N.Y. Comp. Codes R. & Regs. tit. 11 § 70.1

Current through Register Vol. 46, No. 45, November 2, 2024

Section 70.1 - Definitions

(a) Medical malpractice insurance, as used in this Part, means insurance against legal liability of the insured and against loss, damage or expense incident to a claim of such liability arising out of the death or injury of any person due to medical or hospital malpractice by any licensed physician or hospital, as such latter term is defined in section 5501 (b) of the Insurance Law.

(b) No-consent policy, as used in this Part, means a policy which provides that the insurer has the sole authority to settle any claim, up to the policy limits, without the consent of the insured.

(c) Consent policy, as used in this Part, means:

(1) a policy which provides that the insurer may not settle any claim under the policy without the consent of the insured; or

(2) a policy which provides that if the insured shall refuse to consent to any settlement or compromise recommended by the insurer and acceptable to the claimant, and shall elect to contest the claim or proceeding, the damages exceeding the amount the insurer would have been liable for, at the time the claims or proceedings could have been settled or compromised, shall be the liability of the insured to indemnify the insurer. Such policy may or may not provide that the insured shall be liable to the insurer for defense costs incurred by the insurer subsequent to any proposed settlement or compromise; or

(3) a policy which contains a provision concerning the consent of the insured, which has been approved by the Insurance Department as being consistent with the intention of this subdivision.

(d) Claims-made policy means an insurance policy that covers liability for injury or damage that the insured is legally obligated to pay (including injury or damage occurring prior to the effective date of the policy, but subsequent to the retroactive date, if any), arising out of incidents, acts or omissions, as long as the claim is first made during the policy period or any extended reporting period (tail).

(e) Occurrence policy means an insurance policy that covers liability for injury or damage that the insured is legally obligated to pay arising out of incidents, acts or omissions that occurred during the policy period, and where a claim may be made during or subsequent to the policy period.

(f) Extended reporting period coverage, tail or tail coverage means that period of time specified in the policy wherein claims first made after the termination date of the policy, for injury or damage that occurs during the policy term, or that occurs on or after the retroactive date, if any, will be considered made during the policy term.

(g) Base year occurrence rate shall have the meaning ascribed to it in section 70.8(c) of this Part.

(h) Primary coverage shall mean a policy affording coverage up to $1 million per claimant and up to $3 million ($1 million/$3 million) for all claimants in any one year.

(i) Excess coverage shall mean a policy affording coverage above a primary coverage policy of $1 million/$3 million.

(j) Rating plan shall mean classifications, territories, corresponding relativities, rating rules and merit rating plans (pursuant to Part 152 of this Title [Regulation 124]).

(k) Retroactive date means a date concurrent with the effective date of the policy or a particular date prior to the effective date of the policy upon which the insurer and insured agree in the policy that policy coverage will be applicable.

(l) Insurer shall include the Medical Malpractice Insurance Association ("the Association" or "MMIA").

(m) Purchasing group means any group formed pursuant to the Federal Liability Risk Retention Act of 1986 (LRRA) (15 USC 3901 et seq.) (published by the U.S. Government Printing Office, Washington, DC. Copies may be obtained by writing to the Superintendent of Documents, U.S. Government Printing Office, Washington, DC 20402. In addition, copies are available for viewing and copying at the New York State Insurance Department, 25 Beaver Street, New York, NY 10004 and at the Albany Office of the Secretary of State, 41 State Street, Albany, NY 12231) and:

(1) has as one of its purposes the purchase of liability insurance on a group basis;

(2) purchases such insurance only for its group members and only to cover their similar or related liability exposure, as described in paragraph (3) of this subdivision;

(3) is composed of members whose business or activities are similar or related with respect to the liability to which members are exposed by virtue of any related, similar or common business, trade, product, services, premises or operations; and

(4) is domiciled in any state.

N.Y. Comp. Codes R. & Regs. Tit. 11 § 70.1