New Jersey Administrative Code

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…

(a) The name of the insurer shall be clearly identified, and if any specific individual policy is advertised it shall be identified either by form number or other appropriate description. An advertisement shall not use a trade name, an insurance group designation, name of a paren…

(a) An advertisement which is intended to be seen or heard beyond the limits of the jurisdiction in which the insurer is licensed shall not imply licensing beyond such limits. (b) An advertisement may state that an insurer is licensed in the state where the advertisement appears,…

(a) All advertisements, regardless of by whom written, created or designed, shall be the responsibility of the insurer sponsoring the same. (b) Every insurer shall at all times maintain complete control over the content, form and method of distribution of all advertisements of it…

Failure to comply with the provisions of this subchapter shall subject the offender to the penalties set forth under N.J.S.A. 17B:30-17 and any other penalty authorized by law. Notes N.J. Admin. Code § 11:2-23.9

(a) The purpose of this subchapter is to set forth standards to protect active duty service members of the United States Armed Forces from dishonest and predatory insurance sales practices by declaring certain identified practices to be false, misleading, deceptive or unfair. (b)…

This subchapter shall apply only to the solicitation or sale of any life insurance or annuity product by an insurer or insurance producer to an active duty service member of the United States Armed Forces. Notes N.J. Admin. Code § 11:2-23A.2

(a) This subchapter shall not apply to solicitations or sales involving: 1. Credit insurance; 2. Group life insurance or group annuities where there is no in-person, face-to-face solicitation of individuals by an insurance producer or where the contract or certificate does not in…

For the purposes of this subchapter, the following terms and phrases shall have the following meanings, unless the context clearly indicates otherwise: "Active duty" means full-time duty in the active military service of the United States and includes members of the reserve compo…

(a) The following acts or practices when committed on a military installation by an insurer or insurance producer with respect to the in-person, face-to-face solicitation of life insurance are declared to be false, misleading, deceptive or unfair: 1. Knowingly soliciting the purc…

(a) The following acts or practices by an insurer or insurance producer constitute corrupt practices, improper influences or inducements and are declared to be false, misleading, deceptive or unfair:1. Submitting, processing or assisting in the submission or processing of any all…

If any provision of this subchapter or the application thereof to any person or circumstance is held invalid for any reason, the invalidity shall not affect any other provisions or any other application of this subchapter which can be given effect without the invalid provisions o…

(a) The purpose of this subchapter is to improve the Department's surveillance of the financial position of insurers by requiring: 1. An annual audit by independent certified public accountants of the financial statements reporting the financial position and the results of operat…

(a) An insurer required to furnish the annual audited financial report shall require the independent certified public accountant to report in writing within five business days to the board of directors or its audit committee any determination by the independent certified public a…

(a) In addition to the annual audited financial report, each insurer shall file with the Commissioner a written communication as to any unremediated material weaknesses in its internal control over financial reporting noted during the audit. Such communication shall be prepared b…

(a) The accountant shall furnish the insurer in connection with, and for inclusion in, the filing of the annual audited financial report, a letter stating: 1. That the accountant is independent with respect to the insurer and conforms to the standards of the profession as contain…

(a) Every insurer required to file an audited financial report pursuant to this subchapter shall require the accountant to make available for review by the Commissioner, all the workpapers prepared in the conduct of his or her audit and any communications related to the audit bet…

(a) This section shall not apply to foreign or alien insurers licensed in this State or an insurer that is a SOX compliant entity or a direct or indirect wholly-owned subsidiary of a SOX compliant entity not otherwise required to establish a committee in accordance with N.J.S.A. …

(a) An insurer is exempt from the requirements of this section if: 1. The insurer has annual direct written and unaffiliated assumed premiums, including international direct and assumed premiums, but excluding premiums reinsured with the Federal Crop Insurance Corporation and Fed…

(a) No director or officer of an insurer shall, directly or indirectly: 1. Make or cause to be made a materially false or misleading statement to an accountant in connection with any audit, review or communication required under this subchapter; or 2. Omit to state, or cause anot…

(a) Every insurer required to file an audited financial report pursuant to this subchapter that has annual direct written and assumed premiums of $ 500,000,000 or more, excluding premiums reinsured with the Federal Crop Insurance Corporation and Federal Flood Program, shall prepa…

(a) Insurers having direct premiums written in this State of less than $ 1,000,000 in any calendar year and less than 1,000 policyholders or certificateholders of directly written policies nationwide at the end of such calendar year shall be exempt from this subchapter for such y…