District of Columbia Administrative Code

1600 PURPOSE 1600.1 The purposes of these regulations are: to set forth rules and procedural requirements which the Commissioner deems necessary to carry out the provisions of the Holding Company System Regulatory Act of the 1983, D.C Law 10-4, hereinafter referred to as "the Act…

1601 SEVERABILITY CLAUSE 1601.1 If any of these regulations, or the application thereof to any person or circumstance, is held invalid, such determination shall not affect other provisions or applications of these regulations which can be given effect without the invalid provisio…

1602 FORMS - GENERAL REQUIREMENTS 1602.1 Forms A, B, C, D, E, and F set forth in the appendix to chapter, are intended to be guides in the preparation of the statements required by Sections 3, 4, and 5 of this Act. They are not intended to be blank forms which are to be filled in…

1603 FORMS - INCORPORATION BY REFERENCE, SUMMARIES AND OMISSION 1603.1 Information required by any item of Form A, Form B, Form D, Form E or Form F may be incorporated by reference in answer or partial answer to any other item. Information contained in any financial statement, an…

1604 FORMS - INFORMATION UNKNOWN OR UNAVAILABLE AND EXTENSION OF TIME TO FURNISH 1604.1 [REPEALED]. 1604.2 If it is impractical to furnish any required information, document or report at the time it is required to be filed, there shall be filed with the Commissioner as a separate…

1605 FORMS - ADDITIONAL INFORMATION AND EXHIBITS 1605.1 In addition to the information expressly required to be included in Form A, Form B, Form D, Form E or Form F, there shall be added such further material information, if any, as may be necessary to make the information contai…

1606 SUBSIDIARIES OF DOMESTIC INSURERS 1606.1 The authority to invest in subsidiaries under Section 3 of the Act is in addition to any authority to invest in subsidiaries which may be contained in any other provision of the Insurance Code. SOURCE: 33 DCRR § 875.5 (March 1975); as…

1607 ACQUISITION OF CONTROL - STATEMENT FILING 1607.1 A person required to file a statement pursuant to Section 4 of the Act shall furnish the required information on Form A, hereby made a part of this regulation. SOURCE: 33 DCRR § 875.6 (March 1975); as amended by Final Rulemaki…

1608 AMENDMENTS TO FORM A 1608.1 The applicant shall promptly advise the Commissioner of any changes in the information so furnished on Form A arising subsequent to the date upon which such information was furnished but prior to the Commissioner's disposition of the application. …

1609 ACQUISITION OF SECTION 4(b) INSURERS 1609 Acquisition of Section 4(b)(4) Insurers 1609.1 If the person being acquired is deemed to be a “domestic insurer” solely because of the provisions of Section 4(b)(4) of the Act, the name of the domestic insurer on the cover page shoul…

1610 ANNUAL REGISTRATION OF INSURERS - STATEMENT FILING 1610.1 An insurer required to file an annual registration statement pursuant to Section 6 of the Act shall furnish the required information on Form B, hereby made a part of these regulations. SOURCE: 33 DCRR § 875.8 (March 1…

1611 SUMMARY OF REGISTRATION - STATEMENT FILING 1611.1 An insurer required to file an annual registration statement pursuant to Section 6 of the Act shall also furnish the required information on Form C, hereby made a part of these regulations. SOURCE: Final Rulemaking published …

1612 AMENDMENTS TO FORM B [RESERVED] SOURCE: 33 DCRR § 875.13 (March 1975); as amended by Final Rulemaking published at 41 DCR 2185 (April 22, 1994). District of Columbia Municipal Regulations Insurance 26-A DCMR § 1612 AUTHORITY: DC-DCMR Section 10 of the Holding Company System …

1613 ALTERNATIVE AND CONSOLIDATED REGISTRATIONS 1613.1 Any authorized insurer may file a registration statement on behalf of any affiliated insurer or insurers which are required to register under Section 6 of the Act. A registration statement may include information not required…

1614 DISCLAIMERS AND TERMINATION OF REGISTRATION 1614.1 A disclaimer of affiliation or a request for termination of registration claiming that a person does not, or will not upon the taking of some proposed action, control another person (hereinafter referred to as the "subject")…

1615 TRANSACTIONS SUBJECT TO PRIOR NOTICE - NOTICE FILING 1615.1 An insurer required to give notice of a proposed transaction pursuant to Section 7 of the Act shall furnish the required information on Form D, hereby made a part of these regulations. 1615.2 Agreements for cost sha…

1616 EXTRAORDINARY DIVIDENDS AND OTHER DISTRIBUTIONS 1616.1 Requests for approval of extraordinary dividends or any other extraordinary distribution to shareholders shall include the following: (a) The amount of the proposed dividend; (b) The date established for payment of the d…

1617 ADEQUACY OF SURPLUS 1617.1 The factors set forth in Section 7(d) of the Act are not intended to be an exhaustive list. In determining the adequacy and reasonableness of an insurer's surplus no single factor is necessarily controlling. The Commissioner, instead, will consider…

1618 ENTERPRISE RISK REPORT 1618.1 The ultimate controlling person of an insurer required to file an enterprise risk report pursuant to Section 5(k-1) of the Act shall furnish the required information on Form F, hereby made a part of these regulations. SOURCE: Final Rulemaking pu…

1699 DEFINITIONS 1699.1 The following words and phrases shall have the meaning ascribed in this section. Unless the context otherwise requires, other terms found in these regulations and in Section 2 of the Act are used as defined in the said Section 2. Other nomenclature or term…

1700 GENERAL PROVISIONS 1700.1 The Bureau shall be administered by a Governing Committee and Manager, in accordance with the Act and this title. 1700.2 The Bureau shall come into existence on the effective date of these rules, and shall be responsible for claims arising from acci…

1701 GOVERNING COMMITTEE 1701.1 The Bureau shall be administered by a Governing Committee and a Manager, in accordance with the Act and this title. 1701.2 The Governing Committee shall consist of seven (7) members whose terms in office except as provided in § 1701.3 shall be as f…

1702 MEETINGS AND NOTICES 1702.1 Annually, on a date fixed by the Governing Committee, there shall be a meeting of representatives of all of the members of the Bureau for the purposes of electing Governing Committee members, receiving reports from the Governing Committee and the …

1703 DUTIES OF THE GOVERNING COMMITTEE 1703.1 The duties of the Governing Committee shall include, but are not limited to, the following: (a) The appointment of a Manager; (b) The establishment of the Administration Fund Bureau Offices; (c) The budgeting of expenses; (d) The levy…

1704 DUTIES OF THE MANAGER 1704.1 The Manager shall perform the following duties: (a) Serve as an ex-officio member of the Governing Committee; (b) Perform the duties of Secretary and Treasurer of the Bureau at the direction of the Governing Committee; and (c) Supervise the day-t…

1705 ASSESSMENTS 1705.1 In accordance with § 1705.3, members of the Bureau shall bear all costs of the administration of the Bureau, including the following: (a) the administrative costs; (b) the costs of claim payments and related expenses; and (c) the establishment and maintena…

1706 DISPUTED BUDGET ITEMS 1706.1 If the Bureau disputes an item in a budget, the affected District agency shall reconsider whether the item is reasonable and necessary to administer and enforce the Act. 1706.2 If the agency determines that the item is reasonable and necessary th…

1707 INDEMNIFICATION 1707.1 Each person serving on the Governing Committee, subcommittee, as an employee of the Governing Committee or the Bureau shall be indemnified by the Bureau against all costs and expenses actually and necessarily incurred by him or her in connection with t…

1708 RECORDS 1708.1 The manager and the bureau members shall, at all reasonable times, make books, records, and files available to the Governing Committee or its representative, and the Commissioner, for the purpose of examining any matter coming within the scope of the rules of …

1709 FAILURE TO PAY SHARE OF ASSESSMENT 1709.1 In the event that any member fails, by reason of insolvency or otherwise, to pay its proportionate share of any expense or of any loss incurred by the Bureau under the program, the unpaid loss or expense shall be paid by the remainin…

1710 APPEALS 1710.1 Any person or member aggrieved by any ruling, order, decision, action or refusal to act on the part of the Bureau may appeal to the Governing Committee. 1710.2 The Governing Committee shall promptly notify the person or member as to its ruling on the appeal. I…

1711 INTER-COMPANY ARBITRATION 1711.1 All matters involving the subrogation of motor vehicle insurance personal injury protection benefits in which insurance companies cannot agree to entitlement shall be arbitrated by a company so designated by the Commissioner. SOURCE: Final Ru…

1799 DEFINITIONS 1799.1 The definitions of terms found in D.C. Law 6-96 shall apply to this chapter. SOURCE: Final Rulemaking published at 35 DCR 7649(October 21, 1988).

1800 GENERAL PROVISIONS 1800.1 The regulations set forth in this chapter govern the administration of the Uninsured Motorist Fund, (hereinafter referred to as the "Fund") as set forth in §9a of the Compulsory/No-Fault Motor Vehicle Insurance Act of 1982 amended by §2h of the Comp…

1801 ADMINISTRATION OF THE FUND 1801.1 The Department of Consumer and Regulatory Affairs, and the Insurance Administration shall be responsible for administration of the Fund. 1801.2 Pursuant to §9a of the Act, the Department shall report annually to the Mayor on the status and a…

1802 ELIGIBILITY 1802.1 A victim may be eligible for compensation if he or she meets the requirements of §9a(b) of the Act and would not otherwise be compensated for his or her loss. 1802.2 The one hundred eighty (180) day filing requirement under § 9a(b)(2) of the Act may be ext…

1803 PROCEDURE FOR FILING 1803.1 Unless authorized by the Administration, all claims shall be filed on forms as provided by the Department. 1803.2 A claim shall be considered filed when the victim submits to the Administration a completed application within one hundred eighty (18…

1804 DETERMINATION OF ELIGIBILITY AND AWARD 1804.1 The Administration shall investigate the claim as necessary to determine a victim's eligibility and the amount, if any, of compensation. 1804.2 The Administration shall examine all documentation received and request from the vict…

1805 NOTICE OF ELIGIBILITY AND AWARD 1805.1 An investigation shall be made in order to determine the eligibility and award of the victim. 1805.2 The determination for loss of earnings shall include replacement services not exceeding fifty ($50) dollars per day. 1805.3 Work loss s…

1806 MODIFICATION OF DETERMINATION 1806.1 The Administration may rescind or modify in whole or in part an award made to the victim under the following circumstances: (a) If evidence is presented to the Administration which would reasonably appear to indicate that the victim has m…

1807 HEARINGS 1807.1 If the victim signs a request for hearing, it shall be held in accordance with procedures set forth in this section. 1807.2 The victim may be present at the hearing and shall be allowed to present testimony or cross examine witnesses in person or by counsel. …

1808 AWARD COMPENSATION 1808.1 To compute wage loss of a victim, the following steps shall be taken: (a) If the victim was employed, the computation shall be as follows: (1) Determine the net weekly income of the victim for the twelve (12) months immediately preceding the acciden…

1809 EMERGENCY AWARDS 1809.1 Emergency awards may be made not to exceed one thousand dollars ($ 1,000), if it appears that a final award is probable. The amount of the award shall be determined by the following factors: (a) Actual documented economic need which is a direct result…

1810 PROFESSIONAL FEES 1810.1 In addition to the amount of compensation awarded to a successful claimant, a reasonable fee may be awarded for any professional assistance required in connection with any claim, not exceeding the amount permitted by §9a of the Act. 1810.2 If a victi…

1811 SUBROGATION AND PRESERVATION 1811.1 The victim shall have the right to sue to recover damages or restitution from the negligent party, as provided in § 9a(g)(1) of the Act. 1811.2 The District of Columbia may initiate a suit against the negligent party for damages or restitu…

1812 FALSE CLAIMS 1812.1 The Administration, upon a finding that a claim has been falsely asserted, shall promptly notify the Office of the Corporation Counsel that a false claim has been asserted and request an investigation by the Office of Compliance of the Department of Consu…

1900 COVERAGE 1900.1 These rules shall apply to all types of group and individual health insurance policies providing coverage as contained in §3 of the Drug Abuse, Alcohol Abuse, and Mental Illness Insurance Coverage Act of 1986 ("the Act"), D.C. Code §35-2302, and those treatme…

1901 METHOD OF PAYMENT 1901.1 If an insurance policy or plan includes deductibles, copayments, or annual and lifetime limitations for alcohol abuse, drug abuse and mental illness coverage which are separate and distinct from those imposed for the treatment of physical illness, th…

1902 INITIATION OF PEER REVIEW 1902.1 If an insurer has specific questions concerning the diagnosis or treatment given or, prescribed, by a physician, psychologist, or social worker, the insurer may request that the health professional undergo peer review as a condition of approv…

1903 CERTIFICATION OF NONHOSPITAL RESIDENTIAL FACILITIES AND OUT-PATIENT TREATMENT FACILITIES 1903.1 Pursuant to §7 of the Act, D.C. Code §35-2306, the Director shall certify each nonhospital residential facility and out-patient facility as a provider of treatment for drug abuse,…