New Jersey Administrative Code
Title 11 - INSURANCE
Chapter 16 - FRAUD PREVENTION AND DETECTION
Subchapter 6 - FRAUD PREVENTION AND DETECTION PLANS
Section 11:16-6.1 - Purpose and scope

Universal Citation: NJ Admin Code 11:16-6.1

Current through Register Vol. 56, No. 24, December 18, 2024

(a) This subchapter sets forth the standards for a plan for the prevention and detection of fraudulent insurance applications and claims filed for approval pursuant to N.J.S.A. 17:33A-15 by insurers which transact the business of private passenger automobile insurance or health insurance in this State. These provisions apply to all insurers that transact the business of private passenger automobile insurance in New Jersey, including both personal and commercial coverage; and to all insurers transacting the business of health insurance as set forth in N.J.S.A. 17:33A-3 and N.J.A.C. 11:16-6.2.

(b) The subchapter also sets forth the reporting standards and forms necessary to refer insurance fraud matters to the Bureau of Fraud Deterrence and the Office of Insurance Fraud Prosecutor (OIFP) in accordance with N.J.S.A. 17:33A-1 et seq., as amended by P.L. 2010, c. 32. These provisions apply to all insurers as defined by N.J.S.A. 17:33A-3 and N.J.A.C. 11:16-6.2 including those with PAIP and CAIP assignments.

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