N.J. Admin. Code § 11:1-43.3

Current through Register Vol. 57, No. 1, January 6, 2025

Section 11:1-43.3 - Unusual hardship

(a) Pursuant to N.J.S.A. 17:30A-5 and 17:22-6.72, as applicable, a covered claim by the Association or Fund shall not include a claim filed with the Association or Fund, as applicable, after the final date set by the court for the filing of claims against the liquidator or receiver of an insolvent insurer, or, in the event a final date is not set by the court for the filing of claims against the liquidator or receiver of an insolvent insurer, two years from the date of the order of liquidation, unless the claimant demonstrates unusual hardship, as determined pursuant to this subchapter, and the Commissioner approves of the treatment of the claim as a covered claim.

(b) For purposes of (a) above, a claimant may show unusual hardship by filing information that demonstrates any of the following:

1. The claimant never received notice of the due date for filing claims;

i. The claimant shall be presumed to have received notice if the notice was timely mailed to the claimant's address currently on file with insurer;

2. The mailing address of the claimant in the insurer's records is erroneous, and the claimant demonstrates that he or she notified the insurer or its agent of a change in address;

3. The claimant was incapable of responding to the notice due to an emergent and extreme medical event or similar emergent and extreme circumstance;

4. The claimant is deceased, and the claimant's estate demonstrates that the death occurred within such a time period that the representative of the claimant's estate did not have sufficient time to advise the insurer or its agent of such circumstance; or

5. In the case of medical malpractice liability insurance claims, the claimant was less than 18 years of age at the time of the issuance of the notice of the due date for filing claims, the claimant's parent or guardian was unaware of the alleged malpractice prior to the due date for filing claims, and the claimant is no older than 20 years of age.

(c) Requests for treatment of a claim on the basis of unusual hardship shall contain the following information:

1. The name, address, social security number, telephone number, and date of birth of the claimant making the application;

2. The policy number;

3. The name of the insured, if different than the claimant;

4. A description of the particular reason(s) that constitute unusual hardship as set forth in (b) above; and

5. Copies of all documents required to support the request, including, but not limited to, as applicable:

i. Notice to the insurer or agent of change of address;

ii. Death certificate;

iii. Report from a physician that specifies the type of medical condition or injury that prevented the claimant from filing a timely claim, the date such condition or injury first occurred, the date treatment was initiated, and any other relevant information; and

iv. Any additional information or documentation the Association or Fund, as applicable, or the Commissioner may specifically request from a particular claimant.

(d) Completed requests shall be sent to the Association or Fund at:

New Jersey Property-Liability Insurance Guaranty Association

(or New Jersey Surplus Lines Insurance Guaranty Fund)

Unusual Hardship Request

222 Mount Airy Rd.

Basking Ridge, NJ 07920

(e) The Association or Fund, as applicable, shall notify the claimant, or his or her legal representative, by certified mail, return receipt requested, whether it has approved the request for a finding of unusual hardship. The Association or Fund shall concurrently file a copy of its determination with the Department. No determination by the Association or Fund, as applicable, to approve a request for a finding of unusual hardship shall be deemed to constitute acceptance of the claim otherwise as a covered claim or approval of any payment of the claim.

N.J. Admin. Code § 11:1-43.3

Amended by R.2006 d.307, effective 9/5/2006.
See: 37 N.J.R. 4156(a), 38 N.J.R. 3586(a).
Rewrote (a) and address in (d).
Amended by R.2011 d.189, effective 7/5/2011.
See: 43 N.J.R. 2197(a), 43 N.J.R. 1532(a).
In (b)3, deleted "or" from the end; in (b)4, substituted "; or" for a period at the end; and added (b)5.