N.J.A.C. 11:2 — INSURANCE GROUP (Subchapter 1 to 43)

(a) This section shall determine carrier liability where one carrier's policy or contract replaces another carrier's plan providing similar types of coverage. (b) The prior carrier remains liable only to the extent of its accrued liabilities and extensions of benefits. The positi…

Noncomplying policy forms shall be deemed withdrawn on October 19, 1999. Notes N.J. Admin. Code § 11:2-13.7 Recodified from N.J.A.C. 11:2-13.9 and amended by R.1999 d.134, effective 4/19/1999. See: 30 New Jersey Register 3356(a), 31 New Jersey Register 1101(a). Rewrote the sectio…

Notes N.J. Admin. Code § 11:2-13.8 Repealed by R.1999 d.134, effective 4/19/1999. See: 30 New Jersey Register 3356(a), 31 New Jersey Register 1101(a). Section was "Separability of provisions".

Notes N.J. Admin. Code § 11:2-13.9 Recodified to N.J.A.C. 11:2-13.7 by R.1999 d.134, effective 4/19/1999. See: 30 New Jersey Register 3356(a), 31 New Jersey Register 1101(a).

(a) This subchapter establishes procedures pursuant to N.J.S.A. 17:17C-5a for the conduct of the vote of the policyholders of a domestic mutual life insurer on a proposal to approve a plan of reorganization to convert from a domestic mutual life insurance company to a domestic st…

In performing any duty set forth in this subchapter or any duty incidental to such tasks, the insurer may utilize the services of a firm that is professionally engaged in the business of mailing materials to shareholders or policyholders and/or soliciting and tabulating sharehold…

Failure to comply with the provisions of this subchapter shall result in the imposition of penalties as authorized by law. Notes N.J. Admin. Code § 11:2-14.11

The following words and terms, as used in this subchapter, shall have the following meanings, unless the context clearly indicates otherwise. "Ballot" means the instrument by which a policyholder indicates his approval or disapproval of the plan of reorganization, including, but …

The insurer shall prepare, in electronic format, a list of policyholders eligible to vote on the plan of reorganization, which list shall be subject to review by the Department. The insurer, acting directly or through one or more agents (as specified in N.J.A.C. 11:2-14.1 0), sha…

The insurer shall operate a toll free telephone center ("Demutualization Call Center") to answer questions from policyholders on the plan, including, but not limited to, questions on the method of voting. The insurer shall submit to the Department for its approval, in advance of …

The insurer shall file with the Department its procedures for the printing, mailing, receipt, custody, safeguarding, verification and tabulation of ballots, and measures to prevent ballot tampering. The insurer shall also file with the Department its procedures for IVR and intern…

(a) In order to be counted as a vote cast, a paper ballot shall have, among other things, a valid signature. Absent challenge to any particular paper ballot, a ballot shall be presumed to have been executed by a person over the age of 18 at the time of execution and all signature…

(a) Voting on the plan shall be in accordance with N.J.S.A. 17:17C-5 under the supervision of the Department or its designee(s). At the conclusion of the policyholder meeting, the insurer shall verify and tabulate such votes separately from those received other than in person and…

The Demutualization Call Center shall be equipped to respond to questions from policyholders concerning the voting procedures, but shall not advise policyholders whether to vote in favor of or against the plan. Notes N.J. Admin. Code § 11:2-14.8

The insurer shall establish a mechanism to be filed with the Department which permits policyholders to verify by telephone whether their votes have been received. Notes N.J. Admin. Code § 11:2-14.9

Whenever an insurer is declared insolvent by a court of competent jurisdiction, or its business is suspended under the laws of its state of incorporation, or its certificate of authority is revoked by this State, the company's insurance policies shall be deemed cancelled by said …

(a) Whenever a domestic or foreign surety company which has qualified to transact surety business in this State, in any year, becomes surety in an amount not to exceed $500.00 with respect to any guaranteed arrest bond certificates issued in such year by an automobile club or ass…

N.J.S.A. 17:29B-4(9) and 17B:30-13.1 prohibit insurers from engaging in unfair claims settlement practices. The purpose of this subchapter is to promote the fair and equitable treatment of claimants by defining certain minimum standards for the settlement of claims which, if viol…

(a) This section, unless otherwise noted in this subchapter, is applicable to claims arising under all property/liability coverages. This section is organized so that the requirements for all lines of property/liability insurance are found in (a)1 through 6 below; for automobile …

(a) Upon payment of $ 5,000 or more in settlement of any third-party liability claim, where the claimant is a natural person, the insurer or its representative (including the insurer's attorney) shall mail to the third-party claimant written notice of payment at the same time pay…

(a) Each insurer's claim files are subject to examination and inspection by the Commissioner or by his duly appointed designees pursuant to N.J.S.A. 17:23-20 et seq., 17:29B-5, and 17B:30-16. (b) Detailed documentation and/or evidence shall be contained in each claim file in orde…

(a) If the Department observes that an insurer's claims settlement practices are not meeting the standards established by statute or by this subchapter, the Department may require such insurer to file periodic reports. Depending on the nature and extent of an insurer's deviations…

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. Notes N.J. Adm…

(a) If, after notice and hearing, the Commissioner finds that a person has violated this subchapter, he shall make his findings in writing and shall issue and cause to be served upon the person charged with the violation an order requiring such person to cease and desist from eng…

This subchapter applies to all persons and all policies except the following: ocean marine, fidelity and surety, boiler and machinery and workers' compensation. It shall also not apply to commercial property and liability policies for which the annual premium is more than $ 10,00…

The following words and terms, when used in this subchapter, shall have the following meanings, unless the context clearly indicates otherwise: "After market part" means sheet metal or plastic parts which constitute the exterior of an automobile, including inner and outer panels,…

(a) Every insurer shall distribute copies of this subchapter to every person directly responsible for the handling and settlement of claims subject to this subchapter. Every insurer shall satisfy itself that all such responsible persons are thoroughly conversant with and are comp…

(a) No insurer shall fail to fully disclose to first party claimants all pertinent benefits, coverages or other provisions of an insurance policy or insurance contract under which a claim is presented. (b) No agent, broker, or insurer shall conceal from first party claimants bene…

(a) All claims must be reported to the designated insurer by a broker no later than three working days following receipt of notification of claim by the broker. For the purposes of this subsection, "broker" shall include a producer of record with respect to any residual market me…

(a) Every insurer shall commence an investigation on all claims other than auto physical damage within 10 working days of receipt of notification of claim. (b) The maximum payment period for all personal injury protection (PIP) claims shall be 60 calendar days after the insurer i…

(a) No insurer shall deny or offer to compromise a claim because of a policy provision, including any concerning liability, a condition, or an exclusion without providing a specific reference to such language and a statement of the facts which make that language operative. (b) An…

(a) No insurer shall indicate on a payment draft, check or in any accompanying cover letter that said payment is "final" if additional benefits relating to the claim for which benefits are being paid are payable under the policy. (b) When it is apparent to the insurer that additi…

The Plain Language Law, N.J.S.A. 56:12-1 et seq., requires certain insurance policies to be written in a "simple, clear, understandable and easily readable way."N.J.S.A. 39:6A-23.g requires that each buyer's guide and coverage selection form required by that section to be issued …

(a) This subchapter applies to all insurance policies which are issued to individuals to provide coverage for personal, family, or household purposes except life, health and annuity policies defined in N.J.S.A. 17B:17-19a, the "Life and Health Policy Language Simplification Act."…

The following words and terms, as used in this subchapter, shall have the following meanings, unless the context clearly indicates otherwise: "Buyer's Guide" means part of a written notice required to be given to insureds and prospective insureds for automobile insurance, pursuan…

(a) The Plain Language Law provides, at N.J.S.A. 56:12-10, certain "examples of guidelines" that the Commissioner may consider in determining whether a contract complies with the Act. The readability standards in this section are in addition to the standards enumerated in the Act…

(a) An insurer may request an opinion from the Commissioner as to whether an insurance policy and related "writings required to complete the consumer transaction", a Buyer's Guide and a Coverage Selection Form are in compliance with the Plain Language Law. The Commissioner shall …

The Commissioner may seek injunctive relief to enforce this subchapter. The court may authorize reasonable attorney's fees and costs in such a proceeding. Notes N.J. Admin. Code § 11:2-18.6

If any provision of this subchapter, or its application to any person or circumstances, is held invalid, the remainder of this subchapter and its application to other persons or circumstances shall be affected. Notes N.J. Admin. Code § 11:2-18.7

(a)N.J.S.A. 17:29C-1.1 and 1.2 allow senior citizen insureds of policies of personal lines insurance to designate a third party to whom the insurer must transmit a copy of important notices affecting insurance coverage. This subchapter provides rules for the implementation of tho…

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 Department of Banking and Insurance. "Insurer" means those entities defined at N.J.S.A. 17:29…

(a) Every insurer shall permit its senior citizen insureds to designate a third party to whom the insurer shall transmit a copy of notices of cancellation, lapse, nonrenewal and conditional renewal with respect to a policy of personal lines insurance. The senior citizen insured s…

Failure to comply with this subchapter shall result in the imposition of penalties as set forth in N.J.S.A. 17:33-2 and 17B:21-2. Notes N.J. Admin. Code § 11:2-19.4

(a)N.J.S.A. 17:16D-14(a) requires that whenever a financial insurance contract is cancelled, the insurer on notice of such financing shall return whatever gross unearned premiums are due under the insurance contract to the premium finance company for the account of the insured or…

The purpose of this subchapter is to implement N.J.S.A. 17B:30-1 et seq. through guidelines intended to assure a full and truthful disclosure to the public of all material and relevant information in the advertising of life insurance policies and annuity contracts. Notes N.J. Adm…

If any provision or clause of this subchapter or the application thereof to any person or situation is held invalid, such invalidity shall not affect any other provision or application of the subchapter which can be given effect without the invalid provision or application, and t…

(a) This subchapter shall apply to any life insurance or annuity advertisement distributed in this State. (b) Every insurer shall establish and at all times maintain a system of control over the content, form and method of dissemination of all advertisements of its policies. All …

The following words and terms, when used in this subchapter, shall have the following meanings, unless the context clearly indicates otherwise: "Advertisement" means material designed to create public interest in life insurance or annuities or in an insurer, or to induce the publ…

(a) Advertisements shall be truthful and not misleading in fact or by implication. Words or phrases the meaning of which is clear only by implication or by familiarity with insurance terminology shall not be used. The form and content of an advertisement of a policy shall be suff…

(a) All information required to be disclosed by this subchapter shall be set out conspicuously and in close conjunction with the statements to which such information relates or under appropriate captions of such prominence that it shall not be minimized, rendered obscure, or pres…