taped statements, original receipts, and original documents submitted by a person or entity in support of or in opposition to a claim applicant, are identified, collected and preserved in order to be turned over to OIFP at the request of OIFP in connection with the referral of cases to OIFP.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 16 - FRAUD PREVENTION AND DETECTION › Subchapter 6 - FRAUD PREVENTION AND DETECTION PLANS › Section 11:16-6.6 - Fraud prevention and detection plan

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The plan shall provide for underwriting inquiry to verify that the insured satisfies the insurer's acceptance criteria and that the policy is properly rated within 60 days of receipt of the application. These underwriting inquiries shall verify the insured's residency provided by the insured on his or her application for insurance. The plan may provide that these inquiries are generally done "in-house" by telephone and by using information from the New Jersey Motor Vehicle Commission (or similar agencies in other states) and prior insurers.
(b) The following concern referral of applications and claims.
1. The plan shall provide that an application or claim shall be referred to the Bureau and OIFP, for further investigation or other appropriate action. The referral shall be made either using electronic referral forms that may be established by the Commissioner and the Insurance Fraud Prosecutor, or using the applicable hard-copy Referral Form OIFP/BFD-1 for Claim Fraud, OIFP/BFD-2 for Application Fraud, OIFP/BFD-3 for Health Claim Fraud, and OIFP/BFD-4 for Health Application Fraud indicating "REFERRAL." The hard-copy referral forms are reproduced in the subchapter Appendix, incorporated herein by reference. The plan shall provide that the referral shall include all information required by the electronic referral form or the hard-copy referral form, when the investigation complies with the requirements set forth in 11:16-6.7.
2. The plan shall provide that all applications and claims, which meet the standard for referral set forth in N.J.A.C. 11:16-6.7, shall be referred to OIFP by the SIU as soon as practicable, but in no case later than 30 days from when the investigation is complete.
3. The plan shall provide criteria and levels of economic impact for the referral of insurance claims and application fraud in accordance with the requirements of N.J.A.C. 11:16-6.7.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 16 - FRAUD PREVENTION AND DETECTION › Subchapter 6 - FRAUD PREVENTION AND DETECTION PLANS › Section 11:16-6.7 - Referrals to the Bureau and the OIFP

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The plan shall provide that upon completion of its investigation, as described in (d) below, an SIU shall refer cases which meet the standards in (a)1 and 2 below. The SIU shall submit one copy of the appropriate referral form and one copy of any attachments to the address indicated on the form. Submission of one copy of the referral form and attachments shall constitute a referral to both the Bureau and OIFP.
1. Any application or claim where the facts and circumstances create a reasonable suspicion that a person or entity has violated 17:33A-4; and
2. There is sufficient independent evidence corroborating the reasonable suspicion described in (a)1 above, from which a person could reasonably conclude that the person or entity has violated 17:33A-4.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 16 - FRAUD PREVENTION AND DETECTION › Subchapter 6 - FRAUD PREVENTION AND DETECTION PLANS › Section 11:16-6.8 - Record retention

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Insurers shall maintain up-to-date and accurate records on their fraud prevention and detection plan, which shall at minimum include those necessary to prepare the report required in (b) below.
(b) Insurers shall submit to the Commissioner on or before March 31 of each year an annual report for the prior calendar year on the MCEAFC Automobile Insurance Anti-fraud Experience Report 20110801 in accordance with the instructions and definitions provided and the MCEAFC Health Insurance Anti-fraud Experience Report 20110801 in accordance with the instructions provided and incorporated herein by reference in the subchapter Appendix. Individual insurers that comprise a group shall submit separate reports. Reports shall be submitted in hard copy or by e-mail to:
New Jersey Department of Banking and Insurance
Market Conduct Examinations and Anti-Fraud Compliance Unit
20 West State Street
PO Box 329
Trenton, NJ 08625-0329
Email: mceafc@dobi.nj.gov
1. The information shall be submitted on a form established by the Department. Insurers may acquire the required form from the Department website at
http://www.state.nj.us/dobi/division_consumers/insurance/mceu.html
or by directing an email request for the "Annual Filing Template" to mceafc@dobi.nj.gov.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 16 - FRAUD PREVENTION AND DETECTION › Subchapter 6 - FRAUD PREVENTION AND DETECTION PLANS › Section 11:16-6.9 - Approval and filing of fraud prevention and detection plans

Current through Register Vol. 56, No. 14, July 15, 2024
(a) An insurer's fraud prevention and detection plan shall be deemed approved by the Commissioner if not affirmatively approved or disapproved by the Commissioner within 90 days of the date of filing.
(b) The Commissioner may request such amendments to the plan as he or she deems necessary.
(c) An insurer must submit amendments to its plan when necessary to achieve compliance with these rules. Any amendments to a plan filed with the Commissioner shall be deemed approved by the Commissioner if not affirmatively approved or disapproved within 90 days of the date of filing.
(d) The insurer shall permit the MCEAFC access to its offices upon reasonable notice and at reasonable hours to conduct an audit of the insurer's compliance with its fraud prevention plan. Nothing in this section shall be construed as to preclude the MCEAFC from conducting reviews of an insurer's compliance with its fraud prevention and detection plan at the office of the MCEAFC when determined to be necessary by the MCEAFC.
(e) In those instances in which an insurer uses an outside agent, third party administrator or contractor to perform SIU functions or claims investigations, the Plan and contract with the outside vendor or third party administrator shall provide that the Department shall be permitted to audit the records, books, and documents maintained by the outside contractor or third party administrator in the same manner and fashion as it would be able to examine the books and records in accordance with 17:33A-15 and 17:23-22.
(f) All information included in an insurer's plan submitted to the MCEAFC pursuant to this subchapter including, but not limited to, training programs submitted to MCEAFC pursuant to this subchapter, shall be confidential and not subject to public disclosure or inspection.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 16 - FRAUD PREVENTION AND DETECTION › Subchapter 6 - FRAUD PREVENTION AND DETECTION PLANS › Section 11:16-6.10 - Penalties

Current through Register Vol. 56, No. 14, July 15, 2024
Failure to comply with the provisions of this subchapter shall subject the insurer to penalties as prescribed by law.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 16 - FRAUD PREVENTION AND DETECTION › Subchapter 6 - FRAUD PREVENTION AND DETECTION PLANS › Section 11:16-6.11 - Confidential records and information

Current through Register Vol. 56, No. 14, July 15, 2024
(a) All information and materials in the possession of the OIFP concerning the possibility of the existence or occurrence of insurance fraud or related criminal activities are confidential and privileged against disclosure, and shall not be deemed public records, so as to protect the public interest in the prosecution of insurance fraud, including protecting witness security, the State's relationship with informants and witnesses, the privacy interests of persons investigated by OIFP where no fraud has been proven and other confidential relationships.
(b) The confidentiality which extends to information and materials possessed by the OIFP with respect to the existence or occurrence of insurance fraud or related criminal activities extends to all papers, documents, reports, evidence and databases, such as investigative reports, referrals, reports or notifications of suspicious claims or applications or suspected insurance fraud, computer maintained databases of such investigative information, and such other materials and information as the Insurance Fraud Prosecutor, on the basis of his experience and exercise of judgment, believes must be kept confidential in order to ensure the orderly investigation and prosecution of insurance fraud.
(c) Confidentiality of the information and materials in the possession of OIFP shall not preclude OIFP from fulfilling its statutory obligations of working with other law enforcement agencies, the Department of Health and Senior Services, the Department of Human Services, any professional board in the Division of Consumer Affairs in the Department of Law and Public Safety, the Department of Banking and Insurance, the Division of State Police and such local government units as may be necessary or practicable and of coordinating and providing information to and among referring entities on pending cases of suspected insurance fraud, where such action would serve the public interest in facilitating the investigation or prosecution of insurance fraud.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 16 - FRAUD PREVENTION AND DETECTION › Subchapter 6 - FRAUD PREVENTION AND DETECTION PLANS › Appendix - APPENDIX

Current through Register Vol. 56, No. 14, July 15, 2024
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New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 16 - FRAUD PREVENTION AND DETECTION › Subchapter 7 - ADMINISTRATIVE PROCEDURES AND PENALTIES › Section 11:16-7.1 - Purpose and scope

Current through Register Vol. 56, No. 14, July 15, 2024
This subchapter sets forth the procedures that govern the conduct of administrative hearings for imposing civil and administrative penalties for violations of the New Jersey Insurance Fraud Prevention Act, as amended, 17:33A-1 et seq. These rules are intended to implement 17:33A-5 which allows for the imposition of civil and administrative penalties, costs of prosecution, including attorneys fees, and orders of restitution. These rules do not govern criminal or civil proceedings for violations of the New Jersey Insurance Fraud Prevention Act filed in the Superior Court.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 16 - FRAUD PREVENTION AND DETECTION › Subchapter 7 - ADMINISTRATIVE PROCEDURES AND PENALTIES › Section 11:16-7.2 - Construction

Current through Register Vol. 56, No. 14, July 15, 2024
(a) These rules shall be liberally construed to permit the Bureau of Fraud Deterrence to discharge its statutory function.
(b) Upon notice to all parties, these rules may be relaxed for good cause in a particular situation in order to effectuate the purposes of the New Jersey Insurance Fraud Prevention Act. Statutory time limits may not be relaxed.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 16 - FRAUD PREVENTION AND DETECTION › Subchapter 7 - ADMINISTRATIVE PROCEDURES AND PENALTIES › Section 11:16-7.3 - Definitions

Current through Register Vol. 56, No. 14, July 15, 2024
The following words and terms, when used in this chapter, shall have the following meanings, unless the context clearly indicates otherwise.
"Administrative complaint" means a pleading that provides the notice to a person required by N.J.S.A. 17:33A-5c that a civil and administrative penalty is being imposed on the person for a violation of 17:33A-1 et seq.
"Administrative consent order" means an offer of settlement in the form of an order in which the BFD and a person alleged to have violated 17:33A-1 et seq. mutually agree to resolve a case.
"BFD" means the Bureau of Fraud Deterrence in the Department of Banking and Insurance.
"Burden of proof" means the obligation of a party to meet the requirements of a rule of law that a fact be proved.
"Civil and administrative penalty" means a sanction authorized by any statute or administrative rule to be imposed on a person for any act or omission in violation of 17:33A-1 et seq., including any monetary penalty and any order to make restitution and to pay the reasonable costs of prosecution, including attorneys fees, of any matter.
"Commissioner" means the Commissioner of the Department of Banking and Insurance.
"Department" means the New Jersey Department of Banking and Insurance.
"Final agency order" means any and all final orders issued or executed by the Commissioner.
"Hearing" means a proceeding held in accordance with the Administrative Procedure Act, 52:14B-1 et seq., and the Uniform Administrative Procedure Rules, N.J.A.C. 1:1, for the purpose of determining disputed issues of fact, law or disposition.
"Insurance company" or 'Insurer' means any entity coming within the definition of insurance company set forth in 17:33A-3.
"Notice" means a written communication from the BFD to an alleged violator of the assessment of a civil and administrative penalty containing those elements set forth in 11:16-7.4.
"Person" means a person as defined in 17:33A-3.
"Petitioner" means the State of New Jersey, Bureau of Fraud Deterrence.
"Respondent" means an alleged violator named in a civil and administrative complaint.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 16 - FRAUD PREVENTION AND DETECTION › Subchapter 7 - ADMINISTRATIVE PROCEDURES AND PENALTIES › Section 11:16-7.4 - Notice of the intent to impose civil and administrative penalties

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Before a civil and administrative penalty is imposed, the BFD shall serve the respondent with a notice, in the nature of an administrative complaint, in the manner provided in 11:16-7.5. The notice shall include:
1. A reference to the statute, rule, order and/or prohibited conduct under the Insurance Fraud Prevention Act (17:33A-1 et seq.) the respondent violated;
2. A concise statement of the facts providing the basis for the determination of a violation of 17:33A-1 et seq.;
3. A statement of the civil and administrative penalty or penalties to be imposed; and
4. A statement advising the respondent of the right to a hearing and the procedure for requesting a hearing.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 16 - FRAUD PREVENTION AND DETECTION › Subchapter 7 - ADMINISTRATIVE PROCEDURES AND PENALTIES › Section 11:16-7.5 - Service of notice

Current through Register Vol. 56, No. 14, July 15, 2024
(a) If the respondent is an individual, service of the notice of administrative complaint described in 11:16-7.4 may be made by delivering a copy of the administrative complaint to the respondent, personally or by leaving a copy thereof at the respondent's dwelling place or usual place of abode with a competent household member of the age of 14 years or over then residing therein, or by delivering a copy thereof to a person authorized by appointment or by law to receive service of process on the respondent's behalf.
(b) In lieu of the manner of service set forth in (a) above, service on an individual may be made by mailing the administrative complaint by regular and certified mail, return receipt requested, to the respondent's last known business or residence mailing address in or outside of this State.
(c) If the respondent is a domestic or foreign corporation, partnership or other business entity, service may be made by delivering a copy of the administrative complaint to either an officer, director, trustee, partner or managing or general agent, or any person authorized by appointment or by law to receive service of process on behalf of the corporation, partnership or other business entity or the person at the registered office or the principal place of business of the corporation, partnership or other business entity in charge thereof. If service cannot be made upon any of the foregoing, then it may be made upon any agent, servant or employee of the corporation acting in the discharge of the duties of the corporation.
(d) In lieu of the manner of service set forth in (c) above, service may be made by mailing the administrative complaint by regular and certified mail, return receipt requested, to either an officer, director, trustee, partner or managing or general agent, or any person authorized by appointment or by law to receive service of process on behalf of the corporation, partnership or other business entity or the person at the registered office or the principal place of business of the corporation, partnership or other business entity in charge thereof.
(e) Service of an administrative complaint may also be made upon a respondent in a manner provided in R. 4:4-4(a) of the Rules Governing the Courts of the State of New Jersey.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 16 - FRAUD PREVENTION AND DETECTION › Subchapter 7 - ADMINISTRATIVE PROCEDURES AND PENALTIES › Section 11:16-7.6 - Failure to respond to notice

Current through Register Vol. 56, No. 14, July 15, 2024
(a) If a respondent does not deliver to BFD a written request for a hearing in the form and manner required by 11:16-7.8, a final agency order shall be issued imposing the civil and administrative penalty or penalties described in the administrative complaint as well as costs of prosecution, including attorneys fees, and restitution, if awarded.
(b) BFD shall mail a copy of the final order to the respondent at the address where service was made or at a respondent's last known address.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 16 - FRAUD PREVENTION AND DETECTION › Subchapter 7 - ADMINISTRATIVE PROCEDURES AND PENALTIES › Section 11:16-7.7 - Resolution of administrative complaints by administrative consent order

Current through Register Vol. 56, No. 14, July 15, 2024
(a) In order for a matter set forth in an administrative complaint to be deemed concluded by consent of the respondent to the imposition of the civil and administrative penalty described in the notice, the BFD may require any or all of the following in an administrative consent order:
1. The payment of a monetary penalty;
2. The restitution of moneys owed to any person;
3. Costs of prosecution, including attorneys fees; and
4. Admissions of material facts, conclusions of law, and such other terms and conditions as the BFD may deem to be necessary and appropriate under the circumstances.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 16 - FRAUD PREVENTION AND DETECTION › Subchapter 7 - ADMINISTRATIVE PROCEDURES AND PENALTIES › Section 11:16-7.8 - Request for a hearing

Current through Register Vol. 56, No. 14, July 15, 2024
(a) A respondent shall have 20 calendar days from the date of service of an administrative complaint within which to deliver a written request for a hearing to the BFD.
(b) A request for a hearing shall include:
1. The name, address and daytime telephone number of the respondent;
2. The caption and agency number of the administrative complaint;
3. A statement requesting a hearing;
4. A specific admission, denial, or explanation of each fact alleged in the administrative complaint, or a statement that the respondent is without knowledge of the action(s) complained of. A respondent shall not generally deny all of the allegations but shall make denials as specific denials that meet the substance of the designated allegations of the complaint; and
5. A concise statement of the facts or principles of law claimed to constitute a factual or legal defense.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 16 - FRAUD PREVENTION AND DETECTION › Subchapter 7 - ADMINISTRATIVE PROCEDURES AND PENALTIES › Section 11:16-7.9 - Penalties, restitution and costs

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Civil and administrative penalties may be imposed of not more than $ 5,000 for the first violation; $ 10,000 for the second violation; and $ 15,000 for each subsequent violation of any provision of 17:33A-1 et seq. and restitution may be ordered to any insurance company or other person who has suffered a loss as a result of a violation.
(b) For the purpose of applying 17:33A-5, each violation of a provision of 17:33A-4 in the course of a single claim or application for insurance constitutes a separate violation of the Fraud Act for which a separate civil and administrative penalty may be imposed in accordance with (a) above.
(c) After a hearing, if requested, as provided in 11:16-7.8 and upon finding that a violation has occurred, the Commissioner shall issue a final agency order assessing the costs of prosecution, including attorneys fees, in addition to the penalty referred to in (a) above.
(d) In any matter in which payment of a civil and administrative penalty is ordered, payment of the civil and administrative penalty shall be made not later than 10 days following service of the final agency order. Payment of an assessed civil and administrative penalty shall be by certified check or money order made payable to the Commissioner, New Jersey Department of Banking and Insurance by forwarding same to the BFD.
(e) In any matter in which payment of the costs of prosecution, including attorneys fees, are ordered, payment thereof shall be made not later than 10 days following service of the final agency order. Payment of the assessed costs of prosecution, including attorneys fees, shall be by certified check or money order made payable to the State of New Jersey, and forwarding same to the BFD.
(f) In any matter in which payment of restitution is ordered, payment thereof shall be made not later than 10 days following service of the final agency order. Payment of restitution shall be by certified check or money order made payable to the person named in the final agency order by forwarding same to the BFD.
(g) Any civil and administrative penalty imposed pursuant to 11:16-7.6, 7.7 or 7.9 may be collected with costs, including attorneys fees, in a summary proceeding pursuant to the penalty enforcement law, 2A:58-10 et seq. Any civil and administrative penalty collected pursuant to this subsection shall be applied in accordance with N.J.S.A. 17:33A-5e.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 16 - FRAUD PREVENTION AND DETECTION › Subchapter 7 - ADMINISTRATIVE PROCEDURES AND PENALTIES › Section 11:16-7.10 - Severability

Current through Register Vol. 56, No. 14, July 15, 2024
If any rule, sentence, paragraph or section of these rules, or the application thereof to any persons or circumstances, shall be adjudged by a court of competent jurisdiction to be invalid, or if by legislative action any rule shall lose its force and effect, such judgment or action shall not affect, impair or void the remainder of these rules.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 17 - PRODUCER LICENSING › Subchapter 1 - GENERAL PROVISIONS › Section 11:17-1.1 - Purpose and scope

Current through Register Vol. 56, No. 14, July 15, 2024
(a) This chapter implements provisions of 17:22A-26 et seq., the New Jersey Insurance Producer Licensing Act of 2001 (the Act). The chapter concerns the licensing conduct of insurance producers and shall be considered part of the insurance law of the State of New Jersey, and violation of any provisions shall be sufficient cause for action against any person as permitted by statute. Specification of the standards of conduct shall not, however, prohibit the application of other insurance statutes or rules to licensed producers.
(b) Provisions of the Act and of this chapter shall be applied to all licensees, required to be licensed pursuant to the Act, including nonresident licensees, in connection with the licensing and standards of conduct on business for which a New Jersey insurance producer license is required.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 17 - PRODUCER LICENSING › Subchapter 1 - GENERAL PROVISIONS › Section 11:17-1.3 - Participation in national insurance producer database

Current through Register Vol. 56, No. 14, July 15, 2024
Pursuant to N.J.S.A. 17:22A-43b(3) and for purposes of carrying out the provisions of the Federal Nonadmitted and Reinsurance Reform Act of 2010, P.L. 111-203, §
										523, the Commissioner shall utilize the national insurance producer database of the NAIC (through the National Insurance Producer Registry), or any other equivalent uniform national database, for the licensure of an individual or entity as an insurance producer and for the renewal of such license.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 17 - PRODUCER LICENSING › Subchapter 2 - LICENSING RULES › Section 11:17-2.1 - Term of license

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The terms of individual producer licenses are established as set forth below.
1. The first term of licenses that are initially issued shall expire on the last day of the birth month of the producer in the year that will result in the term of the license being at least 18 months.
2. All such licenses shall thereafter expire biennially on the last day of the birth month of the individual producer that is two years subsequent to the preceding expiration date.
3. For example, a producer is initially licensed on February 1, 2007. His or her birth month is March. The second birth month after the February 1, 2007 issue date is March 2008 (less than 18 months). In this case, the first renewal will be March 31, 2009, and subsequent renewals would be on March 31, 2011, March 31, 2013, and so on. If the birth month was September, the second September 30 following the February 1, 2007 issue date would be September 30, 2008, more than 18 months from issuance. Thus, the license would initially renew on September 30, 2008 and thereafter on September 30, 2010, September 30, 2012, and so on.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 17 - PRODUCER LICENSING › Subchapter 2 - LICENSING RULES › Section 11:17-2.2 - License authorities

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Producers licensed in accordance with the Act and this chapter shall be authorized to write the kinds of insurance designated, if qualified by each authority set forth below.
1. Life Authority: All coverages defined as "life insurance" in 17B:17-3; and all coverages defined as an "annuity" in 17B:17-5.
2. Accident and health or sickness Authority: all coverages defined as "health insurance" in 17B:17-4.
3. Property Authority: All coverages written by authorized insurers for direct and consequential loss or damage to property of any kind including fire and allied lines, earthquake, growing crops, ocean marine, inland marine, boiler and machinery, credit property, burglary and theft, glass, sprinkler leakage and water damage, livestock, smoke or smudge, physical loss to buildings, radioactive contamination, mechanical breakdown or power failure, and other property loss.
4. Casualty Authority: All coverages written by authorized insurers for coverage against legal liability from death, disability, injury or damage to real or personal property including employers' liability, automobile liability bodily injury, automobile liability property damage, other liability, credit casualty, other casualty loss, fidelity and surety, workers' compensation, mortgage guaranty insurance and municipal bond insurance.
5. Surplus Lines Authority: All coverages written by unauthorized insurers and defined as "surplus lines" in N.J.S.A. 17:22-6.4 2.
6. Title Insurance Authority: All policies of insurance guaranteeing or indemnifying owners of real property or others interested therein against loss or damage suffered by reason of liens, encumbrances upon, defects in or the unmarketability of the title to said property, guaranteeing, warranting or otherwise insuring by a title insurance company the correctness of searches relating to the title to real property, or doing any real business in substance equivalent to any of the foregoing.
7. Variable life and variable annuity: all coverages defined as a "contract on a variable basis" pursuant to 17B:28-1.
8. Personal lines Authority: All property and casualty insurance coverage sold to individuals and families for primarily noncommercial purposes.
9. Limited lines Authority includes:
i. Bail bonds;
ii. Car rental insurance;
iii. Credit insurance;
iv. Pet insurance;
v. Travel insurance;
vi. Group mortgage cancellation;
vii. Legal expense insurance;
viii. Portable electronics insurance;
ix. Special nonresident limited lines. This authority shall be limited to those authorities for which the applicant is licensed in his or her home state and for which there is no corresponding authority in this State.
x. Other nonresident limited lines. This authority shall be limited to those limited line authorities in which the applicant is licensed in his or her home state and for which there is no corresponding authority in this State.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 17 - PRODUCER LICENSING › Subchapter 2 - LICENSING RULES › Section 11:17-2.3 - Application filing requirements for initial licenses

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Requirements for a first time applicant for an individual license are as follows:
1. A properly completed application, in a form, including electronic online submissions, approved by the Department or the current version of the NAIC uniform application for individual producers in effect at the time of application, requesting issuance of an insurance producer license with one or more authorities, which shall contain the applicant's legal name, home address, date of birth, social security number, business mailing and location address, business trade name, if any, and responses to questions concerning the applicant's character and fitness for licensing. The application must be signed, dated and certified to be correct by the applicant or, in electronic online submissions, by the authorized submitter. In lieu of the NAIC uniform application, a nonresident applicant may submit a copy of the application for licensure submitted to the home state with a statement certifying to the truthfulness and accuracy of all responses to the questions concerning the applicant's character and fitness for licensure as of the date of the submission of the certification;
2. If a resident, when required, a certificate evidencing completion of an approved course of prelicensing education or a certificate evidencing waiver of that requirement; and a certificate evidencing that the applicant has passed the State licensing examination for the authority or authorities requested not longer than one year prior to the application date, or a certificate evidencing waiver of the examination requirement pursuant to 17:22A-35;
3. If a nonresident, the applicant shall certify that he or she holds a currently valid license authorizing transaction of insurance business in the applicant's home state for the kinds of insurance for which application is made;
4. Any documents or statements required to explain responses to questions concerning the applicant's character, fitness or financial responsibility;
5. If a resident and applying for major lines of authority (excluding limited lines of authority) or bail bonds authority, properly completed criminal history requests and fingerprint forms in a format prescribed by the Department, which shall include electronic fingerprinting; and
6. Payment of the fees required in accordance with 11:17-2.13.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 17 - PRODUCER LICENSING › Subchapter 2 - LICENSING RULES › Section 11:17-2.4 - Requirements for licensing of certain limited lines insurance producers

Current through Register Vol. 56, No. 14, July 15, 2024
(a) A limited lines portable electronics insurance producer license issued to a portable electronics insurance vendor shall authorize the licensee and its employees or authorized representatives to engage in those activities permitted pursuant to that license. The insurer providing the portable electronics insurance coverage shall either directly supervise, or appoint a supervising entity to supervise, the administration of the portable electronics insurance program, including development of a training program subject to review by the Department for employees and authorized representatives of the portable electronics vendors in accordance with 17:22A-51.
(b) Upon a travel retailer and its employees and authorized representatives being registered with a licensed limited lines travel insurance producer and subject to the requirements as described below, the travel retailer and its registered employees and representatives shall be authorized to offer travel insurance on behalf of and under the direction of the licensed limited lines travel insurance producer.
1. The registration with the limited lines travel insurance producer shall include, at a minimum, the following: the name and contact information of the travel retailer and an officer or person who directs or controls the travel retailer's operations, and the travel retailer's Federal Employer Identification Number (FEIN). Upon request, the licensed limited lines travel insurance producer shall provide the Department a list of all travel retailers registered with the producer.
2. The licensed limited lines travel insurance producer shall require each employee of the travel retailer whose duties include offering and disseminating travel insurance to be registered and to receive a program of instruction subject to review by Department.
3. All marketing materials and travel documents distributed by travel retailers to customers that make reference to travel insurance shall clearly identify the licensed limited lines travel insurance producer with whom the travel retailer is registered and provide its contact information.
4. The licensed limited lines travel insurance producer shall be responsible for the insurance-related conduct of all travel retailers registered with the licensee and of all of the travel retailer's employees and authorized representatives.