N.J. Admin. Code § 11:17-6.6

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

Section 11:17-6.6 - Claim processing requirements

(a) If the contract between the MGA and the insurer permits the MGA to settle claims on behalf of the insurer the MGA shall comply with the requirements governing the settlement of claims set forth in N.J.S.A. 17:29B-4, 17B:30-13.1 and 17B:30-13.2 as applicable and any regulations promulgated by the Commissioner thereunder. In addition:

1. All claims shall be reported to the company within 30 days of a claim being reported to the MGA, unless otherwise specified with the insurer; and

2. A copy of the claim file shall be sent to the insurer at its request or as soon as it becomes known that the claim:

i. Has the potential to exceed $ 1,000,000 or exceeds the limit set by the insurer, whichever is less;

ii. Involves a coverage dispute;

iii. May exceed the managing general agent's claims settlement authority;

iv. Is open for more than six months; or

v. Is closed by payment of $ 1,000,000 or an amount set by the insurer, whichever is less.

N.J. Admin. Code § 11:17-6.6