New Jersey Administrative Code Title 11 - INSURANCE
Here’s a breakdown of New Jersey Administrative Code – Title 11: Insurance:
📘 Overview
Title 11 is overseen by the NJ Department of Banking and Insurance, covering comprehensive insurance regulation—from licensing and rates to claims handling and consumer protections (regulations.justia.com).
🏷 Chapter Structure
Here's a summary of the major chapters:
Chapter
Focus
1 – Administration
Licensing, policy filings, regulatory procedures, discrimination, cancellation/nonrenewal rules, privacy, electronic transactions (regulations.justia.com)
2 – Insurance Group
Group solvency, self-insurance, unfair claims settlement, capital and surplus rules
3 – Automobile Insurance
Policy standards, auto claim processes (physical damage, subrogation, timelines)
4 – Actuarial Services
Actuarial requirements for insurers
5 – Real Estate Commission
Real estate aspects related to insurance
6 – Workers’ Comp Managed Care
Requirements for WC managed care plans
7 – Insurance of Municipal Bonds
Regulation of bond & ABS insurance
10 – Dental Services
Standards for dental plan offerings
12 – Legal Insurance
Regulation of prepaid legal plans
13 – Commercial Lines Insurance
Rules on commercial multi-peril and liability insurance
15 – Group Self‑Insurance
Oversight of group self-insurers
16 – Fraud Prevention & Detection
Anti-fraud regulations and procedures
17A–D – Producer Standards
Licensing and conduct rules: marketing, conduct, financial handling, penalties
19 – Financial Examinations
Insurer audit and examination standards
20–24C – Health Insurance
Rules for individual, small-group, HMOs, third-party administrators, managed care
25 – Claims Ombudsman
Establishes an office to assist consumer claim issues
27 – Medical Malpractice
Malpractice policy requirements
28 – Captive Insurance
Rules governing captive insurance companies
Appendix
Includes forms, definitions, cross-references
🔍 Highlights from Key Chapters
Chapter 1 (Admin): Covers organization, rate filing processes, anti-discrimination rules, cancellation/renewal procedures, digital transactions, corporate governance, and privacy standards (regulations.justia.com).
Chapter 2, Subchapter 17 (Unfair Claims Settlement Practices): Sets clear mandates for fair, timely claim resolution, communication standards, and prohibiting misleading conduct (eagle-law.com).
Chapter 3 (Auto): Defines claim timelines (e.g., 7 days to inspect, 30-day payment), subrogation rules, loss-of-use reimbursement, estimate handling, and insurer obligations (nj.gov).
Chapter 2, Group self-insurance (e.g., workers' comp): Employers seeking self-insured status must submit financials, obtain surety bonding, undergo risk assessments, and may face regular exam/audit scrutiny (nj.gov).
📚 Authority & Updates
Title 11 derives authority from statutes like N.J.S.A. 17, 17B, 17:29B, 34:15, etc. (regulations.justia.com).
Effective dates vary by subchapter; e.g., Chapter 1 updated through March 2025, Chapter 2 readopted June 29, 2018 (law.cornell.edu).
RELATED Blog
0 comments