New Jersey Administrative Code

The provisions of this subchapter apply to any person seeking to qualify as a motor vehicle self-insurer in New Jersey, except public entities pursuant to N.J.S.A. 39:6-54. Notes N.J. Admin. Code § 11:3-30.2

The following words and terms, when used in this subchapter, shall have the following meanings, unless the context clearly indicates otherwise. "Applicant" means a person applying for a certificate of self-insurance who does not currently possess a valid certificate. "Association…

(a) Any person in whose name more than 25 motor vehicles are registered or in whose name more than 25 motor vehicles are leased may qualify as a self-insurer by obtaining a certificate of self-insurance issued at the discretion of the Commissioner as provided in this subchapter. …

(a) Any person applying for a certificate of self-insurance shall submit the following to the Commissioner: 1. A completed application form on forms to be provided by the Commissioner; 2. The most current financial statement and financial statements for the two years immediately …

(a) Any certificate holder applying for renewal shall submit the following so that it is received by the Commissioner not later than June 1 of the year of the expiration date of such certificate:1. An accident and claim activity report on forms to be provided by the Commissioner;…

(a) The Commissioner may require the furnishing of a surety bond and/or evidence of excess insurance. (b) If the applicant or certificate holder is required to furnish a surety bond, the surety bond shall be in an amount of not less than $ 300,000, with an additional $ 10,000 for…

(a) The Commissioner may make or cause to be made audits or examinations as may be necessary to determine the ability of the applicant or the certificate holder to discharge its financial obligations as a self-insurer. (b) The applicant or certificate holder shall pay the reasona…

(a) This subchapter does not apply to any motor vehicle owned by the United States, this State, any political subdivision of this State or any municipality therein; nor to any motor vehicle which is subject to the requirements of law requiring insurance or other security on certa…

(a) This subchapter establishes the procedures and requirements for automobile or motor vehicle insurers to certify that automotive or motor vehicle insurance liability policies issued outside of New Jersey provide coverage pursuant to N.J.S.A. 39:6A-3, 39:6A-4, 39:6B-1a, N.J.S.A…

The following words and terms, when used in this subchapter, shall have the following meanings, unless the context clearly indicates otherwise: "Certification" means a written statement certified or sworn to be true and signed by a duly authorized officer of the insurer. "Commiss…

(a) Each insurer authorized to transact automobile or motor vehicle insurance business in this State pursuant to N.J.S.A. 17:28-1.4 shall file a certification of compliance with the Department on its own behalf and on behalf of: 1. Any insurer that is controlled by the insurer au…

(a) Any person requesting a copy of a certification on file with the Department shall make the request in writing and include the complete name of the company or companies for which the certification is requested. (b) Requests for copies of certification on file with the Departme…

(a) This subchapter sets forth an appeal procedure for a person who has been either denied personal private passenger automobile insurance or nonrenewed in the voluntary market by an insurer on the basis that they are not an eligible person as defined in N.J.A.C. 11:3-34.4. This …

The following words and terms, when used in this subchapter, shall have the following meanings, unless the context clearly indicates otherwise. "Applicant" means an insured or prospective insured who has made a request for personal private passenger automobile insurance on either…

Any eligible person who has been denied automobile insurance in the voluntary market by an insurer shall be entitled to appeal the denial in the manner provided by this subchapter. Notes N.J. Admin. Code § 11:3-33.3

(a) If the application or request for coverage was made in writing, the insurer or agent shall provide the applicant with an explanation of the reasons for the denial in writing. If the application or request for coverage was made orally, the insurer or agent may provide the appl…

(a) Appeals from a denial of automobile insurance in the voluntary market shall be submitted to the Department, on a form prescribed by the Department (Appendix B to this subchapter, which is incorporated herein by reference as part of this rule), within 90 days of the date of a …

(a) Upon receipt of an appeal submitted in accordance with N.J.A.C. 11:3-33.5, the Department shall send to the insurer or insurance agent (the "respondent") who provided the written denial, a copy of all pertinent documents which have been submitted by applicant (the "appellant"…

(a) An appeal from a decision of the Department made pursuant to N.J.A.C. 11:3-33.6 shall be heard as a contested case pursuant to the Administrative Procedure Act, N.J.S.A. 52:14B-1 et seq., as implemented by the Uniform Administrative Procedure Rules, N.J.A.C. 1:1. (b) The proc…

Any insurer or insurance producer who violates any provision of this subchapter shall be subject to the penalties provided by law, including, but not limited to, the suspension or revocation of a certificate of authority or licensure and a civil penalty in an amount of up to $ 2,…

(a) Pursuant to N.J.S.A. 39:6A-3 and 17:33B-15, compliance with the provisions of this subchapter shall be effected in the following manner: 1. Appeals from denials concerning new policies on or after April 1, 1992 may be filed in the manner prescribed by this subchapter; and 2. …

The purpose of this subchapter is to set forth the requirements for determining who can qualify as an "eligible person," and to provide the schedule for "automobile insurance eligibility points" pursuant to N.J.S.A. 17:33B-13 and 14. Notes N.J. Admin. Code § 11:3-34.1 Amended by …

(a) The provisions of this subchapter apply to all insurers which write personal private passenger automobile insurance and all persons who are required to procure automobile insurance coverage in this State. (b) Except to the extent that the definition of eligible and ineligible…

The following words and terms, as used in this subchapter, shall have the following meanings, unless the context clearly indicates otherwise. "At-fault accident" is any accident involving a driver insured under the policy: 1. Where a driver is proportionately responsible based on…

(a) An "eligible person" is a person who is an owner or registrant of an automobile registered and principally garaged in this State or who is a resident and holds a valid New Jersey driver's license to operate an automobile, but does not include any person: 1. Who, during the th…

(a) Automobile insurance eligibility points shall be accumulated as a result of convictions, suspensions, revocations and determinations of responsibility for civil infractions in accordance with the schedule set forth in the Appendix to this subchapter herein incorporated by ref…

(a) The purpose of this subchapter is to provide rules for the inspection of automobiles in connection with the issuance of physical damage insurance coverage by insurers pursuant to N.J.S.A. 17:33B-33 through N.J.S.A. 17:33B-40. (b) The provisions of this subchapter apply to all…

If any section or portion of a section of this subchapter or its application to any person, entity or circumstance is held invalid by any court, the remainder of this regulation or the applicability of such provisions to other persons, entities or circumstances shall not be affec…

(a) For all policies providing automobile physical damage coverage issued on or after June 1, 1991, or renewed on or after July 1, 1991, insurers may adopt any one of the following procedures: 1. Amend the policy by adding thereto the endorsements as set out in (c) below, which m…

§ 11:3-36.12 - Reserved Notes N.J. Admin. Code § 11:3-36.12

The following words and terms, as used in this subchapter, shall have the following meanings, unless the context clearly indicates otherwise. "Authorized representative" means any person which is authorized by the insurer to conduct insurance inspections pursuant to this subchapt…

(a) No insurer shall provide automobile physical damage insurance coverage prior to conducting an insurance inspection in accordance with this subchapter, under the following circumstances:1. When a new policy or endorsement adding physical damage coverage insuring a private pass…

(a) An insurer shall waive a mandatory inspection when a new automobile is purchased from a franchised automobile dealership and the insurer is provided with the following documents in accordance with N.J.A.C. 11:3-36.7(e): 1. A copy of the bill of sale which contains a full desc…

(a) An insurer, by itself or through its authorized producers, may defer the mandatory inspection required by N.J.A.C. 11:3-36.3 for seven calendar days following the effective date of coverage, upon an insured's requests for coverage for automobile physical damage insurance on a…

(a) Inspections shall be made by an authorized representative of the insurer at a time and place reasonably convenient to the insured. A reasonably convenient time shall include, in addition to customary business hours, sufficient early morning, evening and weekend hours. A reaso…

(a) If the inspection is not conducted prior to the expiration of the deferral period or the expiration of the policy in the case of renewals, the insurer shall suspend automobile physical damage coverage on the automobile at 12:01 A.M. of the day following the last day for inspe…

(a) A violation of any provision of this subchapter by an insurer shall be punishable by a $ 500.00 fine pursuant to N.J.S.A. 17:33B-39. 1. Insurers shall be responsible for the conduct of their authorized representatives with respect to all duties imposed by this subchapter. 2. …

Insurers shall maintain records as to the costs and savings related to this subchapter and make such records available to the Department upon request. Notes N.J. Admin. Code § 11:3-36.9 Amended by R.1996 d.58, effective 2/5/1996. See: 27 New Jersey Register 3682(a), 28 New Jersey…

The purpose of this subchapter is to establish guidelines for the order of benefit determination between a plan of health insurance and personal injury protection provided through an automobile policy pursuant to N.J.S.A. 39:6A-4, when a named insured elects to have his or her pe…

(a) Automobile insurers shall develop and utilize an explanation of benefits form to be provided with the payment of benefits for expenses incurred for treatment of injuries which clearly identifies and explains the following: 1. Each procedure for which a claim has been made; 2.…

(a) If, subsequent to the selection of the PIP-as-secondary coverage option by the named insured, injuries are sustained by an insured eligible for health benefits plan coverage, but a dispute exists between the health benefits provider and the automobile insurer, then the health…

(a) If an insured is eligible for coverage of medical expenses under more than one automobile policy, the determination as to which automobile policy will assume coverage responsibility for that insured shall be as follows: 1. A named insured shall receive benefits for medical ex…

Each automobile policy or health benefits plan subject to the terms of this subchapter which fails to comply with the terms herein shall be in violation of this subchapter. Failure to comply with the terms of this subchapter may result in the assessment of any and all penalties i…

If any provision of this subchapter or 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. Notes N.J. Admin. Code § 11:3-37.14…

The following words and terms, when used in this subchapter, shall have the following meanings, unless the context clearly indicates otherwise. "Actual benefits" means those benefits determined to be payable for allowable expenses. "Allowable expense" means a medically necessary,…

(a) Nothing in this subchapter shall be construed as requiring any health benefits provider to offer, provide, or continue coverage to or for any individual or group, except as may be set forth by other laws of this State, or of the Federal government. (b) Nothing in this subchap…

(a) When a named insured elects the PIP option, whereby the named insured intends that medical expenses incurred for treatment of an injury are to be covered by a health benefits provider or providers, as evidenced on the Coverage Selection Form, then the medical expense provisio…

(a) An automobile insurer may eliminate the premium reduction on the base rate applicable to the amount of medical expense benefit chosen in conjunction with the PIP-as-secondary coverage option election if the automobile insurer complies with (b) below, and verifies that the cov…

(a) When the named insured of an automobile policy has selected the PIP-as-secondary coverage option, all health benefits plans for which the insured is eligible shall provide coverage for the allowable expenses incurred by the insured due to an automobile-related injury prior to…

(a) In calculating the actual benefits to be paid by the automobile insurer when the PIP-as-secondary coverage option has been selected, the automobile insurer shall first determine the amount of eligible expenses which would have been paid after application of the deductible and…