New Jersey Administrative Code
Title 11 - INSURANCE
Chapter 17 - PRODUCER LICENSING
Subchapter 6 - MANAGING GENERAL AGENTS
Section 11:17-6.6 - Claim processing requirements
Universal Citation: NJ Admin Code 11:17-6.6
Current through Register Vol. 56, No. 6, March 18, 2024
(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 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.
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