New Jersey Administrative Code
Title 11 - INSURANCE
Chapter 22 - HEALTH BENEFIT PLANS
Subchapter 1 - PROMPT PAYMENT OF CLAIMS
Section 11:22-1.15 - Remediation/penalty

Universal Citation: NJ Admin Code 11:22-1.15

Current through Register Vol. 56, No. 18, September 16, 2024

(a) Upon review of the reports required by 11:22-1.14, the Commissioner may require that the carrier , ODS, or the agent of a carrier or ODS, at its own expense:

1. Implement a plan of remedial action; and/or

2. Have the claims processing procedures of the carrier or its agent be monitored by a private auditing firm for a period to be determined by the Commissioner.

(b) The Commissioner may impose a civil penalty of not more than $ 10,000 upon the carrier , ODS, or the agent of a carrier or ODS, to be collected pursuant to the Penalty Enforcement Law, 2A:58-1 et seq., if, following the remediation measures in (a) above, the Commissioner determines that:

1. An unreasonably large or disproportionate number of eligible claims continue to be disputed, denied or not paid in accordance with the time frames in N.J.A.C. 11:22-1.5; or

2. A carrier , ODS, or the agent of a carrier or ODS has failed to pay interest as required pursuant to 11:22-1.7.

(c) In addition to any other penalties provided by law, the Commissioner may impose a civil penalty as set forth at 17B:30-55 against any person found in violation of this subchapter based upon their having engaged in a pattern or practice of conduct as determined by the Commissioner.

Disclaimer: These regulations may not be the most recent version. New Jersey may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.