New Jersey Administrative Code
Title 11 - INSURANCE
Chapter 24A - HEALTH CARE QUALITY ACT APPLICATION TO INSURANCE COMPANIES, HEALTH SERVICE CORPORATIONS, HOSPITAL SERVICE CORPORATIONS, AND MEDICAL SERVICE CORPORATIONS
Subchapter 2 - PROVISIONS APPLICABLE TO ALL CARRIERS
Section 11:24A-2.7 - Violations

Universal Citation: NJ Admin Code 11:24A-2.7

Current through Register Vol. 56, No. 6, March 18, 2024

(a) The Commissioner may issue an order directing a carrier to cease and desist from an act or omission that violates a provision of the rules of this chapter that are applicable to the carrier, which order shall serve as constructive written notice to the carrier of an intent to levy a penalty for the violation of the rules, notwithstanding that a specific statement to that effect is not included in the order, if the order is followed by a written notice in compliance with (b)3 below.

1. A carrier shall have the right to request a hearing on the order within 20 days following the date of service of the order on the carrier, which shall be conducted in accordance with the Administrative Procedures Act, 52:14B-1 et seq., and the Uniform Administrative Procedure Rules, N.J.A.C. 1:1.
i. When requesting a hearing, the carrier shall specify in writing all reasons for which it disputes the order to cease and desist, enclose a copy of the order and verification of the date on which the order was served.

ii. When requesting a hearing, the carrier shall notify the Department of the request, providing the information set forth in (a)1i above.

2. The agency that issued the order to cease and desist shall determine whether to transfer the case to the Office of Administrative Law based upon the papers before it.

3. In the event that a civil penalty is to be levied in the circumstance in which an order to cease and desist is issued, the civil penalty shall not be effective until the rendering of a final agency decision on the matter in favor of the Department.

4. In the event that a civil penalty is to be levied in the circumstance in which an order to cease and desist is issued, the request for a hearing shall not toll the time for calculation of the penalty.

(b) If the Commissioner intends to levy a civil penalty against a carrier for violation of an applicable rule, the Commissioner shall provide the carrier with written notice of an intent to levy a penalty at least five business days prior to the date that the penalty shall be effective, except as (b)3 below applies.

1. Except as (b)3 below applies, written notice of an intent to levy a penalty shall provide the following information:
i. The rules the carrier has violated or is violating;

ii. The facts upon which the Commissioner is relying in determining that the carrier is in violation of a rule applicable to the carrier;

iii. The known duration of the violation, including a statement of whether the violation is believed to be continuing;

iv. The daily dollar amount of the penalty, which shall be no less than $ 250.00 and no more than $ 10,000 per day; and

v. The date upon which the levy of the penalty shall be effective.

2. In addition to (b)1 above, the Commissioner may, through the written notice of intent to levy a penalty, provide the carrier with an opportunity to reduce or eliminate the civil penalty, or toll the violation period through correction of the violation within a specified period of time, in which event, the written notice shall contain the following information:
i. The time period for correction of the violation, which shall be no less than 30 calendar days from the date of the written notice;

ii. The minimum actions that the carrier is required to take in order to determine at the end of the period whether the carrier has corrected the violation; and

iii. The effect of correction of the violation upon the levying of the civil penalty.

3. An order to cease and desist shall serve as a written notice of an intent to levy a penalty if followed within no more than five business days of the date of service of the order to cease and desist with a written notice including all of the statements required in (b)1 above, except that the effective date of the penalty may be the same as the date of the written notice.

(c) In accordance with the provisions of the act, the Commissioner may seek injunctive relief against a carrier.

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