New Jersey Administrative Code

(a) Commercial insurance rating plans shall not be used in a manner that results in excessive, inadequate or unfairly discriminatory rates. (b) Commercial insurance rating plans shall be applied uniformly to all insureds who qualify for debits or credits in accordance with the pl…

(a) These rules interpret provisions of the Commercial Insurance Deregulation Act, N.J.S.A. 17:29AA-1 et seq. and set standards for the acceptance or disapproval of policy forms submitted pursuant to N.J.S.A. 17:29AA-6. These standards are established pursuant to N.J.S.A. 17:29AA…

The following words and terms, when used in this subchapter, shall have the following meanings unless the context clearly indicates otherwise. "Commercial lines insurance" includes all property-casualty insurance policies except those excluded by N.J.S.A. 17:29AA-3a and N.J.A.C. …

(a) No commercial insurance policy shall be issued or renewed on a form required to be filed pursuant to N.J.S.A. 17:29AA-1 et seq. which contains a provision that includes defense costs within policy limits, except as provided in this section. 1. Regardless of whether the policy…

(a) The Department shall approve policy forms filings that include policy provisions or rating rules as follows: 1. That the lead liability exclusion applies only if the covered premises were constructed prior to 1978; and 2. That the insurer be required to offer liability covera…

Notes N.J. Admin. Code § 11:13-7.5 Repealed by 47 N.J.R. 2154(a), effective 8/17/2015

(a) This subchapter establishes data requirements and procedures for member/subscriber insurers in rating organizations or advisory organizations to adopt or modify a rating organization's or advisory organization's prospective loss cost filing for commercial lines insurance made…

The following words and terms, when used in this subchapter, shall have the following meanings unless the context clearly indicates otherwise. "Commissioner" means the Commissioner of the New Jersey Department of Banking and Insurance. "Department" means the New Jersey Department…

(a) A rating organization or advisory organization that desires to file prospective loss costs with the Commissioner shall develop a filing containing advisory prospective loss costs and supporting actuarial and statistical data. (b) Rating organizations or advisory organizations…

(a) In order for an insurer to incorporate a rating organization's or advisory organization's filed prospective loss costs to establish its own rates, an insurer shall: 1. Be a member/subscriber insurer in the rating organization or advisory organization; and 2. File its loss cos…

Rating organizations or advisory organizations and insurers which fail to comply with the filing submission requirements of this subchapter shall be subject to penalties pursuant to N.J.S.A. 17:29AA-26. Notes N.J. Admin. Code § 11:13-8.5 Amended by R.2003 d.21, effective 1/6/2003…

P.L. 1983, c.376, approved November 10, 1983, authorizes 10 or more employers licensed by the state as hospitals under the Health Care Facilities Planning Act, N.J.S.A. 26:2H-1 et seq., to apply to the Commissioner of Insurance, pursuant to rules and regulations established by hi…

(a) Except with the approval of the Commissioner, no service organization or its employees, officers, or directors shall be an employee, officer, or director of, or have either a direct or indirect financial interest in, an administrator, and no administrator or its employees, of…

No person shall make a material misrepresentation or omission of a material fact in connection with the solicitation of a membership in a group or engage, with respect to membership in or the business and affairs of a group, in any activities of the type prohibited by N.J.S.A. 17…

Funds not needed for current obligations may be invested by the trustees in accordance with N.J.S.A. 17:24-1 et seq. Notes N.J. Admin. Code § 11:15-1.12

(a) For the first five years of its existence, except as otherwise approved by the Commissioner, each group shall maintain information in accord with the uniform classification system, uniform experience rating plan, and manual rules filed with the Commissioner. (b) Contributions…

(a) Any monies for a fund year in excess of the amount necessary to fund all obligations for that fund year may be declared to be refundable by the trustees not less than 12 months after the end of the fund year. (b) Each applicant for membership in the group shall be given a wri…

(a) The group shall establish to the satisfaction of the Commissioner a contribution payment plan. (b) The group shall establish and maintain actuarially appropriate loss reserves, which shall include reserves for: (1) known claims and expenses associated therewith; and (2) claim…

(a) If the assets of a group are at any time insufficient to enable the group to discharge its legal liabilities and other obligations and to maintain the reserves required of it under the Act and these regulations, it shall forthwith make up the deficiency or levy an assessment …

(a) After notice and opportunity for a hearing as in a contested case (N.J.S.A. 52:14B-9), the Commissioner may revoke a group's certificate of approval if it is found that: 1. There has been deterioration of the financial condition of the group to such an extent that such deteri…

Any document filed with the Commissioner pursuant to the Act or these regulations shall be deemed a public record and available for inspection at the New Jersey Department of Insurance during usual business hours. Notes N.J. Admin. Code § 11:15-1.18

The following words and terms, when used in this subchapter, shall have the following meanings, unless the context clearly indicates otherwise. "Act" means the provisions of the New Jersey Workers' Compensation Law regarding self-insurance as contained in N.J.S.A. 34:15-77, as am…

(a) A proposed group shall file its application with the Commissioner for his or her approval on a form prescribed by him or her and accompanied by a nonrefundable processing fee in the amount of $ 1,000. The application shall include the group's name, location of its principal o…

(a) The Commissioner shall issue a certificate of approval to the group upon finding that the group: 1. Guarantees benefit levels equal to those required by the Workers' Compensation Law; 2. Demonstrates sufficient aggregate financial strength and liquidity to assure that all obl…

(a) Annually (or more frequently if the Commissioner deems it necessary), each group shall submit to the Commissioner, on or before the last day of the sixth month following the end of the group's fiscal year, a sworn statement of financial condition audited by an independent cer…

The Commissioner shall examine the affairs, method of conducting business, transactions, account, records, and assets of each group as often as the Commissioner deems advisable, but not less often than once every three years. The expense of such examinations shall be assessed aga…

(a) Each group shall be operated by not fewer than five trustees whom the members of a group shall elect for stated terms of office. At least two-thirds of the trustees shall be employees, officers, directors, or trustees of members of the group. Except in the case of bona fide h…

(a) An employer joining a group after the group has been issued a certificate of approval shall: 1. Submit an application for membership to the trustees or the administrator; and 2. Enter into the indemnity and trust agreement. Membership shall take effect no earlier than each me…

(a) A group may not voluntarily dissolve, or otherwise cease to do business, and distribute its assets to its members, unless and until it satisfies the following requirements: 1. A majority of the group's members must have voted in favor of a resolution to dissolve the group pur…

(a)N.J.S.A. 40A:10-36 et seq. authorizes two or more local units of government to join together to establish a joint insurance fund for the purpose of insuring against liability, property damage, workers' compensation, and loss or theft of money or securities, providing blanket b…

(a) A member of the fund must remain a member for the full term of membership, as provided in the fund's bylaws, unless earlier terminated by the fund for nonpayment of assessments, noncompliance with risk management or underwriting standards, or for other reasons subject to prio…

The insolvency or bankruptcy of a member does not relieve the fund or any other member of joint and several liability for the payment of any claims incurred by the member during the period of its membership, including, but not limited to, being subject to and liable for supplemen…

(a) A fund may not voluntarily dissolve or otherwise cease to do business and distribute its assets to its members, unless and until it satisfies the following requirements: 1. A majority of the fund's members must have voted in favor of a resolution to dissolve the fund, pursuan…

(a) Pursuant to the terms of the indemnity and trust agreement, each fund shall establish a separate trust fund account in accordance with N.J.A.C. 11:15-2.6(b)10 from which monies shall be disbursed solely for the payment of claims, allocated claim expenses and excess insurance …

Each fund shall establish an administrative account for each fund year which shall be utilized for payment of the fund's general operating expenses, including, but not limited to, loss prevention activities, data processing services and general legal expenses. A fund shall not be…

(a) Each participating member of a joint insurance fund shall appropriate and pay to the fund its assessment as required by the joint insurance fund. During the first year of operation of a joint insurance fund these contributions shall be paid in two equal installments, the firs…

(a) Each fund shall levy upon its members an additional assessment whenever needed or so ordered by the Commissioner, to supplement the fund's claim or loss retention or administrative accounts to assure payment of the fund's obligations, including payment of benefits under the w…

Should any member of a fund fail or refuse to pay as directed its assessment(s) to the fund or to pay as directed any supplemental assessment(s), or should the fund commissioners fail to assess funds required to meet the obligations of the fund, the chairman of the fund commissio…

(a) Whenever the risk management plan of a joint insurance fund requires the fund's members to individually retain a specific amount of risk, potential liability, or incurred losses, the participant shall provide for such liability, or incurred loss: 1. As a deductible to be char…

Prior to any commitment or agreement requiring the expenditures of funds by the fund, the custodian of the fund's assets shall certify the availability of sufficient unencumbered funds in the account to fully pay all charges or commitments to be accepted. Notes N.J. Admin. Code §…

The following words and terms, when 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 r…

(a) The free balance of any account maintained by a fund, whether for claim or loss retention, administrative, contingency, or, in the case of an environmental impairment liability fund, the contingency account to be funded by bond proceeds pursuant to N.J.A.C. 11:15-2.1 3(b), sh…

(a) Any monies for a fund year in excess of the amount necessary to fund all obligations for that fiscal year as certified by an actuary may be declared to be refundable by the fund not sooner than the time periods after the end of the fiscal year as set forth in (b) and (c) belo…

(a) All disbursements, payments of claims settlements or other expenditures of funds of the fund whether for administrative expenses or for claims purposes must be approved by a majority of the fund commissioners or the executive committee thereof, unless approved pursuant to (b)…

(a) Consistent with N.J.A.C. 11:15-2.6(a)6, each fund providing primary or underlying coverage on a self-insured or commercially insured basis shall secure excess insurance or reinsurance in a form, in an amount and by an insurer, or other entity authorized to provide such covera…

(a) An annual certified report in a form acceptable to the Commissioner shall be prepared by each fund, filed concurrently with the Department and Department of Community Affairs and made available to each fund member on or before June 30 of each year. The report shall include:1.…

(a) In addition to any examination conducted pursuant to N.J.A.C. 11:15-2.6(f), the Commissioner may conduct an examination of any fund as he or she deems necessary, or at any time the Commissioner has reasonable cause to believe the fund may be insolvent or in a financial condit…