New Jersey Administrative Code
Title 11 - INSURANCE
Chapter 16 - FRAUD PREVENTION AND DETECTION
Subchapter 2 - REPORTS TO THE NATIONAL INSURANCE CRIME BUREAU
Section 11:16-2.7 - Deferred claim processing and payment
Universal Citation: NJ Admin Code 11:16-2.7
Current through Register Vol. 56, No. 18, September 16, 2024
(a) Notwithstanding any provision of Title 11 of the New Jersey Administrative Code to the contrary, an insurer shall defer the processing and payment of a claim filed under comprehensive or other coverage in accordance with the following:
1. No insurer shall pay a claim filed by an
insured under comprehensive or other coverage for the theft of a motor vehicle
or its major component parts unless said claim has first been reported to and
acknowledged by the NICB.
2. An
insurer shall defer the payment of a claim for five calendar days following
receipt of the acknowledgment from the NICB of the insurer's report. If no
further communication is received from the NICB during this five-day period
indicating unresolved questionable circumstances, the insurer shall continue
with the processing of the claim in accordance with the provisions of this
section and other provisions of Title 11 of the New Jersey Administrative
Code.
3. If the NICB indicates in
its response to the insurer that coverage is in effect by more than one insurer
for the same motor vehicle or that the motor vehicle has been previously
reported as stolen and unrecovered, or that previous claims on the vehicle have
been reported, the insurer shall promptly investigate and resolve such
discrepancy.
4. If the NICB
discovers an erroneous vehicle identification number (VIN) and the NICB is
unable to clear up such discrepancy internally, the NICB shall send a
questionnaire to the insurer. This questionnaire shall be returned within five
working days of receipt by the insurer. If the NICB and insurer are
unsuccessful, after due diligence, in resolving the VIN error after a 30-day
period from the date of the receipt by the insurer of sufficient information
from the insured, the insurer shall proceed with the processing of the loss
claim.
5. If the NICB indicates in
its response to the insurer or the insurer finds that it has reasonable cause
to believe that the loss may have been caused by the criminal or fraudulent act
of any person, the insurer shall suspend the processing of the claim and
promptly begin an investigation. The insurer shall promptly provide such
information to the NICB and shall cooperate fully with the NICB in its
investigation of criminal or fraudulent acts.
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