North Carolina Administrative Code

11 NCAC 04 .0207 MAINTENANCE OF RECORDS History Note: Authority G.S. 57-10; 58-9; 58-9.2; 58-15; 58-25; 58-25.1; 58-26; 58-27; Eff. December 15, 1979; Transferred to T11.11G; Eff. August 14, 1986.

11 NCAC 04 .0208 COMPLAINT RECORDS History Note: Authority G.S. 57-10; 58-9; 58-16; 58-25.1; 58-26; 58-27; 58-54.5; 58-54.6; Eff. December 15, 1979; Transferred to T11.11G; Eff. August 14, 1986.

11 NCAC 04 .0310 CLAIM PRACTICES: PROCEDURES: LIFE: ACCIDENT: HEALTH History Note: Filed as an Emergency Repeal Eff. April 25, 1979, for a Period of 120 Days to be Reinstated on August 23, 1979; Authority G.S. 57-1; 57-4; 58-9; 58-54.3; Eff. March 16, 1979; Repealed Eff. August 2…

11 NCAC 04 .0311 FUNCTION OF SECTION History Note: Authority G.S. 57-1, -4; 58-9, -262.4; Eff. December 15, 1979; Repealed Eff. July 1, 1988.

11 NCAC 04 .0312 INFORMATION USED IN CLAIM SETTLEMENTS (a) Any information, including medical information, used in whole or in part as the basis of settling a life, accident, health, or disability claim shall be provided to the Division as requested in connection with a complaint…

11 NCAC 04 .0313 PROVISIONS OF CONTRACTS The following phrases and provisions, found in life, accident, health, and disability contracts, if not defined in the contracts, shall be construed by the Department in the following manner: (1) Regular Care and Attendance of a Physician.…

11 NCAC 04 .0314 PREMIUM NOTICES: PAYMENTS AND REFUNDS The Commissioner shall consider an unfair trade practice the failure by an insurer to adhere to any of the following procedures concerning premium notices, payments and refunds on life, accident, health, or disability policie…

11 NCAC 04 .0315 ISSUANCE OF CONTRACTS The Commissioner shall consider an unfair trade practice the failure by an insurer to adhere to any of the following procedures with respect to the issuance of life, accident, health, or disability policies pursuant to G.S. 58-63-15: (1) Pol…

11 NCAC 04 .0316 CONTESTABILITY CLAUSE AND RESCISSION If an insurer does not attempt to rescind an accident, health, or disability policy upon becoming aware that the insured's application contained false statements, the insurer may not subsequently use such false statements as a…

11 NCAC 04 .0317 SEX DISCRIMINATION: LIFE: ACCIDENT AND HEALTH INSURANCE (a) Prohibited Practices. The Commissioner shall consider unfair discrimination the denial of life, accident, health or disability insurance on the basis of the insured's or prospective insured's sex or mari…

11 NCAC 04 .0318 LIFE INSURANCE SALES: FINANCING FIRST YEAR PREMIUM (a) The Commissioner shall consider an unfair trade practice the failure by an insurance company to adhere to the following procedures concerning the sale of life insurance contracts for which the first year's pr…

11 NCAC 04 .0319 CLAIMS PRACTICES: LIFE: ACCIDENT AND HEALTH INSURANCE The Commissioner shall consider as prima facie violative of G.S. 58-63-15(11) the failure by an insurer to adhere to the following procedures concerning settlement of life, accident, health and claims: (1) Exa…

11 NCAC 04 .0320 STUDENT LOANS History Note: Authority G.S. 58-2-40; 58-3-135; 58-3-150; Eff. July 1, 1986; Amended Eff. April 8, 2002; April 1, 1989; Repealed Eff. November 1, 2021.

11 NCAC 04 .0414 FUNCTION OF SECTION History Note: Authority G.S. 58-7.3, -9, -72; Eff. December 15, 1979; Repealed Eff. July 1, 1988.

11 NCAC 04 .0415 SAFE DRIVER INCENTIVE PLAN The following are Department of Insurance provisions regarding the Safe Driver Incentive Plan ("SDIP"): (1) License revocation for refusal to submit to chemical tests shall not be considered conviction of a moving traffic violation. (2)…

11 NCAC 04 .0416 BILLING PROCEDURES FOR AUTOMOBILE INSURANCE (a) With respect to new business, an insurer shall take no more than 90 days from the effective date of the policy to make any investigation other than review of the initial application and to bill the insured for prope…

11 NCAC 04 .0417 DRIVE-IN CLAIM SERVICE FACILITIES No insurer shall require any claimant to use a drive-in claim service operated by the insurer. The claimant's voluntary utilization of a drive-in claim service or preferred repair shop shall not prejudice the right of either part…

11 NCAC 04 .0418 TOTAL LOSSES ON MOTOR VEHICLES (a) The Commissioner shall consider as prima facie violative of G.S. 58-63-15(11) the failure by an insurance company to adhere to the procedures in this Rule concerning the settlement of covered "total loss" motor vehicle claims wh…

11 NCAC 04 .0419 MOTOR VEHICLE REPAIR ESTIMATES (a) The Commissioner shall consider as prima facie violative of G.S. 58-63-15(11) the failure by an insurance company to adhere to the procedures in this Rule concerning repair estimates on covered motor vehicle damage claims when t…

11 NCAC 04 .0420 WRITTEN CONFIRMATION OF ORAL AGREEMENTS (a) Once an insurer accepts liability or advises a claimant to have damaged property repaired with the understanding that the insurer will pay or reimburse the claimant, the insurer shall, if requested by the claimant, conf…

11 NCAC 04 .0421 HANDLING OF LOSS AND CLAIM PAYMENTS (a) The Commissioner shall consider the failure by an insurer to adhere to the procedures in this Rule concerning loss and claim payments as prima facie evidence violation of G.S. 58-63-15(11) when such failure is so frequent a…

11 NCAC 04 .0422 CANCELLATION OF INSURANCE The Commissioner shall consider an unfair trade practice the cancellation by an insurer of any personal lines insurance policy for which the premium has been paid because there is another policy in force for which the premium has not bee…

11 NCAC 04 .0423 ETHICAL STANDARDS (a) Every agent, limited representative, broker, adjuster, appraiser, or other insurer's representative shall, when conducting insurance business with a member of the public: (1) identify himself or herself and his or her occupation; and (2) pro…

11 NCAC 04 .0424 PURPOSE History Note: Authority G.S. 58-9; Eff. April 1, 1989; Repealed Eff. April 1, 1993.

11 NCAC 04 .0425 DEFINITIONS As used in this Section the following terms shall be construed as follows: (1) "After market part" means a part made by a nonoriginal manufacturer. (2) "Claimant" means a first-party or third-party claimant. (3) "Diminution in Fair Market Value," as t…

11 NCAC 04 .0426 LIKE KIND AND QUALITY No insurer shall require the use of an aftermarket part in the repair of a motor vehicle unless the aftermarket part is at least equal to the original part in terms of fit, quality, performance, and warranty. Insurers specifying the use of a…

11 NCAC 04 .0427 DISCLOSURE REQUIREMENTS Every insurer that writes motor vehicle insurance in this State and that intends to require or specify the use of after market parts must disclose to its policyholders in writing, either in the policy or on a sticker attached thereto, the …

11 NCAC 04 .0428 ENFORCEMENT History Note: Authority G.S. 58-9; Eff. May 1, 1989; Repealed Eff. May 3, 1993.

11 NCAC 04 .0429 COMMINGLING The accounting records maintained by agents, brokers, and limited representatives shall be separate and apart from any other business records and demonstrate at all times that collected funds due to insurers and return premiums due to policyholders ar…

11 NCAC 04 .0430 PROOF OF MAILING; AUTOMOBILE INSURANCE As used in G.S. 58-36-85, "proof of mailing" means a certificate issued by and bearing the date stamp of the United States Postal Service or an official United States Postal Service tracking number or similar proof of mailin…

11 NCAC 04 .0431 DEFINITION OF CLAIMANT As used in this Section, unless the context indicates otherwise, "claimant" means a first party claimant or a third party claimant. History Note: Authority G.S. 58-2-40(1); 58-63-15; Eff. April 1, 1993; Readopted Eff. November 1, 2021.

11 NCAC 04 .0432 REFUND OF EXCESS PREMIUM ON SCHEDULED ITEMS If an insured has any scheduled item listed for additional insurance covered by a homeowner's or personal inland marine insurance policy, and that item is replaced for less than the scheduled amount of coverage, the ins…

11 NCAC 04 .0433 REFUND OF AUTO INSURANCE PREMIUM ON NEW BUSINESS If an insured asks an insurer to cancel a newly issued motor vehicle insurance policy on or before the premium billing due date, the unearned premium refund made by the insurer shall be made on a pro rata rather th…

SECTION .0500 - LIFE INSURANCE ILLUSTRATIONS 11 NCAC 04 .0501 SCOPE AND DEFINITIONS (a) These Rules apply to all policies sold on and after the effective dates of these Rules and to all certificates issued under those policies. (b) As used in this Section, the following terms hav…

11 NCAC 04 .0502 ASSUMED EXPENSES AND CURRENT SCALE (a) An insurer may choose to designate each year the method of determining assumed expenses for all policies from the following: (1) Fully allocated expenses. (2) Marginal expense. (3) A table of fully allocated expenses develop…

11 NCAC 04 .0503 ILLUSTRATED POLICIES (a) Each insurer marketing policies regulated by this Section shall notify the Commissioner whether a policy form is to be marketed with or without an illustration. For all policy forms being marketed on the effective date of this Section, th…

11 NCAC 04 .0504 GENERAL RULES (a) As used in this Rule, "generic name" means a title descriptive of the policy being illustrated, such as "whole life", "term life", or "flexible premium adjustable life." An illustration used in the sale of a policy shall satisfy the requirements…

11 NCAC 04 .0505 STANDARDS FOR BASIC ILLUSTRATIONS (a) Format. A basic illustration shall conform with the following requirements: (1) The illustration shall be labeled with the date on which it was prepared. (2) Each page, including any explanatory notes or pages, shall be numbe…

11 NCAC 04 .0506 STANDARDS FOR SUPPLEMENTAL ILLUSTRATIONS (a) A supplemental illustration may be provided as long as: (1) It is appended to, accompanied by or preceded by a basic illustration that complies with Rule .0505 of this Section; (2) The non-guaranteed elements shown are…

11 NCAC 04 .0507 DELIVERY OF ILLUSTRATION AND RECORD RETENTION (a) If a basic illustration is used by an insurance agent or other authorized representative of the insurer in the sale of a policy and the policy is applied for as illustrated, a copy of that illustration, signed in …

11 NCAC 04 .0508 ANNUAL REPORTS AND NOTICES TO POLICY OWNERS (a) In the case of a policy designated as one for which an illustration will be issued, the insurer shall provide each policy owner with an annual report on the status of the policy that shall contain the information sp…

11 NCAC 04 .0509 ANNUAL CERTIFICATIONS (a) The board of directors of each insurer shall appoint one or more illustration actuaries. (b) The illustration actuary shall certify that the disciplined current scale used in illustrations is in conformity with the Actuarial Standard of …

chapter 05 - OFFICE OF STATE FIRE MARSHAL SUBCHAPTER 05A - FIRE AND RESCUE SECTION .0100 - GENERAL PROVISIONS 11 NCAC 05A .0101 DEFINITIONS As used in this Subchapter: (1) "ISO" means the Insurance Services Office, Inc., or any successor organization. (2) "North Carolina Fire Sup…

11 NCAC 05A .0102 PURPOSE OF DIVISION History Note: Authority G.S. 11-23; 58-7.3; 58-9; 69-19; 118-1 through 118-17; 118A-3; 147-33.1; Eff. February 1, 1976; Amended Eff. July 1, 1986; Repealed Eff. July 1, 1988.

11 NCAC 05A .0103 MAILING ADDRESS All requests for information, assistance, training, or required reports shall be directed to: North Carolina Department of Insurance, Office of State Fire Marshal, 1202 Mail Service Center, Raleigh, NC 27699-1202. History Note: Authority G.S. 58-…

11 NCAC 05A .0104 DIVISION PERSONNEL History Note: Authority G.S. 58-7.3; 58-9; Eff. February 1, 1976; Readopted Eff. May 12, 1978; Amended Eff. July 1, 1986; Repealed Eff. July 1, 1988.

11 NCAC 05A .0105 TRAINING OPERATIONS History Note: Authority G.S. 58-2-40; 58-78-10; Eff. February 1, 1976; Readopted Eff. May 12, 1978; Amended Eff. October 1, 1988; Repealed Eff. May 1, 2017.

SECTION .0200 - STATE VOLUNTEER FIRE DEPARTMENT 11 NCAC 05A .0201 ADMINISTRATION OF STATE VOLUNTEER FIRE DEPARTMENT History Note: Authority G.S. 58-2-40; 58-80-1 thru 58-80-60; Eff. February 1, 1976; Readopted Eff. May 12, 1978; Amended Eff. April 8, 2002; July 1, 1986; Repealed …

11 NCAC 05A .0202 COMPREHENSIVE EMERGENCY MANAGEMENT PLAN The Commissioner of Insurance acts as an advisor to the Governor for Structural Fire Suppressions and Rescue Services under the North Carolina Emergency Operations Plan and assists other state and local agencies through th…

SECTION .0300 - FIREFIGHTERS' RELIEF FUND 11 NCAC 05A .0301 ELIGIBLE MEMBERS History Note: Authority G.S. 58-2-40(1); 58-84-40; Eff. February 1, 1976; Readopted Eff. May 12, 1978; Amended Eff. September 1, 2010; October 1, 2006; February 1, 1993; July 1, 1986; Repealed Eff. May 1…