Title 11 NCAC — Insurance

title-1111 NCACRegulation

Open source

Chapter 01 Departmental Rules

11 NCAC 01 .0101 Name and Purpose {#sec-11-ncac-01-.0101 omnilex-key=us-nc-regs-official--title-11--11 NCAC 01 .0101}

History

  • Status: repealed
  • Authority G.S. 58-2; 58-4
  • Eff. February 1, 1976
  • Readopted Eff. May 12, 1978
  • Repealed Eff. July 1, 1988.
11 NCAC 01 .0102 Definitions {#sec-11-ncac-01-.0102 omnilex-key=us-nc-regs-official--title-11--11 NCAC 01 .0102}

History

  • Status: repealed
  • Authority G.S. 58-2; 58-4
  • Eff. February 1, 1976
  • Readopted Eff. May 12, 1978
  • Repealed Eff. July 1, 1988.
11 NCAC 01 .0103 Location and Mailing Address {#sec-11-ncac-01-.0103 omnilex-key=us-nc-regs-official--title-11--11 NCAC 01 .0103}

(a) The primary location of the North Carolina Department of Insurance is 3200 Beechleaf Court, Raleigh, North Carolina. The Piedmont Regional Office is located at 106 Baker Road, Archdale, North Carolina. The Whiteville Regional Office is located at 2 Whiteville Plaza, Whiteville, North Carolina. The Gastonia Regional Office is located at 1422 Burtonwood Drive, Suite 101, Gastonia, North Carolina.

(b) The mailing address for the North Carolina Department of Insurance is 1201 Mail Service Center, Raleigh, NC 27699-1201. The mailing address for the Piedmont Regional Office is 106 Baker Road, Archdale, NC 27263. The mailing address for the Whiteville Regional Office is 2 Whiteville Plaza, Whiteville, NC 27842. The mailing address for the Gastonia Regional Office is 1422 Burtonwood Drive, Gastonia, NC 28054.

(c) The Department's normal working hours shall be between 8:00 a.m. and 5:00 p.m., Monday through Friday, except for State recognized holidays as set forth in 25 NCAC 01E .0901.

History

  • Authority G.S. 58-2-1; 58-2-40
  • Eff. February 1, 1976
  • Readopted Eff. May 12, 1978
  • Amended Eff. January 1, 2018; November 1, 2005; July 1, 1992; September 1, 1988
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. April 27, 2019
  • Amended Eff. February 1, 2024.
11 NCAC 01 .0104 Office Hours {#sec-11-ncac-01-.0104 omnilex-key=us-nc-regs-official--title-11--11 NCAC 01 .0104}

History

  • Status: repealed
  • Authority G.S. 58-4; 58-5; 58-9
  • Eff. February 1, 1976
  • Readopted Eff. May 12, 1978
  • Repealed Eff. August 1, 1988.
11 NCAC 01 .0105 Commissioner of Insurance {#sec-11-ncac-01-.0105 omnilex-key=us-nc-regs-official--title-11--11 NCAC 01 .0105}

History

  • Status: repealed
  • Authority G.S. 58-4; 58-5; 58-9
  • Eff. February 1, 1976
  • Readopted Eff. May 12, 1978
  • Repealed Eff. August 1, 1988.
11 NCAC 01 .0106 Organization of the Department {#sec-11-ncac-01-.0106 omnilex-key=us-nc-regs-official--title-11--11 NCAC 01 .0106}

History

  • Status: repealed
  • Authority G.S. 58-2-25; 58-2-40
  • Eff. February 1, 1976
  • Readopted Eff. May 12, 1978
  • Amended Eff. August 1, 1988; June 1, 1985
  • Repealed Eff. August 3, 1992.
11 NCAC 01 .0107 Public Information and Departmental Records {#sec-11-ncac-01-.0107 omnilex-key=us-nc-regs-official--title-11--11 NCAC 01 .0107}

Departmental records that are properly deemed to be public information may be reproduced upon request. The request must be made in writing and directed to the head of the appropriate division. Reproduction of departmental records will be permitted on a discretionary basis depending on the volume of the request and the availability of personnel to make the reproductions. Fees will be charged in accordance with the applicable General Statutes of North Carolina.

History

  • Authority G.S. 58-2-1; 58-2-40
  • Eff. February 1, 1976
  • Readopted Eff. May 12, 1978
  • Amended Eff. August 1, 1988
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. April 27, 2019.
11 NCAC 01 .0108 Definitions and Rules of Construction for This Title {#sec-11-ncac-01-.0108 omnilex-key=us-nc-regs-official--title-11--11 NCAC 01 .0108}

(a) The definitions contained in G.S. 58-1-5 are incorporated in this Title by reference.

(b) The rules of construction contained in G.S. 12-3 apply in the construction of this Title.

History

  • Authority G.S. 58-2-40(1)
  • Eff. January 1, 1993
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. April 27, 2019.
11 NCAC 01 .0201 Location of and Inspection of Departmental Rules {#sec-11-ncac-01-.0201 omnilex-key=us-nc-regs-official--title-11--11 NCAC 01 .0201}

(a) Location of Departmental Rules. All rules for the Department and all codes, standards and rules adopted by reference are located in the Hearings Office of the Department of Insurance.

(b) Inspection of Rules. Any person desiring to inspect the rules of the Department shall so notify the Deputy Commissioner of the North Carolina Department of Insurance in charge of the Hearings Office.

History

  • Authority G.S. 58-2-40; 150B-21
  • Eff. February 1, 1976
  • Readopted Eff. May 12, 1978
  • Amended Eff. December 1, 1994; July 1, 1992; June 1, 1985
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. April 27, 2019.
11 NCAC 01 .0202 Former Departmental Regulations Retained/Cited {#sec-11-ncac-01-.0202 omnilex-key=us-nc-regs-official--title-11--11 NCAC 01 .0202}

History

  • Status: repealed
  • Authority G.S. 58-9
  • Eff. February 1, 1976
  • Readopted Eff. May 12, 1978
  • Repealed Eff. July 1, 1988.
11 NCAC 01 .0203 Petition for Adoption: Amendment or Repeal of Rules {#sec-11-ncac-01-.0203 omnilex-key=us-nc-regs-official--title-11--11 NCAC 01 .0203}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 150B-12
  • Eff. February 1, 1976
  • Readopted Eff. May 12, 1978
  • Amended Eff. August 1, 1988; June 1, 1985
  • Repealed Eff. July 1, 1992.
11 NCAC 01 .0204 Notice of Rule-Making Hearings {#sec-11-ncac-01-.0204 omnilex-key=us-nc-regs-official--title-11--11 NCAC 01 .0204}

Notice of rule-making hearings will be given in accordance with the provisions of Part 2 of Article 2A of General Statute Chapter 150B.

History

  • Authority G.S. 150B-21.1; 150B-21.2; 150B-21.4; 150B-21.5
  • Eff. February 1, 1976
  • Readopted Eff. May 12, 1978
  • Amended Eff. July 1, 1992; August 1, 1988
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. April 27, 2019.
11 NCAC 01 .0205 Rule-Making Hearings: General Information {#sec-11-ncac-01-.0205 omnilex-key=us-nc-regs-official--title-11--11 NCAC 01 .0205}

The hearing officer shall have complete control of the proceedings, including extensions of any time requirements, order of presentations, time allotments for presentations, direction of the flow of the discussion and the management of the hearing. Each person participating in the hearing shall be given a fair opportunity to present views, data and comments.

History

  • Authority G.S. 150B-12
  • Eff. February 1, 1976
  • Readopted Eff. May 12, 1978
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. April 27, 2019.
11 NCAC 01 .0206 Oral/Written Presentations at Rule-Making Hearings {#sec-11-ncac-01-.0206 omnilex-key=us-nc-regs-official--title-11--11 NCAC 01 .0206}

History

  • Status: repealed
  • Authority G.S. 150B-12; 150B-13
  • Eff. February 1, 1976
  • Readopted Eff. May 12, 1978
  • Amended Eff. June 1, 1985
  • Repealed Eff. July 1, 1988.
11 NCAC 01 .0207 Request for Notice of Rule-Making Hearings {#sec-11-ncac-01-.0207 omnilex-key=us-nc-regs-official--title-11--11 NCAC 01 .0207}

History

  • Status: repealed
  • Authority G.S. 150B-12; 150B-13
  • Eff. February 1, 1976
  • Readopted Eff. May 12, 1978
  • Amended Eff. June 1, 1985
  • Repealed Eff. July 1, 1988.
11 NCAC 01 .0208 Emergency Rules {#sec-11-ncac-01-.0208 omnilex-key=us-nc-regs-official--title-11--11 NCAC 01 .0208}

History

  • Status: repealed
  • Authority G.S. 150B-12; 150B-13
  • Eff. February 1, 1976
  • Readopted Eff. May 12, 1978
  • Amended Eff. June 1, 1985
  • Repealed Eff. July 1, 1988.
11 NCAC 01 .0209 Instructions for Filing a Petition for Rule-Making {#sec-11-ncac-01-.0209 omnilex-key=us-nc-regs-official--title-11--11 NCAC 01 .0209}

(a) Any person may petition the Department to adopt a new rule, or amend or repeal an existing rule by submitting a rulemaking petition to the Department. The petition must be titled "Petition for Rulemaking", must be in writing, must be signed by the person submitting the petition, and must include the following information:

(1) the name and address of the person submitting the petition;

(2) a citation to any rule for which an amendment or repeal is requested;

(3) a draft of any proposed rule or amended rule;

(4) an explanation of why the new rule or amendment or repeal of an existing rule is requested and the reason for the request;

(5) the effect of the new rule, amendment, or repeal on existing rules or orders, or both, and on the procedures of the Department;

(6) any other information the person submitting the petition considers relevant.

(b) The Commissioner must decide whether to grant or deny a petition for rulemaking within 30 days of receiving the petition. In making his decision, the Commissioner will consider the information submitted with the petition and any other relevant information.

(c) When the Commissioner denies a petition for rulemaking, he must send written notice of the denial to the person who submitted the request. The notice must state the reason for the denial. When the Commissioner grants a rulemaking petition, he must initiate rulemaking proceedings and send written notice of the proceedings to the person who submitted the request.

History

  • Authority G.S. 58-2-40(1); 150B-20
  • Eff. July 1, 1992
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. April 27, 2019.
11 NCAC 01 .0301 Declaratory Rulings: General Information {#sec-11-ncac-01-.0301 omnilex-key=us-nc-regs-official--title-11--11 NCAC 01 .0301}

(a) Declaratory rulings pursuant to G.S. 150B-4 shall be issued by the Department only:

(1) as to the validity of a rule adopted by the Department; or

(2) as to the applicability to a given state of facts of:

(A) a statute administered by the Department,

(B) a rule adopted by the Department, or

(C) an order issued by the Department.

(b) A declaratory ruling shall not be issued on a matter requiring an evidentiary proceeding.

History

  • Authority G.S. 58-2-40(1); 150B-4
  • Eff. February 1, 1976
  • Readopted Eff. May 12, 1978
  • Amended Eff. March 1, 2011; July 1, 1992; August 1, 1988
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. April 27, 2019.
11 NCAC 01 .0302 Petition for Declaratory Ruling {#sec-11-ncac-01-.0302 omnilex-key=us-nc-regs-official--title-11--11 NCAC 01 .0302}

(a) Petitioner Must Possess Interest. The petitioner must possess such an interest in the question to be ruled on that the petitioner's need to have such a ruling in order to comply with statutory requirements, departmental rules, or departmental policy shall be apparent from the petition and shall be fully explained therein.

(b) Form and Content of Petition. The petition shall be typewritten and shall contain the name and address of the petitioner, the specific factual situation involved, the question or questions sought to be answered, and the identification of the rules, statutes, or orders applicable to the question presented.

(c) Written Brief May Be Submitted. The petitioner may submit a written brief, but oral argument shall not be allowed unless deemed necessary by the commissioner.

(d) Mailing Address. All requests for declaratory rulings shall be mailed to: Commissioner of Insurance, P.O. Box 26387, Raleigh, North Carolina 27611.

History

  • Authority G.S. 58-2-40(1); 150B-4
  • Eff. February 1, 1976
  • Readopted Eff. May 12, 1978
  • Amended Eff. August 1, 1988
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. April 27, 2019.
11 NCAC 01 .0303 Response of Commissioner to Petition {#sec-11-ncac-01-.0303 omnilex-key=us-nc-regs-official--title-11--11 NCAC 01 .0303}

(a) Written Response. A written response to the petition for a declaratory ruling, whether in the form of a declaratory ruling or a refusal to issue a declaratory ruling, shall be signed by the commissioner or his designated representative within 60 days following the date on which the petition was received by the department.

(b) Refusal to Issue Declaratory Ruling. The commissioner may refuse to issue a declaratory ruling if one of the following circumstances exists:

(1) The subject matter is one in which the commissioner has no authority to issue a binding deci­sion;

(2) The situation is one in which the amount of work that would be required by the commissioner and his staff to issue the declaratory ruling would be the same as or greater than the work required to process the request through normal departmental procedures or a contested case proceeding;

(3) The petition does not state with enough specificity the factual situation involved, or the ques­tion is presented in such a manner that the commissioner cannot determine what the question is, or that the commissioner cannot respond with a specific ruling that will be binding on all parties;

(4) The petitioner does not, in the opinion of the commissioner, possess sufficient interest in the question to be ruled on; or

(5) For any other reason the commissioner finds the issuance of a declaratory ruling to be unde­sir­able.

History

  • Authority G.S. 58-2-40(1); 150B-4
  • Eff. February 1, 1976
  • Readopted Eff. May 12, 1978
  • Amended Eff. August 1, 1988
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. April 27, 2019.
11 NCAC 01 .0401 Right to Hearing {#sec-11-ncac-01-.0401 omnilex-key=us-nc-regs-official--title-11--11 NCAC 01 .0401}

Whenever the Department acts in such a way as to affect the rights, duties or privileges of a specific identified party, the party may appeal for a final decision by the Department in accordance with this Section and Article 3A of G.S. 150B.

History

  • Authority G.S. 58-2-40; 150B-38
  • Eff. February 1, 1976
  • Readopted Eff. May 12, 1978
  • Amended Eff. July 1, 1992; August 1, 1988
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. April 27, 2019.
11 NCAC 01 .0402 Informal Settlement {#sec-11-ncac-01-.0402 omnilex-key=us-nc-regs-official--title-11--11 NCAC 01 .0402}

History

  • Status: repealed
  • Authority G.S. 58-2-40
  • Eff. February 1, 1976
  • Readopted Eff. May 12, 1978
  • Repealed Eff. August 3, 1992.
11 NCAC 01 .0403 Request for Hearing {#sec-11-ncac-01-.0403 omnilex-key=us-nc-regs-official--title-11--11 NCAC 01 .0403}

(a) A request for an administrative hearing under 11 NCAC 01 .0401 must be in writing and shall contain the following information:

(1) name and address of the person requesting the hearing,

(2) a statement of the departmental action being challenged,

(3) a statement of the manner in which the petitioner is aggrieved, and

(4) a specific demand for a public hearing.

(b) The request for hearing shall be filed with: General Counsel, N.C. Department of Insurance, 1201 Mail Service Center, Raleigh, NC 27699-1201.

History

  • Authority G.S. 58-2-40; 150B-38
  • Eff. February 1, 1976
  • Readopted Eff. May 12, 1978
  • Amended Eff. August 1, 2004; December 1, 1994; July 1, 1992; October 1, 1988; June 1, 1985
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. April 27, 2019.
11 NCAC 01 .0404 Granting or Denying Hearing Requests {#sec-11-ncac-01-.0404 omnilex-key=us-nc-regs-official--title-11--11 NCAC 01 .0404}

History

  • Status: repealed
  • Authority G.S. 158-9
  • Eff. February 1, 1976
  • Readopted Eff. May 12, 1978
  • Repealed Eff. September 1, 1988.
11 NCAC 01 .0405 Notice of Hearing {#sec-11-ncac-01-.0405 omnilex-key=us-nc-regs-official--title-11--11 NCAC 01 .0405}

History

  • Status: repealed
  • Authority G.S. 58-2-50; 150B-23
  • Eff. February 1, 1976
  • Readopted Eff. May 12, 1978
  • Repealed Eff. July 1, 1992.
11 NCAC 01 .0406 Failure to Appear at Hearing {#sec-11-ncac-01-.0406 omnilex-key=us-nc-regs-official--title-11--11 NCAC 01 .0406}

History

  • Status: repealed
  • Authority G.S. 150B-39
  • Eff. February 1, 1976
  • Readopted Eff. May 12, 1978
  • Repealed Eff. September 1, 1988.
11 NCAC 01 .0407 Intervention in an Administrative Hearing {#sec-11-ncac-01-.0407 omnilex-key=us-nc-regs-official--title-11--11 NCAC 01 .0407}

History

  • Status: repealed
  • Authority G.S. 1A-1; 150B-28; 150B-38; 150B-39; 150B-40
  • Eff. February 1, 1976
  • Readopted Eff. May 12, 1978
  • Amended Eff. August 1, 1988; June 1, 1985
  • Repealed Eff. July 1, 1992.
11 NCAC 01 .0408 Depositions {#sec-11-ncac-01-.0408 omnilex-key=us-nc-regs-official--title-11--11 NCAC 01 .0408}

History

  • Status: repealed
  • Authority G.S. 1A-1; 150B-28; 150B-38; 150B-39; 150B-40
  • Eff. February 1, 1976
  • Readopted Eff. May 12, 1978
  • Amended Eff. August 1, 1988; June 1, 1985
  • Repealed Eff. July 1, 1992.
11 NCAC 01 .0409 Subpoenas {#sec-11-ncac-01-.0409 omnilex-key=us-nc-regs-official--title-11--11 NCAC 01 .0409}

History

  • Status: repealed
  • Authority G.S. 1A-1; 150B-28; 150B-38; 150B-39; 150B-40
  • Eff. February 1, 1976
  • Readopted Eff. May 12, 1978
  • Amended Eff. August 1, 1988; June 1, 1985
  • Repealed Eff. July 1, 1992.
11 NCAC 01 .0410 Service of Subpoenas {#sec-11-ncac-01-.0410 omnilex-key=us-nc-regs-official--title-11--11 NCAC 01 .0410}

History

  • Status: repealed
  • Authority G.S. 1A-1; 150B-28; 150B-38; 150B-39; 150B-40
  • Eff. February 1, 1976
  • Readopted Eff. May 12, 1978
  • Amended Eff. August 1, 1988; June 1, 1985
  • Repealed Eff. July 1, 1992.
11 NCAC 01 .0411 Objection to a Subpoena {#sec-11-ncac-01-.0411 omnilex-key=us-nc-regs-official--title-11--11 NCAC 01 .0411}

History

  • Status: repealed
  • Authority G.S. 1A-1; 150B-28; 150B-38; 150B-39; 150B-40
  • Eff. February 1, 1976
  • Readopted Eff. May 12, 1978
  • Amended Eff. August 1, 1988; June 1, 1985
  • Repealed Eff. July 1, 1992.
11 NCAC 01 .0412 Appeals to the Commissioner {#sec-11-ncac-01-.0412 omnilex-key=us-nc-regs-official--title-11--11 NCAC 01 .0412}

History

  • Status: repealed
  • Authority G.S. 58-155.49, -155.83, -173.11, -173.23, -248.39
  • Eff. May 12, 1978
  • Repealed Eff. August 1, 1988.
11 NCAC 01 .0413 Definitions {#sec-11-ncac-01-.0413 omnilex-key=us-nc-regs-official--title-11--11 NCAC 01 .0413}

The definitions contained in G.S. 150B-2 are incorporated in this Section by reference. In addition to those definitions, the following definitions apply to this Section:

(1) "File or filing" means to place or the placing of the paper or item to be filed into the care and custody of the hearing officer, and acceptance thereof by him. All documents filed with the hearing officer, except exhibits, shall be in duplicate in letter size 8 1/2" by 11".

(2) "Hearing officer" means the Commissioner, a member of the Commissioner's staff appointed by the Commissioner under G.S. 58-2-55, or an administrative law judge assigned under G.S. 58-2-55.

(3) "Party" means the Department, the licensee, or an intervenor who qualifies under 11 NCAC 1 .0425.

(4) "Service or serve" means personal delivery or, unless otherwise provided by law or rule, delivery by first class United States Postal Service mail or a licensed overnight express mail service, postage prepaid and addressed to the person to be served at his or her last known address. A certificate of service by the person making the service shall be appended to every document requiring service under this Section. Service by mail or licensed overnight express mail is complete upon placing the item to be served, enclosed in a wrapper addressed to the person to be served, in an official depository of the United States Postal Service; or postage prepaid and wrapped in a wrapper addressed to the person to be served, to an agent of the overnight express mail service.

History

  • Authority G.S. 58-2-40(1); 58-2-50; 58-2-55; 58-2-70; 150B-38(h)
  • Eff. July 1, 1992
  • Amended Eff. April 1, 1995
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. April 27, 2019.
11 NCAC 01 .0414 General Provisions {#sec-11-ncac-01-.0414 omnilex-key=us-nc-regs-official--title-11--11 NCAC 01 .0414}

Governed by the principles of fairness, uniformity, and punctuality, the following general provisions apply to this Section:

(1) The Rules of Civil Procedure as contained in G.S. 1A-1 and the General Rules of Practice for the Superior and District Courts as authorized by G.S. 7A-34 and found in the Rules Volume of the North Carolina General Statutes apply in contested cases before the Commissioner unless another specific statute or rule provides otherwise.

(2) The Department may supply, at the cost for copies specified in G.S. 58-6-5(3), forms for use in contested cases.

(3) Every document filed with the hearing officer shall be signed by the author of the document, and shall contain his name, address, telephone number, and North Carolina State Bar number if the author is an attorney. An original and one copy of each document shall be filed.

(4) Except as otherwise provided by statute, the rules contained in this Section govern the conduct of contested case hearings under Chapter 58 of the General Statutes.

(5) The content and the manner of service of the notice of hearing shall be as specified in G.S. 150B-38(b) and (c) and in 11 NCAC 1 .0413(4).

(6) Venue in a contested case shall be determined in accordance with G.S. 150B-38(e).

(7) Hearings shall be conducted, as nearly as practical, in accordance with the practice in the Trial Division of the General Court of Justice.

(8) Ex parte communications in a contested case are governed by G.S. 150B-40(d).

(9) This Section and copies of all matter adopted by reference in this Section are available from the Department at the cost established in G.S. 58-6-5(3).

(10) The rules of statutory construction contained in Chapter 12 of the General Statutes apply in the construction of this Section.

(11) Unless otherwise provided in a specific statute, time computations in contested cases under this Section are governed by G.S. 1A-1, Rule 6.

History

  • Authority G.S. 58-2-40(1); 58-2-50; 58-2-55; 58-2-70; 150B-38(h)
  • Eff. July 1, 1992
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. April 27, 2019.
11 NCAC 01 .0415 Order for Prehearing Statements {#sec-11-ncac-01-.0415 omnilex-key=us-nc-regs-official--title-11--11 NCAC 01 .0415}

The hearing officer may serve all parties with an order for prehearing statements together with, or after service of, the notice of hearing. Every party thus served shall, within 30 days after service, file the requested statements setting out the party's present position on the following:

(1) The nature of the proceeding and the issues to be resolved;

(2) A brief statement of the facts and reasons supporting the party's position on each matter in dispute;

(3) A list of proposed witnesses with a brief description of his or her proposed testimony;

(4) A description of what discovery, if any, the party will seek to conduct prior to the contested case hearing and an estimate of the time needed to complete discovery;

(5) Venue considerations;

(6) Estimation of length of the hearing;

(7) The name, address, and telephone number of the party's attorney, if any; and

(8) Other special matters.

History

  • Authority G.S. 58-2-40(1); 58-2-50; 58-2-55; 58-2-70; 150B-38(h)
  • Eff. July 1, 1992
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. April 27, 2019.
11 NCAC 01 .0416 Duties of the Hearing Officer {#sec-11-ncac-01-.0416 omnilex-key=us-nc-regs-official--title-11--11 NCAC 01 .0416}

In conjunction with the powers in this Section, in General Statute Chapter 58, and in Article 3A of General Statute Chapter 150B, the hearing officer shall perform the following duties, consistent with law:

(1) Hear and rule on motions;

(2) Grant or deny continuances;

(3) Issue orders regarding prehearing matters, including directing the appearance of the parties at a prehearing conference;

(4) Examine witnesses when deemed to be necessary to make a complete record and to aid in the full development of material facts in the case;

(5) Make preliminary, interlocutory, or other orders as deemed to be appropriate;

(6) Order a summary disposition of the case or any part thereof when there is no genuine issue as to any material fact or recommend dismissal when the case or any part thereof has become moot or for other reasons; and

(7) Apply sanctions in accordance with 11 NCAC 01 .0423.

History

  • Authority G.S. 58-2-40(1); 58-2-50; 58-2-55; 58-2-70; 150B-38(h)
  • Eff. July 1, 1992
  • Amended Eff. August 1, 2004
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. April 27, 2019.

Informal disposition may be made of a contested case or an issue in a contested case by stipulation, agreement, or consent order at any time during the proceedings. Parties may enter into such agreements on their own or may ask for a settlement conference with the hearing officer to promote consensual disposition of the case.

History

  • Authority G.S. 58-2-40(1); 58-2-50; 58-2-55; 58-2-70; 150B-38(h)
  • Eff. July 1, 1992
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. April 27, 2019.
11 NCAC 01 .0418 Settlement Conference {#sec-11-ncac-01-.0418 omnilex-key=us-nc-regs-official--title-11--11 NCAC 01 .0418}

(a) A settlement conference is for the primary purpose of assisting the parties in resolving disputes and for the secondary purpose of narrowing the issues and preparing for hearing.

(b) Upon the request of any party, the hearing officer shall assign the case to another hearing officer appointed by the Commissioner under G.S. 58-2-55 for the purpose of conducting a settlement conference. Unless the parties and the other hearing officer agree, a unilateral request for a settlement conference does not constitute good cause for a continuance. The conference shall be conducted at a time and place agreeable to all parties and the hearing officer. It shall be conducted by telephone if any party would be required to travel more than 50 miles to attend, unless that party agrees to travel to the location set for the conference. If a telephone conference is scheduled, the parties must be available by telephone at the time of the conference.

(c) All parties shall attend or be represented at a settlement conference. Parties or their representatives shall be prepared to participate in settlement discussions.

(d) The parties shall discuss the possibility of settlement before a settlement conference if they believe that a reasonable basis for settlement exists.

(e) At the settlement conference, the parties shall be prepared to provide information and to discuss all matters required in 11 NCAC 01 .0415.

History

  • Authority G.S. 58-2-40(1); 58-2-50; 58-2-55; 58-2-70; 150B-38(h)
  • Eff. July 1, 1992
  • Amended Eff. August 1, 2004
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. April 27, 2019.
11 NCAC 01 .0419 Prehearing Conference {#sec-11-ncac-01-.0419 omnilex-key=us-nc-regs-official--title-11--11 NCAC 01 .0419}

(a) The purpose of the prehearing conference is to simplify the issues to be determined; to obtain stipulations in regard to foundations for testimony or exhibits; to obtain stipulations of agreement on undisputed facts or the application of particular laws; to consider the proposed witnesses for each party; to identify and exchange documentary evidence intended to be introduced at the hearing; to determine deadlines for the completion of any discovery; to establish hearing dates and locations if not previously set; to consider such other matters that may be necessary or advisable; and, if possible, to reach a settlement without the necessity for further hearing. Any final settlement shall be set forth in a settlement agreement or consent order and made a part of the record.

(b) Upon the request of any party or upon the hearing officer's own motion, the hearing officer may hold a prehearing conference before a contested case hearing. The hearing officer may require the parties to file prehearing statements in accordance with 11 NCAC 01 .0415. A prehearing conference shall be an informal proceeding conducted expeditiously by the hearing officer. Agreements on the simplification of issues, amendments, stipulations, or other matters may be entered on the record or may be made the subject of an order by the hearing officer. Venue for purposes of a prehearing conference shall be determined in accordance with G.S. 150B-38(e).

History

  • Authority G.S. 58-2-40(1); 58-2-50; 58-2-55; 58-2-70; 150B-38(h)
  • Eff. July 1, 1992
  • Amended Eff. May 1, 2008
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. April 27, 2019.
11 NCAC 01 .0420 Consolidation of Cases {#sec-11-ncac-01-.0420 omnilex-key=us-nc-regs-official--title-11--11 NCAC 01 .0420}

(a) The hearing officer may order a joint hearing of any matters at issue in contested cases involving common questions of law or fact or multiple proceedings involving the same or related parties, or may order the cases consolidated or make other orders to reduce costs or delay in the proceedings.

(b) A party requesting consolidation shall serve a petition for consolidation on all parties to the cases to be consolidated and shall file the original with the hearing officer, together with a certificate of service showing service on all parties as herein required. Any party objecting to the petition shall serve and file his objections within 10 days after service of the petition for consolidation.

(c) Upon determining whether cases should be consolidated, the hearing officer shall serve a written order on all parties that contains a description of the cases for consolidation and the reasons for the decision.

(d) Nothing contained in this Rule prohibits the parties from stipulating and agreeing to a consolidation, which shall be granted upon submittal of a written stipulation, signed by every party, to the hearing officer.

(e) Following receipt of a notice of or order for consolidation, any party may petition for severance by serving it on all other parties and filing with the hearing officer at least seven days before the first scheduled hearing date. If the hearing officer finds that the consolidation will prejudice any party, he shall order the severance or other relief that will prevent the prejudice from occurring.

History

  • Authority G.S. 58-2-40(1); 58-2-50; 58-2-55; 58-2-70; 150B-38(h)
  • Eff. July 1, 1992
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. April 27, 2019.
11 NCAC 01 .0421 Discovery {#sec-11-ncac-01-.0421 omnilex-key=us-nc-regs-official--title-11--11 NCAC 01 .0421}

(a) Discovery methods are means designed to assist parties in preparing to meet their responsibilities and protect their rights during hearings without unduly delaying, burdening or complicating the hearings process and with due regard to the rights and responsibilities of other parties and persons affected. Accordingly, parties are obligated to exhaust all less formal opportunities to obtain discoverable material before utilizing this Rule.

(b) Any means of discovery available pursuant to the North Carolina Rules of Civil Procedure, G.S. 1A-1, is allowed. If the party from whom discovery is sought objects to the discovery, the party seeking the discovery may file a motion with the hearing officer to obtain an order compelling discovery. In the disposition of the motion, the party seeking discovery shall have the burden of showing that the discovery is needed for the proper presentation of the party's case, is not for purposes of delay, and that the issues in controversy are significant enough to warrant the discovery. In ruling on a motion for discovery, the hearing officer shall recognize all privileges recognized at law.

(c) When a party serves another party with a request for discovery, that request need not be filed with the hearing officer but shall be served upon all parties.

(d) The parties shall immediately commence to exchange information voluntarily, to seek access as provided by law to public documents, and to exhaust other informal means of obtaining discoverable material.

(e) All discovery shall be completed no later than the first day of the hearing. The hearing officer may shorten or lengthen the period for discovery and adjust hearing dates accordingly and, when necessary, allow discovery during the pendency of the hearing.

(f) No later than 15 days after receipt of a notice requesting discovery, the receiving party shall:

(1) move for relief from the request;

(2) provide the requested information, material or access; or

(3) offer a schedule for reasonable compliance with the request.

(g) Sanctions for failure of a party to comply with an order of the hearing officer made pursuant to this Rule shall be as provided for by G.S. 1A-1, Rule 37, to the extent that a hearing officer may impose such sanctions, and 11 NCAC 1 .0423.

History

  • Authority G.S. 58-2-40(1); 58-2-50; 58-2-55; 58-2-70; 150B-38(h)
  • Eff. July 1, 1992
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. April 27, 2019.
11 NCAC 01 .0422 Subpoenas {#sec-11-ncac-01-.0422 omnilex-key=us-nc-regs-official--title-11--11 NCAC 01 .0422}

(a) Subpoenas for the attendance and testimony of witnesses or for the production of documents, either at a hearing or for the purposes of discovery, shall be issued in accordance with G.S. 150B-39(c) and G.S. 1A-1 Rule 45.

(b) A subpoena shall be served in the manner provided by G.S. 150B-39(c) and G.S. 1A-1, Rule 45. The cost of service, fees, and expenses of any witnesses subpoenaed shall be paid by the party at whose request the witness appears. A party seeking an order imposing sanctions for failure to comply with any subpoena issued under this Rule must prove proper service of the subpoena.

(c) Objections to subpoenas shall be heard in accordance with G.S. 150B-39(c) and G.S. 1A-1, Rule 45.

History

  • Authority G.S. 58-2-40(1); 58-2-50; 58-2-55; 58-2-70; 150B-38(h)
  • Eff. July 1, 1992
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. April 27, 2019.
11 NCAC 01 .0423 Sanctions {#sec-11-ncac-01-.0423 omnilex-key=us-nc-regs-official--title-11--11 NCAC 01 .0423}

(a) If a party fails to appear at a hearing or fails to comply with an interlocutory order of the hearing officer, the hearing officer may:

(1) Find that the allegations of or the issues set out in the notice of hearing or other pleading may be taken as true or deemed to be proved without further evidence;

(2) Dismiss or grant the motion or petition;

(3) Suppress a claim or defense; or

(4) Exclude evidence.

(b) In the event that any party, attorney at law, or other representative of a party engages in behavior that obstructs the orderly conduct of proceedings or would constitute contempt if done in the General Court of Justice, the hearing officer may enter a show cause order returnable in Superior Court for contempt proceedings in accordance with G.S. 150B-40(c)(6).

History

  • Authority G.S. 58-2-40(1); 58-2-50; 58-2-55; 58-2-70; 150B-38(h)
  • Eff. July 1, 1992
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. April 27, 2019.
11 NCAC 01 .0424 Motions {#sec-11-ncac-01-.0424 omnilex-key=us-nc-regs-official--title-11--11 NCAC 01 .0424}

(a) Any application to the hearing officer for an order shall be by motion, which shall be in writing unless made during a hearing, and must be filed and served upon all parties not less than 10 days before the hearing, if any, is to be held either on the motion or the merits of the case. The nonmoving party has 10 days after the date of service of the motion to file a response, which must be in writing. Motions practice in contested cases before the Commissioner are governed by Rule 6 of the General Rules of Practice for the Superior and District Court.

(b) If any party desires a hearing on the motion, he shall make a request for a hearing at the time of the filing of his motion or response. A response shall set forth the nonmoving party's objections. All motions in writing shall be decided without oral argument unless an oral argument is directed by the hearing officer. When oral argument is directed by the hearing officer, a motion shall be considered submitted for disposition at the close of the argument. A hearing on a motion will be directed by the hearing officer only if it is determined that a hearing is necessary to the development of a full and complete record on which a proper decision can be made. All orders on such motions, other than those made during the course of a hearing, shall be in writing and shall be served upon all parties of record not less than five days before a hearing, if any, is held.

History

  • Authority G.S. 58-2-40(1); 58-2-50; 58-2-55; 58-2-70; 150B-38(h)
  • Eff. July 1, 1992
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. April 27, 2019.
11 NCAC 01 .0425 Intervention {#sec-11-ncac-01-.0425 omnilex-key=us-nc-regs-official--title-11--11 NCAC 01 .0425}

(a) Any person not named in the notice of hearing who desires to intervene in a contested case as a party shall file a motion to intervene and shall serve the motion upon all existing parties. The motion shall show how the movant's rights, duties, or privileges may be determined or affected by the contested case; shall show how the movant may be directly affected by the outcome or show that the movant's participation is authorized by statute, rule, or court decision; shall set forth the grounds and purposes for which intervention is sought; and shall indicate movant's statutory right to intervene if one exists.

(b) Any party may object to the motion for intervention by filing a written notice of objections with the hearing officer within five days after service of the motion if there is sufficient time before the hearing. The notice of objection shall state the party's reasons for objection and shall be served upon all parties. If there is insufficient time before the hearing for a written objection, the objection may be made at the hearing.

(c) When the hearing officer deems it to be necessary to develop a full record on the question of intervention, he may conduct a hearing on the motion to determine specific standards that will apply to each intervenor and to define the extent of allowed intervention.

(d) Pursuant to the powers granted in G.S. 150B-40(c), the hearing officer may allow intervention upon a proper showing under this Rule, unless he finds that the movant's interest is adequately represented by one or more parties participating in the case or unless intervention is mandated by statute, rule, or court decision. An order allowing intervention shall specify the extent of participation permitted the intervenor and shall state the hearing officer's reason. An intervenor may be allowed to:

(1) File a written brief without acquiring the status of a party;

(2) Intervene as a party with all the rights of a party; or

(3) Intervene as a party with all the rights of a party but limited to specific issues and to the means necessary to present and develop those issues.

History

  • Authority G.S. 58-2-40(1); 58-2-50; 58-2-55; 58-2-70; 150B-38(h)
  • Eff. July 1, 1992
  • Amended Eff. September 1, 2004
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. April 27, 2019.
11 NCAC 01 .0426 Continuances {#sec-11-ncac-01-.0426 omnilex-key=us-nc-regs-official--title-11--11 NCAC 01 .0426}

(a) As used in this Rule, "good cause" includes death or incapacitating illness of a party, representative, or attorney of a party; a court order requiring a continuance; lack of proper notice of the hearing; a substitution of the representative or attorney of a party if the substitution is shown to be required; a change in the parties or pleadings requiring postponement; and agreement for a continuance by all parties if either more time is clearly necessary to complete mandatory preparation for the case, such as authorized discovery, and the parties and the hearing officer have agreed to a new hearing date or the parties have agreed to a settlement of the case that had been or is likely to be approved by the final decision maker.

(b) As used in this Rule, "good cause" does not include: intentional delay; unavailability of counsel or other representative because of engagement in another judicial or administrative proceeding unless all other members of the attorney's or representative's firm familiar with the case are similarly engaged; unavailability of a witness if the witness' testimony can be taken by deposition; or failure of the attorney or representative to properly utilize the statutory notice period to prepare for the hearing.

(c) A request for a continuance of a hearing shall be granted upon a showing of good cause. Unless time does not permit, a request for a continuance of a hearing shall be made in writing to the hearing officer and shall be served upon all parties of record. In determining whether good cause exists, due regard shall be given to the ability of the party requesting a continuance to proceed effectively without a continuance. A request for a continuance filed within five days before a hearing shall be denied unless the reason for the request could not have been ascertained earlier.

(d) During a hearing, if it appears in the interest of justice that further testimony should be received and sufficient time does not remain to conclude the testimony, the hearing officer shall either order the additional testimony taken by deposition or continue the hearing to a future date for which oral notice on the record is sufficient.

(e) A continuance shall not be granted if granting it would prevent the case from being concluded within any statutory or regulatory deadline.

History

  • Authority G.S. 58-2-40(1); 58-2-50; 58-2-55; 58-2-70; 150B-38(h)
  • Eff. August 3, 1992
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. April 27, 2019.
11 NCAC 01 .0427 Rights and Responsibilities of Parties {#sec-11-ncac-01-.0427 omnilex-key=us-nc-regs-official--title-11--11 NCAC 01 .0427}

(a) A party may present evidence, rebuttal testimony, and argument with respect to the issues of law and policy, and cross-examine witnesses, including the author of a document prepared by, on behalf of, or for use of the Department and offered in evidence.

(b) A party shall have all evidence to be presented, both oral and written, available on the date for hearing. Requests for subpoenas, depositions, or continuances shall be made within a reasonable time after their needs become evident to the requesting party. In cases when the hearing time is expected to exceed one day, the parties shall be prepared to present their evidence at the date and time ordered by the hearing officer or agreed upon at a prehearing conference.

(c) The hearing officer shall send copies of all orders or decisions to all parties simultaneously. Any party sending a letter, exhibit, brief, memorandum, or other document to the hearing officer shall simultaneously send a copy to all other parties.

(d) All parties have the continuing responsibility to notify the hearing officer of their current addresses and telephone numbers.

(e) A party need not be represented by an attorney unless the party is a corporate entity. A corporate entity shall not be represented by its President or other officers. If a party has notified other parties of that party's representation by an attorney, all communications shall be directed to that attorney.

(f) With the approval of the hearing officer, any person may offer testimony or other evidence relevant to the case. Any nonparty offering testimony or other evidence may be questioned by parties to the case and by the hearing officer.

(g) Before issuing a recommended decision, the hearing officer may order any party to submit proposed findings of fact and written arguments. Before issuing a final decision, the Commissioner may order any party to submit proposed findings of fact and written arguments.

History

  • Authority G.S. 58-2-40(1); 58-2-50; 58-2-55; 58-2-70; 150B-38(h)
  • Eff. July 1, 1992
  • Amended Eff. August 1, 2004
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. April 27, 2019.
11 NCAC 01 .0428 Witnesses {#sec-11-ncac-01-.0428 omnilex-key=us-nc-regs-official--title-11--11 NCAC 01 .0428}

Any party may be a witness and may present witnesses on the party's behalf at the hearing. All oral testimony at the hearing shall be under oath or affirmation and shall be recorded. At the request of a party or upon the hearing officer's own motion, the hearing officer may exclude witnesses from the hearing room so that they cannot hear the testimony of other witnesses.

History

  • Authority G.S. 58-2-40(1); 58-2-50; 58-2-55; 58-2-70; 150B-38(h)
  • Eff. July 1, 1992
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. April 27, 2019.
11 NCAC 01 .0429 Evidence {#sec-11-ncac-01-.0429 omnilex-key=us-nc-regs-official--title-11--11 NCAC 01 .0429}

(a) The North Carolina Rules of Evidence as found in Chapter 8C of the General Statutes govern in all contested case proceedings, except as provided otherwise in this Section and G.S. 150B-41.

(b) The hearing officer may admit all evidence that has probative value. Irrelevant, incompetent, immaterial, or unduly repetitious evidence shall be excluded. In accordance with Rule 403 of the N.C. Rules of Evidence, the hearing officer may, in his discretion, exclude any evidence if its probative value is substantially outweighed by the danger of unfair prejudice, confusion of the issues, or by considerations of undue delay, waste of time, or needless presentation of cumulative evidence.

(c) Contemporaneous objections by a party or a party's attorney are not required in the course of a hearing to preserve the right to object to the consideration of evidence by the hearing officer in reaching a decision or by the court upon judicial review.

(d) All evidence to be considered in the case, including all records and documents or true and accurate photocopies thereof, shall be offered and made a part of the record in the case. Except as provided in Paragraph (f) of this Rule, factual information or evidence that is not offered shall not be considered in the determination of the case. Documentary evidence incorporated by reference may be admitted only if the materials so incorporated are available for examination by the parties.

(e) Documentary evidence in the form of copies or excerpts may be received in the discretion of the hearing officer or upon agreement of the parties. Copies of a document shall be received to the same extent as the original document unless a genuine question is raised about the accuracy or authenticity of the copy or, under the circumstances, it would be unfair to admit the copy instead of the original.

(f) The hearing officer may take notice of judicially cognizable facts by entering a statement of the noticed fact and its source into the record. Upon a timely request, any party shall be given the opportunity to contest the facts so noticed through submission of evidence and argument.

(g) A party may call an adverse party, or an officer, director, managing agent, or employee of the State or any local government, of a public or private corporation, or of a partnership or association or body politic that is an adverse party; and may interrogate that party by leading questions and may contradict and impeach that party on material matters in all respects as if that party had been called by the adverse party. The adverse party may be examined by that party's counsel upon the subject matter of that party's examination in chief under the rules applicable to direct examination, and may be cross-examined, contradicted, and impeached by any other party adversely affected by the testimony.

History

  • Authority G.S. 58-2-40(1); 58-2-50; 58-2-55; 58-2-70; 150B-38(h)
  • Eff. July 1, 1992
  • Amended Eff. May 1, 2008; August 1, 2004
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. April 27, 2019.
11 NCAC 01 .0430 Official Record {#sec-11-ncac-01-.0430 omnilex-key=us-nc-regs-official--title-11--11 NCAC 01 .0430}

(a) The official record of a contested case is available for public inspection upon reasonable request. The hearing officer may, upon good cause shown and consistent with law, order part or all of an official record sealed.

(b) The official record shall be prepared in accordance with G.S. 150B-42.

(c) Contested case hearings shall be recorded either by a recording system or a professional court reporter using stenomask or stenotype.

(d) Transcript costs incurred by the Department shall be charged to or apportioned equally among the party or parties requesting a transcript.

(e) Any other costs incurred by the Department when using a professional court reporter shall be charged to or apportioned equally among the requesting party or parties.

(f) A 24-hour cancellation notice is required in all cases. The party or parties responsible for the cancellation shall be liable for any cancellation fees.

(g) Transcripts of proceedings during which oral evidence is presented will be made only upon request of a party. Transcript costs shall include the cost of an original for the Department. An attorney requesting a transcript on behalf of a party is a guarantor of payment of the cost. Cost shall be determined under supervision of the hearing officer who, in cases deemed to be appropriate by him, may require an advance security deposit to cover the prospective cost. The security deposit shall be applied to the actual cost and any excess shall be returned to the party that submitted it.

(h) Copies of tapes are available upon written request at a cost of five dollars ($5.00) per tape.

(i) Copies of Department hearings tapes or Non-Department certified transcripts from those tapes are not part of the official record. Note: Rule 5.3(B) of the Rules of Professional Conduct permits an attorney to advance or guarantee expenses of litigation provided the client remains ultimately liable for such expenses.

History

  • Authority G.S. 58-2-40(1); 58-2-50; 58-2-55; 58-2-70; 150B-38(h)
  • Eff. July 1, 1992
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. April 27, 2019.
11 NCAC 01 .0431 Ratemaking Procedures for Rate Bureau Filings {#sec-11-ncac-01-.0431 omnilex-key=us-nc-regs-official--title-11--11 NCAC 01 .0431}

History

  • Status: repealed
  • Authority G.S. 58-2-40(1) ; 58-36-1; 58-36-10; 58-36-15; 58-36-20; 58-36-70
  • 150B-38
  • Eff. January 1, 1993
  • Repealed Eff. December 1, 1994.
11 NCAC 01 .0501 Public Hearings on Rate Matters; Special Requirements {#sec-11-ncac-01-.0501 omnilex-key=us-nc-regs-official--title-11--11 NCAC 01 .0501}

History

  • Status: repealed
  • Authority G.S. 58-127; 58-131; 58-155.50; 58-155.83; 58-173.11; 58-173.23; 58-173.44; 58-246; 58-248.1; 58-248.6; 58-248.39; 97-104.1; 97-104.6; 58-27.2
  • Eff. February 1, 1976
  • Repealed Eff. May 12, 1978.
11 NCAC 01 .0502 Notice of Public Hearing on Rate Matters {#sec-11-ncac-01-.0502 omnilex-key=us-nc-regs-official--title-11--11 NCAC 01 .0502}

History

  • Status: repealed
  • Authority G.S. 58-127; 58-131; 58-155.50; 58-155.83; 58-173.11; 58-173.23; 58-173.44; 58-246; 58-248.1; 58-248.6; 58-248.39; 97-104.1; 97-104.6; 58-27.2
  • Eff. February 1, 1976
  • Repealed Eff. May 12, 1978.
11 NCAC 01 .0503 Appeals to the Commissioner {#sec-11-ncac-01-.0503 omnilex-key=us-nc-regs-official--title-11--11 NCAC 01 .0503}

History

  • Status: repealed
  • Authority G.S. 58-127; 58-131; 58-155.50; 58-155.83; 58-173.11; 58-173.23; 58-173.44; 58-246; 58-248.1; 58-248.6; 58-248.39; 97-104.1; 97-104.6; 58-27.2
  • Eff. February 1, 1976
  • Repealed Eff. May 12, 1978.
11 NCAC 01 .0601 Communications with Insurance Companies {#sec-11-ncac-01-.0601 omnilex-key=us-nc-regs-official--title-11--11 NCAC 01 .0601}

It is the policy of this department, when deemed necessary, to communicate with insurance companies at company expense by means of collect telephone calls, telegrams, and other similar communications.

History

  • Authority G.S. 58-2-40; 58-2-190
  • Eff. February 1, 1976
  • Readopted Eff. May 12, 1978
  • Amended Eff. August 1, 1988
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. April 27, 2019.
11 NCAC 01 .0602 Insurance Companies' Response to Departmental Inquiries {#sec-11-ncac-01-.0602 omnilex-key=us-nc-regs-official--title-11--11 NCAC 01 .0602}

Every insurer, upon receipt of an inquiry, oral or written, from the department shall furnish the commissioner or his designated representative with a complete and accurate response in writing, unless such response is specifically authorized by the commissioner to be given orally. Such response must be made by the insurer within seven calendar days of receipt of the request, except that the commissioner may extend this time period in an individual case.

History

  • Authority G.S. 58-2-40; 58-2-190
  • Eff. February 1, 1976
  • Readopted Eff. May 12, 1978
  • Amended Eff. August 1, 1988
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. April 27, 2019.
11 NCAC 01 .0603 Facsimile Countersignature Not Valid {#sec-11-ncac-01-.0603 omnilex-key=us-nc-regs-official--title-11--11 NCAC 01 .0603}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-33-30(i); 58-33-60
  • Eff. February 1, 1976
  • Readopted Eff. May 12, 1978
  • Amended Eff. July 1, 1992; August 1, 1988
  • Repealed Eff. July 1, 2012.
11 NCAC 01 .0604 Special Agent Not Resident/Countersignature Purposes {#sec-11-ncac-01-.0604 omnilex-key=us-nc-regs-official--title-11--11 NCAC 01 .0604}

History

  • Status: repealed
  • Authority G.S. 58-9.3; 58-9.4; 58-37; 58-38; 58-39; 58-44; 58-44.4A
  • 58-56.3; 66-49.13; 85C-17; 85C-18
  • Eff. February 1, 1976
  • Readopted Eff. May 12, 1978
  • Repealed Eff. August 1, 1988.
11 NCAC 01 .0605 Hearing and License Revocation Proceedings {#sec-11-ncac-01-.0605 omnilex-key=us-nc-regs-official--title-11--11 NCAC 01 .0605}

History

  • Status: repealed
  • Authority G.S. 58-9.3; 58-9.4; 58-37; 58-38; 58-39; 58-44; 58-44.4A
  • 58-56.3; 66-49.13; 85C-17; 85C-18
  • Eff. February 1, 1976
  • Readopted Eff. May 12, 1978
  • Repealed Eff. August 1, 1988.
11 NCAC 01 .0701 Purposes of Division {#sec-11-ncac-01-.0701 omnilex-key=us-nc-regs-official--title-11--11 NCAC 01 .0701}

History

  • Status: repealed
  • Authority G.S. 58-7.1; 58-7.3
  • Eff. May 12, 1978
  • Repealed Eff. July 1, 1988.
11 NCAC 01 .0702 Division Personnel {#sec-11-ncac-01-.0702 omnilex-key=us-nc-regs-official--title-11--11 NCAC 01 .0702}

History

  • Status: repealed
  • Authority G.S. 58-7.1; 58-7.3
  • Eff. May 12, 1978
  • Repealed Eff. July 1, 1988.

Chapter 02 Support Services Division (Repealed)

11 NCAC 02 .0101 Purpose of Division {#sec-11-ncac-02-.0101 omnilex-key=us-nc-regs-official--title-11--11 NCAC 02 .0101}

History

  • Status: repealed
  • Authority G.S. 58-9; 143-1 to 143-34.4; 128-1 to 128-4; 105-59
  • Eff. February 1, 1976
  • Readopted Eff. May 12, 1978
  • Repealed Eff. December 1, 1994.
11 NCAC 02 .0102 Division Personnel {#sec-11-ncac-02-.0102 omnilex-key=us-nc-regs-official--title-11--11 NCAC 02 .0102}

SECTION .0200 - LIGHTNING ROD SALESPERSONS AND COMPANIES

History

  • Authority G.S. 58-7.3; 58-9
  • Eff. February 1, 1976
  • Readopted Eff. May 12, 1978
  • Repealed Eff. July 1, 1988.
11 NCAC 02 .0201 Application for License Sale and Erection of Lightning Rods {#sec-11-ncac-02-.0201 omnilex-key=us-nc-regs-official--title-11--11 NCAC 02 .0201}

History

  • Status: repealed
  • Authority G.S. 105-59
  • Eff. February 1, 1976
  • Readopted Eff. May 12, 1978
  • Repealed Eff. July 1, 1988.
11 NCAC 02 .0202 Application for License: Lightning Rod Manufacturer {#sec-11-ncac-02-.0202 omnilex-key=us-nc-regs-official--title-11--11 NCAC 02 .0202}

History

  • Status: repealed
  • Authority G.S. 105-59
  • Eff. February 1, 1976
  • Readopted Eff. May 12, 1978
  • Repealed Eff. July 1, 1988.
11 NCAC 02 .0203 Application for Local Agents {#sec-11-ncac-02-.0203 omnilex-key=us-nc-regs-official--title-11--11 NCAC 02 .0203}

History

  • Status: repealed
  • Authority G.S. 105-59
  • Eff. February 1, 1976
  • Readopted Eff. May 12, 1978
  • Repealed Eff. July 1, 1988.
11 NCAC 02 .0204 Semi-Annual Tax Returns for the Sale of Lightning Rods {#sec-11-ncac-02-.0204 omnilex-key=us-nc-regs-official--title-11--11 NCAC 02 .0204}

History

  • Status: repealed
  • Authority G.S. 105-59
  • Eff. February 1, 1976
  • Readopted Eff. May 12, 1978
  • Repealed Eff. July 1, 1988.
11 NCAC 03 .0101 Definitions {#sec-11-ncac-03-.0101 omnilex-key=us-nc-regs-official--title-11--11 NCAC 03 .0101}

History

  • Status: repealed
  • Authority G.S. 58-9; 150A-12(f)
  • Eff. February 1, 1976
  • Readopted Eff. May 12, 1978
  • Amended Eff. June 1, 1985
  • Repealed Eff. July 1, 1988.
11 NCAC 03 .0102 Purpose of Division {#sec-11-ncac-03-.0102 omnilex-key=us-nc-regs-official--title-11--11 NCAC 03 .0102}

History

  • Status: repealed
  • Authority G.S. 58-7.3; 58-9
  • Eff. February 1, 1976
  • Readopted Eff. May 12, 1978
  • Amended Eff. August 1, 1988; June 1, 1985
  • Repealed Eff. December 1, 1992.
11 NCAC 03 .0103 Deputy Commissioner {#sec-11-ncac-03-.0103 omnilex-key=us-nc-regs-official--title-11--11 NCAC 03 .0103}

History

  • Status: repealed
  • Authority G.S. 58-7.3; 58-9; 150A-12(f)
  • Eff. February 1, 1976
  • Readopted Eff. May 12, 1978
  • Amended Eff. June 1, 1985
  • Repealed Eff. July 1, 1988.
11 NCAC 03 .0104 Division Personnel {#sec-11-ncac-03-.0104 omnilex-key=us-nc-regs-official--title-11--11 NCAC 03 .0104}

History

  • Status: repealed
  • Authority G.S. 58-7.3; 58-9; 150A-12(f)
  • Eff. February 1, 1976
  • Readopted Eff. May 12, 1978
  • Amended Eff. June 1, 1985
  • Repealed Eff. July 1, 1988.

History

  • Status: repealed
  • Authority G.S. 58-9; 58-9.3; 58-153; 58-153.1; 58-397; 58-440; 58-508(1)
  • 58-512(b); 58-615(h)(2); 150A-12(f)
  • Eff. February 1, 1976
  • Readopted Eff. May 12, 1978
  • Amended Eff. August 1, 1988; June 1, 1985
  • Repealed Eff. December 1, 1992.
11 NCAC 03 .0106 Records of Division {#sec-11-ncac-03-.0106 omnilex-key=us-nc-regs-official--title-11--11 NCAC 03 .0106}

History

  • Status: repealed
  • Authority G.S. 58-9; 58-9.3; 58-153; 58-153.1; 58-397; 58-440; 58-508(1)
  • 58-512(b); 58-615(h)(2); 150A-12(f)
  • Eff. February 1, 1976
  • Readopted Eff. May 12, 1978
  • Amended Eff. August 1, 1988; June 1, 1985
  • Repealed Eff. December 1, 1992.
11 NCAC 03 .0107 Purchase of Hearing Transcripts {#sec-11-ncac-03-.0107 omnilex-key=us-nc-regs-official--title-11--11 NCAC 03 .0107}

History

  • Status: repealed
  • Authority G.S. 58-9; 58-9.3; 58-153; 58-153.1; 58-397; 58-440; 58-508(1)
  • 58-512(b); 58-615(h)(2); 150A-12(f)
  • Eff. February 1, 1976
  • Readopted Eff. May 12, 1978
  • Amended Eff. August 1, 1988; June 1, 1985
  • Repealed Eff. December 1, 1992.

History

  • Status: repealed
  • Authority G.S. 58-7.3; 58-9
  • Eff. August 1, 1988
  • Repealed Eff. December 1, 1992.

Chapter 04 Consumer Services Division

11 NCAC 04 .0101 Purpose of Division {#sec-11-ncac-04-.0101 omnilex-key=us-nc-regs-official--title-11--11 NCAC 04 .0101}

History

  • Status: repealed
  • Filed as an Emergency Repeal Eff. April 25, 1979, for a Period of 120 Days to be Reinstated
  • on August 23, 1979
  • Authority G.S. 57-1; 57-4; 57-10; 57-13; 57A-18; 58-9; 58-9.2; 58-10; 58-11; 58-15; 58-18
  • 58-25; 58-25.1; 58-26; 58-27; 58-262; 58-262.4; 58-296; 58-357; 58-7.3
  • Eff. February 1, 1976
  • Readopted Eff. March 16, 1979
  • Repealed Eff. August 23, 1979.
11 NCAC 04 .0102 Deputy Commissioner {#sec-11-ncac-04-.0102 omnilex-key=us-nc-regs-official--title-11--11 NCAC 04 .0102}

History

  • Status: repealed
  • Filed as an Emergency Repeal Eff. April 25, 1979, for a Period of 120 Days to be Reinstated
  • on August 23, 1979
  • Authority G.S. 57-1; 57-4; 57-10; 57-13; 57A-18; 58-9; 58-9.2; 58-10; 58-11; 58-15; 58-18
  • 58-25; 58-25.1; 58-26; 58-27; 58-262; 58-262.4; 58-296; 58-357; 58-7.3
  • Eff. February 1, 1976
  • Readopted Eff. March 16, 1979
  • Repealed Eff. August 23, 1979.
11 NCAC 04 .0103 Structure of Division {#sec-11-ncac-04-.0103 omnilex-key=us-nc-regs-official--title-11--11 NCAC 04 .0103}

History

  • Status: repealed
  • Filed as an Emergency Repeal Eff. April 25, 1979, for a Period of 120 Days to be Reinstated
  • on August 23, 1979
  • Authority G.S. 57-1; 57-4; 57-10; 57-13; 57A-18; 58-9; 58-9.2; 58-10; 58-11; 58-15; 58-18
  • 58-25; 58-25.1; 58-26; 58-27; 58-262; 58-262.4; 58-296; 58-357; 58-7.3
  • Eff. February 1, 1976
  • Readopted Eff. March 16, 1979
  • Repealed Eff. August 23, 1979.
11 NCAC 04 .0104 Division Personnel and Procedures {#sec-11-ncac-04-.0104 omnilex-key=us-nc-regs-official--title-11--11 NCAC 04 .0104}

History

  • Status: repealed
  • Filed as an Emergency Repeal Eff. April 25, 1979, for a Period of 120 Days to be Reinstated
  • on August 23, 1979
  • Authority G.S. 57-1; 57-4; 57-10; 57-13; 57A-18; 58-9; 58-9.2; 58-10; 58-11; 58-15; 58-18
  • 58-25; 58-25.1; 58-26; 58-27; 58-262; 58-262.4; 58-296; 58-357; 58-7.3
  • Eff. February 1, 1976
  • Readopted Eff. March 16, 1979
  • Repealed Eff. August 23, 1979.
11 NCAC 04 .0105 Complaints and Inquiries and Information {#sec-11-ncac-04-.0105 omnilex-key=us-nc-regs-official--title-11--11 NCAC 04 .0105}

History

  • Status: repealed
  • Filed as an Emergency Repeal Eff. April 25, 1979, for a Period of 120 Days to be Reinstated
  • on August 23, 1979
  • Authority G.S. 57-1; 57-4; 57-10; 57-13; 57A-18; 58-9; 58-9.2; 58-10; 58-11; 58-15; 58-18
  • 58-25; 58-25.1; 58-26; 58-27; 58-262; 58-262.4; 58-296; 58-357; 58-7.3
  • Eff. February 1, 1976
  • Readopted Eff. March 16, 1979
  • Repealed Eff. August 23, 1979.
11 NCAC 04 .0106 Rule for Loss and Claim Practices and Procedures {#sec-11-ncac-04-.0106 omnilex-key=us-nc-regs-official--title-11--11 NCAC 04 .0106}

History

  • Status: repealed
  • Authority G.S. 57-4; 57-10; 58-9; 58-9.2; 58-15; 58-25; 58-25.1; 58-26; 58-27; 58-40
  • 58-40.1; 58-128
  • Eff. February 1, 1976
  • Repealed Eff. March 8, 1978.
11 NCAC 04 .0107 Sex Discrimination in Insurance {#sec-11-ncac-04-.0107 omnilex-key=us-nc-regs-official--title-11--11 NCAC 04 .0107}

History

  • Status: repealed
  • Filed as an Emergency Repeal Eff. April 25, 1979, for a Period of 120 Days to be Reinstated
  • on August 23, 1979
  • Authority G.S. 58-9; 58-44.3; 58-54.1; 58-54.13
  • Eff. May 5, 1977
  • Readopted Eff. March 16, 1979
  • Repealed Eff. August 23, 1979.
11 NCAC 04 .0108 Misrepresentation of Policy Provisions {#sec-11-ncac-04-.0108 omnilex-key=us-nc-regs-official--title-11--11 NCAC 04 .0108}

History

  • Status: repealed
  • Filed as an Emergency Repeal Eff. April 25, 1979, for a Period of 120 Days to be Reinstated
  • on August 23, 1979
  • Authority G.S. 57-4; 58-8; 58-9; 58-39; 58-40; 58-40.1; 58-40.6; 58-41; 58-48; 58-52
  • 58-54.4; 58-199; 58-249
  • Eff. March 16, 1979
  • Repealed Eff. August 23, 1979.
11 NCAC 04 .0109 Ethical Standards {#sec-11-ncac-04-.0109 omnilex-key=us-nc-regs-official--title-11--11 NCAC 04 .0109}

History

  • Status: repealed
  • Filed as an Emergency Repeal Eff. April 25, 1979, for a Period of 120 Days to be Reinstated
  • on August 23, 1979
  • Authority G.S. 57-4; 58-8; 58-9; 58-39; 58-40; 58-40.1; 58-40.6; 58-41; 58-48; 58-52
  • 58-54.4; 58-199; 58-249
  • Eff. March 16, 1979
  • Repealed Eff. August 23, 1979.
11 NCAC 04 .0110 Statement of Action {#sec-11-ncac-04-.0110 omnilex-key=us-nc-regs-official--title-11--11 NCAC 04 .0110}

History

  • Status: repealed
  • Filed as an Emergency Repeal Eff. April 25, 1979, for a Period of 120 Days to be Reinstated
  • on August 23, 1979
  • Authority G.S. 57-4; 58-8; 58-9; 58-39; 58-40; 58-40.1; 58-40.6; 58-41; 58-48; 58-52
  • 58-54.4; 58-199; 58-249
  • Eff. March 16, 1979
  • Repealed Eff. August 23, 1979.
11 NCAC 04 .0111 Loss or Claim Notice {#sec-11-ncac-04-.0111 omnilex-key=us-nc-regs-official--title-11--11 NCAC 04 .0111}

History

  • Status: repealed
  • Filed as an Emergency Repeal Eff. April 25, 1979, for a Period of 120 Days to be Reinstated
  • on August 23, 1979
  • Authority G.S. 57-4; 58-8; 58-9; 58-39; 58-40; 58-40.1; 58-40.6; 58-41; 58-48; 58-52
  • 58-54.4; 58-199; 58-249
  • Eff. March 16, 1979
  • Repealed Eff. August 23, 1979.
11 NCAC 04 .0112 Purpose of Division {#sec-11-ncac-04-.0112 omnilex-key=us-nc-regs-official--title-11--11 NCAC 04 .0112}

History

  • Status: repealed
  • Authority G.S. 58-7.3; 58-9
  • Eff. December 15, 1979
  • Amended Eff. July 1, 1986
  • Repealed Eff. July 1, 1988.
11 NCAC 04 .0113 Deputy Commissioner {#sec-11-ncac-04-.0113 omnilex-key=us-nc-regs-official--title-11--11 NCAC 04 .0113}

History

  • Status: repealed
  • Authority G.S. 58-7.3; 58-9
  • Eff. December 15, 1979
  • Amended Eff. July 1, 1986
  • Repealed Eff. July 1, 1988.
11 NCAC 04 .0114 Structure of Division {#sec-11-ncac-04-.0114 omnilex-key=us-nc-regs-official--title-11--11 NCAC 04 .0114}

History

  • Status: repealed
  • Authority G.S. 58-7.3; 58-9
  • Eff. December 15, 1979
  • Amended Eff. July 1, 1986
  • Repealed Eff. July 1, 1988.
11 NCAC 04 .0115 Division Procedures {#sec-11-ncac-04-.0115 omnilex-key=us-nc-regs-official--title-11--11 NCAC 04 .0115}

(a) Complaints arising from insurance products, companies, insurance agents, adjusters, brokers, producers, and motor vehicle damage appraisers regulated under G.S. Chapter 58 will be processed in the following manner:

(1) The analyst will request an explanation from company, agent, appraiser, or adjuster.

(2) If the analyst finds that the issue has been handled in a manner that does not comply with statute, rule or policy contract, then the analyst will require that corrective action taken be to resolve the complaint.

(3) If the issue is not resolved, the Deputy Commissioner may arrange a conference with the company representatives to resolve the problem.

(b) If a conference does not resolve a disputed issue, the Deputy Commissioner may recommend to the Commissioner that legal action as outlined in G.S. Chapter 58 be taken to ensure compliance with the statutes and rules, administered by the Department. Alternatively, this Division may refer issues to other Divisions for further investigation and regulatory action.

(c) The Division will not investigate a complaint that is also the subject matter of a pending lawsuit filed by an attorney representing the complainant. If a lawsuit has not been filed but the complainant has retained an attorney, as indicted on the complaint form or other correspondence submitted relating to the complaint, the Division will investigate the complaint provided it has first obtained the attorney's written consent solicited through the complainant.

History

  • Authority G.S. 58-2-40; 58-2-50; 58-2-155; 58-2-185; 58-2-190; 58-2-195; 58-2-200; 58-3-100; 58-33-45; 58-65-1; 58-65-40; 58-67-20; 58-67-150
  • Eff. December 15, 1979
  • Amended Eff. April 1, 1989
  • Readopted Eff. December 1, 2021.
11 NCAC 04 .0116 Inquiries and Information {#sec-11-ncac-04-.0116 omnilex-key=us-nc-regs-official--title-11--11 NCAC 04 .0116}

The toll free telephone number for the Consumer Services Division is 1-855-408-1212. The mailing address of the Consumer Services Division is: North Carolina Department of Insurance, 1201 Mail Service Center, Raleigh, North Carolina 27699-1201; (Attention: Consumer Services Division). The street address of the Consumer Services Division is North Carolina Department of Insurance Consumer Services Division, 3200 Beechleaf Court, Raleigh, North Carolina.

History

  • Authority G.S. 58-2-25; 58-2-40
  • Eff. December 15, 1979
  • Amended Eff. January 1, 2018; July 1, 2012; April 1, 1989; July 1, 1986
  • Readopted Eff. October 1, 2021.
  • Amended Eff. February 1, 2024.
11 NCAC 04 .0117 Statement of Action {#sec-11-ncac-04-.0117 omnilex-key=us-nc-regs-official--title-11--11 NCAC 04 .0117}

(a) When an insurer denies a claim that included information for the insurer to identify the coverage involved, the denial shall be in writing and cite the policy provision or other legal basis used to deny the claim.

(b) When an insurer offers to settle a claim that included information for the insurer to identify the coverage involved, the offer, when requested by the consumer, shall be in writing and cite the specific policy provision or legal basis used in support of the claim statement.

History

  • Authority G.S. 58-2-40; 58-3-100; 58-63-15(11); 58-67-150
  • Eff. December 15, 1979
  • Amended Eff. April 1, 1989; December 15, 1979
  • Readopted Eff. November 1, 2021.
11 NCAC 04 .0118 Insurance Carriers as Lenders {#sec-11-ncac-04-.0118 omnilex-key=us-nc-regs-official--title-11--11 NCAC 04 .0118}

(a) Any lender who offers an insurance product to a consumer either directly or indirectly through a subsidiary or affiliate in conjunction with an extension of credit shall inform the consumer of the protections afforded by G.S. 58-3-135.

(b) Nothing in this Rule shall limit the right of the lender to require insurance in connection with a loan.

(c) This Rule shall not apply where the extension of credit arises out of a life insurance contract itself or where the extension of credit is subject to the provisions of Regulation Z, 12 CFR 226, or other federal statutes or regulations requiring similar disclosures.

History

  • Authority G.S. 58-2-40; 58-3-135; 58-3-150
  • Eff. July 1, 1986
  • Amended Eff. April 8, 2002; April 1, 1989
  • Readopted Eff. November 1, 2021.
11 NCAC 04 .0119 Insurer Defined {#sec-11-ncac-04-.0119 omnilex-key=us-nc-regs-official--title-11--11 NCAC 04 .0119}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-65-1; 58-67-150
  • Eff. April 1, 1989
  • Amended Eff. April 8, 2002
  • Repealed Eff. November 1, 2021.
11 NCAC 04 .0120 Policy or Service Fees {#sec-11-ncac-04-.0120 omnilex-key=us-nc-regs-official--title-11--11 NCAC 04 .0120}

An insurer, agent, broker, or limited representative who deals with an applicant and who intends to charge a policy or service fee in accordance with G.S. 58-33-85(b) shall not do so unless he or she complies with the following:

(1) A sign that shall be displayed and visible using large and bolded print so as to be seen and read by the public from any part of the office lobby that informs the applicant that a policy or service fee of [amount] will be charged.

(2) The applicant's written consent shall be obtained on a separate form each time a policy or service fee is charged. The form, created by the insurer, agent, broker or limited representative, shall be entitled, "Policy or Service Fee Consent" and shall include the date and amount of each fee charged.

(3) A dated receipt for the payment of a policy or service fee shall be issued either separately from the policy premium receipt or stated separately on the receipt issued for the policy premium.

History

  • Authority G.S. 58-2-40; 58-2-195; 58-33-85(b)
  • Eff. February 1, 1993
  • Amended Eff. February 1, 1996
  • Readopted Eff. December 1, 2021.
11 NCAC 04 .0121 Premium Payment Receipts {#sec-11-ncac-04-.0121 omnilex-key=us-nc-regs-official--title-11--11 NCAC 04 .0121}

All premium payment receipts and copies issued by an agent, broker, or limited representative, shall be dated and contain the printed or stamped name and address of the agency or agent, broker, or limited representative, and the name of the insurer. Receipts shall be signed by the person accepting the payment.

History

  • Authority G.S. 58-2-40; 58-2-185; 58-2-195
  • Eff. February 1, 1993
  • Amended Eff. February 1, 1996
  • Readopted Eff. October 1, 2021.
11 NCAC 04 .0122 Power-of-Attorney {#sec-11-ncac-04-.0122 omnilex-key=us-nc-regs-official--title-11--11 NCAC 04 .0122}

Except for authorizations given in accordance with G.S. 58-45-35(a) or G.S. 58-46-15, no agent, broker, or limited representative shall solicit a power-of-attorney from a consumer that authorizes the agent, broker, or limited representative to sign insurance-related forms.

History

  • Authority G.S. 58-2-40; 58-2-195
  • Eff. February 1, 1993
  • Readopted Eff. October 1, 2021.
11 NCAC 04 .0123 Use of Specific Company Name in Responses {#sec-11-ncac-04-.0123 omnilex-key=us-nc-regs-official--title-11--11 NCAC 04 .0123}

When an insurer makes a written response to an inquiry by the Division or complaint made by a consumer, the insurer shall identify on its response:

(1) its mailing address;

(2) official corporate name of the company against which the complaint is made;

(3) the NAIC company code; and

(4) specific corporate name if the insurer is part of a group of companies.

History

  • Authority G.S. 58-2-40; 58-2-190; 58-3-50; 58-63-65
  • Eff. April 1, 1995
  • Amended Eff. February 1, 1996
  • Readopted Eff. November 1, 2021.
11 NCAC 04 .0124 Insurance Company Contact Persons {#sec-11-ncac-04-.0124 omnilex-key=us-nc-regs-official--title-11--11 NCAC 04 .0124}

(a) Every insurer shall provide the Division with company contact information using a form provided by the Division, which shall include the name, title, address, and telephone number, including a toll-free number, of a designated person to whom any person may send a complaint or inquiry, and the company president's name, address, and telephone number for the Division's use.

(b) The form shall be completed, signed by a corporate officer, and returned to the Division by every insurer.

(c) A new form must be filed with the Division within 15 business days after any change in the information on the form.

History

  • Authority G.S. 58-2-40; 58-2-190; 58-63-65
  • Eff. April 1, 1995
  • Amended Eff. February 1, 1996
  • Readopted Eff. November 1, 2021.
11 NCAC 04 .0201 Function of Section {#sec-11-ncac-04-.0201 omnilex-key=us-nc-regs-official--title-11--11 NCAC 04 .0201}

History

  • Status: repealed
  • Filed as an Emergency Repeal Eff. April 25, 1979, for a Period of 120 Days to be Reinstated on August 23, 1979
  • Authority G.S. 57-10; 57A-18; 58-7.3; 58-9; 58-9.2; 58-18; 58-25; 58-16; 58-16.2; 58-63; 58-25.1; 58-26; 58-27; 58-296
  • Eff. February 1, 1976
  • Readopted Eff. March 16, 1979
  • Repealed Eff. August 23, 1979
  • Transferred Eff. August 14, 1986.
11 NCAC 04 .0202 Report and Collection Procedures {#sec-11-ncac-04-.0202 omnilex-key=us-nc-regs-official--title-11--11 NCAC 04 .0202}

History

  • Status: repealed
  • Filed as an Emergency Repeal Eff. April 25, 1979, for a Period of 120 Days to be Reinstated on August 23, 1979
  • Authority G.S. 57-10; 57A-18; 58-7.3; 58-9; 58-9.2; 58-18; 58-25; 58-16; 58-16.2; 58-63; 58-25.1; 58-26; 58-27; 58-296
  • Eff. February 1, 1976
  • Readopted Eff. March 16, 1979
  • Repealed Eff. August 23, 1979
  • Transferred Eff. August 14, 1986.
11 NCAC 04 .0203 Maintenance of Records {#sec-11-ncac-04-.0203 omnilex-key=us-nc-regs-official--title-11--11 NCAC 04 .0203}

History

  • Status: repealed
  • Filed as an Emergency Repeal Eff. April 25, 1979, for a Period of 120 Days to be Reinstated on August 23, 1979
  • Authority G.S. 57-10; 58-9; 58-9.2; 58-15; 58-16; 58-25; 58-25.1; 58-26; 58-27
  • Eff. March 16, 1979
  • Repealed Eff. August 23, 1979
  • Transferred to T11.11G; Eff. August 14, 1986.
11 NCAC 04 .0204 Complaint Records {#sec-11-ncac-04-.0204 omnilex-key=us-nc-regs-official--title-11--11 NCAC 04 .0204}

History

  • Status: repealed
  • Filed as an Emergency Repeal Eff. April 25, 1979, for a Period of 120 Days to be Reinstated on August 23, 1979
  • Authority G.S. 57-10; 58-9; 58-9.2; 58-15; 58-16; 58-25; 58-25.1; 58-26; 58-27
  • Eff. March 16, 1979
  • Repealed Eff. August 23, 1979
  • Transferred to T11.11G; Eff. August 14, 1986.
11 NCAC 04 .0205 Function of Section {#sec-11-ncac-04-.0205 omnilex-key=us-nc-regs-official--title-11--11 NCAC 04 .0205}

History

  • Authority G.S. 57-10; 57A-18; 58-7.3; 58-9; 58-9.2; 58-16; 58-25; 58-25.1; 58-26
  • 58-27; 58-296
  • Eff. December 15, 1979
  • Transferred to T11.11G; Eff. August 14, 1986.
11 NCAC 04 .0206 Report and Collection Procedures {#sec-11-ncac-04-.0206 omnilex-key=us-nc-regs-official--title-11--11 NCAC 04 .0206}

History

  • Authority G.S. 57-10; 58-16; 58-16.2; 58-18; 58-63
  • Eff. December 15, 1979
  • Transferred to T11.11G; Eff. August 14, 1986.
11 NCAC 04 .0207 Maintenance of Records {#sec-11-ncac-04-.0207 omnilex-key=us-nc-regs-official--title-11--11 NCAC 04 .0207}

History

  • Authority G.S. 57-10; 58-9; 58-9.2; 58-15; 58-25; 58-25.1; 58-26; 58-27
  • Eff. December 15, 1979
  • Transferred to T11.11G; Eff. August 14, 1986.
11 NCAC 04 .0208 Complaint Records {#sec-11-ncac-04-.0208 omnilex-key=us-nc-regs-official--title-11--11 NCAC 04 .0208}

History

  • Authority G.S. 57-10; 58-9; 58-16; 58-25.1; 58-26; 58-27; 58-54.5; 58-54.6
  • Eff. December 15, 1979
  • Transferred to T11.11G; Eff. August 14, 1986.
11 NCAC 04 .0301 Function of Section {#sec-11-ncac-04-.0301 omnilex-key=us-nc-regs-official--title-11--11 NCAC 04 .0301}

History

  • Status: repealed
  • Filed as an Emergency Repeal Eff. April 25, 1979, for a Period of 120 Days to be Reinstated on August 23, 1979
  • Authority G.S. 57-1; 57-4; 57-10; 58-9; 58-25.1; 58-26; 58-27; 58-42.1; 58-207; 58-251.1; 58-251.4; 58-260.1
  • Eff. February 1, 1976
  • Readopted Eff. March 16, 1979
  • Repealed Eff. August 23, 1979.
11 NCAC 04 .0302 Receipt and Distribution of Medical Information {#sec-11-ncac-04-.0302 omnilex-key=us-nc-regs-official--title-11--11 NCAC 04 .0302}

History

  • Status: repealed
  • Filed as an Emergency Repeal Eff. April 25, 1979, for a Period of 120 Days to be Reinstated on August 23, 1979
  • Authority G.S. 57-1; 57-4; 57-10; 58-9; 58-25.1; 58-26; 58-27; 58-42.1; 58-207; 58-251.1; 58-251.4; 58-260.1
  • Eff. February 1, 1976
  • Readopted Eff. March 16, 1979
  • Repealed Eff. August 23, 1979.
11 NCAC 04 .0303 Provisions of Accident: Health and Disability Contracts {#sec-11-ncac-04-.0303 omnilex-key=us-nc-regs-official--title-11--11 NCAC 04 .0303}

History

  • Status: repealed
  • Filed as an Emergency Repeal Eff. April 25, 1979, for a Period of 120 Days to be Reinstated on August 23, 1979
  • Authority G.S. 57-1; 57-4; 57-10; 58-9; 58-25.1; 58-26; 58-27; 58-42.1; 58-207; 58-251.1; 58-251.4; 58-260.1
  • Eff. February 1, 1976
  • Readopted Eff. March 16, 1979
  • Repealed Eff. August 23, 1979.
11 NCAC 04 .0304 Premium Notices: Payments: and Refunds {#sec-11-ncac-04-.0304 omnilex-key=us-nc-regs-official--title-11--11 NCAC 04 .0304}

History

  • Status: repealed
  • Filed as an Emergency Repeal Eff. April 25, 1979, for a Period of 120 Days to be Reinstated on August 23, 1979
  • Authority G.S. 57-1; 57-4; 57-10; 58-9; 58-25.1; 58-26; 58-27; 58-42.1; 58-207; 58-251.1; 58-251.4; 58-260.1
  • Eff. February 1, 1976
  • Readopted Eff. March 16, 1979
  • Repealed Eff. August 23, 1979.
11 NCAC 04 .0305 Issuance of Accident: Health and Disability Contracts {#sec-11-ncac-04-.0305 omnilex-key=us-nc-regs-official--title-11--11 NCAC 04 .0305}

History

  • Status: repealed
  • Filed as an Emergency Repeal Eff. April 25, 1979, for a Period of 120 Days to be Reinstated on August 23, 1979
  • Authority G.S. 57-1; 57-4; 57-10; 58-9; 58-25.1; 58-26; 58-27; 58-42.1; 58-207; 58-251.1; 58-251.4; 58-260.1
  • Eff. February 1, 1976
  • Readopted Eff. March 16, 1979
  • Repealed Eff. August 23, 1979.
11 NCAC 04 .0306 Contestability Clause and Rescission {#sec-11-ncac-04-.0306 omnilex-key=us-nc-regs-official--title-11--11 NCAC 04 .0306}

History

  • Status: repealed
  • Filed as an Emergency Repeal Eff. April 25, 1979, for a Period of 120 Days to be Reinstated on August 23, 1979
  • Authority G.S. 57-1; 57-4; 57-10; 58-9; 58-25.1; 58-26; 58-27; 58-42.1; 58-207; 58-251.1; 58-251.4; 58-260.1
  • Eff. February 1, 1976
  • Readopted Eff. March 16, 1979
  • Repealed Eff. August 23, 1979.
11 NCAC 04 .0307 Issue and Premium Payments of Life Insurance Contracts {#sec-11-ncac-04-.0307 omnilex-key=us-nc-regs-official--title-11--11 NCAC 04 .0307}

History

  • Status: repealed
  • Filed as an Emergency Repeal Eff. April 25, 1979, for a Period of 120 Days to be Reinstated on August 23, 1979
  • Authority G.S. 57-1; 57-4; 57-10; 58-9; 58-25.1; 58-26; 58-27; 58-42.1; 58-207; 58-251.1; 58-251.4; 58-260.1
  • Eff. February 1, 1976
  • Readopted Eff. March 16, 1979
  • Repealed Eff. August 23, 1979.
11 NCAC 04 .0308 Credit Accident: Health and Life Insurance {#sec-11-ncac-04-.0308 omnilex-key=us-nc-regs-official--title-11--11 NCAC 04 .0308}

History

  • Status: repealed
  • Filed as an Emergency Repeal Eff. April 25, 1979, for a Period of 120 Days to be Reinstated on August 23, 1979
  • Authority G.S. 57-1; 57-4; 57-10; 58-9; 58-25.1; 58-26; 58-27; 58-42.1; 58-207; 58-251.1; 58-251.4; 58-260.1
  • Eff. February 1, 1976
  • Readopted Eff. March 16, 1979
  • Repealed Eff. August 23, 1979.
11 NCAC 04 .0309 Life Insurance Sales: Financing First Year Premium {#sec-11-ncac-04-.0309 omnilex-key=us-nc-regs-official--title-11--11 NCAC 04 .0309}

History

  • Status: repealed
  • Filed as an Emergency Repeal Eff. April 25, 1979, for a Period of 120 Days to be Reinstated on August 23, 1979
  • Authority G.S. 57-1; 57-4; 57-10; 58-9; 58-25.1; 58-26; 58-27; 58-42.1; 58-207; 58-251.1; 58-251.4; 58-260.1
  • Eff. February 1, 1976
  • Readopted Eff. March 16, 1979
  • Repealed Eff. August 23, 1979.
11 NCAC 04 .0310 Claim Practices: Procedures: Life: Accident: Health {#sec-11-ncac-04-.0310 omnilex-key=us-nc-regs-official--title-11--11 NCAC 04 .0310}

History

  • Status: repealed
  • Filed as an Emergency Repeal Eff. April 25, 1979, for a Period of 120 Days to be Reinstated on August 23, 1979
  • Authority G.S. 57-1; 57-4; 58-9; 58-54.3
  • Eff. March 16, 1979
  • Repealed Eff. August 23, 1979.
11 NCAC 04 .0311 Function of Section {#sec-11-ncac-04-.0311 omnilex-key=us-nc-regs-official--title-11--11 NCAC 04 .0311}

History

  • Status: repealed
  • Authority G.S. 57-1, -4; 58-9, -262.4
  • Eff. December 15, 1979
  • Repealed Eff. July 1, 1988.
11 NCAC 04 .0312 Information Used in Claim Settlements {#sec-11-ncac-04-.0312 omnilex-key=us-nc-regs-official--title-11--11 NCAC 04 .0312}

(a) Any information, including medical information, used in whole or in part as the basis of settling a life, accident, health, or disability claim shall be provided to the Division as requested in connection with a complaint or injury. The delivery method may include a secure electronic portal provided by the Division.

(b) To the extent permitted by law, the Department shall treat medical information as confidential.

History

  • Authority G.S. 58-2-40; 58-2-190; 58-2-195; 58-2-200; 58-63-20; 58-65-105; 58-67-65; 58-67-150
  • Eff. December 15, 1979
  • Amended Eff. April 1, 1989
  • Readopted Eff. November 1, 2021.
11 NCAC 04 .0313 Provisions of Contracts {#sec-11-ncac-04-.0313 omnilex-key=us-nc-regs-official--title-11--11 NCAC 04 .0313}

The following phrases and provisions, found in life, accident, health, and disability contracts, if not defined in the contracts, shall be construed by the Department in the following manner:

(1) Regular Care and Attendance of a Physician. As used in life, accident, health, and disability policies, "regular care and attendance of a physician" shall not be construed to require insureds to see or be under the care of a physician on a regular basis if it can be shown that the insured has reached his or her maximum point of recovery yet is still disabled under the terms of the insurance contract. This requirement shall not restrict the right of the insurer, at its own expense, to examine or cause to have examined the insured according to the terms of the contract of insurance.

(2) Premature Baby. A premature baby shall not be considered a well baby. The protection afforded newborn infants under G.S. 58-51-30 shall be provided to premature babies.

(3) Medical Necessity. "Medical necessity" shall be construed as including treatment that restores not only the insured's physical but also his or her mental well-being. As used in this Item, "restoration of mental well-being" does not require coverage of psychiatric disorders when those disorders are excluded under the express terms of the contract.

(4) Sound Health. The question, "Are you in sound health?" shall be considered ambiguous, and therefore answers to that question on an insurance application shall not be used as the basis for rescission of a policy or denial of a claim.

History

  • Authority G.S. 58-2-40; 58-3-150; 58-51-1; 58-63-15; 58-63-65; 58-65-1; 58-65-40; 58-67-65; 58-67-150
  • Eff. December 15, 1979
  • Amended Eff. July 1, 2012; April 8, 2002; April 1, 1989
  • Readopted Eff. November 1, 2021.
11 NCAC 04 .0314 Premium Notices: Payments and Refunds {#sec-11-ncac-04-.0314 omnilex-key=us-nc-regs-official--title-11--11 NCAC 04 .0314}

The Commissioner shall consider an unfair trade practice the failure by an insurer to adhere to any of the following procedures concerning premium notices, payments and refunds on life, accident, health, or disability policies pursuant to G.S. 58-63-15:

(1) Premium Notices. Any insurer that makes a practice of sending premium notices shall maintain records to show that it mailed or otherwise delivered the notice to an individual insured or policy owner.

(2) Timely Remittance. Insurance companies shall use date of mailing, rather than date of receipt, to determine whether the insured has made timely remittance of premium, provided the premium payment is received within seven days after either the termination date of the policy or the last day of its grace period, whichever is later.

(3) Right to Return Policy. When this right is given by contract or statute, no insurer shall abridge or frustrate the right of the insured to return a policy within 10 days after he or she receives it for a full refund of premiums paid. Evidence of such delivery shall be signed statements from the policyowner of the date of delivery, copies of signed certified mail receipt, certification of mailing, or firm mailing book entry.

(4) Unearned Premium Refund. When this right is given by contract or statute, no insurer shall abridge or frustrate the right of the insured to receive a refund of unearned premium.

(5) Unearned Premium on Health Policies. When an insured covered by an accident, health or disability policy dies during the term of the policy, his or her insurer shall refund the unearned premium.

(6) Commingling. No licensed person may commingle premiums, insurance deposits or other such funds. These funds are received in a fiduciary capacity on behalf of policyowner and must be immediately forwarded to the proper insurers or be deposited into an authorized account that is separate and distinct from the person's operating or personal accounts. The account shall be used to receive and disburse premiums paid for insurers, return premiums to policyowner, pay bank charges for the account, and transfer of earned commissions or fees.

History

  • Authority G.S. 58-2-40; 58-2-195; 58-51-10; 58-51-15; 58-63-65; 58-65-40; 58-67-50; 58-67-65; 58-67-150; 58-63-40
  • Eff. December 15, 1979
  • Amended Eff April 1, 1989
  • Readopted Eff. December 1, 2021.
11 NCAC 04 .0315 Issuance of Contracts {#sec-11-ncac-04-.0315 omnilex-key=us-nc-regs-official--title-11--11 NCAC 04 .0315}

The Commissioner shall consider an unfair trade practice the failure by an insurer to adhere to any of the following procedures with respect to the issuance of life, accident, health, or disability policies pursuant to G.S. 58-63-15:

(1) Policies to Cover Newborn Infants. No health application or requirements of insurability shall be used to circumvent the requirements of North Carolina General Statute 58-51-30.

(2) Rating of Guaranteed Issue Coverages. There shall be no rating of policies where guaranteed issue at a specified rate is to the public. When only guaranteed issue is presented for sale, the insurer shall disclose in writing to any applicant subjected to individual rating because the applicant did not qualify for guaranteed issue, the fact that his or her rate deviates from the specified rate for the guaranteed issue coverage. This Item shall not apply to individual policies issued to employees under a contract between their employer and his or her insurer.

(3) Replacement of Existing Coverage. With respect to individual accident, health and disability coverages, when an insurer's agent, by misrepresenting the new policy as a supplement or addition to the existing policy, induces an insured to consent to the replacement of his or her existing policy with a new policy, new waiting periods shall be decreased by the amount of time coverage was afforded under the existing policy.

(4) Continuous Coverage Under Credit Life, Accident and Health Policies. In a series of credit life or credit accident and health insurance transactions where the insured, the lender, and the insurer are the same and there is no lapse in coverage between transactions, the waiting periods of the insurance agreements shall run from the date of the first insurance contract, at least to the extent of the amount and term of the indebtedness outstanding at the time of renewal or refinancing.

History

  • Authority G.S. 58-2-40; 58-3-125; 58-3-150; 58-33-75; 58-51-30; 58-63-40; 58-65-40; 58-67-50; 58-67-65; 58-67-150
  • Eff. December 15, 1979
  • Amended Eff. April 8, 2002; April 1, 1989; December 15, 1979
  • Readopted Eff. December 1. 2021.
11 NCAC 04 .0316 Contestability Clause and Rescission {#sec-11-ncac-04-.0316 omnilex-key=us-nc-regs-official--title-11--11 NCAC 04 .0316}

If an insurer does not attempt to rescind an accident, health, or disability policy upon becoming aware that the insured's application contained false statements, the insurer may not subsequently use such false statements as a basis for attempted rescission or alteration of the policy. The Commissioner shall consider failure to adhere to this principle an unfair trade practice pursuant to G.S. 58-63-15.

History

  • Authority G.S. 58-2-40; 58-63-40; 58-65-1; 58-63-15; 58-65-40
  • Eff. December 15, 1979
  • Readopted Eff. December 1, 2021.
11 NCAC 04 .0317 Sex Discrimination: Life: Accident and Health Insurance {#sec-11-ncac-04-.0317 omnilex-key=us-nc-regs-official--title-11--11 NCAC 04 .0317}

(a) Prohibited Practices. The Commissioner shall consider unfair discrimination the denial of life, accident, health or disability insurance on the basis of the insured's or prospective insured's sex or marital status. The amount of benefits payable on any term, condition or type of coverage shall not be restricted, modified, excluded or reduced on the basis of the sex or marital status of the insured or prospective insured. All underwriting criteria shall be applied in all instances of similar circumstances without regard to the sex or marital status of the insured or prospective insured, except to the extent that the amount of the benefits, terms, conditions or type of coverage vary as a result of the application of rate or premium differentials not prohibited under this Chapter, such as differentials for life insurance or annuities derived from sex-based life expectancy tables. Nothing in this Paragraph shall prohibit an insurer from taking marital status into account for the purpose of determining persons eligible for dependent benefits. Examples of the practices prohibited by this Section include:

(1) denying coverage to females employed at home, employed part-time or employed by relatives when coverage is offered to males similarly employed;

(2) denying policy riders to females when the riders are available to males;

(3) denying maternity coverage to unmarried females covered under a policy or contract if maternity coverage is available to married females covered under that policy or contract;

(4) denying, under group contracts, dependent coverage to husbands of female employees, when dependent coverage is available to wives of male employees;

(5) denying disability income contracts to employed women when coverage is offered to men similarly employed;

(6) treating complications of pregnancy differently from any other illness or sickness under the contract;

(7) restricting, reducing, modifying, or excluding benefits payable for disorders of the genital organs of only one sex;

(8) offering lower maximum monthly benefits to women than to men who are in the same classification under a disability income contract;

(9) offering more restrictive benefit periods and more restrictive definitions of disability to women than to men in the same classifications under a disability income contract;

(10) establishing different conditions by sex under which the policyholder may exercise benefit options contained in the contract; and

(11) limiting the amount of coverage an insured or prospective insured may purchase based upon the insured's or prospective insured's marital status unless such limitation is for the purpose of defining persons eligible for dependent benefits.

(b) Applicability and Scope. This Rule shall apply to all contracts delivered or issued for delivery in this State by an insurer on or after the effective date of this Rule and to all existing group contracts which are amended or renewed on or after the effective date of this Rule.

History

  • Authority G.S. 58-2-40; 58-3-120; 58-63-1; 58-63-65
  • Eff. December 15, 1979
  • Readopted Eff. December 1, 2021.
11 NCAC 04 .0318 Life Insurance Sales: Financing First Year Premium {#sec-11-ncac-04-.0318 omnilex-key=us-nc-regs-official--title-11--11 NCAC 04 .0318}

(a) The Commissioner shall consider an unfair trade practice the failure by an insurance company to adhere to the following procedures concerning the sale of life insurance contracts for which the first year's premium or any portion thereof is financed through a device suggested by the insurer or its agent with the insurance policy itself being assigned as security:

(1) Minimum Down-Payment Required. A minimum down-payment of twenty five dollars ($25.00) in cash or by valid and currently collectible check of the applicant is required for the insurance. Under no circumstances shall a company or an agent directly or indirectly either furnish this down-payment or waive this requirement.

(2) Financing Device to be Explained in Policy Application. The furnishing of a promissory note in connection with financing part of the first year's premium must be explained in the policy application. The explanation must be clear and complete and shall specify the principal sum of the note or notes, the interest payable, the due date, the amount payable on that due date, the interest rate and the annual percentage rate.

(3) Execution of Promissory Note. All blank spaces in a promissory note form or an assignment of an insurance policy form subsequently executed by the insured must be filled in by the handwriting of the insured except blank spaces relating to the policy number to be issued, and the signatures of witnesses and co-makers. No agent or anyone acting under his or her direction or control other than the insured shall write in such spaces.

(4) Promissory Note May be Sold Only With Recourse. If a promissory note is taken to finance part of the first year's premium, the note may be sold or otherwise transferred by the payee with recourse only, and this fact must appear in bold print on the face of the note.

(5) Note to be Retained Until Policy Acceptance is Executed. Any promissory note given by the applicant in connection with an application for a policy shall not be sold or otherwise transferred by the agent or company, nor any commissions on the sale paid to the agent until 15 days after a properly executed policy acceptance form has been received in the home office of the insurance company issuing the policy.

(6) Copy of Note to be Furnished Applicant. A copy of the note executed by the applicant must be attached to the policy when delivered.

(7) Policy Acceptance to be Executed on Delivery of the Policy; Contract Rescission. Upon delivery of the policy, a policy acceptance form must be executed that recites the following:

(a) The policy has been issued as represented;

(b) The applicant acknowledges and understands the provisions and obligations of the debt he has incurred in connection with applying for the policy and the terms are set forth in the record;

(c) The applicant understands that he or she may cancel the policy and his or her promissory note and his or her down-payment will be returned if he or she refuses to accept delivery of the policy and sign the acceptance form, and the applicant understands that at any time within 10 days after the execution of the policy acceptance form he or she shall be allowed to rescind the agreement, and the promissory note, together with the total amount of his or her down-payment, shall be returned to the applicant;

(d) The applicant further understands that the rescission or rejection must be communicated to the company by mail and return of the policy within the 10 day period; and

(e) The applicant acknowledges that the obligations of the debt cannot be altered by a cancellation of the policy at his or her request unless properly cancelled within 10 days, in writing, mailed to the company at the address specified. The policy acceptance form shall contain a number designation corresponding to the policy issued and shall not be made available to the agent until the application is received in the home office. The provisions of Sub-items (7)(c) and (d) of this Item shall be printed in bold type upon the face of the policy.

(8) Insured to be Notified of Assignment. The insurer, the note purchaser, assignee or company shall notify the note maker (insured) and all co-makers regarding the purchase, transfer or assignment of the note, after such transfer, inviting any questions relative to the note or the policy that is used as collateral security for the note.

(9) Requests for Cancellation to be Handled Promptly. The company and its agents shall give prompt and complete cooperation to the insured and the Department when requests to cancel the policy and premium financing arrangements are received.

(10) Special Rule in Event Applicant is Under Eighteen Years of Age. If the applicant is a minor and executes a promissory note for the payment of part or all of the first year's premium, the note must be witnessed by at least one of the applicant's parents or guardian.

(11) Disclosure of Extended Obligations. The agent shall clearly disclose to the insured that the cancellation of the note may reduce the cash surrender value of the policy in direct proportion to the amount of the promissory note. The agent shall not use terms such as "bonus payment", "free insurance", or any other term that induces the applicant to believe that the promissory note will be paid by monies other than his or her policy cash values. Terms leading the applicant to believe that he is receiving free insurance by deferring the premium payment for the first year shall not be employed.

(12) Cash Values. Cash values shown at the presentation shall be based on the policy offered. The cash values shown at the time of presentation shall be a specimen of the policy being offered and not for a larger policy.

(13) Cancellation of Existing Insurance. The disturbing of any permanent insurance, including the partial or total replacement of any provisions of an existing policy for the purpose of placing additional insurance, or "twisting" as defined in G.S. 58-3-115, will be cause for investigation and review by the Department of Insurance.

(14) Licensed Agents. Only licensed agents are eligible to sell life insurance. No person other than a licensed agent shall participate in or receive commission or any other valuable consideration in connection with the solicitation, negotiation, procurement, or making of life insurance contracts in this State.

(15) Agent Identification. An agent or field representative who is licensed by this State as a life insurance agent shall not represent, refer to, or hold himself or herself out to the public under any special title that would obscure the fact that he is a licensed agent of the company. Identification as an agent or representative of a special division may be permitted providing such a division actually exists and the agency relationship is disclosed.

(b) This Rule shall not apply to life insurance policies financed in conformity with G.S. 58, Article 35.

History

  • Authority G.S. 58-2-40; 58-3-115; 58-63-40
  • Eff. December 15, 1979
  • Amended Eff. April 8, 2002
  • Readopted Eff. December 1, 2021.
11 NCAC 04 .0319 Claims Practices: Life: Accident and Health Insurance {#sec-11-ncac-04-.0319 omnilex-key=us-nc-regs-official--title-11--11 NCAC 04 .0319}

The Commissioner shall consider as prima facie violative of G.S. 58-63-15(11) the failure by an insurer to adhere to the following procedures concerning settlement of life, accident, health and claims:

(1) Examining Physician's Opinion. When the patient's health is in question, an insurer shall give greater weight to the opinion of a physician who has examined the patient than to the opinion of a physician who has not examined the patient and whose opinion is based solely on a review of the examining physician's notes or reports. As used in this Item, "examination of the patient" shall include the interpretation by a specialist of the results of diagnostic tests performed on the patient by others.

(2) Settlement Offers. Initial offers of settlement or compromise made by an insurer or its representative shall remain open for a period of time of not less than 30 calendar days.

(3) Multiple Health Impairments. When an insured is confined to the hospital with multiple health impairments some of which are excluded from coverage, the insurer or its representative shall make pro rata payments where treatment for excluded conditions can be separated.

(4) Assignment of Benefits. If an accident, health, or disability contract does not prohibit assignment of benefits and an assignment including notice to the insurer prior to the payment of the claim, is made, the insurer shall honor the assignment, even though it may have erroneously paid the insured. Submission of a completed claims form indicating that an assignment is on file shall be treated as though it were submission of the actual assignment.

(5) Claim Status Reports. Health insurance claims subject to 58-3-225 shall be processed in accordance with the provisions of that statute. Otherwise, if benefits claimed under an accident, health, or disability contract have not been paid within 45 days after receipt of the initial claim by the insurer, the insurer shall at that time mail a claim status report to the insured.

History

  • Authority G.S. 58-2-40; 58-3-225; 58-63-15; 58-63-65; 58-65-1; 58-65-40; 58-65-125; 58-67-65; 58-67-150
  • Eff. December 15, 1979
  • Amended Eff. July 1, 2012; April 8, 2002; April 1, 1989
  • Readopted Eff. December 1, 2021.
11 NCAC 04 .0320 Student Loans {#sec-11-ncac-04-.0320 omnilex-key=us-nc-regs-official--title-11--11 NCAC 04 .0320}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-3-135; 58-3-150
  • Eff. July 1, 1986
  • Amended Eff. April 8, 2002; April 1, 1989
  • Repealed Eff. November 1, 2021.
11 NCAC 04 .0401 Function of Section {#sec-11-ncac-04-.0401 omnilex-key=us-nc-regs-official--title-11--11 NCAC 04 .0401}

History

  • Status: repealed
  • Filed as an Emergency Repeal Eff. April 25, 1979, for a Period of 120 Days to be Reinstated
  • on August 23, 1979
  • Authority G.S. 58-9; 58-30.3; 58-30.4; 58-32; 58-72(4) through -72(22); 58-131.56
  • 58-131.57; 58-248.26; 58-248.31; 58-248.32; 58-248.36; 20-310
  • Eff. February 1, 1976
  • Readopted Eff. March 16, 1979
  • Repealed Eff. August 23, 1979.
11 NCAC 04 .0402 Rating of Automobile Insurance {#sec-11-ncac-04-.0402 omnilex-key=us-nc-regs-official--title-11--11 NCAC 04 .0402}

History

  • Status: repealed
  • Filed as an Emergency Repeal Eff. April 25, 1979, for a Period of 120 Days to be Reinstated
  • on August 23, 1979
  • Authority G.S. 58-9; 58-30.3; 58-30.4; 58-32; 58-72(4) through -72(22); 58-131.56
  • 58-131.57; 58-248.26; 58-248.31; 58-248.32; 58-248.36; 20-310
  • Eff. February 1, 1976
  • Readopted Eff. March 16, 1979
  • Repealed Eff. August 23, 1979.
11 NCAC 04 .0403 Billing Procedures for Automobile Liability Insurance {#sec-11-ncac-04-.0403 omnilex-key=us-nc-regs-official--title-11--11 NCAC 04 .0403}

History

  • Status: repealed
  • Filed as an Emergency Repeal Eff. April 25, 1979, for a Period of 120 Days to be Reinstated
  • on August 23, 1979
  • Authority G.S. 58-9; 58-30.3; 58-30.4; 58-32; 58-72(4) through -72(22); 58-131.56
  • 58-131.57; 58-248.26; 58-248.31; 58-248.32; 58-248.36; 20-310
  • Eff. February 1, 1976
  • Readopted Eff. March 16, 1979
  • Repealed Eff. August 23, 1979.
11 NCAC 04 .0404 Cancellation: Termination: Renewal or Nonrenewal {#sec-11-ncac-04-.0404 omnilex-key=us-nc-regs-official--title-11--11 NCAC 04 .0404}

History

  • Status: repealed
  • Filed as an Emergency Repeal Eff. April 25, 1979, for a Period of 120 Days to be Reinstated
  • on August 23, 1979
  • Authority G.S. 58-9; 58-30.3; 58-30.4; 58-32; 58-72(4) through -72(22); 58-131.56
  • 58-131.57; 58-248.26; 58-248.31; 58-248.32; 58-248.36; 20-310
  • Eff. February 1, 1976
  • Readopted Eff. March 16, 1979
  • Repealed Eff. August 23, 1979.
11 NCAC 04 .0405 Drive-in Claim Service Facilities {#sec-11-ncac-04-.0405 omnilex-key=us-nc-regs-official--title-11--11 NCAC 04 .0405}

History

  • Status: repealed
  • Filed as an Emergency Repeal Eff. April 25, 1979, for a Period of 120 Days to be Reinstated
  • on August 23, 1979
  • Authority G.S. 58-9; 58-30.3; 58-30.4; 58-39; 58-44.3; 58-54; 58-54.4; 58-131.37
  • Eff. March 16, 1979
  • Repealed Eff. August 23, 1979.
11 NCAC 04 .0406 Total Losses on Motor Vehicles {#sec-11-ncac-04-.0406 omnilex-key=us-nc-regs-official--title-11--11 NCAC 04 .0406}

History

  • Status: repealed
  • Filed as an Emergency Repeal Eff. April 25, 1979, for a Period of 120 Days to be Reinstated
  • on August 23, 1979
  • Authority G.S. 58-9; 58-30.3; 58-30.4; 58-39; 58-44.3; 58-54; 58-54.4; 58-131.37
  • Eff. March 16, 1979
  • Repealed Eff. August 23, 1979.
11 NCAC 04 .0407 Repair Estimates {#sec-11-ncac-04-.0407 omnilex-key=us-nc-regs-official--title-11--11 NCAC 04 .0407}

History

  • Status: repealed
  • Filed as an Emergency Repeal Eff. April 25, 1979, for a Period of 120 Days to be Reinstated
  • on August 23, 1979
  • Authority G.S. 58-9; 58-30.3; 58-30.4; 58-39; 58-44.3; 58-54; 58-54.4; 58-131.37
  • Eff. March 16, 1979
  • Repealed Eff. August 23, 1979.
11 NCAC 04 .0408 Determination of Repair Costs {#sec-11-ncac-04-.0408 omnilex-key=us-nc-regs-official--title-11--11 NCAC 04 .0408}

History

  • Status: repealed
  • Filed as an Emergency Repeal Eff. April 25, 1979, for a Period of 120 Days to be Reinstated
  • on August 23, 1979
  • Authority G.S. 58-9; 58-30.3; 58-30.4; 58-39; 58-44.3; 58-54; 58-54.4; 58-131.37
  • Eff. March 16, 1979
  • Repealed Eff. August 23, 1979.
11 NCAC 04 .0409 Notice of Cession {#sec-11-ncac-04-.0409 omnilex-key=us-nc-regs-official--title-11--11 NCAC 04 .0409}

History

  • Status: repealed
  • Filed as an Emergency Repeal Eff. April 25, 1979, for a Period of 120 Days to be Reinstated
  • on August 23, 1979
  • Authority G.S. 58-9; 58-30.3; 58-30.4; 58-39; 58-44.3; 58-54; 58-54.4; 58-131.37
  • Eff. March 16, 1979
  • Repealed Eff. August 23, 1979.
11 NCAC 04 .0410 Prompt Determination of Damage {#sec-11-ncac-04-.0410 omnilex-key=us-nc-regs-official--title-11--11 NCAC 04 .0410}

History

  • Status: repealed
  • Filed as an Emergency Repeal Eff. April 25, 1979, for a Period of 120 Days to be Reinstated
  • on August 23, 1979
  • Authority G.S. 58-9; 58-30.3; 58-30.4; 58-39; 58-44.3; 58-54; 58-54.4; 58-131.37
  • Eff. March 16, 1979
  • Repealed Eff. August 23, 1979.
11 NCAC 04 .0411 Sex Discrimination in Automobile Insurance {#sec-11-ncac-04-.0411 omnilex-key=us-nc-regs-official--title-11--11 NCAC 04 .0411}

History

  • Status: repealed
  • Filed as an Emergency Repeal Eff. April 25, 1979, for a Period of 120 Days to be Reinstated
  • on August 23, 1979
  • Authority G.S. 58-9; 58-30.3; 58-30.4; 58-39; 58-44.3; 58-54; 58-54.4; 58-131.37
  • Eff. March 16, 1979
  • Repealed Eff. August 23, 1979.
11 NCAC 04 .0412 Handling of Loss and Claim Payments {#sec-11-ncac-04-.0412 omnilex-key=us-nc-regs-official--title-11--11 NCAC 04 .0412}

History

  • Status: repealed
  • Filed as an Emergency Repeal Eff. April 25, 1979, for a Period of 120 Days to be Reinstated
  • on August 23, 1979
  • Authority G.S. 58-9; 58-30.3; 58-30.4; 58-39; 58-44.3; 58-54; 58-54.4; 58-131.37
  • Eff. March 16, 1979
  • Repealed Eff. August 23, 1979.
11 NCAC 04 .0413 Written Confirmation of Oral Agreements {#sec-11-ncac-04-.0413 omnilex-key=us-nc-regs-official--title-11--11 NCAC 04 .0413}

History

  • Status: repealed
  • Filed as an Emergency Repeal Eff. April 25, 1979, for a Period of 120 Days to be Reinstated
  • on August 23, 1979
  • Authority G.S. 58-9; 58-30.3; 58-30.4; 58-39; 58-44.3; 58-54; 58-54.4; 58-131.37
  • Eff. March 16, 1979
  • Repealed Eff. August 23, 1979.
11 NCAC 04 .0414 Function of Section {#sec-11-ncac-04-.0414 omnilex-key=us-nc-regs-official--title-11--11 NCAC 04 .0414}

History

  • Status: repealed
  • Authority G.S. 58-7.3, -9, -72
  • Eff. December 15, 1979
  • Repealed Eff. July 1, 1988.
11 NCAC 04 .0415 Safe Driver Incentive Plan {#sec-11-ncac-04-.0415 omnilex-key=us-nc-regs-official--title-11--11 NCAC 04 .0415}

The following are Department of Insurance provisions regarding the Safe Driver Incentive Plan ("SDIP"):

(1) License revocation for refusal to submit to chemical tests shall not be considered conviction of a moving traffic violation.

(2) A conviction for driving the wrong way on a one-way street is not a conviction for driving on the wrong side of the road.

(3) The revocation or suspension of a driver's license solely because of the accumulation of motor vehicle points shall not be considered a conviction.

(4) When new operators are added to an automobile policy, their SDIP points may be added to the policy at the same time coverage is extended to them.

(5) SDIP points for an operator whose license has been suspended or revoked may be added only at the date the operator again becomes eligible for license. However, SDIP points may be charged at the inception date of the current policy if the operator has previously been convicted of a moving traffic violation while his or her license was suspended or revoked or if there is evidence that the operator does operate a motor vehicle.

(6) If an operator dies or permanently leaves an insured's household during the policy period, the operator's SDIP points shall be removed at the time of his or her death or departure.

History

  • Authority G.S. 58-2-40; 58-36-65; 58-36-75
  • Eff. December 15, 1979
  • Amended Eff. February 1, 1993
  • Readopted Eff. December 1, 2021.
11 NCAC 04 .0416 Billing Procedures for Automobile Insurance {#sec-11-ncac-04-.0416 omnilex-key=us-nc-regs-official--title-11--11 NCAC 04 .0416}

(a) With respect to new business, an insurer shall take no more than 90 days from the effective date of the policy to make any investigation other than review of the initial application and to bill the insured for proper rate classification or sub-classification.

(b) With respect to renewal business, an insurer shall not bill for any additional premium after the renewal quotation is made for any condition that existed at the time of renewal and is on the driver's motor vehicle record.

(c) With respect to renewal business, if the insured does not provide updated and complete rating information necessary to underwrite the policy or makes an effort to withhold rating information, the insurer shall take no more than 90 days from the effective date of the renewal to make inquiry of the insured, to make any other investigation, and to bill the insured for proper rate classification and sub-classification.

(d) When an insurer obtains information from sources other than the Department of Motor Vehicles for use in underwriting an automobile policy and the insured alleges that the information is incorrect, the insurer shall verify the accuracy of such information.

(e) Unearned premium refunds shall be determined from the later of either the date the consumer gives direct notice to a company or an agent of the company of the cancellation or the effective date of cancellation requested by the insured. In the case of physical damage insurance where there is a loss payee, the effective date of cancellation for the purposes of determining unearned premium refund shall be 10 days from the date cancellation notice was given to a company or a company's agent.

(f) If the consumer can show proof that within the 10 day period in this Rule where cancellation involves a loss payee, and the consumer had obtained replacement physical damage coverage that included the loss payee, then the cancellation date for purposes of determining unearned premium refund shall be the last date of any lapse in coverage for the loss payee during the 10 day time set out in this Rule. In the case of no lapse, shall be determined as if no loss payee was involved.

History

  • Authority G.S. 58-2-40; 58-63-65
  • Eff. December 15, 1979
  • Amended Eff. April 1, 1989; July 1, 1986
  • Readopted Eff. November 1, 2021.
11 NCAC 04 .0417 Drive-in Claim Service Facilities {#sec-11-ncac-04-.0417 omnilex-key=us-nc-regs-official--title-11--11 NCAC 04 .0417}

No insurer shall require any claimant to use a drive-in claim service operated by the insurer. The claimant's voluntary utilization of a drive-in claim service or preferred repair shop shall not prejudice the right of either party to obtain independent appraisals and negotiate settlement on the basis of such appraisals.

History

  • Authority G.S. 58-2-40; 58-63-65
  • Eff. December 15, 1979
  • Amended Eff. July 1, 2012
  • Readopted Eff. October 1, 2021.
11 NCAC 04 .0418 Total Losses on Motor Vehicles {#sec-11-ncac-04-.0418 omnilex-key=us-nc-regs-official--title-11--11 NCAC 04 .0418}

(a) The Commissioner shall consider as prima facie violative of G.S. 58-63-15(11) the failure by an insurance company to adhere to the procedures in this Rule concerning the settlement of covered "total loss" motor vehicle claims when the failure is so frequent as to indicate a general business practice.

(b) For the purposes of this Rule, the following terms shall mean:

(1) "Licensed Motor Vehicle Dealer" means a person who is licensed by the North Carolina Department of Transportation Division of Motor Vehicles pursuant to Chapter 20, Article 12 of the N.C. General Statutes.

(2) "Local Market Area" means an area within a 100-mile radius of the place where the motor vehicle is principally garaged. If a substantially similar motor vehicle is unavailable within a 100-mile radius, the insurance company may increase the radius in increments of 50 miles until a substantially similar motor vehicle can be found.

(3) "Published Regional Average Values" means values derived from printed or electronically published motor vehicle pricing guides recognized in the motor vehicle industry, including National Automobile Dealers Association Pricing Guide Book or Kelley Blue Book that analyze current and historical motor vehicle sales data taking into consideration the year, make, model and condition of the motor vehicle, motor vehicle market conditions, and geographic area to reach an average retail value of the motor vehicle.

(4) "Substantially Similar Motor Vehicle" means a motor vehicle of the same make, model, and year of the damaged motor vehicle.

(c) When a motor vehicle is damaged in an amount which, inclusive of original and supplemental claims, equals or exceeds 75 percent of the pre-accident actual cash value as determined in accordance with Paragraph (d) of this Rule, an insurance company shall designate the motor vehicle as a "total loss" and pay the claimant the pre-accident value. In return, the insurance company shall receive possession of the legal title of the salvage of the total loss motor vehicle.

(d) If the insurance company and the claimant are unable to reach an agreement as to the actual cash value of the total loss motor vehicle, the settlement offer shall be based upon the following values:

(1) The published regional average values of substantially similar motor vehicles; and

(2) The retail cost of two or more substantially similar motor vehicles in the local market area when substantially similar motor vehicles are available or were available within 90 days of the accident to consumers in the local market area.

If no substantially similar motor vehicle is able to be located in the local market area, the settlement offer may be based upon quotations obtained from two or more licensed motor vehicle dealers located within the local market area.

(e) The settlement offer may be adjusted for condition, options, equipment, and mileage, less the cost of unrepaired damage that pre-existed the accident.

(f) Applicable sales tax and vehicle registration fees shall be included as part of the actual cash value settlement of the total loss motor vehicle, except where the claimant retains the salvage vehicle.

(g) The insurance company shall give consideration to evidence presented by the claimant such as receipts, photographs, or other documentation that the total loss motor vehicle owned by him or her was in a better condition prior to the accident than suggested by the insurer's settlement offer.

(h) When a motor vehicle's total loss is settled on a basis which deviates from this Rule, the deviation must be supported by documentation within the claim file detailing the total loss motor vehicle's condition and the reason for the deviation. Any deductions from the actual cash value of the total loss motor vehicle, including deduction for salvage or prior damage, shall be itemized and contain the amount of the deduction. The documentation that supports the basis for the settlement shall be shared with the claimant. The insurance company's record shall include documentation of the total loss settlement.

(i) If requested by the claimant, a total loss payment by an insurance company shall be accompanied by a written statement listing the estimates, evaluations, and any deductions used in calculating the payment, and the source of these values.

(j) No insurance company, adjuster, appraiser, agent, or any other person shall enter into any oral or written agreement(s), by and between themselves, to limit any original or supplemental claim(s) to keep the repair cost of a damaged motor vehicle below 75 percent of its pre-accident value.

(k) At the election of the claimant, or in those circumstances where the insurance company will be unable to obtain an unencumbered title to the total loss motor vehicle, the insurance company shall have the right to deduct the value of the salvage of the total loss motor vehicle from the actual cash value calculation and leave the salvage motor vehicle with the claimant.

(l) If the insurance company makes a deduction for the salvage value of a total loss motor vehicle retained by the claimant, the insurance company shall, upon request of the claimant, furnish the claimant with the name and address of a salvage dealer who will purchase the salvage for the amount deducted.

(m) Where the insurance company has the right to elect to replace the total loss motor vehicle and does so, the replacement motor vehicle shall be substantially similar to the total loss motor vehicle and paid for by the insurance company, subject only to the deductible and to the value of any additional options and equipment chosen by the claimant.

(n) The insurance company shall be responsible for all reasonable towing and storage charges until three days after the motor vehicle's owner and storage facility are notified in writing that the insurance company shall no longer reimburse the motor vehicle's owner or storage facility for storage charges. Notification to the motor vehicle's owner shall include the name, address, and telephone number of the facility where the motor vehicle is being stored. Notification to the storage facility shall include the name, address, and, if available, telephone number of the motor vehicle's owner. Proof of mailing, as defined in Rule .0430 of this Section, shall serve as the proof that the notification required by this Rule occurred.

(o) In instances where the towing and storage charges are paid to the owner, the check or draft for the amount of such service shall be payable jointly to the owner and the towing or storage service.

(p) No insurance company shall abandon the salvage of a total loss motor vehicle to a towing or storage service without the consent of the towing or storage service involved.

History

  • Authority G.S. 20-279.2; 58-2-40; 58-63-65
  • Eff. December 15, 1979
  • Amended Eff. April 1, 1993; April 1, 1989; July 1, 1986
  • Readopted Eff. October 1, 2020.
11 NCAC 04 .0419 Motor Vehicle Repair Estimates {#sec-11-ncac-04-.0419 omnilex-key=us-nc-regs-official--title-11--11 NCAC 04 .0419}

(a) The Commissioner shall consider as prima facie violative of G.S. 58-63-15(11) the failure by an insurance company to adhere to the procedures in this Rule concerning repair estimates on covered motor vehicle damage claims when the failure is so frequent as to indicate a general business practice.

(b) For the purposes of this Rule, the following terms shall mean:

(1) "Digital Inspection" means an inspection of a damaged motor vehicle conducted by using digital photographs, videos, or other digital evidence through an electronic processing system authorized by an insurer.

(2) "Licensed Motor Vehicle Damage Appraiser" means an individual who is licensed as a motor vehicle damage appraiser pursuant to Article 33 of Chapter 58 of the N.C. General Statutes or is licensed in another state whose licensing requirements are substantially similar to or exceed those established under that Article.

(3) "Physical Inspection" means an inspection of a damaged motor vehicle conducted in person by an insurer's representative.

(c) When a motor vehicle is damaged, and the claim is either covered by an insurer for a first-party claim or liability is established for a third-party claim, the insurer shall adhere to the following procedures concerning repair estimates:

(1) If the insurer requires the claimant to obtain more than two estimates of property damage, any cost of the additional estimate(s) shall be paid by the insurer.

(2) An insurer shall perform a physical or digital inspection of the damaged vehicle within 10 business days of receipt of the claim. If the insurer cannot perform the inspection in the timeframe, the insurer shall provide the claimant with a verbal or written explanation of the reason the inspection has not occurred. The reason for the delay shall be documented in writing within the claim file.

(3) No insurer shall refuse to perform a physical inspection of the damaged vehicle if requested by the claimant.

(4) The insurer may satisfy the inspection requirements of this Rule by having a licensed motor vehicle damage appraiser conduct the inspection of the damaged vehicle.

(5) An insurer shall provide a verbal or written explanation to the claimant if there is any delay in responding to a request for a supplemental inspection. The reason for the delay shall be documented in writing in the claim file.

(6) An insurer shall, upon request, provide copies of the original estimate and all supplemental estimates to the claimant.

(7) When the insurer elects to have the damaged vehicle repaired, the insurer shall, upon request of the claimant, furnish the claimant with a copy of its estimate. This estimate shall contain the name and address of the insurer and, if the estimate was prepared by someone other than the insurer, the name and address of the person preparing the estimate. If there is a dispute concerning pre-existing damage to the vehicle that the insurer does not intend to have repaired, the extent of such damage shall be stated in the estimate.

History

  • Authority G.S. 58-2-40; 58-63-65
  • Eff. December 15, 1979
  • Amended Eff. April 1, 1993; April 1, 1989
  • Readopted Eff. October 1, 2020.
11 NCAC 04 .0420 Written Confirmation of Oral Agreements {#sec-11-ncac-04-.0420 omnilex-key=us-nc-regs-official--title-11--11 NCAC 04 .0420}

(a) Once an insurer accepts liability or advises a claimant to have damaged property repaired with the understanding that the insurer will pay or reimburse the claimant, the insurer shall, if requested by the claimant, confirm the understanding in writing. Such writing shall clearly state the responsibility assumed by the insurer for payment of incurred costs.

(b) If so requested by the claimant, the insurer or its representative shall confirm in writing all other oral agreements between itself or its representative and the claimant.

History

  • Authority G.S. 58-2-40; 58-3-100; 58-63-15
  • Eff. December 15, 1979
  • Readopted Eff. November 1, 2021.
11 NCAC 04 .0421 Handling of Loss and Claim Payments {#sec-11-ncac-04-.0421 omnilex-key=us-nc-regs-official--title-11--11 NCAC 04 .0421}

(a) The Commissioner shall consider the failure by an insurer to adhere to the procedures in this Rule concerning loss and claim payments as prima facie evidence violation of G.S. 58-63-15(11) when such failure is so frequent as to indicate a general business practice.

(b) When a motor vehicle is damaged and the claim is covered by an insurer, the insurer shall adhere to the following procedures concerning loss and claim payments.

(1) Loss and claim payments shall be mailed or delivered within 10 business days after the claim is settled.

(2) Unless the insured consents, no insurer shall deduct premiums owed by the insured on a policy from a loss or claim payment made under another policy.

(3) No insurer shall withhold the entire amount of a loss or claim payment because the insured owes premium or other monies in an amount less than the loss or claim payment.

(4) If a release or full payment of claim is executed by a claimant involving a repair to a motor vehicle, it shall not bar the right of the claimant to assert a claim for property damages unknown to either the claimant or to the insurance carrier prior to the repair of the motor vehicle if the damages were caused by the accident and could not be determined or known until after the repair or attempted repair of the motor vehicle. This claim shall be asserted within the statute of limitations set forth in G.S. 1-52(16).

(5) If a release or full payment of claim is executed by a third-party claimant involving a repair to a motor vehicle, it shall not bar the right of the third-party claimant to assert a claim for diminution in fair market value pursuant to G.S. 20-279.21(d1) caused by the accident and could not be determined or known until after the repair or attempted repair of the motor vehicle. This claim shall be asserted within the statute of limitations set forth in G.S. 1-52(16).

(c) For purposes of this Rule, "diminution in fair market value" shall be as defined in 11 NCAC 04 .0425.

(d) If a claim for diminution in fair market value is asserted pursuant to this Rule and G.S. 20-279.21(d1), the written appraisal reports prepared by each appraiser shall be exchanged with the other party.

History

  • Authority G.S. 20-279.2; 58-2-40; 58-63-65
  • Eff. December 15, 1979
  • Amended Eff. February 1, 1996; April 1, 1993; April 1, 1989; July 1, 1986
  • Readopted Eff. October 1, 2020.
11 NCAC 04 .0422 Cancellation of Insurance {#sec-11-ncac-04-.0422 omnilex-key=us-nc-regs-official--title-11--11 NCAC 04 .0422}

The Commissioner shall consider an unfair trade practice the cancellation by an insurer of any personal lines insurance policy for which the premium has been paid because there is another policy in force for which the premium has not been paid.

History

  • Authority G.S. 58-2-40; 58-63-40
  • Eff. December 15, 1979
  • Amended Eff. February 1, 1996
  • Readopted Eff. November 1, 2021.
11 NCAC 04 .0423 Ethical Standards {#sec-11-ncac-04-.0423 omnilex-key=us-nc-regs-official--title-11--11 NCAC 04 .0423}

(a) Every agent, limited representative, broker, adjuster, appraiser, or other insurer's representative shall, when conducting insurance business with a member of the public:

(1) identify himself or herself and his or her occupation; and

(2) provide his or her National Producer Number and the Department's website address and phone number for verification of licensure status when requested to show proof of licensure by any claimant, any repairer while he or she is investigating a claim or loss, any Department representative, or any other person with whom he or she has contact while performing his or her insurance business.

(b) No claims management person, agent, agency employee, limited representative, broker, adjuster, appraiser, or other insurer's representative shall:

(1) accept any gratuity or other form of remuneration from any provider of services for recommending that provider to claimants;

(2) purchase salvage from a claimant;

(3) intimidate or discourage any claimant from seeking legal advice or counsel by withdrawing and reducing a settlement offer previously tendered to the claimant or threatening to do so if the claimant seeks legal advice or counsel. No adjuster shall advise a claimant of the advisability of seeking legal counsel nor recommend any legal counsel to any claimant; or

(4) cause a delay in the settlement of a property damage claim on account of the claimant's choice of a motor vehicle repair service.

(c) No claims management person, agent, agency employee, limited representative, broker, or other insurer's representative shall recommend the utilization of a particular motor vehicle repair service without informing the claimant that he or she is under no obligation to use the recommended repair service and that he or she may use the service of his or her choice.

History

  • Authority G.S. 58-2-40; 58-33-130; 58-35-25; 58-63-65; 58-65-40
  • Eff. December 15, 1979
  • Amended Eff. October 1, 2010; April 1, 1993; April 1, 1989; July 1, 1986
  • Readopted Eff. November 1, 2021.
11 NCAC 04 .0424 Purpose {#sec-11-ncac-04-.0424 omnilex-key=us-nc-regs-official--title-11--11 NCAC 04 .0424}

History

  • Status: repealed
  • Authority G.S. 58-9
  • Eff. April 1, 1989
  • Repealed Eff. April 1, 1993.
11 NCAC 04 .0425 Definitions {#sec-11-ncac-04-.0425 omnilex-key=us-nc-regs-official--title-11--11 NCAC 04 .0425}

As used in this Section the following terms shall be construed as follows:

(1) "After market part" means a part made by a nonoriginal manufacturer.

(2) "Claimant" means a first-party or third-party claimant.

(3) "Diminution in Fair Market Value," as that term is used in G.S. 20-279.21, means the difference in the fair market value of the vehicle immediately before the accident and after any repairs made to the vehicle as a result of the accident have been completed.

(4) "Disinterested appraiser," as that term is used in G.S. 20-279.21, means a motor vehicle damage appraiser who:

(a) Is not employed by either the claimant or the insurer;

(b) Has no financial interest in the outcome of the appraisal; and

(c) Did not participate in the original appraisal.

(5) "First-Party Claimant" means a person that is making a claim on an insurance policy in which they are the insured party.

(6) "Insurer" means as defined in G.S. 58-1-5(3), and includes any person authorized by the insurer to represent the insurer with respect to a claim and who is acting within the scope of the person's authority.

(7) "Nonoriginal manufacturer" means any manufacturer other than the original manufacturer of a part.

(8) "Part" means a component of a motor vehicle.

(9) "Third-Party Claimant" means a person that is making a claim on an insurance policy in which they are not the insured party.

History

  • Authority G.S. 20-279.2; 20-279.21; 58-2-40
  • Eff. April 1, 1989
  • Readopted Eff. October 1, 2020.
11 NCAC 04 .0426 Like Kind and Quality {#sec-11-ncac-04-.0426 omnilex-key=us-nc-regs-official--title-11--11 NCAC 04 .0426}

No insurer shall require the use of an aftermarket part in the repair of a motor vehicle unless the aftermarket part is at least equal to the original part in terms of fit, quality, performance, and warranty. Insurers specifying the use of aftermarket parts shall include in the estimate the costs of any modifications made necessary by the use of aftermarket parts.

History

  • Authority G.S. 58-2-40
  • Eff. April 1, 1989
  • Readopted Eff. November 1, 2021.
11 NCAC 04 .0427 Disclosure Requirements {#sec-11-ncac-04-.0427 omnilex-key=us-nc-regs-official--title-11--11 NCAC 04 .0427}

Every insurer that writes motor vehicle insurance in this State and that intends to require or specify the use of after market parts must disclose to its policyholders in writing, either in the policy or on a sticker attached thereto, the following information in all capital letters and font size no smaller than ten-point:

IN THE REPAIR OF YOUR COVERED AUTO UNDER THE PHYSICAL DAMAGE COVERAGE PROVISIONS OF THIS POLICY, WE MAY REQUIRE OR SPECIFY THE USE OF AUTOMOBILE PARTS NOT MADE BY THE ORIGINAL MANUFACTURER. THESE PARTS ARE REQUIRED TO BE AT LEAST EQUAL IN TERMS OF FIT, QUALITY, PERFORMANCE AND WARRANTY TO THE ORIGINAL MANUFACTURER PARTS THEY REPLACE.

All after market parts installed on a motor vehicle shall be identified on the estimate and invoice for such repair.

History

  • Authority G.S. 58-2-40
  • Eff. April 1, 1989
  • Amended Eff. March 1, 2004
  • Readopted Eff. December 1, 2021.
11 NCAC 04 .0428 Enforcement {#sec-11-ncac-04-.0428 omnilex-key=us-nc-regs-official--title-11--11 NCAC 04 .0428}

History

  • Status: repealed
  • Authority G.S. 58-9
  • Eff. May 1, 1989
  • Repealed Eff. May 3, 1993.
11 NCAC 04 .0429 Commingling {#sec-11-ncac-04-.0429 omnilex-key=us-nc-regs-official--title-11--11 NCAC 04 .0429}

The accounting records maintained by agents, brokers, and limited representatives shall be separate and apart from any other business records and demonstrate at all times that collected funds due to insurers and return premiums due to policyholders are available at all times.

History

  • Authority G.S. 58-2-40; 58-2-195
  • Eff. February 1, 1993
  • Amended Eff. February 1, 1996
  • Readopted Eff. December 1, 2021.
11 NCAC 04 .0430 Proof of Mailing; Automobile Insurance {#sec-11-ncac-04-.0430 omnilex-key=us-nc-regs-official--title-11--11 NCAC 04 .0430}

As used in G.S. 58-36-85, "proof of mailing" means a certificate issued by and bearing the date stamp of the United States Postal Service or an official United States Postal Service tracking number or similar proof of mailing.

History

  • Authority G.S. 58-2-40; 58-36-85
  • Eff. February 1, 1993
  • Amended Eff. July 1, 2012; February 1, 1996
  • Readopted Eff. October 1, 2021.
11 NCAC 04 .0431 Definition of Claimant {#sec-11-ncac-04-.0431 omnilex-key=us-nc-regs-official--title-11--11 NCAC 04 .0431}

As used in this Section, unless the context indicates otherwise, "claimant" means a first party claimant or a third party claimant.

History

  • Authority G.S. 58-2-40(1); 58-63-15
  • Eff. April 1, 1993
  • Readopted Eff. November 1, 2021.
11 NCAC 04 .0432 Refund of Excess Premium on Scheduled Items {#sec-11-ncac-04-.0432 omnilex-key=us-nc-regs-official--title-11--11 NCAC 04 .0432}

If an insured has any scheduled item listed for additional insurance covered by a homeowner's or personal inland marine insurance policy, and that item is replaced for less than the scheduled amount of coverage, the insurer shall refund the insured the difference in premium charged between the scheduled amount of coverage and the actual amount of the loss paid by the insurer, if the refund per policy term is greater than five dollars ($5.00). Any refund shall be computed from the date of issuance of the policy or five years, whichever is less.

History

  • Authority G.S. 58-2-40; 58-63-65
  • Eff. April 1, 1995
  • Amended Eff. July 1, 2012
  • Readopted Eff. December 1, 2021.
11 NCAC 04 .0433 Refund of Auto Insurance Premium on New Business {#sec-11-ncac-04-.0433 omnilex-key=us-nc-regs-official--title-11--11 NCAC 04 .0433}

If an insured asks an insurer to cancel a newly issued motor vehicle insurance policy on or before the premium billing due date, the unearned premium refund made by the insurer shall be made on a pro rata rather than a short rate basis, and the refund shall be based on the premium initially quoted by the insurer if both of the following conditions are met:

(1) The insured provided the insurer with accurate and complete rating information.

(2) The insurer subsequently calculated the premium to be greater than the premium initially quoted.

History

  • Authority G.S. 58-2-40; 58-36-85; 58-63-65
  • Eff. April 1, 1995
  • Readopted Eff. December 1, 2021.
11 NCAC 04 .0501 Scope and Definitions {#sec-11-ncac-04-.0501 omnilex-key=us-nc-regs-official--title-11--11 NCAC 04 .0501}

(a) These Rules apply to all policies sold on and after the effective dates of these Rules and to all certificates issued under those policies.

(b) As used in this Section, the following terms have the following meanings:

(1) "Actuarial Standards Board" means the board established by the American Academy of Actuaries to develop and promulgate standards of actuarial practice.

(2) "Basic illustration" means a ledger or proposal used in the sale of a policy that shows both guaranteed and non-guaranteed elements.

(3) "Contract premium" means the gross premium that is required to be paid under a fixed premium policy, including the premium for a rider for which benefits are shown in the illustration.

(4) "Currently payable scale" means a scale of non-guaranteed elements in effect for a policy as of the preparation date of the illustration or declared to become effective within the next 95 days.

(5) "Disciplined current scale" means a scale of non-guaranteed elements constituting a limit on illustrations currently being illustrated by an insurer that is based on actual recent historical experience, as certified annually by an illustration actuary designated by the insurer.

(6) "Guaranteed elements" means the premiums, benefits, values, credits, or charges under a policy that are guaranteed and determined at issue.

(7) "Illustrated scale" means a scale of non-guaranteed elements currently being illustrated that is not more favorable to the policy owner than the lesser of:

(A) The disciplined current scale; or

(B) The currently payable scale.

(8) "Illustration" means a presentation or depiction that includes non-guaranteed elements of a policy over a period of years and that is either a basic illustration, in-force illustration, or a supplemental illustration.

(9) "In force illustration" means an illustration furnished at any time after the policy that it depicts has been in force for one year or more.

(10) "Illustration actuary" means an actuary meeting the requirements of 11 NCAC 04 .0509 who certifies to illustrations based on the standard of practice promulgated by the Actuarial Standards Board.

(11) "Lapse-supported illustration" means an illustration of a policy failing the test of self-supporting as defined in this Subparagraph (b)(16) of this Rule, under a modified persistency rate assumption using persistency rates underlying the disciplined current scale for the first five years and 100 percent policy persistency thereafter.

(12) "Non-guaranteed elements" means the premiums, benefits, values, credits, or charges under a policy that are not guaranteed or not determined at issue.

(13) "Policy" means a group or individual life insurance policy or certificate. "Policy" does not include:

(A) A variable life insurance policy or certificate.

(B) An annuity contract.

(C) A credit life insurance policy or certificate.

(D) A life insurance policy with no illustrated death benefit on any individual exceeding ten thousand dollars ($10,000).

(14) "Policy owner" means the owner named in a policy or the certificate holder in the case of a group policy.

(15) "Premium outlay" means the amount of premium assumed to be paid by the policy owner or other premium payer out-of-pocket.

(16) "Self-supporting illustration" means an illustration of a policy for which it can be demonstrated that, when using experience assumptions underlying the disciplined current scale, for all illustrated points in time on or after the fifteenth policy anniversary or the twentieth policy anniversary for second-or-later-to-die policies (or upon policy expiration if sooner), the accumulated value of all policy cash flows equals or exceeds the total policy owner value available. For this purpose, policy owner value will include cash surrender values and any other illustrated benefit amounts available at the policy owner's election.

(17) "Supplemental illustration" means an illustration furnished in addition to a basic illustration that meets the applicable requirements of this Section, and that may be presented in a format differing from the basic illustration, but may only depict a scale of non-guaranteed elements that is permitted in a basic illustration.

History

  • Authority G.S. 58-2-40; 58-58-1; 58-58-40; 58-60-15; 58-60-20; 58-63-15; 58-63-65
  • Eff. January 1, 1997
  • Readopted Eff. December 1, 2021.
11 NCAC 04 .0502 Assumed Expenses and Current Scale {#sec-11-ncac-04-.0502 omnilex-key=us-nc-regs-official--title-11--11 NCAC 04 .0502}

(a) An insurer may choose to designate each year the method of determining assumed expenses for all policies from the following:

(1) Fully allocated expenses.

(2) Marginal expense.

(3) A table of fully allocated expenses developed by the Actuarial Standards Board and approved by the National Association of Insurance Commissioners.

Marginal expenses may be used only if greater than a generally recognized expense table. If no generally recognized expense table is approved, fully allocated expenses must be used.

(b) Further guidance in determining the disciplined current scale as contained in standards established by the Actuarial Standards Board may be relied upon if the standards:

(1) Are consistent with all provisions of this Section.

(2) Limit a disciplined current scale to reflect only actions that have been taken on events that have already occurred.

(3) Do not permit a disciplined current scale to include any projected trends of improvements in experience or any assumed improvements in experience beyond the illustration date.

(4) As used in this Rule, "minimum assumed expenses" means the minimum expenses used in the calculation of the disciplined current scale for a policy. Do not permit assumed expenses to be less than minimum assumed expenses.

History

  • Authority G.S. 58-2-40; 58-58-1; 58-58-40; 58-60-15; 58-60-20; 58-63-15; 58-63-65
  • Eff. January 1, 1997
  • Readopted Eff. December 1, 2021.
11 NCAC 04 .0503 Illustrated Policies {#sec-11-ncac-04-.0503 omnilex-key=us-nc-regs-official--title-11--11 NCAC 04 .0503}

(a) Each insurer marketing policies regulated by this Section shall notify the Commissioner whether a policy form is to be marketed with or without an illustration. For all policy forms being marketed on the effective date of this Section, the insurer shall identify in writing those policy forms and whether or not an illustration will be used with them. For policy forms filed after the effective date of this Section, the identification shall be made at the time of filing. Any previous identification may be changed by notice to the Commissioner.

(b) If the insurer identifies a policy form as one to be marketed without an illustration, any use of an illustration before the first policy anniversary for any policy form using that policy is prohibited.

(c) If a policy form is identified by an insurer as one to be marketed with an illustration, the insurer shall prepare and deliver a basic illustration in accordance with this Section, except that a basic illustration need not be provided to individual members of a single employer group or to individuals insured under multiple lives coverage issued to a single applicant unless the coverage is marketed to those individuals. The illustration furnished to an applicant for a group policy issued to a single applicant on multiple lives may be either an individual or composite illustration representative of the coverage on the lives of members of the group or the multiple lives covered.

(d) As used in this Paragraph, "non-term group life" means a group policy or individual policies of traditional permanent or universal life insurance issued to members of a single employer group where:

(1) Every plan of coverage was selected by the employer.

(2) The premium is paid by the employer or through payroll deduction.

(3) Group underwriting or simplified underwriting is used.

Potential enrollees for policies and certificates of non-term group life subject to this Section shall be furnished a quotation with the enrollment materials. The quotation shall show potential policy values for sample ages and policy years on a guaranteed and non-guaranteed basis appropriate to the group and the coverage. This quotation shall not be considered an illustration for purposes of this Section, but all information provided shall be consistent with the illustrated scale. A basic illustration shall be provided at delivery of the policy or certificate to enrollees for non-term group life who enroll for more than the minimum premium necessary to provide pure death benefit protection. In addition, the insurer shall make a basic illustration available to any non-term group life enrollee who requests it.

History

  • Authority G.S. 58-2-40; 58-58-1; 58-58-40; 58-60-15; 58-60-20; 58-63-15; 58-63-65
  • Eff. January 1, 1997
  • Readopted Eff. December 1, 2021.
11 NCAC 04 .0504 General Rules {#sec-11-ncac-04-.0504 omnilex-key=us-nc-regs-official--title-11--11 NCAC 04 .0504}

(a) As used in this Rule, "generic name" means a title descriptive of the policy being illustrated, such as "whole life", "term life", or "flexible premium adjustable life." An illustration used in the sale of a policy shall satisfy the requirements of this Section, be labeled "life insurance illustration" and contain the following information:

(1) Name of insurer;

(2) Name and business address of producer or insurer's authorized representative, if any;

(3) Name, age and sex of proposed insured, except where a composite illustration is permitted under this Section;

(4) Underwriting or rating classification upon which the illustration is based;

(5) Generic name of the policy, the company product name, if different, and policy form number;

(6) Initial death benefit; and

(7) Dividend option election or application of non-guaranteed elements, if applicable.

(b) When using an illustration in the sale of a policy, an insurer or its agents or other authorized representatives shall not:

(1) Represent the policy as anything other than a life insurance policy;

(2) Use or describe non-guaranteed elements in a manner that is misleading;

(3) State or imply that the payment or amount of non-guaranteed elements is guaranteed;

(4) Use an illustration that does not comply with the requirements of this Section;

(5) Use an illustration that at any policy duration depicts policy performance more favorable to the policy owner than that produced by the illustrated scale of the insurer whose policy is being illustrated;

(6) Provide an applicant with an incomplete illustration;

(7) Represent in any way that premium payments will not be required for each year of the policy in order to maintain the illustrated death benefits, unless that is the fact;

(8) Use the term "vanish" or "vanishing premium", or a similar term that implies the policy becomes paid up, to describe a plan for using non-guaranteed elements to pay a portion of future premiums;

(9) Except for policies that can never develop nonforfeiture values, use an illustration that is "lapse-supported"; or

(10) Use an illustration that is not "self-supporting."

(c) If an interest rate used to determine the illustrated non-guaranteed elements is shown, it shall not be greater than the earned interest rate underlying the disciplined current scale.

History

  • Authority G.S. 58-2-40; 58-58-1; 58-58-40; 58-60-15; 58-60-20; 58-63-15; 58-63-65
  • Eff. January 1, 1997
  • Readopted Eff. December 1, 2021.
11 NCAC 04 .0505 Standards for Basic Illustrations {#sec-11-ncac-04-.0505 omnilex-key=us-nc-regs-official--title-11--11 NCAC 04 .0505}

(a) Format. A basic illustration shall conform with the following requirements:

(1) The illustration shall be labeled with the date on which it was prepared.

(2) Each page, including any explanatory notes or pages, shall be numbered and show its relationship to the total number of pages in the illustration (e.g., the fourth page of a seven-page illustration shall be labeled "page 4 of 7 pages").

(3) The assumed dates of payment receipt and benefit pay-out within a policy year shall be clearly identified.

(4) If the age of the proposed insured is shown as a component of the tabular detail, it shall be issue age plus the numbers of years the policy is assumed to have been in force.

(5) The assumed payments on which the illustrated benefits and values are based shall be identified as premium outlay or contract premium, as applicable. For policies that do not require a specific contract premium, the illustrated payments shall be identified as premium outlay.

(6) Guaranteed death benefits and values available upon surrender, if any, for the illustrated premium outlay or contract premium shall be shown and clearly labeled guaranteed.

(7) If the illustration shows any non-guaranteed elements, they shall not be based on a scale more favorable to the policy owner than the insurer's illustrated scale at any duration. These elements shall be clearly labeled non-guaranteed.

(8) The guaranteed elements, if any, shall be shown before corresponding non-guaranteed elements and shall be specifically referred to on any page of an illustration that shows or describes only the non-guaranteed elements (e.g., "see page one for guaranteed elements").

(9) The account or accumulation value of a policy, if shown, shall be identified by the name this value is given in the policy being illustrated and shown in close proximity to the corresponding value available upon surrender.

(10) The value available upon surrender shall be identified by the name this value is given in the policy being illustrated and shall be the amount available to the policy owner in a lump sum after deduction of surrender charges, policy loans and policy loan interest, as applicable.

(11) Illustrations may show policy benefits and values in graphic or chart form in addition to the tabular form.

(12) Any illustration of non-guaranteed elements shall be accompanied by a statement indicating that:

(A) The benefits and values are not guaranteed;

(B) The assumptions on which they are based are subject to change by the insurer; and

(C) Actual results may be more or less favorable.

(13) If the illustration shows that the premium payer may have the option to allow policy charges to be paid using non-guaranteed values, the illustration must clearly disclose that a charge continues to be required and that, depending on actual results, the premium payer may need to continue or resume premium outlays. Similar disclosure shall be made for premium outlay of lesser amounts or shorter durations than the contract premium. If a contract premium is due, the premium outlay shall not be left blank or show zero unless accompanied by an asterisk or similar mark to draw attention to the fact that the policy is not paid up.

(14) If the applicant plans to use dividends or policy values, guaranteed or non-guaranteed, to pay all or a portion of the contract premium or policy charges, or for any other purpose, the illustration may reflect those plans and the effect on future policy benefits and values.

(b) Narrative Summary. A basic illustration shall include the following:

(1) A brief description of the policy being illustrated, including a statement that it is a life insurance policy.

(2) A brief description of the premium outlay or contract premium, as applicable, for the policy. For a policy that does not require payment of a specific contract premium, the illustration shall show the premium outlay that must be paid to guarantee coverage for the term of the policy, subject to maximum premiums allowable to qualify as a life insurance policy under the applicable provisions of the Internal Revenue Code.

(3) A brief description of any policy features, riders or options, guaranteed or non-guaranteed, shown in the basic illustration and the effect they may have on the benefits and values of the policy.

(4) Identification and a brief definition of column headings and key terms used in the illustration.

(5) A statement containing the following: This illustration assumes that the currently illustrated non-guaranteed elements will continue unchanged for all years shown. This is not likely to occur. Actual results may be more or less favorable than those shown.

(c) Numeric Summary.

(1) Following the narrative summary, a basic illustration shall include a numeric summary of the death benefits and values and the premium outlay and contract premium, as applicable. For a policy that provides for a contract premium, the guaranteed death benefits and values shall be based on the contract premium. This summary shall be shown for at least policy years 5, 10 and 20 and at age 70, if applicable, on the three bases shown below. For multiple life policies the summary shall show policy years 5, 10, 20 and 30. The columns of the numeric summary shall be as follows:

(A) Policy guarantees;

(B) Insurer's illustrated scale; and

(C) Insurer's illustrated scale used but with the non-guaranteed elements reduced as follows:

(i) Dividends at 50 percent of the dividends contained in the illustrated scale used;

(ii) Non-guaranteed credited interest at rates that are the average of the guaranteed rates and the rates contained in the illustrated scale used; and

(iii) All non-guaranteed charges, including but not limited to, term insurance charges, mortality and expense charges, at rates that are the average of the guaranteed rates and the rates contained in the illustrated scale used.

(2) In addition, if coverage would cease before policy maturity or age 100, the year when coverage ceases shall be identified for each of the three bases.

(d) Statements. Statements substantially similar to the following shall be included on the same page as the numeric summary and signed by the applicant, or the policy owner in the case of an illustration provided at time of delivery, as required in this Section.

(1) A statement to be signed and dated by the applicant or policy owner reading as follows: "I have received a copy of this illustration and understand that any non-guaranteed elements illustrated are subject to change and could be either higher or lower. The agent has told me they are not guaranteed."

(2) A statement to be signed and dated by the insurance producer or other authorized representative of the insurer reading as follows: "I certify that this illustration has been presented to the applicant and that I have explained that any non-guaranteed elements illustrated are subject to change. I have made no statements that are inconsistent with the illustration."

(e) Tabular Detail.

(1) A basic illustration shall include the following for at least each policy year from one to 10 and for every fifth policy year thereafter ending at age 100, policy maturity or final expiration, and except for term insurance beyond the 20th year, for any year in which the premium outlay and contract premium, if applicable is to change:

(A) The premium outlay and mode the applicant plans to pay and the contract premium, as applicable;

(B) The corresponding guaranteed death benefit, as provided in the policy; and

(C) The corresponding guaranteed value available upon surrender, as provided in the policy.

(2) For a policy that provides for a contract premium, the guaranteed death benefit and value available upon surrender shall correspond to the contract premium.

(3) Non-guaranteed elements may be shown if described in the policy. In the case of an illustration for a policy on which the insurer intends to credit terminal dividends, they may be shown if the insurer's current practice is to pay terminal dividends. If any non-guaranteed elements are shown they must be shown at the same durations as the corresponding guaranteed elements, if any. If no guaranteed benefit or value is available at any duration for which a non-guaranteed benefit or value is shown, a zero shall be displayed in the guaranteed column.

History

  • Authority G.S. 58-2-40; 58-58-1; 58-58-40; 58-60-15; 58-60-20; 58-63-15; 58-63-65
  • Eff. January 1, 1997
  • Readopted Eff. December 1, 2021.
11 NCAC 04 .0506 Standards for Supplemental Illustrations {#sec-11-ncac-04-.0506 omnilex-key=us-nc-regs-official--title-11--11 NCAC 04 .0506}

(a) A supplemental illustration may be provided as long as:

(1) It is appended to, accompanied by or preceded by a basic illustration that complies with Rule .0505 of this Section;

(2) The non-guaranteed elements shown are not more favorable to the policy owner than the corresponding elements based on the scale used in the basic illustration;

(3) It contains the same statement required of a basic illustration that non-guaranteed elements are not guaranteed; and

(4) For a policy that has a contract premium, the contract premium underlying the supplemental illustration is equal to the contract premium shown in the basic illustration. For policies that do not require a contract premium, the premium outlay underlying the supplemental illustration shall be equal to the premium outlay shown in the illustration.

(b) The supplemental illustration shall include a notice referring to the basic illustration for guaranteed elements.

History

  • Authority G.S. 58-2-40; 58-58-1; 58-58-40; 58-60-15; 58-60-20; 58-63-15; 58-63-65
  • Eff. January 1, 1997
  • Readopted Eff. December 1, 2021.
11 NCAC 04 .0507 Delivery of Illustration and Record Retention {#sec-11-ncac-04-.0507 omnilex-key=us-nc-regs-official--title-11--11 NCAC 04 .0507}

(a) If a basic illustration is used by an insurance agent or other authorized representative of the insurer in the sale of a policy and the policy is applied for as illustrated, a copy of that illustration, signed in accordance with this Rule, shall be submitted by an insurance agent or other authorized representative to the insurer and the applicant at the time of policy application.

(b) If the policy is issued other than as applied for, a revised basic illustration conforming to the policy as issued shall be sent with the policy. The revised illustration shall conform to the requirements of this Rule, shall be labeled "Revised Illustration" and shall be signed and dated by the applicant or policy owner and insurance agent or other authorized representative of the insurer no later than the time the policy is delivered. A copy shall be provided to the insurer and the policy owner.

(c) If no illustration is used by an insurance agent or other authorized representative in the sale of a policy or if the policy is applied for other than as illustrated, the producer or representative shall certify to that effect in writing on a form provided by the insurer. On the same form the applicant shall acknowledge that no illustration conforming to the policy applied for was provided and shall further acknowledge an understanding that an illustration conforming to the policy as issued will be provided no later than at the time of policy delivery. This form shall be submitted to the insurer at the time of policy application.

(d) If the policy is issued, a basic illustration conforming to the policy as issued shall be sent with the policy and signed no later than the time the policy is delivered. A copy shall be provided to the insurer and the policy owner.

(e) If the basic illustration or revised illustration is sent to the applicant or policy owner by mail directly from the insurer, it shall include instructions for the applicant or policy owner to sign the duplicate copy of the numeric summary page of the illustration for the policy issued and return the signed copy to the insurer. The insurer's obligation under this Paragraph shall be satisfied if it can demonstrate that it has made a diligent effort to secure a signed copy of the numeric summary page. The requirement to make a diligent effort shall be deemed satisfied if the insurer includes in the mailing a self-addressed postage prepaid envelope with instructions for the return of the signed numeric summary page.

(f) A copy of the basic illustration and a revised basic illustration, if any, signed if required by rule, along with any certification that either no illustration was used or that the policy was applied for other than as illustrated, shall be retained by the insurer until three years after the policy is no longer in force. A copy need not be retained if no policy is issued.

History

  • Authority G.S. 58-2-40; 58-58-1; 58-58-40; 58-60-15; 58-60-20; 58-63-15; 58-63-65
  • Eff. January 1, 1997
  • Readopted Eff. December 1, 2021.
11 NCAC 04 .0508 Annual Reports and Notices to Policy Owners {#sec-11-ncac-04-.0508 omnilex-key=us-nc-regs-official--title-11--11 NCAC 04 .0508}

(a) In the case of a policy designated as one for which an illustration will be issued, the insurer shall provide each policy owner with an annual report on the status of the policy that shall contain the information specified in this Rule.

(b) For universal life policies, the report shall include the following:

(1) The beginning and end date of the current report period;

(2) The policy value at the end of the previous report period and at the end of the current report period;

(3) The total amounts that have been credited or debited to the policy value during the current period, identifying each by type (e.g., interest, mortality, expense and riders);

(4) The current death benefit at the end of the current report period on each life covered by the policy;

(5) The net cash surrender value of the policy as of the end of the current report period;

(6) The amount of outstanding loans, if any, as of the end of the current report period; and

(7) Either:

(A) For fixed premium policies: If, assuming guaranteed interest, mortality, expense loads and continued scheduled premium payments, the policy's net cash surrender value is such that it would not maintain insurance in force until the end of the next reporting period, a notice to this effect shall be included in the report; or

(B) For flexible premium policies: If, assuming guaranteed interest, mortality and expense loads, the policy's net cash surrender value will not maintain insurance in force until the end of the next reporting period unless further premium payments are made, a notice to this effect shall be included in the report.

(c) For all other policies, where applicable, the report shall contain:

(1) Current death benefit;

(2) Annual contract premium;

(3) Current cash surrender value;

(4) Current dividend;

(5) Application of current dividend; and

(6) Amount of outstanding loan.

(d) Insurers writing policies that do not build nonforfeiture values shall only be required to provide an annual report with respect to these policies for those years when a change has been made to nonguaranteed policy elements by the insurer.

(e) If the annual report does not include an in force illustration, it shall contain the following notice in boldface print with a capitalized heading "IMPORTANT POLICY OWNER NOTICE: You should consider requesting more detailed information about your policy to understand how it may perform in the future. You should not consider replacement of your policy or make changes in your coverage without requesting a current illustration of your policy. You may annually request, without charge, such an illustration by calling [insurer's phone number], writing to [insurer's name] at [insurer's address] or contacting your agent. If you do not receive an illustration of your policy within 30 days from your request, you should contact your State insurance department." The insurer may vary the sequential order of the methods for obtaining an in force illustration.

(f) Upon the request of the policy owner, the insurer shall furnish an in force illustration of current and future benefits and values based on the insurer's present illustrated scale. This illustration shall comply with the requirements of 11 NCAC 04 .0504(a), .0504(b), .0505(a), and .0505(e). No signature or other acknowledgment of receipt of this illustration shall be required.

(g) If an adverse change in any non-guaranteed element that could affect the policy has been made by the insurer since the last annual report, the annual report shall contain a notice of that fact and a description of the change. The notice and description shall be printed in boldface print in a type at least two points larger than the report.

History

  • Authority G.S. 58-2-40; 58-58-1; 58-58-40; 58-60-15; 58-60-20; 58-63-15; 58-63-65
  • Eff. January 1, 1997
  • Readopted Eff. December 1, 2021.
11 NCAC 04 .0509 Annual Certifications {#sec-11-ncac-04-.0509 omnilex-key=us-nc-regs-official--title-11--11 NCAC 04 .0509}

(a) The board of directors of each insurer shall appoint one or more illustration actuaries.

(b) The illustration actuary shall certify that the disciplined current scale used in illustrations is in conformity with the Actuarial Standard of Practice for Compliance with the NAIC Model Regulation on Life Insurance Illustrations promulgated by the Actuarial Standards Board, and that the illustrated scales used in insurer-authorized illustrations meet the requirements of this Section.

(c) The illustration actuary shall:

(1) Be a member in good standing of the American Academy of Actuaries;

(2) Be knowledgeable of the standard of practice regarding life insurance policy illustrations;

(3) Not have been found by the Commissioner, following appropriate notice and opportunity for hearing to have:

(A) Violated any provision of, or any obligation imposed by, the insurance law or other law in the course of his or her dealings as an illustration actuary;

(B) Been found guilty of fraudulent or dishonest practices;

(C) Demonstrated his or her incompetence, lack of cooperation, or untrustworthiness to act as an illustration actuary; or

(D) Resigned or been removed as an illustration actuary within the past five years as a result of acts or omissions indicated in any adverse report on examination or as a result of a failure to adhere to generally acceptable actuarial standards;

(4) Notify the Commissioner of any action taken by an insurance regulator of another state with laws similar to that under Subparagraph (c)(3) of this Rule;

(5) Disclose in the annual certification whether, since the last certification, a currently payable scale applicable for business issued within the previous five years and within the scope of the certification has been reduced for reasons other than changes in the experience factors underlying the disciplined current scale. If nonguaranteed elements illustrated for new policies are not consistent with those illustrated for similar in force policies, this shall be disclosed in the annual certification. If nonguaranteed elements illustrated for both new and in force policies are not consistent with the nonguaranteed elements actually being paid, charged, or credited to the same or similar form, this shall be disclosed in the annual certification; and

(6) Disclose in the annual certification which of the following methods are used to allocate overhead expenses for all illustrations:

(A) Fully allocated expenses;

(B) Marginal expenses; or

(C) A table of fully allocated expenses developed by the Actuarial Standards Board and approved by the National Association of Insurance Commissioners.

(d) The illustration actuary shall file a certification with the board and with the Commissioner:

(1) Annually for all policies for which illustrations are used; and

(2) Before a new policy is illustrated.

At the time an error in a previous certification is discovered, the illustration actuary shall notify the board of directors of the insurer and the Commissioner.

(e) If an illustration actuary is unable to certify the scale for any policy illustration the insurer intends to use, the actuary shall notify the board of directors of the insurer and the Commissioner of his or her inability to certify.

(f) An officer of the insurer, other than the illustration actuary, shall certify annually that the illustration formats meet the requirements of this Rule and that the scales used in insurer-authorized illustrations are those scales certified by the illustration actuary and that the company has provided its agents with information about the expense allocation used by the company in its illustrations and disclosed as required in Subparagraph (c)(6) of this Rule.

(g) The annual certifications shall be provided to the Commissioner each year by a date determined by the insurer.

(h) At the time an insurer changes the illustration actuary responsible for all or a portion of the company's policies, the insurer shall notify the Commissioner of that fact and disclose the reason for the change.

History

  • Authority G.S. 58-2-40; 58-2-171; 58-58-1; 58-58-40; 58-60-15; 58-60-20; 58-63-15; 58-63-65
  • Eff. January 1, 1997
  • Readopted Eff. December 1, 2021.

Chapter 05 Office of State Fire Marshal

Subchapter A

11 NCAC 05A .0101 Definitions {#sec-11-ncac-05a-.0101 omnilex-key=us-nc-regs-official--title-11--11 NCAC 05A .0101}

As used in this Subchapter:

(1) "ISO" means the Insurance Services Office, Inc., or any successor organization.

(2) "North Carolina Fire Suppression Rating Schedule" or "NCFSRS" means the ISO Fire Suppression Rating Schedule. The NCFSRS is incorporated into this Subchapter by reference, including subsequent amendments or editions. The NCFSRS may be obtained from the ISO at http://www.iso.com/ for a fee of one hundred dollars ($100.00). Fire chiefs and local government chief administrative officials may request a single copy of the FSRS, free of charge at www.iso.com.

(3) "NFIRS" means the National Fire Incident Reporting System administered by the United States Fire Administration (USFA) and coordinated and collected in North Carolina by the Office of the State Fire Marshal. State fire incident reporting instructions are provided by OSFM at http://www.ncdoi.com/OSFM/Fire_Rescue_Commission/Default.aspx?field1=Incident_Reporting_-_Information&user=Incident_Reporting for no charge and satisfy NFIRS reporting requirements.

(4) "Office of State Fire Marshal" or "OSFM" means the Office of State Fire Marshal of the North Carolina Department of Insurance

History

  • Authority G.S. 58-2-40
  • Eff. February 1, 1976
  • Readopted Eff. May 12, 1978
  • Amended Eff. February 1, 2017; September 1, 2010; October 1, 2006; July 1, 1986
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 19, 2019.
11 NCAC 05A .0102 Purpose of Division {#sec-11-ncac-05a-.0102 omnilex-key=us-nc-regs-official--title-11--11 NCAC 05A .0102}

History

  • Status: repealed
  • Authority G.S. 11-23; 58-7.3; 58-9; 69-19; 118-1 through 118-17; 118A-3; 147-33.1
  • Eff. February 1, 1976
  • Amended Eff. July 1, 1986
  • Repealed Eff. July 1, 1988.
11 NCAC 05A .0103 Mailing Address {#sec-11-ncac-05a-.0103 omnilex-key=us-nc-regs-official--title-11--11 NCAC 05A .0103}

All requests for information, assistance, training, or required reports shall be directed to: North Carolina Department of Insurance, Office of State Fire Marshal, 1202 Mail Service Center, Raleigh, NC 27699-1202.

History

  • Authority G.S. 58-2-40
  • Eff. February 1, 1976
  • Readopted Eff. May 12, 1978
  • Amended Eff. October 1, 2006; July 1, 1986
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 19, 2019.
11 NCAC 05A .0104 Division Personnel {#sec-11-ncac-05a-.0104 omnilex-key=us-nc-regs-official--title-11--11 NCAC 05A .0104}

History

  • Status: repealed
  • Authority G.S. 58-7.3; 58-9
  • Eff. February 1, 1976
  • Readopted Eff. May 12, 1978
  • Amended Eff. July 1, 1986
  • Repealed Eff. July 1, 1988.
11 NCAC 05A .0105 Training Operations {#sec-11-ncac-05a-.0105 omnilex-key=us-nc-regs-official--title-11--11 NCAC 05A .0105}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-78-10
  • Eff. February 1, 1976
  • Readopted Eff. May 12, 1978
  • Amended Eff. October 1, 1988
  • Repealed Eff. May 1, 2017.
11 NCAC 05A .0201 Administration of State Volunteer Fire Department {#sec-11-ncac-05a-.0201 omnilex-key=us-nc-regs-official--title-11--11 NCAC 05A .0201}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-80-1 thru 58-80-60
  • Eff. February 1, 1976
  • Readopted Eff. May 12, 1978
  • Amended Eff. April 8, 2002; July 1, 1986
  • Repealed Eff. May 1, 2017.
11 NCAC 05A .0202 Comprehensive Emergency Management Plan {#sec-11-ncac-05a-.0202 omnilex-key=us-nc-regs-official--title-11--11 NCAC 05A .0202}

The Commissioner of Insurance acts as an advisor to the Governor for Structural Fire Suppressions and Rescue Services under the North Carolina Emergency Operations Plan and assists other state and local agencies through the OSFM in the following areas:

(1) planning in the fire and rescue services;

(2) training in the various fields of emergency structural fire suppression, rescue services, search and rescue, fire prevention and education;

(3) serving as the lead agency for Structural Fire Suppressions and Rescue Services during these declared emergencies; and

(4) serving as a support agency for search and rescue functions during these declared emergencies.

History

  • Authority G.S. 58-2-40
  • Eff. February 1, 1976
  • Readopted Eff. May 12, 1978
  • Amended Eff. February 1, 2017; July 1, 1986
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 19, 2019.
11 NCAC 05A .0301 Eligible Members {#sec-11-ncac-05a-.0301 omnilex-key=us-nc-regs-official--title-11--11 NCAC 05A .0301}

History

  • Status: repealed
  • Authority G.S. 58-2-40(1); 58-84-40
  • Eff. February 1, 1976
  • Readopted Eff. May 12, 1978
  • Amended Eff. September 1, 2010; October 1, 2006; February 1, 1993; July 1, 1986
  • Repealed Eff. May 1, 2017.
11 NCAC 05A .0302 Certification of Eligibility {#sec-11-ncac-05a-.0302 omnilex-key=us-nc-regs-official--title-11--11 NCAC 05A .0302}

The certification form required by G.S. 58-84-46 shall be entitled "Local Relief Fund Board of Trustees Report" and shall, include the following:

(1) the name of the city, fire district, or sanitary district;

(2) names, home addresses, email addresses, and phone numbers of the "board of trustees of the local Firefighters' Relief Fund";

(3) identify of the treasurer and board chair of the local Firefighters' Relief Fund; and

(4) the date each person was (re)elected or (re)appointed to the board.

History

  • Authority G.S. 58-2-40(1); 58-84-86
  • Eff. February 1, 1976
  • Readopted Eff. May 12, 1978
  • Amended Eff. February 1, 2017; September 1, 2010; October 1, 2006; July 1, 2002; February 1, 1993; July 1, 1986
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 19, 2019.
11 NCAC 05A .0303 Administration of Firefighters' Relief Fund {#sec-11-ncac-05a-.0303 omnilex-key=us-nc-regs-official--title-11--11 NCAC 05A .0303}

(a) OSFM shall compile and maintain records, including the following information:

(1) certifications of the "Local Relief Fund Board of Trustees Report" filed in accordance with G.S. 58-84-46;

(2) certifications filed by the North Carolina State Firemen's Association in accordance with G.S. 58-84-40(b);

(3) amount of Firefighters' Relief Fund tax assigned by the North Carolina Department of Revenue; and

(4) amount of property tax values for each rated fire district as filed by each County.

(b) If a fire department dissolves, the following procedures apply:

(1) If a neighboring fire department elects to expand its boundaries to include the area served by the dissolved fire department, the Firefighters' Relief Fund account shall be transferred to the expanding fire department.

(2) If no neighboring fire department elects to include the dissolved fire department's territory into its own, the dissolved fire department shall not be certified and shall forfeit its right to future annual payments from the Firefighters' Relief Fund.

(c) If a rated and certified fire department that is serving two or more rated and certified districts divides into separate fire departments, the original rated and certified fire department shall retain the relief fund for each rated and certified district. Any new fire department resulting from the division shall be entitled to receive relief fund money after it has been rated and certified in accordance with 11 NCAC 05A .0503.

(d) Fire department checks shall be disbursed by the Department of Insurance Controllers office to the fire departments in that county through Electronic Funds Transfer, unless a fire department's account cannot accept electronic funds transfers, in which case the Commissioner shall distribute the department's allocation by paper check.

History

  • Authority G.S. 58-2-40(1); 58-84-25; 58-84-40; 58-84-50; 58-85-1
  • Eff. February 1, 1976
  • Readopted Eff. May 12, 1978
  • Amended Eff. February 1, 2017; September 1, 2010; February 1, 1993; July 1, 1986
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 19, 2019.
11 NCAC 05A .0401 Firemen's Pension Fund {#sec-11-ncac-05a-.0401 omnilex-key=us-nc-regs-official--title-11--11 NCAC 05A .0401}

History

  • Status: repealed
  • Authority G.S. 118A-19; 143-166.1 through 143-166.7
  • Eff. February 1, 1976
  • Readopted Eff. May 12, 1978
  • Repealed Eff. July 1, 1986.
11 NCAC 05A .0402 Firemen and Rescue Squad in Line of Duty Death Benefit {#sec-11-ncac-05a-.0402 omnilex-key=us-nc-regs-official--title-11--11 NCAC 05A .0402}

History

  • Status: repealed
  • Authority G.S. 118A-19; 143-166.1 through 143-166.7
  • Eff. February 1, 1976
  • Readopted Eff. May 12, 1978
  • Repealed Eff. July 1, 1986.
11 NCAC 05A .0403 Rural Volunteer Fire Department Fund {#sec-11-ncac-05a-.0403 omnilex-key=us-nc-regs-official--title-11--11 NCAC 05A .0403}

History

  • Status: repealed
  • Authority G.S. 118-50; 118-61
  • Eff. October 1, 1988
  • Repealed Eff. February 1, 1993.
11 NCAC 05A .0404 Rescue Squad Workers' Relief Fund {#sec-11-ncac-05a-.0404 omnilex-key=us-nc-regs-official--title-11--11 NCAC 05A .0404}

History

  • Status: repealed
  • Authority G.S. 118-50; 118-61
  • Eff. October 1, 1988
  • Repealed Eff. February 1, 1993.
11 NCAC 05A .0501 Purpose {#sec-11-ncac-05a-.0501 omnilex-key=us-nc-regs-official--title-11--11 NCAC 05A .0501}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-86-25
  • Eff. September 1, 1985
  • Amended Eff. October 1, 2006: July 1, 1992; July 1, 1986
  • Repealed Eff. January 1, 2018.
11 NCAC 05A .0502 Qualifications {#sec-11-ncac-05a-.0502 omnilex-key=us-nc-regs-official--title-11--11 NCAC 05A .0502}

11 NCAC 05A .0503 ESTABLISHMENT OF FIRE DEPARTMENT

11 NCAC 05A .0504 PRIMARY PERSONNEL

History

  • Authority G.S. 58-2-40; 58-84-5; 58-86-25; 143-166.1
  • Eff. September 1, 1985
  • Amended Eff. February 1, 2017; October 1, 2006; July 1, 1992; July 1, 1986
  • Repealed Eff. January 1, 2018.
11 NCAC 05A .0505 Drills and Meeting Requirements {#sec-11-ncac-05a-.0505 omnilex-key=us-nc-regs-official--title-11--11 NCAC 05A .0505}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-36-10; 58-78-5; 58-86-25
  • Eff. September 1, 1985
  • Amended Eff. October 1, 2010; October 1, 2006; July 1, 1992
  • Repealed Eff. January 1, 2018.
11 NCAC 05A .0506 Alarm and Communications {#sec-11-ncac-05a-.0506 omnilex-key=us-nc-regs-official--title-11--11 NCAC 05A .0506}

11 NCAC 05A .0507 RECORDS AND DOCUMENTS

History

  • Authority G.S. 58-2-40; 58-79-45
  • Eff. September 1, 1985
  • Amended Eff. February 1, 2017; September 1, 2010; October 1, 2006; July 1, 1992
  • Repealed Eff. January 1, 2018.
11 NCAC 05A .0508 Apparatus {#sec-11-ncac-05a-.0508 omnilex-key=us-nc-regs-official--title-11--11 NCAC 05A .0508}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-36-10(3); 58-86-25
  • Eff. September 1, 1985
  • Amended Eff. October 1, 2006; August 3, 1992
  • Repealed Eff. January 1, 2018.
11 NCAC 05A .0509 Fire Station {#sec-11-ncac-05a-.0509 omnilex-key=us-nc-regs-official--title-11--11 NCAC 05A .0509}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-86-25; 143-166.1
  • Eff. September 1, 1985
  • Repealed Eff. January 1, 2018.
11 NCAC 05A .0510 Inspection {#sec-11-ncac-05a-.0510 omnilex-key=us-nc-regs-official--title-11--11 NCAC 05A .0510}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-36-10(3); 58-86-25
  • Eff. September 1, 1985
  • Amended Eff. October 1, 2006; July 1, 1992
  • Repealed Eff. February 1, 2017.
11 NCAC 05A .0511 Six Mile Insurance District {#sec-11-ncac-05a-.0511 omnilex-key=us-nc-regs-official--title-11--11 NCAC 05A .0511}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-86-25; 58-40-25(4)
  • Eff. October 1, 2006
  • Repealed Eff. January 1, 2018.
11 NCAC 05A .0512 Standards and Policies {#sec-11-ncac-05a-.0512 omnilex-key=us-nc-regs-official--title-11--11 NCAC 05A .0512}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-36-10(3)
  • Eff. October 1, 2006
  • Amended Eff. February 1, 2017
  • Repealed Eff. January 1, 2018.
11 NCAC 05A .0601 Definitions {#sec-11-ncac-05a-.0601 omnilex-key=us-nc-regs-official--title-11--11 NCAC 05A .0601}

History

  • Status: repealed
  • Authority G.S. 58-2-40(1); 58-87-1
  • Eff. February 1, 1993.
  • Repealed Eff. February 1, 2017.
11 NCAC 05A .0602 Fire District Rating Certification {#sec-11-ncac-05a-.0602 omnilex-key=us-nc-regs-official--title-11--11 NCAC 05A .0602}

If a fire department is working with OSFM to obtain its fire district rating certification as of March 1, it may apply for a grant. In order to receive a grant, the fire department shall obtain its fire district rating certification within 60 days after OSFM has determined that the fire department has otherwise satisfied the requirements of G.S. 58-87-1 and the rules in this Section.

History

  • Authority G.S. 58-2-40(1); 58-36-10(3); 58-87-1
  • Eff. February 1, 1993
  • Amended Eff. February 1, 2017
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 19, 2019.
11 NCAC 05A .0603 Requirements {#sec-11-ncac-05a-.0603 omnilex-key=us-nc-regs-official--title-11--11 NCAC 05A .0603}

(a) A department shall apply for a grant by using an online application made available by OSFM. This application shall contain the following information:

(1) general contact information for the applicant;

(2) a description of the department, including the names and total number of active members, services provided, the number of volunteers and paid personnel and the total annual salary;

(3) a list of current vehicles owned by the department;

(4) total county and city funding received by the department;

(5) contract information for each city and county; and

(6) a list of equipment requested by the department.

(b) Online applications shall be submitted to OSFM and be electronic date stamped no later than March 1. Applications bearing electronic date stamps later than March 1 shall be disqualified.

(c) Any application received by OSFM that is incorrect or incomplete shall be returned to the department with a request that the correct or complete information be sent to OSFM within 10 business days after receipt by the department. The failure of the department to return the requested correct or complete information shall result in the forfeiture by the department of its eligibility for a grant during that grant cycle.

(d) Any department listed on the Office of State Budget and Management Suspension of Funding List for Non State Entities available at http://www.osbm.state.nc.us/ shall be ineligible to participate in the grant program until the department is removed from the Suspension of Funding List pursuant to G.S. 143C-6-23. If a department is awarded a grant and becomes ineligible to receive funding due to being listed on Suspension of Funding List, the department may be required to forfeit the grant pursuant to 09 NCAC 03M .0801.

(e) If the application includes a request for a motor vehicle, the vehicle specifications shall accompany the application. If a used vehicle is requested, then the previous year's maintenance records shall accompany the application. Maintenance records shall consist of items such as weekly or monthly vehicle checks that would include annual inspections, oil changes, fuel level, tire pressure, mileage, hour meter, and other pertinent fluid levels and service test records, if applicable.

(f) The following documents shall accompany a grant application:

(1) A contract verification form showing an agreement between the department and a county for the department to provide fire protection to a district;

(2) A current roster comprising a list of "eligible firefighters" as defined in G.S. 58-86-2;

(3) A financial statement of the department; and

(4) A statement verifying that the department is financially able to match the grant in accordance with G.S. 58-87-1(a1)(2).

(g) Statements that there are no overdue taxes, conflict of interest statements as defined in G.S. 143C-6-23(b), payment agreements, and equipment invoices shall be received by OSFM no later than September 30 following the announcement of grant recipients. Departments submitting incorrect invoices, such as sales orders, acknowledgements, and packing slips, on or before September 30 shall be contacted by OSFM and given 10 business days to submit correct documents. The failure of any department to comply shall result in the department forfeiting its eligibility for a grant from the Fund. Equipment or capital improvements that are ordered by a department before May 15 or equipment that is back-ordered by a vendor for a department or equipment not received by a department on or before September 30 shall not be funded by grants from the Fund.

(h) OSFM may extend the September 30 deadline for invoice submission for the following:

(1) new vehicles;

(2) self-contained breathing apparatus;

(3) personal protective equipment; or

(4) capital improvements.

(i) In order for the deadline to be extended pursuant to Paragraph (h) of this Rule, the department shall notify OSFM in writing by August 31. OSFM shall review the grant extension request and may approve an extension of up to 90 days. If an extension greater than the initial 90 days is needed by the department, another written request shall be submitted to OSFM no later than 30 days prior to the end of the first extension. The first extension shall be for 90 days, any subsequent extension and its length shall be determined by OSFM based on the information provided, but shall not exceed 90 days. Extensions may be granted for the following reasons: manufacturing delays, state declared disasters, shipping delays, and supply shortages.

History

  • Authority G.S. 58-2-40(1); 58-87-1
  • Eff. February 1, 1993
  • Amended Eff. May 1, 2017; September 1, 2010; January 1, 2007
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 19, 2019.
11 NCAC 05A .0604 Other Grant Criteria {#sec-11-ncac-05a-.0604 omnilex-key=us-nc-regs-official--title-11--11 NCAC 05A .0604}

In addition to criteria in G.S. 58-87-1, in awarding grants the Commissioner of Insurance shall consider the following criteria in relation to each fire department:

(1) number of paid personnel;

(2) personnel salary paid by the unit or the city or county;

(3) number and age of vehicles;

(4) county population density;

(5) county per capita income;

(6) source of fire department funding, including the following funding sources for the last fiscal year:

(a) city or county funding;

(b) fire tax;

(c) sales tax;

(d) contracted services;

(e) revenue from EMS billing;

(f) fund raising;

(g) donations; and

(h) revenue from non-OSFM grants.

(7) cash balance as of the beginning of current fiscal year;

(8) protective equipment requested;

(9) miscellaneous equipment requested;

(10) vehicles requested;

(11) capital improvements requested; and

(12) current fire insurance rating.

History

  • Authority G.S. 58-2-40(1); 58-87-1
  • Eff. February 1, 1993
  • Amended Eff. February 1, 2017
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 19, 2019.
11 NCAC 05A .0701 Definitions {#sec-11-ncac-05a-.0701 omnilex-key=us-nc-regs-official--title-11--11 NCAC 05A .0701}

As used in the section:

(1) "Office of State Fire Marshal" or "OFSM" means the Office of State Fire Marshal of the North Carolina Department of Insurance.

(2) "Fund" means the Volunteer Rescue/EMS Fund created in G.S. 58-87-5.

(3) "Unit" means a volunteer unit, a rescue/EMS unit, or an EMS unit recognized by OSFM in accordance with G.S. 58-87-5(b)(3).

History

  • Authority G.S. 58-2-40(1); 58-87-5
  • Eff. February 1, 1976
  • Readopted Eff. May 12, 1978
  • Amended Eff. February 1, 2017
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 19, 2019.
11 NCAC 05A .0702 Als Certification {#sec-11-ncac-05a-.0702 omnilex-key=us-nc-regs-official--title-11--11 NCAC 05A .0702}

If a unit is working with the Office of Emergency Medical Services (OEMS) to obtain its Advanced Life Support (ALS) certification as of October 1, that unit may apply for a grant. In order to receive a grant, the unit shall obtain its ALS certification from OEMS within 60 days after OSFM has determined that the unit has otherwise satisfied the requirements in G.S. 58-87-5 and the rules in this Section.

History

  • Authority G.S. 58-2-40(1); 58-87-5
  • Eff. February 1, 1993
  • Amended Eff. February 1, 2017
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 19, 2019.
11 NCAC 05A .0703 Requirements for Units Required to Match Grants {#sec-11-ncac-05a-.0703 omnilex-key=us-nc-regs-official--title-11--11 NCAC 05A .0703}

(a) A unit shall apply for a grant by using an online application made available by OSFM. This application shall contain the following information:

(1) general contact information for the applicant;

(2) a description of the unit, including the names and total number of active members, services provided, the number of volunteers and paid personnel and the total annual salary;

(3) a list of current vehicles owned by the unit;

(4) total county and city funding received by the unit;

(5) contract information for each city and county; and

(6) a list of equipment requested by the unit.

(b) Online applications shall be submitted to OSFM and be electronic date stamped no later than October 1. Applications bearing electronic date stamps later than October 1 shall be disqualified.

(c) Any application received by OSFM that is incorrect or incomplete shall be returned to the unit with a request that the correct or complete information be sent to OSFM within 10 business days after receipt by the unit. The failure by the unit to return the requested correct or complete information shall result in the forfeiture by the unit of its eligibility for a grant during that grant cycle.

(d) Any unit listed on the Office of State Budget and Management Suspension of Funding List for Non State Entities available at http://www.osbm.state.nc.us/ shall be ineligible to participate in the grant program until the unit is removed from the Suspension of Funding List pursuant to G.S. 143C-6-23. If a unit is awarded a grant and becomes ineligible to receive funding due to being listed on the Suspension of Funding List, the unit may be required to forfeit the grant pursuant to 09 NCAC 03M .0801.

(e) If the application includes a request for a motor vehicle, the vehicle specifications shall accompany the application. If a used vehicle is requested, then the previous year's maintenance records shall accompany the application. Maintenance records shall consist of items such as weekly or monthly vehicle checks that would include annual inspections, oil changes, fuel level, tire pressure, mileage, hour meter, and other pertinent fluid levels and service test records, if applicable.

(f) The following documents shall accompany a grant application;

(1) A Rescue Provider Statement showing that a county recognizes the unit as providing rescue or rescue/EMS services to a specified district. As used in this Subparagraph, "rescue provider statement" means a statement, signed by representatives of a unit and the county in which the rescue or rescue/EMS services are provided, that the unit provides rescue or rescue/EMS services within the county;

(2) A current roster of unit members;

(3) A statement verifying that the unit is financially able to match the amount of the grant in accordance with G.S. 58-87-5(a)(2); and

(4) A financial statement of the unit.

(g) Statements that there are no overdue taxes, conflict of interest statements as defined in G.S. 143C-6-23(b), payment agreements, and equipment invoices shall be received by OSFM no later than April 30. Units submitting incorrect invoices, such as sales orders, acknowledgements, and packing slips, before April 30 shall be contacted by OSFM and given 10 business days to submit the correct documents. The failure of any unit to comply shall result in the unit forfeiting its eligibility for a grant from the Fund. Equipment or capital improvements that are ordered by a unit before December 15 or equipment that is back-ordered by a vendor for a unit or equipment not received by a unit on or before April 30 shall not be funded by grants from the Fund.

(h) OSFM may extend the April 30 deadline for invoice submission for the following:

(1) new vehicles;

(2) self-contained breathing apparatus;

(3) personal protective equipment; or

(4) capital improvements.

(i) In order for the deadline to be extended pursuant to Paragraph (h) of this Rule, the unit shall notify OSFM in writing by March 31. OSFM shall review the grant extension request and may approve an extension of up to 90 days. If an extension greater than the initial 90 days is needed by the unit, another written request shall be submitted to OSFM no later than 30 days prior to the end of the first extension. The first extension shall be for 90 days, any subsequent extension and its length shall be determined by OSFM based on the information provided, but shall not exceed 90 days. Extensions may be granted for the following reasons: manufacturing delays, state declared disasters, shipping delays, and supply shortages.

History

  • Authority G.S. 58-2-40(1); 58-87-5
  • Eff. February 1, 1993
  • Amended Eff. May 1, 2017; September 1, 2010; January 1, 2007
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 19, 2019.
11 NCAC 05A .0704 Requirements for Units Not Required to Match Grants {#sec-11-ncac-05a-.0704 omnilex-key=us-nc-regs-official--title-11--11 NCAC 05A .0704}

History

  • Status: repealed
  • Authority G.S. 58-2-40(1); 58-87-5
  • Eff. February 1, 1993
  • Repealed Eff. May 1, 2017.
11 NCAC 05A .0705 Other Grant Criteria {#sec-11-ncac-05a-.0705 omnilex-key=us-nc-regs-official--title-11--11 NCAC 05A .0705}

In addition to criteria in G.S. 58-87-5 and other Rules in this Section, in awarding grants the OSFM shall consider the following criteria in relation to each unit:

(1) number of paid personnel;

(2) personnel salary paid by the unit or the city or county;

(3) number and age of vehicles;

(4) county population density;

(5) county per capita income;

(6) unit funding sources including the following funding sources for the last fiscal year:

(a) city or county funding;

(b) fire tax;

(c) sales tax;

(d) contracted services;

(e) revenue from EMS billing;

(f) fund raising;

(g) donations; and

(h) revenue from non-OSFM grants;

(7) cash balance as of the beginning of current fiscal year;

(8) protective equipment requested;

(9) miscellaneous equipment requested;

(10) capital improvements requested; and

(11) vehicles requested.

History

  • Authority G.S. 58-2-40(1); 58-87-5
  • Eff. February 1, 1993
  • Amended Eff. February 1, 2017
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 19, 2019.
11 NCAC 05A .0801 Certifications {#sec-11-ncac-05a-.0801 omnilex-key=us-nc-regs-official--title-11--11 NCAC 05A .0801}

(a) Certifications and fees submitted pursuant to G.S. 58-92-20 shall be sent to:

NCDOI-OSFM

NC Fire Safety Programs

1202 Mail Service Center

Raleigh, NC 27699-1202

(b) OSFM shall return incomplete certifications. The submitter shall complete or correct the original submittal within 90 days after the date of return. If the submitter fails to return a completed or corrected submittal within the 90-day period, the submitter shall pay the fee specified in G.S 58-92-20(e) for each subsequent submittal.

(c) Payment of all fees under Article 92 of Chapter 58 of the General Statutes shall be remitted by way of a check drawn on a bank. As used in this Paragraph, "bank" has the meaning set forth in Section 2(c) of the Bank Holding Company Act of 1956, as amended (12 U.S.C. 1841(c)).

History

  • Authority G.S. 58-2-40; 58-92-20; 58-92-35; 58-92-30(g)
  • Eff. February 1, 2010
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 19, 2019.
11 NCAC 05A .0901 Definitions {#sec-11-ncac-05a-.0901 omnilex-key=us-nc-regs-official--title-11--11 NCAC 05A .0901}

As used in this Subchapter:

(1) "9S Inspection" means an inspection conducted by the Office of State Fire Marshal (OSFM) to ensure compliance with the requirements of this Section in order to receive a public protection classification rating.

(2) "Automatic Aid" means assistance dispatched automatically by contractual agreement between two communities or fire districts to all structure fires.

(3) "Eligible Firefighter" means all persons 18 years of age or older who are firefighters as defined by G.S. 58-86-2.

(4) "Engine" means a motorized vehicle meeting the requirements of NFPA 1901, "Standard for Automotive Fire Apparatus."

(5) "Fire Department" means an organization established or organized under applicable State and local laws, for the purpose of limiting, reducing, or preventing damage or personal injury caused by fire or other emergency.

(6) "Fire Districts" or "Insurance Districts" means an area within a city, town, municipality, or county that is established in order to provide fire prevention and fire suppression services.

(7) "Fire Station" means a building for housing a certified engine and personnel.

(8) "Gallons Per Minute" or "GPM" means the volume of water flow from a hose, hydrant, or other fire suppression apparatus.

(9) "Insurance Services Office" or "ISO" means the Insurance Services Office, Inc.

(10) "North Carolina Fire Suppression Rating Schedule" or "NCFSRS" means the current edition of the ISO Fire Suppression Rating Schedule.

(11) "Pounds Per Square Inch" or "PSI" means the pressure a gas or liquid exerts on the walls of its container.

(12) "Public Protection Classification" or "PPC" means a rating given to fire districts or insurance districts throughout the State on their ability to provide fire prevention and fire suppression services to affected areas within its jurisdictional boundaries.

(13) "Response District" means an area within a city, town, or municipality to which a fire department responds in order to provide fire prevention and fire suppression services.

(14) "Road Miles" are the miles that a fire apparatus will travel from a fire station to an emergency scene.

(15) "Rural Fire District" means a fire district that is outside the jurisdictional boundaries of a city, town, or municipality and is established pursuant to Chapter 69, Article 3A or Chapter 153A, Article 11 of the General Statutes.

(16) "Structure Fire" means a condition where an actual monetary loss or physical damage has occurred to a building or constructed area due to the result of a fire.

(17) "Tanker" means an apparatus designed to carry water to fires, whether equipped with or without a pump to dispense the water.

History

  • Authority G.S. 58-78A-1(b)(20); 58-78A-2; 58-36-10; 58-40-25
  • Eff. January 1, 2018
  • Amended Eff. June 1, 2026.
11 NCAC 05A .0902 Purpose {#sec-11-ncac-05a-.0902 omnilex-key=us-nc-regs-official--title-11--11 NCAC 05A .0902}

(a) This Section establishes standards for insurance public protection classifications for fire districts

throughout the State.

(b) Fire districts in all rural areas of the State and in cities with populations of 100,000 or fewer

according to the most recent annual population estimates certified by the State Budget Officer shall be inspected by OSFM in accordance with the requirements of this Section. All other fire districts in the State shall be inspected by the Insurance Services Office in accordance with this Section.

(c) A "PPC 1" is the best rating, and a "PPC 10" indicates that the fire district does not meet the

minimum protection requirements.

(d) A fire district that meets the certification requirements set forth in this Section shall be given a

public protection classification of "PPC 9S."

(e) A fire district that meets the certification requirements set forth in this Section, but contains

properties within its jurisdictional limits that are more than five but within six road miles from a responding fire station, shall be given a public protection classification rating of "PPC 9E."

(f) If a fire district contains some properties within its jurisdictional limits that meet the requirements

of a certain PPC rating, and some properties within its jurisdictional limits that meet the requirements of another PPC rating, the fire district may receive a split rating.

(g) To receive a public protection classification better than a "PPC 9S," a fire district must meet the

requirements of this Section and the North Carolina Fire Suppression Rating Schedule.

History

  • Authority G.S. 58-36-10; 58-40-25; 58-78A-1(b)(20); 58-78A-2
  • Eff. January 1, 2018
  • Amended Eff. June 1, 2026.
11 NCAC 05A .0903 Rating of Fire Districts {#sec-11-ncac-05a-.0903 omnilex-key=us-nc-regs-official--title-11--11 NCAC 05A .0903}

(a) To receive a PPC rating, a fire department shall submit a written request to OSFM containing the

following information:

(1) The name of the fire district;

(2) The name of the entity that operates the fire district. Note: as an example, the city, town, county, or non-profit corporation;

(3) The name of the person in charge of the entity that operates the fire district. Note: as an example, the president of the board of directors of the fire district, county manager, or city manager;

(4) The name and title of the Fire Chief;

(5) The physical address of the location of every fire station utilized by the fire department;

(6) The mailing address of the fire department;

(7) The Federal (FEIN) Tax ID number of the fire department;

(8) Copies of any contracts with a local government body to provide fire protection; and

(9) A Geographic Information System ("GIS") computer-generated map of the fire district, and documentation of the approval of the map by the local governing body if applicable.

(b) A fire department may contract with more than one unit of government to provide fire protection.

In addition, a local unit of government may contract with more than one fire department to provide fire

protection.

(c) 9S Re-Inspections. Fire departments shall be re-inspected by OSFM at least every seven years and shall be notified by OSFM of such 9S re-inspection in writing at least 30 days in advance. In addition, upon receipt of information alleging noncompliance with this Section that is reviewed and verified by OSFM, OSFM shall perform unannounced re-inspections of fire departments.

(d) New Station Inspection. A fire department may request a certification inspection for any

additional station that the fire department seeks to include in the rating of its fire district. Before OSFM will conduct the inspection, the fire department must provide the following:

(1) Proof of Certificate of Occupancy; and

(2) If the fire department is adding to their rated insurance district with an additional station or making any changes to the response district lines, new maps and approvals in accordance with Subparagraph (a)(9) of this Rule.

(e) Merging of fire departments. When two or more fire departments merge into one fire department,

OSFM shall conduct a 9S inspection. Before the inspection will be conducted, the fire departments must provide to OSFM the information required by Paragraph (a) of this Rule.

(f) Unless otherwise approved pursuant to Paragraph (g) of this Rule, a fire district may not extend

more than five road miles from a responding fire station.

(g) A rural fire district may extend its boundaries to more than five but within six road miles from a responding fire department if the fire department enters a written automatic aid contract with another jurisdiction that requires the responding party to respond with at least one piece of fire apparatus capable of carrying at least 1,000 gallons of water and the extension is approved by the board of county commissioners of the county to which the rural fire district is extended.

History

  • Authority G.S. 58-36-10; 58-40-25; 58-78A-1(b)(20); 58-78A-2; 58-83-1
  • Eff. January 1, 2018
  • Amended Eff. June 1, 2026.
11 NCAC 05A .0904 Facilities {#sec-11-ncac-05a-.0904 omnilex-key=us-nc-regs-official--title-11--11 NCAC 05A .0904}

A fire department shall have heating for all-weather protection of apparatus at every fire station.

History

  • Authority G.S. 58-36-10; 58-40-25; 58-78A-1(b)(20); 58-78A-2
  • Eff. January 1, 2018
  • Amended Eff. June 1, 2026.
11 NCAC 05A .0905 Apparatus Specifications and Equipment {#sec-11-ncac-05a-.0905 omnilex-key=us-nc-regs-official--title-11--11 NCAC 05A .0905}

(a) Engines. All stations shall have at least one engine that:

(1) Is constructed in accordance with NFPA 1901;

(2) Annually undergoes a fire pump performance test, as identified in NFPA 1911. If the engine was purchased within the previous 12 months, the certification required by Part (a)(3)(A) of this Rule shall satisfy this requirement; and

(3) Is equipped with the following:

(A) A pump certified by an independent third-party certification organization that is accredited for inspection and testing systems on fire apparatus in accordance with NFPA 1901.

(B) A pump rated at not less than 750 GPM at 150 PSI net pump pressure.

(C) A tank with at least a 300-gallon capacity.

(D) Two 200-foot pre-connected hose lines, with a diameter of 1 ½ inches, 1 ¾ inches, or 2 inches, with nozzles that have a minimum flow of 95 GPM.

(E) At least 20 feet of hard-suction hose in a size to flow the capacity of the engine, or at least 15 feet of soft-suction hose with a diameter of at least four inches.

(F) Four self-contained breathing apparatus (SCBA). To the extent practicable, SCBAs shall comply with NFPA 1981.

(G) Four spare SCBA cylinders.

(H) One roof ladder at least 12 feet long.

(I) One extension ladder at least 24 feet long.

(J) One folding ladder.

(K) One pike-head axe.

(L) One flat-head axe.

(M) One forcible entry tool.

(N) One pike pole or plaster hook at least 6 feet long.

(O) Two portable, rechargeable hand lights in accordance with NFPA 70.

(P) 100 feet of utility rope, at least ½ inch in diameter.

(Q) Two 20-pound, class BC portable extinguishers.

(R) One 2½-gallon water extinguisher.

(S) One first aid kit.

(T) One bolt cutter at least 14 inches long.

(U) One two-way radio assigned to the apparatus.

(V) One traffic vest for each riding position or a minimum of two traffic vests if the fire department has issued a traffic vest to all members.

(b) Tankers. If a station has a tanker, the tanker shall:

(1) Be equipped with at least 1,000 gallons of water.

(2) Be equipped with hoses and equipment for filling the tank and transferring water to the engine.

(3) Be properly baffled in accordance with NFPA 1901.

(4) Be equipped with one traffic vest for each riding position or a minimum of two traffic vests if the fire department has issued a traffic vest to all members.

(c) Protective Clothing. Each eligible firefighter shall be provided protective clothing. Protective clothing provided to eligible firefighters should, to the extent practicable, comply with the requirements of NFPA 1851 and shall include the following:

(1) Helmet.

(2) Coat.

(3) Pants.

(4) Boots.

(5) Gloves.

(6) Hoods.

(d) Fire departments shall ensure that all apparatus are registered with the North Carolina Division of Motor Vehicles and insured.

(e) All NFPA standards referenced in this Section are hereby incorporated by reference, including subsequent amendments and editions. Copies of these standards may be viewed online for free at the National Fire Protection Association website at http://www.nfpa.org.

History

  • Authority G.S. 58-36-10; 58-40-25; 58-78A-1(b)(20); 58-78A-2
  • Eff. January 1, 2018
  • Amended Eff. June 1, 2026.
11 NCAC 05A .0906 Staffing Levels {#sec-11-ncac-05a-.0906 omnilex-key=us-nc-regs-official--title-11--11 NCAC 05A .0906}

(a) Fire Station.

(1) Each fire department shall maintain a minimum of 15 eligible firefighters on its roster.

(2) Each fire department shall provide a roster containing the names and date of birth of all eligible firefighters. A report submitted to the North Carolina State Firefighters' Association pursuant to G.S. 58-86-25 constitutes compliance with this Subparagraph.

(3) Each fire department shall provide current workers compensation insurance certifications for all of its eligible firefighters.

(4) Firefighters under the age of 18 will not be counted for purposes of meeting the requirements of this Rule.

(b) Additional Fire Stations: Fire departments that operate more than one station shall have four additional personnel for each additional station.

History

  • Authority G.S. 58-2-30; 58-36-10; 58-40-25; S.L. 2017-167
  • Eff. January 1, 2018.
11 NCAC 05A .0907 Training {#sec-11-ncac-05a-.0907 omnilex-key=us-nc-regs-official--title-11--11 NCAC 05A .0907}

(a) Eligible firefighters shall have attended at least 36 hours of training in the previous 12 months in the area of fire prevention, fire suppression, or protection of life and property. No more than 12 hours of emergency medical services training may be counted toward the 36-hour training requirement.

(b) Fire departments shall provide a total of 48 hours of training per year.

(c) Within one year of appointment, the fire chief of each fire department shall complete a class on management of fire department operations and records approved by the State Fire and Rescue Commission.

(d) Fire departments shall maintain training records in accordance with 11 NCAC 05A .0911.

History

  • Authority G.S. 58-36-10; 58-40-25; 58-78A-1(b)(20); 58-78A-2
  • Eff. January 1, 2018
  • Amended Eff. June 1, 2026.
11 NCAC 05A .0908 Communications and Alarms {#sec-11-ncac-05a-.0908 omnilex-key=us-nc-regs-official--title-11--11 NCAC 05A .0908}

(a) Fire departments shall utilize a Public Service Answering Point (PSAP) established pursuant to NCFSRS Section 107 D, to receive 911 calls and dispatching, 24 hours per day, 7 days per week.

(b) Notification to firefighters of emergencies may be provided by pagers, portable radios with alerting capabilities, or station alerting devices with paid personnel. Text paging or phone paging by a third party shall not be an acceptable means of notification, unless the paging system is owned by the authority having jurisdiction.

(c) In jurisdictions utilizing Automatic Vehicle Location (AVL) systems, the fire department that is responsible for the fire district shall be dispatched, along with the closest unit recommendation of the AVL systems. In accordance with 11 NCAC 05A .0903(g), if a jurisdiction is utilizing AVL for unit dispatch in a six-mile district, it shall ensure that an apparatus with a minimum of 1,000 gallons of water is dispatched as required by the automatic aid protocols.

History

  • Authority G.S. 58-36-10; 58-40-25; 58-78A-1(b)(20); 58-78A-2
  • Eff. January 1, 2018
  • Amended Eff. June 1, 2026.
11 NCAC 05A .0909 Response to Structure Fires {#sec-11-ncac-05a-.0909 omnilex-key=us-nc-regs-official--title-11--11 NCAC 05A .0909}

(a) Each fire department shall ensure the response of at least four of its eligible firefighters and one engine to all structure fires. The fire chief may be one of the four responding members.

(b) The fire department responding to a structure fire shall have a plan to provide a minimum flow of 200 GPM for 20 minutes within five minutes of the first arriving engine.

History

  • Authority G.S. 58-2-40; 58-36-10; 58-40-25
  • Eff. January 1, 2018.
11 NCAC 05A .0910 Incident Reporting {#sec-11-ncac-05a-.0910 omnilex-key=us-nc-regs-official--title-11--11 NCAC 05A .0910}

(a) In addition to the requirements of this Rule regarding reporting the storage and deployment of Aqueous Film Forming Foam (AFFF), when a fire department responds to an incident, the fire chief shall ensure that an incident report containing the date, time, and location of the incident is completed using software compatible with the records management system maintained by OSFM.

(b) All reports shall be submitted to OSFM as soon as practicable. Incident reports shall not be submitted to OSFM later than 90 days from incident occurrence.

(c) When a fire department responds to a fire involving fatalities, an initial report shall be filed by the fire chief or fire marshal of the authority having jurisdiction within 48 hours of the incident to OSFM.

(d) In accordance with G.S. 58-82B-10, an online reporting portal for the storage and deployment of AFFF has been created at the following website: https://ncdoi.imagetrendelite.com/Elite/Organizationncdoi/. This online reporting portal consists of an online database and an online reporting tool to capture the storage and deployment of AFFF.

(e) The fire chief or fire marshal of the authority having jurisdiction shall ensure that the following information regarding AFFF inventory for their fire department is entered into the online database:

(1) The number of trucks at each department that carry AFFF, and the fire station or other location, including street address, where each truck is located.

(2) The volume, trade name, and Chemical Abstract Service (CAS) number of the AFFF on each truck.

(3) An inventory, including the volume, trade name, and CAS number of AFFF stored by each fire department at a fire station or other location, including the street address where the AFFF is stored.

(4) The volume, trade name, and CAS number of AFFF products that are no longer utilized and could be removed from inventory for disposal, including the street address where the AFFF is stored.

(5) A photograph of the label and the container of the AFFF. For the purpose of this Subparagraph, a photograph includes an electronic image produced by the camera of an electronic device. The information entered in the online database shall be updated annually in accordance with G.S. 58-82B-5.

(f) When a fire department responds to a fire, conducts training involving AFFF in any quantity, or has an accidental spill, the fire chief shall ensure an initial report is entered in the online reporting tool within 15 days of the incident or the training event, including the following:

(1) The date, time, and location, including street address and GPS coordinates, where AFFF was involved, the trade name, and CAS number of the AFFF used.

(2) The total volume of AFFF involved, including gallons of foam and gallons of water and total concentration of foam.

(3) The reason for the deployment of AFFF, such as firefighting, fire prevention, other emergency response actions intended to protect property or public safety, training, or an accidental spill.

(g) The fire chief or fire marshal of the authority having jurisdiction shall ensure that an annual report is available in the online reporting tool by July 1st of each year that includes the information required by Paragraph (g) of this Rule.

History

  • Authority G.S. 58-36-10; 58-40-25; 58-78A-1(b)(20); 58-78A-2; 58-79-1; 58-79-45; 58-82B-5; 58-82B-10; S.L. 2021-180, s. 8.10(i)
  • Eff. January 1, 2018
  • Amended Eff. June 1, 2026; June 1, 2023.
11 NCAC 05A .0911 Records {#sec-11-ncac-05a-.0911 omnilex-key=us-nc-regs-official--title-11--11 NCAC 05A .0911}

(a) A fire department shall maintain the following records for 36 months for inspection by OSFM:

(1) Apparatus maintenance logs and equipment inventory for in service engines and tankers. A fire department shall inspect all in service engine and tanker equipment inventory monthly and document the inspection.

(2) Fire pump performance tests. A fire department shall perform a fire pump performance test on at least one engine annually, in accordance with NFPA 1911. If the engine was purchased within the previous 12 months, the certification required by Part (a)(3)(A) of 11 NCAC 05A .0905 shall satisfy the requirement.

(3) Training records for all eligible firefighters. Training records shall include the dates, topics, hours, and personnel in attendance.

(4) The AFFF inventory and usage reports created in accordance with 11 NCAC 05A .0910.

(5) Records evidencing monthly functional testing of the components of the fire department's self-contained breathing apparatus (SCBA).

(6) Evidence of completion of criminal history record checks for each applicant over the age of 18, in accordance with G.S. 143B-1209.24.

(b) A fire department shall maintain incident reports related to response to structure fires for a minimum of five years in accordance with 11 NCAC 05A .0910.

History

  • Authority G.S. 58-36-10; 58-40-25; 58-78A-1(b)(20); 58-78A-2; 58-82B-5; 58-82B-10
  • Eff. January 1, 2018
  • Amended Eff. June 1, 2026; June 1, 2023.
11 NCAC 05A .0912 Non-Compliance {#sec-11-ncac-05a-.0912 omnilex-key=us-nc-regs-official--title-11--11 NCAC 05A .0912}

(a) Upon completion of an inspection, the OSFM representative will review the inspection results with the fire chief or the chief's designee. Any fire department that fails to meet any of the standards set forth in this Section shall be considered non-compliant for the purpose of determining Fire Insurance District Rating Classifications.

(b) A non-compliant fire department shall have a period of 15 days from the date of the inspection to submit a written corrective action plan to OSFM. The corrective action plan shall address each deficiency found in the inspection and the corrective action the fire department will take in response to the deficiency. If a non-compliant fire department fails to provide a written corrective action plan to OSFM within 15 days from the date of the inspection, OSFM shall consult with the governing body that contracts for the fire district and place the fire department on probation until the fire department provides the written corrective action plan to OSFM, for a period not to exceed three months. If the fire department fails to provide the written corrective action plan to OSFM by the end of the three-month probation period, OSFM shall designate the fire department as "PPC10" (non-certified).

(c) Upon receipt of approval of the corrective action plan from OSFM, the fire department shall have three months to become compliant. If the fire department remains non-compliant after the expiration of the three-month corrective action period, OSFM shall consult with the governing body that contracts for the fire district and place the fire department on probation until the fire department becomes compliant, for a period not to exceed six months. Upon completion of the probationary period, OSFM shall re-inspect the fire department for compliance. If the fire department remains non-compliant, OSFM shall designate the fire department as a "PPC10" (non-certified).

(d) Notwithstanding the provisions of Paragraph (c) of this Rule, a non-compliant fire department that is determined to be non-compliant based on its failure to ensure four eligible firefighters respond to all structure fires shall have a period of 15 days from the date of inspection to submit a written action plan to OSFM and six months from the date of providing the written corrective action plan to OSFM to become compliant. If no structure fires occur in the fire department's fire district within the six-month period following submission of a written corrective action plan to OSFM, OSFM shall re-inspect the fire department for compliance after an additional six months.

History

  • Authority G.S. 58-36-10; 58-40-25; 58-78A-1(b)(20); 58-78A-2
  • Eff. January 1, 2018
  • Amended Eff. June 1, 2026.
11 NCAC 05A .1001 Federal Emergency Management Agency-Owned Transportable Temporary Housing Units {#sec-11-ncac-05a-.1001 omnilex-key=us-nc-regs-official--title-11--11 NCAC 05A .1001}

History

  • Status: expired
  • Authority G.S. 58-78A-2; S.L. 2024-57, s. 1F.4.
  • Emergency Adoption Eff. January 7, 2025
  • Temporary Adoption Eff. March 7, 202
  • Temporary Adoption Expired December 27, 2025.

Subchapter B

11 NCAC 05B .0101 Definitions {#sec-11-ncac-05b-.0101 omnilex-key=us-nc-regs-official--title-11--11 NCAC 05B .0101}

As used in this Chapter, the following terms shall be construed as follows:

(1) "Community College" shall mean the Fire Training Services Section of the North Carolina Department of Community Colleges;

(2) "FEMA" shall mean the Federal Emergency Management Agency of the Federal Government;

(3) "Fire and Rescue Division" or "fire and rescue" shall mean the Fire and Rescue Division of the North Carolina Department of Insurance;

(4) "Fire Commission" or "the Commission" shall mean the North Carolina State Fire Commission of the North Carolina Department of Insurance;

(5) "NFA" shall mean the National Fire Academy, Division of the Federal Emergency Management Agency.

(6) "US Fire Administration" or "USFA" shall mean the United States Fire Administration, Division of the Federal Emergency Management Agency.

History

  • Authority G.S. 58-2-40; 58-78-1
  • Eff. November 1, 1988
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 19, 2019.
11 NCAC 05B .0102 Purpose {#sec-11-ncac-05b-.0102 omnilex-key=us-nc-regs-official--title-11--11 NCAC 05B .0102}

In order to carry out the duties of the State Fire Commission as listed in G.S. 58-78-5, that Commission shall:

(1) develop voluntary certification and professional standards for all levels of fire service personnel;

(2) develop and maintain a statewide fire incident reporting system;

(3) serve as the central state clearing house for all federal programs from the USFA, and NFA involving fire prevention and control programs that come into North Carolina; and

(4) provide on a bi-annual basis an updated listing of North Carolina fire departments and fire marshals.

History

  • Authority G.S. 58-2-4-; 58-78-1; 58-78-5; 58-78-10
  • Eff. November 1, 1988
  • Amended Eff. April 8, 2002
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 19, 2019.
11 NCAC 05B .0103 Mailing Address {#sec-11-ncac-05b-.0103 omnilex-key=us-nc-regs-official--title-11--11 NCAC 05B .0103}

All requests for information, assistance, or forms, and all replies, answers, supplied information, etc., shall be forwarded to the North Carolina Fire Commission, P.O. Box 26387, Raleigh, N.C. 27611.

History

  • Authority G.S. 58-2-40; 58-78-20
  • Eff. November 1, 1988
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 19, 2019.
11 NCAC 05B .0201 State Fire Training {#sec-11-ncac-05b-.0201 omnilex-key=us-nc-regs-official--title-11--11 NCAC 05B .0201}

The commission shall develop and monitor a master plan which shall include guidelines for training of fire service personnel in North Carolina. These guidelines shall be consistent with the needs of the state's fire service, and shall be continually monitored and updated to reflect the training needs of the state's fire service. Any state agency involved in the training of fire service personnel shall submit to the executive director on a quarterly basis descriptions of programs currently under way or planned.

The executive director shall serve as state training director for the purpose of coordinating state training programs. The director shall serve as the central clearinghouse for the information on state programs and information coming into the state from federal agencies and other states.

History

  • Authority G.S. 58-2-40; 58-78-5
  • Eff. November 1, 1988
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 19, 2019.
11 NCAC 05B .0202 Additional Programs {#sec-11-ncac-05b-.0202 omnilex-key=us-nc-regs-official--title-11--11 NCAC 05B .0202}

The state master plan shall contain guidelines for additional programs deemed useful to fire service organizations throughout the state. These may include, but are not limited to:

(1) fire service computer coordination;

(2) data collection and analysis;

(3) fire codes and inspections;

(4) radio communications; and

(5) arson.

History

  • Authority G.S. 58-2-40; 58-78-5
  • Eff. November 1, 1988
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 19, 2019.
11 NCAC 05B .0301 Minimum Professional Qualifications {#sec-11-ncac-05b-.0301 omnilex-key=us-nc-regs-official--title-11--11 NCAC 05B .0301}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-78-5(a)(14b)
  • Eff. November 1, 1988
  • Repealed Eff. December 1, 2022.
11 NCAC 05B .0302 Voluntary Certification {#sec-11-ncac-05b-.0302 omnilex-key=us-nc-regs-official--title-11--11 NCAC 05B .0302}

The commission shall establish certification levels for the qualifications developed, and shall issue such certification to appropriate individuals who meet the commission's standards. Certification shall be voluntary, unless adopted as mandatory at the local level. The commission shall be the only state agency certifying fire service personnel on professional qualifications for fire prevention and control duties. The commission shall maintain appropriate records and provide same to individuals upon written request. The commission shall rule on all questions and appeals regarding certification programs. The commission shall inform participating agencies of standard changes and status of certified personnel.

History

  • Authority G.S. 58-2-40; 58-78-5(a)(14); 58-78-5(a)(14b)
  • Eff. November 1, 1988
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 19, 2019.
11 NCAC 05B .0303 Coordination with Other State Agencies {#sec-11-ncac-05b-.0303 omnilex-key=us-nc-regs-official--title-11--11 NCAC 05B .0303}

The commission shall serve as the central clearinghouse for certification issues. All state agencies participating in the certification process shall follow reporting procedures developed by the commission.

History

  • Authority G.S. 58-78-5(a)(14); 58-78-5(a)(14b)
  • Eff. November 1, 1988
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 19, 2019.
11 NCAC 05B .0401 Development {#sec-11-ncac-05b-.0401 omnilex-key=us-nc-regs-official--title-11--11 NCAC 05B .0401}

The North Carolina Fire Commission shall develop and implement a uniform fire incident reporting system for the fire service of North Carolina.

History

  • Authority G.S. 58-79-45
  • Eff. November 1, 1988
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 19, 2019.
11 NCAC 05B .0402 Operation and Control {#sec-11-ncac-05b-.0402 omnilex-key=us-nc-regs-official--title-11--11 NCAC 05B .0402}

(a) The commission shall have full authority over the operation and control of the fire incident reporting system. Each county shall have a central collection site to which participating fire departments shall report. Larger municipal departments may obtain permission from the executive director to report directly to the commission. The data collected shall be available for use at the local, county and state levels. The commission may submit state data to the United States Fire Administration. Any equipment dispersed by the commission for the purpose of inputting incident reports shall remain under the control of the commission, and said local agency shall sign an approved contract with the commissioner of insurance for the use of said equipment.

(b) The commission may utilize dispersed equipment for the purpose of creating a fire information network, to be used for the collection and dissemination of information pertinent to the state's fire service. The network may contain, but not be limited to:

(1) fire incident reporting;

(2) emergency medical reporting;

(3) hazardous material reporting;

(4) arson or suspicious fire reporting;

(5) hazardous material data collection and disbursement;

(6) bulletin board for exchange of information; and

(7) schedule announcements.

(c) Those locations which agree to the use of any provided equipment shall keep said equipment in good order and shall provide the commission with requested reports.

History

  • Authority G.S. 58-79-45
  • Eff. November 1, 1988
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 19, 2019.
11 NCAC 05B .0501 Collection and Dissemination of Information {#sec-11-ncac-05b-.0501 omnilex-key=us-nc-regs-official--title-11--11 NCAC 05B .0501}

The commission shall be the central information office for all fire service activity in the state. Any state agency involved in fire service activities shall submit to the executive director quarterly reports in a form set out by the commission. The commission staff shall provide available information to individuals whenever requested in accordance with applicable state or federal laws.

History

  • Authority G.S. 58-78-5(a)(14a)
  • Eff. November 1, 1988
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 19, 2019.
11 NCAC 05B .0502 Federal Programs {#sec-11-ncac-05b-.0502 omnilex-key=us-nc-regs-official--title-11--11 NCAC 05B .0502}

The commission shall be the central clearinghouse for all fire prevention and control programs coming into the state from federal agencies including the National Fire Academy and the United States Fire Administration. The executive director shall serve as the state representative to the USFA and NFA, and shall be considered the state fire training director for the purposes of participating in federal training programs.

History

  • Authority G.S. 58-78-5
  • Eff. November 1, 1988
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 19, 2019.

Subchapter C

11 NCAC 05C .0101 Definitions {#sec-11-ncac-05c-.0101 omnilex-key=us-nc-regs-official--title-11--11 NCAC 05C .0101}

As used in this Subchapter:

(1) "Commission" means the State Fire and Rescue Commission, created in G.S. 58-78-1.

(2) "Eligible unit" has the same meaning as in G.S. 58-87-10(a).

(3) "Fund" means the Workers' Compensation Fund, created in G.S. 58-87-10(b).

History

  • Authority G.S. 58-87-10
  • Eff. August 1, 1998
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 19, 2019.
11 NCAC 05C .0102 Membership Cancellation {#sec-11-ncac-05c-.0102 omnilex-key=us-nc-regs-official--title-11--11 NCAC 05C .0102}

If the Commission determines that an eligible unit is no longer eligible for membership in the Fund, or the eligible unit ceases to pay premiums as they become due, the Commission shall cancel the eligible unit's membership. The Commission shall provide written notice of the cancellation to the eligible unit. Upon cancellation of membership, the eligible unit shall pay any additional premiums that are due.

History

  • Authority G.S. 58-87-10
  • Eff. August 1, 1998
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 19, 2019.
11 NCAC 05C .0103 Roster of Covered Individuals {#sec-11-ncac-05c-.0103 omnilex-key=us-nc-regs-official--title-11--11 NCAC 05C .0103}

Each year every eligible unit shall determine and report to the unit's governing body the names of the individual members of the eligible unit who are covered by the Fund. The governing body shall, upon determination of the validity and accuracy of the information, certify the information to the Commission by June 30 of each year.

History

  • Authority G.S. 58-87-10
  • Eff. August 1, 1998
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 19, 2019.

Subchapter D

11 NCAC 05D .0101 Definitions {#sec-11-ncac-05d-.0101 omnilex-key=us-nc-regs-official--title-11--11 NCAC 05D .0101}

History

  • Status: expired
  • Authority G.S. 58-82A-1; 58-82A-3
  • Eff. February 1, 2010
  • Expired Eff. February 1, 2019 pursuant to G.S. 150B-21.3A.
11 NCAC 05D .0102 Display Operator's Identification Badges {#sec-11-ncac-05d-.0102 omnilex-key=us-nc-regs-official--title-11--11 NCAC 05D .0102}

History

  • Status: expired
  • Authority G.S. 58-82A-1; 58-82A-3
  • Eff. February 1, 2010
  • Expired Eff. February 1, 2019 pursuant to G.S. 150B-21.3A.
11 NCAC 05D .0103 Display Operator's Permit {#sec-11-ncac-05d-.0103 omnilex-key=us-nc-regs-official--title-11--11 NCAC 05D .0103}

History

  • Status: expired
  • Authority G.S. 58-82A-1; 58-82A-3
  • Eff. February 1, 2010
  • Expired Eff. February 1, 2019 pursuant to G.S. 150B-21.3A.
11 NCAC 05D .0104 Assistant Display Operator's Permit {#sec-11-ncac-05d-.0104 omnilex-key=us-nc-regs-official--title-11--11 NCAC 05D .0104}

History

  • Status: expired
  • Authority G.S. 58-82A-1; 58-82A-3
  • Eff. February 1, 2010
  • Expired Eff. February 1, 2019 pursuant to G.S. 150B-21.3A.
11 NCAC 05D .0105 Assistant Display Operator's Certification {#sec-11-ncac-05d-.0105 omnilex-key=us-nc-regs-official--title-11--11 NCAC 05D .0105}

History

  • Status: expired
  • Authority G.S. 58-82A-1; 58-82A-3
  • Eff. February 1, 2010
  • Expired Eff. February 1, 2019 pursuant to G.S. 150B-21.3A.
11 NCAC 05D .0106 Application for Permit {#sec-11-ncac-05d-.0106 omnilex-key=us-nc-regs-official--title-11--11 NCAC 05D .0106}

History

  • Status: expired
  • Authority G.S. 58-82A-1; 58-82A-3
  • Eff. February 1, 2010
  • Expired Eff. February 1, 2019 pursuant to G.S. 150B-21.3A.
11 NCAC 05D .0107 Examination {#sec-11-ncac-05d-.0107 omnilex-key=us-nc-regs-official--title-11--11 NCAC 05D .0107}

History

  • Status: expired
  • Authority G.S. 58-82A-1; 58-82A-3
  • Eff. February 1, 2010
  • Expired Eff. February 1, 2019 pursuant to G.S. 150B-21.3A.
11 NCAC 05D .0108 Application for Reciprocity {#sec-11-ncac-05d-.0108 omnilex-key=us-nc-regs-official--title-11--11 NCAC 05D .0108}

History

  • Status: expired
  • Authority G.S. 58-82A-1; 58-82A-3
  • Eff. February 1, 2010
  • Expired Eff. February 1, 2019 pursuant to G.S. 150B-21.3A.
11 NCAC 05D .0109 Permit Renewal {#sec-11-ncac-05d-.0109 omnilex-key=us-nc-regs-official--title-11--11 NCAC 05D .0109}

History

  • Status: expired
  • Authority G.S. 58-82A-1; 58-82A-3
  • Eff. February 1, 2010
  • Expired Eff. February 1, 2019 pursuant to G.S. 150B-21.3A.
11 NCAC 05D .0110 Fees {#sec-11-ncac-05d-.0110 omnilex-key=us-nc-regs-official--title-11--11 NCAC 05D .0110}

History

  • Status: expired
  • Authority G.S. 58-82A-1; 58-82A-3
  • Eff. February 1, 2010
  • Expired Eff. February 1, 2019 pursuant to G.S. 150B-21.3A.
11 NCAC 05D .0111 Notification to Osfm {#sec-11-ncac-05d-.0111 omnilex-key=us-nc-regs-official--title-11--11 NCAC 05D .0111}

History

  • Status: expired
  • Authority G.S. 58-82A-1; 58-82A-3
  • Eff. February 1, 2010
  • Expired Eff. February 1, 2019 pursuant to G.S. 150B-21.3A.
11 NCAC 05D .0112 Replacement and Duplicate Permit {#sec-11-ncac-05d-.0112 omnilex-key=us-nc-regs-official--title-11--11 NCAC 05D .0112}

History

  • Status: expired
  • Authority G.S. 58-82A-1; 58-82A-3
  • Eff. February 1, 2010
  • Expired Eff. February 1, 2019 pursuant to G.S. 150B-21.3A.
11 NCAC 05D .0113 Report of Theft or Loss of Pyrotechnics {#sec-11-ncac-05d-.0113 omnilex-key=us-nc-regs-official--title-11--11 NCAC 05D .0113}

(a) A permittee shall report the theft or loss of pyrotechnics to the county sheriff or city police, to ATF and to OSFM, by telephone, within eight hours after the permittee discovers the theft or loss. OSFM may be reached at 919-661-5880 during normal working hours and at the North Carolina Highway Patrol dispatch number, 919-733-3861, outside normal working hours.

(b) Within 24 hours after discovery of the loss or theft, the permittee shall provide OSFM written notice that includes a description of the pyrotechnics, including the manufacturer, brand name, any manufacturer marking and quantity, and a description of the circumstances surrounding the theft or loss. The written notice shall also name the law enforcement agencies contacted by the permittee under Paragraph (a) of this Rule.

History

  • Authority G.S. 58-82A-1
  • Eff. February 1, 2010
  • Readopted Eff. November 1, 2021.
11 NCAC 05D .0114 Report of Injury or Property Damage {#sec-11-ncac-05d-.0114 omnilex-key=us-nc-regs-official--title-11--11 NCAC 05D .0114}

(a) A permittee shall notify OSFM within 24 hours after any of the following involving pyrotechnics:

(1) A fire causing property damage in excess of one thousand dollars ($1,000) to an automobile or ten thousand dollars ($10,000) to real property;

(2) An injury to any person caused by the display resulting in hospitalization; or

(3) Damage to property in excess of one thousand dollars ($1,000), not related to fire.

(b) OSFM may be reached at 919-661-5880 during normal working hours and at the North Carolina Highway Patrol dispatch number, 919-733-3861, outside normal working hours.

(c) The permittee shall submit a written report to OSFM within three days after a pyrotechnics display conducted by the permittee if any of the following occurred:

(1) Any of the incidents identified in Paragraph (a) of this Rule; or

(2) Whenever a defective pyrotechnic product or equipment resulting in any amount of injury or damage occurs.

History

  • Authority G.S. 58-82A-1
  • Eff. February 1, 2010
  • Readopted Eff. October 1, 2021.
11 NCAC 05D .0115 Inspections {#sec-11-ncac-05d-.0115 omnilex-key=us-nc-regs-official--title-11--11 NCAC 05D .0115}

(a) A permittee shall make any records required under Article 54 of Chapter 14 of the General Statutes and Article 82A of Chapter 58 of the General Statutes available to authorized representatives of OSFM or a city or county fire code official.

(b) A permittee shall allow the display site, storage facility, or delivery point to be inspected at all times by authorized representatives of OSFM or a city or county fire code official.

History

  • Authority G.S. 58-82A-1
  • Eff. February 1, 2010
  • Readopted Eff. November 1, 2021.

Chapter 06 Agent Services Division

Subchapter A

11 NCAC 06A .0101 Definitions {#sec-11-ncac-06a-.0101 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06A .0101}

(a) In this Chapter, unless the context otherwise requires:

(1) "Adjusting company" means any insurance company, independent adjusting company, or public adjusting company adjusting claims in this State.

(2) "Agent Services Division" or "Division" means the Agent Services Division of the North Carolina Department of Insurance, the Division responsible for the licensing, education and regulation of agents and other licensees.

(3) "Professional Testing Service" or "Service" means the organization specializing in the development and administration of licensing examinations on a contract basis.

(4) "State Licensing Examination" or "Examination" means a collection of items designed to test the applicant's knowledge of the basic concepts, principles and laws relevant to the insurance profession to determine the competence to be licensed in North Carolina.

(b) The definitions contained in G.S. 58-33-10 are incorporated in this Chapter by reference.

History

  • Authority G.S. 58-2-40; 58-33-30(e)(h)
  • Eff. February 1, 1976
  • Readopted Eff. June 12, 1978
  • Amended Eff. February 1, 2008; October 1, 1990; February 1, 1989; July 1, 1986
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. June 25, 2016.
11 NCAC 06A .0102 Purpose of Division {#sec-11-ncac-06a-.0102 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06A .0102}

History

  • Status: repealed
  • Authority G.S. 57-12; 57A-16; 58-7.3; 58-9; 58-9.2; 58-40; 58-40.1
  • Eff. February 1, 1976
  • Readopted Eff. June 12, 1978
  • Repealed Eff. July 1, 1988.
11 NCAC 06A .0103 Deputy Commissioner {#sec-11-ncac-06a-.0103 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06A .0103}

History

  • Status: repealed
  • Authority G.S. 57-12; 57A-16; 58-7.3; 58-9; 58-9.2; 58-40; 58-40.1
  • Eff. February 1, 1976
  • Readopted Eff. June 12, 1978
  • Repealed Eff. July 1, 1988.
11 NCAC 06A .0104 Division Personnel {#sec-11-ncac-06a-.0104 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06A .0104}

History

  • Status: repealed
  • Authority G.S. 57-12; 57A-16; 58-7.3; 58-9; 58-9.2; 58-40; 58-40.1
  • Eff. February 1, 1976
  • Readopted Eff. June 12, 1978
  • Repealed Eff. July 1, 1988.
11 NCAC 06A .0201 General Information {#sec-11-ncac-06a-.0201 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06A .0201}

(a) All forms pertaining to licensure including applications, bonds, appointments, termination of appointments and other forms required by Chapter 58 shall be supplied by the Division. The Division shall make these forms available in an electronic format and require the licensee or company to file documents electronically with the Commissioner or the Commissioner's designee. The actual cost of the electronic filing is the administrative fee charged by the Commissioner's designee which may include a transaction fee, a credit card processing fee, or other bank processing fee. The administrative fee shall be paid at the time of the electronic filing transaction by the electronic payment options made available by the Commissioner's designee through electronic check, credit card, automated clearing house (ACH), or electronic funds transfer (EFT). The Division shall provide instructions for proper completion of all forms.

(b) Forms shall be completed in full and must contain necessary signatures in order to be accepted. Companies and applicants shall submit all forms or complete other requirements within time schedules established under Chapter 58.

(c) Companies or applicants may duplicate forms without alteration or modification thereto.

(d) If any additional supporting documents, information or fees are required under Chapter 58, they shall be submitted with the appropriate forms or applications. The additional supporting documents, information, or fees required under Chapter 58 shall be filed electronically to the Commissioner or the Commissioner's designee. The actual cost of the electronic filing is the administrative fee charged by the Commissioner's designee which may include a transaction fee, a credit card processing fee, or other bank processing fee. The administrative fee shall be paid at the time of the electronic filing transaction by the electronic payment options made available by the Commissioner's designee through electronic check, credit card, automated clearing house (ACH) or electronic funds transfer (EFT).

History

  • Authority G.S. 58-2-40; 58-2-250
  • Eff. February 1, 1976
  • Readopted Eff. June 12, 1978
  • Amended Eff. October 1, 2010; February 1, 1989
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. June 25, 2016.
11 NCAC 06A .0202 Form a-1 {#sec-11-ncac-06a-.0202 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06A .0202}

History

  • Status: repealed
  • Authority G.S. 58-9; 58-40; 58-40.2; 58-40.6; 58-41.1; 58-44.2
  • Eff. February 1, 1976
  • Readopted Eff. June 12, 1978
  • Amended Eff. July 1, 1986
  • Repealed Eff. February 1, 1989.
11 NCAC 06A .0203 Form a-2 {#sec-11-ncac-06a-.0203 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06A .0203}

History

  • Status: repealed
  • Authority G.S. 58-9; 58-40; 58-40.2; 58-40.6; 58-41.1; 58-44.2
  • Eff. February 1, 1976
  • Readopted Eff. June 12, 1978
  • Amended Eff. July 1, 1986
  • Repealed Eff. February 1, 1989.
11 NCAC 06A .0204 Application for Broker's License {#sec-11-ncac-06a-.0204 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06A .0204}

History

  • Status: repealed
  • Authority G.S. 58-9; 58-40; 58-40.2; 58-40.6; 58-41.1; 58-44.2
  • Eff. February 1, 1976
  • Readopted Eff. June 12, 1978
  • Amended Eff. July 1, 1986
  • Repealed Eff. February 1, 1989.
11 NCAC 06A .0205 License Application/Motor Vehicle Damage Appraisers {#sec-11-ncac-06a-.0205 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06A .0205}

History

  • Status: repealed
  • Authority G.S. 58-9; 58-40; 58-40.2; 58-40.6; 58-41.1; 58-44.2
  • Eff. February 1, 1976
  • Readopted Eff. June 12, 1978
  • Amended Eff. July 1, 1986
  • Repealed Eff. February 1, 1989.
11 NCAC 06A .0206 Examination Permit {#sec-11-ncac-06a-.0206 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06A .0206}

History

  • Status: repealed
  • Authority G.S. 58-9; 58-40; 58-40.2; 58-40.6; 58-41.1; 58-44.2
  • Eff. February 1, 1976
  • Readopted Eff. June 12, 1978
  • Amended Eff. July 1, 1986
  • Repealed Eff. February 1, 1989.
11 NCAC 06A .0207 Failure Letter-Permit {#sec-11-ncac-06a-.0207 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06A .0207}

History

  • Status: repealed
  • Authority G.S. 58-9; 58-40; 58-40.2; 58-40.6; 58-41.1; 58-44.2
  • Eff. February 1, 1976
  • Readopted Eff. June 12, 1978
  • Amended Eff. July 1, 1986
  • Repealed Eff. February 1, 1989.
11 NCAC 06A .0208 Bond Forms for Accident and Health Agents {#sec-11-ncac-06a-.0208 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06A .0208}

History

  • Status: repealed
  • Authority G.S. 58-9; 58-41
  • Eff. February 1, 1976
  • Readopted Eff. June 12, 1978
  • Repealed Eff. July 1, 1986.
11 NCAC 06A .0209 Bond Form for Agents and General Agents: Non-Residents {#sec-11-ncac-06a-.0209 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06A .0209}

History

  • Status: repealed
  • Authority G.S. 58-9; 58-41
  • Eff. February 1, 1976
  • Readopted Eff. June 12, 1978
  • Repealed Eff. July 1, 1986.
11 NCAC 06A .0210 N.c. Resident Broker's Insurance Bond {#sec-11-ncac-06a-.0210 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06A .0210}

The "North Carolina Resident Broker's Insurance Bond" shall include the name of the principal, name of the surety, date and conditions of bond, bond number, amount of the bond, appropriate signatures and other pertinent information and must be accompanied by a power of attorney.

History

  • Authority G.S. 58-33-30(f)(1)
  • Eff. February 1, 1976
  • Readopted Eff. June 12, 1978
  • Amended Eff. February 1, 1989
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. June 25, 2016.
11 NCAC 06A .0211 N.c. Non-Resident Broker's Insurance Bond {#sec-11-ncac-06a-.0211 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06A .0211}

History

  • Status: repealed
  • Authority G.S. 58-33-30(f)(1)
  • Eff. February 1, 1976
  • Readopted Eff. June 12, 1978
  • Amended Eff. February 1, 1989
  • Repealed Eff. February 1, 2008.
11 NCAC 06A .0212 Licenses {#sec-11-ncac-06a-.0212 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06A .0212}

The Commissioner shall issue an electronic license record to the licensed individual or business entity showing the name of the licensee, identifying number of the licensee, date of issue and, if applicable, the type of insurance a licensee is authorized to sell and the terms of the license.

History

  • Authority G.S. 58-2-40; 58-33-26(k)
  • Eff. February 1, 1976
  • Readopted Eff. June 12, 1978
  • Amended Eff. October 1, 2010; October 1, 1990; February 1, 1989; July 1, 1986
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. June 25, 2016.
11 NCAC 06A .0213 Self-Employed Adjuster Renewal Application {#sec-11-ncac-06a-.0213 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06A .0213}

History

  • Status: repealed
  • Authority G.S. 58-33-25(n); 58-33-30(a); 58-33-30(h)(1); 58-33-30(h)(2); 58-33-125
  • Eff. February 1, 1976
  • Readopted Eff. June 12, 1978
  • Amended Eff. October 1, 1990; February 1, 1989
  • Repealed Eff. April 1, 2003.
11 NCAC 06A .0214 Motor Vehicle Damage Appraiser Renewal Application {#sec-11-ncac-06a-.0214 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06A .0214}

History

  • Status: repealed
  • Authority G.S. 58-33-25(n); 58-33-30(a); 58-33-30(h)(1); 58-33-30(h)(2); 58-33-125
  • Eff. February 1, 1976
  • Readopted Eff. June 12, 1978
  • Amended Eff. October 1, 1990; February 1, 1989
  • Repealed Eff. April 1, 2003.
11 NCAC 06A .0215 Resident Broker Application {#sec-11-ncac-06a-.0215 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06A .0215}

History

  • Status: repealed
  • Authority G.S. 58-33-25(n); 58-33-30(a); 58-33-30(h)(1); 58-33-30(h)(2); 58-33-125
  • Eff. February 1, 1976
  • Readopted Eff. June 12, 1978
  • Amended Eff. October 1, 1990; February 1, 1989
  • Repealed Eff. April 1, 2003.
11 NCAC 06A .0216 Nonresident Broker Application {#sec-11-ncac-06a-.0216 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06A .0216}

History

  • Status: repealed
  • Authority G.S. 58-33-25(n); 58-33-30(a); 58-33-30(h)(1); 58-33-30(h)(2); 58-33-125
  • Eff. February 1, 1976
  • Readopted Eff. June 12, 1978
  • Amended Eff. October 1, 1990; February 1, 1989
  • Repealed Eff. April 1, 2003.
11 NCAC 06A .0217 North Carolina Notice of Cancellation {#sec-11-ncac-06a-.0217 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06A .0217}

History

  • Status: repealed
  • Authority G.S. 58-33-55(a)(b)
  • Eff. February 1, 1976
  • Readopted Eff. June 12, 1978
  • Amended Eff. February 1, 1989
  • Repealed Eff. February 1, 2008.
11 NCAC 06A .0218 Termination of Agent Writing Automobile Insurance {#sec-11-ncac-06a-.0218 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06A .0218}

History

  • Status: repealed
  • Authority G.S. 58-9; 58-40.01; 58-44.3
  • Eff. June 12, 1978
  • Repealed Eff. July 1, 1986.
11 NCAC 06A .0219 Application to Determine Eligibility for Designated Agent {#sec-11-ncac-06a-.0219 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06A .0219}

The "Application to Determine Eligibility for Designated Agent" shall include the name and address of the agent, evidence that the agent has satisfied the statutory requirements set out in G.S. 58-37-35(g)(6) and other information to aid the Division in determining the qualification of the applicant. The form must be signed by the applicant and notarized.

History

  • Authority G.S. 58-2-40; 58-37-35(g)(6)
  • Eff. June 12, 1978
  • Amended Eff. October 1, 1990; February 1, 1989
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. June 25, 2016.
11 NCAC 06A .0220 Designated Agent Bond {#sec-11-ncac-06a-.0220 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06A .0220}

The "Designated Agent Bond" shall include the name of the principal, name of the surety, date and conditions of the bond, bond number, amount of the bond, appropriate signatures and other pertinent information and must be accompanied by a power of attorney.

History

  • Authority G.S. 58-37-35(g)(6)
  • Eff. February 1, 1989
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. June 25, 2016.
11 NCAC 06A .0221 Candidate Guide {#sec-11-ncac-06a-.0221 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06A .0221}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-21-65(b)(2),(f); 58-21-65(b)(4); 58-22-60; 58-33-30; 58-33-30(a); 58-33-35; 58-33-40(b)(c); 58-33-40(e)
  • Eff. February 1, 1989
  • Amended Eff. October 1, 1990
  • Temporary Adoption Eff. October 3, 1991 for a period of 180 days to expire on March 30, 1992
  • Amended Eff. March 1, 1992
  • Repealed Eff. April 1, 2003.
11 NCAC 06A .0222 North Carolina Insurance License Application {#sec-11-ncac-06a-.0222 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06A .0222}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-21-65(b)(2),(f); 58-21-65(b)(4); 58-22-60; 58-33-30; 58-33-30(a); 58-33-35; 58-33-40(b)(c); 58-33-40(e)
  • Eff. February 1, 1989
  • Amended Eff. October 1, 1990
  • Temporary Adoption Eff. October 3, 1991 for a period of 180 days to expire on March 30, 1992
  • Amended Eff. March 1, 1992
  • Repealed Eff. April 1, 2003.
11 NCAC 06A .0223 North Carolina Limited Representative Application {#sec-11-ncac-06a-.0223 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06A .0223}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-21-65(b)(2),(f); 58-21-65(b)(4); 58-22-60; 58-33-30; 58-33-30(a); 58-33-35; 58-33-40(b)(c); 58-33-40(e)
  • Eff. February 1, 1989
  • Amended Eff. October 1, 1990
  • Temporary Adoption Eff. October 3, 1991 for a period of 180 days to expire on March 30, 1992
  • Amended Eff. March 1, 1992
  • Repealed Eff. April 1, 2003.
11 NCAC 06A .0224 Adjuster and Appraiser N.c. License Application {#sec-11-ncac-06a-.0224 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06A .0224}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-21-65(b)(2),(f); 58-21-65(b)(4); 58-22-60; 58-33-30; 58-33-30(a); 58-33-35; 58-33-40(b)(c); 58-33-40(e)
  • Eff. February 1, 1989
  • Amended Eff. October 1, 1990
  • Temporary Adoption Eff. October 3, 1991 for a period of 180 days to expire on March 30, 1992
  • Amended Eff. March 1, 1992
  • Repealed Eff. April 1, 2003.
11 NCAC 06A .0225 Appointment of North Carolina Agent {#sec-11-ncac-06a-.0225 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06A .0225}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-21-65(b)(2),(f); 58-21-65(b)(4); 58-22-60; 58-33-30; 58-33-30(a); 58-33-35; 58-33-40(b)(c); 58-33-40(e)
  • Eff. February 1, 1989
  • Amended Eff. October 1, 1990
  • Temporary Adoption Eff. October 3, 1991 for a period of 180 days to expire on March 30, 1992
  • Amended Eff. March 1, 1992
  • Repealed Eff. April 1, 2003.
11 NCAC 06A .0226 Termination of North Carolina Agent Appointment {#sec-11-ncac-06a-.0226 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06A .0226}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-21-65(b)(2),(f); 58-21-65(b)(4); 58-22-60; 58-33-30; 58-33-30(a); 58-33-35; 58-33-40(b)(c); 58-33-40(e)
  • Eff. February 1, 1989
  • Amended Eff. October 1, 1990
  • Temporary Adoption Eff. October 3, 1991 for a period of 180 days to expire on March 30, 1992
  • Amended Eff. March 1, 1992
  • Repealed Eff. April 1, 2003.
11 NCAC 06A .0227 Application for License to Represent a Purchasing Group {#sec-11-ncac-06a-.0227 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06A .0227}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-21-65(b)(2),(f); 58-21-65(b)(4); 58-22-60; 58-33-30; 58-33-30(a); 58-33-35; 58-33-40(b)(c); 58-33-40(e)
  • Eff. February 1, 1989
  • Amended Eff. October 1, 1990
  • Temporary Adoption Eff. October 3, 1991 for a period of 180 days to expire on March 30, 1992
  • Amended Eff. March 1, 1992
  • Repealed Eff. April 1, 2003.
11 NCAC 06A .0228 Bond (form B) Pg-2 {#sec-11-ncac-06a-.0228 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06A .0228}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-21-65(b)(2),(f); 58-21-65(b)(4); 58-22-60; 58-33-30; 58-33-30(a); 58-33-35; 58-33-40(b)(c); 58-33-40(e)
  • Eff. February 1, 1989
  • Amended Eff. October 1, 1990
  • Temporary Adoption Eff. October 3, 1991 for a period of 180 days to expire on March 30, 1992
  • Amended Eff. March 1, 1992
  • Repealed Eff. April 1, 2003.
11 NCAC 06A .0229 N.c. Insurance Agent/License Application Risk Retention {#sec-11-ncac-06a-.0229 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06A .0229}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-21-65(b)(2),(f); 58-21-65(b)(4); 58-22-60; 58-33-30; 58-33-30(a); 58-33-35; 58-33-40(b)(c); 58-33-40(e)
  • Eff. February 1, 1989
  • Amended Eff. October 1, 1990
  • Temporary Adoption Eff. October 3, 1991 for a period of 180 days to expire on March 30, 1992
  • Amended Eff. March 1, 1992
  • Repealed Eff. April 1, 2003.
11 NCAC 06A .0230 Appointment of North Carolina Agent - Risk Retention {#sec-11-ncac-06a-.0230 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06A .0230}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-21-65(b)(2),(f); 58-21-65(b)(4); 58-22-60; 58-33-30; 58-33-30(a); 58-33-35; 58-33-40(b)(c); 58-33-40(e)
  • Eff. February 1, 1989
  • Amended Eff. October 1, 1990
  • Temporary Adoption Eff. October 3, 1991 for a period of 180 days to expire on March 30, 1992
  • Amended Eff. March 1, 1992
  • Repealed Eff. April 1, 2003.
11 NCAC 06A .0231 Termination of North Carolina Agent - Risk Retention {#sec-11-ncac-06a-.0231 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06A .0231}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-21-65(b)(2),(f); 58-21-65(b)(4); 58-22-60; 58-33-30; 58-33-30(a); 58-33-35; 58-33-40(b)(c); 58-33-40(e)
  • Eff. February 1, 1989
  • Amended Eff. October 1, 1990
  • Temporary Adoption Eff. October 3, 1991 for a period of 180 days to expire on March 30, 1992
  • Amended Eff. March 1, 1992
  • Repealed Eff. April 1, 2003.
11 NCAC 06A .0232 Application for Resident Surplus Lines License {#sec-11-ncac-06a-.0232 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06A .0232}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-21-65(b)(2),(f); 58-21-65(b)(4); 58-22-60; 58-33-30; 58-33-30(a); 58-33-35; 58-33-40(b)(c); 58-33-40(e)
  • Eff. February 1, 1989
  • Amended Eff. October 1, 1990
  • Temporary Adoption Eff. October 3, 1991 for a period of 180 days to expire on March 30, 1992
  • Amended Eff. March 1, 1992
  • Repealed Eff. April 1, 2003.
11 NCAC 06A .0233 Bond (form B) Sl-2 {#sec-11-ncac-06a-.0233 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06A .0233}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-21-65(b)(2),(f); 58-21-65(b)(4); 58-22-60; 58-33-30; 58-33-30(a); 58-33-35; 58-33-40(b)(c); 58-33-40(e)
  • Eff. February 1, 1989
  • Amended Eff. October 1, 1990
  • Temporary Adoption Eff. October 3, 1991 for a period of 180 days to expire on March 30, 1992
  • Amended Eff. March 1, 1992
  • Repealed Eff. April 1, 2003.
11 NCAC 06A .0234 Resident Surplus Lines License Renewal {#sec-11-ncac-06a-.0234 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06A .0234}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-21-40(d); 58-21-65(d),(f)
  • Eff. February 1, 1989
  • Temporary Amendment Eff. October 3, 1991 For a Period of 180 Days to Expire on March 30, 1992
  • Amended Eff. February 1, 1996; March 1, 1992
  • Repealed Eff. October 1, 2010.
11 NCAC 06A .0235 Corporate Surplus Lines Application {#sec-11-ncac-06a-.0235 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06A .0235}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-21-65(c)(d); 58-33-25(h); 58-33-30(a)
  • Eff. February 1, 1989
  • Amended Eff. April 1, 1996; October 1, 1990
  • Repealed Eff. April 1, 2003.
11 NCAC 06A .0236 Application for Corporate/Partnership Insurance License {#sec-11-ncac-06a-.0236 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06A .0236}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-21-65(c)(d); 58-33-25(h); 58-33-30(a)
  • Eff. February 1, 1989
  • Amended Eff. April 1, 1996; October 1, 1990
  • Repealed Eff. April 1, 2003.
11 NCAC 06A .0237 Foreign Military Sales Agent License Application {#sec-11-ncac-06a-.0237 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06A .0237}

The "Foreign Military Sales Agent License Application" shall include personal information, company name, number and address, signature of applicant and authorized company representative, a certificate signed by an officer of the company, and other information to aid the Division in determining if the applicant is qualified for the license.

History

  • Authority G.S. 58-33-15
  • Eff. February 1, 1989
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. June 25, 2016.
11 NCAC 06A .0238 Rental Car Company License Application {#sec-11-ncac-06a-.0238 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06A .0238}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-33-17; 58-33-125(c)
  • Temporary Adoption Eff. October 3, 1991 For a Period of 180 Days to Expire on March 30, 1992
  • Eff. March 1, 1992
  • Repealed Eff. October 1, 2010.
11 NCAC 06A .0239 Nonresident Surplus Lines License Application {#sec-11-ncac-06a-.0239 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06A .0239}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-21-40(d); 58-21-65(f)
  • Temporary Adoption Eff. October 3, 1991 for a period of 180 days to expire on March 30, 1992
  • Eff. March 1, 1992
  • Amended Eff. February 1, 1996
  • Repealed Eff. April 1, 2003.
11 NCAC 06A .0240 Nonresident Surplus Lines License Renewal {#sec-11-ncac-06a-.0240 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06A .0240}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-21-40(d); 58-21-65(f)
  • Temporary Adoption Eff. October 3, 1991 for a period of 180 days to expire on March 30, 1992
  • Eff. March 1, 1992
  • Amended Eff. February 1, 1996
  • Repealed Eff. April 1, 2003.
11 NCAC 06A .0301 Types of Examinations {#sec-11-ncac-06a-.0301 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06A .0301}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-21-65(b)(3); 58-33-30(e)
  • Eff. February 1, 1976
  • Readopted Eff. June 12, 1978
  • Amended Eff. February 1, 1996, October 1, 1990; February 1, 1989; July 1, 1986
  • Repealed Eff. April 1, 2003.
11 NCAC 06A .0302 EXAMINATIONS – Special ACCOMMODATIONS (ADA) {#sec-11-ncac-06a-.0302 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06A .0302}

An individual with a physical disability may have special assistance from other individuals acting as readers or recorders. Applicants requiring special assistance shall request the assistance from the test administrator before registration for the examination. Verification of handicaps and a statement of all assistance needed shall be included at the time of application.

History

  • Authority G.S. 58-2-40; 58-33-30(e)
  • Eff. February 1, 1976
  • Readopted Eff. June 12, 1978
  • Amended Eff. February 1, 1996; February 1, 1989
  • Amended Eff. April 1, 2003
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. June 25, 2016.
11 NCAC 06A .0303 Schedule of Examinations {#sec-11-ncac-06a-.0303 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06A .0303}

The Division will publish or cause to have published the current schedules of examinations. The schedules shall include day, time and location of examination. The Commissioner may set other special times for examinations in addition to those listed on the current examination schedule. An applicant who cannot take the examination on a scheduled examination date for religious reasons may request an individually administered test. Such a request must be in writing by the applicant's religious advisor and sent with the application for examination and licensure. Individually administered examinations are given only on a pre-registered basis.

History

  • Authority G.S. 58-33-30(e)
  • Eff. February 1, 1976
  • Readopted Eff. June 12, 1978
  • Amended Eff. February 1, 1989; July 1, 1986
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. June 25, 2016.
11 NCAC 06A .0304 Responsibility of Applicant at Examination Site {#sec-11-ncac-06a-.0304 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06A .0304}

(a) Applicants who have not previously failed the same examination shall bring to the examination site the Examination Admission Ticket/Certificate of Course Completion, their confirmation numbers obtained from the testing service at the time of registration, and two forms of proof of identity, one of which must be photo bearing.

(b) Applicants who have previously failed an examination may retake the examination and shall pay applicable fees for each administration.

(c) Applicants taking the life, accident and health or sickness, Medicare supplement, long term care, personal lines, property, or casualty examination shall bring to the examination site an Examination Admission Ticket/Certificate of Course Completion, validated by an approved prelicensing school or by the Division indicating that the applicant has successfully completed the mandatory prelicensing education requirements as specified in G.S. 58-33-30(d)(2). The Examination Admission Ticket/Certificate of Course Completion is valid for 90 days from the date of course completion or a maximum of five examination sittings, whichever occurs first.

(d) No applications shall be supplied at the examination site for completion by applicants; nor shall required supplies be furnished to applicants.

(e) Applicants shall arrive at the examination site at the time specified in the current examination schedule.

History

  • Authority G.S. 58-2-40; 58-33-30(d)(2); 58-33-31; 58-33-30(e); 58-33-125
  • Eff. February 1, 1976
  • Readopted Eff. June 12, 1978
  • Amended Eff. February 1, 2008; April 1, 2003; April 1, 1996; October 1, 1990; February 1, 1989
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. June 25, 2016.
11 NCAC 06A .0305 Administration of Examination {#sec-11-ncac-06a-.0305 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06A .0305}

(a) Individuals applying for an agent or adjuster license shall present to the test site personnel upon request the applicable items described in 11 NCAC 06A .0304(a) through (d).

(b) Applicants may take simple function calculators, but shall not take textbooks, other books or papers into the examinations. Applicants found to have any of these materials shall not be allowed to continue the examination.

(c) Applicants shall leave the examination room only after obtaining permission from the examination proctors and handing in exam materials. No extra time shall be allowed for completing the examination.

(d) Any applicant who gives or receives assistance during the examination shall not receive an examination score. The proctors of the examination shall report the incident to the Commissioner.

History

  • Authority G.S. 58-2-40; 58-33-30(e)
  • Eff. February 1, 1976
  • Readopted Eff. June 12, 1978
  • Amended Eff. October 1, 2010; February 1, 1996; October 1, 1990; February 1, 1989
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. June 25, 2016.
11 NCAC 06A .0306 Registration for Examination {#sec-11-ncac-06a-.0306 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06A .0306}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-33-30(e)
  • Eff. February 1, 1976
  • Readopted Eff. June 12 1978
  • Amended Eff. February 1, 1996; October 1, 1990; February 1, 1989
  • Repealed Eff. April 1, 2003.
11 NCAC 06A .0401 Licenses: General Provisions {#sec-11-ncac-06a-.0401 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06A .0401}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-21-65(f); 58-33-17; 58-33-25; 58-33-30(h)
  • Eff. February 1, 1976
  • Readopted Eff. June 12, 1978
  • Temporary Amendment Eff. October 3, 1991 for a period of 180 days to expire on March 30, 1992
  • Amended Eff. March 1, 1992; October 1, 1990; February 1, 1989; July 1, 1986
  • Repealed Eff. April 1, 2003.
11 NCAC 06A .0402 Licensing of Resident Agent, Ltd Representative and Adjuster {#sec-11-ncac-06a-.0402 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06A .0402}

(a) An applicant for a resident variable life and variable annuity product shall hold a resident life license before making application for a resident variable life and variable annuity product license. An agent licensed to sell variable life and variable annuity products shall be appointed by a company authorized to sell variable annuities and variable life insurance products in North Carolina. The company shall verify that the agent has met the requirements of the Financial Industry Regulatory Authority (FINRA) or its successor organization.

(b) A limited representative shall be appointed with each company for which he or she will solicit business for the following kinds of insurance:

(1) Dental services;

(2) Limited line credit insurance;

(3) Prearrangement insurance, as defined in G.S. 58-60-35(a)(2), when offered or sold by a preneed sales licensee licensed under Article 13D of Chapter 90 of the General Statutes; or

(4) Travel, accident, and baggage.

(c) Responsibility of insurance companies for forms:

(1) Companies shall have on file with the Division the address and email address of one central licensing office and the individual within that office to whom all correspondence, licenses, and invoices will be forwarded.

(2) Companies shall have on file with the Division the name of the individual responsible for all agent appointments and termination of agent appointments submitted by the company to the Division.

(3) A company shall verify the licensure of an agent before the company appoints the agent.

(4) Companies shall notify the Division within 10 days after any change of address or email address of the central licensing office and of any change of the individual within that office to whom all correspondence, licenses, and invoices will be forwarded.

(d) Responsibility of the agent, limited representative, and adjuster:

(1) A person, after surrender or termination of a license for such period of time that he or she is no longer eligible for waiver of the examination, shall meet all legal requirements for previously unlicensed persons.

(2) Every licensee shall, upon demand from the Division, furnish in writing any information relating to the licensee's insurance business within 10 business days after the demand in accordance with G.S. 58-2-195(a).

(e) An applicant for a resident license shall, if an electronic record is not available, obtain an original letter of clearance from his or her former state of residency certifying the kinds of insurance for which the applicant was licensed, that all licenses held in that state have been canceled and that the applicant was in good standing in that state at the time of the cancellation of licenses. A letter of clearance is valid for 90 days from date of issuance.

(f) Only individuals may apply for limited representative and adjuster licenses.

History

  • Authority G.S. 58-2-40; 58-2-195(a); 58-33-26; 58-33-30; 58-33-66
  • Eff. February 1, 1976
  • Readopted Eff. June 12, 1978
  • Amended Eff. October 1, 2010; February 1, 2008; April 1, 2003; February 1, 1996; October 1, 1990; February 1, 1989
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. June 25, 2016
  • Amended Eff. August 1, 2021.
11 NCAC 06A .0403 Licensing: Nonresident Agent, Ltd Representative and Adjuster {#sec-11-ncac-06a-.0403 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06A .0403}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-33-30(a),(h)(2)
  • Eff. February 1, 1976
  • Readopted Eff. June 12, 1978
  • Amended Eff. October 1, 1990; February 1, 1989
  • Repealed Eff. April 1, 2003.
11 NCAC 06A .0404 Licensing of Broker {#sec-11-ncac-06a-.0404 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06A .0404}

(a) An applicant shall be a licensed agent in North Carolina for each kind of insurance to be brokered.

(b) A broker's license gives the holder authority to broker only those kinds of insurance for which he holds an agent's license. Brokering shall be done through a licensed and appointed agent of the company with which the business is being placed. A broker's license does not confer binding authority; it only gives authority to share in commissions with a writing agent.

(c) Each applicant shall file with his application a surety bond or cash, certificates of deposit, or securities as provided by statute. Any cash, certificate of deposit, or securities deposited in lieu of the surety bond shall be held in accordance with 11 NCAC 11B .0100.

History

  • Authority G.S. 58-2-40; 58-33-30(f),(h)(1)
  • Eff. February 1, 1976
  • Readopted Eff. June 12, 1978
  • Amended Eff. October 1, 1990; February 1, 1989; July 1, 1986
  • Temporary Amendment Eff. October 3, 1991 For a Period of 180 Days to Expire on March 30, 1992
  • Amended Eff. February 1, 2008; March 1, 1992
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. June 25, 2016.
11 NCAC 06A .0405 Licensing of Nonresident Broker {#sec-11-ncac-06a-.0405 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06A .0405}

History

  • Status: repealed
  • Filed as a Temporary Amendment Eff. October 3, 1991 For a Period of 180 Days to Expire
  • on March 30, 1992
  • Authority G.S. 58-2-40; 58-33-30(f),(h)(2); 58-33-125(a)
  • Eff. February 1, 1976
  • Readopted Eff. June 12, 1978
  • Amended Eff. March 1, 1992; October 1, 1990; February 1, 1989
  • Repealed Eff. February 1, 2008.
11 NCAC 06A .0406 Licensing of Resident Variable Contract Ltd Representative {#sec-11-ncac-06a-.0406 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06A .0406}

History

  • Status: repealed
  • Authority G.S. 58-614(e)(1); 58-615
  • Eff. February 1, 1976
  • Readopted Eff. June 12, 1978
  • Amended Eff. February 1, 1989
  • Repealed Eff. October 1, 1990.
11 NCAC 06A .0407 Licensing/Non-Resident Variable Contract Ltd Representative {#sec-11-ncac-06a-.0407 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06A .0407}

History

  • Status: repealed
  • Authority G.S. 58-614(e)(1); 58-615
  • Eff. February 1, 1976
  • Readopted Eff. June 12, 1978
  • Amended Eff. February 1, 1989
  • Repealed Eff. October 1, 1990.
11 NCAC 06A .0408 Licensing of Motor Vehicle Damage Appraiser {#sec-11-ncac-06a-.0408 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06A .0408}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-33-10(14); 58-33-30
  • Eff. February 1, 1976
  • Readopted Eff. June 12, 1978
  • Amended Eff. October 1, 1990; February 1, 1989; July 1, 1986
  • Repealed Eff. February 1, 2008.
11 NCAC 06A .0409 Licensing of Other Agents and Adjusters {#sec-11-ncac-06a-.0409 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06A .0409}

History

  • Status: repealed
  • Authority G.S. 58-9; 58-40; 58-268
  • Eff. February 1, 1976
  • Readopted Eff. June 12, 1978
  • Repealed Eff. February 1, 1989.
11 NCAC 06A .0410 Temporary License {#sec-11-ncac-06a-.0410 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06A .0410}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-33-65
  • Eff. February 1, 1976
  • Readopted Eff. June 12, 1978
  • Amended Eff. February 1, 1996; October 1, 1990; February 1, 1989; July 1, 1986
  • Repealed Eff. April 1, 2003.
11 NCAC 06A .0411 Limited Licenses {#sec-11-ncac-06a-.0411 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06A .0411}

History

  • Status: repealed
  • Authority G.S. 58-41.2
  • Eff. February 1, 1976
  • Readopted Eff. June 12, 1978
  • Repealed Eff. February 1, 1989.
11 NCAC 06A .0412 Appointment of Agent: Responsibility of Company {#sec-11-ncac-06a-.0412 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06A .0412}

Before appointing an agent, an insurance company shall determine that:

(1) The agent holds the proper license for each kind of authority for which the agent will be appointed; and

(2) The agent has not committed any act that is a ground for probation, suspension, nonrenewal, or revocation set forth in G.S. 58-33-46.

History

  • Authority G.S. 58-2-40; 58-33-40; 58-33-46; 18 U.S.C. 1033
  • Eff. February 1, 1989
  • Amended Eff. April 1, 2003; October 1, 1990
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. June 25, 2016.
11 NCAC 06A .0413 Licensing of Business Entities {#sec-11-ncac-06a-.0413 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06A .0413}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-33-31
  • Eff. February 1, 1989
  • Amended Eff. March 1, 2008; April 1, 2003; February 1, 1996; October 1, 1990
  • Repealed Eff. October 1, 2010.
11 NCAC 06A .0414 Adjuster's Learner's Permit {#sec-11-ncac-06a-.0414 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06A .0414}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-33-70
  • Eff. October 1, 1990
  • Amended Eff. April 1, 2003
  • Repealed Eff. February 1, 2008.
11 NCAC 06A .0415 Licensing of Rental Car Companies' Employees/Representatives {#sec-11-ncac-06a-.0415 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06A .0415}

History

  • Status: repealed
  • Filed as a Temporary Repeal Eff. October 3, 1991 For a Period of 180 Days to Expire on
  • March 30, 1992
  • Authority G.S. 58-2-40; 66-205
  • Eff. October 1, 1990
  • Repealed Eff. March 1, 1992.
11 NCAC 06A .0416 Licensing of Rental Car Companies {#sec-11-ncac-06a-.0416 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06A .0416}

(a) An applicant must meet the minimum qualifications in G.S. 58-33-17.

(b) An applicant must make application on a form prescribed by the Commissioner along with the fee prescribed by G.S. 58-33-125(c).

(c) An applicant must submit for approval a copy of any brochure as required in G.S. 58-33-17(f)(2). Any changes in the brochure must be submitted for approval at least 90 days before the proposed effective date of such changes.

(d) An applicant must submit for approval a copy of its employee training program. Any changes in the training program must be submitted for approval at least 90 days before the proposed effective date of such changes.

(e) Each employee of the licensee who sells insurance coverages in relation to a rental agreement must meet the minimum training requirements in the types of insurance authorized in G.S. 58-33-17(e).

(f) A list of all employees who have successfully completed the training course required in G.S. 58-33-17(h) and approved by the Commissioner must be maintained at each licensee's location and must be available for inspection upon request by the Commissioner at all times during normal business hours.

(g) The licensee must notify the Commissioner in writing of any changes, including changes of addresses or the addition of new rental locations, within 30 days after such changes.

(h) The licensee must provide the Commissioner with any changes of coverages being provided or insurers at least 30 days before the effective dates of such changes. If there is a change in insurer, the written notification must be accompanied by a newly executed certification executed by the insurer.

(i) The certification from the insurer providing coverage shall include the:

(1) name of the licensee;

(2) name of the insurer providing coverage;

(3) types of coverage being offered;

(4) policy form number; and

(5) signature and title of the insurance company officer executing the certificate.

History

  • Authority G.S. 58-2-40; 58-33-17; 58-33-125(c)
  • Temporary Adoption Eff. October 3, 1991 For a Period of 180 Days to Expire on March 30, 1992
  • Eff. March 1, 1992
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. June 25, 2016.
11 NCAC 06A .0417 Requirements for Pre Need Limited Rep. Agent {#sec-11-ncac-06a-.0417 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06A .0417}

Individuals applying to be licensed to sell prearrangement insurance policies, as defined in G.S. 58-60-35(a)(2), shall submit a Uniform Limited Insurance Representative Application and appropriate fees. Applicants shall also submit evidence that they are licensed to sell preneed funeral contracts under G.S. 90, Article 13D.

History

  • Authority G.S. 58-2-40; 58-33-26(g)(5)
  • Eff. February 1, 1996
  • Amended Eff. April 1, 2003
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. June 25, 2016.
11 NCAC 06A .0418 Fingerprints Required for Criminal Record Checks {#sec-11-ncac-06a-.0418 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06A .0418}

(a) An applicant for a resident insurance producer license shall furnish the Commissioner with a complete set of the applicant's fingerprints as authorized by G.S. 58-33-48. An applicant for an insurance producer license as defined in G.S. 58-33-10(7), includes:

(1) An applicant for an initial resident insurance producer license;

(2) A non-resident insurance producer applying for a resident insurance producer license;

(3) An adjuster applying for an initial resident insurance producer license;

(4) A resident insurance producer license applicant applying for reinstatement of an insurance producer license that has been lapsed for more than one year; and

(5) A resident insurance producer license applicant whose license has been suspended or revoked for non-payment of child support pursuant to G.S. 110-142.1.

(b) As authorized by G.S. 58-33-48, fingerprints shall be furnished in the following manner:

(1) Each resident insurance producer license applicant who is required to submit fingerprints under G.S. 58-33-48 shall have a complete set of their fingerprints electronically captured by a criminal law enforcement agency approved by State Bureau of Investigation (SBI) to submit fingerprints via electronic means;

(2) Each resident insurance producer license applicant who is required to submit fingerprints under G.S. 58-33-48 shall submit with the insurance producer license application the Electronic Fingerprint Submission Release of Information Form that has been completed and certified by a law enforcement officer that the applicant's fingerprints have been submitted via electronic means to the SBI;

(3) Each resident insurance producer license applicant who is required to submit fingerprints under G.S. 58-33-48 shall submit with the insurance producer license application the Authority for Release of Information form required by the SBI to release the criminal history record check information to the Department;

(4) Each resident insurance producer license applicant who is required to submit fingerprints under G.S. 58-33-48 shall submit with the insurance producer license application the cost for the state and national criminal history record fee that is set forth pursuant to G.S. 114-19.1(a); and

(5) All fingerprint impressions must be suitable for use by the SBI to conduct a state criminal history record check and for the Federal Bureau of Investigations (FBI) to conduct a national criminal history record check. If the SBI deems the electronic fingerprints are not suitable, the Commissioner shall notify and provide instructions to the applicant to resubmit his fingerprints in the manner set forth in Subparagraph (1) of this Paragraph within 30 days.

(c) The application of a resident insurance producer required to submit fingerprints is not be complete until the Commissioner receives the state and national criminal history record information. In accordance with G.S. 58-33-30(a), the Commissioner shall not issue the license of an insurance producer that does not satisfy the license application requirements.

History

  • Authority G.S. 58-2-40; 58-33-30; 58-33-48
  • Eff. October 1, 2010
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. June 25, 2016.
11 NCAC 06A .0501 RENEWAL OF AGENT APPTS: LICENSES/LIMITED reps {#sec-11-ncac-06a-.0501 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06A .0501}

(a) Annually the Division shall notify each insurance company of dates and methods for renewing agent and limited representative appointments. Companies shall be given at least 30 days' advance notice of the last date the Division shall process terminations.

(b) On the last date to submit terminations, the Division shall cease processing all terminations and bill companies for renewals. All appointments and licenses shall automatically be billed for the appointment renewal unless the Division has received a termination request from the company within the specified time.

(c) The Division shall send each company an invoice stating the total amount of money due and a list of all appointees or licensees associated with the total due. The Division shall make this invoice and a list of all appointees or licensees associated with the total due available electronically to each company. Companies shall remit the amount stated in the invoice by electronic payment to the Commissioner or the Commissioner's designee and shall pay all associated fees for electronic processing. Any discrepancies claimed by companies shall be investigated only after full payment is received.

(d) Upon receipt of the company payment, the Division shall provide to the company an electronic list of all appointments and licenses renewed.

(e) Appointments recorded and licenses issued prior to the renewal date, but after the date specified by the Division as the last date to process termination, shall be valid until the following year.

(f) Failure of a company to pay any invoice by the due date shall automatically result in the termination of all appointees or licensees of that company. The Commissioner shall not issue any new appointments until all outstanding invoices have been paid. Any company that has had appointments or licensees cancelled by the Commissioner pursuant to this Rule shall not process any new electronic appointments until all outstanding invoices have been paid. When the outstanding invoices are paid, the company may re-appoint agents or limited representatives and shall pay the appointment fees.

History

  • Authority G.S. 58-2-40; 58-2-250; 58-33-40(f); 58-33-56; 58-33-125(a); 58-33-125(h)
  • Eff. February 1, 1976
  • Readopted Eff. June 12, 1978
  • Amended Eff. October 1, 2010; February 1, 1996; October 1, 1990; February 1, 1989; July 1, 1986
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. June 25, 2016
  • Amended Eff. August 1, 2021.
11 NCAC 06A .0502 Renewal of Brokers' Licenses {#sec-11-ncac-06a-.0502 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06A .0502}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-33-25(n); 58-33-30(f); 58-33-125
  • Eff. February 1, 1976
  • Readopted Eff. June 12, 1978
  • Amended Eff. October 1, 1990; February 1, 1989
  • Repealed Eff. April 1, 2003.
11 NCAC 06A .0503 Renewal: Self-Employed Adjuster: Motor Vehicle Damage Appr {#sec-11-ncac-06a-.0503 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06A .0503}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-33-25(n); 58-33-30(f); 58-33-125
  • Eff. February 1, 1976
  • Readopted Eff. June 12, 1978
  • Amended Eff. October 1, 1990; February 1, 1989
  • Repealed Eff. April 1, 2003.
11 NCAC 06A .0504 Failure to Renew License {#sec-11-ncac-06a-.0504 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06A .0504}

Failure to renew a broker, limited representative, adjuster or motor vehicle damage appraiser license by March 31 by payment of the annual renewal fee as specified in G.S. 58-33-125(a) shall result in automatic lapse of the license on April 1 by the Division.

History

  • Authority G.S. 58-2-40; 58-33-26(m); 58-33-125(a)
  • Eff. February 1, 1976
  • Readopted Eff. June 12, 1978
  • Amended Eff. October 1, 2010; February 1, 1989
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. June 25, 2016.
11 NCAC 06A .0505 termination of appointments FOR LIMITED REPS {#sec-11-ncac-06a-.0505 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06A .0505}

All companies shall submit termination of appointments through an electronic system provided by the Commissioner.

History

  • Authority G.S. 58-2-40; 58-2-250; 58-33-56(b)
  • Eff. June 12, 1978
  • Amended Eff. October 1, 2010; October 1, 1990; February 1, 1989; July 1, 1986
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. June 25, 2016.
11 NCAC 06A .0506 Cancellation of Licenses Issued to Individuals {#sec-11-ncac-06a-.0506 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06A .0506}

(a) Any insurance producer, adjuster, viatical settlement broker or surplus lines licensee desiring to cancel a license shall submit a written request to the Division.

(b) Cancellation of a license automatically terminates all appointments for the kind of insurance covered by the license.

History

  • Authority G.S. 58-2-40; 58-33-40(e)
  • Eff. February 1, 1989
  • Amended Eff. October 1, 2010; April 1, 2003; October 1, 1990
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. June 25, 2016.
11 NCAC 06A .0507 Termination of Agent Appointment {#sec-11-ncac-06a-.0507 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06A .0507}

History

  • Status: repealed
  • Authority G.S. 58-33-40(e)
  • Eff. February 1, 1989
  • Repealed Eff. April 1, 2003.
11 NCAC 06A .0508 Rental Car Company License Renewal {#sec-11-ncac-06a-.0508 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06A .0508}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-33-17; 58-33-25(n); 58-33-125
  • Temporary Adoption Eff. October 3, 1991 for a period of 180 days to expire on March 30, 1992
  • Eff. March 1, 1992
  • Repealed Eff. April 1, 2003.
11 NCAC 06A .0601 Basis for Denial of License {#sec-11-ncac-06a-.0601 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06A .0601}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-33-45
  • Eff. February 1, 1976
  • Readopted Eff. June 12, 1978
  • Amended Eff. October 1, 1990; February 1, 1989; July 1, 1986
  • Repealed Eff. April 1, 2003.
11 NCAC 06A .0602 Court Records and Affidavits Required {#sec-11-ncac-06a-.0602 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06A .0602}

An individual who has been convicted of an offense specified in G.S. 58-33-46(a)(6), shall submit to the Division the following information with the application for licensure and examination:

(1) a copy of the entire court record including the judgment, as well as a complete criminal history check;

(2) a copy of unconditional release or unconditional discharge from the Post Release Supervision and Parole Commission, if applicable, on the forms provided by the North Carolina Department of Correction;

(3) if the applicant or licensee is currently employed or expects to be employed by an insurer, agency, company or firm in the business of insurance, the applicant or licensee shall submit a letter from the employer or potential employer stating that the applicant or licensee has disclosed to the employer information about the conviction;

(4) a notarized affidavit from the applicant about the conviction; and

(5) if applicable, a statement from the applicant's probation officer.

History

  • Authority G.S. 58-2-40; 58-33-46(6)
  • Eff. February 1, 1976
  • Readopted Eff. June 12, 1978
  • Amended Eff. April 1, 2003; October 1, 1990; April 1, 1989; July 1, 1986
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. June 25, 2016.
11 NCAC 06A .0603 Evaluation of Records and Affidavits {#sec-11-ncac-06a-.0603 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06A .0603}

In its evaluation of court records and affidavits, the Division shall consider all information and as many facts as are presented to it, including, but not limited to:

(1) time elapsed since last offense or conviction;

(2) seriousness of the offense or alleged offense;

(3) extenuating circumstances, particularly in the case of juvenile offenses;

(4) statements of character witnesses, including the notarized affidavits which are submitted by previous employers.

History

  • Authority G.S. 58-33-45
  • Eff. February 1, 1976
  • Readopted Eff. June 12, 1978
  • Amended Eff. February 1, 1989
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. June 25, 2016.
11 NCAC 06A .0604 Personal Interviews {#sec-11-ncac-06a-.0604 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06A .0604}

History

  • Status: repealed
  • Authority G.S. 58-33-45
  • Eff. February 1, 1976
  • Readopted Eff. June 12, 1978
  • Amended Eff. February 1, 1989
  • Repealed Eff. February 1, 2008.
11 NCAC 06A .0605 Notification of Denial of License {#sec-11-ncac-06a-.0605 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06A .0605}

History

  • Status: repealed
  • Authority G.S. 58-9
  • Eff. February 1, 1976
  • Readopted Eff. June 12, 1978
  • Repealed Eff. February 1, 1989.
11 NCAC 06A .0701 General Requirements {#sec-11-ncac-06a-.0701 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06A .0701}

History

  • Authority G.S. 58-2-40; 58-33-30(d); 58-33-35; 58-33-132
  • Eff. February 1, 1989
  • Amended Eff. April 1, 1996; October 1, 1990
  • Amended Eff. February 1, 2008
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. June 25, 2016
  • Temporary Repeal Eff. May 6, 2026.
11 NCAC 06A .0702 Prelicensing Education Schools {#sec-11-ncac-06a-.0702 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06A .0702}

History

  • Authority G.S. 58-2-40; 58-33-30(d); 58-33-132
  • Eff. February 1, 1989
  • Amended Eff. February 1, 2008; April 1, 2003; April 1, 1996; November 1, 1990
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. June 25, 2016
11 NCAC 06A .0703 Program Directors {#sec-11-ncac-06a-.0703 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06A .0703}

History

  • Authority G.S. 58-2-40; 58-33-30(d); 58-33-132
  • Eff. February 1, 1989
  • Amended Eff. February 1, 2008; October 1, 1990
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. June 25, 2016
  • Temporary Repeal Eff. May 6, 2026.
11 NCAC 06A .0704 Courses {#sec-11-ncac-06a-.0704 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06A .0704}

History

  • Authority G.S. 58-2-40; 58-33-30(d); 58-33-132
  • Eff. February 1, 1989
  • Amended Eff. February 1, 2008; April 1, 1996; October 1, 1990
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. June 25, 2016
11 NCAC 06A .0705 Instructors {#sec-11-ncac-06a-.0705 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06A .0705}

History

  • Authority G.S. 58-2-40; 58-33-30(d); 58-33-132
  • Eff. February 1, 1989
  • Amended Eff. February 1, 2008; April 1, 1996; October 1, 1990
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. June 25, 2016
11 NCAC 06A .0706 Proctors {#sec-11-ncac-06a-.0706 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06A .0706}

History

  • Status: repealed
  • Authority G.S. 58-615(d)
  • Eff. February 1, 1989
  • Repealed Eff. October 1, 1990.
11 NCAC 06A .0801 Definitions {#sec-11-ncac-06a-.0801 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06A .0801}

As used in this Section:

(1) "Biennial compliance period" means the 24-month period during which an agent or adjuster shall comply with continuing education requirements.

(2) "Cluster of courses" means a number of courses, each of which is less than 100 minutes in length, but altogether 100 minutes or more in length, that are offered within one state or national program or convention.

(3) "Compliance year" means the second year of the biennial compliance period.

(4) "Continuing Education Administrator" or "Administrator" means the entity with which the Commissioner contracts for continuing education administration, including the approval of providers and courses and the retention of ICEC records for licensees.

(5) "Course" means a continuing education course directly related to insurance principles and practices or a course designed and approved specifically for licensees; but does not mean a business course of a general nature or an insurance marketing or sales course. Courses shall be for instructional purposes only and not for promoting the interests of or recruiting employees for any particular insurance agency or company.

(6) "Disinterested third party" means a person not concerned, with respect to possible gain or loss, in the result of a pending course final examination.

(7) "Distance learning" means an educational program in which the licensee and the instructor are in different physical locations and interact with each other through various methods of telecommunication.

(8) "Ethics course" means a continuing education course that deals with usage and customs among members of the insurance profession involving their moral and professional duties toward one another, toward clients, toward insureds, and toward insurers.

(9) "Insurance continuing education credit" or "ICEC" means a value assigned to a course by the Commissioner after review and approval of a course information. This term means the same as "credit hour" as used in G.S. 58-33-130.

(10) "Instructor" means an individual who teaches, lectures, leads, or otherwise instructs a course.

(11) "Licensee" means a licensed adjuster, a licensed broker, or a licensed agent with any of the following lines of authority: property, casualty, personal lines, life, or accident and health or sickness.

(12) "Long-Term Care Partnership Education" means a continuing education course related to long-term care insurance, long-term care services and qualified state long-term care insurance partnership programs which includes:

(a) State and federal regulations and requirements relating to long-term care partnership policies;

(b) the relationship between qualified state long-term care insurance partnership programs and other public and private coverage of long-term care services, including Medicaid:

(c) available long-term care services and providers;

(d) changes or improvements in long-term care services or providers;

(e) alternatives to the purchase of private long-term care insurance;

(f) the effect of inflation on long-term care partnership policy benefits and the importance of inflation protection; and

(g) consumer suitability standards and guidelines for long-term care partnership policies.

(13) Qualified Policy" has the same meaning as in G.S. 58-55-55(6) and includes a certificate issued under a group policy as specified in G.S. 58-55-60.

(14) "Supervised examination" means a timed, closed book examination that is monitored and graded by a disinterested third party.

(15) "Supervised individual study" means learning through the use of audio tapes, video tapes, computer programs, programmed learning courses, and other types of electronic media that are completed in the presence of an instructor.

History

  • Authority G.S. 58-2-40; 58-33-130; 58-55-55; 58-55-60; 58-55-65; 58-55-75
  • Temporary Adoption Eff. June 22, 1990, for a period of 180 days to expire on December 19, 1990
  • ARRC Objection Lodged July 19, 1990
  • Eff. December 1, 1990
  • Amended Eff. March 1, 2011; February 1, 2008; February 1, 1995; June 1, 1992
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. June 25, 2016.
11 NCAC 06A .0802 Licensee Requirements {#sec-11-ncac-06a-.0802 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06A .0802}

(a) Each person holding a life, accident and health or sickness, property, casualty, personal lines, or adjuster license shall obtain 24 ICECs during each biennial compliance period. Each person holding one or more life, accident and health or sickness, property, casualty, personal lines, variable life and variable annuity products, or adjuster license shall complete an ethics course or courses within two years after January 1, 2008, and every biennial compliance period thereafter as defined in this Section. The course or courses shall comprise three ICECs.

(b) Each person holding one or more property, personal lines, or adjuster license shall complete a continuing education course or courses on flood insurance and the National Flood Insurance Program, or any successor programs, within the first biennial compliance period after January 1, 2008, and every other biennial compliance period thereafter. The course or courses shall comprise three ICECs.

(c) Each licensee shall, before the end of that licensee's biennial compliance year, furnish evidence as set forth in this Section that the continuing education requirements have been satisfied.

(d) An instructor shall receive the maximum ICECs awarded to a student for the course.

(e) Licensees shall not receive ICECs for the same course more often than one time in any biennial compliance period.

(f) Licensees shall receive ICECs for a course only for the biennial compliance period in which the course is completed. Any course requiring an examination shall not be considered completed until the licensee passes the examination.

(g) Licensees shall maintain records of all ICECs for five years after obtaining those ICECs, which records shall be available for inspection by the Commissioner.

(h) Nonresident licensees who meet continuing education requirements in their home states shall be deemed to meet the continuing education requirements of this Section. Nonresident adjusters who qualify for licensure by passing the North Carolina adjuster examination pursuant to G.S. 58-33-30(h)(2)a. shall meet the same continuing education requirements as a resident adjuster, including mandatory flood and ethics courses. Nonresident adjusters who qualify for licensure by passing an adjuster examination in another state pursuant to G.S. 58-33-30(h)(2)b. and are in good standing in that state shall be credited with having met the same continuing education requirements as resident adjusters, including mandatory flood and ethics courses.

(i) Only a licensed insurance producer who is unable to comply with continuing education requirements due to military service or long-term medical disability may request a waiver for continuing education requirements. A long-term medical disability shall be certified on an annual basis by the producer's attending physician. The Commissioner shall grant an exemption from Continuing Education requirements for up to one year if the producer submits the following:

(1) deployment orders from the United States Department of Defense; or

(2) a notarized statement from a licensed physician stating the producer is unable to do the work he or she is licensed to do.

(j) A producer who was granted an exemption from the requirements of this Section prior to October 1, 2010 continues to be exempt from continuing education requirements for as long as the producer certifies to the Commissioner that he or she:

(1) is age 65 or older;

(2) has been continuously licensed in the line of insurance for at least 25 years; and

(3) either:

(A) holds a professional designation specified in 11 NCAC 06A .0803; or

(B) certifies to the Commissioner annually that the producer is an inactive agent who neither solicits applications for insurance nor takes part in the day to day operation of an insurance agency.

(k) Courses completed before the issue date of a new license shall not meet the requirements of this Section for that new license.

(l) No credit shall be given for courses taken before they have been approved by the Commissioner.

(m) Each person with an even numbered birth year shall meet continuing education requirements in an even numbered compliance year. Each person with an odd numbered birth year shall meet continuing education requirements in an odd numbered compliance year. Each licensee shall complete 24 hours of continuing education by the last day of the licensee's birth month in the compliance year.

(n) An existing licensee requiring continuing education means an individual who holds any of the following licenses on or before December 31, 2007: life and health, property and liability, personal lines, or adjuster. The licensee's birth year shall determine whether an individual must satisfy continuing education requirements in an even-numbered or odd-numbered year. (Example: 1960 is an even-numbered year; 1961 is an odd-numbered year.) The licensee's birth month shall determine the month that continuing education is due. (Example: An individual born in October shall complete 24 hours of continuing education by the end of October in the licensee's compliance year.) The number of ICECs required by this Rule shall be prorated based on one ICEC per month, up to 24 months. This conversion shall be completed within four years. (Example: An individual with a birth date of February 16, 1960, shall have the following two compliance periods during the continuing education conversion: 1st – two ICECs by the end of February 2008; the 2nd – 24 ICECs by the end of February 2010. An individual with a birth date of April 4, 1957, shall have the following two compliance periods during the continuing education conversion: 1st – 16 ICECs by the end of April 2009; the 2nd – 24 ICECs by the end of April 2011.) The chart below reflects the number of hours an existing licensee requiring continuing education shall have during the four-year conversion.

(o) A new licensee requiring continuing education means an individual who is issued any of the following licenses on or after January 1, 2008: life, accident and health or sickness, property, casualty, personal lines or adjuster. The licensee's birth year shall determine whether an individual must satisfy continuing education requirements in an even-numbered or odd-numbered year. (Example: 1960 is an even-numbered year; 1961 is an odd-numbered year.) The licensee's birth month shall determine the month that continuing education is due. (Examples: An individual born in October shall complete 24 hours of continuing education by the end of October in the licensee's compliance year. An individual with a birth date of December 1, 1960, licensed in 2008, is required to meet 24 hours of continuing education by December 31, 2010. An individual with a birth date of October 1, 1957, licensed in 2008, shall complete 24 hours of continuing education by October 31, 2011.) The chart below shows the earliest deadline by which a new licensee shall be required to complete 24 hours of continuing education.

(p) A member of a professional insurance association shall receive no more than four ICECs during the biennial compliance period based solely on membership in the association, if the professional insurance association:

(1) is approved as a continuing education provider;

(2) has been in existence for at least five years;

(3) was formed for purposes other than providing continuing education;

(4) has provided the Commissioner or the Administrator with the association's Articles of Incorporation on file with the N.C. Secretary of State;

(5) certifies to the Commissioner or Administrator that the licensee's membership is active during the biennial compliance period;

(6) certifies to the Commissioner or Administrator that the licensee attended 50 percent of the regular meetings;

(7) certifies to the Commissioner or Administrator that the licensee attended a statewide or intrastate regional educational meeting on an annual basis, where the regional meeting covered an area of at least 25 counties of the State;

(8) certifies to the Commissioner or Administrator that the licensee attended a national meeting on an annual basis (i.e., National Convention, Legislative "Day on the Hill" in Washington, DC); and

(9) pays one dollar ($1.00) per ICEC to the Commissioner or Administrator.

History

  • Authority G.S. 58-2-40; 58-2-185; 58-2-195; 58-33-130; 58-33-133
  • Temporary Adoption Eff. June 22, 1990, for a period of 180 days to expire on December 19, 1990
  • ARRC Objection Lodged July 19, 1990
  • Eff. December 1, 1990
  • Temporary Amendment Eff. October 3, 1991 for a period of 180 days to expire on March 30, 1992
  • Amended Eff. June 1, 2011; October 1, 2010; February 1, 2008; January 1, 2007; February 1, 1995; August 1, 1994; February 1, 1994; January 1, 1993
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. June 25, 2016
  • Amended Eff. November 1, 2017.
11 NCAC 06A .0803 Courses Specifically Approved {#sec-11-ncac-06a-.0803 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06A .0803}

(a) Courses that are necessary to obtain the following nationally recognized designations are approved for 18 ICECs upon successful completion of the national examination for each part:

(1) Accredited Advisor in Insurance (AAI);

(2) Associate in Claims (AIC);

(3) Associate in Loss Control Management (ALCM);

(4) Associate in Risk Management (ARM);

(5) Associate in Underwriting (AU);

(6) Certified Employees Benefit Specialist (CEBS);

(7) Chartered Financial Consultant (ChFC);

(8) Chartered Life Underwriter (CLU);

(9) Chartered Property and Casualty Underwriter (CPCU);

(10) Fellow Life Management Institute (FLMI);

(11) General Insurance (INS);

(12) Life Underwriter Training Council Fellow, 26 week (LUTCF);

(13) Certified Financial Planner (CFP).

(b) Courses that are necessary to obtain the following nationally recognized designations are approved for an amount of ICECs to be determined by the Commissioner under this Section.

(1) Agency Management Training Course Graduate;

(2) Certified Insurance Counselor (CIC);

(3) Certified Insurance Service Representative (CISR);

(4) Certified Professional Service Representative (CPSR);

(5) Fraternal Insurance Counselor (FIC);

(6) Health Insurance Associate (HIA);

(7) Life Underwriter Training Council Fellow, 13 weeks (LUTCF);

(8) Registered Health Underwriter (RHU).

(c) Courses that are taught by a college or university that is accredited by the Southern Association of Colleges and Schools or by an accreditation agency recognized by the U.S. Department of Education are approved for a number of ICECs to be determined by the Commissioner under this Section.

(d) Any course prepared by the Commissioner is approved as a component of each resident licensee's continuing education requirement for a number of ICECs to be determined by the Commissioner under this Section.

History

  • Authority G.S. 58-2-40; 58-33-130
  • Temporary Adoption Eff. June 22, 1990, for a period of 180 days to expire on December 19, 1990
  • ARRC Objection Lodged July 19, 1990
  • Eff. December 1, 1990
  • Amended Eff. January 1, 2007; February 1, 1995; June 1, 1992
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. June 25, 2016.
11 NCAC 06A .0804 Carryover Credit {#sec-11-ncac-06a-.0804 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06A .0804}

Only whole ICECs may be carried over from one biennial compliance period to the next biennial compliance period. There is no limit on the number of ICECs that can be carried over.

History

  • Authority G.S. 58-2-40; 58-33-130
  • Temporary Adoption Eff. June 22, 1990, for a period of 180 days to expire on December 19, 1990
  • ARRC Objection Lodged July 19, 1990
  • Eff. December 1, 1990
  • Temporary Amendment Eff. October 3, 1991 for a period of 180 days to expire on March 30, 1992
  • Amended Eff. February 1, 2008; February 1, 1995; June 1, 1992; March 1, 1992
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. June 25, 2016.
11 NCAC 06A .0805 Calculation of Icecs {#sec-11-ncac-06a-.0805 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06A .0805}

The following standards are used to evaluate courses submitted for continuing education approval:

(1) Programs requiring meeting or classroom attendance:

(a) Courses or clusters of courses of less than 50 minutes shall not be evaluated for continuing education ICECs.

(b) Courses shall not be approved for less than one ICEC.

(c) One ICEC shall be awarded for each 50 minutes of instruction unless the Commissioner assigns fewer ICECs based upon the evaluation of the submitted course materials. Courses shall only be approved for whole ICECs.

(d) Course providers shall monitor participants for attendance and attention.

(2) Independent study programs:

(a) Independent study programs qualify for continuing education only when there is a supervised examination. No examination administered or graded by insurance company personnel for its own employees is considered to be administered by a disinterested third party. The examination supervisor shall submit to the provider a sworn affidavit that certifies the authenticity of the examination. The provider shall retain the affidavit and examination records.

(b) Each course shall be assigned ICECs, which shall be awarded upon the passing of the supervised examination.

(3) Distance Learning Programs:

(a) Distance learning qualifies only when an instructor is available to respond to questions and to maintain attendance records.

(b) Any organization sponsoring a teleconference shall have an on-site instructor.

(4) Internet programs qualify only when there is a secure examination required at the end of the licensee's study of the course material and when periodic security measures have been used throughout the course material before the final examination.

(5) Webinar courses qualify only when there is a method of monitoring attendance, by way of a random question and answer segment throughout the course, or a monitor at each location. Examinations are not required in Webinar courses.

History

  • Authority G.S. 58-2-40; 58-33-130
  • Temporary Adoption Eff. June 22, 1990, for a period of 180 days to expire on December 19, 1990
  • ARRC Objection Lodged July 19, 1990
  • Eff. December 1, 1990
  • Amended Eff. February 1, 2008; April 1, 2003; February 1, 1995; June 1, 1992
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. June 25, 2016.
11 NCAC 06A .0806 Attendance {#sec-11-ncac-06a-.0806 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06A .0806}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-33-130
  • Temporary Adoption Eff. June 22, 1990, for a period of 180 days to expire on December 19, 1990
  • ARRC Objection Lodged July 19, 1990
  • Eff. December 1, 1990
  • Amended Eff. January 1, 2007; February 1, 1995; June 1, 1992
  • Repealed Eff. July 1, 2012.
11 NCAC 06A .0807 Hardship {#sec-11-ncac-06a-.0807 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06A .0807}

A licensee may request in writing an extension of time under G.S. 58-33-130(c) during or before the last month of the licensee's compliance year.

History

  • Authority G.S. 58-2-40; 58-33-130
  • Temporary Adoption Eff. June 22, 1990, for a period of 180 days to expire on December 19, 1990; ARRC Objection Lodged July 19, 1990
  • Eff. December 1, 1990
  • Amended Eff. February 1, 2008; January 1, 2007; June 1, 1992
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. June 25, 2016.
11 NCAC 06A .0808 Instructor Qualification {#sec-11-ncac-06a-.0808 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06A .0808}

(a) Continuing education providers shall certify that continuing education instructors meet the qualification requirements as provided in Paragraph (b) of this Rule. The Commissioner may approve instructors, not meeting the qualifications as provided in Paragraph (b) of this Rule, who possess specific areas of expertise to instruct courses comprising those areas of expertise.

(b) Each instructor must meet one of the following qualifications which shall be verified by the instructor's continuing education provider:

(1) Accident and health or sickness; Medicare supplement insurance and long-term care insurance:

(A) Registered Health Underwriter (RHU);

(B) Certified Employee Benefits Specialist (CEBS);

(C) Registered Employee Benefits Consultant (REBC);

(D) Health Insurance Associate (HIA);

(E) Five years of full-time experience as an employee, agent, or broker interpreting or explaining policies covering accident and health or sickness insurance, Medicare supplement insurance, or long term care insurance; or

(F) Has an associate or bachelor's degree in insurance, or possesses education and experience determined by the Commissioner to be equivalent to either: (i) a baccalaureate or higher degree and at least two years of experience as an insurance instructor or as an educational administrator; or (ii) a baccalaureate degree or higher and at least six years of experience in the insurance industry with a minimum of two years of experience in insurance management.

(2) Life insurance and annuities:

(A) Chartered Life Underwriter (CLU);

(B) Chartered Financial Consultant (ChFC);

(C) Fellow Life Management Institute (FLMI);

(D) Life Underwriter Training Council Fellow (LUTCF);

(E) Certified Employee Benefits Specialist (CEBS);

(F) Certified Financial Planner (CFP):

(G) Five years of full-time experience as an employee, agent, or broker interpreting or explaining life insurance policies, or annuities; or

(H) Has an associate or bachelor's degree in insurance, or possesses education and experience determined by the Commissioner to be equivalent to either: (i) a baccalaureate or higher degree and at least two years of experience as an insurance instructor or as an educational administrator; or (ii) a baccalaureate degree or higher and at least six years of experience in the insurance industry with a minimum of two years of experience in insurance management.

(3) Property insurance, casualty insurance, and personal lines:

(A) Chartered Property and Casualty Underwriter (CPCU);

(B) Accredited Advisor in Insurance (AAI);

(C) Associate in Risk Management (ARM);

(D) Certified Insurance Counselor (CIC);

(E) Five years of full-time experience as an employee, agent, or broker interpreting or explaining property insurance, casualty insurance, or personal lines policies; or

(F) Has an associate or bachelor's degree in insurance, or possesses education and experience determined by the Commissioner to be equivalent to either: (i) a baccalaureate or higher degree and at least two years of experience as an insurance instructor or as an educational administrator; or (ii) a baccalaureate degree or higher and at least six years of experience in the insurance industry with a minimum of two years of experience in insurance management.

(c) Insurance company trainers as instructors shall be full time salaried employees of the insurance company sponsoring the course and shall have as part of their full time responsibilities the duty to provide

insurance company training.

(d) College and university instructors may be full time or adjunct faculty of the college or university, and shall be teaching a curriculum course in his or her field of expertise.

(e) The Commissioner shall require applicants and current instructors to participate in a personal interview, provide a video or audio tape demonstrating course instruction, and submit a written history of courses taught or any other documentation that will verify the applicant's qualifications to instruct approved insurance courses.

(f) Temporary instructor authority shall be given to each qualified applicant. The instructor authority shall become permanent after six months unless otherwise denied, suspended, terminated, or revoked by the Commissioner.

(g) As a condition to continued instructor qualification, providers shall ensure that each instructor teaches at least one continuing education course each calendar year.

(h) The Commissioner shall deny, revoke, suspend, or terminate the approval of an instructor upon finding that:

(1) The instructor fails to meet the criteria for approval provided by this Rule;

(2) The instructor has failed to comply with statutes or rules regarding continuing education courses or providers;

(3) The instructor's employment has been terminated by any approved provider on the grounds of incompetence or failure to comply with institutional policies and procedures;

(4) The instructor provided false information to the Commissioner;

(5) The instructor has, at any time, had an insurance license denied, suspended, revoked, or terminated by the Commissioner, or any other state insurance regulator, or has ever been required to return a license while under investigation;

(6) The instructor has obtained or used, or attempted to obtain or use, in any manner or form, licensing examination questions under G.S. 58-33-30.

(i) In all proceedings to deny, revoke, suspend, or terminate approval of an instructor, the provisions of Chapter 150B of the General Statutes shall be applied.

(j) When an instructor's approval is discontinued, the procedure for reinstatement shall be to apply as a new instructor, with a statement of reasons that the applicant is now eligible for reconsideration. The Commissioner may require an investigation before new approval is granted.

History

  • Authority G.S. 58-2-40; 58-33-130; 58-33-132
  • Temporary Adoption Eff. June 22, 1990, for a period of 180 days to expire on December 19, 1990
  • ARRC Objection Lodged July 19, 1990
  • Eff. December 1, 1990
  • Amended Eff. February 1, 2008; February 1, 1996
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. June 25, 2016
  • Temporary Amendment Eff. May 6, 2026.
11 NCAC 06A .0809 Approval of Courses {#sec-11-ncac-06a-.0809 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06A .0809}

(a) All providers of courses specifically approved under Rule .0803 of this Section shall pay the fee prescribed in G.S. 58-33-133(b) and shall provide to the Commissioner or Administrator copies of:

(1) program catalogs;

(2) course outlines; and

(3) advertising literature.

(b) All providers of courses not specifically approved under Rule .0803 of this Section shall do the following:

(1) Any individual, school, insurance company, insurance industry association, or other organization intending to provide classes, seminars, or other forms of instruction as approved courses shall:

(A) apply on forms provided by the Commissioner or Administrator, located on the N.C. Department of Insurance's website at http://www.ncdoi.com/ASD/CE_Providers_For_Insurance.aspx#Forms;

(B) pay the fee prescribed in G.S. 58-33-133(b);

(C) provide outlines of the subject matter to be covered; and

(D) provide copies of handouts to be distributed to course participants.

(2) All providers of supervised individual study programs shall file copies of:

(A) the study programs;

(B) the examination; and

(C) the Internet course security procedures.

(c) The Commissioner shall determine the number of ICECs that have been assigned to the approved course in accordance with Rule .0805 of this Section.

(d) If a course is not approved or disapproved by the Commissioner or his or her designee within 60 days after receipt of all required information, the course shall be deemed to be approved at the end of the 60-day period.

(e) If a course approval application is denied by the Commissioner or his or her designee, a written explanation of the reason for denial shall be furnished to the provider.

(f) Course approval applications shall include the following:

(1) a statement indicating for whom the course is designed;

(2) the course objectives;

(3) the names and duties of all persons who will be affiliated in an official capacity with the course;

(4) the course provider's tuition and fee refund policy;

(5) an outline that shall include:

(A) a statement of whether there will be a written examination, a written report, or only a certification of attendance;

(B) the method of course presentation;

(C) a course content outline with instruction hours assigned to the major topics; and

(D) a schedule of dates, beginning and ending times, and places the course will be offered, along with the names of instructors for each course session, submitted at least 10 days before any subsequent course offerings.

(6) a copy of the course completion certificate;

(7) a course rating form;

(8) a course bibliography; and

(9) an electronic copy of the course content and course examination for Internet courses.

(g) A provider may request that its materials be kept confidential if they are of a proprietary nature.

(h) A provider shall not cancel a course unless the provider gives written notification to all students on the roster and to the Commissioner or Administrator at least five days before the date of the course. This Paragraph does not apply to the cancellation of a course or class because of inclement weather.

(i) A provider shall submit course attendance records electronically to the Commissioner or Administrator within 15 business days after course completion.

(j) An error on the licensee's record that is caused by the provider in submitting the course attendance records shall be resolved by the provider within 15 days after the discovery of the error by the provider.

History

  • Authority G.S. 58-2-40; 58-33-130; 58-33-132; 58-33-133
  • Temporary Adoption Eff. June 22, 1990, for a period of 180 days to expire on December 19, 1990
  • ARRC Objection Lodged July 19, 1990
  • Eff. December 1, 1990
  • Amended Eff. October 1, 2014; March 1, 2011; February 1, 2008; February 1, 1996; June 1, 1992
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. June 25, 2016
  • Amended Eff. July 1, 2017; December 1, 2016.
11 NCAC 06A .0810 Advertising {#sec-11-ncac-06a-.0810 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06A .0810}

(a) Courses shall not be advertised as approved for ICECs unless such approval has been granted by the Commissioner in writing.

(b) When a course has been approved for ICECs and is advertised as such, the advertisement shall include:

(1) the provider name, assigned provider number, course(s) title(s), assigned course number course(s) date(s) and course location;

(2) the number of approved ICECs;

(3) the type of licensee for whom the course would be most applicable;

(4) all fees and associated expenses; and

(5) course rating.

(c) Advertisements shall be complete, truthful, clear, and not deceptive or misleading.

(d) The Commissioner may withdraw his approval of any violator to provide or conduct courses.

History

  • Authority G.S. 58-2-40; 58-33-130; 58-33-132
  • Temporary Adoption Eff. June 22, 1990, for a period of 180 days to expire on December 19, 1990
  • ARRC Objection Lodged July 19, 1990
  • Eff. December 1, 1990
  • Amended Eff. February 1, 1996; June 1, 1992
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. June 25, 2016.
11 NCAC 06A .0811 Sanctions for Noncompliance {#sec-11-ncac-06a-.0811 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06A .0811}

(a) If the license of any person lapses under G.S. 58-33-130(c), the license shall be reinstated when the person has completed the continuing education requirements and paid an administrative fee of seventy-five dollars ($75.00) within four months after the end of the person's previous compliance year. If the person does not satisfy the requirements for licensure reinstatement within four months after the end of the person's previous compliance year, the person shall pass the appropriate licensing examination, at which time the Commissioner shall reinstate the person's license.

(b) The Commissioner may suspend, revoke, or refuse to renew a license for any of the following causes:

(1) Failing to respond to Department inquiries, including continuing education audit requests, within seven calendar days after the receipt of the inquiry or request.

(2) Requesting an extension or waiver under false pretenses.

(3) Refusing to cooperate with Department employees in an investigation or inquiry.

(c) The Commissioner may suspend, revoke, or refuse to renew a course provider's, presenters, or instructor's authority to offer courses for any of the following causes:

(1) Advertising that a course is approved before the Commissioner has granted such approval in writing.

(2) Submitting a course outline with material inaccuracies, either in length, presentation time, or topic content.

(3) Presenting or using unapproved material in providing an approved course.

(4) Failing to conduct a course for the full time specified in the approval request submitted to the Commissioner.

(5) Preparing and distributing certificates of attendance or completion before the course has been approved.

(6) Issuing certificates of attendance or completion before the completion of the course.

(7) Failing to issue certificates of attendance or completion to any licensee who satisfactorily completes a course.

(8) Failing to notify the Commissioner in writing of suspected or known violations of the North Carolina General Statutes or Administrative Code within 30 days after suspecting or knowing about the violations.

(9) Violating the North Carolina General Statutes or Administrative Code.

(10) Failing to monitor attendance and attention of attendees.

(11) Preparing and distributing fraudulent certificates of attendance or completion.

(12) Failing to ensure that the licensee completes the course hours approved by the Commissioner.

(13) Failing to use qualified or approved instructors.

(14) Refusing to cooperate with Department employees in an investigation or inquiry.

(d) Course providers and presenters are responsible for the activities of persons conducting, supervising, instructing, proctoring, monitoring, moderating, facilitating, or in any way responsible for the conduct of any of the activities associated with the course.

(e) The Commissioner may require any one of the following upon a finding of a violation of this Section:

(1) Refunding all course tuition and fees to licensees.

(2) Providing licensees with a course to replace the course that was found in violation.

(3) Withdrawal of approval of courses offered by the provider, presenter, or instructor.

History

  • Authority G.S. 58-2-40; 58-33-125(a); 58-33-130; 58-33-132
  • Temporary Adoption Eff. June 22, 1990, for a period of 180 days to expire on December 19, 1990
  • ARRC Objection Lodged July 19, 1990
  • Eff. December 1, 1990
  • Amended Eff. October 1, 2010; February 1, 2008; January 1, 2007; June 1, 1992
  • Temporary Amendment Eff. May 6, 2026.
11 NCAC 06A .0812 Special Cases {#sec-11-ncac-06a-.0812 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06A .0812}

(a) In addition to the courses in 11 NCAC 06A .0803, the Commissioner shall prepare courses to address and remedy deficiencies in licensee professional performance or conduct detected by the Commissioner through analyses of consumer complaints or from Departmental audits or examinations of insurance companies, licensees, or insurance agencies or brokerages.

(b) The Commissioner shall require an individual licensee to take and complete remedial or rehabilitative courses if the licensee has committed any of the acts or omissions specified in G.S. 58-33-46.

(c) The Commissioner shall award 24 biennial continuing professional educational credit hours based on government service relative to insurance or finance, such as service as a legislator on a committee in the General Assembly that hears insurance and finance matters.

History

  • Authority G.S. 58-2-40; 58-33-46; 58-33-130; 58-33-130(a)(5)
  • Eff. August 1, 1995
  • Amended Eff. October 1, 2010
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. June 25, 2016.
11 NCAC 06A .0813 Issuance/Continuation of Provider Approval {#sec-11-ncac-06a-.0813 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06A .0813}

(a) Any individual or entity intending to provide classes, seminars, or other forms of instruction as approved courses shall submit:

(1) an application prescribed by the Commissioner for provider approval; and

(2) a course approval application in accordance with Rule .0809 of this Section.

(b) The Commissioner or the Administrator shall approve or deny the provider and course approval application.

(c) Any provider approval that is denied shall be furnished a written explanation for the denial in accordance with Rule .0809(4) of this Section.

(d) Any provider receiving a provider approval denial shall have 15 business days to respond to the denial.

(e) As a condition to continued provider approval, providers shall conduct a minimum of one course within the State of North Carolina each calendar year.

(f) Providers shall retain continuing education records for three years and shall provide these records upon request to the Commissioner or to the Administrator.

History

  • Authority G.S. 58-2-40; 58-33-130; 58-33-132
  • Eff. February 1, 1996
  • Amended Eff. February 1, 2008
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. June 25, 2016.
11 NCAC 06A .0814 Agent Education on Ltcp Policies: Company Responsibility {#sec-11-ncac-06a-.0814 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06A .0814}

(a) Each licensee who holds an accident and health or sickness license, a Medicare/Supplement Long-Term Care limited lines license, and who sells, solicits or negotiates Long-term Care Partnership policies shall complete eight hours of continuing education in Long-Term Care Partnership as defined in 11 NCAC 06A .0801(12) within one year of March 7, 2011.

(b) Each licensee issued an accident and health or sickness license or a Medicare/Supplement Long-Term Care limited lines license after March 7, 2011 shall complete eight hours of continuing education in Long-Term Care Partnership as defined in 11 NCAC 06A .0801(12) prior to selling, soliciting or negotiating a Long-Term Care Partnership Policy.

(c) Each licensee who holds an accident and health or sickness license, a Medicare/Supplement Long-Term Care limited lines license, and who sells, solicits or negotiates Long-term Care Partnership policies shall complete four hours of continuing education in Long-Term Care Partnership every biennial compliance period thereafter as defined in this Section.

(d) Insurers who provide Long-Term Care Partnership insurance shall verify that their appointed agents who sell, solicit or negotiate Long-Term Care Partnership policies as defined in G.S. 58-55-55(6) and G.S. 58-55-60 meet the continuing education requirements prescribed by this Rule. Verification may be accomplished by obtaining and maintaining the continuing education certificate of completion or by obtaining and maintaining a copy of the continuing education transcript for each agent.

(e) Upon written request by the Commissioner the records obtained by the insurer to verify the agent has satisfied the continuing education requirements of this Rule shall be provided to the Commissioner within 30 calendar days.

History

  • Authority G.S. 58-2-40; 58-2-190; 58-33-130; 58-55-55; 58-55-60
  • Eff. March 1, 2011
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. June 25, 2016.
11 NCAC 06A .0901 Definitions {#sec-11-ncac-06a-.0901 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06A .0901}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-33-10; 58-33-10(b); 58-33-25(a); 58-33-30; 58-33-70; 58-33-76; 58-63-15(2), 58-63-15(11)
  • Eff. April 1, 1996
  • Amended Eff. February 1, 2006
  • Repealed Eff. October 1, 2010.
11 NCAC 06A .0902 Transactions with Insureds {#sec-11-ncac-06a-.0902 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06A .0902}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-33-10; 58-33-10(b); 58-33-25(a); 58-33-30; 58-33-70; 58-33-76; 58-63-15(2), 58-63-15(11)
  • Eff. April 1, 1996
  • Amended Eff. February 1, 2006
  • Repealed Eff. October 1, 2010.
11 NCAC 06A .0903 Relationships with Third Parties {#sec-11-ncac-06a-.0903 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06A .0903}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-33-10; 58-33-10(b); 58-33-25(a); 58-33-30; 58-33-70; 58-33-76; 58-63-15(2), 58-63-15(11)
  • Eff. April 1, 1996
  • Amended Eff. February 1, 2006
  • Repealed Eff. October 1, 2010.
11 NCAC 06A .0904 Regulatory Matters {#sec-11-ncac-06a-.0904 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06A .0904}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-33-10; 58-33-10(b); 58-33-25(a); 58-33-30; 58-33-70; 58-33-76; 58-63-15(2), 58-63-15(11)
  • Eff. April 1, 1996
  • Amended Eff. February 1, 2006
  • Repealed Eff. October 1, 2010.
11 NCAC 06A .0905 Catastrophic Disasters {#sec-11-ncac-06a-.0905 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06A .0905}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-33-46; 58-33-70; 58-33-120; 58-63-10; 58-63-15
  • Eff. February 1, 2006
  • Repealed Eff. October 1, 2010.
11 NCAC 06A .0906 Fingerprints Required for Criminal Record Checks {#sec-11-ncac-06a-.0906 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06A .0906}

(a) An applicant for a resident public adjuster license shall furnish the Commissioner with a complete set of the applicant's fingerprints as authorized by G.S. 58-33A-15. An applicant for a public adjuster license includes:

(1) An applicant for an initial resident public adjuster license;

(2) A non-resident public adjuster applying for a resident public adjuster license;

(3) A resident public adjuster license applicant applying for reinstatement of license that has been lapsed for more than one year;

(4) A resident public adjuster license applicant whose license has been suspended or revoked for non-payment of child support pursuant to G.S. 110-142.1; or

(5) An owner, partner, officer manager, or director of a business entity, or member or manager of a limited liability company applying for a resident public adjuster business entity license.

(b) As authorized by G.S. 58-33A-15, fingerprints shall be furnished in the following manner:

(1) Each resident public adjuster license applicant who is required to submit fingerprints under G.S. 58-33A-15 shall have a complete set of their fingerprints electronically captured by a criminal law enforcement agency approved by State Bureau of Investigation (SBI) to submit fingerprints via electronic means;

(2) Each resident public adjuster license applicant who is required to submit fingerprints under G.S. 58-33A-15 shall submit with the public adjuster license application the Electronic Fingerprint Submission Release of Information Form that has been completed and certified by a law enforcement officer that the applicant's fingerprints have been submitted via electronic means to the SBI;

(3) Each resident public adjuster license applicant who is required to submit fingerprints under G.S. 58-33A-15 shall submit with the public adjuster license application the Authority For Release Of Information form required by the SBI to release the criminal history record check information to the Department;

(4) Each resident public adjuster license applicant who is required to submit fingerprints under G.S. 58-33A-15 shall submit with the public adjuster license application the cost for the state and national criminal history record fee that is set forth pursuant to G.S. 114-19.1(a); and

(5) All fingerprint impressions must be suitable for use by the SBI to conduct a state criminal history record check and for the Federal Bureau of Investigations (FBI) to conduct a national criminal history record check. If the SBI deems the electronic fingerprints are not suitable, the Commissioner shall notify and provide instructions to the applicant to resubmit his fingerprints in the manner set forth in Subparagraph (1) of this Paragraph within 30 days.

(c) The application of a resident public adjuster required to submit fingerprints is not be complete until the Department receives the state and national criminal history record information. In accordance with G.S. 58-33A-20(c), the Commissioner shall not issue the license of a public adjuster that does not satisfy the license application requirements.

History

  • Authority G.S. 58-2-40; 58-33A-15; 58-33A-20
  • Eff. October 1, 2010.
11 NCAC 06A .1001 Definitions {#sec-11-ncac-06a-.1001 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06A .1001}

As used in this Section, the following terms shall mean:

(1) "Claimant" means as defined in 11 NCAC 04 .0425.

(2) "Motor vehicle damage appraiser" means as defined in G.S. 58-33-10(14).

History

  • Authority G.S. 58-2-40
  • Eff. April 1, 2020.
11 NCAC 06A .1002 Ethical Standards {#sec-11-ncac-06a-.1002 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06A .1002}

(a) Every licensed motor vehicle damage appraiser, when conducting business, shall:

(1) identify himself or herself and his or her job title;

(2) when requested, provide his or her National Producer Number, and the Department's website address and phone number for verification of license status;

(3) prepare an independent appraisal of damages; and

(4) comply with all local, State, and federal laws, in the motor vehicle damage appraiser's business affairs.

(b) Every licensed motor vehicle damage appraiser shall refrain from:

(1) disparaging the professional reputation of a motor vehicle damage appraiser or other persons associated with the claim;

(2) recommending the utilization of a particular motor vehicle repair service in violation of G.S. 58-33-76(a).

(3) recommending a claimant needing repairs or other services in connection with a loss to any person with whom the motor vehicle damage appraiser has a financial interest or who provides the motor vehicle damage appraiser any compensation for the referral or any resulting business;

(4) impeding the appraisal process or the settlement of a property damage claim;

(5) receiving any gratuity or other consideration in violation of G.S. 58-33-76(b).

(6) advising or recommending a claimant to obtain or not obtain legal advice or counsel from a particular legal counsel;

(7) giving legal advice on property damage claims in violation of G.S. 84-4;

(8) solicit a power of attorney from a consumer that authorizes the motor vehicle damage appraiser to sign insurance-related forms;

(9) attempting to influence a magistrate in the selection of an umpire pursuant to G.S. 20-279.21(d1), including using influence through a client or claimant;

(10) engaging in the salvage of automobiles if the salvage is obtained as a result of appraisal services rendered by the motor vehicle damage appraiser; and

(11) act in any manner outside the scope of a motor vehicle damage appraiser, as set forth in Chapter 58, Article 33 of the General Statutes.

(c) Pursuant to G.S. 58-2-70 and G.S. 58-33-46, the Commissioner may consider the failure of a licensed motor vehicle damage appraiser to comply with this Rule as a basis for administrative action.

History

  • Authority G.S. 58-2-40
  • Eff, April 1, 2020.

Subchapter B

11 NCAC 06B .0101 Application Form {#sec-11-ncac-06b-.0101 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06B .0101}

History

  • Status: repealed
  • Filed as a Temporary Amendment Eff. July 18, 1989, For a Period of 180 Days to Expire on
  • January 12, 1990
  • Filed as a Temporary Rule Eff. May 16, 1988 For a Period of 180 Days to Expire on
  • November 11, 1988
  • Authority G.S. 58-9; 58-536
  • Eff. November 1, 1988
  • Amended Eff. February 1, 1990
  • Repealed Eff. January 1, 1997.
11 NCAC 06B .0102 Biographical Affidavit {#sec-11-ncac-06b-.0102 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06B .0102}

History

  • Status: repealed
  • Filed as a Temporary Amendment Eff. July 18, 1989, For a Period of 180 Days to Expire on
  • January 12, 1990
  • Filed as a Temporary Rule Eff. May 16, 1988 For a Period of 180 Days to Expire on
  • November 11, 1988
  • Authority G.S. 58-9; 58-536
  • Eff. November 1, 1988
  • Amended Eff. February 1, 1990
  • Repealed Eff. January 1, 1997.
11 NCAC 06B .0103 Tpa Transmittal {#sec-11-ncac-06b-.0103 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06B .0103}

History

  • Status: repealed
  • Filed as a Temporary Amendment Eff. July 18, 1989, For a Period of 180 Days to Expire on
  • January 12, 1990
  • Filed as a Temporary Rule Eff. May 16, 1988 For a Period of 180 Days to Expire on
  • November 11, 1988
  • Authority G.S. 58-9; 58-536
  • Eff. November 1, 1988
  • Amended Eff. February 1, 1990
  • Repealed Eff. January 1, 1997.
11 NCAC 06B .0104 Renewal Application Form {#sec-11-ncac-06b-.0104 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06B .0104}

History

  • Status: repealed
  • Filed as a Temporary Amendment Eff. July 18, 1989, For a Period of 180 Days to Expire on
  • January 12, 1990
  • Filed as a Temporary Rule Eff. May 16, 1988 For a Period of 180 Days to Expire on
  • November 11, 1988
  • Authority G.S. 58-9; 58-536
  • Eff. November 1, 1988
  • Amended Eff. February 1, 1990
  • Repealed Eff. January 1, 1997.
11 NCAC 06B .0105 Renewal Tpa Transmittal {#sec-11-ncac-06b-.0105 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06B .0105}

History

  • Status: repealed
  • Filed as a Temporary Amendment Eff. July 18, 1989, For a Period of 180 Days to Expire on
  • January 12, 1990
  • Filed as a Temporary Rule Eff. May 16, 1988 For a Period of 180 Days to Expire on
  • November 11, 1988
  • Authority G.S. 58-9; 58-536
  • Eff. November 1, 1988
  • Amended Eff. February 1, 1990
  • Repealed Eff. January 1, 1997.
11 NCAC 06B .0106 Administrator's Questionnaire {#sec-11-ncac-06b-.0106 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06B .0106}

History

  • Status: repealed
  • Authority G.S. 58-9; 58-527; 58-529; 58-536
  • Eff. February 1, 1990
  • Repealed Eff. January 1, 1997.
11 NCAC 06B .0107 Internal Control (tpa-Ic-89) {#sec-11-ncac-06b-.0107 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06B .0107}

History

  • Status: repealed
  • Authority G.S. 58-9; 58-527; 58-529; 58-536
  • Eff. February 1, 1990
  • Repealed Eff. January 1, 1997.
11 NCAC 06B .0201 Contents of Full Application {#sec-11-ncac-06b-.0201 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06B .0201}

History

  • Status: repealed
  • Filed as a Temporary Amendment Eff. July 18, 1989 For a Period of 180 Days to Expire on January 12, 1990
  • Filed as a Temporary Rule Eff. May 16, 1988 For a Period of 180 Days to Expire on November 11, 1988
  • Authority G.S. 58-9; 58-525; 58-527; 58-529; 58-532; 58-536
  • Eff. November 1, 1988
  • Amended Eff. February 1, 1990
  • Repealed Eff. July 1, 2000.
11 NCAC 06B .0202 Modification of Application {#sec-11-ncac-06b-.0202 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06B .0202}

History

  • Status: repealed
  • Filed as a Temporary Amendment Eff. July 18, 1989 For a Period of 180 Days to Expire on January 12, 1990
  • Filed as a Temporary Rule Eff. May 16, 1988 For a Period of 180 Days to Expire on November 11, 1988
  • Authority G.S. 58-9; 58-525; 58-527; 58-529; 58-532; 58-536
  • Eff. November 1, 1988
  • Amended Eff. February 1, 1990
  • Repealed Eff. July 1, 2000.
11 NCAC 06B .0203 Duration of Initial Certificate of Registration {#sec-11-ncac-06b-.0203 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06B .0203}

History

  • Status: repealed
  • Filed as a Temporary Amendment Eff. July 18, 1989 For a Period of 180 Days to Expire on January 12, 1990
  • Filed as a Temporary Rule Eff. May 16, 1988 For a Period of 180 Days to Expire on November 11, 1988
  • Authority G.S. 58-9; 58-525; 58-527; 58-529; 58-532; 58-536
  • Eff. November 1, 1988
  • Amended Eff. February 1, 1990
  • Repealed Eff. July 1, 2000.
11 NCAC 06B .0204 Application for Renewal of a Certificate of Registration {#sec-11-ncac-06b-.0204 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06B .0204}

History

  • Status: repealed
  • Filed as a Temporary Amendment Eff. July 18, 1989 For a Period of 180 Days to Expire on January 12, 1990
  • Filed as a Temporary Rule Eff. May 16, 1988 For a Period of 180 Days to Expire on November 11, 1988
  • Authority G.S. 58-9; 58-525; 58-527; 58-529; 58-532; 58-536
  • Eff. November 1, 1988
  • Amended Eff. February 1, 1990
  • Repealed Eff. July 1, 2000.
11 NCAC 06B .0205 Renewal Certificate of Registration {#sec-11-ncac-06b-.0205 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06B .0205}

History

  • Status: repealed
  • Filed as a Temporary Amendment Eff. July 18, 1989 For a Period of 180 Days to Expire on January 12, 1990
  • Filed as a Temporary Rule Eff. May 16, 1988 For a Period of 180 Days to Expire on November 11, 1988
  • Authority G.S. 58-9; 58-525; 58-527; 58-529; 58-532; 58-536
  • Eff. November 1, 1988
  • Amended Eff. February 1, 1990
  • Repealed Eff. July 1, 2000.
11 NCAC 06B .0301 Financial Statements {#sec-11-ncac-06b-.0301 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06B .0301}

History

  • Status: repealed
  • Filed as a Temporary Rule Eff. July 18, 1989 for a Period of 180 days to Expire on January 12, 1990
  • Filed as a Temporary Rule Eff. May 16, 1988 For a Period of 180 Days to Expire on November 11, 1988
  • Authority G.S. 58-9; 58-11; 58-15; 58-29; 58-532; 58-536; 132-6
  • Eff. November 1, 1988
  • Amended Eff. February 1, 1990
  • Repealed Eff. July 1, 2000.
11 NCAC 06B .0302 Determination of Financial Responsibility {#sec-11-ncac-06b-.0302 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06B .0302}

History

  • Status: repealed
  • Filed as a Temporary Rule Eff. July 18, 1989 for a Period of 180 days to Expire on January 12, 1990
  • Filed as a Temporary Rule Eff. May 16, 1988 For a Period of 180 Days to Expire on November 11, 1988
  • Authority G.S. 58-9; 58-11; 58-15; 58-29; 58-532; 58-536; 132-6
  • Eff. November 1, 1988
  • Amended Eff. February 1, 1990
  • Repealed Eff. July 1, 2000.
11 NCAC 06B .0303 Financial Information Public Records {#sec-11-ncac-06b-.0303 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06B .0303}

History

  • Status: repealed
  • Filed as a Temporary Rule Eff. July 18, 1989 for a Period of 180 days to Expire on January 12, 1990
  • Filed as a Temporary Rule Eff. May 16, 1988 For a Period of 180 Days to Expire on November 11, 1988
  • Authority G.S. 58-9; 58-11; 58-15; 58-29; 58-532; 58-536; 132-6
  • Eff. November 1, 1988
  • Amended Eff. February 1, 1990
  • Repealed Eff. July 1, 2000.
11 NCAC 06B .0304 Surety Bond Issued by Licensed Company {#sec-11-ncac-06b-.0304 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06B .0304}

History

  • Status: repealed
  • Filed as a Temporary Rule Eff. July 18, 1989 for a Period of 180 days to Expire on January 12, 1990
  • Filed as a Temporary Rule Eff. May 16, 1988 For a Period of 180 Days to Expire on November 11, 1988
  • Authority G.S. 58-9; 58-11; 58-15; 58-29; 58-532; 58-536; 132-6
  • Eff. November 1, 1988
  • Amended Eff. February 1, 1990
  • Repealed Eff. July 1, 2000.
11 NCAC 06B .0401 service contracts with insurance companies {#sec-11-ncac-06b-.0401 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06B .0401}

History

  • Status: repealed
  • Filed as a Temporary Rule Eff. May 16, 1988 For a Period of 180 Days to Expire on November 11, 1988
  • Authority G.S. 58-9; 58-9.7; 58-15; 58-527; 58-529; 58-533; 58-536; 58-611(b)
  • Eff. November 1, 1988
  • Amended Eff. February 1, 1990
  • Repealed Eff. July 1, 2000.
11 NCAC 06B .0402 adjusting claims by administrators {#sec-11-ncac-06b-.0402 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06B .0402}

History

  • Status: repealed
  • Filed as a Temporary Rule Eff. May 16, 1988 For a Period of 180 Days to Expire on November 11, 1988
  • Authority G.S. 58-9; 58-9.7; 58-15; 58-527; 58-529; 58-533; 58-536; 58-611(b)
  • Eff. November 1, 1988
  • Amended Eff. February 1, 1990
  • Repealed Eff. July 1, 2000.
11 NCAC 06B .0403 violations: penalties {#sec-11-ncac-06b-.0403 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06B .0403}

History

  • Status: repealed
  • Filed as a Temporary Rule Eff. May 16, 1988 For a Period of 180 Days to Expire on November 11, 1988
  • Authority G.S. 58-9; 58-9.7; 58-15; 58-527; 58-529; 58-533; 58-536; 58-611(b)
  • Eff. November 1, 1988
  • Amended Eff. February 1, 1990
  • Repealed Eff. July 1, 2000.
11 NCAC 06B .0404 definitions {#sec-11-ncac-06b-.0404 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06B .0404}

History

  • Status: repealed
  • Eff. February 1, 1990
  • Repealed Eff. July 1, 2000.
11 NCAC 06B .0405 payments of claims {#sec-11-ncac-06b-.0405 omnilex-key=us-nc-regs-official--title-11--11 NCAC 06B .0405}

History Note: Authority G.S. 58-9; 58-530; 58-536;

History

  • Eff. February 1, 1990
  • Repealed Eff. July 1, 2000.

Chapter 07 State Property Fire Insurance Fund Division

11 NCAC 07 .0101 Definitions {#sec-11-ncac-07-.0101 omnilex-key=us-nc-regs-official--title-11--11 NCAC 07 .0101}

The following definitions shall apply for this division:

(1) "Agent of Record" shall mean that insurance agent or agents authorized to represent the North Carolina Department of Insurance in procurement of insurance for North Carolina agencies.

(2) "Self-liquidating buildings" shall mean buildings using their own revenues to retire their obligations.

(3) "Special Fund Agencies" shall mean departments or agencies that receive their operating revenue from sources other than the general fund.

History

  • Authority G.S. 58-2-40; 58-31-10
  • Eff. February 1, 1976
  • Readopted Eff. May 12, 1978
  • Amended Eff. October 1, 1988
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 19, 2019.
11 NCAC 07 .0102 Purpose of Division {#sec-11-ncac-07-.0102 omnilex-key=us-nc-regs-official--title-11--11 NCAC 07 .0102}

History

  • Status: repealed
  • Authority G.S. 58-7.3; 58-9; 58-189 through 58-194
  • Eff. February 1, 1976
  • Readopted Eff. May 12, 1978
  • Repealed Eff. July 1, 1988.
11 NCAC 07 .0103 Deputy Commissioner {#sec-11-ncac-07-.0103 omnilex-key=us-nc-regs-official--title-11--11 NCAC 07 .0103}

History

  • Status: repealed
  • Authority G.S. 58-7.3; 58-9; 58-189 through 58-194
  • Eff. February 1, 1976
  • Readopted Eff. May 12, 1978
  • Repealed Eff. July 1, 1988.
11 NCAC 07 .0104 Division Personnel {#sec-11-ncac-07-.0104 omnilex-key=us-nc-regs-official--title-11--11 NCAC 07 .0104}

History

  • Status: repealed
  • Authority G.S. 58-7.3; 58-9; 58-189 through 58-194
  • Eff. February 1, 1976
  • Readopted Eff. May 12, 1978
  • Repealed Eff. July 1, 1988.
11 NCAC 07 .0105 Billing {#sec-11-ncac-07-.0105 omnilex-key=us-nc-regs-official--title-11--11 NCAC 07 .0105}

A charge will be made by the State Property Fire Insurance Fund for fire coverage provided to special fund agencies, self-liquidating buildings, special fund buildings, and buildings utilizing funds from revenue-producing endeavors connected therewith, for operation or maintenance. Rates for said coverages shall be fixed by the Commissioner of Insurance.

Charges will be levied to agencies for requested extended coverage, sprinkler leakage, business interruption, or other property insurance. All checks must be made payable to the North Carolina Department of Insurance. Rates for said coverages shall be fixed by the Commissioner of Insurance.

History

  • Authority G.S. 58-2-40; 58-31-5; 58-31-15; 58-31-20; 58-31-55
  • Eff. February 1, 1976
  • Readopted Eff. May 12, 1978
  • Amended Eff. October 1, 1988
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 19, 2019.
11 NCAC 07 .0106 Report and Proof of Loss Form {#sec-11-ncac-07-.0106 omnilex-key=us-nc-regs-official--title-11--11 NCAC 07 .0106}

All forms for submission of loss claims and other forms necessary for daily operation of the division in fulfilling its purpose shall be supplied by the division. The form entitled "Report and Proof of Loss Form" shall require the claimant to provide information including, but not limited to, the name of the department or agency, division, building name, location, date of loss, description of loss, amount requested to repair building and supporting information to aid the division in making a recommendation for amount of payment to the Council of State.

History

  • Authority G.S. 58-2-40; 58-31-55
  • Eff. February 1, 1976
  • Readopted Eff. May 12, 1978
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 19, 2019.
11 NCAC 07 .0201 Plan Review {#sec-11-ncac-07-.0201 omnilex-key=us-nc-regs-official--title-11--11 NCAC 07 .0201}

History

  • Status: expired
  • Authority G.S. 58-2-40; 58-31-40
  • Eff. February 1, 1976
  • Readopted Eff. May 12, 1978
  • Amended Eff. October 1, 1988
  • Expired Eff. February 1, 2019 pursuant to G.S. 150B-21.3A.
11 NCAC 07 .0202 Submission of Plans {#sec-11-ncac-07-.0202 omnilex-key=us-nc-regs-official--title-11--11 NCAC 07 .0202}

History

  • Status: repealed
  • Authority G.S. 58-193
  • Eff. February 1, 1976
  • Readopted Eff. May 12, 1978
  • Repealed Eff. October 1, 1988.
11 NCAC 07 .0203 Correction of Plans {#sec-11-ncac-07-.0203 omnilex-key=us-nc-regs-official--title-11--11 NCAC 07 .0203}

History

  • Status: repealed
  • Authority G.S. 58-193
  • Eff. February 1, 1976
  • Readopted Eff. May 12, 1978
  • Repealed Eff. October 1, 1988.
11 NCAC 07 .0301 State Property Fire Insurance Fund: Purpose and Funding {#sec-11-ncac-07-.0301 omnilex-key=us-nc-regs-official--title-11--11 NCAC 07 .0301}

History

  • Status: repealed
  • Authority G.S. 58-189 to 58-191.2; S.L. 1975, Ch. 875
  • Eff. February 1, 1976
  • Readopted Eff. May 12, 1978
  • Repealed Eff. October 1, 1988.
11 NCAC 07 .0302 Reinsurance {#sec-11-ncac-07-.0302 omnilex-key=us-nc-regs-official--title-11--11 NCAC 07 .0302}

History

  • Status: repealed
  • Authority G.S. 58-189 to 58-191.2; S.L. 1975, Ch. 875
  • Eff. February 1, 1976
  • Readopted Eff. May 12, 1978
  • Repealed Eff. October 1, 1988.
11 NCAC 07 .0303 Loss Adjustment {#sec-11-ncac-07-.0303 omnilex-key=us-nc-regs-official--title-11--11 NCAC 07 .0303}

The staff of the state property division shall investigate all losses reported to the department. The Commissioner of Insurance shall make recommendations to the Governor and Council of State for any loss.

The claimant shall submit a "Report and Proof of Loss Form" in accordance with division procedures. Said form must be signed by an authorized representative of the agency and include data in support of the claim.

History

  • Authority G.S. 58-2-40; 58-31-10; 58-31-15; 58-31-20
  • Eff. February 1, 1976
  • Readopted Eff. May 12, 1978
  • Amended Eff. October 1, 1988
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 19, 2019.
11 NCAC 07 .0304 Insurance Placement Other Than Under the Fund {#sec-11-ncac-07-.0304 omnilex-key=us-nc-regs-official--title-11--11 NCAC 07 .0304}

Insurance coverage which is requested by agencies, but which is not available under the State Property Fire Insurance Fund, is placed by the division through the Agent of Record. The Agent of Record shall acquire coverage from companies authorized to do business in North Carolina.

History

  • Authority G.S. 58-2-40; 58-31-45; 58-31-50; 58-31-55
  • Eff. February 1, 1976
  • Readopted Eff. May 12, 1978
  • Amended Eff. October 1, 1988
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 19, 2019.
11 NCAC 07 .0305 Revaluation of Property {#sec-11-ncac-07-.0305 omnilex-key=us-nc-regs-official--title-11--11 NCAC 07 .0305}

In the revaluation of property, the division shall use recognized standards and methods for computing replacement costs of real and personal property. Such methods may include, but are not limited to, factors of inflation and current construction indices.

History

  • Authority G.S. 58-2-40; 58-31-10; 58-31-15; 58-31-20
  • Eff. February 1, 1976
  • Readopted Eff. May 12, 1978
  • Amended Eff. October 1, 1988
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 19, 2019.
11 NCAC 07 .0306 Inspection of State-Owned Buildings {#sec-11-ncac-07-.0306 omnilex-key=us-nc-regs-official--title-11--11 NCAC 07 .0306}

To insure the safety of the buildings and occupants therein, on-site inspections of state-owned buildings are made as required by statute to determine property conditions.

Upon completion of its inspection and evaluation of fire and other safety hazards, the division will report, verbally or in writing or both to the authority in charge of the agency, institution or department. Said authority is responsible for correction of any deficiencies which may have been found by the division in accordance with the applicable General Statutes.

History

  • Authority G.S. 58-2-40; 58-31-40
  • Eff. February 1, 1976
  • Readopted Eff. May 12, 1978
  • Amended Eff. October 1, 1988
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 19, 2019.
11 NCAC 07 .0401 Definitions {#sec-11-ncac-07-.0401 omnilex-key=us-nc-regs-official--title-11--11 NCAC 07 .0401}

The definitions contained in G.S. 66-455 are incorporated in this Section by reference. In addition to those definitions, the following definitions apply to this Section:

(1) "Proof of Insurance" shall mean a Certificate of Insurance (COI) from an acceptable insurer.

(2) "Acceptable Insurer" shall mean any insurance company licensed under G.S. 58-6-7.

History

  • Authority G.S. 66-458
  • Eff. January 1, 2019.

Chapter 08 Engineering and Building Codes Division

11 NCAC 08 .0101 Purpose of the Division {#sec-11-ncac-08-.0101 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0101}

History

  • Status: repealed
  • Authority G.S. 58-7.3; 58-9; 58-9.1; 58-9.2; 143-139
  • Eff. February 1, 1976
  • Readopted Eff. May 12, 1978
  • Repealed Eff. July 1, 1988.
11 NCAC 08 .0102 Deputy Commissioner {#sec-11-ncac-08-.0102 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0102}

History

  • Status: repealed
  • Authority G.S. 58-7.3; 58-9; 58-9.1; 58-9.2; 143-139
  • Eff. February 1, 1976
  • Readopted Eff. May 12, 1978
  • Repealed Eff. July 1, 1988.
11 NCAC 08 .0103 Division Personnel {#sec-11-ncac-08-.0103 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0103}

History

  • Status: repealed
  • Authority G.S. 58-7.3; 58-9; 58-9.1; 58-9.2; 143-139
  • Eff. February 1, 1976
  • Readopted Eff. May 12, 1978
  • Repealed Eff. July 1, 1988.
11 NCAC 08 .0104 Organization of Division {#sec-11-ncac-08-.0104 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0104}

History

  • Status: repealed
  • Authority G.S. 58-7.3; 58-9; 58-9.1; 58-9.2; 143-139
  • Eff. February 1, 1976
  • Readopted Eff. May 12, 1978
  • Repealed Eff. July 1, 1988.
11 NCAC 08 .0201 North Carolina Building Code Council {#sec-11-ncac-08-.0201 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0201}

The North Carolina Building Code Council is established to adopt and amend the North Carolina State Building Code and hear appeals from state enforcement agencies. The Commissioner of Insurance of the State of North Carolina has responsibility for supervision of the State Building Code in cooperation with local officials appointed by city and county commissioners.

History

  • Authority G.S. 143-136; 143-138; 143A-78
  • Eff. February 1, 1976
  • Readopted Eff. May 12, 1978
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .0202 North Carolina State Building Code {#sec-11-ncac-08-.0202 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0202}

All rules and regulations, code requirements, procedures for amendment or repeal of requirements and other pertinent information are contained in published volumes of the North Carolina State Building Code as described in this Section. For purposes of this Section the terms "building code" or "code" shall mean the North Carolina State Building Code.

History

  • Authority G.S. 143-138
  • Eff. February 1, 1976
  • Readopted Eff. May 12, 1978
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .0203 Building Code Publications: General Information {#sec-11-ncac-08-.0203 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0203}

(a) All volumes of the North Carolina State Building Code are published by the North Carolina Department of Insurance under the direction of the North Carolina Building Code Council. Amendments to all volumes of the code are published at: https://ncdoi.com/OSFM/Engineering_and_Codes/Default.aspx?field1=Codes_-_Code_Book_Sales&user=State_Building_Codes.

(b) Copies of the various volumes of the Building Code may be obtained from: North Carolina Department of Insurance, Engineering & Codes, 325 North Salisbury Street, Raleigh, North Carolina 27603. Information regarding cost of the publications may be obtained at the same address. Costs are based upon the cost to the Department of publication, distribution, and annual revisions.

History

  • Authority G.S. 143-138; 143-138.1
  • Eff. February 1, 1976
  • Readopted Eff. May 12, 1978
  • Amended Eff. May 1, 2008; September 1, 1987
  • Readopted Eff. May 1, 2020.
11 NCAC 08 .0204 Bldg Code/Volume I/General Construction {#sec-11-ncac-08-.0204 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0204}

History

  • Status: repealed
  • Authority G.S. 143-138; 143-146 through 143-151.1
  • Eff. February 1, 1976
  • Readopted Eff. May 12, 1978
  • Amended Eff. February 1, 1987; August 1, 1986; May 1, 1984
  • Repealed Eff. September 1, 1987.
11 NCAC 08 .0205 Bldg Code/Volume Ib/Uniform Residential Code {#sec-11-ncac-08-.0205 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0205}

History

  • Status: repealed
  • Authority G.S. 143-138; 143-146 through 143-151.1
  • Eff. February 1, 1976
  • Readopted Eff. May 12, 1978
  • Amended Eff. February 1, 1987; August 1, 1986; May 1, 1984
  • Repealed Eff. September 1, 1987.
11 NCAC 08 .0206 Bldg Code/Volume Ii/Plumbing {#sec-11-ncac-08-.0206 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0206}

History

  • Status: repealed
  • Authority G.S. 143-138; 143-146 through 143-151.1
  • Eff. February 1, 1976
  • Readopted Eff. May 12, 1978
  • Amended Eff. February 1, 1987; August 1, 1986; May 1, 1984
  • Repealed Eff. September 1, 1987.
11 NCAC 08 .0207 Heating/Air Conditioning/Refrigeration/Ventilation {#sec-11-ncac-08-.0207 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0207}

History

  • Status: repealed
  • Authority G.S. 143-138; 143-146 through 143-151.1
  • Eff. February 1, 1976
  • Readopted Eff. May 12, 1978
  • Amended Eff. February 1, 1987; August 1, 1986; May 1, 1984
  • Repealed Eff. September 1, 1987.
11 NCAC 08 .0208 Building Code/Volume Iv/Electrical {#sec-11-ncac-08-.0208 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0208}

History

  • Status: repealed
  • Authority G.S. 143-138; 143-146 through 143-151.1
  • Eff. February 1, 1976
  • Readopted Eff. May 12, 1978
  • Amended Eff. February 1, 1987; August 1, 1986; May 1, 1984
  • Repealed Eff. September 1, 1987.
11 NCAC 08 .0209 Regulations for Mobile Homes {#sec-11-ncac-08-.0209 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0209}

History

  • Status: repealed
  • Authority G.S. 143-138; 143-146 through 143-151.1
  • Eff. February 1, 1976
  • Readopted Eff. May 12, 1978
  • Amended Eff. February 1, 1987; August 1, 1986; May 1, 1984
  • Repealed Eff. September 1, 1987.
11 NCAC 08 .0210 Building Code/Handicapped Section {#sec-11-ncac-08-.0210 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0210}

History

  • Status: repealed
  • Authority G.S. 143-138; 143-146 through 143-151.1
  • Eff. February 1, 1976
  • Readopted Eff. May 12, 1978
  • Amended Eff. February 1, 1987; August 1, 1986; May 1, 1984
  • Repealed Eff. September 1, 1987.
11 NCAC 08 .0211 Temporary Housing Buildings During Hurricane Helene State of Emergency {#sec-11-ncac-08-.0211 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0211}

History

  • Authority G.S. 143-138
  • Emergency Adoption Eff. December 18, 2024
  • Emergency Adoption Exp. March 16, 2025.
11 NCAC 08 .0301 Application Forms Furnished {#sec-11-ncac-08-.0301 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0301}

History

  • Status: repealed
  • Authority G.S. 153A-351(b)
  • Eff. February 1, 1976
  • Readopted Eff. May 12, 1978
  • Repealed Eff. July 1, 1988.
11 NCAC 08 .0302 Application for Co. Electrical Inspectors Certification {#sec-11-ncac-08-.0302 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0302}

History

  • Status: repealed
  • Authority G.S. 153A-351(b)
  • Eff. February 1, 1976
  • Readopted Eff. May 12, 1978
  • Repealed Eff. July 1, 1988.
11 NCAC 08 .0303 Type of Examination {#sec-11-ncac-08-.0303 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0303}

History

  • Status: repealed
  • Authority G.S. 153A-351(b)
  • Eff. February 1, 1976
  • Readopted Eff. May 12, 1978
  • Repealed Eff. July 1, 1988.
11 NCAC 08 .0304 Scope of Examination {#sec-11-ncac-08-.0304 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0304}

History

  • Status: repealed
  • Authority G.S. 153A-351(b)
  • Eff. February 1, 1976
  • Readopted Eff. May 12, 1978
  • Repealed Eff. July 1, 1988.
11 NCAC 08 .0305 Examination Schedule {#sec-11-ncac-08-.0305 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0305}

History

  • Status: repealed
  • Authority G.S. 153A-351(b)
  • Eff. February 1, 1976
  • Readopted Eff. May 12, 1978
  • Repealed Eff. July 1, 1988.
11 NCAC 08 .0306 Classes of Certification {#sec-11-ncac-08-.0306 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0306}

History

  • Status: repealed
  • Authority G.S. 153A-351(b)
  • Eff. February 1, 1976
  • Readopted Eff. May 12, 1978
  • Repealed Eff. July 1, 1988.
11 NCAC 08 .0307 Certification Costs {#sec-11-ncac-08-.0307 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0307}

History

  • Status: repealed
  • Authority G.S. 153A-351(b)
  • Eff. February 1, 1976
  • Readopted Eff. May 12, 1978
  • Repealed Eff. July 1, 1988.
11 NCAC 08 .0401 Application Forms Furnished {#sec-11-ncac-08-.0401 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0401}

The staff of the electrical section shall provide application forms for persons wishing to apply for approval as a school maintenance electrician.

History

  • Authority G.S. 58-2-40; 115C-525
  • Eff. February 1, 1976
  • Readopted Eff. May 12, 1978
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .0402 Application for School Maintenance Electricians Approval {#sec-11-ncac-08-.0402 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0402}

The application requires the applicant to furnish all of the following pertinent information and such other information as may be deemed necessary in determining the qualifications of the applicant, including but not limited to:

(1) date, school unit, name, address, telephone number, age, educational background, whether or not applicant has taken qualifying examinations previously, electrical experience background, whether or not employed full time by school unit, present responsibilities and title, signature of applicant, etc.;

(2) signature of superintendent or maintenance supervisor other than applicant requesting application be processed and the applicant be approved.

History

  • Authority G.S. 58-2-40; 115C-525
  • Eff. February 1, 1976
  • Readopted Eff. May 12, 1978
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .0403 Methods of Approval of School Maintenance Electricians {#sec-11-ncac-08-.0403 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0403}

Approved school maintenance electricians may be certified by two methods as set forth in 11 NCAC 08 .0404 and .0405.

History

  • Authority G.S. 58-2-40; 115C-525
  • Eff. February 1, 1976
  • Readopted Eff. May 12, 1978
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .0404 Application Approval {#sec-11-ncac-08-.0404 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0404}

An applicant will be approved as a school maintenance electrician if he has filed a completed application on a form furnished by the Commissioner and the applicant furnishes with his application satisfactory evidence that he has complied with one of the following conditions:

(1) The applicant has taken and passed a regular qualifying examination administered by the State Board of Examiners of Electrical Contractors; or

(2) The applicant has qualified for and obtained a journeyman electrician's certification from a duly established city or county journeyman electrician's examining board in the State of North Carolina; or

(3) The applicant was on May 29, 1957 (date of enactment of statute) regularly employed by a local school unit in the State of North Carolina for the purposes of installing electrical wiring or altering or adding to any existing wiring as prescribed in G.S. 115-150.1(2) and has had at least 10 years of experience in such electrical work.

History

  • Authority G.S. 58-2-40; 115C-525
  • Eff. February 1, 1976
  • Readopted Eff. May 12, 1978
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .0405 Approval of School Maintenance Electricians by Exam {#sec-11-ncac-08-.0405 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0405}

The Commissioner will certify an applicant as a school maintenance electrician if the applicant:

(1) furnishes with his application satisfactory evidence that he has had at least two years experience in the capacity of a journeyman electrician or in a capacity equivalent to or higher than that of a journeyman electrician classification, and

(2) takes and passes the qualifying examination prepared and administered by the Commissioner of Insurance.

History

  • Authority G.S. 58-2-40; 115C-525
  • Eff. February 1, 1976
  • Readopted Eff. May 12, 1978
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .0406 Examination Information {#sec-11-ncac-08-.0406 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0406}

The qualifying examination shall be designed to test applicants knowledge of fundamentals of electricity, acceptable materials, devices, appliances and equipment, provisions contained in the current edition of the National Electrical Code; the requirements regarding emergency lighting as contained in the North Carolina State Building Code; and other pertinent statutory requirements.

The examination may contain multiple-choice, true-false, essay type and research type questions, as well as problems and questions requiring calculations. All of the questions and problems will be designed to cover typical electrical installations as found on the premises of school properties.

The examination may be of the open-book and closed-book type with the majority of the examination being of the open-book type. All reference books will be provided the examinee for use during the examination.

The passing grade on the examination will be a minimum of 75. There will be no examination fee charged.

Arrangements shall be made to conduct the examination twice yearly in the Raleigh area and may be conducted at other times and places as deemed desirable by the Commissioner.

History

  • Authority G.S. 58-2-40; 115C-525
  • Eff. February 1, 1976
  • Readopted Eff. May 12, 1978
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.

History

  • Status: repealed
  • Authority G.S. 143-151.13
  • Eff. June 28, 1979
  • Repealed Eff. February 1, 1991.
11 NCAC 08 .0502 Nature of Limited Certificate {#sec-11-ncac-08-.0502 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0502}

A limited certificate shall be issued to each code enforcement official who held such a position on June 13, 1977. This certificate will entitle the official to continue in the position held on that date; it will not entitle him to shift to another employer or to another position for the same employer. The limited certificate will be issued and renewed from year to year without examination, on application of the official and verification of his status. However, it will not be renewed beyond the applicable date specified in Rule .0508 unless the official has prior to that date completed in-service training prescribed by the Board.

On or after the appropriate "applicable date" specified in Rule .0510, a limited certificate will be issued to each code enforcement official who makes application in accordance with these regulations. Such certificate will authorize the official to continue in the position held on the "applicable date" in the same manner as a limited certificate issued to an official who held a position on June 13, 1977.

History

  • Authority G.S. 143-151.13(c)
  • Eff. June 28, 1979
  • Amended Eff. January 15, 1980
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .0503 Application Form: Availability {#sec-11-ncac-08-.0503 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0503}

The Board shall provide, upon request, application forms for any person desiring a limited certificate, obtainable from the Division of Engineering and Building Codes of the Department of Insurance.

History

  • Authority G.S. 143-151.19
  • Eff. June 28, 1979
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .0504 Application Form: Contents {#sec-11-ncac-08-.0504 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0504}

(a) The application form requires the applicant to furnish all of the following pertinent information necessary to determine the qualifications of the applicant for a limited certificate:

(1) the date;

(2) name, address, and telephone number where applicant can be reached;

(3) age;

(4) title of position held on June 13, 1977 or applicable date;

(5) government unit by which employed on June 13, 1977 (or applicable date);

(6) duties in position held on June 13, 1977 (or applicable date);

(7) educational background;

(8) employment record.

(b) Each application for a limited certificate authorizing continuation in a position held after June 13, 1977, shall be accompanied by a notarized certificate from the department head or higher level supervisor of the code enforcement official that:

(1) the official occupied that position on the applicable date;

(2) that the duties and title of the position were as set forth in the application; and

(3) that the supervisor understands that the limited certificate will become invalid if the code enforcement official fails within two years to complete in-service training required under Rule .0508 of these Regulations.

History

  • Authority G.S. 143-151.13
  • Eff. June 28, 1979
  • Amended Eff. January 15, 1980
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .0505 Application: Where Made and Fee {#sec-11-ncac-08-.0505 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0505}

The completed application shall be returned to the Board at P.O. Box 26387, Raleigh, North Carolina 27611. Each application shall be accompanied by payment of a twenty dollar ($20.00) fee, either in cash or by a check made payable to the North Carolina Code Officials Qualification Board.

History

  • Authority G.S. 143-151.12(1); 143-151.16
  • Eff. June 28, 1979
  • Amended Eff. February 1, 1991
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .0506 Certificate {#sec-11-ncac-08-.0506 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0506}

If an application is found to be in order, the Board's staff shall mail a limited certificate to the applicant at the address specified on the application. The certificate shall describe with particularity the position which it authorizes the applicant to hold and the governmental unit for which he is authorized to hold such position. The certificate shall be effective for one year, as specified in the certificate.

History

  • Authority G.S. 143-151.13
  • Eff. June 28, 1979
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .0507 Renewal {#sec-11-ncac-08-.0507 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0507}

To remain effective, a limited certificate must be renewed annually on or before the first day of July. Applications for renewal shall be made in the same manner as the original application for the certificate, on forms furnished by the Board. A ten dollar ($10.00) renewal fee shall accompany each such application. In the event that an application is not received by July 1, an additional late renewal fee of two dollars ($2.00) shall be charged. In accordance with 11 NCAC 08 .0712, continuing education requirements must be completed by June 30 for renewal of the limited certificate.

History

  • Authority G.S. 143-151.12(1); 143-151.13A(b); 143-151.16
  • Eff. June 28, 1979
  • Amended Eff. February 1, 2006; February 1, 1991
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .0508 Required in-Service Training for Renewal {#sec-11-ncac-08-.0508 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0508}

No code enforcement official may have a limited certificate authorizing continuation in a position he held on June 13, 1977, renewed after July 1, 1981 unless he shall have submitted valid evidence that he has completed in-service training as prescribed by the Board.

No code enforcement official may have a limited certificate authorizing continuation in a position he held on an "applicable date" as specified in 11 NCAC 8 .0510 renewed beyond two years following such date, fire prevention inspectors beyond July 1, 1993, unless he shall have submitted valid evidence that he has completed in-service training as prescribed by the Board; said training shall be identical to the training required of applicants for standard certificates for the types and levels of code enforcement duties performed.

History

  • Authority G.S. 143-151.12(1); 143-151.13
  • Eff. June 28, 1979
  • Amended Eff. February 1, 1991; January 15, 1980
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .0509 Return of Certificate When Leave Employment {#sec-11-ncac-08-.0509 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0509}

History

  • Status: repealed
  • Authority G.S. 143-151.15
  • Eff. June 28, 1979
  • Repealed Eff. February 1, 1991.
11 NCAC 08 .0510 Certificates for Positions Held on Applicable Dates {#sec-11-ncac-08-.0510 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0510}

History

  • Status: repealed
  • Authority G.S. 143-151.13
  • Eff. January 15, 1980
  • Repealed Eff. February 1, 1991.

History

  • Status: repealed
  • Authority G.S. 143-151.13
  • Eff. June 28, 1979
  • Repealed Eff. February 1, 1991.
11 NCAC 08 .0602 Nature of Probationary Certificate {#sec-11-ncac-08-.0602 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0602}

(a) A probationary certificate may be issued as a building inspector, electrical inspector, mechanical inspector, plumbing inspector, or fire inspector, as set forth in the rule in this Chapter specific to the type of probationary certificate being sought, to any newly employed or newly promoted code-enforcement official who lacks a standard certificate that covers the new position. A probationary certificate shall be issued for three years and shall not be renewed. During the three-year period, the official shall complete the requirements set forth in the rule in this Chapter specific to the type of probationary certificate being sought to qualify for the appropriate standard certificate. A probationary certificate shall authorize the official, during the effective period of the certificate, to hold the position of the type, level, and jurisdiction specified. A probationary certificate may be placed on inactive status upon written request by the code-enforcement official. While on inactive status, the code-enforcement official shall not administer nor enforce the State Building Code for the probationary certificate held. Once a probationary certificate is placed on inactive status, the three-year effective period is tolled. The certificate shall be conditioned on the applicant's completion of a high school diploma, or a high school equivalency certificate, and meeting one of the following:

(1) working under supervision sufficient, as determined by a supporting letter provided for in 11 NCAC 08 .0706(b), to protect the public health and safety;

(2) possessing a minimum of one year of design, construction, or inspection experience working under a certified inspector or under a licensed professional engineer, licensed architect, licensed contractor, or registered interior designer; or

(3) possessing one of the education or experience qualifications listed in the rule in this Chapter specific to the area of code enforcement for which the probationary certificate is issued.

(b) A probationary certificate as a residential changeout inspector set forth in 11 NCAC 08 .0734 may be issued to any employed code-enforcement official, whose employment can be verified pursuant to 11 NCAC 08 .0734(d)(2), who lacks a standard certificate as a residential changeout inspector and who successfully completes a residential changeout inspections course set forth in 11 NCAC 08 .0734(c)(3). A probationary certificate shall be issued for three years and shall not be renewed. During the three-year period, the official shall complete the requirements set forth in the rules in this Chapter, specific to an area of code enforcement, to qualify for the corresponding standard certificate. A probationary certificate as a residential changeout inspector shall authorize the inspector, during the effective period of the certificate, to hold the position set forth in 11 NCAC 08 .0734(a). A probationary certificate may be placed on inactive status upon written request by the code-enforcement official. While on inactive status, the code-enforcement official shall not administer nor enforce the State Building Code. Once a probationary certificate is placed on inactive status, the three-year effective period is tolled. The probationary certificate shall be conditioned on the applicant's completion of a high school diploma, or a high school equivalency certificate, and working under the direct supervision of a person who possesses, or persons who collectively possess, standard certificates as an electrical inspector III, mechanical inspector III, and plumbing inspector III, or an individual holding a residential changeout inspector certificate and five years of code enforcement experience.

History

  • Authority G.S. 143-151.12(1); 143-151.12(2); 143-151.13
  • Eff. June 28, 1979; Amended Eff. December 1, 1982
  • Temporary Amendment Eff. January 1, 1983; For a Period of 120 Days to Expire on April 30, 1983
  • Amended Eff. December 1, 2017; July 18, 2002; October 1, 1992; February 1, 1991; May 1, 1983
  • Readopted Eff. July 1, 2019
  • Amended Eff. February 1, 2025; August 1, 2020
  • Temporary Amendment Eff. March 6, 2026
  • Amended Eff. April 1. 2026.
11 NCAC 08 .0603 Application Form: Availability {#sec-11-ncac-08-.0603 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0603}

The Board shall provide, upon request, application forms for any person desiring a probationary certificate, obtainable from the Division of Engineering and Building Codes of the Department of Insurance.

History

  • Authority G.S. 143-151.19
  • Eff. June 28, 1979
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .0604 Application Form: Contents {#sec-11-ncac-08-.0604 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0604}

The application form requires the applicant to furnish all of the following pertinent information necessary to determine the qualifications of the applicant for a probationary certificate:

(1) the date;

(2) name, address and telephone number where applicant can be reached;

(3) date of birth;

(4) education;

(5) work experience;

(6) certificates and other professional licenses, if any, held previously or currently;

(7) title of position to which appointed or promoted;

(8) date of appointment or promotion to position;

(9) governmental unit by which employed;

(10) duties in a new position, in sufficient detail to determine appropriate type and level of certification;

(11) name and title, certification, or other qualifications of persons to be responsible for supervision; and

(12) Social Security number.

History

  • Authority G.S. 143-151.13
  • Eff. June 28, 1979
  • Amended Eff. July 18, 2002
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .0605 Application: Where Made and Fee {#sec-11-ncac-08-.0605 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0605}

The completed application shall be returned to the Board at P.O. Box 26387, Raleigh, North Carolina 27611. Each application shall be accompanied by payment of a twenty dollar ($20.00) fee, either in cash or by a check made payable to the North Carolina Code Officials Qualification Board.

History

  • Authority G.S. 143-151.12(1); 143-151.16
  • Eff. June 28, 1979
  • Amended Eff. February 1, 1991
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .0606 Certificate {#sec-11-ncac-08-.0606 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0606}

If an application is found to be in order, the Board's staff shall mail a probationary certificate to the applicant at the address specified on the application. The certificate shall specify the type and level of code enforcement in which the applicant may engage and may be conditioned upon his having supervision from an official with specified certification or qualifications. The certificate shall be effective for the period specified in the certificate.

History

  • Authority G.S. 143-151.13
  • Eff. June 28, 1979
  • Amended Eff. December 1, 1982
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .0607 Return of Certificate When Leave Employment {#sec-11-ncac-08-.0607 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0607}

A probationary certificate shall remain valid only so long as the person certified is employed by the state or a local government as a code enforcement official of the type and level indicated on the certificate. When the person certified leaves such employment for any reason, he shall return the certificate to the Board. If the person subsequently returns to such employment, the Board shall re-issue the certificate to him, provided there is any period remaining of its effective life. In such event, the effective period shall be calculated as though the resumed employment followed immediately after the cessation of employment.

History

  • Authority G.S. 143-151.15
  • Eff. June 28, 1979
  • Amended Eff. December 1, 1982
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.

History

  • Status: repealed
  • Authority G.S. 143-151.13
  • Eff. January 15, 1980
  • Repealed Eff. February 1, 1991.
11 NCAC 08 .0702 Nature of Standard Certificate {#sec-11-ncac-08-.0702 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0702}

(a) The Board shall issue one or more standard certificates to each code enforcement official demonstrating the qualifications set forth in 11 NCAC 08 .0706, .0707, and .0734. Standard certificates are available for each of the following types of qualified code enforcement officials:

(1) building inspector;

(2) electrical inspector;

(3) mechanical inspector;

(4) plumbing inspector;

(5) fire inspector; and

(6) residential changeout inspector.

(b) The holder of a standard certificate may practice code enforcement only within the inspection area and level described upon the certificate issued by the Board. A code enforcement official may qualify and hold more than one certificate. These certificates may be for different levels in different types of positions.

(c) A code enforcement official holding a certificate indicating a specified level of proficiency in a particular type of position may hold a position calling for that type of qualification anywhere in the State. A standard certificate must be renewed annually in order to remain valid.

History

  • Authority G.S. 143-151.13; 143-151.16
  • Eff. January 15, 1980
  • Amended Eff. August 1, 2004; August 1, 1990; July 1, 1983
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018
  • Amended Eff. August 1, 2020.
11 NCAC 08 .0703 Application Form: Availability {#sec-11-ncac-08-.0703 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0703}

The Board shall provide, upon request, application forms for any person desiring a standard certificate, obtainable from the Division of Engineering and Building Codes of the Department of Insurance.

History

  • Authority G.S. 143-151.19
  • Eff. January 15, 1980
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .0704 Application Form: Contents {#sec-11-ncac-08-.0704 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0704}

The application form requires the applicant to furnish all of the following pertinent information necessary to determine the qualifications of the applicant for a standard certificate:

(1) the date;

(2) name, address, and telephone number where applicant can be reached;

(3) date of birth;

(4) education;

(5) work experience;

(6) certificates and other professional licenses, if any, held previously or currently;

(7) type and level of certificate for which application is made;

(8) governmental unit by which currently employed;

(9) supporting data needed for verification of applicant's qualifications called for by Rule .0706 or .0707 of this Section; and

(10) Social Security number.

History

  • Authority G.S. 143-151.13
  • Eff. January 15, 1980
  • Amended Eff. July 18, 2002
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .0705 Application: Where Made and Fee {#sec-11-ncac-08-.0705 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0705}

The completed application and all required supplementary information shall be returned to the Board at P.O. Box 26387, Raleigh, North Carolina 27611. Each application (whether for one or several standard certificates for a single individual) shall be accompanied by payment of a twenty dollar ($20.00) fee, either in cash or by a check made payable to the North Carolina Code Officials Qualification Board.

History

  • Authority G.S. 143-151.16
  • Eff. January 15, 1980
  • Amended Eff. August 1, 1990
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .0706 Required Qualifications: Types and Levels {#sec-11-ncac-08-.0706 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0706}

(a) Qualification Levels: With respect to all types of code-enforcement officials certified by the Board prior to January 1, 2027, those with Level I, Level II, or Level III certificates shall be qualified to inspect and approve only those buildings limited by the occupancy classification for Fire inspectors and by the occupancy classification, number of stories, and square feet (sf) per floor area of buildings for Building, Electrical, Mechanical, and Plumbing inspectors, as shown in Subparagraphs (a)(1) and (a)(2) of this Rule. Code-enforcement officials certified for Level I and II shall be authorized to inspect and approve these buildings until December 31, 2032. Any code-enforcement official with a probationary Level I or Level II certificate, who earns a Standard Level I or Level II certificate between January 1, 2027 and December 31, 2032, shall be qualified to inspect and approve only those buildings shown in Subparagraphs (a)(1) and (a)(2) of this Rule until December 31, 2032. As of January 1, 2033, code- enforcement officials certified for Level I and Level II shall continue to be certified at those same levels but shall be qualified to inspect and approve only those types of buildings shown in Subparagraph (a)(3) of this Rule. Standard Level III certificates shall be authorized to inspect and approve the types of buildings shown in Subparagraph (a)(3) of this Rule indefinitely.

(1) Fire inspectors shall be limited to occupancy classifications, Highrise, and plan review as follows, except all Levels include Business, Mercantile, Residential, and Utility and Miscellaneous:

(A) Level I. Assembly (limited to 1 story/20,000 sf), Factory Industrial F-2, and Storage S-2. No Highrise or plan review.

(B) Level II. Assembly, Educational, Factory Industrial F-1 and F-2, and Storage S-1 and S-2. Plan review.

(C) Level III. Assembly, Educational, Factory Industrial F-1 and F-2, Hazardous, Institutional, and Storage S-1 and S-2. Highrise and plan review.

(2) Building, Mechanical, Electrical and Plumbing inspectors shall be limited to occupancy classifications, number of stories, and square feet (sf) per floor as follows, except for any Level, there shall be no number of stories or square footage limit for one and two family dwellings and townhouses or Utility and Miscellaneous.

(A) Level I. Single (1) story/7,500 sf, for Assembly, Education, Institutional, and Residential Multi-unit. Single (1) story/20,000 sf, for Business, Factory Industrial, Mercantile, and Storage. Single (1) story/3,000 sf, for Hazardous.

(B) Level II. Single (1) story/10,000 sf, for Institutional; 20,000 sf, for Assembly, Education, and Hazardous; and, 60,000 sf, for Business, Factory Industrial, and Mercantile. Multi- story: 2 stories, maximum 20,000 sf per floor for Education and Hazardous. Multi-story: 3 stories, maximum 10,000 sf per floor Institutional; and, unlimited sf Residential Multi- unit. Multi-story: 4 stories, maximum 20,000 sf per floor for Business, Factory Industrial, and Mercantile.

(C) Level III. Unlimited stories and sf per floor.

(3) With respect to all types of code-enforcement officials, except fire inspectors, newly certified by the Board on or after January 1, 2027, those with Level I, Level II, or Level III certificates are qualified to inspect and approve buildings as follows except for any Level there shall be no number of stories or square footage limit for one and two family dwellings and townhouses or Utility and Miscellaneous:

(A) Level I inspectors shall be qualified to perform code-enforcement official duties for residential buildings up to three stories in height with no more than four dwelling units subject to the limitations for the type of inspector.

(B) Level II inspectors shall be qualified to perform code-enforcement official duties for commercial buildings subject to the limitations for the type of inspector.

(C) Level III inspectors shall be qualified to perform code-enforcement official duties for any residential or commercial building or structure subject to the limitations for the type of inspector.

(4) With respect to fire inspectors newly certified by the Board on or after January 1, 2027, those with Level I, Level II, or Level III certificates are qualified to inspect and approve buildings as provided in Rule .0741 of this Section.

(b) Whenever a provision of the rules in this Section requires a supporting letter (maximum of two per level) from a supervisor, the letter(s) shall be notarized, shall state the supervisor's qualifications (i.e., what type and level of certificate or license the supervisor holds), shall state that the applicant has worked under the supervisor's direct supervision for a specified period of time, and shall recommend certification of the applicant as a specified type and level of inspector upon satisfaction of other required qualifications. The supervisor shall describe the name, floor area, and number of stories of the buildings worked on by the applicant and shall describe the work performed by the applicant.

(c) References in the rules in this Section to professional engineer or licensed engineer means engineers licensed by the North Carolina State Board of Examiners for Engineers and Surveyors pursuant to Chapter 89C of the North Carolina General Statutes. References in the rules in this Section to registered architect means architects licensed by the Board of Architecture pursuant to Chapter 83A of the North Carolina General Statutes. References to licensed building, residential, electrical, heating, plumbing, and fire sprinkler contractors means contractors licensed by the State Licensing Board for General Contractors, the North Carolina State Board of Examiners of Electrical Contractors, or the North Carolina State Board of Examiners of Plumbing, Heating and Fire Sprinkler Contractors, pursuant to Chapter 87 of the North Carolina General Statutes. References to licensed "building" contractors do not include licensed "residential" contractors. Specialty licenses issued by these occupational licensing boards are applicable as prescribed by the inspector type and level contained in this Section. Applicants with licenses from other states or countries must provide a copy of their license and documentation to prove that the requirements of the other state or country are at least equivalent to the statewide licensing requirements of North Carolina occupational licensing boards.

(d) Whenever a provision of the rules in this Section requires the possession of an occupational license other than those certificates that are issued by the Board, if that license is inactive, the applicant must provide documentation from the appropriate occupational licensing board to prove that the applicant previously held the license and that the license is currently inactive.

(e) Whenever a provision of the rules in this Section requires inspector experience on a minimum number of buildings or systems, the experience must include all the inspections typically performed by an inspector during construction of the building or system. Inspections do not have to be performed on the same building.

(f) Whenever a provision of the rules in this Section requires a high school education or other education and experience qualifications, the Board may approve equivalent qualifications. Whenever a provision of the rules in this Section requires the possession of a diploma or degree from an accredited college, university, or trade school, accredited shall mean accreditation from a regional accrediting association. Note: as an example, Southern Association of Colleges and Schools.

(g) Every applicant for a standard certificate shall:

(1) provide documentation that the applicant possesses a minimum of a high school education or a high school equivalency certificate; and

(2) provide notarized certification by a city or county manager, clerk, or director of inspection department that the applicant will be performing "code enforcement", as defined in G.S. 143-151.8(a)(3), as an employee of or under contract with that city or county jurisdiction; or provide certification by the head of the Engineering and Building Codes Division of the North Carolina Office of State Fire Marshal that the applicant will be performing "code enforcement", as defined in G.S. 143-151.8(a)(3), for a state department or agency; and

(3) make a passing grade of at least 70 percent on a law and administration course administered and taught by a Board-approved sponsor; and

(4) make a passing grade of at least 70 percent on courses for certification in building, electrical, fire prevention, mechanical, or plumbing inspection at Levels I, II, or III, unless exempted by 11 NCAC 08 .0707. For the purpose of entry into the state examination, courses must be completed within five years of the exam in Subparagraph (g)(5) of this Rule. These courses shall be administered and taught by the North Carolina Office of State Fire Marshal and the North Carolina Community College System or other educational agencies accredited by a regional accrediting association; for example, Southern Association of Colleges and Schools; and

(5) make a passing grade of 70 percent on the state examination administered by the Board for each inspector type and level of certification, unless exempted by 11 NCAC 08.0707.

History

  • Authority G.S. 143-151.12(1); 143-151.12(9); 143-151.13
  • Eff. January 15, 1980
  • Amended Eff. August 1, 2004; July 18, 2002; February 1, 1991; August 1, 1990; July 1, 1983; Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018
  • Amended Eff. February 1, 2025
  • Temporary Amendment Eff. November 7, 2025
  • Amended Eff. April 1, 2026.
11 NCAC 08 .0707 Special Circumstances {#sec-11-ncac-08-.0707 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0707}

(a) Licensed Architect, Licensed General Contractor, Licensed Plumbing or Heating Contractor, Licensed Electrical Contractor, Licensed Professional Engineer. Applicants under this Paragraph shall be currently registered or licensed (as of June 13, 1977) by the State of North Carolina as an architect, a general contractor, a plumbing or heating contractor, an electrical contractor, or a professional engineer to receive certification. The standard certificate shall authorize the person to practice as a qualified code-enforcement official of the type and at the performance level determined by the Board to be appropriate, in accordance with the rule in this Chapter specific to that area of code enforcement, in light of the applicant's education, training, and experience.

(b) Certified Code-Enforcement Official From Another State. Pursuant to G.S. 143-151.14(a), the Board may issue a standard certificate to any person who holds a currently valid certificate as a qualified code-enforcement official from another state or territory whose standards are acceptable to the Board and not lower than those required of North Carolina applicants, under Article 9C of Chapter 143 of the North Carolina General Statutes, and all applicable administrative rules governing code-enforcement officials, and passes a state examination in the area and level of the standard certificate sought. The standard certificate shall authorize the person to practice as a qualified code-enforcement official of the type and at the performance level determined by the Board to be appropriate, in accordance with the area and level of the state examination passed by the applicant and the rule in this Chapter specific to that area of code enforcement, in light of the applicant's education, training, and experience.

(c) Certified Code-Enforcement Official with International Code Council (ICC) Certification. Pursuant to G.S. 143-151.14(b), the Board may issue a standard certificate to any person who is certified as a qualified code-enforcement official in good standing by the International Code Council where standards and examinations are acceptable to the Board and not lower than those required of North Carolina applicants, under Article 9C of Chapter 143 of the North Carolina General Statutes and all applicable administrative rules governing code-enforcement officials, and passes a state examination in the area and level of the standard certificate sought. The standard certificate shall authorize the person to practice as a qualified code-enforcement official of the type and at the performance level determined by the Board to be appropriate, in accordance with the area and level of the state examination passed by the applicant and the rule in this Chapter specific to that area of code enforcement, in light of the applicant's education, training, and experience.

(d) Comity Applicants. Comity applicants as set out in in Paragraphs (b) and (c) of this Rule shall meet the experience requirements specified in the rule in this Chapter specific to the area and level of code enforcement sought to be eligible for comity consideration. The successful completion of a short course required by G.S. 143-151.14(c) concerning the State Building Code rules and code enforcement administration must be completed within three years to maintain any standard certificate issued due to comity. Standard certificates issued under comity shall expire if the required course is not completed within the three-year period.

(e) Applicants may submit other experience in the design, construction, installation or inspection of buildings and electrical, mechanical, plumbing, and fire systems for consideration as other special circumstances meeting the Board's requirements. The Board's Qualification and Evaluation Committee shall consider such experience on a case-by-case basis and make a recommendation to the Board.

History

  • Authority G.S. 143-151.12(1); 143-151.12(3); 143-151.13; 143-151.14
  • Eff. January 15, 1980
  • Amended Eff. July 1, 1983
  • Readopted Eff. July 1, 2019
  • Amended Eff. February 1, 2025.
11 NCAC 08 .0708 Certificate {#sec-11-ncac-08-.0708 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0708}

(a) If an application meets the requirements of Rules .0704 and .0706 of this Section, the application fee has been paid, and the applicant qualified for a particular type and level of certificate, the Board's staff shall mail a standard certificate of that type and level to the applicant at the address specified on the application. The certificate shall be effective until the renewal date specified in G.S. 143-151.16(b).

(b) If the applicant does not meet the criteria for the certificate for which he or she applied, the applicant shall be given written notice of the criterion that the applicant fails to meet and offered a choice of:

(1) accepting a certificate for a lower level for which the applicant is qualified;

(2) submitting additional evidence in support of the application;

(3) withdrawing the application; or

(4) appealing the decision to the Board.

If an appeal is filed, the Board shall conduct a hearing and render a decision in accordance with Article 3A of G.S. 150B.

History

  • Authority G.S. 143-151.12; 143-151.13; 143-151.14; 143-151.17; 143-151.19
  • Eff. January 15, 1980
  • Amended Eff. December 1, 2017; July 18, 2002; January 1, 1991
  • Readopted Eff. July 1, 2019.
11 NCAC 08 .0709 Renewal {#sec-11-ncac-08-.0709 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0709}

To remain effective, a standard certificate must be renewed in accordance with G.S. 143-151.16(b). Applications for renewal shall be made on forms furnished by the Division of Engineering and Building Codes of the Department of Insurance. A ten dollar ($10.00) renewal fee shall accompany each such application. In the event that an application for renewal is not received by July 1, an additional late-renewal fee of two dollars ($2.00) shall be charged. Any person who fails to renew a certificate for a period of two consecutive years shall take and pass the same examination as unlicensed applicants for that type and level of certificate before that person shall be allowed to renew the certificate. In accordance with 11 NCAC 08 .0712, continuing education requirements must be completed by June 30 for renewal of the standard certificate.

History

  • Authority G.S. 143-151.13A(b); 143-151.16
  • Eff. January 15, 1980
  • Amended Eff. February 1, 2006; July 18, 2002; August 1, 1990
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .0710 Return of Certificate When Leave Employment {#sec-11-ncac-08-.0710 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0710}

A standard certificate issued by the Board shall remain valid only so long as the person certified is employed by the State of North Carolina or any political subdivision thereof as a code enforcement official. When the person certified leaves such employment for any reason, he shall return the certificate to the Board. If the person subsequently obtains employment as a code enforcement official in any of such governmental jurisdictions, the Board shall re-issue the certificate to him, subject to the provisions of Rule .0709, provided, however, that if there is time remaining on the re-issued certificate, no additional fee will be charged.

History

  • Authority G.S. 143-151.15
  • Eff. January 15, 1980
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .0711 Pre-Qualification Program {#sec-11-ncac-08-.0711 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0711}

The Board may prequalify, as an inspector, an applicant who is not an employee of a city, county, or state inspection department. The Board shall accept applicants who meet the same education, experience, and other requirements listed in Rules .0702 through .0707 of this Section. The Board shall prequalify the applicant at the area and level of certification when the applicant completes these requirements. The Board shall issue a standard inspection certificate when the prequalified applicant is employed by a city, county, or state inspection department.

History

  • Authority G.S. 143-151.12
  • Eff. July 18, 2002
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .0712 Continuing Education - General {#sec-11-ncac-08-.0712 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0712}

As a condition of certificate renewal, holders of active standard and limited certificates must meet continuing education (CE) requirements in accordance with 11 NCAC 08 .0713 through 08 .0733. Courses and sponsors must meet the requirements in 11 NCAC 08 .0713 through 08 .0733.

History

  • Authority G.S. 143-151.13A(b)
  • Eff. February 1, 2006
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .0713 Continuing Education Requirements {#sec-11-ncac-08-.0713 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0713}

(a) To be eligible to renew a certificate, whether active standard or active limited, a Code Enforcement Official (CEO) shall have completed the requisite number of credit hours by June 30, 2007, and each June 30 thereafter.

(b) A credit hour is 50 minutes of class contact course instruction or 50 minutes of distance learning time.

(c) A CEO with an active limited certificate shall complete six hours of continuing education courses per renewal year in each technical area for which the limited certificate is valid. A CEO with an active standard certificate shall complete six hours of continuing education courses per renewal year for each standard certificate. A CEO with a limited and a standard certificate valid for the same technical area shall complete only six hours for that technical area.

(d) A CEO with only a probationary certificate and no standard or limited certificate is not required to complete any continuing education courses.

(e) If a course exceeds the number of credit hours specified for renewal of a technical area certificate, the excess credit hours may be carried forward into the following renewal year of that technical area certificate. The number of carry-forward credit hours shall not exceed six.

History

  • Authority G.S. 143-151.13A(b); 143-151.13A(f)(1); 143-151.13A(f)(4); 143-151.13A(f)(5); 143-151.16(b)
  • Eff. March 1, 2006
  • Amended Eff. April 1, 2007
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .0714 Inactive Code Enforcement Officials {#sec-11-ncac-08-.0714 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0714}

(a) A CEO either who is no longer employed by a local inspection department or who remains employed by a local inspection department but no longer has Code enforcement responsibility shall be inactive. Inactive CEOs shall not be subject to certificate renewal requirements nor continuing education requirements.

(b) When an inactive CEO wishes to become reemployed as an active CEO, the CEO shall complete continuing education courses within one year after reemployment to re-activate certificates in addition to completing the courses required for renewal of certificates as follows:

(1) A CEO who has been on inactive status for more than two years and who has not been continuously employed by a localinspection department during the period of inactive status shall complete continuing education courses of six hours for each technical area in which the CEO is certified.

(2) A CEO who has been on inactive status for more than two years and who has been continuously employed by a local inspection department during the period of inactive status shall complete continuing education courses of three hours for each technical area in which the CEO is certified.

(3) A CEO who has been on inactive status for two years or less shall complete CE courses of two hours for each technical area in which the CEO is certified.

History

  • Authority G.S. 143-151.13A(b); 143-151.13A(d); 143-151.15
  • Eff. February 1, 2006
  • Readopted Eff. July 1, 2019.
11 NCAC 08 .0715 Failure to Complete Continuing Education {#sec-11-ncac-08-.0715 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0715}

Any active CEO who fails to complete the required continuing education courses by June 30 of the current renewal year shall have his or her certificates suspended until the CE requirement is met. A CEO without a currently valid certificate shall not perform Code enforcement.

History

  • Authority G.S. 143-151.13A(f)(7)
  • Eff. February 1, 2006
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .0716 Compliance {#sec-11-ncac-08-.0716 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0716}

(a) General CEO compliance with annual CE requirements may be determined through an audit process conducted by the Board's staff. Determination of individuals to be audited shall be accomplished either through a random selection process or based on information available to the Board's staff. Individuals selected for auditing shall provide the Board's staff with documentation of the CE activities claimed for the renewal period, including attendance verification records in the form of transcripts, completion certificates, and any other documents supporting evidence of attendance.

(b) Attendance records shall be maintained by CEOs for a period of three years following the applicable certificate renewal date for audit verification purposes.

History

  • Authority G.S. 143-151.13A(f)
  • Eff. February 1, 2006
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .0717 Extensions of Time {#sec-11-ncac-08-.0717 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0717}

Upon petition to the Board staff, extensions of time to complete continuing education courses shall be granted to CEOs for good cause only, such as military service, physical disability, illness, and similar hardship if the period of hardship exceeded 90 consecutive days. Supporting documentation such as military orders or a letter from a physician must be furnished to the Board's staff. The Board staff shall determine whether the extension shall be granted within 10 calendar days of receipt of the petition and shall notify the CEO of its determination.

History

  • Authority G.S. 143-151.13A (e)
  • Eff. February 1, 2006
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .0718 Course Sponsors {#sec-11-ncac-08-.0718 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0718}

(a) A course sponsor is an organization or individual that has submitted an application and has been approved by the Board to provide courses and instructors for continuing education. No retroactive approval of a sponsor shall be granted by the Board for any reason.

(b) A prospective sponsor of a CE course shall obtain written approval from the Board to conduct the course before offering or conducting the course and before advertising or otherwise representing that the course is or may be approved for continuing education credit.

(c) Sponsors may include community colleges; colleges and universities; CEO associations; trade associations; providers of self-paced or internet based training programs; city, county, and state inspection departments or other agencies; and private instructors. A prospective sponsor shall be approved by the Board as a course sponsor if, upon submission of a completed application under Paragraph (d) of this Rule, the Board determines that at least one course proposed to be offered by the prospective sponsor meets the criteria for course approval under 11 NCAC 08 .0720, each instructor that is to offer course instruction for the prospective sponsor satisfies the requirements of Paragraph (e) of this Rule, and there are no other grounds under the laws of North Carolina on the basis of which approval should not be granted to the sponsor.

(d) Each course sponsor shall submit an application for continuing education course sponsor approval to the Board on a form provided by the Board. The application shall include:

(1) The name of the sponsor;

(2) The sponsor contact person, address and telephone number;

(3) The course contact hours;

(4) A description of the courses or types of courses the sponsor proposes to offer and the schedule of courses, if established, including dates, time and locations; and

(5) The identity and qualifications and experience of each instructor.

(e) Instructors shall have a minimum of one year of experience in architecture; engineering; construction; inspection; installation of equipment, building materials, or components; or other Code-related areas which shall be pertinent to the nature and purpose of the course(s) for which they will provide instruction. Instructors shall possess the ability to:

(1) Communicate through speech, with the ability to speak clearly, and with voice inflection, using proper grammar and vocabulary;

(2) Present instruction in a thorough, accurate, logical, orderly and understandable manner;

(3) Use varied instructional techniques in addition to straight lecture, such as class discussion, role-playing, or other techniques; and

(4) Use instructional aids, such as projectors and computers to enhance learning.

Instructors shall assure that class sessions are started on time and are conducted for the full amount of time that is scheduled. Instructors shall also assure that each CE course is taught according to the course outline and plan that was approved by the Board, including the furnishing of approved student materials.

History

  • Authority G.S. 143-151.13A(f)(2)
  • Eff. March 1, 2006
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .0719 Continuing Education Coordinator {#sec-11-ncac-08-.0719 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0719}

Each sponsor of a CE course shall designate one person to serve as the Continuing Education Coordinator for all Board-approved continuing education courses offered by the sponsor. The designated Coordinator shall serve as the official contact person for the sponsor and shall be responsible for signing the course completion certificates provided by the sponsor to CEOs completing courses and submitting to the Board's staff all required rosters, sign-in sheets, reports, and other information.

History

  • Authority G.S. 143-151.13A(f)
  • Eff. February 1, 2006
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .0720 Approved Courses {#sec-11-ncac-08-.0720 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0720}

(a) To be approved for credit in the continuing education program, a course shall be directly related to State Building Codes, inspection, administration, or enforcement of State Building Codes; construction or design of buildings or electrical, mechanical, plumbing, or fire prevention systems; or certification courses approved for CEOs.

(b) Credit shall be given only for courses that have been approved by the Board. Continuing education courses for other State occupational licenses must be specifically approved to satisfy the Board's continuing education requirements. Courses from approved sponsors must be specifically approved before being offered.

(c) Some courses shall be approved for credit in more than one area of certification. A CEO with multiple certificates may apply the credit to any certificate for which the course is approved. If the course hours are greater than required for one certificate, the remaining hours may be applied to other certificates for which the course is approved or the remaining hours may be carried over in accordance with 11 NCAC 08 .0713(e).

(d) A CEO shall only receive credit for the same course once within any three-year period.

(e) A course shall contain a minimum of one credit hour.

(f) A CEO may select a course other than one offered by an approved sponsor. In order to obtain approval for the course, the CEO shall, upon completion of the course, submit an application for approval on a form provided by the Board. The application shall include:

(1) the topic;

(2) content of lecture material;

(3) date, time, and location of the course;

(4) name and qualifications of the instructor; and

(5) the number of course contact hours received upon completion of the course.

In lieu of the form, the CEO may submit a course brochure that contains all of the information required by the form. The CEO shall also provide verification of attendance from the course instructor. The Board shall not accept any applications for course approval under this paragraph after April 30 of each year.

(g) Instructors shall receive twice the number of course credit hours for each instructional hour in an approved course. An instructor shall only receive twice the number of course credit hours for the same course once within any two-year period.

History

  • Authority G.S. 143-151.13A(f)(1); 143-151.13A(f)(4)
  • Eff. February 1, 2006
  • Amended Eff. April 1, 2007
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .0721 Course Accreditation Requirements {#sec-11-ncac-08-.0721 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0721}

(a) Sponsors of prospective CE courses shall apply for approval from the Board by submitting the following information to the Board's staff for consideration:

(1) course title and outline;

(2) nature and purpose of the course;

(3) outline of the course, including the number of training hours for each segment; and

(4) copies of handouts and materials to be furnished to students.

(b) To determine if a course is approved, the Board's staff shall review the course to determine if the course meets the requirements of 11 NCAC 08 .0720 and its stated objectives. The Board's staff shall issue written approval to the course sponsor for all courses deemed to be acceptable. The Board's staff shall notify the course sponsor of any course found not to be acceptable, providing specific reasons for the disapproval. A course sponsor may appeal the Board's staff's disapproval of a course to the Board, and such appeal shall be heard at the next scheduled meeting of the Board.

History

  • Authority G.S. 143-151.13A(f)(2)
  • Eff. February 1, 2006
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .0722 Distance Education Courses {#sec-11-ncac-08-.0722 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0722}

A distance education course is a continuing education course in which instruction is accomplished through the use of media and methods whereby instructor and student are separated by distance and sometimes by time. In addition to fulfilling all course accrediting requirements, a sponsor requesting approval of a distance education course must demonstrate that the proposed distance education course satisfies the following criteria:

(1) The course shall be designed to assure that students have defined learning objectives. If the nature of the subject matter is such that the learning objectives cannot be reasonably accomplished without some direct interaction between the instructor and students, then the course must be designed to provide for such interaction.

(2) A course that does not provide the opportunity for continuous audio and visual communication between instructor and all students during the course presentation shall utilize testing processes to assure student understanding of the subject material.

(3) A course that involves students completing the course on a self-paced study basis shall be designed so that the time required for a student of average ability to complete the course will be equivalent to a similar course taught in a classroom setting. The sponsor shall utilize a system that assures that students have actually performed all tasks required for completion and understanding of the subject material.

(4) The sponsor shall provide technical support to enable students to satisfactorily complete the course.

(5) The course instructors shall be available to respond in a timely manner to student questions about the subject matter of the course. Instructors shall have training in the proper use of the instructional delivery method utilized in the course, including the use of computer hardware and software or other applicable equipment and systems.

(6) The sponsor shall provide students with an information package containing all pertinent information regarding requirements unique to completing a distance education course, including any special requirements with regard to computer hardware and software or other equipment, and outlining in detail the instructor and technical support that will be available when taking the course.

(7) The sponsor shall use procedures that provide reasonable assurance that the student receiving continuing education credit for completing the course actually performed all the work required to complete the course. For courses that involve independent study by students, certification that the student personally completed all required course work shall be provided by the student to the sponsor, either by a signed statement (on a form provided by the sponsor) or, in the case of internet or computer based courses, by electronic means that are indicated in the software or on the website. Signed course completion statements or records of electronic certification shall be retained by the sponsor together with any other course records required by the rules in this Section.

(8) Sponsors seeking approval of distance education courses must submit to the Board's staff a complete copy of the course in the medium that is to be used, including all computer software that will be used in presenting the course and administering tests. If the course is to be internet based, the Board's staff must be provided access to the course via the internet and shall not be charged a fee for such access.

(9) Distance education courses shall comply with requirements for course completion reporting. Students shall not be reported for continuing education credit for distance education courses until the signed form from the student or electronic certification as described in Item (7) of this Rule has been received by the sponsor.

History

  • Authority G.S. 143-151.13A(f)(2); 143-151.13A(f)(3)
  • Eff. February 1, 2006
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .0723 Denial or Withdrawal of Approval of Sponsor or Course {#sec-11-ncac-08-.0723 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0723}

The Board may deny, suspend or terminate approval of sponsors or courses offered by a sponsor if the Board finds a failure to comply with the Board's rules or the course outline, or for misstatements as to content or participation.

History

  • Authority G.S. 143-151.13A(f)(7)
  • Eff. February 1, 2006
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .0724 Sponsor and Course Changes {#sec-11-ncac-08-.0724 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0724}

(a) Course sponsors shall obtain prior approval from the Board's staff for any proposed changes in the content or number of hours for approved CE courses. Requests for approval of changes shall be in writing. The Board's staff shall approve the changes if they satisfy the accreditation requirements as provided in 11 NCAC 08 .0721. Changes in course content that are solely for the purpose of assuring that information provided in a course is current, such as updating to address code amendments or changes in regulations, need not be submitted for approval.

(b) Course sponsors shall give prior written notice to the Board's staff in writing of any change in business name, Continuing Education Coordinator, address, or business telephone number.

History

  • Authority G.S. 143-151.13A(f)(2)
  • Eff. February 1, 2006
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .0725 Notice of Scheduled Courses {#sec-11-ncac-08-.0725 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0725}

(a) A sponsor shall provide the Board's staff with written notice of each scheduled course offering no later than 20 calendar days before a scheduled course date. The notice shall include the name and assigned number for the sponsor, the name and assigned number for the course, and the scheduled date, time, and location of the course.

(b) A sponsor shall notify any registered CEOs and the Board's staff of any schedule changes or course cancellations at least five calendar days before the original scheduled course date. If a change or cancellation becomes necessary after the five-day deadline, the sponsor shall notify the Board's staff and any registered CEOs as soon as the sponsor effects the change or cancellation.

History

  • Authority G.S. 143-151.13A(f)
  • Eff. February 1, 2006
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .0726 Advertising and Providing Course Information {#sec-11-ncac-08-.0726 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0726}

(a) Course sponsors shall not use false or misleading advertising.

(b) Any flyers, brochures, or other medium used to promote a CE course shall describe the fee to be charged and the sponsor's cancellation and fee refund policies.

(c) A sponsor of a CE course shall provide a description of the course content to the CEO.

History

  • Authority G.S. 143-151.13A(f)
  • Eff. February 1, 2006
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .0727 Fee for Ce Courses {#sec-11-ncac-08-.0727 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0727}

The sponsor of an approved CE course shall establish the amount of any fee to be charged to CEOs taking the course. The fee shall be all-inclusive. No separate or additional fee shall be charged to CEOs for providing course materials, providing course completion certificates, reporting course completion to the Board's staff, or for recouping administrative expenses. The total amount of any fees to be charged shall be included in any advertising or promotional materials for the course.

History

  • Authority G.S. 143-151.13A(f)
  • Eff. February 1, 2006
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .0728 Cancellation and Refund Policies {#sec-11-ncac-08-.0728 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0728}

If a scheduled course is canceled, a sponsor shall immediately notify preregistered CEOs of the cancellation. All prepaid fees received from preregistered CEOs shall be refunded within 30 days after the date of cancellation. Failure to provide a refund shall result in revocation of sponsor approval.

History

  • Authority G.S. 143-151.13A(f)
  • Eff. February 1, 2006
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .0729 Course Attendance {#sec-11-ncac-08-.0729 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0729}

(a) Course instructors shall monitor attendance to assure that all CEOs have completed the course. A CEO shall not be reported to the Board's staff as having completed a course unless the CEO satisfies the attendance requirement.

(b) Any CEO providing false information to a course sponsor shall not receive CE credits for the course, shall not be entitled to a refund of course fees, and may be subject to disciplinary action by the Board.

History

  • Authority G.S. 143-151.13A(f)
  • Eff. February 1, 2006
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .0730 Accommodations for Persons with Disabilities {#sec-11-ncac-08-.0730 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0730}

Course sponsors and instructors shall comply with the Americans with Disabilities Act or other laws requiring accommodation of persons with disabilities.

History

  • Authority G.S. 143-151.13A(f)
  • Eff. February 1, 2006
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .0731 Course Completion Reporting {#sec-11-ncac-08-.0731 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0731}

(a) Each sponsor shall submit to the Board's staff a report verifying completion of a CE course for each CEO who completes the course. A sponsor shall submit this report to the Board's staff within 15 calendar days following the course completion. Reports shall be submitted electronically on forms provided by the Board. Reports shall include the sponsor name and the sponsor identifying number, the name and the identifying number of the CEO who completed the course, the date of course completion, the course name and course identifying number, the trade area to which the course applies, the instructor name, the standard or limited certificate number to which to credit the course, and the number of credit hours, and the renewal year to apply the course credit.

(b) Course sponsors shall provide CEOs enrolled in each CE course an opportunity to complete an evaluation on a form provided by the Board of each approved CE course. Sponsors shall submit the completed evaluation forms to the Board's staff. The evaluation form may be provided on the internet at the option of the provider.

(c) Course sponsors shall provide each CEO who completes an approved CE course with a course completion certificate. Sponsors shall provide the certificates to CEOs within 15 calendar days following the course completion. The certificate shall be retained for three years by the CEO as proof of having completed the course.

History

  • Authority G.S. 143-151.13A(f)
  • Eff. February 1, 2006
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .0732 Retention of Course Records {#sec-11-ncac-08-.0732 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0732}

All course sponsors shall retain records of student registration, attendance, and course completion for CE courses for at least three years. All course sponsors shall make these records available to the Board's staff upon request.

History

  • Authority G.S. 143-151.13A(f)
  • Eff. February 1, 2006
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .0733 Board Monitors {#sec-11-ncac-08-.0733 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0733}

A course sponsor shall admit representatives of the Board to monitor any CE class without prior notice. Board representatives shall not be required to register or pay any fee and shall not be reported as having completed the course.

History

  • Authority G.S. 143-151.13A(f)
  • Eff. February 1, 2006
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .0734 Residential Changeout Inspector {#sec-11-ncac-08-.0734 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0734}

(a) Qualifications and types:

(1) A residential changeout inspector shall be authorized to inspect the replacement of a residential appliance as described in Subparagraph (2) of this Paragraph for one-and-two family dwellings, and individual residential units of condominiums and apartments provided the individual residential appliance serves only that residential dwelling unit.

(2) A residential changeout inspector may inspect the replacement of heating and air conditioning appliances and water heaters, provided that all of the following apply:

(A) the new appliance requires no alterations to the existing ducting, fuel type, or piping systems other than that required for transitioning to the new appliance;

(B) any venting associated with the new appliance shall be allowed to be installed, replaced, and repaired where such venting does not pass through a rated assembly;

(C) any new gas appliance shall be of the same category as the appliance being replaced;

(D) the new appliance does not require relocation, excluding minor adjustments in the same general vicinity;

(E) the installation of the new appliance does not require the relocation or addition to the existing electrical system, except the replacement of the appliance's branch circuit overcurrent device, or the replacement of the appliance's branch circuit where such circuit does not pass through a rated assembly shall be allowed; and

(F) the electrical branch circuit serving the appliance is single phase.

(b) The inspection performance log referenced in this Rule is available on the Office of State Fire Marshal website. The inspection performance log shall describe the criteria for authenticating the applicant and supervisors' qualifications, and the inspections performed.

(c) Every applicant shall:

(1) provide documentation that the applicant possesses a minimum of a high school education or a high school equivalency certificate;

(2) provide notarized certification by a city or county manager, clerk, or director of inspection department that the applicant will be performing "code enforcement," as defined in G.S. 143-151.8(a)(3), as an employee of that city or county; or provide certification by the head of the Engineering and Building Codes Division of the North Carolina Department of Insurance that the applicant will be performing "code enforcement," as defined in G.S. 143-151.8(a)(3), for a State department or agency;

(3) successfully complete courses developed by the Board. All applicants must successfully complete a law and administration course and a residential changeout inspections course. For the purpose of entry into the written examination administered by the Board, courses must be completed within five years of the exam in Subparagraph (4) of this Paragraph. These courses shall be administered and taught in the N.C. Community College System or other educational agencies accredited by a regional accrediting association. The North Carolina Department of Insurance, Office of State Fire Marshal may administer and teach certification courses for the purposes of developing program content and professional development. For the purposes of this Rule, "successful completion" is defined as attendance of a minimum of 80 percent of the hours taught and achieving a minimum score of 70 percent on the course exam; and

(4) achieve a passing grade of 70 percent on the written examination administered by the Board.

(d) Residential Changeout Inspector. A standard certificate, residential changeout inspector, shall be issued to any applicant who possesses a probationary residential changeout inspection certificate pursuant to Rule 11 NCAC 08 .0602, complies with Paragraph (c) of this Rule, and one of the following education and experience qualifications:

(1) possess any level standard certificate as an electrical inspector, mechanical inspector, or plumbing inspector; or

(2) all the following:

(A) at least six months of conducting residential changeout inspections with a probationary residential changeout inspection certificate; and

(B) completion and submission of an inspection performance log as administered by the North Carolina Department of Insurance, Office of State Fire Marshal.

History

  • Authority G.S. 143-151.12; 143-151.13
  • Eff. August 1, 2020
  • Amended Eff. December 1, 2021.
11 NCAC 08 .0735 Temporary Certificate {#sec-11-ncac-08-.0735 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0735}

History

  • Authority G.S. 143-151.12; 143-151.13
  • Emergency Adoption Eff. April 20, 2020
  • Temporary Adoption Eff. July 1, 2020
  • Emergency Adoption Eff. February 25, 2021
  • Temporary Adoption Eff. April 23, 2021
  • Temporary Adoption Exp. Eff. February 11, 2022
  • Emergency Adoption Eff. November 1, 2024
  • Emergency Adoption Eff. January 14, 2025.
11 NCAC 08 .0736 Fy 2020-2021 Special Ce Requirement {#sec-11-ncac-08-.0736 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0736}

History

  • Status: expired
  • Authority G.S. 143-151.12; 143-151.13A
  • Emergency Adoption Eff. February 25, 2021
  • Temporary Adoption Eff. April 23, 2021
  • Temporary Adoption Expired Eff. February 11, 2022.
11 NCAC 08 .0737 Building Inspector Level I, Ii and Iii {#sec-11-ncac-08-.0737 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0737}

(a) A Building Inspector, Level I (Residential), certified on or after January 1, 2027 shall be qualified to perform code-enforcement official duties for residential buildings up to three stories in height with no more than four dwelling units, in accordance with the provisions of the North Carolina Residential Code.

(b) A Building Inspector, Level II (Commercial), certified on or after January 1, 2027 shall be qualified to perform code-enforcement official duties for commercial buildings up to four stories in height, except for hazardous and institutional occupancy classifications.

(c) A Building Inspector, Level III, shall be qualified to perform code-enforcement official duties for any residential or commercial building or structure occupancy classification.

(d) Building Inspectors, Levels I, II, or III certified on or before December 31, 2026 shall be qualified to perform code-enforcement official duties for the types of structures described in Rule .0706(a)(2) of this Section until December 31, 2032.

(e) Building Inspector, Level I. A standard certificate, Building Inspector, Level I, shall be issued to any applicant who complies with Rule .0706(b) through (g) of this Section and who provides documentation that the applicant possesses one of the following:

(1) A license as a professional engineer, architect, residential or building contractor or a registered interior designer;

(2) A one-year diploma in building construction from an accredited college or an equivalent apprenticeship or trade school program in building construction;

(3) A two-year degree from an accredited college or university in building construction, electrical, mechanical, or plumbing contracting, construction management or engineering technology;

(4) A four-year degree from an accredited college or university;

(5) At least six months of residential inspection experience, with a probationary Level I building inspection certificate, on a minimum of two Level I buildings while working under the direct supervision of a standard certified building inspector I, II, or III, with a supporting letter from the applicant's supervisor which complies with of Rule .0706(b) of this Section;

(6) At least one year of residential design, construction, or inspection experience on a minimum of two Level I buildings while working under the direct supervision of a licensed professional engineer, architect, or residential or building contractor, with a supporting letter from the applicant's supervisor which complies with Rule .0706(b) of this Section;

(7) At least two years of residential design, construction, or inspection experience while working under a licensed residential contractor;

(8) At least two years of experience as an owner, manager, supervisor, or qualifier, as that term is defined in G.S. 87-10(b), of a residential construction company, who has a license as a residential contractor, and who has construction experience on a minimum of two Level I buildings (this does not include a business partner providing monetary backing for the company);

(9) At least two years of construction experience as a subcontractor or employee of a residential contractor in the building trades, or work in building construction, on a minimum of two Level I buildings and under the direct supervision of a licensed residential contractor who at that time had at least three years of experience;

(10) At least one year of experience with a probationary Level I building inspection certificate inspecting residential construction on a minimum of two Level I buildings.

(f) Building Inspector, Level II. A standard certificate, building inspector, Level II, shall be issued to any applicant who complies with Rule .0706(b) through (g) and who provides documentation that the applicant possesses one of the following:

(1) A license as a professional engineer, architect, building contractor or registered interior designer;

(2) A one-year diploma in building construction from an accredited college or an equivalent apprenticeship or trade school program in building construction;

(3) A two-year degree from an accredited college or university in architecture, civil or architectural engineering, building construction, or construction management and at least one year of building design, construction, or inspection experience on a minimum of two Level II buildings while working under the direct supervision of a certified building inspector II or III, licensed engineer, architect, or building contractor;

(4) A four-year degree from an accredited college or university and at least one year of design, construction, or inspection experience on a minimum of two Level II buildings while working under the direct supervision of a certified building inspector II or III, licensed professional engineer, architect, or building contractor;

(5) At least six months of commercial inspection experience with a probationary Level II building inspection certificate on a minimum of two Level II buildings while working under the direct supervision of a standard certified building inspector II or III, with a supporting letter from the applicant's supervisor which complies with Rule .0706(b) of this Section;

(6) At least one year of commercial design, construction, or inspection experience on a minimum of two Level II buildings while working under the direct supervision of a licensed professional engineer, architect, or building contractor, with a supporting letter from the applicant's supervisor which complies with Rule .0706(b) of this Section;

(7) At least two years of commercial building inspection experience including one year of inspection experience with a probationary Level II building inspection certificate on a minimum of two Level II buildings while working under the direct supervision of a certified building inspector II or III, with a supporting letter from the applicant's supervisor which complies with Rule .0706(b) of this Section;

(8) At least two years of commercial building design, construction, or inspection experience on a minimum of two Level II buildings while working under the direct supervision of a licensed engineer, registered architect, or licensed intermediate or unlimited building contractor, with a supporting letter from the applicant's supervisor which complies with Rule .0706(b) of this Section; or

(9) At least one year of experience with a probationary Level II building inspection certificate inspecting construction of a minimum of two Level II buildings.

(g) Building Inspector, Level III. A standard certificate, building inspector, Level III, shall be issued to any applicant who complies with Rule .0706(b) through (g) of this Section and who provides documentation that the applicant possesses one of the following education and experience qualifications:

(1) A license as a professional engineer, architect, or unlimited building contractor with design, construction, or inspection experience on a minimum of two Level III buildings and specialization in architecture, civil or architectural engineering, or fire protection engineering;

(2) A four-year degree from an accredited college or university in architecture, civil or architectural engineering, building construction or construction management and at least one year of building design, construction, or inspection experience while working under the direct supervision of a certified building inspector III, licensed professional engineer, architect, or unlimited building contractor, at least at the level of supervisor in responsible charge of a minimum of two Level III buildings;

(3) A two-year degree from an accredited college or university in architecture, civil or architectural engineering, building construction, or construction management and at least three years of building design, construction, or inspection experience while working under the direct supervision of a certified building inspector III, licensed professional engineer, architect, or unlimited building contractor with at least one year at the level of supervisor in responsible charge of a minimum of two Level III buildings;

(4) At least four years of inspection experience including one year of building inspection experience with a probationary Level III building inspection certificate on a minimum of two Level III buildings while working under the direct supervision of a certified building inspector III, with a supporting letter from the applicant's supervisor which complies with Rule .0706(b) of this Section;

(5) At least four years of building design, construction, or inspection experience while working under the direct supervision of a licensed engineer, architect, or unlimited building contractor, two years of which have been performed at the level of supervisor in responsible charge of a minimum of two Level III buildings with a supporting letter from the applicant's supervisor which complies with Rule .0706(b) of this Section; or

(6) At least one year of experience with a probationary Level III building inspection certificate inspecting the construction of a minimum of two Level III buildings.

History

  • Authority G.S. 143-151.12(1); 143-151.12(3); 143-151.13
  • Eff. February 1, 2025
  • Temporary Amendment Eff. November 7, 2025
  • Amended Eff. April 1, 2026.
11 NCAC 08 .0738 Electrical Inspector Level I, Ii and Iii {#sec-11-ncac-08-.0738 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0738}

(a) An Electrical Inspector, Level I (Residential), certified on or after January 1, 2027, shall be qualified to perform code-enforcement official duties for electrical systems that serve individual residential dwelling units and equipment including its accessory structures and equipment, except for those systems described in Paragraph (b) or (c) of this Rule.

(b) An Electrical Inspector, Level II (Commercial), certified on or after January 1, 2027, shall be qualified to perform code-enforcement official duties for electrical systems that serve non-residential structures and equipment including common areas of multi-family residential structures, except for those systems described in Paragraph (a) or (c) of this Rule.

(c) An Electrical Inspector, Level III, (Special Systems) shall be qualified to perform code-enforcement official duties for any residential or commercial building or structure and the following special systems:

(1) Photovoltaic systems

(2) Electrical power production facilities and equipment with a generating capacity of 5,000 kW or greater.

(d) Electrical Inspectors, Levels I, II, or III certified on or before December 31, 2026 shall be qualified to perform code-enforcement official duties for electrical systems that serve the types of structures described in Rule .0706(a)(2) of this Section until December 31, 2032.

(e) Electrical Inspector, Level I. A standard certificate, electrical inspector, Level I, shall be issued to any applicant who complies with Rule .0706(b) through (g) of this Section and who provides documentation that the applicant possesses one of the following:

(1) A one-year diploma in electrical construction from an accredited college or an equivalent apprenticeship or trade school program in electrical construction;

(2) A four-year degree from an accredited college or university;

(3) At least six months of electrical inspection experience with a probationary Level I electrical inspection certificate on a minimum of two Level I buildings while working under the direct supervision of a standard certified electrical inspector I or III, with a supporting letter from the applicant's supervisor which complies with Rule .0706(b) of this Section;

(4) At least one year of electrical design, construction, or inspection experience on a minimum of two Level I buildings while working under the direct supervision of a licensed professional engineer or licensed electrical contractor, with a supporting letter from the applicant's supervisor which complies with Rule .0706(b) of this Section;

(5) A restricted (one family dwelling) license or license as an electrical contractor;

(6) At least two years of electrical installation or inspection experience while working under a licensed electrical contractor; or

(7) At least one year of experience with a probationary Level I electrical inspection certificate inspecting electrical installations on a minimum of two Level I buildings.

(f) Electrical Inspector, Level II. A standard certificate, electrical inspector, Level II, shall be issued to any applicant who complies with Rule .0706(b) through (g) of this Section and who provides documentation that the applicant possesses one of the following:

(1) A license as a professional engineer;

(2) A four-year degree from an accredited college or university in electrical engineering or electrical construction;

(3) A four-year degree from an accredited college or university and at least two years of electrical design, construction, or inspection experience on a minimum of two Level II buildings while working under the direct supervision of a certified electrical inspector II or III, licensed engineer, or intermediate or unlimited licensed electrical contractor;

(4) A two-year degree from an accredited college or university in electrical engineering or electrical construction and at least two years of electrical design, construction, or inspection experience on a minimum of two Level II buildings while working under the direct supervision of a certified electrical inspector II or III, licensed engineer, or intermediate or unlimited licensed electrical contractor;

(5) An intermediate or unlimited license as an electrical contractor with experience on a minimum of two Level II buildings;

(6) At least three years of electrical inspection experience including one year of inspection experience with a probationary Level II electrical inspection certificate on a minimum of two Level II buildings while working under the direct supervision of a certified electrical inspector II or III, with a supporting letter from the applicant's supervisor which complies with Rule .0706(b) of this Section

(7) At least three years of electrical design, construction, or inspection experience on a minimum of two Level II buildings while working under the direct supervision of a licensed professional engineer or licensed intermediate or unlimited electrical contractor, with a supporting letter from the applicant's supervisor which complies Rule .0706(b) of this Section; or

(8) At least one year of experience with a probationary Level II electrical inspection certificate inspecting electrical installations on a minimum of two Level II buildings.

(g) Electrical Inspector, Level III. A standard certificate, electrical inspector, Level III, shall be issued to any applicant who complies with Rule .0706(b) through (g) of this Section and who provides documentation that the applicant possesses one of the following:

(1) A license as a professional engineer with design, construction, or inspection experience on Level III buildings and specialization in electrical engineering;

(2) A four-year degree from an accredited university in electrical engineering or electrical construction and at least one year of electrical design, installation, or inspection experience while working under the direct supervision of a certified electrical inspector III, licensed professional engineer, or licensed unlimited electrical contractor at least at the level of supervisor in responsible charge of a minimum of two Level III buildings;

(3) A two-year degree from an accredited college or university in electrical engineering or electrical construction and at least three years of electrical design, installation, or inspection experience while working under the direct supervision of a certified electrical inspector III, licensed professional engineer, or licensed unlimited electrical contractor with at least one year at the level of supervisor in responsible charge of a minimum of two Level III buildings;

(4) An unlimited license as an electrical contractor with experience on a minimum of two Level III buildings;

(5) At least four years of electrical inspection experience including one year of inspection experience with a probationary Level III electrical inspection certificate on a minimum of two Level III buildings while working under the direct supervision of a certified electrical inspector III, with a supporting letter from the applicant's supervisor which complies with Rule .0706(b) of this Section;

(6) At least four years of electrical design, construction, or inspection experience while working under the direct supervision of a licensed professional engineer or licensed unlimited electrical contractor, two years of which have been performed at the level of supervisor in responsible charge of a minimum of two Level III buildings, with a supporting letter from the applicant's supervisor which complies with Rule .0706(b) of this Section; or

(7) At least one year of experience with a probationary Level III electrical inspection certificate inspecting the electrical installations of a minimum of two Level III buildings.

History

  • Authority G.S. 143-151.12(1); 143-151.12(3); 143-151.13
  • Eff. February 1, 2025
  • Temporary Amendment Eff. November 7, 2025
  • Amended Eff. April 1, 2026.
11 NCAC 08 .0739 Mechanical Inspector Level I, Ii and Iii {#sec-11-ncac-08-.0739 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0739}

(a) A Mechanical Inspector, Level I (Residential), certified on or after January 1, 2027, shall be qualified to perform code-enforcement official duties in accordance with the provisions of the North Carolina Residential Code.

(b) A Mechanical Inspector, Level II (Commercial), certified on or after January 1, 2027, shall be qualified to perform code-enforcement official duties in accordance with the provisions of the North Carolina Mechanical Code, North Carolina Fuel Gas Code, and the North Carolina Energy Conservation Code.

(c) A Mechanical Inspector, Level III, shall be qualified to perform code-enforcement official duties in accordance with the provisions of the North Carolina Residential Code, North Carolina Mechanical Code, North Carolina Fuel Gas Code, and the North Carolina Energy Conservation Code for any residential or commercial building or structure.

(d) Mechanical Inspectors, Levels I, II, or III certified on or before December 31, 2026 shall be qualified to perform code-enforcement official duties for the types of structures described in Rule .0706(a)(2) of this Section until December 31, 2032.

(e) Mechanical Inspector, Level I. A standard certificate, mechanical inspector, Level I, shall be issued to any applicant who complies with Rule .0706(b) through (g) of this Section and who provides documentation that the applicant possesses one of the following:

(1) A one-year diploma in mechanical construction from an accredited college or an equivalent apprenticeship or trade school program in mechanical construction;

(2) A four-year degree from an accredited college or university;

(3) At least six months of mechanical inspection experience with a probationary Level I mechanical inspection certificate on a minimum of two Level I buildings while working under the direct supervision of a standard certified mechanical inspector I or III, with a supporting letter from the applicant's supervisor which complies with Rule .0706(b) of this Section;

(4) At least one year of mechanical design, construction, or inspection experience on a minimum of two Level I buildings while working under the direct supervision of a licensed professional engineer or licensed Class I mechanical contractor, with a supporting letter from the applicant's supervisor which complies with Rule .0706(b) of this Section;

(5) An H-1, H-2, or H-3 Class I license as a mechanical contractor;

(6) At least two years of mechanical installation or inspection experience while working under a Class I H-1, H-2, or H-3 licensed mechanical contractor; or

(7) At least one year of experience with a probationary Level I mechanical inspection certificate inspecting mechanical installations on a minimum of two Level I buildings.

(f) Mechanical Inspector, Level II. A standard certificate, mechanical inspector, Level II, shall be issued to any applicant who complies with Rule .0706(b) through (g) of this Section and who provides documentation that the applicant possesses one of the following:

(1) A license as a professional engineer;

(2) A four-year degree from an accredited college or university in mechanical engineering or mechanical construction;

(3) A four-year degree from an accredited college or university and at least two years of mechanical design, construction, or inspection experience on a minimum of two Level II buildings while working under the direct supervision of a certified mechanical inspector II or III, licensed professional engineer, or licensed Class I mechanical contractor;

(4) A two-year degree from an accredited college or university in mechanical engineering or mechanical construction and at least two years of mechanical design, construction, or inspection experience on a minimum of two Level II buildings while working under the direct supervision of a certified mechanical inspector II or III, licensed professional engineer, or licensed Class I mechanical contractor;

(5) An H-1, H-2, or H-3 Class I license as a mechanical contractor with experience on a minimum of two Level II buildings;

(6) At least three years of mechanical inspection experience including one year of inspection experience with a probationary Level II mechanical inspection certificate on a minimum of two Level II buildings while working under the direct supervision of a certified mechanical inspector II or III, with a supporting letter from the applicant's supervisor which complies with Rule .0706(b) of this Section;

(7) At least three years of mechanical design, construction, or inspection experience on a minimum of two Level II buildings while working under the direct supervision of a licensed professional engineer or licensed Class I H-1, H-2, or H-3 mechanical contractor, with a supporting letter from the applicant's supervisor which complies with Rule .0706(b) of this Section; or

(8) At least one year of experience with a probationary Level II mechanical inspection certificate inspecting mechanical installations on a minimum of two Level II buildings.

(g) Mechanical Inspector, Level III. A standard certificate, mechanical inspector, Level III shall be issued to any applicant who complies with Rule .0706(b) through (g) of this Section and who provides documentation that the applicant possesses one of the following:

(1) A license as a professional engineer, with design, construction, or inspection experience on Level III buildings and specialization in mechanical engineering;

(2) A four-year degree from an accredited university in mechanical engineering or mechanical construction and at least one year of mechanical design, installation, or inspection experience while working under the direct supervision of a certified mechanical inspector III, licensed professional engineer, or licensed Class I H-1, H-2, and H-3 mechanical contractor at least at the level of supervisor in responsible charge of a minimum of two Level III buildings;

(3) A two-year degree from an accredited college or university in mechanical engineering or mechanical construction and at least three years of mechanical design, installation, or inspection experience while working under the direct supervision of a certified mechanical inspector III, licensed professional engineer, or licensed Class I H-1, H-2, and H-3 mechanical contractor with at least one year at the level of supervisor in responsible charge of a minimum of two Level III buildings;

(4) H-1, H-2, and H-3 Class I licenses as a mechanical contractor with experience on a minimum of two Level III buildings;

(5) At least four years of mechanical inspection experience including one year of inspection experience with a probationary Level III mechanical inspection certificate on a minimum of two Level III buildings while working under the direct supervision of a certified mechanical inspector III, with a supporting letter from the applicant's supervisor which complies with Rule .0706(b) of this Section;

(6) At least four years of mechanical design, construction, or inspection experience while working under the direct supervision of a licensed professional engineer or licensed Class I H-1, H-2, and H-3 mechanical contractor, two years of which have been performed at the level of supervisor in responsible charge of a minimum of two Level III buildings, with a supporting letter from the applicant's supervisor which complies with Rule .0706(b) of this Section; or

(7) At least one year of experience with a probationary Level III mechanical inspection certificate inspecting the mechanical installations of a minimum of two Level III buildings.

History

  • Authority G.S. 143-151.12(1); 143-151.12(3); 143-151.13
  • Eff. February 1, 2025
  • Temporary Amendment Eff. November 7, 2025
  • Amended Eff. April 1, 2026.
11 NCAC 08 .0740 Plumbing Inspector Level I, Ii and Iii {#sec-11-ncac-08-.0740 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0740}

(a) A Plumbing Inspector, Level I (Residential), certified on or after January 1, 2027 shall be qualified to perform code-enforcement official duties for residential buildings up to three stories in height with no more than four dwelling units in accordance with the provisions of the North Carolina Residential Code, including NFPA 13D residential sprinkler systems.

(b) A Plumbing Inspector, Level II (Commercial), certified on or after January 1, 2027 shall be qualified to perform code-enforcement official duties for commercial buildings up to four stories in height.

(c) A Plumbing Inspector, Level III, shall be qualified to perform code-enforcement official duties for any residential or commercial building or structure.

(d) Plumbing Inspectors, Levels I, II, or III certified on or before December 31, 2026 shall be qualified to perform code-enforcement official duties for the types of structures described in Rule .0706(a)(2) of this Section until December 31, 2032.

(e) Plumbing Inspector, Level I. A standard certificate, plumbing inspector, Level I, shall be issued to any applicant who complies with Rule .0706(b) through (g) of this Section and who provides documentation that the applicant possesses one of the following:

(1) A one-year diploma in plumbing construction from an accredited college or an equivalent apprenticeship or trade school program in plumbing construction;

(2) A four-year degree from an accredited college or university;

(3) At least six months of plumbing inspection experience with a probationary Level I plumbing inspection certificate on a minimum of two Level I buildings while working under the direct supervision of a standard certified plumbing inspector I or III, with a supporting letter from the applicant's supervisor which complies with Rule .0706(b) of this Section;

(4) At least one year of plumbing design, construction, or inspection experience on a minimum of two Level I buildings while working under the direct supervision of a licensed professional engineer or licensed Class I plumbing contractor with a supporting letter from the applicant's supervisor which complies with Rule .0706(b) of this Section;

(5) A Class I license as a plumbing contractor;

(6) At least two years of plumbing installation or inspection experience while working under a licensed Class I plumbing contractor; or

(7) At least one year of experience with a probationary Level I plumbing inspection certificate inspecting plumbing installations a minimum of two Level I buildings.

(f) Plumbing Inspector, Level II. A standard certificate, plumbing inspector, Level II, shall be issued to any applicant who complies with Rule .0706(b) through (g) of this Section and who provides documentation that the applicant possesses one of the following:

(1) A license as a professional engineer;

(2) A four-year degree from an accredited college or university in mechanical engineering or mechanical or plumbing construction;

(3) A four-year degree from an accredited college or university and at least two years of plumbing design, construction, or inspection experience on a minimum of two Level II buildings while working under the direct supervision of a certified plumbing inspector II or III, licensed professional engineer, or licensed Class I plumbing contractor;

(4) A two-year degree from an accredited college or university in mechanical engineering or mechanical or plumbing construction and at least two years of plumbing design, construction, or inspection experience on a minimum of two Level II buildings while working under the direct supervision of a certified plumbing inspector II or III, licensed professional engineer, or licensed Class I plumbing contractor;

(5) A Class I license as a plumbing contractor with experience on a minimum of two Level II buildings;

(6) At least three years of plumbing inspection experience including one year of inspection experience with a probationary Level II plumbing inspection certificate on a minimum of two Level II buildings while working under the direct supervision of a certified plumbing inspector II or III, with a supporting letter from the applicant's supervisor which complies with Rule .0706(b) of this Section;

(7) At least three years of plumbing design, construction, or inspection experience on a minimum of two Level II buildings while working under the direct supervision of a licensed professional engineer or licensed Class I plumbing contractor with a supporting letter from the applicant's supervisor which complies with Rule .0706(b) of this Section; or

(8) At least one year of experience with a probationary Level II plumbing inspection certificate inspecting plumbing installations on a minimum of two Level II buildings.

(g) Plumbing Inspector, Level III. A standard certificate, plumbing inspector, Level III shall be issued to any applicant who complies with Rule .0706(b) through (g) of this Section and who provides documentation that the applicant possesses one of the following:

(1) A license as a professional engineer with design, construction, or inspection experience on Level III buildings and specialization in mechanical engineering;

(2) A four-year degree from an accredited university in mechanical engineering or mechanical or plumbing construction and at least one year of plumbing design, installation, or inspection experience while working under the direct supervision of a certified plumbing inspector III, licensed professional engineer, or licensed Class I plumbing contractor at least at the level of supervisor in responsible charge of a minimum of two Level III buildings;

(3) A two-year degree from an accredited college or university in mechanical engineering or plumbing construction and at least three years of plumbing design, installation, or inspection experience while working under the direct supervision of a certified plumbing inspector III, licensed professional engineer, or licensed Class I plumbing contractor, with at least one year at the level of supervisor in responsible charge of a minimum of two Level III buildings;

(4) A Class I license as a plumbing contractor with experience on a minimum of two Level III buildings;

(5) At least four years of plumbing inspection experience including one year of inspection experience with a probationary Level III plumbing inspection certificate on a minimum of two Level III buildings while working under the direct supervision of a certified plumbing inspector III, with a supporting letter from the applicant's supervisor which complies with Rule .0706(b) of this Section;

(6) At least four years of plumbing design, construction, or inspection experience while working under the direct supervision of a licensed professional engineer or licensed Class I plumbing contractor, two years of which have been performed at the level of supervisor in responsible charge of a minimum of two Level III buildings, with a supporting letter from the applicant's supervisor which complies with Rule .0706(b) of this Section; or

(7) At least one year of experience with a probationary Level III plumbing inspection certificate inspecting the plumbing installations of a minimum of two Level III buildings.

History

  • Authority G.S. 143-151.12(1); 143-151.12(3); 143-151.13
  • Eff. February 1, 2025
  • Temporary Amendment Eff. November 7, 2025
  • Amended Eff. April 1, 2026.
11 NCAC 08 .0741 Fire Inspector Level I, Ii and Iii {#sec-11-ncac-08-.0741 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0741}

(a) A Fire Inspector, Level I, certified on or after January 1, 2027 shall be qualified to perform code-enforcement official duties of operational permit issuance, field inspection, and related code enforcement activities for existing Assembly (limited to 1 story, 20,000 sf), Business, Mercantile, Residential, Utility and Miscellaneous occupancies, and other existing facilities, premises, and structures within those occupancies as required. A Fire Inspector Level I is not authorized to conduct inspections on high-rise buildings, inspections on new construction, or plan review for any occupancy.

(b) A Fire Inspector, Level II, certified on or after January 1, 2027 shall be qualified to perform code-enforcement official duties of plan review, permit issuance, field inspection, certificate of compliance and occupancy, change of occupancy and code-enforcement activities for existing building occupancies and new construction. A Fire Inspector, Level II, is limited to Assembly, Business, Educational, Factory-Industrial, Mercantile, Residential, Storage, Utility and Miscellaneous, and other facilities, premises, and structures within those occupancies as required. A Fire Inspector, Level II, is not authorized to conduct plan review or inspections of high-rise buildings, institutional, or hazardous occupancies.

(c) A Fire Inspector, Level III, shall be qualified to perform code-enforcement official duties of plan review, permit issuance, field inspection, certificate of compliance and occupancy, change of occupancy, and related code- enforcement activities for any existing or new occupancy classification and other facilities, premises, and structures within those occupancies as required.

(d) Fire Inspectors, Levels I, II, or III certified on or before December 31, 2026 shall be qualified to perform code-enforcement official duties for the types of structures described in Rule .0706(a)(1) of this Section until December 31, 2032.

(e) The level of certification required for buildings with multiple occupancy classifications shall be assigned based on the highest level required as indicated in Paragraphs (a) through (c) of this Rule.

(f) Fire Inspector, Level I. A standard certificate, fire inspector, Level I, shall be issued to any applicant who complies with Rule .0706(b) through (g) of this Section and who provides documentation that the applicant possesses one of the following education and experience qualifications:

(1) A one-year diploma in fire science from an accredited college or an equivalent certificate of completion from an apprenticeship or trade school program in fire science;

(2) A four-year degree from an accredited college or university;

(3) At least six months of fire inspection experience with a probationary Level I fire inspection certificate on a minimum of two Level I buildings while working under the direct supervision of a standard certified fire inspector Level I, II, or III, with a supporting letter from the applicant's supervisor which complies with Rule .0706(b) of this Section;

(4) At least one year of fire protection design, construction, or inspection experience on a minimum of two Level I buildings while working under the direct supervision of a licensed professional engineer, licensed architect, or licensed building, electrical, or fire sprinkler contractor, with a supporting letter from the applicant's supervisor which complies with Rule .0706(b) of this Section;

(5) A license as a fire sprinkler contractor;

(6) At least two years of construction or inspection experience in fire protection systems while working under a licensed building, electrical, or fire sprinkler contractor;

(7) At least one year of experience with a probationary Level I fire inspection certificate conducting fire inspections on a minimum of two Level I buildings;

(8) At least four years of experience in fire suppression activities for a city, county, volunteer, or other governmental fire department; or

(9) Firefighter Level II certification under the North Carolina State Fire and Rescue Commission with at least one year of fire inspection experience in Level I buildings.

(g) Fire Inspector, Level II. A standard certificate, fire inspector, Level II, shall be issued to any applicant who complies with Rule .0706(b) through (g) of this Section and who provides documentation that the applicant possesses one of the following education and experience qualifications:

(1) A license as a professional engineer or architect;

(2) A four-year degree from an accredited college or university in architecture, civil or architectural engineering, building construction, or fire science;

(3) A four-year degree from an accredited college or university and at least two years of fire protection design, construction, or inspection experience on a minimum of two Level II buildings while working under the direct supervision of a certified fire inspector Level II or III, licensed professional engineer, architect, intermediate or unlimited licensed building contractor, or licensed fire sprinkler contractor;

(4) A two-year degree from an accredited college or university in architecture, civil or architectural engineering, building construction, construction management or fire science and at least two years of fire protection design, construction, or inspection experience on a minimum of two Level II building fire protection systems while working under the direct supervision of a certified fire inspector Level II or III, licensed professional engineer, architect, intermediate or unlimited licensed building contractor, or licensed fire sprinkler contractor;

(5) A license as a fire sprinkler contractor with experience on a minimum of two Level II buildings;

(6) At least three years of fire inspection experience including at least one year of inspection experience with a probationary Level II fire inspection certificate on a minimum of two Level II buildings while working under the direct supervision of a certified fire inspector II or III, with a supporting letter from the applicant's supervisor which complies with Rule .0706(b) of this Section;

(7) At least three years of fire protection system design, construction, or inspection experience on a minimum of two Level II buildings while working under the direct supervision of a licensed professional engineer, architect, licensed intermediate or unlimited building contractor, or licensed fire sprinkler contractor, with a supporting letter from the applicant's supervisor which complies with Rule .0706(b) of this Section;

(8) At least one year of experience with a probationary Level II fire inspection certificate conducting fire inspections on a minimum of two Level II buildings; or

(9) Completion of the basic, intermediate, and advanced classes of the North Carolina Fire Prevention School with at least three years of fire inspection experience in Level II buildings.

(h) Fire Inspector, Level III. A standard certificate, fire inspector, Level III, shall be issued to any applicant who complies with Rule .0706(b) through (g) of this Section and who provides documentation that the applicant possesses one of the following education and experience qualifications:

(1) A license as a professional engineer or architect with design, construction, or inspection experience on Level III buildings and specialization in architecture, civil or architectural engineering, or fire protection engineering;

(2) A four-year degree from an accredited college or university in civil, architectural, construction management or fire protection engineering and at least one year of fire inspection experience while working under a certified fire inspector III, licensed professional engineer, architect, or licensed fire sprinkler contractor on a minimum of two Level III buildings;

(3) A two-year degree from an accredited college or university in civil, architectural, or fire protection engineering and at least three years of fire protection design, installation, or inspection experience while working under the direct supervision of a certified fire inspector Level III, licensed professional engineer, architect, licensed unlimited building contractor, or licensed fire sprinkler contractor with at least one year in responsible charge of a minimum of two Level III buildings;

(4) A license as a fire sprinkler contractor with experience on a minimum of two Level III buildings;

(5) At least four years of fire inspection experience in fire protection systems including one year of inspection experience with a probationary Level III fire inspection certificate on a minimum of two Level III buildings while working under the direct supervision of a certified fire inspector Level III, with a supporting letter from the applicant's supervisor which complies with Rule .0706(b) of this Section;

(6) At least four years of fire protection system design, construction, or inspection experience while working under the direct supervision of a licensed professional engineer, architect, licensed intermediate or unlimited building contractor, or licensed fire sprinkler contractor, two years of which have been performed at the level of supervisor in responsible charge of a minimum of two Level III buildings, with a supporting letter from the applicant's supervisor which complies with Rule .0706(b) of this Section; or

(7) At least one year of experience with a probationary Level III fire inspection certificate conducting fire inspections on a minimum of two Level III buildings.

History

  • Authority G.S. 143-151.12(1); 143-151.12(3); 143-151.13
  • Eff. February 1, 2025
  • Temporary Amendment Eff. November 7, 2025
  • Amended Eff. April 1, 2026.
11 NCAC 08 .0801 Disciplinary Powers {#sec-11-ncac-08-.0801 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0801}

(a) As used in this Section "Board" and "Code" have the same meanings as those terms are defined in G.S. 143-151.8(a); and "official" means a qualified Code-enforcement official as defined in G.S. 143-151.8(5).

(b) Any person who believes that an official is or has been in violation of G.S. 143-151.17(a) may file a complaint against that official. Copies of this Section and G.S. 143-151.17 shall be mailed to any person requesting complaint information from the Board.

(c) The complaint must specifically refer to one or more of the grounds in G.S. 143-151.17(a). The name of the official, if known, and the name of the local inspection department must be listed. If the official is unknown, the complaint must refer to "the inspector who performed the building (or electrical, mechanical, plumbing, or fire prevention) inspection."

(d) Supporting information must be included to justify the complaint. If the complaint involves violations of the Code that the official did not discover, a list of those violations must be submitted with the complaint. Such information may be provided by the complainant, an architect, professional engineer, licensed contractor, certified inspector, or other person with knowledge of the Code. Supporting information must refer to specific violations of the Code or of the General Statutes.

(e) The complaint must be in writing, signed by the complainant, and dated. The complaint must include the complainant's mailing address and a daytime phone number at which the complainant may be reached. The street address of the structure must be included. There must be a notarized verification at the end of the complaint.

History

  • Authority G.S. 143-151.12(1); 143-151.17; 150B-38(h)
  • Eff. January 15, 1980
  • Amended Eff. September 1, 1991
  • Temporary Amendment Eff. March 3, 1992 For a Period of 169 Days to Expire on August 21, 1992
  • Amended Eff. June 1, 1992
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .0802 Preliminary Investigation {#sec-11-ncac-08-.0802 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0802}

History

  • Status: repealed
  • Filed as a Temporary Amendment Eff. March 3, 1992 For a Period of 169 Days to Expire on August 21, 1992
  • Authority G.S. 143-151.12(1); 143-151.17(b); 150B-38(h)
  • Eff. January 15, 1980
  • Amended Eff. June 1, 1992; September 1, 1991
  • Repealed Eff. July 18, 2002.
11 NCAC 08 .0803 Notice to Parties {#sec-11-ncac-08-.0803 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0803}

History

  • Status: repealed
  • Authority G.S. 150A-3(b); 150A-3(c); 150A-23(b)(c)(d)
  • Eff. January 15, 1980
  • Repealed Eff. September 1, 1991.
11 NCAC 08 .0804 Emergency Suspension {#sec-11-ncac-08-.0804 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0804}

History

  • Status: repealed
  • Authority G.S. 150A-3(b); 150A-3(c); 150A-23(b)(c)(d)
  • Eff. January 15, 1980
  • Repealed Eff. September 1, 1991.
11 NCAC 08 .0805 Hearing Officer {#sec-11-ncac-08-.0805 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0805}

In all contested case hearings before the Board, the Chairman of the Board shall serve as presiding officer. In the absence of the Chairman, the Vice-Chairman shall serve as presiding officer, or a presiding officer shall be elected by the Board.

History

  • Authority G.S. 143-151.12(1); 143-151.17; 150B-38(h)
  • Eff. January 15, 1980
  • Amended Eff. September 1, 1991
  • Temporary Amendment Eff. March 3, 1992 For a Period of 169 Days to Expire on August 21, 1992
  • Amended Eff. June 1, 1992
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .0806 Consolidation of Several Cases {#sec-11-ncac-08-.0806 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0806}

History

  • Status: repealed
  • Authority G.S. 150A-23(e); 150A-24; 150A-25; 150A-25(b); 150A-26
  • 150A-27; 150A-28(a); 150A-28(b); 150A-29; 150A-30; 150A-31(a); 150A-31(b)
  • 150A-33; 150A-34; 150A-37; 150A-37(b)
  • Eff. January 15, 1980
  • Repealed Eff. September 1, 1991.
11 NCAC 08 .0807 Venue of Hearing {#sec-11-ncac-08-.0807 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0807}

History

  • Status: repealed
  • Authority G.S. 150A-23(e); 150A-24; 150A-25; 150A-25(b); 150A-26
  • 150A-27; 150A-28(a); 150A-28(b); 150A-29; 150A-30; 150A-31(a); 150A-31(b)
  • 150A-33; 150A-34; 150A-37; 150A-37(b)
  • Eff. January 15, 1980
  • Repealed Eff. September 1, 1991.
11 NCAC 08 .0808 Powers of Hearing Officer: Hearing Committee: Chairman {#sec-11-ncac-08-.0808 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0808}

History

  • Status: repealed
  • Authority G.S. 150A-23(e); 150A-24; 150A-25; 150A-25(b); 150A-26
  • 150A-27; 150A-28(a); 150A-28(b); 150A-29; 150A-30; 150A-31(a); 150A-31(b)
  • 150A-33; 150A-34; 150A-37; 150A-37(b)
  • Eff. January 15, 1980
  • Repealed Eff. September 1, 1991.
11 NCAC 08 .0809 Actions Prior to Hearing {#sec-11-ncac-08-.0809 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0809}

History

  • Status: repealed
  • Authority G.S. 150A-23(e); 150A-24; 150A-25; 150A-25(b); 150A-26
  • 150A-27; 150A-28(a); 150A-28(b); 150A-29; 150A-30; 150A-31(a); 150A-31(b)
  • 150A-33; 150A-34; 150A-37; 150A-37(b)
  • Eff. January 15, 1980
  • Repealed Eff. September 1, 1991.
11 NCAC 08 .0810 Conduct of Hearing {#sec-11-ncac-08-.0810 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0810}

History

  • Status: repealed
  • Authority G.S. 150A-23(e); 150A-24; 150A-25; 150A-25(b); 150A-26
  • 150A-27; 150A-28(a); 150A-28(b); 150A-29; 150A-30; 150A-31(a); 150A-31(b)
  • 150A-33; 150A-34; 150A-37; 150A-37(b)
  • Eff. January 15, 1980
  • Repealed Eff. September 1, 1991.
11 NCAC 08 .0811 Rules of Evidence {#sec-11-ncac-08-.0811 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0811}

History

  • Status: repealed
  • Authority G.S. 150A-23(e); 150A-24; 150A-25; 150A-25(b); 150A-26
  • 150A-27; 150A-28(a); 150A-28(b); 150A-29; 150A-30; 150A-31(a); 150A-31(b)
  • 150A-33; 150A-34; 150A-37; 150A-37(b)
  • Eff. January 15, 1980
  • Repealed Eff. September 1, 1991.
11 NCAC 08 .0812 Disposition of Case by Stipulation: Etc: of Parties {#sec-11-ncac-08-.0812 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0812}

History

  • Status: repealed
  • Authority G.S. 150A-23(e); 150A-24; 150A-25; 150A-25(b); 150A-26
  • 150A-27; 150A-28(a); 150A-28(b); 150A-29; 150A-30; 150A-31(a); 150A-31(b)
  • 150A-33; 150A-34; 150A-37; 150A-37(b)
  • Eff. January 15, 1980
  • Repealed Eff. September 1, 1991.
11 NCAC 08 .0813 Proposal for Decision {#sec-11-ncac-08-.0813 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0813}

History

  • Status: repealed
  • Authority G.S. 150A-23(e); 150A-24; 150A-25; 150A-25(b); 150A-26
  • 150A-27; 150A-28(a); 150A-28(b); 150A-29; 150A-30; 150A-31(a); 150A-31(b)
  • 150A-33; 150A-34; 150A-37; 150A-37(b)
  • Eff. January 15, 1980
  • Repealed Eff. September 1, 1991.
11 NCAC 08 .0814 Official Record {#sec-11-ncac-08-.0814 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0814}

History

  • Status: repealed
  • Authority G.S. 150A-23(e); 150A-24; 150A-25; 150A-25(b); 150A-26
  • 150A-27; 150A-28(a); 150A-28(b); 150A-29; 150A-30; 150A-31(a); 150A-31(b)
  • 150A-33; 150A-34; 150A-37; 150A-37(b)
  • Eff. January 15, 1980
  • Repealed Eff. September 1, 1991.
11 NCAC 08 .0815 Final Board Order {#sec-11-ncac-08-.0815 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0815}

(a) If after the close of a contested case hearing the Board decides that an official's conduct does not justify the suspension or revocation of his certificate but that his conduct does fail to conform to the standards of good code enforcement practice, the Board may issue a letter of reprimand or a letter of caution to the official in which the Board may summarize those deficiencies and make appropriate recommendations.

(b) If a final board order is to suspend, revoke, or refuse to issue a certificate, the order shall set forth the conditions, if any, that must be met in order to remove the suspension, to re-issue the certificate, or to issue the certificate.

History

  • Authority G.S. 143-151.12(1); 143-151.17(c); 150B-38(h)
  • Eff. January 15, 1980
  • Amended Eff. October 1, 1991
  • Temporary Amendment Eff. March 3, 1992 For a Period of 169 Days to Expire on August 21, 1992
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .0816 Judicial Review {#sec-11-ncac-08-.0816 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0816}

History

  • Status: repealed
  • Authority G.S. 143-151.12; 150A, Article 3; 150A, Article 4; 150A-35
  • Eff. January 15, 1980
  • Repealed Eff. September 1, 1991.
11 NCAC 08 .0817 Appeals from Administrative Decisions {#sec-11-ncac-08-.0817 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0817}

History

  • Status: repealed
  • Authority G.S. 143-151.12; 150A, Article 3; 150A, Article 4; 150A-35
  • Eff. January 15, 1980
  • Repealed Eff. September 1, 1991.
11 NCAC 08 .0818 Prohibition Against Ex Parte Communications {#sec-11-ncac-08-.0818 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0818}

History

  • Status: repealed
  • Authority G.S. 143-151.12; 150A, Article 3; 150A, Article 4; 150A-35
  • Eff. January 15, 1980
  • Repealed Eff. September 1, 1991.
11 NCAC 08 .0819 General {#sec-11-ncac-08-.0819 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0819}

Governed by the principles of fairness, uniformity, and punctuality, the following general rules apply:

(1) The Rules of Civil Procedure as contained in G.S. 1A-1, the General Rules of Practice for the Superior and District Courts as authorized by G.S. 7A-34 and found in the Rules Volume of the North Carolina General Statutes apply in contested cases before the Board unless another specific statute or rule of the Board provides otherwise.

(2) The Board may supply, at the cost of reproduction, forms for use in contested cases.

(3) Every document filed with the hearing officer or the Board shall be signed by the author of the document, and shall contain his name, address, telephone number, and North Carolina State Bar number if the author is an attorney. An original and one copy of each document shall be filed.

(4) Except as otherwise provided by statute, the rules contained in this Section govern the conduct of contested case hearings under G.S. 143-151.17.

(5) The content and the manner of service of the notice of hearing shall be as specified in G.S. 150B-38(b) and (c).

(6) Venue in a contested case shall be determined in accordance with G.S. 150B-38(e).

(7) Hearings shall be conducted, as nearly as practical, in accordance with the practice in the Trial Division of the General Court of Justice.

(8) Ex parte communications in a contested case are governed by G.S. 150B-40(d).

(9) This Section and copies of all matter adopted by reference herein are available from the Board at the cost established in 11 NCAC 1 .0103.

(10) The rules of statutory construction contained in Chapter 12 of the General Statutes apply in the construction of this Section.

(11) Unless otherwise provided in the rules of the Board or in a specific statute, time computations in contested cases before the Board are governed by G.S. 1A-1, Rule 6.

History

  • Authority G.S. 143-151.12(1); 143-151.17; 150B-38(h)
  • Temporary Adoption Eff. March 3, 1992 For a Period of 169 Days to Expire on August 21, 1992
  • Eff. June 1, 1992
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .0820 Definitions {#sec-11-ncac-08-.0820 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0820}

The definitions contained in G.S. 150B-2, including subsequent amendments, are incorporated herein by reference. In addition to the definitions in 11 NCAC 8 .0801(a), the following definitions apply to this Section:

(1) "File or filing" means to place the paper or item to be filed into the care and custody of the hearing officer, and acceptance thereof by him, except that the Board may permit the papers to be filed with the Board, in which event the Board shall note thereon the filing date. All documents filed with the hearing officer or the Board, except exhibits, shall be duplicate in letter size 8" by 11".

(2) "Hearing officer" means the presiding officer specified in 11 NCAC 8 .0805.

(3) "Party" means the Board, the official, or an intervenor who qualifies under 11 NCAC 8 .0831. "Party" does not include a complainant unless the complainant is allowed to intervene under 11 NCAC 8 .0831.

(4) "Service or serve" means personal delivery or, unless otherwise provided by law or rule, delivery by first class United States Postal Service mail or a licensed overnight express mail service, addressed to the person to be served at his or her last known address. A Certificate of Service by the person making the service shall be appended to every document requiring service under these Rules. Service by mail or licensed overnight express mail is complete upon addressing, enveloping, and placing the item to be served, in an official depository of the United State Postal Service or delivering the item to an agent of an overnight express mail service.

History

  • Authority G.S. 143-151.12(1); 143-151.17; 150B-38(h)
  • Temporary Adoption Eff. March 3, 1992 For a Period of 169 Days to expire on August 21, 1992
  • Eff. June 1, 1992
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .0821 Order for Prehearing Statements {#sec-11-ncac-08-.0821 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0821}

The hearing officer may serve all parties with an order for prehearing statements together with, or after service of, the notice of hearing. Every party thus served shall, within 30 days after service, file the requested statements setting out the party's present position on the following:

(1) The nature of the proceeding and the issues to be resolved;

(2) A brief statement of the facts and reasons supporting the party's position on each matter in dispute;

(3) A list of proposed witnesses with a brief description of his or her proposed testimony;

(4) A description of what discovery, if any, the party will seek to conduct prior to the contested case hearing and an estimate of the time needed to complete discovery;

(5) Venue considerations;

(6) Estimation of length of the hearing;

(7) The name, address, and telephone number of the party's attorney, if any; and

(8) Other special matters.

History

  • Authority G.S. 143-151.12(1); 143-151.17; 150B-38(h)
  • Temporary Adoption Eff. March 3, 1992 For a Period of 169 Days to Expire on August 21, 1992
  • Eff. June 1, 1992
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .0822 Duties of the Hearing Officer {#sec-11-ncac-08-.0822 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0822}

In conjunction with the powers in this Section and in G.S. 143-151.17, the hearing officer shall perform the following duties, consistent with law:

(1) Hear and rule on motions;

(2) Grant or deny continuances;

(3) Issue orders regarding prehearing matters, including directing the appearance of the parties at a prehearing conference;

(4) Examine witnesses when deemed to be necessary to make a complete record and to aid in the full development of material facts in the case;

(5) Make preliminary, interlocutory, or other orders as deemed to be appropriate;

(6) Recommended a summary disposition of the case or any part thereof when there is no genuine issue as to any material fact or recommend dismissal when the case or any part thereof has become moot or for other reasons; and

(7) Apply sanctions in accordance with 11 NCAC 8 .0829.

History

  • Authority G.S. 143-151.12(1); 143-151.17; 150B-38(h)
  • Temporary Adoption Eff. March 3, 1992 For a Period of 169 Days to Expire on August 21, 1992
  • Eff. June 1, 1992
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.

Informal disposition may be made of a contested case or an issue in a contested case by stipulation, agreement, or consent order at any time during the proceedings. Parties may enter into such agreements on their own or may ask for a settlement conference with the hearing officer to promote consensual disposition of the case.

History

  • Authority G.S. 143-151.12(1); 143-151.17; 150B-38(h)
  • Temporary Adoption Eff. March 3, 1992 For a Period of 169 Days to Expire on August 21, 1992
  • Eff. June 1, 1992
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .0824 Settlement Conference {#sec-11-ncac-08-.0824 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0824}

(a) A settlement conference is for the primary purpose of assisting the parties in resolving disputes and for the secondary purpose of narrowing the issues and preparing for hearing.

(b) Upon the request of any party, the hearing officer shall assign the case to another Board member for the purpose of conducting a settlement conference. Unless the parties and the other Board member agree, a unilateral request for a settlement conference does not constitute good cause for a continuance. The conference shall be conducted at a time and place agreeable to all parties and the hearing officer. It shall be conducted by telephone if any party would be required to travel more than 50 miles to attend, unless that party agrees to travel to the location set for the conference. If a telephone conference is scheduled, the parties must be available by telephone at the time of the conference.

(c) All parties shall attend or be represented at a settlement conference. Parties or their representatives shall be prepared to participate in settlement discussions.

(d) The parties shall discuss the possibility of settlement before a settlement conference if they believe that a reasonable basis for settlement exists.

(e) At the settlement conference, the parties shall be prepared to provide information and to discuss all matters required in 11 NCAC 8 .0821.

(f) If, following a settlement conference, a settlement has not been reached but the parties have reached an agreement on any facts or other issues, the Board member presiding over the settlement conference shall issue an order confirming and approving, if necessary, those matters agreed upon. The order is binding on the hearing officer who is assigned to hear the case.

History

  • Authority G.S. 143-151.12(1); 143-151.17; 150B-38(h)
  • Temporary Adoption Eff. March 3, 1992 For a Period of 169 Days to Expire on August 21, 1992
  • Eff. June 1, 1992
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .0825 Prehearing Conference {#sec-11-ncac-08-.0825 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0825}

(a) The purpose of the prehearing conference is to simplify the issues to be determined; to obtain stipulations in regard to foundations for testimony or exhibits; to obtain stipulations of agreement on nondisputed facts or the application of particular laws; to consider the proposed witnesses for each party; to identify and exchange documentary evidence intended to be introduced at the hearing; to determine deadlines for the completion of any discovery; to establish hearing dates and locations if not previously set; to consider such other matters that may be necessary or advisable; and, if possible, to reach a settlement without the necessity for further hearing. Any final settlement shall be set forth in a settlement agreement or consent order and made a part of the record.

(b) Upon the request of any party or upon the hearing officer's own motion, the hearing officer may hold a prehearing conference before a contested case hearing. The hearing officer may require the parties to file prehearing statements in accordance with 11 NCAC 8 .0821. A prehearing conference on the simplification of issues, amendments, stipulations, or other matters may be entered on the record or may be made the subject of an order by the hearing officer. Venue for purposes of a prehearing conference shall be determined in accordance with G.S. 150B-38(e).

History

  • Authority G.S. 143-151.12(1); 143-151.17; 150B-38(h)
  • Temporary Adoption Eff. March 3, 1992 For a Period of 169 Days to Expire on August 21, 1992
  • Eff. June 1, 1992
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .0826 Consolidation of Cases {#sec-11-ncac-08-.0826 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0826}

(a) The hearing officer may order a joint hearing of any matters at issue in contested cases involving common questions of law or fact or multiple proceedings involving the same or related parties, or may order the cases consolidated or make other orders to reduce costs or delay in the proceedings.

(b) A party requesting consolidation shall serve a petition for consolidation on all parties to the cases to be consolidated and shall file the original with the hearing officer, together with a certificate of service showing service on all parties as herein required. Any party objecting to the petition shall serve and file his objections within 10 days after service of the petition for consolidation.

(c) Upon determining whether cases should be consolidated, the hearing officer shall serve a written order on all parties that contains a description of the cases for consolidation and the reasons for the decision.

(d) Nothing contained in this Rule prohibits the parties from stipulating and agreeing to a consolidation, which shall be granted upon submittal of a written stipulation, signed by every party, to the hearing officer.

(e) Following receipt of a notice of or order for consolidation, any party may petition for severance by serving it on all other parties and filing with the hearing officer at least seven days before the first scheduled hearing date. If the hearing officer finds that the consolidation will prejudice any party, he shall order the severance or other relief that will prevent the prejudice from occurring.

History

  • Authority G.S. 143-151.12(1); 143-151.17; 150B-38(h)
  • Temporary Adoption Eff. March 3, 1992 For a Period of 169 Days to Expire on August 21, 1992
  • Eff. June 1, 1992
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .0827 Discovery {#sec-11-ncac-08-.0827 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0827}

(a) Discovery methods are means designed to assist parties in preparing to meet their responsibilities and protect their rights during hearings without unduly delaying, burdening or complicating the hearings process and with due regard to the rights and responsibilities of other parties and persons affected. Accordingly, parties are obligated to exhaust all less formal opportunities to obtain discoverable material before utilizing this Rule.

(b) Any means of discovery available pursuant to the North Carolina Rules of Civil Procedure, G.S. 1A-1, is allowed. If the party from whom discovery is sought objects to the discovery, the party seeking the discovery may file a motion with the hearing officer to obtain an order compelling discovery. In the disposition of the motion, the party seeking discovery shall have the burden of showing that the discovery is needed for the proper presentation of the party's case, is not for purposes of delay, and that the issues in controversy are significant enough to warrant the discovery. In ruling on a motion for discovery, the hearing officer shall recognize all privileges recognized at law.

(c) When a party serves another party with a request for discovery, that request need not be filed with the hearing officer but shall be served upon all parties.

(d) The parties shall immediately commence to exchange information voluntarily, to seek access as provided by law to public documents, and to exhaust other informal means of obtaining discoverable material.

(e) All discovery shall be completed no later than the first day of the hearing. The hearing officer may shorten or lengthen the period for discovery and adjust hearing dates accordingly and, when necessary, allow discovery during the pendency of the hearing.

(f) No later than 15 days after receipt of a notice requesting discovery, the receiving party shall:

(1) move for relief from the request;

(2) provide the requested information, material or access; or

(3) offer a schedule for reasonable compliance with the request.

(g) Sanctions for failure of a party to comply with an order of the hearing officer made pursuant to this Rule shall be as provided for by G.S. 1A-1, Rule 37, to the extent that a hearing officer may impose such sanctions, and 11 NCAC 8 .0829.

History

  • Authority G.S. 143-151.12(1); 143-151.17; 150B-38(h)
  • Temporary Adoption Eff. March 3, 1992 For a Period of 169 Days to Expire on August 21, 1992
  • Eff. June 1, 1992
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .0828 Subpoenas {#sec-11-ncac-08-.0828 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0828}

(a) Subpoenas for the attendance and testimony of witnesses or for the production of documents, either at a hearing or for the purposes of discovery, shall be issued in accordance with G.S. 150B-39(c) and G.S. 1A-1 Rule 45.

(b) A subpoena shall be served in the manner provided by G.S. 150B-39(c) and G.S. 1A-1, Rule 45. The cost of service, fees, and expenses of any witnesses subpoenaed shall be paid by the party at whose request the witness appears. A party seeking an order imposing sanctions for failure to comply with any subpoena issued under this Rule must prove proper service of the subpoena.

(c) Objections to subpoenas shall be heard in accordance with G.S. 150B-39(c) and G.S. 1A-1, Rule 45.

History

  • Authority G.S. 143-151.12(1); 143-151.17; 150B-38(h)
  • Temporary Adoption Eff. March 3, 1992 For a Period of 169 Days to Expire on August 21, 1992
  • Eff. June 1, 1992
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .0829 Sanctions {#sec-11-ncac-08-.0829 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0829}

(a) If a party fails to appear at a hearing or fails to comply with an interlocutory order of the hearing officer, the hearing officer may:

(1) Find that the allegations of or the issues set out in the notice of hearing or other pleading may be taken as true or deemed to be proved without further evidence;

(2) Dismiss or grant the motion or petition;

(3) Suppress a claim or defense; or

(4) Exclude evidence.

(b) In the event that any party, attorney at law, or other representative of a party engages in behavior that obstructs the orderly conduct of proceedings or would constitute contempt if done in the General Court of Justice, the hearing officer may enter a show cause order returnable in Superior Court for contempt proceedings in accordance with G.S. 150B-40(c)(6).

History

  • Authority G.S. 143-151.12(1); 143-151.17; 150B-38(h)
  • Temporary Adoption Eff. March 3, 1992 For a Period of 169 Days to Expire on August 21, 1992
  • Eff. June 1, 1992
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .0830 Motions {#sec-11-ncac-08-.0830 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0830}

(a) Any application to the hearing officer for an order shall be by motion, which shall be in writing unless made during a hearing, and must be filed and served upon all parties not less than 10 days before the hearing, if any, is to be held either on the motion or the merits of the case. The nonmoving party has 10 days after the date of service of the motion to file a response, which must be in writing. Motions practice in contested cases before the Board are governed by Rule 6 of the General Rules of Practice for the Superior and District Court.

(b) If any party desires a hearing on the motion, he shall make a request for a hearing at the time of the filing of his motion or response. A response shall set forth the nonmoving party's objections. All motions in writing shall be decided without oral argument unless an oral argument is directed by the hearing officer. When oral argument is directed by the hearing officer, a motion shall be considered submitted for disposition at the close of the argument. A hearing on a motion will be directed by the hearing officer only if it is determined that a hearing is necessary to the development of a full and complete record on which a proper decision can be made. All orders on such motions, other than those made during the course of a hearing, shall be in writing and shall be served upon all parties of record not less than five days before a hearing, if any, is held.

History

  • Authority G.S. 143-151.12(1); 143-151.17; 150B-38(h)
  • Temporary Adoption Eff. March 3, 1992 For a Period of 169 Days to Expire on August 21, 1992
  • Eff. June 1, 1992
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .0831 Intervention {#sec-11-ncac-08-.0831 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0831}

(a) Any person not named in the notice of hearing who desires to intervene in a contested case as a party shall file a timely motion to intervene and shall serve the motion upon all existing parties. Timeliness will be determined by the hearing officer in each case based on circumstances at the time of filing. The motion shall show how the movant's rights, duties, or privileges may be determined or affected by the contested case; shall show how the movant may be directly affected by the outcome or show that the movant's participation is authorized by statute, rule, or court decision; shall set forth the grounds and purposes for which intervention is sought; and shall indicate movant's statutory right to intervene if one exists.

(b) Any party may object to the motion for intervention by filing a written notice of objections with the hearing officer within five days after service of the motion if there is sufficient time before the hearing. The notice of objection shall state the party's reasons for objection and shall be served upon all parties. If there is insufficient time before the hearing for a written objection, the objection may be made at the hearing.

(c) When the hearing officer deems it to be necessary to develop a full record on the question of intervention, he may conduct a hearing on the motion to determine specific standards that will apply to each intervenor and to define the extent of allowed intervention.

(d) The hearing officer shall allow intervention upon a proper showing under this Rule, unless he finds that the movant's interest is adequately represented by one or more parties participating in the case or unless intervention is mandated by statute, rule, or court decision. An order allowing intervention shall specify the extent of participation permitted the intervenor and shall state the hearing officer's reason. An intervenor may be allowed to:

(1) File a written brief without acquiring the status of a party;

(2) Intervene as a party with all the rights of a party; or

(3) Intervene as a party with all the rights of a party but limited to specific issues and to the means necessary to present and develop those issues.

History

  • Authority G.S. 143-151.12(1); 143-151.17; 150B-38(h)
  • Temporary Adoption Eff. March 3, 1992 For a Period of 169 Days to Expire on August 21, 1992
  • Eff. June 1, 1992
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .0832 Continuances {#sec-11-ncac-08-.0832 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0832}

(a) A request for a continuance of a hearing shall be granted upon a showing of good cause. Unless time does not permit, a request for a continuance of a hearing shall be made in writing to the hearing officer and shall be served upon all parties of record. In determining whether good cause exists, due regard shall be given to the ability of the party requesting a continuance to proceed effectively without a continuance. A request for a continuance filed within five days before a hearing shall be denied unless the reason for the request could not have been ascertained earlier.

(b) "Good cause" includes death or incapacitating illness of a party, representative, or attorney of a party; a court order requiring a continuance; lack of proper notice of the hearing; a substitution of the representative or attorney of a party if the substitution is shown to be required; a change in the parties or pleadings requiring postponement; and agreement for a continuance by all parties if either more time is clearly necessary to complete mandatory preparation for the case, such as authorized discovery, and the parties and the hearing officer have agreed to a new hearing date or the parties have agreed to a settlement of the case that had been or is likely to be approved by the final decision maker.

(c) "Good cause" does not include: intentional delay; unavailability of counsel or other representative because of engagement in another judicial or administrative proceeding unless all other members of the attorney's or representative's firm familiar with the case are similarly engaged, or if the notice of the other proceeding was received subsequent to the notice of the hearing for which the continuance is sought; unavailability of a witness if the witness' testimony can be taken by deposition; or failure of the attorney or representative to properly utilize the statutory notice period to prepare for the hearing.

(d) During a hearing, if it appears in the interest of justice that further testimony should be received and sufficient time does not remain to conclude the testimony, the hearing officer shall either order the additional testimony taken by deposition or continue the hearing to a future date for which oral notice on the record is sufficient.

(e) A continuance shall not be granted if granting it would prevent the case from being concluded within any statutory or regulatory deadline.

History

  • Authority G.S. 143-151.12(1); 143-151.17; 150B-38(h)
  • Temporary Adoption Eff. March 3, 1992 For a Period of 169 Days to Expire on August 21, 1992
  • Eff. June 1, 1992
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .0833 Rights and Responsibilities of Parties {#sec-11-ncac-08-.0833 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0833}

(a) A party has the right to present evidence, rebuttal testimony, and argument with respect to the issues of law and policy, and to cross-examine witnesses, including the author of a document prepared by, on behalf of, or for use of the Board and offered in evidence.

(b) A party shall have all evidence to be presented, both oral and written, available on the date for hearing. Requests for subpoenas, depositions, or continuances shall be made within a reasonable time after their needs become evident to the requesting party. In cases when the hearing time is expected to exceed one day, the parties shall be prepared to present their evidence at the date and time ordered by the hearing officer or agreed upon at a prehearing conference.

(c) The hearing officer shall send copies of all orders or decisions to all parties simultaneously. Any party sending a letter, exhibit, brief, memorandum, or other document to the hearing officer shall simultaneously send a copy to all other parties.

(d) All parties have the continuing responsibility to notify the hearing officer of their current address and telephone number.

(e) A party need not be represented by an attorney. If a party has notified other parties of that party's representation by an attorney, all communications shall be directed to that attorney.

(f) With the approval of the hearing officer, any person may offer testimony or other evidence relevant to the case. Any nonparty offering testimony or other evidence may be questioned by parties to the case and by the hearing officer.

(g) Before issuing a recommended decision, the hearing officer may order any party to submit proposed findings of fact and written arguments.

History

  • Authority G.S. 143-151.12(1); 143-151.17; 150B-38(h)
  • Temporary Adoption Eff. March 3, 1992 For a Period of 169 Days to Expire on August 21, 1992
  • Eff. June 1, 1992
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .0834 Witnesses {#sec-11-ncac-08-.0834 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0834}

Any party may be a witness and may present witnesses on the party's behalf at the hearing. All oral testimony at the hearing shall be under oath or affirmation and shall be recorded. At the request of a party or upon the hearing officer's own motion, the hearing officer may exclude witnesses from the hearing room so that they cannot hear the testimony of other witnesses.

History

  • Authority G.S. 143-151.12(1); 143-151.17; 150B-38(h)
  • Temporary Adoption Eff. March 3, 1992 For a Period of 169 Days to Expire on August 21, 1992
  • Eff. June 1, 1992
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .0835 Evidence {#sec-11-ncac-08-.0835 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0835}

(a) The North Carolina Rules of Evidence as found in Chapter 8C of the General Statutes govern in all contested case proceedings, except as provided otherwise in this Section and G.S. 150B-41.

(b) The hearing officer may admit all evidence that has probative value. Irrelevant, incompetent, immaterial, or unduly repetitious evidence shall be excluded. The hearing officer may, in his discretion, exclude any evidence if its probative value is substantially outweighed by the risk that its admission will require undue consumption of time or create substantial danger of undue prejudice or confusion.

(c) Contemporaneous objections by a party or a party's attorney are not required in the course of a hearing to preserve the right to object to the consideration of evidence by the hearing officer in reaching a decision or by the court upon judicial review.

(d) All evidence to be considered in the case, including all records and documents or true and accurate photocopies thereof, shall be offered and made a part of the record in the case. Except as provided in Paragraph (f) of this Rule, factual information or evidence that is not offered shall not be considered in the determination of the case. Documentary evidence incorporated by reference may be admitted only if the materials so incorporated are available for examination by the parties.

(e) Documentary evidence in the form of copies or excerpts may be received in the discretion of the hearing officer or upon agreement of the parties. Copies of a document shall be received to the same extent as the original document unless a genuine question is raised about the accuracy or authenticity of the copy or, under the circumstances, it would be unfair to admit the copy instead of the original.

(f) The hearing officer may take notice of judicially cognizable facts by entering a statement of the noticed fact and its source into the record. Upon a timely request, any party shall be given the opportunity to contest the facts so noticed through submission of evidence and argument.

(g) A party may call an adverse party; or an officer, director, managing agent, or employee of the State or any local government, of a public or private corporation, or of a partnership or association or body politic that is an adverse party; and may interrogate that party by leading questions and may contradict and impeach that party on material matters in all respects as if that party had been called by the adverse party. The adverse party may be examined by that party's counsel upon the subject matter of that party's examination in chief under the rules applicable to direct examination, and may be cross-examined, contradicted, and impeached by any other party adversely affected by the testimony.

History

  • Authority G.S. 143-151.12(1); 143-151.17; 150B-38(h)
  • Temporary Adoption Eff. March 3, 1992 For a Period of 169 Days to Expire on August 21, 1992
  • Eff. June 1, 1992
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .0836 Official Record {#sec-11-ncac-08-.0836 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0836}

(a) The official record of a contested case is available for public inspection upon reasonable request. The hearing officer may, upon good cause shown and consistent with law, order part or all of an official record sealed.

(b) The official record shall be prepared in accordance with G.S. 150B-42.

(c) Contested case hearings shall be recorded either by a recording system or a professional court reporter using stenomask or stenotype.

(d) Transcript costs incurred by the Board shall be apportioned equally among the party(ies) requesting a transcript.

(e) Any other costs incurred by the Board when using a professional court reporter shall be apportioned equally among the requesting party(ies).

(f) A 24-hour cancellation notice is required in all cases. The party(ies) responsible for the cancellation shall be liable for any cancellation fees.

(g) Transcripts of proceedings during which oral evidence is presented will be made only upon request of a party. Transcript costs shall include the cost of an original for the Board. An attorney requesting a transcript on behalf of a party is a guarantor of payment of the cost. Cost shall be determined under supervision of the hearing officer who, in cases deemed to be appropriate by him, may require an advance security deposit to cover the prospective cost. The security deposit shall be applied to the actual cost and any excess shall be returned to the party that submitted it.

(h) Copies of tapes are available upon written request at a cost of five dollars ($5.00) per tape.

(i) Copies of Board hearings tapes or Non-Board certified transcripts therefrom are not part of the official record.

Note: Rule 5.3(B) of the Rules of Professional Conduct permits an attorney to advance or guarantee expenses of litigation provided the client remains ultimately liable for such expenses.

History

  • Authority G.S. 143-151.12(1); 143-151.17; 150B-38(h)
  • Temporary Adoption Eff. March 3, 1992 For a Period of 169 Days to Expire on August 21, 1992
  • Eff. June 1, 1992
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .0901 Manufactured Housing Board {#sec-11-ncac-08-.0901 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0901}

The North Carolina Manufactured Housing Board is established to provide for a comprehensive framework for regulation of all segments of the manufactured housing industry. The Commissioner of Insurance or his designee shall serve as chairman of a nine member board representing the industry and the public.

History

  • Authority G.S. 143-143.8; 143-143.10
  • Eff. January 1, 1983
  • Amended Eff. April 1, 1989
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .0902 Address {#sec-11-ncac-08-.0902 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0902}

The mailing address for the North Carolina Manufactured Housing Board is: North Carolina Manufactured Housing Board, c/o North Carolina Department of Insurance, 1202 Mail Service Center, Raleigh, NC 27699-1202.

History

  • Authority G.S. 143-143.8; 143-143.10; 143-143.17
  • Eff. January 1, 1983
  • Amended Eff. June 1, 2005; April 1, 1989
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .0903 Rule-Making and Hearing Procedures {#sec-11-ncac-08-.0903 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0903}

Copies of Standards and rules adopted by the Manufactured Housing Board or the Commissioner of Insurance may be obtained by writing or calling:

The Manufactured Building Division is located at:

History

  • Legislative Objection Lodged Eff. December 22, 1982
  • Authority G.S. 143-143.10; 143-143.11; 143-143.11B; 143-143.12; 143-143.14; 143-143.19
  • Eff. January 1, 1983
  • Amended Eff. March 1, 1988 at ARRC request to cure referenced Legislative Objection
  • Amended Eff. January 1, 2018; June 1, 2005
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .0904 Forms {#sec-11-ncac-08-.0904 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0904}

(a) An application for a license as a manufactured housing manufacturer or manufactured housing dealer shall include the following:

(1) the name of the person or business applicant;

(2) the business address of the applicant;

(3) the state under whose laws the applicant firm or corporation is organized or incorporated;

(4) a resume of each owner, partner, and officer of the applicant firm or corporation. Each resume shall state his or her education and a complete job history, as well as a listing of residences for the last seven years;

(5) the type of license applied for;

(6) a signature of the person with authority to legally obligate the applicant; and

(7) a statement that the appropriate bond is attached.

(b) An application for a license as a manufactured set-up contractor shall include the following:

(1) the name of the person or business applicant;

(2) the business address of the applicant;

(3) the state under whose laws the applicant firm or corporation is organized or incorporated;

(4) a resume of each owner, partner, or officer of the applicant firm or corporation. Each resume shall state his or her education and a complete job history, as well as a listing of residences for the last seven years;

(5) the type of license applied for;

(6) a signature of the person with authority to legally obligate the applicant;

(7) a statement that the appropriate bond is attached;

(8) a criminal history record check consent form signed by each owner, partner, and officer of the applicant firm or corporation with their initial application and other documentation or materials required by G.S. 143-143.10A; and

(9) the social security number for each owner.

(c) An application for a license as a manufactured housing salesperson shall include the following:

(1) the name of the applicant;

(2) the applicant's address;

(3) the name and business address of the dealer employing the applicant;

(4) the name and address of previous employers of the applicant for the past three years;

(5) three personal references;

(6) a wallet size photograph;

(7) a criminal history record check consent form signed by each applicant with their initial application and other documentation or materials required by G.S. 143-143.10A; and

(8) The applicant's social security number.

(d) Corporate surety bonds, as specified in 11 NCAC 08 .0905, shall include the name of the applicant, the name of the surety, the amount of the bond, and the terms of cancellation.

(e) The Board shall provide applications for renewal of licenses, which shall include the name and address of the applicant, the type of license, the date the license expires, the amount of the license renewal fee, and instructions for completion.

(f) A request for cancellation of license shall include the name and address of the licensee, the effective date of the cancellation, the specific reason for the cancellation, and the signature of the person with authority to legally obligate the licensee.

(g) All applications pursuant to this Rule shall use a form provided by the Manufactured Housing Board. Each application and form required by this Rule may be obtained from the North Carolina Manufactured Housing Board, c/o North Carolina Department of Insurance, Manufactured Building Division, 1202 Mail Service Center, Raleigh, NC 27699-1202.

History

  • Authority G.S. 110-142.1; 132-1.10; 143-143.10; 143-143.10A; 143-143.11; 143-143.12
  • Eff. January 1, 1983
  • Amended Eff. July 1, 2017; February 1, 2006; March 1, 1988
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .0905 Licensing {#sec-11-ncac-08-.0905 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0905}

(a) Any person employed by a dealer whose occupational activity is that of selling on behalf of the retail dealership shall be licensed as a salesperson. Each salesperson's license shall be conspicuously displayed at all times by the dealership employing the salesperson.

(b) The following shall not be required to be licensed as a manufactured housing dealer:

(1) Receivers, trustees, administrators, executors, guardians or other persons appointed by or acting under the judgment or order of any court;

(2) Public officials while performing their official duties;

(3) Persons disposing of manufactured homes acquired for their own use, provided that said home is not used for the purpose of avoiding the provisions of G.S. 143-143.11;

(4) Licensed real estate salesmen or brokers who negotiate or sell a manufactured home for any individual who is the owner of not more than three manufactured homes;

(5) Banks and finance companies who sell repossessed manufactured homes who do not maintain a sales lot or building with one or more employed retail salespersons.

(c) Licenses shall be issued by the Board whenever the application is in compliance with the applicable laws and regulations. Such license shall entitle the licensee to conduct the specified business for a period of one year from date of issuance or the first day of July, whichever is earlier. The Board may, if it deems necessary, cause an investigation to be made to ascertain if all the requirements set forth in the application are true and shall not issue a license to the applicant until it is satisfied as to the accuracy of the application.

(d) Manufactured housing manufacturers, dealers, and set-up contractors shall conspicuously display their licenses at all times at their place of business.

(e) Whenever a bond is required by G.S. 143-143.12, before any license shall be issued by the Board, the applicant shall deliver to the Board a corporate surety bond, cash bond or fixed value equivalent. The bond shall be to the Board and in favor of any person who shall suffer any loss as a result of any violation of the law or administrative rules governing manufactured housing. The bond shall be for the license period and a new bond or proper continuation certificate shall be delivered to the Board at the beginning of each license period. The bond for one type of license may not be considered as the bond for another type of license.

(f) License fees are as follows:

(1) three hundred dollars ($300.00) per Certificate of Origin plant for manufactured housing manufacturers;

(2) two hundred fifty dollars ($250.00) per county of operation for manufactured housing dealers;

(3) one hundred dollars ($100.00) per county for supplemental manufactured housing dealer locations;

(4) twenty-five dollars ($25.00) for retail manufactured housing salesperson; and

(5) two hundred fifty dollars ($250.00) per business location for set-up contractors.

History

  • Authority G.S. 143-143.10; 143-143.11
  • Legislative Objection Lodged Eff. December 22, 1982
  • Eff. January 1, 1983
  • Amended Eff. January 4, 1994; June 1, 1990; April 1, 1990; April 1, 1989
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .0906 Duties and Responsibilities of Board {#sec-11-ncac-08-.0906 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0906}

(a) The Board shall be required to keep minutes and records of all its transactions, proceedings and meetings, and duly certified copies thereof shall be sufficient to comply with the rules of evidence.

(b) The Board may investigate on its own initiative or upon receipt of inquiries or complaints (See 11 NCAC 8 .0910) any allegation of a wrongful act or acts involving manufactured housing manufacturers, suppliers, dealers, salesmen, or set-up contractors. Violation of the laws or administrative rules governing the manufactured housing industry shall be grounds for revocation or suspension of licenses issued by the Board or for the civil penalties prescribed by G.S. 143-143.13.

History

  • Authority G.S. 143-143.10; 143-143.13; 143-143.14; 143-143.17; 143-143.18; 143-143.22
  • Legislative Objection Lodged Eff. December 22, 1982
  • Eff. January 1, 1983
  • Amended Eff. March 1, 1988 at ARRC request to cure referenced Legislative Objection
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .0907 Unfair Competition and Deceptive Practices {#sec-11-ncac-08-.0907 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0907}

Unfair methods of competition or unfair or deceptive commercial acts or practices shall include, but not be limited to:

(1) Failure to perform repairs, alterations and/or additions completely or in a workmanlike and competent manner.

(2) Repeated failure to give timely notice of inability to appear for a scheduled repair.

(3) Representing used manufactured homes, appliances, or fixtures as new or failure to identify used appliances, fixtures and/or equipment in new manufactured homes.

(4) Repeated failure to respond promptly to consumer complaints and inquiries.

(5) Failure to give clear and conspicuous notice that the wheels, axles, and/or tongue are not included in the sales price, when such is the case. An example of clear and conspicuous notice is a sticker or printed notice in bold face type stating "The purchase price does not include the wheels, axles, and tongue of this manufactured home."

(6) Failure to give clear and conspicuous notice of the significance of leveling a manufactured home and when releveling becomes the customer's responsibility. An example of clear and conspicuous notice is a sticker or printed notice in bold face type stating "Proper set-up, leveling and anchoring of your manufactured home is necessary in order to assure proper functioning and safe operation of your manufactured home."

(7) Misrepresenting the model year or size of a manufactured home. Size shall be calculated as follows:

(a) length means the distance from the exterior of the front wall (nearest to the drawbar and coupling mechanism) to the exterior of the rear wall (at the opposite end of the home) where such walls enclose living or other interior space, but not bay windows, porches, drawbars, couplings, hitches, wall and roof extensions, or other attachments;

(b) width means the distance from the exterior of one side wall to the exterior of the opposite side wall where such walls enclose living or other interior space, but not bay windows, porches, wall and roof extensions, or other attachments;

(c) measurements may be represented to the nearest foot.

History

  • Authority G.S. 143-143.10; 143-143.13
  • Legislative Objection Lodged Eff. December 22, 1982
  • Eff. January 1, 1983
  • Amended Eff. March 1, 1988 at ARRC request to cure referenced Legislative Objection
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .0908 Suspension of Imminent Safety Hazard Period {#sec-11-ncac-08-.0908 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0908}

(a) Suspension of the five day period to remedy imminent safety hazards in the event of widespread defects or damages resulting from adverse weather conditions or other natural catastrophes authorized by G.S. 143-143.18 may be ordered by the Board in emergency meeting or telephone conference by a quorum of the Board.

(b) Such suspension order shall be in writing and shall specify an expiration date for the suspension.

History

  • Authority G.S. 143-143.18
  • Eff. January 1, 1983
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .0909 Maintenance of Records {#sec-11-ncac-08-.0909 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0909}

(a) Every manufactured housing manufacturer, supplier, dealer, and set-up contractor shall maintain for at least five years all service records.

(b) Every manufactured housing manufacturer, supplier, dealer, or set-up contractor shall maintain a record of all written complaints listing the name and address of the complainant, the nature of the complaint, and the disposition of the complaint. This record shall be retained for at least five years.

(c) Nothing in this Rule shall be construed to prohibit use of electronic or photographic processes to store such records.

History

  • Authority G.S. 143-143.10 through 143-143.13; 143-143.17; 143-143.18; 143-143.22
  • Eff. January 1, 1983
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .0910 Complaint Handling and Inspection Procedure {#sec-11-ncac-08-.0910 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0910}

(a) Complaints received by telephone shall be confirmed in writing over the signature of the owner or his or her agent; however, this shall not delay any action to resolve the complaint. Complaints shall be processed as follows:

(1) The Manufactured Building Division shall forward complaints to the manufactured housing manufacturer, dealer, or set-up contractor as appropriate.

(2) If the complaint is not resolved, the Manufactured Building Division shall schedule an on-site inspection or the deputy commissioner shall arrange a conference to discuss the problem. Unless otherwise agreed, concerned parties shall be given at least 72 hours notice, orally, in writing, or electronically, of the time and place of the inspection or conference and the opportunity to attend the inspection or conference.

(3) If the complaint is not resolved, the deputy commissioner shall refer the complaint to the Board. The secretary of the Board may recommend legal action be taken to ensure compliance with the applicable statutes and rules. Such action may include the convening of a public hearing.

(b) The Manufactured Building Division shall not knowingly attempt to resolve a complaint which is also the subject matter of a pending lawsuit filed by the complainant or on the complainant's behalf by the complainant's attorney unless authorized by the Board, which authorization shall occur upon mutual assent of all parties to the lawsuit, whether through the parties themselves or attorneys for the parties. If no lawsuit has been filed but the complainant has retained an attorney, the Manufactured Building Division shall, upon request by the complainant or the complainant's attorney, investigate a complaint, which investigation shall consist of inspecting the home for violations of the Code, as defined in G.S. 143-143.9, providing a copy of the inspection report to all the parties, and attempting to resolve the matter between the parties.

History

  • Authority G.S. 143-143.10; 143-143.13; 143-143.14; 143-143.17
  • Eff. January 1, 1983
  • Amended Eff. June 1, 2005
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .0911 Salesman Exam; Temporary License; License Transfer; Fees {#sec-11-ncac-08-.0911 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0911}

(a) A salesman's license shall be issued to any applicant after the Board has approved the applicant's criminal history record check upon receipt by the Board of a properly executed application, receipt of the applicant of a passing grade (70 percent of a possible 100 percent) on a written examination administered by the Board, and qualification of the applicant for licensure, except as follows:

(1) Those persons holding a Registered Housing Specialist certification from the North Carolina Manufactured Housing Institute on or before June 30, 1992, are exempt from the examination requirement.

(2) Any salesman who has been tested and licensed under this Section and whose license has lapsed is not required to be re-tested if he re-applies for licensing within 12 months after the expiration of the lapsed license.

(b) A temporary salesman's license shall be issued prior to the Board's approval of the applicant's criminal history record check for a period of 90 days to a person upon request of the employing dealer. The holder of a valid salesman's or temporary salesman's license may sell manufactured homes only for the dealer with whom he is employed as shown on the application. A temporary salesman's license shall not be renewed.

(c) A salesman's license is valid only as long as the person remains employed with the dealer shown on the application. A salesman must apply for a new salesman's license if he changes or transfers from one dealer to another. In lieu of applying for a new license, the salesman may transfer his license from one dealership to another upon application from the new dealer and the salesman and approval of the Board. When a salesman leaves employment with a dealer, the dealer shall report this fact to the Board within 10 days thereafter.

(d) The fee for a salesman's or temporary salesman's license shall be twenty five dollars ($25.00). The temporary salesman's license fee shall apply toward the salesman's license fee if both licenses are issued in the same license year. The fee for a salesman's license transfer application shall be fifteen dollars ($15.00).

(e) A criminal history record check fee in the amount of fifty five dollars ($55.00) shall be submitted with each applicant application.

History

  • Authority G.S. 143-143.10; 143-143.10A; 143-143.11
  • Eff. July 1, 1992
  • Amended Eff. February 1, 2006
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .0912 Set-Up Contractor Exams {#sec-11-ncac-08-.0912 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0912}

(a) Definitions. The definitions contained in G.S. 143-143.9 are incorporated into this Rule by reference. As used in this Rule, "qualifier" means an individual taking the examination on behalf of an applicant that is not an individual.

(b) Examination Required. Each applicant for a set-up contractor's license shall pass a written examination administered by the Board before the Board will issue a license to the applicant. Every applicant shall pass the examination with a grade of at least 70 percent. An applicant who does not pass the examination shall be allowed to retake the examination.

(c) Time and Place of Examinations. The Board shall administer examinations in its offices in Raleigh. The Board shall announce the time and place for each examination at least 10 days before the date of the examination.

(d) Application Process. Each applicant shall complete an application on a form provided by the Board. If the applicant is not an individual, the applicant shall identify on the application any individuals who will take the examination for the applicant. In order to take an examination on a particular date, an applicant shall file a completed application no later than 30 days before the scheduled date of the examination.

(e) Person Taking Examination. A qualifier shall be associated with the applicant, and shall be actively engaged in the work of the applicant for a minimum of 20 hours per week, or a majority of the hours operated by the applicant, whichever is less. Each licensee shall notify the Board in writing within 10 days after any qualifier no longer meets the preceding requirements. If one qualifier fails, and another passes, the license shall be granted to that applicant. An individual shall not serve as a qualifier for more than one license. The applicant may have more than one individual serve as a qualifier.

(f) General Requirements. All applicants scheduled for an examination shall bring a form of identification with a current picture. No visitors shall be allowed in the testing room.

(g) Special Arrangements for the Disabled. If an applicant has a disability which will require special arrangements to take an examination, the applicant shall request in writing that appropriate special arrangements be made. The Board shall make reasonable accommodations for applicants requesting assistance pursuant to this Rule.

(h) Cheating and Related Misconduct. Applicants shall not cheat or attempt to cheat on an examination by any means, including both giving and receiving assistance, and shall not communicate in any manner for any purpose with any person other than staff members for the Board during an examination.

(i) Notification of Results. The examination results shall be mailed to the applicant at the address on the application form within 30 days after the examination. Passing applicants shall receive only a grade of "pass."

(j) Review of Examinations. Upon the applicant's written request, made within 30 days after the written notification of the examination results, an applicant who did not pass the examination shall be allowed to review his examination. The review shall be at the Board's offices, at a time schedule by the Board's staff. An applicant shall review his examination in the presence of a staff member of the Board and shall not be accompanied by any other individual at a review session. No other individual shall review an examination on behalf of the applicant. An applicant shall not be permitted to copy a question or answer contained in the examination report or alter an examination paper in any way. An applicant who has passed the examination shall not be permitted to review his examination. If the applicant is not an individual, the review of the examination shall be made by the applicant's qualifier.

History

  • Authority G.S. 143-143.10(b)(4); 143-143.11(h)
  • Eff. April 1, 1999
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .0913 Extension of Temporary License for Manufactured Housing Salesperson {#sec-11-ncac-08-.0913 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .0913}

History

  • Status: expired
  • Authority G.S. 143-143.10(b)(1); 143-143.10(b)(4); 143-143.11
  • Emergency Adoption Eff. April 20, 2020
  • Emergency Adoption Expired June 30, 2020
  • Temporary Adoption Eff. August 28, 2020
  • Temporary Adoption Expired Eff. June 12, 2021.
11 NCAC 08 .1001 Officers {#sec-11-ncac-08-.1001 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1001}

The term of each officer shall be one year. Officers shall serve until a successor is elected and installed. Officers shall be eligible for re-election.

History

  • Authority G.S. 143-151.48(a)
  • Codifier determined that agency findings did not meet criteria for temporary rule Eff. October 15, 1996
  • Temporary Adoption Eff. October 24, 1996
  • Eff. July 1, 1998
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .1002 Meetings {#sec-11-ncac-08-.1002 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1002}

History

  • Status: repealed
  • Authority G.S. 143-151.48(a)
  • Codifier determined that agency findings did not meet criteria for temporary rule Eff. October 15, 1996
  • Temporary Adoption Eff. October 24, 1996
  • Eff. July 1, 1998
  • Repealed Eff. March 1, 2010.
11 NCAC 08 .1003 Persons and Practices Not Affected {#sec-11-ncac-08-.1003 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1003}

Registered architects, professional engineers, and licensed general contractors do not need home inspector licenses to make on site inspections of residential buildings for which they are preparing plans, designs, specifications, or estimates for construction, remodeling, or repairs.

History

  • Authority G.S. 143-151.49(a)(13)
  • Codifier determined that agency findings did not meet criteria for temporary rule Eff. October 15, 1996
  • Temporary Adoption Eff. October 24, 1996
  • Eff. July 1, 1998
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .1004 Equivalent Experience {#sec-11-ncac-08-.1004 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1004}

(a) The Board shall consider equivalent experience of applicants who do not meet the experience requirements of G.S. 143-151.51(5)a. Any one of the following descriptions of experience is considered sufficient to meet the equivalent experience requirements:

(1) A bachelor of science degree from any engineering, architecture or building technology school and two years experience working in building design, construction, or inspection of building, electrical, mechanical, and plumbing systems.

(2) A two year Associate of Applied Science degree from a community college or technical school in building technology, civil engineering, electrical engineering, mechanical engineering, or architecture; and either four years of design experience in building, electrical, mechanical, and plumbing systems, or four years experience as an employee who works under the direct supervision of a licensed general (residential or building) contractor and who supervises electrical, mechanical, and plumbing subcontractors.

(3) Six years experience as an employee who works under the direct supervision of a licensed general contractor (residential or building) performing building construction and who supervises electrical, mechanical, and plumbing subcontractors.

(4) Certification by the North Carolina Code Officials Qualification Board as a Code Enforcement Official with Standard Level I (or higher) inspection certification in four areas: building, electrical, mechanical, and plumbing.

(5) Any combination of certification listed in Paragraph (a)(4) of this Rule and a license as an electrical contractor (limited or greater) issued by the N.C. Board of Electrical Examiners, or a license as a heating or cooling contractor (H1, H2, or H3), or a plumbing contractor issued by the N.C. Board of Examiners of Plumbing, Heating and Fire Sprinkler Contractors, resulting in either a certificate or a license in four areas in building, electrical, mechanical, and plumbing contracting or inspections.

(b) Applicants may submit other experience in the design, installation, or inspection of buildings and electrical, mechanical, and plumbing systems. The Board's Application Evaluation Committee shall consider such experience on a case-by-case basis.

(c) Successful completion of a home inspection course or training program, approved by the Board, is sufficient to meet the equivalent experience requirement for licensure. The applicant must provide to the Board certification from the home inspection course or training program demonstrating that the applicant has met all requirements of that program, including attendance, testing, and training as applicable. The home inspection course or training program shall consist of at least 120 hours of instruction. The Board shall approve a home inspection course or training program if such course or program provides adequate instruction to teach all skills and knowledge necessary to be a fully licensed home inspector in this State. The Board shall request any documentation or information needed to demonstrate that a home inspection course or training program meets such requirements.

History

  • Authority G.S. 143-151.49(a)(13); 143-151.51(5)b
  • Codifier determined that agency findings did not meet criteria for temporary rule Eff. October 15, 1996
  • Temporary Adoption Eff. October 24, 1996
  • Eff. July 1, 1998
  • Amended Eff. April 1, 2010
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .1005 Reciprocity {#sec-11-ncac-08-.1005 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1005}

If an applicant is licensed as a home inspector in another state that has laws and rules that are similar to G.S. 143, Article 9F and to the rules of the Board, the Board shall accept that license as evidence of experience. However, the applicant shall satisfactorily complete the Board's written examination and other licensing requirements before the Board shall issue the applicant a license.

History

  • Authority G.S. 143-151.49(a)(13)
  • Codifier determined that agency findings did not meet criteria for temporary rule Eff. October 15, 1996
  • Temporary Adoption Eff. October 24, 1996
  • Eff. July 1, 1998
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .1006 insurance requirements {#sec-11-ncac-08-.1006 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1006}

(a) To be licensed as a home inspector, an applicant shall meet the requirements set forth in G.S. 143-151.51(b) including general liability insurance that meets the following requirements:

(1) The general liability insurance policy shall cover the licensee's activities performed during the course of a home inspection on the premises of the home inspection; and

(2) The general liability insurance policy shall include coverage for both property damage and bodily injury coverage.

(b) The amount of the surety bond required in G.S. 143-151.51(b) shall be at least five thousand dollars ($5,000). Any surety bond shall be written by a surety company that is authorized by the Commissioner of Insurance to do business in this State.

(c) Each licensed home inspector shall annually submit, during the month of January, a certificate of insurance evidencing the general liability insurance required by G.S. 143-151.58(b) and Paragraph (a) of this Rule. The Board shall be listed as the certificate holder on the certificate of insurance. Failure to timely submit the required certificate of insurance shall constitute grounds for disciplinary action.

History

  • Authority G.S. 143-151.49(a)(13); 143-151.51; 143-151.56(a)(8); 143-151.58(b)
  • Codifier determined that agency findings did not meet criteria for temporary rule Eff. October 15, 1996
  • Temporary Adoption Eff. October 24, 1996
  • Eff. July 1, 1998
  • Amended Eff. October 1, 2011
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018
  • Amended Eff. June 1, 2026.
11 NCAC 08 .1007 Examination {#sec-11-ncac-08-.1007 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1007}

An applicant must pass an examination administered by the Board. The examination shall be administered at least twice each year. The applicant must answer 70% of the questions correctly to receive a passing grade. The examination shall include questions about the administrative rules adopted by the Board, G.S. 143, Article 9F inspections of the building structures and their components, and electrical, mechanical, and plumbing systems and appliances.

History

  • Authority G.S. 143-151.49(a)(13); 143-151.51(2); 143-151.42(2)
  • Codifier determined that agency findings did not meet criteria for temporary rule Eff. October 15, 1996
  • Temporary Adoption Eff. October 24, 1996
  • Eff. July 1, 1998
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .1008 Applications for Licenses {#sec-11-ncac-08-.1008 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1008}

Persons may obtain license applications from the Board after they pay the appropriate fee. Applicants shall return a completed application form and any supporting documentation to the Board at least 30 days before the next scheduled examination. The Board shall notify applicants of the times, dates, and locations of examinations. If available space is not sufficient for the number of applicants, additional examinations shall be scheduled.

History

  • Authority G.S. 143-151.49; 143-151.51
  • Codifier determined that agency findings did not meet criteria for temporary rule Eff. October 15, 1996
  • Temporary Adoption Eff. October 24, 1996
  • Eff. July 1, 1998
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .1009 Display of License {#sec-11-ncac-08-.1009 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1009}

Home inspectors shall display their licenses at their places of business. If a home inspector works out of his or her home, the inspector shall keep the license on file in the home.

History

  • Authority G.S. 143-151.49; 143-151.51
  • Codifier determined that agency findings did not meet criteria for temporary rule Eff. October 15, 1996
  • Temporary Adoption Eff. October 24, 1996
  • Eff. July 1, 1998
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .1010 Appeals of Denials {#sec-11-ncac-08-.1010 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1010}

The initial evaluations of license applications shall be made by the Board's staff. Any applicant wishing to appeal the staff's decision to deny his or her application shall make a written request for a review to the Board's Application Evaluation Committee. The applicant shall request a hearing if aggrieved by any final decision of the Board denying the application.

History

  • Authority G.S. 143-151.49(a)(13); 143-151.56(b)
  • Codifier determined that agency findings did not meet criteria for temporary rule Eff. October 15, 1996
  • Temporary Adoption Eff. October 24, 1996
  • Eff. July 1, 1998
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .1011 Fee Schedule {#sec-11-ncac-08-.1011 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1011}

(a) The following fees apply to the licensure of home inspectors:

Application for Home Inspector License $ 35.00

Home Inspector Examination $ 80.00

Issuance or Renewal of Home Inspector License $160.00

Late Renewal of Home Inspector License $ 30.00

Copies of Board Rules and License Standards Cost of printing and mailing

Unapproved Continuing Education Course $ 50.00

(b) The home inspector initial issuance license fees are due after successful completion of the examination. The Board shall not issue a license until it receives the fee. The license is valid from the date of issuance until the following September 30.

History

  • Authority G.S. 143-151.49; 143-151.55; 143-151.57
  • Codifier determined that agency findings did not meet criteria for temporary rule Eff. October 15, 1996
  • Temporary Adoption Eff. October 24, 1996
  • Eff. July 1, 1998
  • Amended Eff. October 1, 2014; October 1, 2010; January 1, 2008
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .1012 Suspension of Authority to Expend Funds {#sec-11-ncac-08-.1012 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1012}

In the event that the Board's authority to expend funds is suspended pursuant to G.S. 93B-2(d), the Board shall continue to issue and renew licenses. All fees tendered shall be placed in an escrow account maintained by the Board for this purpose. Once the Board's authority is restored, the funds shall be moved from the escrow account into the general operating account.

History

  • Authority G.S. 93B-2(d)
  • Eff. April 1, 2013
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .1013 reserved for future codification {#sec-11-ncac-08-.1013 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1013}
11 NCAC 08 .1014 reserved for future codification {#sec-11-ncac-08-.1014 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1014}
11 NCAC 08 .1015 reserved for future codification {#sec-11-ncac-08-.1015 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1015}
11 NCAC 08 .1016 reserved for future codification {#sec-11-ncac-08-.1016 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1016}
11 NCAC 08 .1017 reserved for future codification {#sec-11-ncac-08-.1017 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1017}
11 NCAC 08 .1018 reserved for future codification {#sec-11-ncac-08-.1018 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1018}
11 NCAC 08 .1019 reserved for future codification {#sec-11-ncac-08-.1019 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1019}
11 NCAC 08 .1020 Definitions {#sec-11-ncac-08-.1020 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1020}

(a) As used in Rules .1020 through .1028 of this Section:

(1) "Course Sponsor" means a person approved by the Board to conduct home inspection prelicensing courses.

(2) "Credit hour" means one continuing education course hour, comprising at least 50 minutes of instruction.

(3) "License period" means October 1 through the following September 30.

(4) "Licensee" means a home inspector licensed by the Board under G.S. 143, Article 9F.

(5) "Person" means an individual, partnership, firm, association, corporation, joint-stock company, trust, any similar entity, or any combination of the foregoing acting in concert.

(b) The definitions contained in G.S. 143-151.45 apply to this Section.

History

  • Authority G.S. 143-151.45; 143-151.49; 143-151.51
  • Eff. October 1, 2011
  • Amended Eff. October 1, 2014
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .1021 Program Structuring and Admission Requirements {#sec-11-ncac-08-.1021 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1021}

The home inspection prelicensing education program shall consist of a minimum total of 200 hours consisting of classroom and field training as follows:

(1) Academic education consisting of at least 120 hours classroom instruction; and

(2) Training consisting of at least 80 hours of field instruction with at least 10 site visits.

History

  • Authority G.S. 143-151.49; 143-151.51
  • Eff. October 1, 2011
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .1022 Program Sponsors {#sec-11-ncac-08-.1022 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1022}

The course sponsor of a home inspection prelicensing program shall obtain approval of the Board for its educational program.

History

  • Authority G.S. 143-151.49; 143-151.51; 143-151.64
  • Eff. October 1, 2011
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .1023 Application for Program Sponsor Approval {#sec-11-ncac-08-.1023 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1023}

(a) An entity seeking approval to sponsor a home inspection prelicensing education program must make written applications to the Board upon a form provided by the Board.

(b) An applying entity that is not a resident of North Carolina shall also file with the application a consent to service of process and pleading.

(c) The applicant shall submit separate applications to sponsor the academic classroom and practical training portions of the program.

(d) The application shall be accompanied by a program plan outline, course description materials, instructor's guide and textbook, North Carolina Standards of Practice and Code of Ethics (Section .1100 of Chapter 8), sample exams, and report formats.

(e) The sponsor must obtain approval by the Board 45 days prior to the commencement of any courses or training.

History

  • Authority G.S. 143-151.49; 143-151.51; 143-151.57
  • Eff. October 1, 2011
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .1024 Course Requirements {#sec-11-ncac-08-.1024 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1024}

(a) Prelicensing programs shall be comprised of the following subject areas:

(1) Introduction to Home Inspection N.C. General Statutes, Standards of Practice and Code of Ethics, and

(2) Inspection defect and report writing including:

(A) Structural Components;

(B) Exteriors;

(C) Roofing;

(D) Plumbing;

(E) Electrical;

(F) Heating;

(g) Air Conditioning;

(H) Insulation and Ventilation;

(I) Interiors; and

(J) Built in Kitchen Appliances.

(b) Courses may include coverage of additional related subject areas not prescribed by the Board; however, any such course shall provide additional class time above the minimum requirement for the coverage of such additional subject areas.

(c) Classroom time and instructional materials shall be utilized for instructional purposes only and not for promoting the interests of or recruiting employees or members for any particular home inspector, home inspection firm or franchise.

(d) Practical training time and instructional materials shall be utilized for instructional purposes only and not for promoting the interests of or recruiting employees or members for any particular home inspector, home inspection firm or franchise.

History

  • Authority G.S. 143-151.49; 143-151.51
  • Eff. October 1, 2011
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .1025 Course Completion Standards {#sec-11-ncac-08-.1025 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1025}

(a) An applicant must attend at least 90 percent of all scheduled classroom hours.

(b) A student's grade shall be based solely on his performance on examinations, on graded homework and class work assignments.

(c) An applicant for licensure shall obtain a grade of at least 75 percent on a comprehensive final course examination that covers all prescribed subject areas. Take home or open book final course examinations are prohibited. Sponsors and instructors may utilize other course quizzes and tests in addition to the final course examination provided that a student's grade on the final course examination accounts for at least 75 percent of the student's grade for the course.

(d) Prelicensing course final examinations may be provided by the Board for use by approved sponsors and instructors. If the Board does not provide such examinations, or if a sponsor or instructor elects not to use Board-provided examinations, the sponsor or instructor shall use a comprehensive examination which tests student's knowledge and mastery of the course subject matter. The examination is subject to review and approval by the Board. Sponsors may, within 90 days of the course ending date, allow a prelicensing course student one opportunity to make up any missed course final examination or to retake any failed course final examination without repeating the course. If examinations provided by the Board are used, any makeup or repeat examination shall consist of a different form of the examination than the one previously administered in the student's course. If examinations not provided by the Board are used, any makeup or repeat examination shall be comparable to the initial examination with regard to the number of questions, subject areas tested and overall difficulty, and at least 75 percent of the questions shall be different from those used on the initial examination.

(e) Sponsors shall protect the security and integrity of course examinations at all times. This includes:

(1) Maintaining examinations and answer keys in a secure place accessible only to the instructor or sponsor;

(2) Prohibiting students from retaining copies of examinations, answer sheets, scratch paper containing notes or calculations that jeopardize examination security; and

(3) Monitoring students at all times when examinations are being administered.

(f) Any student who gives or receives assistance during the examination shall turn in all exam materials and leave the room. Under these circumstances, the student's answer sheet shall not be scored and information regarding the giving of assistance shall be reported by the course sponsor to the Board within 10 days of the incident.

History

  • Authority G.S. 143-151.49; 143-151.51
  • Eff. October 1, 2011
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .1026 Course Scheduling {#sec-11-ncac-08-.1026 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1026}

(a) All courses must have fixed beginning and ending dates.

(b) Sponsors may not utilize a scheduling system that allows students to enroll late for a course and then complete their course work in a subsequently scheduled course.

(c) Late enrollment is permitted only if the enrolling student can satisfy the minimum attendance requirements set forth in Rule .1025 of this Section.

(d) Courses shall not have practical training field exercises that exceed a total of eight hours in any given day.

History

  • Authority G.S. 143-151.49; 143-151.51
  • Eff. October 1, 2011
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .1027 Textbooks {#sec-11-ncac-08-.1027 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1027}

(a) Each course shall utilize a textbook or course materials which are approved by the Board

(b) A request for Board approval of a proposed textbook or similar course materials shall be submitted in writing to the Board and accompanied by two copies of the proposed textbook or course materials.

(c) Approval of a textbook or other course materials applies only to the edition reviewed by the Board.

(d) A request for approval of a new edition of an approved textbook shall be made in writing to the Board.

(e) If requested by the Board, the sponsor shall provide a copy of the new edition to the Board or shall submit a list of changes.

(f) Approval is for an indefinite period; however, such approval may be terminated by the Board at any time upon determining that the approved edition no longer complies with the criteria for approval. The criteria for approval is:

(1) The textbook or materials shall provide accurate, current and complete coverage of the subject matter required by the Board for the course for which approval of the textbook or materials is sought, including coverage of unique North Carolina home inspection related laws, rules and practices that are integrated into the basic coverage; and

(2) The information provided shall be logically organized.

History

  • Authority G.S. 143-151.49; 143-151.51
  • Eff. October 1, 2011
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .1028 Course Completion Reporting {#sec-11-ncac-08-.1028 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1028}

(a) Program sponsors shall submit to the Board verification of each student who completes a prelicensing course that is in compliance with Board rules.

(b) Sponsors shall provide students a certificate of course completion upon completing a prelicensing course that is in compliance with the Board rules.

(c) A course completion certificate shall be prepared in the following format:

(1) the certificate shall be printed on the official sponsor letterhead offering the prelicensing course;

(2) the title of the completed prelicensing course;

(3) the first and last name of the student who completed the prelicensing course;

(4) the instructor's name; and

(5) the signature certifying the completion of the course program shall be either an original signature, an electronic signature or stamped signature of the director, dean or other official and shall be in a color other than black ink.

History

  • Authority G.S. 143-151.49; 143-151.51
  • Eff. October 1, 2011
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .1101 Definitions {#sec-11-ncac-08-.1101 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1101}

The following definitions apply to this Section:

(1) "Abnormal" means nontypical or unusual conditions that could cause damage to systems and components of the home.

(2) "Arc-fault circuit interrupter" means a device intended to provide protection from the effects of arc faults by recognizing characteristics unique to arcing and de-energizing the circuit when an arc fault is detected.

(3) "Automatic safety controls" means devices designed and installed to protect systems and components from excessively high or low pressures and temperatures, excessive electrical current, loss of water, loss of ignition, fuel leaks, fire, freezing, or other unsafe conditions as stated in manufacturer's instructions.

(4) "Central air conditioning" means a system that uses ducts to distribute cooled or dehumidified air to more than one room or uses pipes to distribute chilled water to heat exchangers in more than one room, and that is not plugged into an electrical convenience outlet.

(5) "Component" means a readily accessible and visible aspect of a system, such as a floor or wall, but not individual pieces such as boards or nails where many similar pieces make up the component.

(6) "Cosmetic damage" means blemishes or defects that do not interfere with the functionality of the component or system.

(7) "Cross connection" means any physical connection or contact between potable water and any source of contamination.

(8) "Dangerous or adverse situations" means situations that pose a threat of injury to the inspector, or those situations that require the use of special protective clothing or safety equipment.

(9) "Describe" means report in writing a system or component by its type, or other inspected characteristics, to distinguish it from other systems or components used for the same purpose.

(10) "Dismantle" means to take apart or remove any component, device, or piece of equipment that is bolted, screwed, or fastened by other means and that would not be disassembled by a homeowner in the course of routine household maintenance.

(11) "Enter" means to go into an area to inspect all visible components.

(12) "Finishes" means ceilings and wall coverings such as drywall, paneling, or drop ceiling panels.

(13) "Functional drainage" means a drain that empties at a rate equal to or greater than the supply water flow to the fixture.

(14) "Functional flow" means a usable flow at the highest fixture in a dwelling when another fixture is operated simultaneously.

(15) "Gray water" means wastewater generated from household activities that do not involve human waste, such as bathing, showering, handwashing, and laundry, which typically contains some residues from soap, detergent, and dirt.

(16) "Gray water system" means a water reuse system contained within a single-family residence

or multiunit residential or commercial building that filters gray water or captured rainwater and reuses it for nonpotable purposes such as toilet flushing and irrigation.

(17) "Ground-fault circuit interrupter" means devices intended for the protection of people that de-energizes a circuit or portion thereof within an established period of time when currents are out of balance.

(18) "Habitable space" means a space in a building for living, sleeping, eating, or cooking. "Habitable space" does not mean a bathroom, toilet room, closet, or any space used or designed for storage.

(19) "Harmful" means conditions that cause damage to systems and components of the home.

(20) "Inspect" means to make a visual examination.

(21) "Installed" means attached or connected such that an item requires tools for removal.

(22) "Normal operating controls" means homeowner operated devices such as a thermostat, wall switch, or safety switch.

(23) "On-site water supply quality" means water quality based on the bacterial, chemical, mineral, and solids content of the on-site well water.

(24) "On-site water supply quantity" means the rate of flow of on-site well water.

(25) "Operate" means to cause systems or equipment to function as intended.

(26) "Pre-drywall inspection" means a limited home inspection primarily performed prior to concealment of plumbing, electrical, mechanical, and structural items that will be covered by insulation and finishes (open cavity) on homes under construction involving two or more systems.

(27) "Readily accessible" means within reach, without the use of a ladder, not blocked by appliances, and approachable or enterable for visual inspection without the risk of damage to any property or alteration of the accessible space, equipment, or opening.

(28) "Readily openable access panel" means a panel provided for homeowner inspection and maintenance that has removable or operable fasteners or latch devices in order to be lifted off, swung open, or otherwise removed by one person; and its edges and fasteners are not painted in place. This definition is limited to those panels within reach standing on the floor or from a four-foot stepladder, and that are not blocked by stored items, furniture, or building components.

(29) "Readily visible" means seen by using natural or artificial light without the use of equipment or tools other than a flashlight.

(30) "Representative number" means, for multiple identical components such as windows and electrical outlets, one such component per room; and, for multiple identical exterior components, one such component on each side of the building.

(31) "Roof drainage systems" means gutters, downspouts, leaders, splash blocks, and similar components used to carry water off a roof and away from a building.

(32) "Sewage pump" means a device used at elevations where mechanical assistance is needed to move effluent to a sewage system.

(33) "Shut down" means a piece of equipment or a system that cannot be operated by the device or control provided for homeowner operation. If its safety switch or circuit breaker is in the "off" position, or its fuse is missing or blown, the inspector is not required to reestablish the circuit for the purpose of operating the equipment or system.

(34) "Solid fuel heating device" means any wood, coal, fossil, or other similar organic fuel burning device, including fireplaces whether masonry or factory built, fireplace inserts and stoves, wood stoves (room heaters), central furnaces, and combinations of these devices.

(35) "Structural component" means a component that supports non-variable forces or weights (dead loads) and variable forces or weights (live loads).

(36) "Sump pump" means a device used to remove non-effluent drainage.

(37) "System" means a combination of interacting or interdependent components, assembled to carry out one or more functions.

(38) "Technically exhaustive" means an inspection involving the use of measurements, instruments, testing, calculations, and other means to develop scientific or engineering findings, conclusions, and recommendations.

(39) "Under floor crawl space" means the area within the confines of the foundation and between the ground and the underside of the lowest floor structural component.

History

  • Authority G.S. 143-151.49
  • Codifier determined that agency findings did not meet criteria for temporary rule Eff. October 15, 1996
  • Temporary Adoption Eff. October 24, 1996
  • Eff. July 1, 1998
  • Amended Eff. February 1, 2007; April 1, 2005; May 1, 2003
  • Readopted Eff. October 1, 2018
  • Amended Eff. June 1, 2026; October 1, 2024.
11 NCAC 08 .1102 Standards of Practice {#sec-11-ncac-08-.1102 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1102}

This Section sets forth the minimum standards of practice required of licensed home inspectors. In this Section, the term "home inspectors" means licensed home inspectors.

History

  • Authority G.S. 143-151.49(a)(2); 143-151.49(a)(13)
  • Codifier determined that agency findings did not meet criteria for temporary rule Eff. October 15, 1996
  • Temporary Adoption Eff. October 24, 1996
  • Eff. July 1, 1998
  • Readopted Eff. October 1, 2018.
11 NCAC 08 .1103 Purpose and Scope {#sec-11-ncac-08-.1103 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1103}

(a) Home inspections performed according to this Section shall provide the client with an understanding of the property conditions, as inspected at the time of the home inspection.

(b) Home inspectors shall:

(1) provide a written contract, signed by the client, before the home inspection is performed that shall:

(A) state that the home inspection is in accordance with the Standards of Practice of the North Carolina Home Inspector Licensure Board as set forth in this Section;

(B) state what services shall be provided and the cost; and

(C) when an inspection is for a limited number of systems or components, state that the inspection is limited to only those systems or components;

(2) inspect readily visible and readily accessible installed systems and components described in Rules .1106 through .1115 of this Section;

(3) submit a written report pursuant to G.S. 143-151.58(a), to the client that shall:

(A) describe those systems and components required to be described in Rules .1106 through .1115 of this Section;

(B) state which systems and components present at the home and designated for inspection in this Section were not inspected, and the reason for not inspecting;

(C) state any systems or components inspected that do not function as intended, allowing for normal wear and tear, or appear not to function as intended, based upon documented tangible evidence;

(D) describe each system or component, pursuant to Part (b)(3)(C) of this Rule; state how the condition is defective; explain the implications of defective conditions reported; and direct the client to a course of action for repair, monitoring, or further investigation by a specialist;

(E) on the first or second page clearly state the name, license number, and signature of the person conducting the inspection.

(4) submit a summary page(s) pursuant to G.S. 143-151.58(a1).

(c) Home inspectors may:

(1) report observations and conditions, including safety or habitability concerns, or render opinions of items in addition to those required in Paragraph (b) of this Rule; or

(2) exclude systems and components from the inspection if requested by the client, and so stated in the written contract.

History

  • Authority G.S. 143-151.49; 143-151.58
  • Codifier determined that agency findings did not meet criteria for temporary rule Eff. October 15, 1996
  • Temporary Adoption Eff. October 24, 1996
  • Eff. July 1, 1998
  • Amended Eff. October 1, 2014; October 1, 2011; March 1, 2010; February 1, 2009; February 1, 2007; April 1, 2005; May 1, 2003; July 1, 2000
  • Readopted Eff. October 1, 2018
  • Amended Eff. October 1, 2024.
11 NCAC 08 .1104 General Limitations {#sec-11-ncac-08-.1104 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1104}

(a) Home inspections done in accordance with this Section are not technically exhaustive.

(b) This Section applies to buildings with four or fewer dwelling units, and individually owned residential units within multi-family buildings, and their attached garages or carports.

History

  • Authority G.S. 143-151.49
  • Codifier determined that agency findings did not meet criteria for temporary rule Eff. October 15, 1996
  • Temporary Adoption Eff. October 24, 1996
  • Eff. July 1, 1998
  • Amended Eff. October 1, 2010
  • Readopted Eff. October 1, 2018.
11 NCAC 08 .1105 General Exclusions {#sec-11-ncac-08-.1105 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1105}

(a) Home inspectors are not required to report on:

(1) life expectancy of any component or system;

(2) the causes of the need for a repair;

(3) the methods, materials, and costs of corrections;

(4) the suitability of the property for any specialized use;

(5) compliance or non-compliance with codes, ordinances, statutes, regulatory requirements, or restrictions;

(6) the market value of the property or its marketability;

(7) the advisability or inadvisability of purchase of the property;

(8) any component or system that was not inspected;

(9) the presence or absence of pests such as wood damaging organisms, rodents, or insects;

(10) cosmetic damage, underground items, or items not installed; or

(11) the presence or absence of systems installed to control or remove suspected hazardous substances listed in Subparagraph (b)(7) of this Rule.

(b) Home inspectors are not required to:

(1) offer warranties or guarantees of any kind;

(2) calculate the strength, adequacy, or efficiency of any system or component;

(3) enter any area or perform any procedure that may damage the property or its components or be dangerous to or adversely affect the health or safety of the home inspector or other persons;

(4) operate any system or component that is shut down or otherwise inoperable;

(5) operate any system or component that does not respond to normal operating controls;

(6) move personal items, panels, furniture, equipment, plant life, soil, snow, ice, or debris that obstructs access or visibility;

(7) determine the presence or absence of any suspected adverse environmental condition or hazardous substance, including mold, toxins, carcinogens, noise, contaminants in the building or in soil, water, and air;

(8) determine the effectiveness of any system installed to control or remove suspected hazardous substances;

(9) determine House Energy Ratings (HER), insulation R values, system or component efficiencies;

(10) inspect heat recovery and similar whole house ventilation systems;

(11) predict future condition, including failure of components;

(12) project operating costs of components;

(13) evaluate acoustical characteristics of any system or component;

(14) inspect special equipment or accessories that are not listed as components to be inspected in this Section;

(15) disturb insulation, except as required in Rule .1114 of this Section;

(16) inspect elevators or related equipment meant to transport occupants or materials between elevations; or

(17) inspect 240V receptacles or outlets.

(c) Home inspectors shall not:

(1) offer or perform any act or service contrary to law; or

(2) offer or perform engineering, architectural, plumbing, electrical or any other job function requiring an occupational license in the jurisdiction where the inspection is taking place, unless the home inspector holds a valid occupational license. In that case the home inspector shall inform the client that the home inspector is so licensed, and therefore qualified to go beyond this Section and perform additional inspections beyond those within the scope of the Standards of Practice.

History

  • Authority G.S. 143-151.49
  • Codifier determined that agency findings did not meet criteria for temporary rule Eff. October 15, 1996
  • Temporary Adoption Eff. October 24, 1996
  • Eff. July 1, 1998
  • Amended Eff. February 1, 2007; April 1, 2005; May 1, 2003
  • Readopted Eff. October 1, 2018
  • Amended Eff. October 1, 2024.
11 NCAC 08 .1106 Structural Components {#sec-11-ncac-08-.1106 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1106}

(a) The home inspector shall inspect structural components including:

(1) Foundation;

(2) Floors;

(3) Walls;

(4) Columns or piers;

(5) Ceilings; and

(6) Roofs.

(b) The home inspector shall describe the type of:

(1) Foundation;

(2) Floor structure;

(3) Wall structure;

(4) Columns or piers;

(5) Ceiling structure; and

(6) Roof structure.

(c) The home inspector shall:

(1) Probe structural components where deterioration is suspected;

(2) Enter underfloor crawl spaces, basements, and attic spaces except when access is obstructed, when entry could damage the property, or when dangerous or adverse situations are suspected;

(3) Report access locations to underfloor crawl spaces and attics, whether underfloor crawl spaces and attics are fully accessible or if specific areas are not accessible, and the methods used to inspect underfloor crawl spaces and attics; and

(4) Report signs of abnormal or harmful water penetration into the building or signs of abnormal or harmful condensation on building components.

History

  • Authority G.S. 143-151.49
  • Codifier determined that agency findings did not meet criteria for temporary rule Eff. October 15, 1996
  • Temporary Adoption Eff. October 24, 1996
  • Eff. July 1, 1998
  • Amended Eff. April 1, 2005; July 1, 2000
  • Readopted Eff. October 1, 2018
  • Amended Eff. June 1, 2026.
11 NCAC 08 .1107 Exterior {#sec-11-ncac-08-.1107 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1107}

(a) The home inspector shall inspect:

(1) wall cladding, flashings, and trim;

(2) entryway doors and a representative number of windows;

(3) garage door operators, including automatic safety controls;

(4) decks, balconies, stoops, steps, areaways, porches, and appurtenant railings;

(5) eaves, soffits, and fascias;

(6) driveways, patios, walkways, and retaining walls; and

(7) vegetation, grading, and drainage with respect only to their effect on the condition of the building.

(b) The home inspector shall:

(1) describe wall cladding materials;

(2) operate all entryway doors;

(3) operate garage doors manually or by using installed controls for any garage door operator;

(4) report any garage door operator that will not automatically reverse when meeting reasonable resistance during closing;

(5) report any garage door that will not automatically reverse when photoelectric safety devices are actuated;

(6) report any garage door operator that does not utilize a photoelectric safety device; and

(7) probe exterior wood components where deterioration is suspected.

(c) The home inspector is not required to inspect:

(1) storm windows, storm doors, screening, shutters, and awnings;

(2) fences;

(3) for the presence of safety glazing in doors and windows;

(4) garage door operator remote control transmitters;

(5) geological conditions;

(6) soil conditions;

(7) recreational facilities (including spas, saunas, steam baths, swimming pools, tennis courts, playground equipment, and other exercise, entertainment, or athletic facilities), except as otherwise required in 11 NCAC 08 .1109(d)(5)(F);

(8) detached buildings or structures; or

(9) for the presence or condition of buried fuel storage tanks.

History

  • Authority G.S. 143-151.49
  • Codifier determined that agency findings did not meet criteria for temporary rule Eff. October 15, 1996
  • Temporary Adoption Eff. October 24, 1996
  • Eff. July 1, 1998
  • Amended Eff. February 1, 2007; April 1, 2005; July 1, 2000
  • Readopted Eff. October 1, 2018
  • Amended Eff. October 1, 2024.
11 NCAC 08 .1108 Roofing {#sec-11-ncac-08-.1108 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1108}

(a) The home inspector shall inspect:

(1) Roof coverings;

(2) Roof drainage systems;

(3) Flashings;

(4) Skylights, chimneys, and roof penetrations; and

(5) Signs of leaks or abnormal condensation on building components.

(b) The home inspector shall:

(1) Describe the type of roof covering materials; and

(2) Report the methods used to inspect the roofing.

(c) The home inspector is not required to:

(1) Walk on the roofing; or

(2) Inspect attached accessories including solar systems, antennae, and lightning arrestors.

History

  • Authority G.S. 143-151.49
  • Codifier determined that agency findings did not meet criteria for temporary rule Eff. October 15, 1996
  • Temporary Adoption Eff. October 24, 1996
  • Amended Eff. April 1, 2005; July 1, 1998
  • Readopted Eff. October 1, 2018.
11 NCAC 08 .1109 Plumbing {#sec-11-ncac-08-.1109 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1109}

(a) The home inspector shall inspect:

(1) interior water supply and distribution system, including: piping materials, supports, and insulation; fixtures and faucets; functional flow; leaks; and cross connections;

(2) interior drain, waste, and vent system, including: traps; drain, waste, and vent piping; piping supports and pipe insulation; leaks; and functional drainage;

(3) hot water systems including: water heating equipment; normal operating controls; automatic safety controls; and chimneys, flues, and vents;

(4) fuel storage and distribution systems including: interior fuel storage equipment, supply piping, venting, and supports; leaks; and

(5) sump pumps.

(b) The home inspector shall describe:

(1) water supply and distribution piping materials;

(2) drain waste, and vent piping materials;

(3) water heating equipment, including fuel or power source, storage capacity or tankless point of use demand systems, and location; and

(4) the location of any main water supply shutoff device.

(c) The home inspector shall operate all plumbing fixtures, including their faucets and all exterior faucets attached to the house, except where the flow end of the faucet is connected to an appliance.

(d) The home inspector is not required to:

(1) state the requirement for or effectiveness of anti-siphon devices;

(2) determine whether water supply and waste disposal systems are public or private;

(3) determine the presence or absence of backflow devices;

(4) operate automatic safety controls;

(5) operate any valve except water closet flush valves, fixture faucets, and hose faucets;

(6) inspect:

(A) water conditioning systems;

(B) fire and lawn sprinkler systems;

(C) on-site water supply quantity and quality;

(D) on-site waste disposal systems including electrical controls, alarms, sewage pumps, and gray water systems;

(E) foundation irrigation systems;

(F) bathroom spas, whirlpools, or air jet tubs except as to functional flow and functional drainage;

(G) swimming pools;

(H) solar water heating equipment; or

(I) fixture overflow devices or shower pan liners;

(7) inspect the system for proper sizing, design, or use of approved materials;

(8) report on the absence or presence of thermal expansion tanks;

(9) report on the adequacy of the reported water heater capacity; or

(10) operate sewage pumps.

History

  • Authority G.S. 143-151.49
  • Codifier determined that agency findings did not meet criteria for temporary rule Eff. October 15, 1996
  • Temporary Adoption Eff. October 24, 1996
  • Eff. July 1, 1998
  • Amended Eff. February 1, 2007; April 1, 2005
  • Readopted Eff. October 1, 2018
  • Amended Eff. October 1, 2024.
11 NCAC 08 .1110 Electrical {#sec-11-ncac-08-.1110 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1110}

(a) The home inspector shall inspect:

(1) electrical service entrance conductors;

(2) electrical service equipment, grounding equipment, main overcurrent device, and interiors of panelboard enclosures unless unsafe conditions are reported;

(3) amperage and voltage ratings of the electrical service;

(4) branch circuit conductors, their overcurrent devices, and the compatibility of their ampacities at the interiors of panelboard enclosures unless unsafe conditions are reported;

(5) the operation of a representative number of installed ceiling fans, lighting fixtures, switches, and receptacles located inside the house, garage, and on the dwelling's exterior walls;

(6) all readily accessible 120V receptacles within six feet of interior plumbing fixtures, not separated from a fixture by an operable door, and all receptacles in the garage or carport, and on the exterior of inspected structures; and

(7) the operation of ground fault circuit interrupters within six feet of the floor/ground.

(b) The home inspector shall describe:

(1) electrical service amperage and voltage;

(2) electrical service entry conductor materials at the readily openable access panels at the main;

(3) the electrical service type as being overhead or underground; and

(4) the location of main and distribution panels.

(c) The home inspector shall report in writing the presence of any readily accessible single strand aluminum branch circuit wiring.

(d) The home inspector shall report in writing the presence or absence of readily accessible:

(1) installed smoke alarms, and operate their test function, except when smoke alarms are part of a central alarm system;

(2) installed carbon monoxide alarms in any homes with fireplaces, fuel fired appliances, or attached garages, and operate their test function, except when carbon monoxide alarms are part of a central alarm system; and

(3) ground fault protection of receptacles within six feet of interior plumbing fixtures not separated from a fixture by an operable door, and all receptacles in the garage or carport, on the exterior of inspected structures.

(e) The home inspector is not required to:

(1) insert any tool, probe, or testing device inside the panels;

(2) test or operate any arc-fault circuit interrupters or other overcurrent devices;

(3) dismantle any electrical device or control other than to remove the covers of panelboard enclosures; or

(4) Inspect:

(A) low voltage systems;

(B) security systems and heat detectors;

(C) telephone, security, cable TV, intercoms, or other ancillary wiring that is not a part of the primary electrical distribution system;

(D) built-in vacuum equipment;

(E) back up electrical generating equipment;

(F) other alternative electrical generating or renewable energy systems such as solar, wind, or hydro power;

(G) battery or electrical automotive charging systems;

(H) electrical systems to swimming pools or spas, including bonding and grounding; or

(I) elevators or related equipment used for the purpose of transporting occupants or materials between elevations.

History

  • Authority G.S. 143-151.49; 143-151.58
  • Codifier determined that agency findings did not meet criteria for temporary rule Eff. October 15, 1996
  • Temporary Adoption Eff. October 24, 1996
  • Eff. July 1, 1998
  • Amended Eff. September 1, 2013; February 1, 2007; April 1, 2005
  • Readopted Eff. October 1, 2018
  • Amended Eff. October 1, 2024.
11 NCAC 08 .1111 Heating {#sec-11-ncac-08-.1111 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1111}

(a) The home inspector shall inspect permanently installed heating systems including:

(1) Heating equipment;

(2) Normal operating controls;

(3) Automatic safety controls;

(4) Chimneys, flues, and vents, where readily visible;

(5) Solid fuel heating devices;

(6) Heat distribution systems including fans, pumps, ducts and piping, with supports, insulation, air filters, registers, radiators, fan coil units, convectors; and

(7) The presence or absence of an installed heat source for each habitable space.

(b) The home inspector shall describe the:

(1) Energy source; and

(2) Heating equipment and distribution type.

(c) The home inspector shall operate the systems using normal operating controls appropriate to weather conditions at the time of the inspection.

(d) The home inspector shall open readily openable access panels provided by the manufacturer or installer for routine homeowner maintenance. The home inspector shall report the method of inspection used to inspect the heating system and whether or not access panels were removed.

(e) The home inspector is not required to:

(1) Operate heating systems when weather conditions or other circumstances may cause equipment damage or when inappropriate to weather conditions at the time of inspection;

(2) Operate automatic safety controls;

(3) Ignite or extinguish solid fuel fires;

(4) Ignite a pilot light; or

(5) Inspect:

(A) The interior of flues;

(B) Fireplace insert flue connections;

(C) Heat exchangers;

(D) Humidifiers;

(E) Electronic air filters;

(F) The uniformity or adequacy of heat supply to the various rooms; or

(G) Solar space heating equipment.

History

  • Authority G.S. 143-151.49
  • Codifier determined that agency findings did not meet criteria for temporary rule Eff. October 15, 1996
  • Temporary Adoption Eff. October 24, 1996
  • Eff. July 1, 1998
  • Amended Eff. February 1, 2007; April 1, 2005
  • Readopted Eff. October 1, 2018.
11 NCAC 08 .1112 Air Conditioning {#sec-11-ncac-08-.1112 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1112}

(a) The home inspector shall inspect:

(1) Central air conditioning and through-the-wall ductless installed cooling systems including:

(A) Cooling and air handling equipment; and

(B) Normal operating controls.

(2) Cooling distribution systems including:

(A) Fans, pumps, ducts and piping, with associated supports, dampers, insulation, air filters, registers, fan-coil units; and

(B) The presence or absence of an installed cooling source for each habitable space.

(b) The home inspector shall describe the:

(1) Energy sources; and

(2) Cooling equipment type.

(c) The home inspector shall operate the systems using normal operating controls appropriate to weather conditions at the time of the inspection.

(d) The home inspector shall open readily openable access panels provided by the manufacturer or installer for routine homeowner maintenance. The home inspector shall report the method used to inspect the air conditioning system and whether or not access panels were removed.

(e) The home inspector is not required to:

(1) Operate cooling systems when weather conditions or other circumstances may cause equipment damage;

(2) Inspect window air conditioners; or

(3) Inspect the uniformity or adequacy of cool-air supply to the various rooms.

History

  • Authority G.S. 143-151.49
  • Codifier determined that agency findings did not meet criteria for temporary rule Eff. October 15, 1996
  • Temporary Adoption Eff. October 24, 1996
  • Eff. July 1, 1998
  • Amended Eff. February 1, 2007; April 1, 2005; May 1, 2003
  • Readopted Eff. October 1, 2018.
11 NCAC 08 .1113 Interiors {#sec-11-ncac-08-.1113 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1113}

(a) The home inspector shall inspect:

(1) Walls, ceiling, and floors;

(2) Steps, stairways, balconies, and railings;

(3) Counters and a representative number of built-in cabinets; and

(4) A representative number of doors and windows.

(b) The home inspector shall:

(1) Operate a representative number of windows and interior doors; and

(2) Report signs of water penetration into the building or signs of abnormal or harmful condensation on building components.

(c) The home inspector is not required to inspect:

(1) Paint, wallpaper, and other finish treatments on the interior walls, ceilings, and floors;

(2) Carpeting;

(3) Draperies, blinds, or other window treatments; or

(4) Coatings on and hermetic seals between panes of glass in windows and doors.

History

  • Authority G.S. 143-151.49
  • Codifier determined that agency findings did not meet criteria for temporary rule Eff. October 15, 1996
  • Temporary Adoption Eff. October 24, 1996
  • Eff. July 1, 1998
  • Amended Eff. February 1, 2007; April 1, 2005; May 1, 2003
  • Readopted Eff. October 1, 2018.
11 NCAC 08 .1114 Insulation and Ventilation {#sec-11-ncac-08-.1114 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1114}

(a) The home inspector shall inspect:

(1) Insulation and vapor retarders in unfinished spaces;

(2) Ventilation of attics and foundation areas;

(3) Kitchen, bathroom, and laundry venting systems; and

(4) The operation of any readily accessible attic ventilation fan, and, when temperature permits, the operation of any readily accessible thermostatic control.

(b) The home inspector shall describe:

(1) Insulation in unfinished spaces; and

(2) The absence of insulation in unfinished space at conditioned surfaces.

(c) The home inspector is not required to report on:

(1) Concealed insulation and vapor retarders; or

(2) Venting equipment for household appliances that are not required to be inspected pursuant to the North Carolina Home Inspector Standards of Practice.

(d) The home inspector shall:

(1) Move insulation where readily visible evidence indicates a problem; and

(2) Move floor insulation where plumbing drain/waste pipes penetrate floors, adjacent to earth-filled stoops or porches, and at exterior doors.

History

  • Authority G.S. 143-151.49
  • Codifier determined that agency findings did not meet criteria for temporary rule Eff. October 15, 1996
  • Temporary Adoption Eff. October 24, 1996
  • Eff. July 1, 1998
  • Amended Eff. February 1, 2007; April 1, 2005; May 1, 2003
  • Readopted Eff. October 1, 2018.
11 NCAC 08 .1115 Built-in Kitchen Appliances {#sec-11-ncac-08-.1115 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1115}

(a) The home inspector shall inspect and operate the basic functions of the following kitchen appliances:

(1) Installed, dishwasher(s) through a complete cycle;

(2) Range(s), cook top(s), and permanently installed oven(s);

(3) Trash compactor(s);

(4) Garbage disposal(s);

(5) Ventilation equipment or range hood(s); and

(6) Installed microwave oven(s).

(b) The home inspector is not required to inspect:

(1) Clocks, timers, self-cleaning oven functions, or thermostats for calibration or automatic operation;

(2) Non built-in appliances; or

(3) Refrigeration units.

(c) The home inspector is not required to operate:

(1) Appliances in use; or

(2) Any appliance that is shut down or otherwise inoperable.

History

  • Authority G.S. 143-151.49
  • Codifier determined that agency findings did not meet criteria for temporary rule Eff. October 15, 1996
  • Temporary Adoption Eff. October 24, 1996
  • Eff. July 1, 1998
  • Amended Eff. April 1, 2005
  • Readopted Eff. October 1, 2018.
11 NCAC 08 .1116 Code of Ethics {#sec-11-ncac-08-.1116 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1116}

(a) Licensees shall discharge their duties faithfully, accurately, and impartially to the public and to their clients.

(b) Opinions expressed by licensees shall be based only on their education, experience, and honest convictions.

(c) A licensee shall not disclose any information about the results of an inspection without the approval of the client for whom the inspection was performed, or the client's representative, unless the licensee finds that public health, safety, or welfare imperatively requires immediate or emergency action.

(d) No licensee shall accept compensation or any other consideration from more than one interested party for the same service without the written consent of all interested parties.

(e) No licensee or licensee's company shall compensate, either financially or through other services or benefits, realty agents or other parties with a financial interest in closing or settlement of real estate transactions for the following:

(1) Referral of inspections; or

(2) Inclusion on a list of recommended inspectors or preferred providers.

This Rule also prohibits co-marketing or sharing of expenses between the licensee or licensee's company and realty agents or other parties with a financial interest in closing or settlement of real estate transactions that obligates the realty agents or other parties with a financial interest in closing or settlement of real estate transactions to include the licensee or the licensee's company on preferred lists of providers.

(f) No licensee shall express, within the context of an inspection, an appraisal or opinion of the market value of the inspected property.

(g) Before the execution of a contract to perform a home inspection, a licensee shall disclose to the client any interest he or she has in a business that may create a conflict of interest for the home inspector or the client. No licensee shall allow his or her interest in any business to affect the quality or results of the inspection work that the licensee may be called upon to perform. The client must approve in writing the licensee's dissemination of personal information including names, addresses, email addresses or phone numbers unrelated to the results of the home inspection to any third parties, other than the Board.

(h) A licensee shall not solicit for repairs of systems or components found defective in the course of a home inspection performed by the licensee or that licensee's company.

(i) Licensees shall not engage in false or misleading advertising or otherwise misrepresent any matters to the public.

(j) Licensees shall not inspect properties under contingent arrangements whereby any compensation or future referrals are dependent on reported findings or on the sale of a property.

(k) A licensee shall not impugn the professional reputation or practice of another home inspector, nor criticize another inspector's reports.

(l) Licensees must obtain written permission from the client or clients to sell, share, or provide data or personal information such as names, addresses, email addresses, telephone numbers about the home inspection or the client or clients to third parties, other than the Board.

History

  • Authority G.S. 143-151.49
  • Codifier determined that agency findings did not meet criteria for temporary rule Eff. October 15, 1996
  • Temporary Adoption Eff. October 24, 1996
  • Eff. July 1, 1998
  • Amended Eff. May 1, 2013; October 1, 2010; July 1, 2000
  • Readopted Eff. October 1, 2018
  • Amended Eff. October 1, 2024.
11 NCAC 08 .1117 Pre-Drywall Inspection {#sec-11-ncac-08-.1117 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1117}

(a) Pre-drywall inspections shall be performed in accordance with this Rule and 11 NCAC 08 .1116. Pre-drywall inspections shall provide the client with an understanding of the property conditions, as inspected at the time of the pre-drywall inspection.

(b) Home inspectors shall:

(1) provide a written contract, signed by the client, before the pre-drywall inspection is performed that shall:

(A) state that the pre-drywall inspection is performed in accordance with the Standards of Practice of the North Carolina Home Inspector Licensure Board as set forth in this Section;

(B) state what services shall be provided and the cost; and

(C) when a pre-drywall inspection is for only one or a limited number of systems or components, state that the inspection is limited to only those systems or components;

(2) inspect readily visible and readily accessible installed systems and components described in this Rule;

(3) submit a written report, pursuant to G.S. 143-151.58(a), to the client that shall:

(A) describe those systems and components required to be described by this Rule;

(B) state which systems and components present at the home and designated for pre-drywall inspection by this Rule were not inspected, and the reason for not inspecting;

(C) state any systems or components inspected that do not function as intended, appear not to be installed as intended, or need further evaluation, based upon documented tangible evidence;

(D) describe each system or component, pursuant to Part (b)(3)(C) of this Rule; state how the condition is defective; explain the implications of defective conditions reported; and direct the client to a course of action for repair, monitoring, or further investigation by a specialist or the contractor;

(E) state the name, license number, and signature of the person conducting the pre- drywall inspection on the cover page or second page of the report; and

(F) state the address of the home inspected and the date of the inspection on the cover page or second page of the report.

(c) Home inspectors may:

(1) report observations and conditions, including safety or habitability concerns, or render opinions of items in addition to those required in Paragraph (b) of this Rule;

(2) exclude systems and components from the inspection if requested by the client, and so stated in the written contract;

(3) cite defects as violations of the North Carolina State Residential Building Code provided that the home inspector conforms to the requirements of G.S. 143-151.58(a2); and

(4) cite variations from or inconsistencies with manufacturers' installation instructions. If citing manufacturers' instructions, home inspectors must provide copies of the instructions or links to those instructions with the report and refer the system or component for verification and repair by a specialist or the contractor.

(d) The home inspector shall inspect installed components and systems including:

(1) Structural foundation and framing:

(A) foundation;

(B) floors;

(C) walls;

(D) columns or posts;

(E) ceilings;

(F) roof; and

(G) presence or absence of fireblocking and draftstopping.

(2) Exterior:

(A) wall cladding and flashing;

(B) fenestrations including doors, windows, and skylights; and

(C) decks, balconies, stoops, steps, areaways, porches, and appurtenant railings.

(3) Roofing:

(A) roof coverings;

(B) flashing;

(C) skylights, chimneys, and roof penetrations; and

(D) signs of leaks or abnormal condensation on building components.

(4) Plumbing:

(A) interior water supply and distribution system, including: piping materials, supports, and insulation;

(B) interior drain, waste, and vent system, including: traps; drain, waste, and vent piping; piping supports; and pipe insulation;

(C) hot water systems including: water heating equipment, normal operating controls, automatic safety controls, and chimneys, flues, and vents; and

(D) fuel gas piping including supports, bonding, and material.

(5) Electrical:

(A) electrical conductors, distribution boxes, and panel boxes; and

(B) compatibility of branch circuit conductors' ampacities for their apparent use.

(6) HVAC:

(A) heating, air conditioning, appliances, and ventilation equipment; and

(B) ductwork.

(e) The home inspector shall describe systems and components listed in Paragraph (d) at the time of the pre-drywall inspection. The home inspector shall identify any system or component that is not completely installed at the time of the pre-drywall inspection and describe the system or component in sufficient detail to explain the extent of installation remaining to be completed.

(f) Pre-drywall exclusions.

(1) Home inspectors are not required to report on:

(A) the life expectancy of any component or system;

(B) the causes of the need for a repair;

(C) the methods, materials, and costs of corrections;

(D) the suitability of the property for any specialized use;

(E) compliance or non-compliance with codes, ordinances, statutes, regulatory requirements, or restrictions, including fire and life safety requirements;

(F) the market value of the property or its marketability;

(G) the advisability or inadvisability of purchasing the property;

(H) any component that was not inspected;

(I) the presence or absence of pests such as wood damaging organisms, rodents, or insects;

(J) cosmetic damage, underground items, or items identified as not installed;

(K) the presence or absence of systems installed to control or remove suspected hazardous substances, pests, or insects;

(L) compliance or non-compliance with contract specifications, construction plans, drawings, and specifications; and

(M) preparation for future installations, such as electric vehicle charging stations or low voltage wiring.

(2) Home inspectors are not required to:

(A) offer warranties or guarantees of any kind;

(B) calculate the strength, adequacy, or efficiency of any system or component;

(C) review plans for compliance with codes or determine the adequacy of the design, strength, or efficiency of any system or component;

(D) determine the adequacy, proper installation, and hourly rating of any fire rated assembly or system;

(E) enter any area or perform any procedure that may damage the property or its components or be dangerous to or adversely affect the health or safety of the home inspector or other persons;

(F) operate any system or component that is shut down or otherwise inoperable;

(G) move personal items, tools, building materials, panels, equipment, plant life, soil, snow, ice, or debris that obstructs access or visibility;

(H) determine the presence or absence of any suspected adverse environmental condition or hazardous substance, including mold, toxins, carcinogens, noise, and contaminants in the building or in soil, water, and air;

(I) determine the effectiveness of any system installed to control or remove suspected hazardous substances;

(J) determine House Energy Ratings (HER), insulation R values, and system or component efficiencies;

(K) inspect heat recovery and similar whole house ventilation systems;

(L) predict future condition, including failure of components;

(M) project operating costs of components;

(N) evaluate acoustical characteristics of any system or component;

(O) inspect equipment or accessories that are not listed as components to be inspected in this Rule;

(P) disturb insulation, except where readily visible evidence indicates a problem;

(Q) inspect elevators or related equipment meant to transport occupants or materials between elevations;

(R) inspect low voltage systems; and

(S) evaluate installation of components with respect to manufacturers' instructions or specifications.

(3) Home inspectors shall not:

(A) offer or perform any act or service contrary to law; or

(B) offer or perform engineering, architectural, plumbing, electrical, or any other job function requiring an occupational license in the jurisdiction where the inspection is taking place, unless the home inspector holds a valid occupational license. In that case the home inspector shall inform the client that the home inspector is so licensed, and therefore qualified to go beyond this Rule and perform additional inspections beyond those within the scope of the Standards of Practice.

History

  • Authority G.S. 143-151.58; 143-151.49
  • Eff. June 1, 2026.
11 NCAC 08 .1201 Definitions {#sec-11-ncac-08-.1201 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1201}

(a) As used in this Section:

(1) "Party" means the Board, the licensee, or an intervenor who qualifies under G.S. 150B-38(f). "Party" does not include a complainant unless the complainant is allowed to intervene under G.S. 150B-38(f).

(2) "Service or serve" means personal delivery or, unless otherwise provided by law or rule, delivery by first class United States Postal Service mail or a licensed overnight express mail service, addressed to the person to be served at his or her last known address. A Certificate of Service meeting the requirements of G.S. 1A-1, Rule 5(b1) by the person making the service shall be appended to every document requiring service under these Rules. Service by mail or licensed overnight express mail is complete upon addressing, enveloping, and placing the item to be served in an official depository of the United States Postal Service or delivering the item to an agent of an overnight express mail service.

(b) The definitions contained in G.S. 143-151.45 apply to this Section.

History

  • Authority G.S. 143-151.49; 150B-38(h)
  • Codifier determined that agency findings did not meet criteria for temporary rule Eff. October 15, 1996
  • Temporary Adoption Eff. October 24, 1996
  • Eff. July 1, 1998
  • Amended Eff. October 1, 2014
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .1202 Complaints {#sec-11-ncac-08-.1202 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1202}

(a) Anyone who believes that a licensee is or has been engaged in any conduct set out in G.S. 143-151.56(a) may file a written complaint against that licensee.

(b) A Complaint Memo containing instructions for filing the complaint is available through the NC Home Inspector Licensure Board website at www.nchilb.com or by contacting the NC Home Inspector Licensure Board.

(c) The complaint shall identify the licensee and describe the conduct complained of as set forth in G.S. 143-151.56(a).

(d) A copy of the contract agreement, the inspection report, and any reports made by other consultants shall be included with the complaint.

(e) The complaint shall be in writing, signed by the complainant, and dated. The complaint shall include the complainant's mailing address and a daytime phone number at which the complainant may be reached. The street address of the structure must be included if the complaint pertains to an inspection of a structure.

(f) Supporting information shall be included to justify the complaint. Supporting information shall refer to violations of the Board's rules or of the General Statutes. If the complaint involves items included in the Standards of Practice that the licensee did not observe, a list of those items may be submitted with the complaint. This information may be provided by the complainant, an architect, professional engineer, licensed contractor, another licensed home inspector, or other person with knowledge of the Standards of Practice.

(g) The Board shall not consider services that are under the jurisdiction of other regulatory agencies or licensing boards, such as termite inspections; appraisals; or services rendered by licensed architects, engineers, or general contractors, unless the persons rendering those services claim to be home inspectors.

(h) The Board has no jurisdiction over persons who make specialized inspections as part of their repair or maintenance businesses, such as roofing repair contractors, chimney sweeps, duct cleaning, and interior environment specialists.

(i) The Board members or the Board staff may initiate an investigation without a written complaint when there is cause to believe that a licensee is or has been engaged in any conduct set out in G.S. 143-151.56(a).

History

  • Authority G.S. 143-151.49; 143-151.56(a); 143-151.58(d); 143-151.62; 150B-38(h)
  • Codifier determined that agency findings did not meet criteria for temporary rule Eff. October 15, 1996
  • Temporary Adoption Eff. October 24, 1996
  • Eff. July 1, 1998
  • Amended Eff. February 1, 2014; April 1, 2006
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .1203 Board Staff {#sec-11-ncac-08-.1203 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1203}

History

  • Status: repealed
  • Authority G.S. 143-151.49; 150B-38(h)
  • Codifier determined that agency findings did not meet criteria for temporary rule Eff. October 15, 1996
  • Temporary Adoption Eff. October 24, 1996
  • Eff. July 1, 1998
  • Amended Eff. April 1, 2005
  • Repealed Eff. February 1, 2014
11 NCAC 08 .1204 Investigation {#sec-11-ncac-08-.1204 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1204}

(a) On receipt of a complaint conforming to this Section, the Engineering and Codes Division shall conduct an investigation.

(b) A copy of the complaint and supporting information as set forth in Rule .1202(d) and (f) of this Section shall be transmitted to the home inspector. The home inspector shall submit a written response to the Engineering and Codes Division within two weeks after receipt of the copy of the complaint.

(c) Upon completion of the investigation, the Board's Investigation Review Committee ("Committee") shall make a determination of whether there is sufficient evidence to support a finding of a violation of G.S. 143-151.56(a). Based on its determination, the Committee may:

(1) recommend to the Board that the complaint be dismissed;

(2) recommend to the Board to dismiss the complaint and issue a letter of caution to the home inspector;

(3) recommend to the Board that the complaint be resolved by consent agreement if the home inspector agrees to the terms of the consent agreement; or

(4) recommend to the Board to establish a time and place for a disciplinary hearing and give notice to the home inspector and complainant. Prior to the matters being heard and determined by the Board, it may be resolved by consent agreement with the approval of the Board.

(d) The Committee shall notify the complainant and the home inspector of its determination.

History

  • Authority G.S. 143-151.49; 143-151.56; 150B-38(h)
  • Codifier determined that agency findings did not meet criteria for temporary rule Eff. October 15, 1996
  • Temporary Adoption Eff. October 24, 1996
  • Eff. July 1, 1998
  • Amended Eff. February 1, 2014
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018
  • Amended Eff. June 1, 2026.
11 NCAC 08 .1205 Disciplinary Hearing {#sec-11-ncac-08-.1205 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1205}

The disciplinary hearing shall be held in accordance with G.S. 150B, Article 3A and this Section.

History

  • Authority G.S. 143-151.49; 143-151.56; 150B-38(h)
  • Codifier determined that agency findings did not meet criteria for temporary rule Eff. October 15, 1996
  • Temporary Adoption Eff. October 24, 1996
  • Eff. July 1, 1998
  • Amended Eff. February 1, 2014
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .1206 Presiding Officer {#sec-11-ncac-08-.1206 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1206}

In all contested case hearings before the Board, the Chairman of the Board shall serve as presiding officer. In the absence of the Chairman, the Vice-Chairman shall serve as presiding officer, or a presiding officer shall be elected by the Board.

History

  • Authority G.S. 143-151.49; 150B-38(h)
  • Codifier determined that agency findings did not meet criteria for temporary rule Eff. October 15, 1996
  • Temporary Adoption Eff. October 24, 1996
  • Eff. July 1, 1998
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .1207 Prehearing Conference {#sec-11-ncac-08-.1207 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1207}

Upon the request of any party or upon the presiding officer's own motion, the presiding officer may hold a prehearing conference before a contested case hearing. A prehearing conference on the simplification of issues, amendments, stipulations, or other matters may be entered on the record or may be made the subject of an order by the presiding officer. Venue for purposes of a prehearing conference shall be determined in accordance with G.S. 150B-38(e).

History

  • Authority G.S. 143-151.49; 150B-38(h)
  • Codifier determined that agency findings did not meet criteria for temporary rule Eff. October 15, 1996
  • Temporary Adoption Eff. October 24, 1996
  • Eff. July 1, 1998
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.

(a) The Board's staff and the home inspector may attempt to resolve the complaint by means of a consent agreement. Such consent agreement may impose upon the licensee a penalty, or penalties, including the following: requiring the licensee to take training or educational courses, probation, letter of reprimand, suspension of license, or revocation of license.

(b) The proposed consent agreement shall then be presented to the Board at the next meeting. The Board may either accept the consent agreement as written, modify the consent agreement and send it back to the licensee for agreement, or reject the consent agreement.

History

  • Authority G.S. 143-151.49(a)(13); 150B-38(h)
  • Codifier determined that agency findings did not meet criteria for temporary rule Eff. October 15, 1996
  • Temporary Adoption Eff. October 24, 1996
  • Eff. July 1, 1998
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .1209 Final Board Order {#sec-11-ncac-08-.1209 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1209}

(a) After the close of a contested case hearing, the Board shall meet and determine if the licensee engaged in the conduct alleged and the appropriate penalty, including requiring the licensee to take training or education courses, probation, letter of reprimand, or license suspension or revocation.

(b) If a final Board order is to suspend, revoke, place on probation, or refuse to issue a license, the order shall set forth any conditions that must be met in order to remove the suspension or probation, to reissue the license, or to issue the license.

(c) Contested case hearings shall be recorded either by a recording system or a professional court reporter using stenomask or stenotype.

(d) Transcript costs incurred by the Board shall be paid by the the party or parties requesting a transcript. Any other costs incurred by the Board when using a professional court reporter shall be paid by the requesting party or parties.

(e) A 24-hour cancellation notice shall be required in all cases. The party or parties responsible for the cancellation shall be responsible for any cancellation fees charged by a professional court reporter.

(f) Transcripts of proceedings during which oral evidence is presented shall be made only upon request of a party. Transcript costs shall include the cost of an original for the Board. An attorney requesting a transcript on behalf of a party shall be a guarantor of payment of the cost. Cost shall be determined under supervision of the presiding officer who, in cases deemed to be appropriate by him, may require an advance security deposit to cover the prospective cost. The security deposit shall be applied to the actual cost and any excess shall be returned to the party that submitted it.

(g) Copies of tapes shall be available upon written request at cost of reproduction and postage.

(h) Copies of Board hearings tapes or non-Board certified transcripts therefrom shall not be part of the official record.

History

  • Authority G.S. 143-151.49; 150B-38(h)
  • Codifier determined that agency findings did not meet criteria for temporary rule Eff. October 15, 1996
  • Temporary Adoption Eff. October 24, 1996
  • Eff. July 1, 1998
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .1301 Definitions {#sec-11-ncac-08-.1301 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1301}

(a) As used in this Section:

(1) "Credit hour" means one continuing education course hour, comprising at least 50 minutes of instruction.

(2) "License period" means October 1 through the following September 30.

(3) "Licensee" means a home inspector licensed by the Board under G.S. 143, Article 9F and Section .1000 of this Chapter.

(4) "Person" means an individual, partnership, firm, association, corporation, joint-stock company, trust, any similar entity, or any combination of the foregoing acting in concert.

(b) The definitions contained in G.S. 143-151.45 apply to this Section.

History

  • Authority G.S. 143-151.49; 143-151.55
  • Eff. August 1, 1998
  • Amended Eff. October 1, 2014; July 18, 2002
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .1302 Continuing Education Required for Renewal of Active License {#sec-11-ncac-08-.1302 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1302}

(a) In order to renew an active home inspector license, for the licensee shall complete 12 credit hours during the license renewal period, except as described in Paragraph (b) of this Rule.

(b) In order to renew an active home inspector license, home inspectors licensed pursuant to G.S. 143-151.51(a)(5), who have not completed the pre-licensing education program or its equivalent pursuant to Rule .1004(c) of this Chapter, shall complete 16 hours of continuing education per year for the first three years of licensure that include the following:

(1) Four hours of a Board-approved course consisting of the following:

(A) for the first year, a Board-approved course on the Standards of Practice and Report Writing; and

(B) for the second and third years, a Board-approved course of the home inspector's choosing.

(2) Four hours of the update course component described in Rule .1309 of this Chapter; and

(3) Eight hours of Board approved elective courses.

(c) A licensee who is newly licensed on or after June 1 is exempt from this Section for the initial license period.

History

  • Authority G.S. 143-151.49; 143-151.51; 143-151.55; 143-151.64
  • Eff. August 1, 1998
  • Amended Eff. October 1, 2014; February 1, 2011; July 18, 2002
  • Readopted Eff. October 1, 2018.
11 NCAC 08 .1303 Inactive License {#sec-11-ncac-08-.1303 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1303}

A person holding an inactive license is not subject to this Section. In order to change a license from inactive status to active status, the licensee must complete the same number of continuing education credit hours that would have been required for an active license during the period of inactive status but not more than the hours required in G.S. 143-151.55.

History

  • Authority G.S. 143-151.49; 143-151.55
  • Eff. August 1, 1998
  • Amended Eff. January 1, 2011
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .1304 Course Requirements {#sec-11-ncac-08-.1304 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1304}

(a) The same elective continuing education course may be taken only once for continuing education credit during any three year period.

(b) A licensee may carry over up to eight elective credit hours per year until the next year.

History

  • Authority G.S. 143-151.49; 143-151.55
  • Eff. August 1, 1998
  • Amended Eff. July 18, 2002
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .1305 Attendance Requirements {#sec-11-ncac-08-.1305 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1305}

In order to receive any credit for completing a continuing education course, a licensee must attend at least 90 percent of the scheduled credit hours for the course, regardless of the length of the course, and must comply with student participation standards described in Rule .1347 of this Section. No credit shall be awarded for attending less than 90 percent of the scheduled credit hours.

History

  • Authority G.S. 143-151.49; 143-151.55
  • Eff. August 1, 1998
  • Amended Eff. July 18, 2002
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .1306 Extensions of Time {#sec-11-ncac-08-.1306 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1306}

A licensee may request and be granted an extension of time to satisfy the continuing education requirement for a particular license period if the licensee provides evidence to the Board that the licensee was unable to obtain the necessary education because of an incapacitating illness or other circumstance that:

(1) existed for 75 percent of the license period; and

(2) constituted a verifiable hardship.

History

  • Authority G.S. 143-151.49; 143-151.55
  • Eff. August 1, 1998
  • Amended Eff. July 18, 2002
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .1307 Denial or Withdrawal of Credit {#sec-11-ncac-08-.1307 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1307}

(a) The Board shall deny continuing education credit claimed by a licensee, and shall withdraw continuing education credit previously awarded by the Board to a licensee if:

(1) The licensee provided incorrect or incomplete information to the Board concerning continuing education or compliance with this Section; or

(2) The licensee was mistakenly awarded continuing education credit because of an administrative error; or

(3) The licensee failed to comply with the attendance requirement established by Rule .1305 of this Section.

(b) When continuing education credit is denied or withdrawn by the Board under Subparagraph (a)(1) or (a)(2) of this Rule, the Board shall, upon written request of the licensee, grant the licensee an extension of time of 60 days to satisfy the continuing education requirement. When continuing education credit is denied or withdrawn by the Board under Subparagraph (a)(3) of this Rule, the licensee remains responsible for satisfying the continuing education requirement.

History

  • Authority G.S. 143-151.49; 143-151.55
  • Eff. August 1, 1998
  • Amended Eff. July 18, 2002
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .1308 Duties of Licensees to Show Proof of Compliance {#sec-11-ncac-08-.1308 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1308}

History

  • Status: repealed
  • Authority G.S. 143-151.49; 143-151.55
  • Eff. August 1, 1998
  • Repealed Eff. July 18, 2002.
11 NCAC 08 .1309 Update Course Component {#sec-11-ncac-08-.1309 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1309}

(a) To keep a license on active status, a licensee shall complete a Board-developed update course within one year preceding license expiration. This course is in addition to the continuing education elective requirement described in Rule .1318 of this Section, and shall consist of four classroom hours of instruction.

(b) The Board shall develop annually an update course which shall be conducted by sponsors approved by the Board under this Section. The subject matter of this course shall be determined by the Board, which shall prepare a completely new course for each one-year period beginning October 1 and ending September 30. Sponsors shall acquire the Board-developed course materials and utilize such materials to conduct the update course. The course shall be conducted exactly as prescribed by the rules in this Section and the course materials developed by the Board. Sponsors shall provide licensees participating in their classes a copy of the student materials developed by the Board

(c) Approval of a sponsor to conduct an update course authorizes the sponsor to conduct the update course using an instructor who has been approved by the Board as an update course instructor under Rules .1313 through .1317 of this Section. The sponsor may conduct the update course at any location as frequently as is desired during the approval period, provided that no courses may be conducted between September 10 and September 30 of any approval period.

History

  • Authority G.S. 143-151.49(13); 143-151.64
  • Eff. July 18, 2002
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .1310 Application for Original Approval of Update Courses {#sec-11-ncac-08-.1310 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1310}

An entity seeking original approval to sponsor a Board-developed update course shall make application on a form prescribed by the Board. An applying entity that is not a resident of North Carolina shall also file with the application a consent to service of process and pleadings.

History

  • Authority G.S. 143-151.49(13); 143-151.64
  • Eff. July 18, 2002
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .1311 Criteria for Approval of Update Course Sponsor {#sec-11-ncac-08-.1311 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1311}

Approval to sponsor a Board-developed update course shall be granted to an applicant upon showing to the satisfaction of the Board that:

(1) The applicant has submitted all information required by the rules in this Section;

(2) The applicant has at least one proposed instructor who has been approved by the Board as an update course instructor under Rules .1313 through .1317 of this Section;

(3) The applicant satisfies the requirements of Rules .1327 through .1337 of this Section relating to qualifications or eligibility of course sponsors; and

(4) The applicant is honest. In this regard, the Board may consider the reputation and character of any owner, officer, continuing education coordinator, or director of any corporation, association, or organization applying for sponsor approval.

History

  • Authority G.S. 143-151.49(13); 143-151.64
  • Eff. July 18, 2002
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .1312 Student Fee for Update Courses {#sec-11-ncac-08-.1312 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1312}

A sponsor of an update course may establish the amount of the fee to be charged to students taking the course. The established fee shall be an all-inclusive fee, and no separate or additional fee may be charged to students for providing course materials required by the Board, providing course completion certificates, reporting course completion to the Board, or for recouping similar routine administrative expenses. The total amount of any fees to be charged shall be included in any advertising or promotional materials for the course.

History

  • Authority G.S. 143-151.49(13); 143-151.64
  • Eff. July 18, 2002
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .1313 Nature and Scope of Approval of Update Course Instructors {#sec-11-ncac-08-.1313 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1313}

Approval of update course instructors shall be accomplished on a calendar year basis separate from the approval of update course sponsors. Approval of an update course instructor authorizes the instructor to teach the update course for any approved update course sponsor; however, an approved update course instructor may not independently conduct an update course unless the instructor has also obtained approval as an update course sponsor. An instructor shall obtain written approval from the Board before teaching an update course and before representing to any sponsor or other party that he or she is approved or may be approved as an update course instructor.

History

  • Authority G.S. 143-151.49(13); 143-151.64
  • Eff. July 18, 2002
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .1314 Application and Criteria for Original Approval of Update Course Instructors {#sec-11-ncac-08-.1314 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1314}

(a) A person seeking original approval as an update course instructor shall make application on a form prescribed by the Board. An applicant who is not a resident of North Carolina shall also file with the application a consent to service of process and pleadings. No application fee is required. All required information regarding the applicant's qualifications shall be submitted.

(b) The applicant shall be honest in all dealings with the Board and in course instruction.

(c) The applicant shall be qualified under one of the following standards:

(1) Possession of a baccalaureate or higher degree with a major in the field of engineering, construction, or architecture;

(2) Possession of a current North Carolina home inspector license, three years active full-time experience in performing home inspections for compensation within the previous 10 years, and 30 classroom hours of home inspection education, excluding prelicensing education, within the past three years, such education covering topics that are acceptable under Board rules for continuing education credit.

(3) Possession of a current North Carolina home inspector license and experience teaching at least 10 home inspector prelicensing courses within the previous five years; or

(4) Possession of qualifications found by the Board to be equivalent to one or more of the above standards, provided that the requirement for a current North Carolina home inspector license shall be waived only for applicants who qualify under Subparagraph (c)(1) of this Rule.

(d) The applicant shall possess good teaching skills as demonstrated on a video portraying the instructor teaching a live audience. The applicant shall submit the video to the Board for review. The video shall be 45-60 minutes in length and shall depict a continuous block of instruction on home inspections or a directly related topic. The video shall be unedited, shall show at least a portion of the audience, and shall have visual and sound quality sufficient to enable reviewers to clearly see and hear the instructor. The video shall have been made within the previous three years. The video shall demonstrate that the instructor possesses the teaching skills described in Rule .1345 of this Section.

History

  • Authority G.S. 143-151.49(13); 143-151.64
  • Eff. July 18, 2002
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .1315 Renewal of Approval of Update Course Instructors {#sec-11-ncac-08-.1315 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1315}

Board approval of update course instructors expires on December 31 following issuance of approval. In order to assure continuous approval, approved instructors shall file applications for renewal of approval on a form prescribed by the Board on or before December 1 immediately preceding expiration of their approval. In order to renew approval, applicants shall satisfy the criteria for original approval, with the exception of the requirement stated in Rule .1314(d) of this Section, unless requested by the Board under Rule .1317 of this Section.

History

  • Authority G.S. 143-151.49(13); 143-151.64
  • Eff. July 18, 2002
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .1316 Denial or Withdrawal of Approval of Update Course Instructors {#sec-11-ncac-08-.1316 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1316}

(a) The Board may deny or withdraw approval of any update course instructor upon finding that:

(1) The instructor has made any false statements or presented any false information in connection with an application for approval or renewal of approval;

(2) The instructor has failed to meet the criteria for approval described in Rule .1314 of this Section or has refused or failed to comply with any other provisions of this Section;

(3) The instructor has failed to demonstrate, during the teaching of update courses, those effective teaching skills described in Rule .1345 of this Section;

(4) The instructor has provided false or incorrect information in connection with any reports a course sponsor is required to submit to the Board; or

(5) The instructor has been disciplined by the Board or any other occupational licensing agency in North Carolina or another jurisdiction.

(b) If a licensee who is an approved update course instructor engages in any dishonest, fraudulent, or conduct lacking moral turpitude in connection with the licensee's activities as an instructor, the licensee shall be subject to disciplinary action pursuant to G.S. 143-151.56.

History

  • Authority G.S. 143-151.49(13); 143-151.64
  • Eff. July 18, 2002
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .1317 Request for Video of Update Course Instructors {#sec-11-ncac-08-.1317 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1317}

When concerns about the quality of a course or instructor are made known to the Board, upon the written request of the Board, an approved update course instructor shall submit to the Board a video depicting the instructor teaching the update course. The video shall have been made within 12 months before the date of submittal, shall include a label that clearly identifies the instructor and the date of the video presentation, shall not be the same video that was submitted under Rule .1314(d) of this Section, and shall conform to specifications set forth in Rule .1314(d) of this Section.

History

  • Authority G.S. 143-151.49(13); 143-151.64
  • Eff. July 18, 2002
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .1318 Elective Course Component {#sec-11-ncac-08-.1318 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1318}

(a) Licensee Requirements: To renew a license on active status, a licensee shall complete eight classroom hours of instruction in two or more Board approved elective courses within the licensure period in addition to satisfying the continuing education mandatory update course requirement described in Rule .1309 of this Section.

(b) Sponsor Requirements: Approval of an elective course requires approval of the sponsor and instructor(s) as well as the course itself. The approval authorizes the sponsor to conduct the approved course using the instructor(s) who have been found by the Board to satisfy the instructor requirements set forth in Rule .1322 of this Section. The sponsor may conduct the course at any location as frequently as is desired during the approval period. However, the sponsor may not conduct any session of an approved course for home inspector continuing education purposes between September 10 and September 30, inclusive, of any approval period.

History

  • Authority G.S. 143-151.49(13); 143-151.64
  • Eff. July 18, 2002
  • Amended Eff. October 1, 2014; October 1, 2011
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .1319 Application for Original Approval of an Elective Course {#sec-11-ncac-08-.1319 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1319}

A person seeking original approval of a proposed elective course shall make application on a form provided by the Board. The course shall be submitted to the Board for approval no less than 45 days before the course presentation date. The Board shall not accept an application for original approval between July 1 and September 30. This restriction shall not apply when an applicant is seeking approval to conduct a course for which another sponsor has obtained approval. The applicant shall submit a nonrefundable fee of one hundred fifty dollars ($150.00) per course paid to the Home Inspector Licensure Board. The application shall be accompanied by a copy of the course plan or instructor's guide for the course and a copy of materials that will be provided to students. An applicant that is not a resident of North Carolina shall also file with the application a consent to service of process and pleadings.

History

  • Authority G.S. 143-151.49(13); 143-151.64
  • Eff. July 18, 2002
  • Amended Eff. February 1, 2011; January 1, 2008
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .1320 Criteria for Elective Course Approval {#sec-11-ncac-08-.1320 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1320}

The following requirements shall be satisfied in order to obtain approval of a proposed elective course:

(1) The applicant shall submit all information required by the rules in this Section and pay the application fee.

(2) The applicant shall satisfy the requirements of Rules .1327 through .1337 of this Section relating to the qualifications or eligibility of course sponsors.

(3) The subject matter of the course shall satisfy the elective course subject matter requirements set forth in Rule .1321 of this Section and all information to be presented in the course shall be current and accurate.

(4) The course shall involve a minimum of two classroom hours of instruction on acceptable subject matter. A classroom hour consists of 50 minutes of instruction and 10 minutes of break time.

(5) The applicant is honest. In this regard, the Board may consider the reputation and character of any owner, member, officer, continuing education coordinator, and director of any corporation, association, or organization applying for sponsor approval.

(6) The proposed instructor(s) for the course shall possess the qualifications described in Rule .1322 of this Section.

(7) The instructional delivery methods to be used in the course shall comply with the requirements described in Rule .1326 of this Section.

(8) The applicant shall submit an instructor guide that includes:

(a) a detailed course outline;

(b) the amount of time to be devoted to each major topic and to breaks;

(c) the learning objective(s) for each major topic; and

(d) the instructional methods and instructional aids that will be used in the course.

The proposed time allotments shall be appropriate for the proposed subject matter to be taught. Unless the applicant can demonstrate that straight lecture is the most effective instructional method for the course, the instructor guide shall provide for the use of a variety of instructional methods and instructional aids intended to enhance student attentiveness and learning. Examples of instructional methods and instructional aids that may be appropriate include class discussion, role-playing, in-class work assignments, overhead transparencies, and videos.

(9) The course shall include handout materials for students unless the applicant can demonstrate that such materials are either inappropriate or unnecessary for the course. Such materials shall be current, accurate, grammatically correct, logically organized, and produced in a manner that reflects reasonable quality.

(10) Either the instructor guide or the student materials shall describe, in narrative form, the details of the substantive information to be presented in the course. The substantive information to be presented must be provided in sufficient detail to demonstrate that the information is current, accurate, and complete.

(11) If an applicant proposes to use copyrighted materials in the course, such materials must be used in a form approved by the copyright holder. If any copyrighted material is to be duplicated by the applicant for use in the course, the sponsor shall have the specific permission of the copyright holder.

(12) Applicants requesting approval of a computer-based instructional program need not comply with the requirements in Subparagraphs (8), (9), and (10) of this Rule; however, such applicants shall submit a written course plan that includes a detailed course outline, the minimum amount of time required for a typical licensee to complete each lesson, and the entire course and the learning objectives for each major topic. Such applicants shall also submit a complete copy of the instructional program on the medium that is to be utilized and shall make available, to the Board and at the sponsor's expense, all hardware and software necessary for review by the Board. The information in the instructional program shall comply with the requirements of Rule .1326 of this Section.

History

  • Authority G.S. 143-151.49(13); 143-151.64
  • Eff. July 18, 2002
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .1321 Elective Course Subject Matter {#sec-11-ncac-08-.1321 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1321}

(a) Elective courses shall directly contribute to accomplishment of the primary purpose of mandatory continuing education, which is to help assure that licensees possess the knowledge, skills, and competence necessary to function in the home inspection profession in a manner that protects and serves the public interest. The knowledge or skills taught in an elective course shall enable licensees to better serve their clients and the subject matter shall be directly related to the home inspection profession. Examples of acceptable subject matter include rules adopted by the Board, including the Standards of Practice and Code of Ethics for home inspectors, which are found in 11 NCAC 08 .1100; G.S. 143, Article 9F; construction techniques; construction materials; residential environmental issues; residential mechanical systems and components; residential structural systems and components; and business administration or management.

(b) If there are unique North Carolina laws, rules, or customary practices that are relevant to a topic being addressed in an elective course, and if the course is to be conducted in North Carolina or primarily for the benefit of North Carolina licensees, then the course shall accurately and completely address such North Carolina laws, rules, or practices.

History

  • Authority G.S. 143-151.49(13); 143-151.64
  • Eff. July 18, 2002
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .1322 Elective Course Instructors {#sec-11-ncac-08-.1322 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1322}

(a) The instructor of an elective course shall be honest and shall be qualified under one of the following standards:

(1) Possession of a baccalaureate or higher degree in a field directly related to the subject matter of the course;

(2) Three years' full-time experience within the previous 10 years that is directly related to the subject matter of the course;

(3) Three years' full-time experience within the previous 10 years teaching the subject matter of the course; or

(4) Education or experience or both found by the Board to be equivalent to one or more of the above standards.

(b) If the subject matter of the course deals directly with conducting a home inspection according to the Standards of Practice and Code of Ethics in 11 NCAC 08, Section 1100, then the instructor shall also possess a current home inspector license issued by the Board.

History

  • Authority G.S. 143-151.49(13); 143-151.64
  • Eff. July 18, 2002
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .1323 Elective Course Credit Hours {#sec-11-ncac-08-.1323 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1323}

The elective course approval issued to a course sponsor shall include the number of credit hours of continuing education credit that may be awarded for the course. The maximum number of credit hours that may be awarded for an elective course is four credit hours.

History

  • Authority G.S. 143-151.49(13); 143-151.64
  • Eff. July 18, 2002
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .1324 Request for Video of an Elective Course {#sec-11-ncac-08-.1324 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1324}

When concerns about the quality of a course or instructor are made known to the Board, upon the written request of the Board, the sponsor of an approved elective course shall submit to the Board a video depicting the course being taught by a particular instructor designated by the Board. The video shall have been made within 12 months before the date of submittal, shall include a label that clearly identifies the instructor and the date of the video presentation, shall not be the same video that was submitted under Rule .1314(d) of this Section, and shall conform to technical specifications set forth in Rule .1314(d) of this Section.

History

  • Authority G.S. 143-151.49(13); 143-151.64
  • Eff. July 18, 2002
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .1325 sTUDENT FEES FOR ELECTIVE COURSES {#sec-11-ncac-08-.1325 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1325}

A sponsor of an elective course may establish the amount of the fee to be charged to students taking the course. The established fee shall be an all-inclusive fee, and no separate or additional fee may be charged to students for providing course materials required by the Board, providing course completion certificates, reporting course completion to the Board, or for recouping similar routine administrative expenses. The total amount of any fees to be charged shall be included in any advertising or promotional materials for the course.

History

  • Authority G.S. 143-151.49(13); 143-151.64
  • Eff. July 18, 2002
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .1326 Elective Course Instructional Delivery Methods {#sec-11-ncac-08-.1326 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1326}

(a) The principal instructional delivery method utilized in elective courses shall be one or more of the following:

(1) Personal teaching by an instructor in a traditional classroom setting;

(2) Instruction through an interactive audio and video system that requires continuous audio communication between the instructor and all students and that provides for monitoring and technical support at each site where the instructor or students are located;

(3) Instruction through an interactive computer-based instructional program, which program provides for control of student progress through the educational materials by testing to assure student mastery of the subject matter at the end of each lesson, monitoring of time devoted to each lesson by the computer with automatic program shutdown after a period of non-activity by the student, which period shall be determined by the sponsor, and a monitoring system that assures that the student receiving continuing education credit for completing the program actually performed all the work required to complete the program; and

(4) Personal teaching by an instructor in a field setting, such as a house or other structure, a new home construction site, a home renovation site, or other locations outside of a classroom that are appropriate for the subject matter of the course.

(b) The use of passive or non-interactive instructional delivery systems such as video, remote non-interactive television, or similar systems may be employed only in a limited manner to enhance or supplement one of the acceptable instructional delivery methods previously described in this Rule. No portion of a course may consist of correspondence instruction.

(c) A field setting shall have technical support at each site where the instructor and students are located, and have safeguards in place to prevent injury to the students, such as hardhats. A field setting shall not be at the residence of the instructor, course sponsor, or any other person affiliated with the course.

History

  • Authority G.S. 143-151.49(13); 143-151.64
  • Eff. July 18, 2002
  • Amended Eff. January 1, 2011
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .1327 General Sponsor Eligibility Requirements {#sec-11-ncac-08-.1327 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1327}

Any person is eligible to seek approval as a sponsor of continuing education courses, provided that the person seeking approval of a continuing education elective course is either the owner of the proprietary rights to the course or has lawfully acquired from the course owner the right to seek course approval from the Board and to conduct the course.

History

  • Authority G.S. 143-151.49(13); 143-151.64
  • Eff. July 18, 2002
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .1328 sPONSOR NAME {#sec-11-ncac-08-.1328 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1328}

(a) The official name to be used by any course sponsor in connection with the offering of an approved continuing education course shall clearly distinguish the sponsor from any other previously approved continuing education course sponsor. Unless the sponsor is a licensed private home inspector training school proposing to operate continuing education courses in its own name, the official name also shall clearly distinguish the sponsor from any licensed private home inspector training school. The Board shall not approve a sponsor name that does not comply with this paragraph.

(b) Any advertisement or promotional material used by an approved course sponsor shall include the course sponsor's official name only.

History

  • Authority G.S. 143-151.49(13); 143-151.64
  • Eff. July 18, 2002
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .1329 Sponsor Advance Approval Required {#sec-11-ncac-08-.1329 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1329}

A prospective sponsor of an update course or elective course shall obtain written approval from the Board to conduct the course before offering or conducting the course and before advertising or otherwise representing that the course is approved for continuing education credit in North Carolina. No retroactive approval to conduct an update course shall be granted for any reason. Retroactive approval of an elective course shall be granted by the Board if the course sponsor can provide evidence to the Board that the course was not offered for purposes of satisfying the home inspector continuing education requirement and that the sponsor could not reasonably have been expected to anticipate that students would want to receive continuing education credit for the course.

History

  • Authority G.S. 143-151.49(13); 143-151.64
  • Eff. July 18, 2002
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .1330 Continuing Education Coordinator {#sec-11-ncac-08-.1330 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1330}

A sponsor of an update course or elective course shall designate one person to serve as the continuing education coordinator for all Board-approved continuing education courses offered by the sponsor. The designated coordinator shall serve as the official contact person for the sponsor and shall be responsible for the following:

(1) Supervising the conduct of attendees at the sponsor's Board-approved continuing education courses;

(2) Signing the course completion certificates provided by the sponsor to licensees completing courses; and

(3) Submitting to the Board all required fees, rosters, reports, and other information.

History

  • Authority G.S. 143-151.49(13); 143-151.64
  • Eff. July 18, 2002
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .1331 Course Completion Reporting {#sec-11-ncac-08-.1331 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1331}

(a) Course sponsors shall prepare and submit to the Board reports verifying completion of a continuing education course for each licensee who satisfactorily completes the course according to the criteria in Rule .1305 of this Section and who desires continuing education credit for the course. The reports shall be completed on forms prescribed by the Board. Sponsors shall submit these reports to the Board in a manner that will assure receipt by the Board within 15 calendar days following the course, but in no case later than September 10 for courses conducted before that date.

(b) Course sponsors shall provide licensees enrolled in each continuing education course an opportunity to complete an evaluation of each approved continuing education course on a form prescribed by the Board. Sponsors shall submit the completed evaluation forms to the Board along with the reports that verify completion of a continuing education course.

(c) Course sponsors shall provide each licensee who satisfactorily completes an approved continuing education course according to the criteria in Rule .1305 of this Section a course completion certificate on a form prescribed by the Board. Sponsors shall provide the certificates to licensees within 15 calendar days following the course, but in no case later than September 10 for any course completed before that date. The certificate may be retained by the licensee as proof of having completed the course.

(d) When a licensee does not comply with the participation standards in Rule .1347 of this Section, the course sponsor shall advise the Board of this matter in writing at the time the sponsor submits the reports verifying completion of continuing education for the course. The sponsor who determines that a licensee failed to comply with either the Board's attendance or student participation standards in Rules .1305 and .1347 of this Section shall not provide the licensee with a course completion certificate nor shall the sponsor include the licensee's name on the reports verifying completion of continuing education.

History

  • Authority G.S. 143-151.49(13); 143-151.64
  • Eff. July 18, 2002
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .1332 Per Student Fee {#sec-11-ncac-08-.1332 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1332}

Following completion of any approved continuing education update or elective course, the course sponsor shall submit to the Board, along with the roster and the items required to be submitted by Rule .1331 of this Section, a fee in the amount of five dollars ($5.00) per credit hour for each licensee who completes the course according to the criteria in Rule .1305 of this Section. Fees shall be paid to the Home Inspector Licensure Board. The sponsor shall make a separate fee payment for each separate class session.

History

  • Authority G.S. 143-151.49(13); 143-151.64
  • Eff. December 4, 2002
  • Amended Eff. February 1, 2011; October 1, 2010
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .1333 Change in Sponsor Ownership {#sec-11-ncac-08-.1333 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1333}

The approval granted to a course sponsor may be transferred to a new or different person only with the prior approval of the Board. The Board shall approve the transfer if the transferee satisfies the requirements of the rules in this Section. If the ownership of an approved course sponsor is to be sold or otherwise changed, the sponsor shall obtain Board approval of the ownership change. The Board shall approve the ownership change if the proposed new owner satisfies the requirements of the rules in this Section.

History

  • Authority G.S. 143-151.49(13); 143-151.64
  • Eff. July 18, 2002
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .1334 Sponsor Changes During Approval Period {#sec-11-ncac-08-.1334 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1334}

(a) Course sponsors shall give prior written notice to the Board in writing of any change in business name, continuing education coordinator, address, or business telephone number.

(b) Course sponsors shall obtain prior approval from the Board for any proposed changes in the content or number of hours for elective courses. The Board shall approve the changes if the changes satisfy the requirements of the rules in this Section. Changes in course content that are solely for the purpose of assuring that information provided in a course is current and accurate do not require approval during the approval period, but shall be reported at the time the sponsor requests renewal of course approval. Requests for approval of changes shall be in writing.

History

  • Authority G.S. 143-151.49(13); 143-151.64
  • Eff. July 18, 2002
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .1335 Course Records {#sec-11-ncac-08-.1335 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1335}

All course sponsors shall retain records of student registration, attendance, and course completion for each session of a continuing education course for two years. All course sponsors shall make these records available to the Board upon request.

History

  • Authority G.S. 143-151.49(13); 143-151.64
  • Eff. July 18, 2002
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .1336 Renewal of Course and Sponsor Approval {#sec-11-ncac-08-.1336 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1336}

(a) Board approval of all continuing education elective courses and of update course sponsors expires on the next September 30 following the date of issuance. In order to assure continuous approval, renewal applications shall be accompanied by the renewal fee and filed on a form provided by the Board on or before July 31 of each year. Any incomplete renewal application received on or before July 30 that is not completed within 10 days after notice of the deficiency, as well as any renewal application received after July 31, shall not be accepted; and the sponsor shall file an application for original approval on or after October 1 in order to be reapproved. Applicants for renewal of approval shall satisfy the criteria for original approval. When the Board issues original course or sponsor approval with an effective date between July 1 and September 10, the deadline for submittal of renewal applications shall be September 10 of the year in which the original approval is issued.

(b) The fee for renewal of Board approval shall be seventy-five dollars ($75.00) for each elective course. Fees shall be paid to the Home Inspector Licensure Board and are nonrefundable.

History

  • Authority G.S. 143-151.49(13); 143-151.64
  • Eff. July 18, 2002
  • Amended Eff. February 1, 2011
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .1337 Denial or Withdrawal of Approval of Course or Course Sponsor {#sec-11-ncac-08-.1337 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1337}

(a) The Board shall deny or withdraw approval of any course or course sponsor upon finding that:

(1) the course sponsor has made any false statements or presented any false information in connection with an application for course or sponsor approval or renewal of the approval;

(2) the course sponsor or any official or instructor employed by or under contract with the course sponsor has refused or failed to comply with any of the provisions of this Section;

(3) the course sponsor or any official or instructor employed by or under contract with the course sponsor has provided false or incorrect information in connection with any reports the course sponsor is required to submit to the Board;

(4) the course sponsor has engaged in a pattern of consistently canceling scheduled courses;

(5) the course sponsor has knowingly paid fees to the Board with a check that was dishonored by a bank;

(6) an instructor employed by or under contract with the course sponsor fails to conduct approved courses in a manner that demonstrates possession of the teaching skills described in Rule .1345 of this Section;

(7) any court of competent jurisdiction has found the course sponsor or any official or instructor employed by or under contract with the course sponsor to have violated, in connection with the offering of continuing education courses, any applicable federal or state law or regulation prohibiting discrimination on the basis of disability, requiring places of public accommodation to be in compliance with prescribed accessibility standards, or requiring that courses related to licensing or certification for professional or trade purposes be offered in a place and manner accessible to persons with disabilities;

(b) If a licensee who is an approved course sponsor or an instructor employed by or under contract with an approved course sponsor engages in any dishonest, fraudulent, or conduct inconsistent with the Rules in this Section in connection with the licensee's activities as a course sponsor or instructor, the licensee shall be subject to disciplinary action pursuant to G.S. 143-151.56.

History

  • Authority G.S. 143-151.49(13); 143-151.64
  • Eff. July 18, 2002
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .1338 Scheduling {#sec-11-ncac-08-.1338 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1338}

Courses shall be scheduled and conducted in a manner that limits class sessions to a maximum of eight classroom hours in any given day, including breaks for each class session. The maximum permissible class session without a break is 90 minutes. Courses scheduled for more than four hours in any given day shall include a meal break of at least one hour.

History

  • Authority G.S. 143-151.49(13); 143-151.64
  • Eff. July 18, 2002
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .1339 Minimum Class Size {#sec-11-ncac-08-.1339 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1339}

The minimum class size for any session of an approved continuing education course shall be five students, as determined by the sponsor's preregistration records. The minimum class size requirement shall not apply to class sessions when the sponsor notifies the Board in writing of the scheduled class session as provided in Rule .1340 of this Section and advertises in advance the scheduled class session in the community where the class session is to be held. A sponsor who conducts a class session for fewer than five students shall submit a copy of the advertisement for the class session with the reports verifying completion of the course plus a statement or other documentation indicating the date of the advertisement and the advertising method.

History

  • Authority G.S. 143-151.49(13); 143-151.64
  • Eff. July 18, 2002
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .1340 Notice of Scheduled Courses {#sec-11-ncac-08-.1340 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1340}

(a) A sponsor shall provide the Board with written notice of each scheduled course offering no later than 10 days before a scheduled course date. The notice shall include the name and assigned number for the sponsor, the name and assigned number for the course, the scheduled date and time, specific location, and name of the instructor.

(b) A sponsor shall notify the Board of any schedule changes or course cancellations at least five days before to the original scheduled course date. If a change or cancellation is necessary because of some unforeseen circumstance, the sponsor shall notify the Board as soon as the sponsor effects the change or cancellation.

(c) A sponsor shall notify the Board as soon as it becomes apparent to the sponsor that enrollment in a planned class session will exceed 100 students.

History

  • Authority G.S. 143-151.49(13); 143-151.64
  • Eff. July 18, 2002
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .1341 Advertising; Providing Course Information {#sec-11-ncac-08-.1341 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1341}

(a) Course sponsors shall not use advertising of any type that is false or misleading. If the number of continuing education credit hours awarded by the Board for an approved elective course is fewer than the number of scheduled hours for the course, any course advertisement or promotional materials that indicate the course is approved for home inspection continuing education credit in North Carolina shall specify the number of continuing education credit hours awarded by the Board for the course.

(b) Any flyers, brochures, or similar materials used to promote a continuing education course shall clearly describe the fee to be charged and the sponsor's cancellation and fee refund policies.

(c) A course sponsor of any elective course shall, upon request, provide any prospective student a description of the course content.

History

  • Authority G.S. 143-151.49(13); 143-151.64
  • Eff. July 18, 2002
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .1342 Classes Open to All Licensees {#sec-11-ncac-08-.1342 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1342}

All class sessions of approved continuing education courses shall be open to all licensees on a first-come, first-served basis. The sponsor of a course that has a bona fide education or experience prerequisite may refuse admission to a licensee who does not satisfy the prerequisite. A sponsor may contract with an organization such as a home inspection firm, franchise, or trade organization to conduct approved continuing education courses for licensees affiliated with the firm, franchise, or organization. The sponsor shall allow licensees not affiliated with the firm, franchise, or organization to enroll in any class session on a first-come, first-served basis.

History

  • Authority G.S. 143-151.49(13); 143-151.64
  • Eff. July 18, 2002
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .1343 Classroom Facilities {#sec-11-ncac-08-.1343 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1343}

A classroom in which a course is provided shall:

(1) accommodate all enrolled students;

(2) be equipped with student desks, worktables with chairs, or other seating having a surface on which students can write;

(3) have light, heat, cooling, ventilation, and, as needed, a public address system; and

(4) be free of distractions that would disrupt class sessions.

Subparagraphs (2) and (3) of this Rule are not required if the course is conducted in a field setting.

History

  • Authority G.S. 143-151.49(13); 143-151.64
  • Eff. July 18, 2002
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .1344 Student Check-in {#sec-11-ncac-08-.1344 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1344}

Upon initially checking in for a class session, sponsors and instructors shall require licensees to provide their license numbers and shall provide each student with a copy of the continuing education student information sheet provided to sponsors by the Board.

History

  • Authority G.S. 143-151.49(13); 143-151.64
  • Eff. July 18, 2002
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .1345 Instructor Requirements {#sec-11-ncac-08-.1345 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1345}

(a) Instructors shall assure that class sessions are started on time and are conducted for the full amount of time that is scheduled. Instructors shall also assure that each update course is taught according to the instructor guide provided by the Board and that each elective course is taught according to the course plan and instructor guide that was approved by the Board, including the furnishing of appropriate student materials.

(b) Instructors shall possess the ability to:

(1) Communicate through speech, with the ability to speak clearly, and with voice inflection, using proper grammar, and vocabulary;

(2) Present instruction in a thorough, accurate, logical, orderly and understandable manner;

(3) Use varied instructional techniques in addition to straight lecture, such as class discussion, role-playing, or other techniques;

(4) Use instructional aids, such as the overhead projector, to enhance learning; and

(5) Interact with adult students in a positive manner that encourages students to learn, that demonstrates an understanding of varied student backgrounds, that avoids offending the sensibilities of students, and that avoids personal criticism of any other person, agency or organization.

History

  • Authority G.S. 143-151.49(13); 143-151.64
  • Eff. July 18, 2002
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .1346 Monitoring Attendance {#sec-11-ncac-08-.1346 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1346}

(a) Sponsors and instructors shall monitor attendance for the duration of each class session to assure that all students reported as satisfactorily completing a course according to the criteria in Rule .1305 of this Section have attended at least 90 percent of the scheduled credit hours. Students shall not be admitted to a class session after 10 percent of the scheduled credit hours have been conducted. A student shall not be allowed to sign a course attendance roster report, shall not be issued a course completion certificate, and shall not be reported to the Board as having completed a course unless the student fully satisfies the attendance requirement. Sponsors and instructors shall not make any exceptions to the attendance requirement for any reason.

(b) Sponsors shall assure that personnel in addition to the instructor are present during all class sessions to assist the instructor in monitoring attendance and performing the necessary administrative tasks associated with conducting a course. Sponsors shall provide one monitor for every 50 students attending a course. If a class size is 20 students or less, requirements for additional personnel are waived.

History

  • Authority G.S. 143-151.49(13); 143-151.64
  • Eff. July 18, 2002
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .1347 Student Participation Standards {#sec-11-ncac-08-.1347 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1347}

(a) In addition to requiring student compliance with the attendance requirement, sponsors and instructors shall require that students comply with the following student participation standards:

(1) A student shall direct his or her attention to the instruction being provided and refrain from engaging in activities unrelated to the instruction.

(2) A student shall refrain from engaging in any activities that are distracting to other students or the instructor, or that otherwise disrupt the orderly conduct of a class.

(3) A student shall comply with all instructions provided by the sponsor or instructor related to providing information needed to properly report completion of a course by the student.

(b) Instructors and sponsors may dismiss from a class session any student who fails to comply with the student participation standards prescribed in Paragraph (a) of this Rule.

(c) Sponsors shall not issue a course completion certificate to any student who fails to comply with the student participation standards set forth in Paragraph (a) of this Rule, nor shall a sponsor include the name of that student on a report verifying completion of a continuing education course. A sponsor shall submit to the Board with the report for the class session a written statement that includes the name and license number of the student for whom the sponsor does not report course credit, details concerning the student's failure to comply with the student participation standards, and names of other persons in attendance at the class who witnessed the student's conduct.

History

  • Authority G.S. 143-151.49(13); 143-151.64
  • Eff. July 18, 2002
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .1348 Solicitation of Students {#sec-11-ncac-08-.1348 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1348}

Sponsors and instructors may make available for purchase by students materials that belong to the sponsor, instructor, or some other party; however, class time may not be used to promote or sell any materials or to solicit affiliation or membership in any business or organization.

History

  • Authority G.S. 143-151.49(13); 143-151.64
  • Eff. July 18, 2002
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .1349 Cancellation and Refund Policies {#sec-11-ncac-08-.1349 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1349}

Course sponsors shall administer course cancellation and fee refund policies in a non-discriminatory manner. If a scheduled course is canceled, a sponsor shall notify preregistered students of the cancellation. All prepaid fees received from preregistered students shall be refunded within 30 days after date of cancellation or, with the student's permission, applied toward the fees for another course.

History

  • Authority G.S. 143-151.49(13); 143-151.64
  • Eff. July 18, 2002
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .1350 Course Monitors {#sec-11-ncac-08-.1350 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1350}

A course sponsor shall admit an authorized representative of the Board to monitor any continuing education class without prior notice. A Board representative shall not be required to register or pay any fee and shall not be reported as having completed the course.

History

  • Authority G.S. 143-151.49(13); 143-151.64
  • Eff. July 18, 2002
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .1351 Accommodations for Persons with Disabilities {#sec-11-ncac-08-.1351 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1351}

Course sponsors may deviate from Board rules concerning the conduct of continuing education courses, such as rules addressing classroom facilities, minimum class size, and instructional methods, as may be necessary in order for the sponsor to comply with the Americans with Disabilities Act or other laws requiring sponsors to accommodate persons with disabilities. A sponsor providing a special accommodation for a licensee with a disability that requires the sponsor to deviate from Board rules shall notify the Board in writing of the accommodation at the time reports are submitted for the class session attended by the licensee.

History

  • Authority G.S. 143-151.49(13); 143-151.64
  • Amended Eff. July 18, 2002
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .1401 Definitions {#sec-11-ncac-08-.1401 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1401}

As used in this Section:

(1) "Board" means the North Carolina Manufactured Housing Board, as defined in G.S. 143-143.9(1).

(2) "CE Administrator" means a person designated by the Board to receive all applications for course approval, course reports, course application and renewal fees, on behalf of the Board for the CE program.

(3) "Continuing education" or "CE" means any educational activity approved by the Board to be a continuing education activity.

(4) "Course" means a continuing education course directly related to manufactured housing principles and practices or a course designed and approved for licensees.

(5) "Credit hour" means at least 50 minutes of continuing education instruction.

(6) "Distance education course" or "distance learning course" means a continuing education course approved by the Board in which instruction is accomplished through the use of media whereby teacher and student are separated by distance and sometimes by time.

(7) "Licensee" means a manufactured housing salesperson or set-up contractor who holds a license issued by the Board in accordance with G.S. 143-143.11, but does not include a licensed manufacturer or dealer.

(8) "Qualifier" means the person or persons having passed the written Set-Up Contractor's Examination as administered by the Board and authorized in G.S. 143-143.11(h), and as defined in 11 NCAC 08 .0912(e), or a person who meets the requirements of 11 NCAC 08 .0912(e) and is designated by a licensee to obtain CE credits.

(9) "Sponsor" means an organization or individual who has submitted information to the Board as specified in this Section and has been approved by the Board to provide instruction for the purpose of CE.

(10) "Staff" means designated employees of the Manufactured Building Division of the Department of Insurance who are authorized to act on behalf of the Board with regard to continuing education matters.

History

  • Authority G.S. 143-143.10; 143-143.11B
  • Eff. August 1, 2002
  • Amended Eff. May 1, 2004
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .1402 Ce Courses -- General {#sec-11-ncac-08-.1402 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1402}

(a) Credit shall be given only for courses that have been approved by the Board. No other continuing education hours for other State occupational licenses shall be used by a licensee to satisfy the continuing education requirements in this Section.

(b) The Board may award CE credit for a course or related educational activity that has not been approved in accordance with 11 NCAC 08 .1405(c). Licensees who wish to have the Board consider an unapproved course or educational activity for possible CE credit shall provide documentation to the Board consisting of not less than the information required in 11 NCAC 08 .1405(a), together with a fee of fifty dollars ($50.00) for each course or educational activity to be reviewed. Fees shall be paid by check, money order, VISA, or MasterCard, made payable to the North Carolina Manufactured Housing Board, and are nonrefundable.

(c) The minimum credit hours that a licensee must obtain during the license year before renewal are as follows:

Salespersons -- six credit hours;

Set-up Contractors -- four credit hours.

History

  • Authority G.S. 143-143.10; 143-143.11B
  • Eff. August 1, 2002
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .1403 Sponsor Advance Approval Required {#sec-11-ncac-08-.1403 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1403}

A prospective sponsor of a CE course shall obtain written approval from the Board according to these Rules to conduct the course before offering or conducting the course and before advertising or otherwise representing that the course is or may be approved for continuing education credit in North Carolina. No retroactive approval to conduct a CE course shall be granted by the Board for any reason.

History

  • Authority G.S. 143-143.10; 143-143.11B
  • Eff. August 1, 2002
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .1404 Sponsor Name {#sec-11-ncac-08-.1404 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1404}

(a) The official name to be used by any course sponsor in connection with the offering of an approved CE course shall clearly distinguish the sponsor from any other previously approved CE course sponsor.

(b) Any advertisement or promotional material used by an approved course sponsor shall include the course sponsor's official name only.

(c) Violations of this Section may result in revocation of course approval.

History

  • Authority G.S. 143-143.10; 143-143.11B
  • Eff. August 1, 2002
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .1405 Accreditation Standards {#sec-11-ncac-08-.1405 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1405}

(a) Prospective sponsors of CE courses shall apply for approval from the Board by submitting the following information to the Board for consideration:

(1) The nature and purpose of the course;

(2) The course objectives or goals;

(3) The outline of the course, including the number of training hours for each segment;

(4) Copies of all handouts and materials to be furnished to students;

(5) The identity, qualifications, and experience of each instructor; and

(6) Inclement weather policies for courses conducted outdoors.

(b) A nonrefundable fee of one hundred fifty dollars ($150.00), in the form of check, money order, VISA, or MasterCard, payable to the North Carolina Manufactured Housing Board, must be received by the Board for each course submitted for approval. The Board will not review a prospective course application before receiving the fee.

(c) To determine if a course will receive approval, the Board shall complete the following review:

(1) The course shall be referred to the staff for review;

(2) The staff shall review the course to determine if the course is pertinent to the industry, if the course meets its stated objectives, and if the instructor(s) meets the requirements of 11 NCAC 08 .1418; and

(3) The staff shall issue written documentation of approval to the course sponsor, with copies to the Board, for all courses deemed to be acceptable. A written report shall be issued to the course sponsor for all courses found not to be acceptable, documenting specific reasons for the disapproval. A course sponsor may appeal the staff's disapproval of a course to the Board and be heard at the next scheduled meeting of the Board.

(d) Once a course has been approved, neither the content of the course nor any handouts or any teaching aids may be changed without prior written approval from the staff.

History

  • Authority G.S. 143-143.10; 143-143.11B; 143-143.25
  • Eff. August 1, 2002
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .1406 Ce Course Subject Matter {#sec-11-ncac-08-.1406 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1406}

(a) CE courses shall help assure that licensees possess the knowledge, skills, and competence necessary to function as manufactured home salespersons or set-up contractors in a manner that protects and serves the public interest. The knowledge or skills taught in a CE course shall enable licensees to better serve manufactured home consumers and the subject matter shall be directly related to manufactured home sales and set-up operations.

(b) If there are unique North Carolina laws, codes, rules, customary practices, or approved methods that are relevant to a topic being addressed in a CE course, and if the course is to be conducted in North Carolina or primarily for the benefit of North Carolina licensees, then the course shall accurately and completely address such North Carolina laws, codes, rules, customary practices, or approved methods.

(c) Instructors shall not communicate any misinformation about or contradiction of any statute, court decision, administrative rule, or order that has been issued by the Board.

History

  • Authority G.S. 143-143.10; 143-143.11B
  • Eff. August 1, 2002
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .1407 Scheduling {#sec-11-ncac-08-.1407 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1407}

Courses shall be scheduled and conducted in a manner that limits class sessions to a maximum of eight classroom hours in any given day, including breaks for each class session. The maximum permissible class session without a break is 90 minutes. Courses scheduled for more than four hours in any given day shall include a meal break of at least one hour. The provisions of this rule do not apply to distance learning courses.

History

  • Authority G.S. 143-143.10; 143-143.11B
  • Eff. August 1, 2002
  • Amended Eff. May 1, 2004
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .1408 Notice of Scheduled Courses {#sec-11-ncac-08-.1408 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1408}

(a) A sponsor shall provide the Board with written notice of each scheduled course offering not later than 10 days before a scheduled course date. The notice shall include the name and assigned number for the sponsor, the name and assigned number for the course, the scheduled date and time, specific location, and name of the instructor(s).

(b) A sponsor shall notify the Board of any schedule changes or course cancellations at least five calendar days before the original scheduled course date. If a change or cancellation is necessary because of some unforeseen circumstance, the sponsor shall notify the Board as soon as the sponsor effects the change or cancellation.

(c) A sponsor shall notify the Board as soon as it becomes apparent to the sponsor that enrollment in a planned class session will exceed 100 students.

(d) Distance learning courses shall be advertised in accordance with 11 NCAC 08 .1409 and shall be posted on the North Carolina Department of Insurance website.

History

  • Authority G.S. 143-143.10; 143-143.11B
  • Eff. August 1, 2002
  • Amended Eff. May 1, 2004
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .1409 ADVERTISING and PROVIDING COURSE INFORMATION {#sec-11-ncac-08-.1409 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1409}

(a) Course sponsors shall not use advertising of any type that is false or misleading. If the number of CE credit hours awarded by the Board for an approved CE course is less than the number of scheduled hours for the course, any course advertisement or promotional materials that indicate the course is approved for CE credit shall specify the number of CE credit hours awarded by the Board for the course.

(b) Any flyers, brochures, or other medium used to promote a CE course shall clearly describe the fee to be charged and the sponsor's cancellation and fee refund policies. Such policies shall be in accordance with 11 NCAC 08 .1411.

(c) A sponsor of a CE course shall, upon request, provide any prospective student with a description of the course content.

History

  • Authority G.S. 143-143.10; 143-143.11B
  • Eff. August 1, 2002
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .1410 Solicitation of Students {#sec-11-ncac-08-.1410 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1410}

Sponsors and instructors may make available for purchase by students unapproved materials, pamphlets, and brochures that belong to the sponsor, instructor, or some other person. However, class time shall not be used to promote or sell any materials or to solicit affiliation or membership in any business or organization. Unapproved materials shall not be used as teaching aids during the class.

History

  • Authority G.S. 143-143.10; 143-143.11B
  • Eff. August 1, 2002
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .1411 Cancellation and Refund Policies {#sec-11-ncac-08-.1411 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1411}

Course sponsors shall administer course cancellation and fee refund policies in a non-discriminatory manner. Such policies shall be clearly defined in course advertising and information as outlined in 11 NCAC 08 .1409. If a scheduled course is canceled, a sponsor shall notify preregistered students of the cancellation. All prepaid fees received from preregistered students shall be refunded within 30 days after the date of cancellation or, with the student's permission, applied toward the fees for another course.

History

  • Authority G.S. 143-143.10; 143-143.11B
  • Eff. August 1, 2002
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .1412 Denial or Withdrawal of Approval of Course or Course Sponsor {#sec-11-ncac-08-.1412 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1412}

The Board shall deny or withdraw approval of any course or course sponsor upon finding that:

(1) The course sponsor has made any false statements or presented any false information in connection with an application for course or sponsor approval or renewal of the approval.

(2) The course sponsor or any official or instructor employed by or under contract with the course sponsor has refused or failed to comply with any of the provisions of this Section.

(3) The course sponsor or any official or instructor employed by or under contract with the course sponsor has provided false or incorrect information in connection with any reports the course sponsor is required to submit to the Board.

(4) The course sponsor has engaged in a pattern of consistently canceling scheduled courses.

(5) The course sponsor has knowingly paid fees to the Board with a check that was dishonored by a bank.

(6) An instructor employed by or under contract with the course sponsor fails to conduct approved courses in a manner that demonstrates compliance with the instructor requirements described in 11 NCAC 08 .1418.

(7) Any court of competent jurisdiction has found the course sponsor to have violated, in connection with the offering of CE courses, any applicable federal or state law or regulation prohibiting discrimination on the basis of disability, requiring places of public accommodation to be in compliance with prescribed accessibility standards, or requiring that courses related to licensing or certification for professional or trade purposes be offered in a place and manner accessible to persons with disabilities.

(8) The course sponsor has failed to comply with cancellation and refund policies as outlined in 11 NCAC 08 .1411.

History

  • Authority G.S. 143-143.10; 143-143.11B
  • Eff. August 1, 2002
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .1413 Renewal of Course and Sponsor Approval {#sec-11-ncac-08-.1413 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1413}

(a) Board approval of all CE courses and course sponsors shall expire one year following the date of approval. In order to assure continuous approval, renewal applications shall be accompanied by the prescribed renewal fee and filed with the Board not later than 30 days prior to the date of expiration. Any incomplete renewal application received 30 days or more prior to the date of expiration that is not completed within 10 days after notice of the deficiency, as well as any renewal application received less than 30 days prior to the date of expiration, shall not be accepted. For renewal applications received less than 30 days prior to the date of expiration, the sponsor shall file an application for original approval in accordance with 11 NCAC 08 .1405 on or after July 1 in order to be reapproved. Fees as prescribed in 11 NCAC 08 .1405 shall apply for all such reapprovals.

(b) The fee for renewal of Board approval shall be seventy-five dollars ($75.00) for each CE course for sponsors meeting the deadlines specified in Paragraph (a) of this Rule. Fees shall be paid by check, money order, or Visa / MasterCard made payable to the North Carolina Manufactured Housing Board and are nonrefundable.

History

  • Authority G.S. 143-143.10; 143-143.11B
  • Eff. August 1, 2002
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .1414 Sponsor Changes During Approval Period {#sec-11-ncac-08-.1414 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1414}

(a) Course sponsors shall give prior written notice to the Board in writing of any change in business name, Continuing Education Coordinator, address, or business telephone number.

(b) Course sponsors shall obtain prior approval from the Board for any proposed changes in the content or number of hours for CE courses. The Board shall approve the changes if they satisfy the accreditation requirements of 11 NCAC 08 .1405. Changes in course content that are solely for the purpose of assuring that information provided in a course is current, such as code amendments, changes in regulations, etc., need not be reported until the time the sponsor requests renewal of course approval as specified in 11 NCAC 08 .1413. Requests for approval of changes shall be in writing.

History

  • Authority G.S. 143-143.10; 143-143.11B
  • Eff. August 1, 2002
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .1415 Ce Requirements {#sec-11-ncac-08-.1415 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1415}

(a) In order to renew an active manufactured housing salesperson or set-up contractor license for license periods beginning on or after July 1, 2003, and in accordance with G.S. 143-143.11B(a), a licensee shall have completed the number of credit hours specified in this Paragraph, by June 30 of the previous license year. Salespersons shall complete six credit hours and set-up contractors shall complete four credit hours. If a licensee exceeds the number of credit hours specified in this Paragraph, the excess credit hours may be carried forward into the next license year, but the number of carry over credit hours may not exceed the number specified in this Paragraph. In addition to the specific requirements stated in this Rule, a Law and Administration course consisting of at least six hours of continuing education for salespersons and at least four hours of continuing education for set-up contractors shall be required to be taken for continuing education credit at least once in every five year period beginning July 1, 2004. In license periods in which a salesperson or set-up contractor takes an approved Law and Administration course, no additional courses shall be required during that license period. All Law and Administration courses taken for credit shall be submitted to and approved by the Board in accordance with 11 NCAC 08 .1405 and 11 NCAC 08 .1433.

(b) For set-up contractors originally licensed on or after July 15, 1999, the person obtaining the required credit hours must be a qualifier. If a set-up contractor licensed on or after July 15, 1999 has more than one qualifier, each qualifier must obtain the required number of CE credits for the license period. For set-up contractors originally licensed prior to July 15, 1999, the licensee shall designate an individual, known as the "qualifier," who is associated with the licensee and is actively engaged in the work of the licensee for a minimum of 20 hours per week or a majority of the hours operated by the licensee, whichever is less. The qualifier shall be the person who obtains CE credits on behalf of the licensee. Each licensee shall notify the Board in writing within 10 days after the qualifier no longer meets the preceding requirements. If a qualifier has obtained excess credit hours which may be carried over into the subsequent license year, and no longer meets the requirements of this Section, the carry over credits shall not apply to the licensee. If the qualifier becomes employed by another licensee and meets the requirements of this Section, the qualifier's carry over credit hours may by applied to the licensee with whom the qualifier is newly employed for the current license year. A licensee whose qualifier no longer meets the requirements of this Section must designate another qualifier who shall obtain the required credit hours for the subsequent license year.

(c) A licensee who is initially licensed on or after January 1 in any license year is exempt from this Section for the license period expiring on the next June 30.

(d) A licensee who is qualified as an instructor in accordance with 11 NCAC 08 .1418 and who serves as an instructor for an approved CE course shall receive the maximum credits for the course taught by the instructor that are awarded to a student for the course. However, teaching credit is valid for teaching an approved CE course or seminar for the first time only.

History

  • Authority G.S. 143-143.10; 143-143.11B
  • Eff. August 1, 2002
  • Amended Eff. May 1, 2004
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .1416 Continuing Education Coordinator {#sec-11-ncac-08-.1416 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1416}

Every sponsor of a CE course shall designate one person to serve as the Continuing Education Coordinator for all Board-approved continuing education courses offered by the sponsor. The designated Coordinator shall serve as the official contact person for the sponsor and shall be responsible for the following:

(1) Monitoring the attendance and conduct of students in accordance with 11 NCAC 08 .1417 and 11 NCAC 08 .1419 at the sponsor's Board-approved CE courses;

(2) Signing the course completion certificates provided by the sponsor to licensees completing courses; and

(3) Submitting to the Board all required fees, rosters, reports, and other information.

History

  • Authority G.S. 143-143.10; 143-143.11B
  • Eff. August 1, 2002
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .1417 Monitoring Attendance {#sec-11-ncac-08-.1417 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1417}

(a) Continuing Education Coordinators, or their designees, shall monitor attendance for the duration of each class session to assure that all students reported as satisfactorily completing a course have attended at least 90 percent of the scheduled classroom hours, regardless of the length of the course. Students shall not be admitted to a class session after 10 percent of the scheduled classroom hours have been conducted. A student shall not be allowed to sign a course attendance roster report, shall not be issued a course completion certificate, and shall not be reported to the Board as having completed a course unless the student fully satisfies the attendance requirement. Sponsors and instructors shall not make any exceptions to the attendance requirement for any reason.

(b) Sponsors shall assure that, if necessary, adequate personnel in addition to the instructor are present during all class sessions to assist the instructor in monitoring attendance and performing the administrative tasks associated with conducting a course. Sponsors shall assure that time required for administrative tasks does not interfere with designated minimum instruction time.

History

  • Authority G.S. 143-143.10; 143-143.11B
  • Eff. August 1, 2002
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .1418 Instructor Requirements {#sec-11-ncac-08-.1418 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1418}

(a) Instructors shall assure that class sessions are started on time and are conducted for the full amount of time that is scheduled. Instructors shall also assure that each CE course is taught according to the course outline and plan that was approved by the Board, including the furnishing of approved student materials.

(b) Instructors shall possess the ability to:

(1) Communicate through speech, with the ability to speak clearly, and with voice inflection, using proper grammar, and vocabulary;

(2) Present instruction in a thorough, accurate, logical, orderly and understandable manner;

(3) Use varied instructional techniques in addition to straight lecture, such as class discussion, role-playing, or other techniques; and

(4) Use instructional aids, such as the overhead projector, to enhance learning.

History

  • Authority G.S. 143-143.10; 143-143.11B
  • Eff. August 1, 2002
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .1419 Student Participation Standards {#sec-11-ncac-08-.1419 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1419}

(a) In addition to requiring student compliance with the attendance requirement, sponsors and instructors shall require that students comply with the following student participation standards:

(1) A student shall direct his or her attention to the instruction being provided and refrain from engaging in activities unrelated to the instruction.

(2) A student shall refrain from engaging in any activities that are distracting to other students or the instructor, or that otherwise disrupt the orderly conduct of a class.

(3) A student shall comply with all instructions provided by the sponsor or instructor related to providing information needed to properly report completion of a course by the student.

(b) Instructors and sponsors may dismiss from a class session any student who fails to comply with the student participation standards prescribed in Paragraph (a) of this Rule.

(c) Sponsors shall not issue a course completion certificate to any student who fails to comply with the student participation standards set forth in Paragraph (a) of this Rule, nor shall a sponsor include the name of that student on a report verifying completion of a CE course. A sponsor shall submit to the Board with the report for the class session a written statement that includes the name and license number of each student for whom the sponsor does not report course credit, details concerning the student's failure to comply with the student participation standards, and names of other persons in attendance at the class who witnessed the student's conduct.

History

  • Authority G.S. 143-143.10; 143-143.11B
  • Eff. August 1, 2002
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .1420 Student Fee for Ce Courses {#sec-11-ncac-08-.1420 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1420}

The sponsor of an approved CE course may establish the amount of the fee to be charged to students taking the course. The established fee shall be an all-inclusive fee, and no separate or additional fee may be charged to students for providing course materials as described in 11 NCAC 08 .1405(a)(4), providing course completion certificates, reporting course completion to the Board, or for recouping similar routine administrative expenses. The total amount of any fees to be charged shall be included in any advertising or promotional materials for the course.

History

  • Authority G.S. 143-143.10; 143-143.11B
  • Eff. August 1, 2002
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .1421 Minimum Class Size {#sec-11-ncac-08-.1421 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1421}

The minimum class size for any session of an approved CE course shall be five students, as determined by the sponsor's preregistration records. The minimum class size requirement shall not apply to class sessions when the sponsor notifies the Board in writing of the scheduled class session as provided in 11 NCAC 08 .1408 and advertises in advance the scheduled class session in the community where the class session is to be held. A sponsor who conducts a class session for fewer than five students shall submit a copy of the advertisement for the class session with the reports verifying completion of the course plus a statement or other documentation indicating the date of the advertisement and the advertising method.

History

  • Authority G.S. 143-143.10; 143-143.11B
  • Eff. August 1, 2002
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .1422 Classes Open to All Licensees {#sec-11-ncac-08-.1422 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1422}

All class sessions of approved CE courses shall be open to all licensees on a first-come, first-served basis. The sponsor of a course that has a bona fide education or experience prerequisite may refuse admission to a licensee who does not satisfy the prerequisite. A sponsor may contract with an organization such as a manufactured home set-up company, dealership, or trade organization to conduct approved CE courses for licensees affiliated with the organization.

History

  • Authority G.S. 143-143.10; 143-143.11B
  • Eff. August 1, 2002
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .1423 Classroom Facilities {#sec-11-ncac-08-.1423 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1423}

A classroom in which a course is provided shall:

(1) Accommodate all enrolled students;

(2) Be equipped with student desks, worktables with chairs, or other seating arrangement which provides a surface whereby each student can sit and write;

(3) Have light, heat, cooling, and ventilation;

(4) Have, if required, a public address system such that all students can hear the instructor clearly;

(5) Provide a direct, unobstructed line of sight from each student to the instructor and all teaching aids; and

(6) Be free of distractions that would disrupt class sessions.

Items (2) and (3) of this Rule are not required if the course is conducted in a field setting.

History

  • Authority G.S. 143-143.10; 143-143.11B
  • Eff. August 1, 2002
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .1424 Student Check-in {#sec-11-ncac-08-.1424 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1424}

Upon initially checking in for a class session, sponsors and instructors shall require licensees to provide their manufactured housing salesperson license number or set-up contractor license number and qualifier number. Student identity shall be verified by a photo identification issued to the student by a federal, state or local government agency. The CE Administrator shall verify information reported in accordance with 11 NCAC 08 .1426(a) regarding each student's license number, qualifier number, and current license status. Any student providing false information to a course sponsor shall not receive CE credits for the course, shall not be entitled to a refund of course fees, and may be subject to disciplinary action by the Board.

History

  • Authority G.S. 143-143.10; 143-143.11B
  • Eff. August 1, 2002
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .1425 Accommodations for Persons with Disabilities {#sec-11-ncac-08-.1425 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1425}

Course sponsors may deviate from Board rules concerning the conduct of CE courses, such as rules addressing classroom facilities, minimum class size, and instructional methods, as may be necessary in order for the sponsor to comply with the Americans with Disabilities Act or other laws requiring sponsors to accommodate persons with disabilities. A sponsor providing a special accommodation for a licensee with a disability that requires the sponsor to deviate from Board rules shall notify the Board in writing of the accommodation at the time reports are submitted for the class session attended by the licensee.

History

  • Authority G.S. 143-143.10; 143-143.11B
  • Eff. August 1, 2002
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .1426 Course Completion Reporting {#sec-11-ncac-08-.1426 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1426}

(a) The Continuing Education Coordinator designated by the sponsor in accordance with 11 NCAC 08 .1416 shall prepare and submit to the Board reports verifying completion of a CE course for each licensee who satisfactorily completes the course according to the criteria in 11 NCAC 08 .1417 and 11 NCAC 08 .1419. The reports shall be submitted in the manner and format as prescribed by this Rule. Sponsors shall submit these reports to the attention of the CE Administrator such that receipt by the Board within 15 calendar days following the course is assured, but in no case later than June 1 for courses conducted before that date. The report shall be submitted to the attention of the CE Administrator. For each course taken, such report shall include a certificate of course completion that is signed by at least one course instructor and shall indicate the name and license number of the licensee who completed the course, the date of course completion, and the number of credit hours granted to the licensee. A fee of five dollars ($5.00) per credit hour per licensee must be provided by the sponsor with this information, and shall be by check, money order, or Visa / MasterCard made payable to the North Carolina Manufactured Housing Board. The same course shall not be repeated and reported for credit by a licensee within any three year period. No refund of required fees shall be issued for any course credits that are rejected for this reason. The sponsor shall make a separate fee payment for each separate class session.

(b) Course sponsors shall provide licensees enrolled in each CE course an opportunity to complete an evaluation of each approved CE course. Sponsors shall submit the completed evaluation forms to the Board along with the reports that verify completion of a CE course. Evaluation forms shall be reviewed to determine course problem areas and to verify compliance with these Rules.

(c) Course sponsors shall provide each licensee who satisfactorily completes an approved CE course according to the criteria in 11 NCAC 08 .1417 and 11 NCAC 08 .1419 a course completion certificate. Sponsors shall provide the certificates to licensees within 15 calendar days following the course, but in no case later than June 1 for any course completed before that date. The certificate may be retained by the licensee as proof of having completed the course.

(d) When a licensee does not comply with the participation standards in 11 NCAC 08 .1419, the course sponsor shall advise the Board of this matter in writing at the time the sponsor submits the reports verifying completion of the course as specified in Paragraph (a) of this Rule. The sponsor who determines that a licensee failed to comply with either the Board's attendance or student participation standards in 11 NCAC 08 .1417 and 11 NCAC 08 .1419 shall not provide the licensee with a course completion certificate nor shall the sponsor include the licensee's name on the reports verifying completion of continuing education. Such persons shall be reported to the CE Administrator as specified in 11 NCAC 08 .1419(c).

History

  • Authority G.S. 143-143.10; 143-143.11B
  • Eff. August 1, 2002
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .1427 retention of COURSE RECORDS {#sec-11-ncac-08-.1427 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1427}

All course sponsors shall retain records of student registration, attendance, and course completion for each session of a CE course for five years. All course sponsors shall make these records available to the Board upon request.

History

  • Authority G.S. 143-143.10; 143-143.11B
  • Eff. August 1, 2002
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .1428 Request for Video of an Elective Course {#sec-11-ncac-08-.1428 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1428}

If concerns about the quality of a course or instructor are made known to the Board, the Board shall, through written request, require that the sponsor of an approved CE course submit to the Board a video depicting the course being taught by a particular instructor or instructors specified by the Board. If not already available, the video shall be produced at the next scheduled course offering. A video produced within a 12-month period preceding the date of submittal shall be acceptable. All videos shall include a label that clearly identifies the instructor and the date of the video presentation, and shall be 45-60 minutes in length. The video shall depict a continuous block of instruction concerning manufactured home salesperson requirements or set-up contractor operations, shall be unedited, shall show at least a portion of the audience, and shall have visual and sound quality sufficient to enable reviewers to clearly see and hear the instructor. Videos requested by the Board shall be shipped within 10 calendar days of receiving the request or within two weeks after course completion. The cost of producing and shipping such videos shall be borne solely by the course sponsor.

History

  • Authority G.S. 143-143.10; 143-143.11B
  • Eff. August 1, 2002
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .1429 Change in Sponsor Ownership {#sec-11-ncac-08-.1429 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1429}

The approval granted to a course sponsor may be transferred to a new or different person, firm, or corporation only with the prior approval of the Board. The Board shall approve the transfer if the transferee satisfies the accreditation requirements as specified in 11 NCAC 08 .1405. If the ownership of an approved course sponsor is to be sold or otherwise changed, the sponsor shall obtain Board approval of the ownership change. The Board shall approve the ownership change if the proposed new owner satisfies the requirements of the Rules in this Section. All requests for Board approval of transfers or changes in ownership shall be in writing and shall be accompanied by a fee of one hundred fifty dollars ($150.00). Fees shall be paid by check, money order, or Visa / MasterCard made payable to the North Carolina Manufactured Housing Board and are nonrefundable.

History

  • Authority G.S. 143-143.10; 143-143.11B
  • Eff. August 1, 2002
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .1430 Course Monitors {#sec-11-ncac-08-.1430 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1430}

A course sponsor shall admit authorized representatives of the Board to monitor any CE class without prior notice. Board representatives shall not be required to register or pay any fee and shall not be reported as having completed the course.

History

  • Authority G.S. 143-143.10; 143-143.11B
  • Eff. August 1, 2002
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .1431 Non-Resident Licensees and Ce Credits {#sec-11-ncac-08-.1431 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1431}

A non-resident licensee may obtain required CE credits as set forth in this section. If a non-resident licensee resides in a state requiring continuing education for a manufactured housing license, the courses or educational activities offered in the state of residence may be considered by the Board for sanctioning in North Carolina on an individual course basis. Licensees who wish to have the Board consider courses or educational activities offered in states other than North Carolina for possible CE credit shall provide documentation to the Board consisting of not less than the information required in 11 NCAC 08 .1405(a), together with a fee of fifty dollars ($50.00) for each course or educational activity to be reviewed. Fees shall be paid by check, money order, or Visa/MasterCard made payable to the North Carolina Manufactured Housing Board and are nonrefundable.

History

  • Authority G.S. 143-143.10; 143-143.11B
  • Eff. August 1, 2002
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .1432 Non-Compliance {#sec-11-ncac-08-.1432 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1432}

If a licensee fails to complete the CE requirements specified in these Rules by June 30 of a given license year, his or her license shall not be renewed. A licensee may renew at any time prior to the following June 30, but may not operate as either a manufactured housing salesperson or set-up contractor until such time as documentation of having completed the CE requirements is furnished to the Board and the license has been renewed. A licensee who has not completed the CE requirements within one year of the original expiration shall be required to pass written State examinations in order to be re-licensed.

History

  • Authority G.S. 143-143.10; 143-143.11B
  • Eff. August 1, 2002
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .1433 Distance Education Courses {#sec-11-ncac-08-.1433 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1433}

A sponsor requesting approval of a distance education course shall comply with 11 NCAC 08 .1405. Additionally, the proposed distance education course shall satisfy the following criteria, as applicable:

(1) The course shall be designed to assure that students have defined learning objectives. If the nature of the subject matter is such that the learning objectives cannot be reasonably accomplished without some direct interaction between the instructor and students, then the course shall be designed to provide for such interaction.

(2) A course that does not provide the opportunity for continuous audio and visual communication between instructor and all students during the course presentation shall utilize testing processes that assure student mastery of the subject material.

(3) A course that involves students completing the course on a self-paced study basis shall be designed so that the time required for a student of average ability to complete the course will be not less than six hours for salespersons and four hours for set-up contractors. The sponsor shall utilize a system that assures that students have actually performed all tasks required for completion and mastery of the subject material.

(4) The sponsor shall provide technical support to enable students to satisfactorily complete the course.

(5) The approved course instructor(s) shall be available to respond in a timely manner to student questions about the subject matter of the course. Instructors shall have training in the proper use of the instructional delivery method utilized in the course, including the use of computer hardware and software or other applicable equipment and systems.

(6) The sponsor shall provide students an orientation or information package containing all pertinent information regarding requirements unique to completing a distance education course, including any requirements with regard to computer hardware and software or other equipment, and outlining in detail the instructor and technical support that will be available when taking the course.

(7) The sponsor shall utilize procedures that provide reasonable assurance that the student receiving continuing education credit for completing the course actually performed, on his or her own, all the work required to complete the course. For courses that involve independent study by students, certification that the student personally completed all required course work shall be provided by the student to the sponsor, either by a signed statement (on a form provided by the sponsor) or, in the case of Internet or computer based courses, by electronic means that are indicated in the software or on the website. Signed course completion statements or records of electronic certification shall be retained by the sponsor together with any other course records required by this Section.

(8) In addition to the information required in 11 NCAC 08 .1405, sponsors seeking approval of distance education courses must submit to the Board a complete copy of the course in the medium that is to be utilized, including all computer software that will be used in presenting the course and administering tests. If the course is to be Internet based, the Board must be provided access to the course via the Internet and shall not be charged a fee for such access.

(9) All reporting of completed distance education courses shall be in full accordance with 11 NCAC 08 .1426. Students shall not be reported for continuing education credit for distance education courses until the signed form from the student or electronic certification, as described in Item (7) of this Rule, has been received.

History

  • Authority G.S. 143-143.10; 143-143.11B
  • Eff. May 1, 2004
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .1501 Time for Appeal and Documents Required {#sec-11-ncac-08-.1501 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1501}

Within 30 days after the date a local authority having jurisdiction ("local authority") notifies a designer or owner-representative that the local authority has decided that an alternative design and construction proposed by the designer or owner-representative violates the North Carolina State Building Code ("Code"), the designer or owner-representative may appeal the decision in writing to the N.C. Department of Insurance, Engineering Division, 1201 Mail Service Center, Raleigh, NC 27699-1201. The designer or owner-representative shall provide the Engineering Division with all construction documents pertaining to the alternative design and construction, including supporting language, drawings, and descriptions.

History

  • Authority G.S. 143-140.1
  • Eff. March 1, 2008
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .1502 Service on Local Authority {#sec-11-ncac-08-.1502 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1502}

The designer or owner-representative shall provide the local authority with a written notice of the appeal and copies of all documents the designer or owner-representative provides to the Engineering Division in accordance with Rule .1501 of this Section. The notice of appeal and the documents shall be sent to the local authority and the Engineering Division by certified mail, return receipt requested.

History

  • Authority G.S. 143-140.1
  • Eff. March 1, 2008
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .1503 Response by Local Authority {#sec-11-ncac-08-.1503 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1503}

Within five business days after the date the appeal is received by the Engineering Division, the local authority may file a response to the appeal with the Engineering Division at the same address in Rule .1501 of this Section.

History

  • Authority G.S. 143-140.1
  • Eff. March 1, 2008
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .1504 Review of Local Authority Decision {#sec-11-ncac-08-.1504 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1504}

(a) If the Engineering Division determines that the requested alternative design and construction does not conform to the requirements of the Code, and does not provide the equivalent level of protection of public health, safety, and welfare prescribed by the Code, the Engineering Division shall uphold the determination by the local authority.

(b) If the Engineering Division determines that the requested alternative design and construction does not conform to the requirements of the Code, but does provide the equivalent level of protection of public health, safety, and welfare prescribed by the Code, the Engineering Division shall overrule the determination by the local authority. The designer or owner-representative may then use the alternative design and construction.

History

  • Authority G.S. 143-140.1
  • Eff. March 1, 2008
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .1505 Administrative and Judicial Review {#sec-11-ncac-08-.1505 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1505}

A party that is aggrieved by the determination of the Engineering Division may appeal to the Building Code Council pursuant to G.S. 143-141.

History

  • Authority G.S. 143-140.1
  • Eff. March 1, 2008
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.
11 NCAC 08 .1601 Definitions {#sec-11-ncac-08-.1601 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1601}

As used in this Section:

(1) "Alternative inspection" means an inspection conducted by a Qualified Marketplace Inspector pursuant to G.S. 143-139.4 and the rules of this Section.

(2) "Authority having jurisdiction" means an organization, office, or individual responsible for enforcing the requirements of a code or standard, or for approving equipment, materials, an installation, or a procedure.

(3) "Engineering Services Division" or "ESD" means a division of the Office of State Fire Marshal responsible for the Administration of the North Carolina Building code and the State resources that support it.

(4) "OSFM" means the Office of State Fire Marshal in the North Carolina Department of Insurance.

(5) "Permit holder" means the individual with overall responsibility for the construction or renovation for which a permit has been applied for from the State or any city or county.

(6) "Qualified Marketplace Inspector" means an inspector that is licensed by the North Carolina Code Officials Qualification Board pursuant to G.S. 143-151.12(9).

(7) "Timely manner" means any requested inspection shall be performed by the close of business on the second day. Inspection requests received after 12:00 noon shall be deemed to have been received on the next business day.

(8) "Other information" means information that will be used to determine whether to assign personnel to conduct the requested inspection. Such information includes, inspection reports showing permit holders exceeding 15 violations in a framing inspection for one-and two-family dwellings, documentation showing a permit holder has been not ready when inspections are requested, or pending legal issues.

History

  • Authority G.S. 143-139.4(a)
  • Eff. September 1. 2019.
11 NCAC 08 .1602 Request for an Alternative Inspection {#sec-11-ncac-08-.1602 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1602}

(a) Each request for an alternative inspection may request only one of the types of inspections outlined in G.S. 143-139(b). Any additional inspections, including a follow-up inspection, require a new written request by the permit holder.

(b) A permit holder may request an alternative inspection by submitting a written request to the Engineering Services Division of the Office of State Fire Marshal that contains, in addition to the requirements of G.S. 143-139.4(b), the following information:

(1) Completed permit application from the authority having jurisdiction;

(2) Proof of paid inspection fees to the authority having jurisdiction; and

(3) Any other documentation required by the authority having jurisdiction.

(c) If a request for an alternative inspection is approved in accordance with G.S. 143-139.4(e), a Qualified Marketplace Inspector shall be assigned to conduct the inspection within one business day of the approval of such request.

(d) If a request for an alternative inspection is not filed in accordance with these Rules, or the request does not meet the requirements of G.S. 143-139.4(e), the request shall be denied and the requestor notified of the reasons for the denial.

(e) The Commissioner shall charge the permit holder a fee of sixty dollars ($60.00) per hour for alternative inspections conducted pursuant to G.S. 143-139.4 and these Rules. The hourly rate shall not include the time travelling to and from inspections, although the Commissioner shall charge for reimbursement for the actual mileage costs of travelling to and from inspections at the rate established under G.S. 138-6. The total fee shall be paid to the Commissioner no later than 30 days after completion of the alternative inspection.

(f) A permit holder who has paid the authority having jurisdiction for an inspection that has been conducted under these Rules may recoup the fees paid for alternative inspections in accordance with G.S. 153A-354 and G.S. 160A-414(b).

History

  • Authority G.S. 58-2-40(1a); 143-139.4(a)
  • Eff. November 4, 2019.
11 NCAC 08 .1603 Qualified Marketplace Inspectors {#sec-11-ncac-08-.1603 omnilex-key=us-nc-regs-official--title-11--11 NCAC 08 .1603}

(a) In order to conduct an alternative inspection in accordance with G.S. 143-139.4 and the rules of this Section, a Qualified Marketplace Inspector shall meet the requirements of a code enforcement official contained in 11 NCAC 08. 0706 for the type and size building requested to be inspected.

(b) A Qualified Marketplace Inspector shall be registered for temporary work with the North Carolina Office of State Human Resources, Temporary Solutions.

(c) A Qualified Marketplace Inspector shall be issued an identification badge by OSFM prior to beginning work. The Qualified Marketplace Inspector shall display his or her identification badge on his or her person at all times during the conduct of an alternative inspection.

(d) A Qualified Marketplace Inspector shall submit an inspection report to OSFM no later than one business day following the completion of the alternative inspection.

History

  • Authority G.S. 134-139.4
  • Eff. September 1, 2019.

Chapter 09 Investigations Division

11 NCAC 09 .0101 Definitions {#sec-11-ncac-09-.0101 omnilex-key=us-nc-regs-official--title-11--11 NCAC 09 .0101}

History

  • Status: repealed
  • Authority G.S. 58-7.3; 58-9; 58-9.2; 58-18
  • Eff. February 1, 1976
  • Readopted Eff. May 12, 1978
  • Repealed Eff. February 1, 1996.
11 NCAC 09 .0102 Purpose of Division {#sec-11-ncac-09-.0102 omnilex-key=us-nc-regs-official--title-11--11 NCAC 09 .0102}

History

  • Status: repealed
  • Authority G.S. 58-7.3; 58-9; 58-9.2; 58-18
  • Eff. February 1, 1976
  • Readopted Eff. May 12, 1978
  • Repealed Eff. February 1, 1996.
11 NCAC 09 .0103 Deputy Commissioner {#sec-11-ncac-09-.0103 omnilex-key=us-nc-regs-official--title-11--11 NCAC 09 .0103}

History

  • Status: repealed
  • Authority G.S. 58-7.3; 58-9; 58-9.2; 58-18
  • Eff. February 1, 1976
  • Readopted Eff. May 12, 1978
  • Repealed Eff. February 1, 1996.
11 NCAC 09 .0104 Division Personnel {#sec-11-ncac-09-.0104 omnilex-key=us-nc-regs-official--title-11--11 NCAC 09 .0104}

History

  • Status: repealed
  • Authority G.S. 58-7.3; 58-9; 58-9.2; 58-18
  • Eff. February 1, 1976
  • Readopted Eff. May 12, 1978
  • Repealed Eff. February 1, 1996.
11 NCAC 09 .0201 Investigation of Crimes: Authority to Arrest {#sec-11-ncac-09-.0201 omnilex-key=us-nc-regs-official--title-11--11 NCAC 09 .0201}

History

  • Status: repealed
  • Authority G.S. 58-9; 59-9.2; 58-18
  • Eff. February 1, 1976
  • Readopted Eff. May 12, 1978
  • Repealed Eff. February 1, 1996.
11 NCAC 09 .0202 Investigation of Crimes: Procedures {#sec-11-ncac-09-.0202 omnilex-key=us-nc-regs-official--title-11--11 NCAC 09 .0202}

History

  • Status: repealed
  • Authority G.S. 58-9; 59-9.2; 58-18
  • Eff. February 1, 1976
  • Readopted Eff. May 12, 1978
  • Repealed Eff. February 1, 1996.
11 NCAC 09 .0203 Non-Criminal Investigations {#sec-11-ncac-09-.0203 omnilex-key=us-nc-regs-official--title-11--11 NCAC 09 .0203}

History

  • Status: repealed
  • Authority G.S. 58-9; 59-9.2; 58-18
  • Eff. February 1, 1976
  • Readopted Eff. May 12, 1978
  • Repealed Eff. February 1, 1996.

Chapter 10 Property and Casualty Division

11 NCAC 10 .0101 Purpose of Division {#sec-11-ncac-10-.0101 omnilex-key=us-nc-regs-official--title-11--11 NCAC 10 .0101}

History

  • Status: repealed
  • Authority G.S. 58-7.2; 58-7.3; 58-9; 58-54; 58-124.17; 58-124.28; 58-131.34; 58-131.60; 58-155.48
  • 58-176; 58-248.32; 58-248.37
  • Eff. February 1, 1976
  • Readopted Eff. July 11, 1978
  • Amended Eff. July 1, 1986
  • Repealed Eff. July 1, 1988.
11 NCAC 10 .0102 Deputy Commissioner {#sec-11-ncac-10-.0102 omnilex-key=us-nc-regs-official--title-11--11 NCAC 10 .0102}

History

  • Status: repealed
  • Authority G.S. 58-7.2; 58-7.3; 58-9; 58-54; 58-124.17; 58-124.28; 58-131.34; 58-131.60; 58-155.48
  • 58-176; 58-248.32; 58-248.37
  • Eff. February 1, 1976
  • Readopted Eff. July 11, 1978
  • Amended Eff. July 1, 1986
  • Repealed Eff. July 1, 1988.
11 NCAC 10 .0103 Division Personnel {#sec-11-ncac-10-.0103 omnilex-key=us-nc-regs-official--title-11--11 NCAC 10 .0103}

History

  • Status: repealed
  • Authority G.S. 58-7.2; 58-7.3; 58-9; 58-54; 58-124.17; 58-124.28; 58-131.34; 58-131.60; 58-155.48
  • 58-176; 58-248.32; 58-248.37
  • Eff. February 1, 1976
  • Readopted Eff. July 11, 1978
  • Amended Eff. July 1, 1986
  • Repealed Eff. July 1, 1988.
11 NCAC 10 .0104 Refusal to Insure {#sec-11-ncac-10-.0104 omnilex-key=us-nc-regs-official--title-11--11 NCAC 10 .0104}

No insurer shall refuse to write any insurance solely because coverage was terminated by another insurer or because the risk was previously insured in a residual market plan.

History

  • Authority G.S. 58-2-40; 58-3-25; 58-3-120; 58-36-1; 58-36-10; 58-37-60; 58-63-15
  • Eff. July 11, 1978
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 3, 2017.
11 NCAC 10 .0105 Manuscript or Individual Risk Filings {#sec-11-ncac-10-.0105 omnilex-key=us-nc-regs-official--title-11--11 NCAC 10 .0105}

(a) Within 60 days after the inception date of a manuscript or individual risk policy, the insurer shall submit to the Department's Property and Casualty Division:

(1) Any form or endorsement not previously filed with the Department and approved for use.

(2) A statement explaining why a manuscript or individual risk policy was needed.

(b) Continuous policies are not permitted.

(c) A copy of the approved filing shall be retained by the filer in accordance with 11 NCAC 19 .0102 through 11 NCAC 19 .0105.

(d) If the rates have been determined by an unfiled "(a) rating" or "individual risk rating", the insurer shall submit the following:

(1) A statement describing how the rates were calculated.

(2) A certification that the rates are not excessive, inadequate, or unfairly discriminatory.

History

  • Authority G.S. 58-2-40; 58-6-5; 58-41-50; 58-43-5
  • Eff. April 1, 1992
  • Amended Eff. August 1, 1998; February 1, 1996
  • Temporary Amendment Eff. December 1, 1999
  • Amended Eff. July 1, 2000
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 3, 2017.
11 NCAC 10 .0201 General Information {#sec-11-ncac-10-.0201 omnilex-key=us-nc-regs-official--title-11--11 NCAC 10 .0201}

History

  • Status: repealed
  • Authority G.S. 58-9; 58-54; 58-124.17; 58-124.28; 58-173.1 to 58-180.2
  • Eff. February 1, 1976
  • Readopted Eff. July 11, 1978
  • Repealed Eff. July 1, 1988.
11 NCAC 10 .0202 Policy Form Filings {#sec-11-ncac-10-.0202 omnilex-key=us-nc-regs-official--title-11--11 NCAC 10 .0202}

History

  • Status: repealed
  • Authority G.S. 58-9; 58-54; 58-131.56; 58-131.41
  • Eff. February 1, 1976
  • Readopted Eff. July 11, 1978
  • Amended Eff. July 1, 1986
  • Repealed Eff. January 1, 1989.
11 NCAC 10 .0203 Rate Filings {#sec-11-ncac-10-.0203 omnilex-key=us-nc-regs-official--title-11--11 NCAC 10 .0203}

History

  • Status: repealed
  • Authority G.S. 58-9; 58-25; 58-25.1; 58-26
  • 58-54; 58-124.17 to 58-124.28; 58-131.34; 58-131.36
  • 58-131.37; 58-131.38; 58-131.39; 58-131.41; 58-131.43
  • 58-131.44; 58-131.45; 58-131.56; 58-131.60
  • Eff. July 11, 1978
  • Amended Eff. July 1, 1986
  • Repealed Eff. January 1, 1989.
11 NCAC 10 .0204 Requirement of Supporting Filing Data {#sec-11-ncac-10-.0204 omnilex-key=us-nc-regs-official--title-11--11 NCAC 10 .0204}

History

  • Status: repealed
  • Authority G.S. 58-9; 58-25; 58-25.1; 58-26
  • 58-54; 58-124.17 to 58-124.28; 58-131.34; 58-131.36
  • 58-131.37; 58-131.38; 58-131.39; 58-131.41; 58-131.43
  • 58-131.44; 58-131.45; 58-131.56; 58-131.60
  • Eff. July 11, 1978
  • Amended Eff. July 1, 1986
  • Repealed Eff. January 1, 1989.
11 NCAC 10 .0205 Reply Forms {#sec-11-ncac-10-.0205 omnilex-key=us-nc-regs-official--title-11--11 NCAC 10 .0205}

History

  • Status: repealed
  • Authority G.S. 58-9; 58-25; 58-25.1; 58-26
  • 58-54; 58-124.17 to 58-124.28; 58-131.34; 58-131.36
  • 58-131.37; 58-131.38; 58-131.39; 58-131.41; 58-131.43
  • 58-131.44; 58-131.45; 58-131.56; 58-131.60
  • Eff. July 11, 1978
  • Amended Eff. July 1, 1986
  • Repealed Eff. January 1, 1989.
11 NCAC 10 .0206 Long Form {#sec-11-ncac-10-.0206 omnilex-key=us-nc-regs-official--title-11--11 NCAC 10 .0206}

History

  • Status: repealed
  • Authority G.S. 58-9; 58-25; 58-25.1; 58-26
  • 58-54; 58-124.17 to 58-124.28; 58-131.34; 58-131.36
  • 58-131.37; 58-131.38; 58-131.39; 58-131.41; 58-131.43
  • 58-131.44; 58-131.45; 58-131.56; 58-131.60
  • Eff. July 11, 1978
  • Amended Eff. July 1, 1986
  • Repealed Eff. January 1, 1989.
11 NCAC 10 .0207 Organization Data Form {#sec-11-ncac-10-.0207 omnilex-key=us-nc-regs-official--title-11--11 NCAC 10 .0207}

History

  • Status: repealed
  • Authority G.S. 58-9; 58-25; 58-25.1; 58-26
  • 58-54; 58-124.17 to 58-124.28; 58-131.34; 58-131.36
  • 58-131.37; 58-131.38; 58-131.39; 58-131.41; 58-131.43
  • 58-131.44; 58-131.45; 58-131.56; 58-131.60
  • Eff. July 11, 1978
  • Amended Eff. July 1, 1986
  • Repealed Eff. January 1, 1989.
11 NCAC 10 .0208 Bureau and Statistical Agent Identification {#sec-11-ncac-10-.0208 omnilex-key=us-nc-regs-official--title-11--11 NCAC 10 .0208}

History

  • Status: repealed
  • Authority G.S. 58-9; 58-25; 58-25.1; 58-26
  • 58-54; 58-124.17 to 58-124.28; 58-131.34; 58-131.36
  • 58-131.37; 58-131.38; 58-131.39; 58-131.41; 58-131.43
  • 58-131.44; 58-131.45; 58-131.56; 58-131.60
  • Eff. July 11, 1978
  • Amended Eff. July 1, 1986
  • Repealed Eff. January 1, 1989.
11 NCAC 10 .0209 No Policy Form Deviations {#sec-11-ncac-10-.0209 omnilex-key=us-nc-regs-official--title-11--11 NCAC 10 .0209}

History

  • Status: repealed
  • Authority G.S. 58-9; 58-25; 58-25.1; 58-26
  • 58-54; 58-124.17 to 58-124.28; 58-131.34; 58-131.36
  • 58-131.37; 58-131.38; 58-131.39; 58-131.41; 58-131.43
  • 58-131.44; 58-131.45; 58-131.56; 58-131.60
  • Eff. July 11, 1978
  • Amended Eff. July 1, 1986
  • Repealed Eff. January 1, 1989.
11 NCAC 10 .0301 Letter of Transmittal {#sec-11-ncac-10-.0301 omnilex-key=us-nc-regs-official--title-11--11 NCAC 10 .0301}

History

  • Status: repealed
  • Filed as a Temporary Amendment Eff. January 19, 1987 For a Period of 120 Days to Expire
  • on May 18, 1987
  • Filed as a Temporary Amendment Eff. September 2, 1986 For a Period of 120 Days to Expire
  • on December 31, 1986
  • Statutory Authority G.S. 58-9; 58-30; 58-30.1; 58-54; 58-72; 58-124.17; 58-124.28
  • 58-131.34; 58-131.60; 58-138; 58-148; 58-156; 58-157; 58-173; 58-173.1
  • 58-173.16; 58-173.33; 58-174; 58-180.2; 58-181; 58-248.2; 58-248.26; 58-248.40; 58-480
  • Eff. February 1, 1976
  • Readopted Eff. July 11, 1978
  • Amended Eff. March 1, 1987; July 1, 1986.
  • Repealed Eff. January 1, 1989.
11 NCAC 10 .0302 Contents of Filing {#sec-11-ncac-10-.0302 omnilex-key=us-nc-regs-official--title-11--11 NCAC 10 .0302}

History

  • Status: repealed
  • Filed as a Temporary Amendment Eff. January 19, 1987 For a Period of 120 Days to Expire
  • on May 18, 1987
  • Filed as a Temporary Amendment Eff. September 2, 1986 For a Period of 120 Days to Expire
  • on December 31, 1986
  • Statutory Authority G.S. 58-9; 58-30; 58-30.1; 58-54; 58-72; 58-124.17; 58-124.28
  • 58-131.34; 58-131.60; 58-138; 58-148; 58-156; 58-157; 58-173; 58-173.1
  • 58-173.16; 58-173.33; 58-174; 58-180.2; 58-181; 58-248.2; 58-248.26; 58-248.40; 58-480
  • Eff. February 1, 1976
  • Readopted Eff. July 11, 1978
  • Amended Eff. March 1, 1987; July 1, 1986.
  • Repealed Eff. January 1, 1989.
11 NCAC 10 .0303 Filing Arrangement {#sec-11-ncac-10-.0303 omnilex-key=us-nc-regs-official--title-11--11 NCAC 10 .0303}

History

  • Status: repealed
  • Filed as a Temporary Amendment Eff. January 19, 1987 For a Period of 120 Days to Expire
  • on May 18, 1987
  • Filed as a Temporary Amendment Eff. September 2, 1986 For a Period of 120 Days to Expire
  • on December 31, 1986
  • Statutory Authority G.S. 58-9; 58-30; 58-30.1; 58-54; 58-72; 58-124.17; 58-124.28
  • 58-131.34; 58-131.60; 58-138; 58-148; 58-156; 58-157; 58-173; 58-173.1
  • 58-173.16; 58-173.33; 58-174; 58-180.2; 58-181; 58-248.2; 58-248.26; 58-248.40; 58-480
  • Eff. February 1, 1976
  • Readopted Eff. July 11, 1978
  • Amended Eff. March 1, 1987; July 1, 1986.
  • Repealed Eff. January 1, 1989.
11 NCAC 10 .0304 Prohibited Policy Provisions {#sec-11-ncac-10-.0304 omnilex-key=us-nc-regs-official--title-11--11 NCAC 10 .0304}

History

  • Status: repealed
  • Filed as a Temporary Amendment Eff. January 19, 1987 For a Period of 120 Days to Expire
  • on May 18, 1987
  • Filed as a Temporary Amendment Eff. September 2, 1986 For a Period of 120 Days to Expire
  • on December 31, 1986
  • Statutory Authority G.S. 58-9; 58-30; 58-30.1; 58-54; 58-72; 58-124.17; 58-124.28
  • 58-131.34; 58-131.60; 58-138; 58-148; 58-156; 58-157; 58-173; 58-173.1
  • 58-173.16; 58-173.33; 58-174; 58-180.2; 58-181; 58-248.2; 58-248.26; 58-248.40; 58-480
  • Eff. February 1, 1976
  • Readopted Eff. July 11, 1978
  • Amended Eff. March 1, 1987; July 1, 1986.
  • Repealed Eff. January 1, 1989.
11 NCAC 10 .0305 Employees: Cars: Not Insured in Employer's Fleet Policy {#sec-11-ncac-10-.0305 omnilex-key=us-nc-regs-official--title-11--11 NCAC 10 .0305}

It is the policy of the N.C. Department of Insurance that the insuring of employees' automobiles in fleet policies of their employer at lower rates than those which apply to other owners of private automobiles is unfair discrimination and is not permitted, whether or not the employees' private cars are operated part of the time in the interest of the employer. This applies to all forms of automobile insurance. The inclusion of a privately owned car in a fleet or group policy will be construed as prima facie evidence of unfair discrimination.

History

  • Authority G.S. 58-2-40; 58-3-120
  • Eff. February 1, 1976
  • Readopted Eff. July 11, 1978
  • Amended Eff. July 1, 1986
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 3, 2017.
11 NCAC 10 .0306 Dividend Payment Requirements {#sec-11-ncac-10-.0306 omnilex-key=us-nc-regs-official--title-11--11 NCAC 10 .0306}

Dividends are to be paid from company surplus uniformly. Dividends are to be paid upon termination of policy year or term from surplus in excess of any minimum surplus required of the company. Advance payment of dividends is not permitted nor can they be guaranteed.

History

  • Authority G.S. 58-8-25; 58-36-60; 58-40-120
  • Eff. February 1, 1976
  • Readopted Eff. July 11, 1978
  • Amended Eff. January 1, 1989; July 1, 1986
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 3, 2017.
11 NCAC 10 .0307 Nation-Wide Marine Definition Adopted {#sec-11-ncac-10-.0307 omnilex-key=us-nc-regs-official--title-11--11 NCAC 10 .0307}

The nation-wide marine definition as adopted by the National Association of Insurance Commissioners in December of 1976 which sets forth the type and kinds of insurance that are to be regarded as marine insurance is adopted by the North Carolina Department of Insurance. However, in no case shall a kind or type of insurance be offered in North Carolina as inland marine insurance unless it has been so designated by the Commissioner of Insurance in his approval of rates and forms.

History

  • Authority G.S. 58-2-40; 58-3-150; 58-7-15; 58-40-15; 58-40-40
  • Eff. February 1, 1976
  • Amended Eff. June 23, 1977
  • Readopted Eff. July 11, 1978
  • Amended Eff. July 1, 1986
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 3, 2017.

History

  • Status: repealed
  • Authority G.S. 58-9; 84-23.1
  • Eff. July 11, 1978
  • Amended Eff. January 1, 1989
  • Repealed Eff. May 1, 1994.
11 NCAC 10 .0309 Investment Income Data-Certification to Commissioner {#sec-11-ncac-10-.0309 omnilex-key=us-nc-regs-official--title-11--11 NCAC 10 .0309}

History

  • Status: repealed
  • Authority G.S. 58-9; 58-25.1; 58-124.18(d); 58-124.20
  • Eff. July 27, 1981
  • Repealed Eff. September 1, 1989.
11 NCAC 10 .0310 Audited Data: Auto-Certification to Commissioner {#sec-11-ncac-10-.0310 omnilex-key=us-nc-regs-official--title-11--11 NCAC 10 .0310}

History

  • Status: repealed
  • Authority G.S. 58-9; 58-25.1; 58-124.18(d); 58-124.20
  • Eff. July 27, 1981
  • Repealed Eff. September 1, 1989.
11 NCAC 10 .0311 Audited Data: Homeowners and Workers' Compensation {#sec-11-ncac-10-.0311 omnilex-key=us-nc-regs-official--title-11--11 NCAC 10 .0311}

History

  • Status: repealed
  • Authority G.S. 58-9; 58-25.1; 58-124.18(d); 58-124.20
  • Eff. September 3, 1981
  • Repealed Eff. September 1, 1989.
11 NCAC 10 .0312 Additional Information {#sec-11-ncac-10-.0312 omnilex-key=us-nc-regs-official--title-11--11 NCAC 10 .0312}

History

  • Status: repealed
  • Filed as a Temporary Rule Eff. January 19, 1987 for a Period of 120 Days to Expire on May
  • 18, 1987
  • Filed as a Temporary Rule Eff. September 2, 1986 for a Period of 120 Days to Expire on
  • December 31, 1986
  • Statutory Authority G.S. 58-480(e)(14); 58-9
  • Eff. March 1, 1987
  • Repealed Eff. January 1, 1989.
11 NCAC 10 .0313 Endorsements to Bureau Residential Programs {#sec-11-ncac-10-.0313 omnilex-key=us-nc-regs-official--title-11--11 NCAC 10 .0313}

(a) For the purposes of G.S. 58-41-10(a), a "residential risk" is a risk covered under any of the following North Carolina Rate Bureau residential programs: Homeowners Program, Dwelling Fire and Extended Coverage Program, Mobile Home Owner (C) Program, and Mobile-Homeowners (F) Program.

(b) When an insurance company, joint underwriting association, advisory organization, or rating organization files an endorsement to attach to a North Carolina Rate Bureau residential program, which endorsement provides coverage that is not subject to the jurisdiction of the Bureau and is exempt from Article 41 of Chapter 58 of the General Statutes by virtue of G.S. 58-41-10(a), the filing entity shall:

(1) provide a copy of the filing to the North Carolina Rate Bureau;

(2) utilize a statistical code for reporting premiums and losses and advise on what line on page 14 of the annual statement this data will be reported;

(3) complete a forms questionnaire; and

(4) submit the rates separately without a rate questionnaire.

History

  • Authority G.S. 58-2-40; 58-3-150; 58-40-30
  • Eff. December 1, 1994
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 3, 2017.
11 NCAC 10 .0401 General Provisions {#sec-11-ncac-10-.0401 omnilex-key=us-nc-regs-official--title-11--11 NCAC 10 .0401}

History

  • Status: repealed
  • Authority G.S. 58-9; 58-125; 58-131.35; 58-131.43
  • Eff. February 1, 1976
  • Readopted Eff. July 11, 1978
  • Repealed Eff. July 1, 1988.
11 NCAC 10 .0402 Rate Bureau: Essential Coverages {#sec-11-ncac-10-.0402 omnilex-key=us-nc-regs-official--title-11--11 NCAC 10 .0402}

History

  • Status: repealed
  • Authority G.S. 58-9; 58-54; 58-131.41; 58-124.17; 58-131.56
  • Eff. February 1, 1976
  • Readopted Eff. July 11, 1978
  • Amended Eff. January 1, 1989; July 1, 1986
  • Repealed Eff. April 1, 1992.
11 NCAC 10 .0403 Rating Organizations: Non-Essential Coverages {#sec-11-ncac-10-.0403 omnilex-key=us-nc-regs-official--title-11--11 NCAC 10 .0403}

History

  • Status: repealed
  • Authority G.S. 58-9; 58-54; 58-131.41; 58-124.17; 58-131.56
  • Eff. February 1, 1976
  • Readopted Eff. July 11, 1978
  • Amended Eff. January 1, 1989; July 1, 1986
  • Repealed Eff. April 1, 1992.
11 NCAC 10 .0404 Filings for Essential Coverages {#sec-11-ncac-10-.0404 omnilex-key=us-nc-regs-official--title-11--11 NCAC 10 .0404}

History

  • Status: repealed
  • Authority G.S. 58-9; 58-54; 58-124.11; 58-124.20
  • 58-124.21; 58-131.37 to 58-131.42; 58-131.45; 58-131.46
  • 58-131.48; 58-131.52; 58-131.56; 58-148
  • Eff. February 1, 1976
  • Readopted Eff. July 11, 1978
  • Amended Eff. July 1, 1986
  • Repealed Eff. January 1, 1989.
11 NCAC 10 .0405 Filings for Non-Essential Coverages {#sec-11-ncac-10-.0405 omnilex-key=us-nc-regs-official--title-11--11 NCAC 10 .0405}

History

  • Status: repealed
  • Authority G.S. 58-9; 58-54; 58-124.11; 58-124.20
  • 58-124.21; 58-131.37 to 58-131.42; 58-131.45; 58-131.46
  • 58-131.48; 58-131.52; 58-131.56; 58-148
  • Eff. February 1, 1976
  • Readopted Eff. July 11, 1978
  • Amended Eff. July 1, 1986
  • Repealed Eff. January 1, 1989.
11 NCAC 10 .0406 Insurer's Report on Rating Organizations {#sec-11-ncac-10-.0406 omnilex-key=us-nc-regs-official--title-11--11 NCAC 10 .0406}

History

  • Status: expired
  • Authority G.S. 58-9; 58-131.41
  • Eff. July 11, 1978
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 3, 2017
  • Expired Eff. December 1, 2024 pursuant to G.S. 150B-21.3A.
11 NCAC 10 .0501 General Information {#sec-11-ncac-10-.0501 omnilex-key=us-nc-regs-official--title-11--11 NCAC 10 .0501}

History

  • Status: repealed
  • Authority G.S. 58-9(1); 58-124.23; 58-131.37
  • 58-131.38; 58-131.39; 58-131.41
  • Eff. February 1, 1976
  • Readopted Eff. July 11, 1978
  • Amended Eff. July 1, 1986
  • Repealed Eff. January 1, 1989.
11 NCAC 10 .0502 Deviation Exhibits Instruction Form {#sec-11-ncac-10-.0502 omnilex-key=us-nc-regs-official--title-11--11 NCAC 10 .0502}

History

  • Status: repealed
  • Authority G.S. 58-9(1); 58-124.23; 58-131.37
  • 58-131.38; 58-131.39; 58-131.41
  • Eff. February 1, 1976
  • Readopted Eff. July 11, 1978
  • Amended Eff. July 1, 1986
  • Repealed Eff. January 1, 1989.
11 NCAC 10 .0503 Form D-1 Financial Statement: Countrywide {#sec-11-ncac-10-.0503 omnilex-key=us-nc-regs-official--title-11--11 NCAC 10 .0503}

History

  • Status: repealed
  • Authority G.S. 58-9(1); 58-124.23; 58-131.37
  • 58-131.38; 58-131.39; 58-131.41
  • Eff. February 1, 1976
  • Readopted Eff. July 11, 1978
  • Amended Eff. July 1, 1986
  • Repealed Eff. January 1, 1989.
11 NCAC 10 .0504 Form D-2 Operating Statement: Countrywide {#sec-11-ncac-10-.0504 omnilex-key=us-nc-regs-official--title-11--11 NCAC 10 .0504}

History

  • Status: repealed
  • Authority G.S. 58-9(1); 58-124.23; 58-131.37
  • 58-131.38; 58-131.39; 58-131.41
  • Eff. February 1, 1976
  • Readopted Eff. July 11, 1978
  • Amended Eff. July 1, 1986
  • Repealed Eff. January 1, 1989.
11 NCAC 10 .0505 Form D-3 Operating Statement: North Carolina {#sec-11-ncac-10-.0505 omnilex-key=us-nc-regs-official--title-11--11 NCAC 10 .0505}

History

  • Status: repealed
  • Authority G.S. 58-9(1); 58-124.23; 58-131.37
  • 58-131.38; 58-131.39; 58-131.41
  • Eff. February 1, 1976
  • Readopted Eff. July 11, 1978
  • Amended Eff. July 1, 1986
  • Repealed Eff. January 1, 1989.
11 NCAC 10 .0601 General Information {#sec-11-ncac-10-.0601 omnilex-key=us-nc-regs-official--title-11--11 NCAC 10 .0601}

History

  • Status: repealed
  • Authority G.S. 58-124.23(b); 58-131.39(c)
  • Eff. February 1, 1976
  • Readopted Eff. July 11, 1978
  • Amended Eff. January 1, 1989
  • Repealed Eff. July 1, 1992.

(a) This Rule applies to automobile physical damage, excess motor vehicle liability coverage and residential property with not more than four housing units. Insurers may charge a premium in excess of that promulgated by the North Carolina Rate Bureau by instituting a consent to rate procedure that meets the requirements of G.S. 58-36-30(b), (b1) and this Rule.

(b) Residential Property With Not More than Four Housing Units:

(1) The premium to be charged against loss to residential property with not more than four housing units shall be presumed reasonable if it does not exceed 250 percent of the premium based upon the approved rates in North Carolina.

(2) Any proposed premium in excess of 250 percent of the premium based upon the approved rates in North Carolina shall be filed with the Commissioner for his or her review and approval in accordance with the procedures set forth in G.S. 58-36-30(a).

(c) Workers' Compensation and Employers' Liability Insurance. An initial (first time) application to effect consent to rate, pursuant to G.S. 58-36-30(c), for workers' compensation or employers' liability insurance in excess of the rate promulgated by the North Carolina Rate Bureau, shall contain the following:

(1) a description of the insurance proposed, including primary and excess limits, the amount of coverage, the deductible, and any other factor used for rating, where applicable;

(2) the rate and premium that would be charged without application of consent to rate;

(3) the proposed rate and premium;

(4) the percent increase. The rate to be charged shall be presumed reasonable if it does not exceed 250 percent of the rate that would be charged without application of consent to rate. Any proposed rate in excess of 250 percent shall be explained and shall be subject to review and approval of the Commissioner;

(5) the names and addresses of the insurer, the writing agent, and the insured;

(6) the effective date of the proposed rate;

(7) the policy period;

(8) the policy number; and

(9) a letter signed by the insured acknowledging and consenting to the proposed rate. If coverage for the specific risk written on consent to rate is available through a residual market, North Carolina Workers Compensation Insurance Plan, a statement signed by the insured acknowledging that fact shall also be executed. This letter shall be retained in the insurer's office and be made available to the Commissioner upon request.

The insurer is not required to obtain the written consent of the insured on any renewal of or endorsement to the policy if the policy renewal or endorsement states that the rates are greater than those rates that are applicable in the State of North Carolina.

(d) All records generated under G.S. 58-36-30(b), (b1), (c), and this Rule shall be maintained in accordance with the requirements of 11 NCAC 19 .0100.

History

  • Authority G.S. 58-2-40(1); 58-36-30(b)
  • Eff. February 1, 1976
  • Readopted Eff. July 11, 1978
  • Amended Eff. August 3, 1992; February 1, 1990; January 1, 1989
  • Temporary Amendment Eff. November 8, 1996
  • Amended Eff. July 1, 1998
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest January 3, 2017
  • Amended Eff. April 1, 2020; December 1, 2018.

(a) An initial (first time) application to effect consent to rate on a specific risk of coverage subject to Article 40 of G.S. 58, in excess of the rate promulgated by a licensed rating organization or filed by a company on its own behalf shall contain the following:

(1) a description of the insurance proposed, including primary and excess limits, the amount of coverage, the property insured, the deductible, and any other factor used for rating, where applicable;

(2) the rate and premium that would be charged without application of consent to rate;

(3) the proposed rate and premium;

(4) the percent increase. The rate to be charged shall be presumed reasonable if it does not exceed 250 percent of the rate that would be charged without application of consent to rate. Any proposed rate in excess of 250 percent is subject to review and approval by the Commissioner pursuant to G.S. 58-40-30(c);

(5) the names and addresses of the insurer, the writing agent, and the insured;

(6) the effective date of the proposed rate;

(7) the policy period;

(8) the policy number; and

(9) a letter signed by the insured acknowledging and consenting to the proposed rate. If coverage for the specific risk written on consent to rate is available through a residual market (FAIR Plan, Beach Plan, North Carolina Reinsurance Facility, North Carolina Workers Compensation Insurance Plan), a statement signed by the insured acknowledging that fact must also be executed.

(b) If a policy for which the insured had consented to pay a higher premium rate is reinstated after a lapse, the insurer shall not have to obtain a signed statement from the insured under this Rule for the reinstatement.

(c) After a signed application is obtained by an insurer under this Rule for a policy, all subsequent changes in the policy shall be endorsements for the purposes of G.S. 58-40-30(c).

(d) If a particular kind of coverage is added to a policy by endorsement during the term of the policy and the added coverage is written at a higher rate under G.S. 58-40-30(c) and under this Rule, the insurer shall obtain the signature of the insured under this Rule no later than the next renewal of the policy.

(e) If an insured consents to pay a higher premium rate under G.S. 58-40-30(c) and this Rule, consent to rate is subsequently terminated, and the insured and insurer later enter into another consent to rate agreement, the insurer shall not be required to obtain the signature of the insured unless three years have elapsed since the termination of the original consent to rate agreement.

(f) All records generated under G.S. 58-40-30(c) and this Rule shall be maintained in accordance with the requirements of 11 NCAC 19 .0100.

History

  • Authority G.S. 58-2-40(1); 58-40-30(c)
  • Eff. February 1, 1976
  • Readopted Eff. July 11, 1978
  • Amended Eff. August 3, 1992; January 1, 1989
  • Temporary Amendment Eff. November 8, 1996
  • Amended Eff. July 1, 1998
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 3, 2017
  • Amended Eff. December 1, 2018.
11 NCAC 10 .0604 Automobile Liability: Non-Essential Coverages {#sec-11-ncac-10-.0604 omnilex-key=us-nc-regs-official--title-11--11 NCAC 10 .0604}

History

  • Status: repealed
  • Authority G.S. 58-131.39(c)
  • Eff. February 1, 1976
  • Readopted Eff. July 11, 1978
  • Amended Eff. July 1, 1986
  • Repealed Eff. January 1, 1989.

When the consent to rate procedures under G.S. 58-36-30(b) are used to provide motor vehicle liability coverage at higher liability limits as required by an excess liability insurer, the required consent to rate notice shall read as follows:

NOTICE: THE PREMIUM THAT WE ARE CHARGING FOR HIGHER LIABILITY LIMITS ON AUTOMOBILE LIABILITY COVERAGE FOR YOUR COVERED VEHICLE(S) EXCEEDS THE PREMIUM BASED UPON THE APPROVED RATES IN NORTH CAROLINA, IN ACCORDANCE WITH G.S. 58-36-30(b).

History

  • Authority G.S. 58-2-40(1); 58-36-30(b)
  • Eff. February 1, 1996
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 3, 2017
  • Amended Eff. December 1, 2018.

History

  • Status: repealed
  • Authority G.S. 58-2-40(1); 58-36-30(b); 58-40-30(c)
  • Temporary Adoption Eff. November 8, 1996
  • Eff. July 1, 1998
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 3, 2017
  • Repealed Eff. December 1, 2018.
11 NCAC 10 .0701 General Information {#sec-11-ncac-10-.0701 omnilex-key=us-nc-regs-official--title-11--11 NCAC 10 .0701}

Citizens who are unable to procure insurance on risks in this state in companies licensed to write insurance in this state may procure policies of insurance in unlicensed foreign and alien companies if the procedures set forth hereafter are strictly adhered to. All the forms described hereafter relating to such insurance, which is known as non-admitted or surplus lines of insurance, are to be sent to the Commissioner of Insurance, Attention: Surplus Lines Coordinator, Property and Casualty Division, P.O. Box 26387, Raleigh, North Carolina 27611.

History

  • Authority G.S. 58-21-15; 58-21-35
  • Eff. February 1, 1976
  • Readopted Eff. July 11, 1978
  • Amended Eff. February 1, 1991; January 1, 1989
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 3, 2017.
11 NCAC 10 .0702 Procedure for Procuring Insurance in Unlicensed Companies {#sec-11-ncac-10-.0702 omnilex-key=us-nc-regs-official--title-11--11 NCAC 10 .0702}

History

  • Status: repealed
  • Authority G.S. 58-21-15; 58-423
  • Eff. February 1, 1976
  • Readopted Eff. July 11, 1978
  • Amended Eff. July 1, 1986
  • Repealed Eff. April 1, 2001.
11 NCAC 10 .0703 Approval of Insurance in Non-Admitted Insurance Companies {#sec-11-ncac-10-.0703 omnilex-key=us-nc-regs-official--title-11--11 NCAC 10 .0703}

History

  • Status: expired
  • Authority G.S. 58-2-40; 58-21-20
  • Eff. February 1, 1976
  • Readopted Eff. July 11, 1978
  • Amended Eff. January 1, 1989; July 1, 1986
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 3, 2017
  • Expired Eff. December 1, 2024 pursuant to G.S. 150B-21.3A.
11 NCAC 10 .0704 Form Sl: Represent a Surplus Lines Insurer {#sec-11-ncac-10-.0704 omnilex-key=us-nc-regs-official--title-11--11 NCAC 10 .0704}

History

  • Status: repealed
  • Authority G.S. 58-53.1 through 58-53.3; 58-433; 58-480
  • Eff. February 1, 1976
  • Readopted Eff. July 11, 1978
  • Amended Eff. January 1, 1989; July 1, 1986
  • Repealed Eff. April 1, 1992.
11 NCAC 10 .0705 Form Sl-1: License Renewal Appl./License Reprsnt/Surplus Lines Co. {#sec-11-ncac-10-.0705 omnilex-key=us-nc-regs-official--title-11--11 NCAC 10 .0705}

History

  • Status: repealed
  • Authority G.S. 58-53.1 through 58-53.3; 58-433; 58-480
  • Eff. February 1, 1976
  • Readopted Eff. July 11, 1978
  • Amended Eff. January 1, 1989; July 1, 1986
  • Repealed Eff. April 1, 1992.
11 NCAC 10 .0706 Form B: Bond {#sec-11-ncac-10-.0706 omnilex-key=us-nc-regs-official--title-11--11 NCAC 10 .0706}

History

  • Status: repealed
  • Authority G.S. 58-53.1 through 58-53.3; 58-433; 58-480
  • Eff. February 1, 1976
  • Readopted Eff. July 11, 1978
  • Amended Eff. January 1, 1989; July 1, 1986
  • Repealed Eff. April 1, 1992.
11 NCAC 10 .0707 Agents License Form {#sec-11-ncac-10-.0707 omnilex-key=us-nc-regs-official--title-11--11 NCAC 10 .0707}

History

  • Status: repealed
  • Authority G.S. 58-53.1 through 58-53.3; 58-433; 58-480
  • Eff. February 1, 1976
  • Readopted Eff. July 11, 1978
  • Amended Eff. January 1, 1989; July 1, 1986
  • Repealed Eff. April 1, 1992.
11 NCAC 10 .0708 Form C {#sec-11-ncac-10-.0708 omnilex-key=us-nc-regs-official--title-11--11 NCAC 10 .0708}

History

  • Status: repealed
  • Authority G.S. 58-53.1 through 58-53.3
  • Eff. February 1, 1976
  • Readopted Eff. July 11, 1978
  • Repealed Eff. July 1, 1986.
11 NCAC 10 .0709 Form C-1 {#sec-11-ncac-10-.0709 omnilex-key=us-nc-regs-official--title-11--11 NCAC 10 .0709}

History

  • Status: repealed
  • Authority G.S. 58-53.1 through 58-53.3
  • Eff. February 1, 1976
  • Readopted Eff. July 11, 1978
  • Repealed Eff. July 1, 1986.
11 NCAC 10 .0710 Form D {#sec-11-ncac-10-.0710 omnilex-key=us-nc-regs-official--title-11--11 NCAC 10 .0710}

History

  • Status: repealed
  • Authority G.S. 58-53.1 through 58-53.3
  • Eff. February 1, 1976
  • Readopted Eff. July 11, 1978
  • Repealed Eff. July 1, 1986.
11 NCAC 10 .0711 Form F {#sec-11-ncac-10-.0711 omnilex-key=us-nc-regs-official--title-11--11 NCAC 10 .0711}

History

  • Status: repealed
  • Authority G.S. 58-2-40(1); 58-21-35
  • Eff. February 1, 1976
  • Readopted Eff. July 11, 1978
  • Amended Eff. July 1, 1986
  • Repealed Eff. December 1, 2007.
11 NCAC 10 .0712 Form E {#sec-11-ncac-10-.0712 omnilex-key=us-nc-regs-official--title-11--11 NCAC 10 .0712}

History

  • Status: repealed
  • Authority G.S. 58-436; 58-437; 58-438
  • Eff. February 1, 1976
  • Readopted Eff. July 11, 1978
  • Amended Eff. July 1, 1986
  • Repealed Eff. April 1, 2001.
11 NCAC 10 .0713 Form E-1 {#sec-11-ncac-10-.0713 omnilex-key=us-nc-regs-official--title-11--11 NCAC 10 .0713}

History

  • Status: expired
  • Authority G.S. 58-2-40; 58-21-80; 58-21-85; 58-21-90
  • Eff. February 1, 1976
  • Readopted Eff. July 11, 1978
  • Amended Eff. July 1, 1986
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 3, 2017
  • Expired Eff. December 1, 2024 pursuant to G.S. 150B-21.3A.
11 NCAC 10 .0714 Form: Instructions/Requirements/Surplus Lines Company {#sec-11-ncac-10-.0714 omnilex-key=us-nc-regs-official--title-11--11 NCAC 10 .0714}

History

  • Authority G.S. 58-2-40; 58-21-65
  • Eff. February 1, 1976
  • Readopted Eff. July 11, 1978
  • Amended Eff. July 1, 1986
  • Repeal Eff. July 1, 2012.
11 NCAC 10 .0715 Adjustment of Losses for Unauthorized Company {#sec-11-ncac-10-.0715 omnilex-key=us-nc-regs-official--title-11--11 NCAC 10 .0715}

History

  • Status: repealed
  • Authority G.S. 58-51
  • Eff. February 1, 1976
  • Readopted Eff. July 11, 1978
  • Amended Eff. July 1, 1986
  • Repealed Eff. April 1, 1992.
11 NCAC 10 .0716 Form Sl-3: Corporate License Application {#sec-11-ncac-10-.0716 omnilex-key=us-nc-regs-official--title-11--11 NCAC 10 .0716}

History

  • Status: repealed
  • Authority G.S. 58-433
  • Eff. July 1, 1986
  • Repealed Eff. April 1, 1992.
11 NCAC 10 .0717 Surplus Licensee Report {#sec-11-ncac-10-.0717 omnilex-key=us-nc-regs-official--title-11--11 NCAC 10 .0717}

In addition to the information specified in G.S. 58-21-35(a), the report required by G.S. 58-21-35(a) shall contain the kind of insurance placed by the licensee, the zip code of the location of the risk, and the amount of any additional or return premium.

History

  • Authority G.S. 58-2-40; 58-21-35
  • Eff. April 1, 2001
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 3, 2017.
11 NCAC 10 .0718 "form F" Report {#sec-11-ncac-10-.0718 omnilex-key=us-nc-regs-official--title-11--11 NCAC 10 .0718}

History

  • Status: expired
  • Authority G.S. 58-2-40; 58-21-35
  • Eff. April 1, 2001
  • Amended Eff. December 1, 2007
  • Expired Eff. February 1, 2017 pursuant to G.S. 150B-21.3A.
11 NCAC 10 .0801 General Information {#sec-11-ncac-10-.0801 omnilex-key=us-nc-regs-official--title-11--11 NCAC 10 .0801}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-2-45; 58-6-7; 58-40-1(2); 58-40-5(5); 58-40-50
  • Eff. February 1, 1976
  • Readopted Eff. July 11, 1978
  • Amended Eff. April 8, 2002; February 1, 1991; January 1, 1989; July 1, 1986
  • Repealed Eff. October 1, 2006.
11 NCAC 10 .0802 Procedure for Application for New License {#sec-11-ncac-10-.0802 omnilex-key=us-nc-regs-official--title-11--11 NCAC 10 .0802}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-2-45; 58-6-7; 58-40-1(2); 58-40-5(5); 58-40-50
  • Eff. February 1, 1976
  • Readopted Eff. July 11, 1978
  • Amended Eff. April 8, 2002; February 1, 1991; January 1, 1989; July 1, 1986
  • Repealed Eff. October 1, 2006.
11 NCAC 10 .0803 Renewal License Fee for Rating Organizations {#sec-11-ncac-10-.0803 omnilex-key=us-nc-regs-official--title-11--11 NCAC 10 .0803}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-2-45; 58-6-7; 58-40-1(2); 58-40-5(5); 58-40-50
  • Eff. February 1, 1976
  • Readopted Eff. July 11, 1978
  • Amended Eff. April 8, 2002; February 1, 1991; January 1, 1989; July 1, 1986
  • Repealed Eff. October 1, 2006.
11 NCAC 10 .0804 Form: License Certificate {#sec-11-ncac-10-.0804 omnilex-key=us-nc-regs-official--title-11--11 NCAC 10 .0804}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-2-45; 58-6-7; 58-40-1(2); 58-40-5(5); 58-40-50
  • Eff. February 1, 1976
  • Readopted Eff. July 11, 1978
  • Amended Eff. April 8, 2002; February 1, 1991; January 1, 1989; July 1, 1986
  • Repealed Eff. October 1, 2006.
11 NCAC 10 .0805 Ppnf Auto Insurance Statistical Agents - Reports {#sec-11-ncac-10-.0805 omnilex-key=us-nc-regs-official--title-11--11 NCAC 10 .0805}

History

  • Status: repealed
  • Authority G.S. 58-9; 58-25.1; 58-124.18(d); 58-131.50
  • Eff. September 30, 1981
  • Repealed Eff. January 1, 1989.
11 NCAC 10 .0806 Changes in Filed Information {#sec-11-ncac-10-.0806 omnilex-key=us-nc-regs-official--title-11--11 NCAC 10 .0806}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-40-55; 58-40-60
  • Eff. January 1, 1989
  • Repealed Eff. October 1, 2006.
11 NCAC 10 .0901 General Information {#sec-11-ncac-10-.0901 omnilex-key=us-nc-regs-official--title-11--11 NCAC 10 .0901}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-40-55
  • Eff. July 11, 1978
  • Amended Eff. April 8, 2002; February 1, 1991; January 1, 1989
  • Repealed Eff. October 1, 2006.
11 NCAC 10 .0902 Procedure for Application of New License {#sec-11-ncac-10-.0902 omnilex-key=us-nc-regs-official--title-11--11 NCAC 10 .0902}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-40-55
  • Eff. July 11, 1978
  • Amended Eff. April 8, 2002; February 1, 1991; January 1, 1989
  • Repealed Eff. October 1, 2006.
11 NCAC 10 .0903 Changes in Filed Information {#sec-11-ncac-10-.0903 omnilex-key=us-nc-regs-official--title-11--11 NCAC 10 .0903}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-40-55
  • Eff. July 11, 1978
  • Amended Eff. April 8, 2002; February 1, 1991; January 1, 1989
  • Repealed Eff. October 1, 2006.
11 NCAC 10 .0904 Prohibited Practices {#sec-11-ncac-10-.0904 omnilex-key=us-nc-regs-official--title-11--11 NCAC 10 .0904}

History

  • Status: repealed
  • Authority G.S. 58-9; 58-131.44
  • Eff. July 11, 1978
  • Repealed Eff. July 1, 1988.
11 NCAC 10 .0905 Insurer's Report on Insurance Advisory Organizations {#sec-11-ncac-10-.0905 omnilex-key=us-nc-regs-official--title-11--11 NCAC 10 .0905}

History

  • Status: repealed
  • Authority G.S. 58-9; 58-131.41; 58-131.44
  • Eff. July 11, 1978
  • Repealed Eff. January 1, 1989.
11 NCAC 10 .0906 Form: License Certificate {#sec-11-ncac-10-.0906 omnilex-key=us-nc-regs-official--title-11--11 NCAC 10 .0906}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-40-55
  • Eff. January 1, 1989
  • Amended Eff. April 8, 2002
  • Repealed Eff. October 1, 2006.
11 NCAC 10 .0907 Renewal License Fee for Licensed Organizations {#sec-11-ncac-10-.0907 omnilex-key=us-nc-regs-official--title-11--11 NCAC 10 .0907}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-40-55
  • Eff. January 1, 1989
  • Amended Eff. April 8, 2002
  • Repealed Eff. October 1, 2006.
11 NCAC 10 .1001 General Information {#sec-11-ncac-10-.1001 omnilex-key=us-nc-regs-official--title-11--11 NCAC 10 .1001}

History

  • Status: expired
  • Authority G.S. 58-2-40; 58-40-60
  • Eff. July 11, 1978
  • Amended Eff. February 1, 1991; January 1, 1989
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 3, 2017
  • Expired Eff. December 1, 2024 pursuant to G.S. 150B-21.3A.
11 NCAC 10 .1002 Procedure for Application of New License {#sec-11-ncac-10-.1002 omnilex-key=us-nc-regs-official--title-11--11 NCAC 10 .1002}

Joint underwriting organizations and joint reinsurance organizations not previously licensed shall submit the fee set forth in G.S. 58-6-7 and an application, including, but not limited to:

(1) the name and address of the organization;

(2) a copy of:

(a) its constitution, charter, or articles of incorporation, association, or agreement;

(b) its bylaws, plan of operation, or other rules governing its business duly certified by the custodian of the original thereof;

(c) any other rules or regulations governing the conduct of its business.

(3) a list of the insurers who are members or subscribers;

(4) list of the states where the organization is licensed;

(5) a list of the lines of insurance involved;

(6) the names and addresses of all officers and managers;

(7) the name and address of one or more residents of this state appointed to receive notices, process, or orders;

(8) a statement demonstrating its technical qualifications;

(9) a check in payment of the organization license fee;

(10) such other information as the commissioner may require.

History

  • Authority G.S. 58-2-40; 58-40-60
  • Eff. July 11, 1978
  • Amended Eff. April 8, 2002; January 1, 1989
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 3, 2017.
11 NCAC 10 .1003 Changes in Filed Information {#sec-11-ncac-10-.1003 omnilex-key=us-nc-regs-official--title-11--11 NCAC 10 .1003}

Any change in or amendment to any document described in Rules .1002 or .1007 of this Section shall be promptly filed with the commissioner.

History

  • Authority G.S. 58-2-40; 58-40-60
  • Eff. July 11, 1978
  • Amended Eff. January 1, 1989
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 3, 2017.
11 NCAC 10 .1004 Prohibited Practices {#sec-11-ncac-10-.1004 omnilex-key=us-nc-regs-official--title-11--11 NCAC 10 .1004}

No joint underwriting organization shall engage in any unfair or unreasonable practices.

History

  • Authority G.S. 58-2-40; 58-40-60
  • Eff. July 11, 1978
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 3, 2017.
11 NCAC 10 .1005 Insurer's Report on Underwriting Organizations {#sec-11-ncac-10-.1005 omnilex-key=us-nc-regs-official--title-11--11 NCAC 10 .1005}

History

  • Status: repealed
  • Authority G.S. 58-9; 58-131.45
  • Eff. July 11, 1978
  • Repealed Eff. January 1, 1989.
11 NCAC 10 .1006 Form: License Certificate {#sec-11-ncac-10-.1006 omnilex-key=us-nc-regs-official--title-11--11 NCAC 10 .1006}

History

  • Status: expired
  • Authority G.S. 58-2-40; 58-40-60
  • Eff. January 1, 1989
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 3, 2017
  • Expired Eff. December 1, 2024 pursuant to G.S. 150B-21.3A.
11 NCAC 10 .1007 Renewal License Fee for Licensed Organizations {#sec-11-ncac-10-.1007 omnilex-key=us-nc-regs-official--title-11--11 NCAC 10 .1007}

The renewal license fee set forth in G.S. 58-6-7 shall be paid annually to the commissioner before March 1 of each year. The renewal license application shall include, but not be limited to:

(1) the name and address of the organization,

(2) the lines of insurance in which the organization engages,

(3) a description of pertinent changes in its services of activities since the previous renewal license was granted.

History

  • Authority G.S. 58-2-40; 58-40-60
  • Eff. January 1, 1989
  • Amended Eff. April 8, 2002
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 3, 2017.
11 NCAC 10 .1101 Purpose {#sec-11-ncac-10-.1101 omnilex-key=us-nc-regs-official--title-11--11 NCAC 10 .1101}

The purposes of this Section are the following:

(1) To expedite the review of rate filings so that statutory time limits can be met;

(2) To avoid the time and expense of unnecessary and duplicative data requests;

(3) To provide for the adequacy of each filing's contents for public inspection.

History

  • Authority G.S. 58-2-40
  • Eff. January 1, 1989
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 3, 2017.
11 NCAC 10 .1102 Applicability {#sec-11-ncac-10-.1102 omnilex-key=us-nc-regs-official--title-11--11 NCAC 10 .1102}

The following Subparagraphs indicate which Rules of this Section apply to a particular filing. All rate filings must be submitted separately and under independent cover from form filings.

(1) Rule .1111 applies to all workers' compensation insurance rate filings made by the North Carolina Rate Bureau.

(2) Rule .1104 applies to all nonfleet private passenger automobile insurance rate filings made by the North Carolina Rate Bureau or the North Carolina Reinsurance Facility.

(3) Rule .1105 applies to all rate filings made by the North Carolina Rate Bureau other than those involving workers' compensation insurance or nonfleet private passenger automobile insurance.

(4) Rule .1106 applies to all filings for deviations from the rates of the North Carolina Rate Bureau.

(5) Rule .1107 applies to all rate filings (including those filings derived from filings of licensed rating organizations), other than those involving:

(a) Lines of insurance under the jurisdiction of the North Carolina Rate Bureau.

(b) Nonfleet private passenger automobile insurance rates for the North Carolina Reinsurance Facility.

(6) Rule .1108 applies to all rate filings described in Subparagraph (5) of this Rule that meet either or both of the following criteria:

(a) A filing for a coverage that involves an increase in one year greater than ten percent or a decrease greater than 20 percent.

(b) A filing for a coverage by a company whose market share is greater than ten percent.

(7) In Subparagraph (6) coverage shall mean one of the following:

(a) Accountants' professional liability;

(b) Architects' and engineers' professional liability;

(c) Child care liability (other than such coverage sold incidental to another coverage, e.g., in homeowners' or commercial multiperil policies);

(d) Dentists' professional liability;

(e) Directors', officers', and trustees' liability;

(f) Errors and omissions liability;

(g) Hospital premises liability;

(h) Hospital professional liability;

(i) Lawyers' professional liability;

(j) Liquor law liability;

(k) Municipal liability;

(l) Nurses' professional liability;

(m) Owners', landlords', and tenants' liability;

(n) Physicians' and surgeons' professional liability;

(o) Police professional liability;

(p) Pollution and environmental impairment liability;

(q) Products and completed operations liability;

(r) Public official liability;

(s) Public school liability;

(t) Recreational liability;

(u) Other health care specialities' professional liability;

(v) If not one of Subparagraphs (7)(a) through (7)(u) of this Rule, one of the lines listed on Page 14 of the Annual Statement.

(8) Rule .1109 applies to all licensed rating organizations participating in a filing made by the North Carolina Rate Bureau or the North Carolina Reinsurance Facility.

(9) Rate filings are not required for the following lines of insurance:

(a) Aviation physical damage;

(b) Mortgage guaranty;

(c) Ocean marine.

(10) Rate filings are not required for the following types of policies:

(a) Those written pursuant to the Surplus Lines Act;

(b) Those written under the Fair Access to Insurance Requirements (FAIR) Plan that include coverages other than crime insurance;

(c) Those written by the North Carolina Insurance Underwriting Association (the Beach Plan) that include coverages other than windstorm and hail only or crime insurance;

(d) Those written in North Carolina covering multistate insureds except in respect to coverages applicable to North Carolina locations;

(e) Those written by a town or county farmers' mutual fire insurance association restricting its operations to not more than six adjacent counties in this State;

(f) Those that contain assessment provisions and that are written by domestic insurance companies, associations, orders, or fraternal benefit societies that are not reciprocals.

(11) All inland marine manual rates and rating plans must be filed.

(a) This Subparagraph applies to the manual rates and rating plans of both companies and rating organizations.

(b) Rates and rating plans that are not contained in or derived from a manual need not be filed.

(12) Rate filings are required for all rates whether advisory, suggested, or manual, except for those lines, policies, and rates specifically excluded in Subparagraphs (9), (10), and (11) of this Rule.

(a) Rates applicable to only one particular risk must be filed.

(b) Rates may be filed either as manual rates or as ranges of rates from which the rates for individual insureds are determined.

(c) Rates based on loss cost filings must be filed in accordance with all the requirements of Rules .1107 and .1108 including the one that requires a comparison of current and proposed rates.

(13) Rules .1107 and .1108 also apply to loss cost filings. In cases where a rating organization files prospective loss costs, the same requirements as for rate filings apply, with the exception of those dealing with expense and profit provisions.

(14) The rates contained in all filings approved prior to January 1, 1990, other than those made by the North Carolina Rate Bureau or the North Carolina Reinsurance Facility, shall have an expiration date of January 1, 1992. Such rates may, subject to the Department's approval, be automatically renewed by a letter to the Department, specifying the Department's file number and the original approval date. Thereafter, they remain in effect until superseded, withdrawn, or modified by a subsequent filing.

(15) Loss costs, rates, or multipliers for workers' compensation and employers' liability that are based upon prospective loss costs filings of the North Carolina Rate Bureau shall be submitted in accordance with Rule .1110 of this Section.

History

  • Authority G.S. 58-2-40; 58-36-15; 58-36-30; 58-36-100; 58-40-30; 58-40-40; 58-41-50; 58-45-35; 58-46-15
  • Eff. January 1, 1989
  • Amended Eff. February 1, 1996; April 1, 1992; July 1, 1990; January 1, 1990
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 3, 2017.
11 NCAC 10 .1103 Workers' Compensation {#sec-11-ncac-10-.1103 omnilex-key=us-nc-regs-official--title-11--11 NCAC 10 .1103}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-36-15(h)
  • Eff. January 1, 1989
  • Amended Eff. October 1, 1990
  • Repealed Eff. February 1, 1996.
11 NCAC 10 .1104 Nonfleet Private Passenger Automobile {#sec-11-ncac-10-.1104 omnilex-key=us-nc-regs-official--title-11--11 NCAC 10 .1104}

The information required by N.C.G.S. 58-36-15(h) for nonfleet private passenger automobile rate filings shall be presented as follows:

Note: If data required by this Rule, other than that specified in Subparagraph (3)(c), are not being collected or reported, or are not readily available to insurers prior to January 1, 1991, then insurers shall commence as of that date prospectively collecting and reporting such data. The date for commencing prospectively collecting and reporting the data specified in Subparagraph (3)(c) is January 1, 1992. Thereafter, such required data as have accrued shall be included in each filing until enough data are available to fully satisfy this Rule. If in addition to the full years of data specified in any of the Subparagraphs below, more recent data of less than a full year are available, such data shall also be provided. If updates to the information specified in any of the Subparagraphs in this Rule become available before the close of evidence relating to the filing, they shall also be provided.

(1) North Carolina earned premiums at the actual and current rate level; losses and loss adjustment expenses, each on paid and incurred bases without trending or other modification for the experience period, including the loss ratio anticipated at the times the rates were promulgated for the experience period:

(a) Include premium, loss, loss adjustment expense, expense, and exposure data from all companies writing North Carolina nonfleet private passenger automobile insurance. If the experience of any company that writes more than one percent of the North Carolina nonfleet private passenger automobile written premium has been excluded from any rate level, trend, loss development, or investment income calculation for any coverage, identify the coverage, the company and its market share and provide an explanation for its exclusion. Also estimate the aggregate market share of other companies whose experience is excluded from such calculations.

(b) Include data relating to increased limits factors and deductible credits if such factors have not been reviewed in the last two filings or reviews. Provide justification that the factors and credits contained in the filing are neither excessive, inadequate, nor unfairly discriminatory. Also provide all information related to their derivation, including the following:

(i) A description of all data reviewed and all worksheets used;

(ii) complete description of the methodology used to derive these factors and credits;

(iii) A description of alternative methodologies used or considered for use in the last three years;

(iv) A description of the criteria used to select a methodology;

(v) Specific details on the application of these criteria in the selection of a methodology for this filing;

(vi) Details on the application of the methodology to this filing.

(c) Clearly describe all adjustments to premiums, losses, loss adjustment expenses, and exposures included in the filing. Show the unadjusted amounts to which adjustments were made, identify the specific adjustments, provide details on the derivation and application of the adjustment factors, and describe all intermediate calculations. Where identical adjustments are applied to a set of similar data, an example of one of these adjustments is similar.

(d) For each coverage, include actual earned premiums and calculate earned premiums at present rates. Also indicate how such calculations were produced, supply supporting documentation for a sample of such calculations, and justify any aggregate factors used.

(e) Provide the latest written and earned premiums and market shares for the ten largest writers of North Carolina nonfleet private passenger automobile insurance.

(f) Provide composite loss and premium information from each of the latest two Annual Statements for the 50 largest writers of North Carolina nonfleet private passenger insurance, including the following:

(i) Underwriting and Investment Exhibit, Part 2, Lines 19 and 21;

(ii) Underwriting and Investment Exhibit, Part 3, Lines 19 and 21;

(iii) North Carolina Page 14, Lines 19.1, 19.2, and 21.1.

(g) Except in filings made by the North Carolina Reinsurance Facility, provide to the extent possible the following information on companies deviating from the nonfleet private passenger automobile rates of the North Carolina Rate Bureau for each of the latest five calendar years by line:

(i) A list of all companies writing at deviated rates;

(ii) he estimated premium written at deviated rates;

(iii) The estimated percentage of statewide premium written at deviated rates;

(iv) The amount of deviations in dollars;

(v) he average percentage deviation for companies writing at deviated rates;

(vi) The average percentage deviation for all companies.

(h) Except in filings made by the North Carolina Reinsurance Facility, provide the following information on companies issuing dividends on North Carolina nonfleet private passenger automobile policies for each of the latest five calendar years by line:

(i) A list of all companies issuing dividends;

(ii) The estimated premium of companies issuing dividends;

(iii) The estimated percentage of statewide premium written by companies issuing dividends;

(iv) The amount of dividends in dollars;

(v) he average percentage dividend issued by all companies issuing dividends;

(vi) The average percentage dividend issued by all companies.

(i) Provide the following information on losses and loss adjustment expenses:

(i) A comparison of the undeveloped and untrended private passenger automobile liability and physical damage losses and premium contained in the latest three Annual Statements and those contained in the filing. Identify the causes of the differences and provide approximate quantification of the effects of each cause;

(ii) For each rate level implemented in the latest three calendar years, the expected loss ratios that were anticipated in the implemented rates, by coverage;

(iii) For each accident year included in the filing, paid losses, case basis reserves, loss development, incurred allocated loss adjustment expense (if collected separately from losses), estimated incurred unallocated (or combined allocated and unallocated) loss adjustment expense, applied trend factors, and trended incurred losses and loss adjustment expenses, by coverage.

(j) Whenever North Carolina losses are separated into excess (catastrophe) and nonexcess (noncatastrophe) losses, provide a clear description and justification of the standard used to separate such losses. Include as many years of data as are available. If the number of years used differs from the number available, provide an explanation. Also provide an explanation if the data from which the excess loading is derived differs from that on which the rate level change is based.

(k) Territorial rate calculations shall include earned premiums, incurred losses, and the number of claims by territory for each of the years used to determine the territorial relativities.

(2) Credibility factor development and application. Provide all information related to the derivation of the credibility factors contained in the filing, including the following:

(a) A description of all data reviewed and all worksheets used.

(b) A complete description of the methodology used to derive these factors.

(c) A description of alternative methodologies used or considered for use in the last three years.

(d) A description of the criteria used to select a methodology.

(e) Specific details on the application of these criteria in the selection of a methodology for this filing.

(f) Details on the application of the methodology to this filing.

(3) Loss development factor development and application on both paid and incurred bases and in both numbers and dollars of claims:

(a) Provide all information related to the derivation of all loss development factors contained in the filing, including the following:

(i) A description of all data reviewed and all worksheets used;

(ii) A complete description of the methodology used to derive these factors;

(iii) A description of alternative methodologies used or considered for use in the last three years;

(iv) A description of the criteria used to select a methodology;

(v) Specific details on the application of these criteria in the selection of a methodology for this filing;

(vi) Details on the application of the methodology to this filing.

(b) Provide for each liability coverage, complete (including the upper left portion) total limits paid loss development triangles for the ten latest available accident years at all available development points for matching companies. Also provide the corresponding loss development factors and five-year average factors derivable from these triangles. Also provide estimated earned premium and exposures corresponding to each accident year.

(c) Provide the information in Subparagraph (3)(b) for basic limits paid losses.

(d) Provide the information in Subparagraph (3)(b) for total limits incurred losses.

(e) Provide the information in Subparagraph (3)(b) for basic limits incurred losses.

(f) Provide the information in Subparagraph (3)(b) for the number of paid claims.

(g) Provide the information in Subparagraph (3)(b) for the number of outstanding claims.

(h) Provide the information in Subparagraphs (3)(b), (3)(c), (3)(d), (3)(e), (3)(f), and (3)(g) separately for voluntary and ceded business.

(i) For each of the 15 largest writers of North Carolina nonfleet private passenger automobile insurance, provide a statement regarding any reserve strengthening or weakening that has occurred in the last five years.

(4) Trending factor development and application:

(a) Provide all information related to the derivation of all trend factors contained in the filing, including the following:

(i) A description of all data reviewed and all worksheets used;

(ii) A complete description of the methodology used to derive these factors;

(iii) A description of alternative methodologies used or considered for use in the last three years;

(iv) A description of the criteria used to select a methodology;

(v) Specific details on the application of these criteria in the selection of a methodology for this filing;

(vi) Details on the application of the methodology to this filing.

(b) Provide the following trend data for the latest available five calendar years by coverage:

(i) Fast-track loss data, both countrywide and for North Carolina (separately for frequency and severity);

(ii) All North Carolina internal loss trend data (separately for frequency and severity);

(iii) Countrywide external expense trend data;

(iv) North Carolina internal expense trend data from the Bureau Special Call for Expense Experience.

(c) For all trend data described in this Rule, calculate annual trend factors and coefficients of correlations as follows:

(i) Include calculations based on the latest six, nine, twelve and fifteen-point periods.

(ii) Include calculations using both exponential and straight line methods.

(d) Provide an assessment of the suitability of historical trends as predictors of future trends and examine changes in seat-belt usage, in the drinking age, in the price of gasoline, and in miles driven. If it is determined that such changes or any other legislative, regulatory, social, and economic factors affecting frequency and severity trends will materially impact anticipated losses and that such impact is not reflected by historical trend data, provide all analyses and data relied on to assess such impact and to incorporate it into the filing.

(5) Changes in premium base resulting from rating exposure trends:

(a) Provide all available exposure distributions by policy term for each of the latest five calendar years and estimate any changes to those distributions during the years in which the proposed rates are expected to be in effect. Also estimate for the same period the premium distribution by policy term.

(b) Provide available data on changes in age and symbol distributions for physical damage coverages over the latest ten calendar years, calculate the trends in such distributions, and demonstrate how such trends have been included in the calculation of earned premiums at present rates.

(6) Limiting factor development and application. Provide information on the following items:

(a) Limitations on losses included in the statistical data used in the filing.

(b) Limitations on the extent of the rate level change by coverage.

(c) Limitations on the extent of territorial rate changes.

(d) Any other limitations applied.

(7) Overhead expense development and application of commission and brokerage, other acquisition expenses, general expenses, taxes, license, and fees:

(a) Provide all information related to the derivation of the expense provisions contained in the filing, including the following:

(i) A description of all data reviewed and all worksheets used;

(ii) A complete description of the methodology used to derive these provisions;

(iii) A description of alternative methodologies used or considered for use in the last three years;

(iv) A description of the criteria used to select a methodology;

(v) Specific details on the application of these criteria in the selection of a methodology for this filing;

(vi) Details on the application of the methodology to this filing.

(b) Provide earned premiums and unallocated loss adjustment expenses for each of the latest five calendar years by coverage or by groups of coverages.

(c) For each of ten largest writers of North Carolina nonfleet private passenger automobile insurance, provide statements regarding any activities affecting expense or service levels undertaken in the last five years.

(8) Percent rate change.

(a) Provide the overall statewide rate change by coverage and by deductible for physical damage coverages.

(b) If the proposed rate changes are dependent on the actual implementation date(s) of the new rates, indicate the number of days after the issuing of the Commissioner's order that are required for an orderly implementation of a change in rates. Also indicate all aspects of the rate filing that will vary with a change in the implementation date(s).

(c) If the rate changes eventually implemented differ from those provided in the filing, submit a supplement to the filing that describes the implemented changes and the modifications made to the filing to produce them. This supplement shall be submitted as soon as possible after a decision is reached to implement rates other than those that were originally filed and in any case no later than the first implementation date of the rates.

(9) Final proposed rates:

(a) Provide the proposed rates for each territory and coverage.

(b) If the rates eventually implemented differ from those provided in the filing, submit a supplement to the filing that describes the implemented rates and the modifications made to the filing to produce them. This supplement shall be submitted as soon as possible after a decision is reached to implement rates other than those that were originally filed and in any case no later than the first implementation date of the rates.

(10) Investment earnings, consisting of investment income and realized plus unrealized capital gains, from loss, loss expense, and unearned premium reserves.

(a) Calculate the amount of investment income earned on loss, loss expense, and unearned premium reserves (as a ratio to earned premium) from North Carolina nonfleet private passenger automobile policies for each of the latest five calendar years and estimate that income for the current year and for all years during which the proposed rates are expected to be in effect. Provide the details of such calculations, including the amount of the composite reserves of each type at the beginning and end of each of the latest five calendar years. Also describe and justify all assumptions used in such calculations.

(b) Provide information on the estimated average length of time that elapses between the occurrence of a loss or accident in North Carolina and the payment of a claim on that loss or accident. The average shall be a weighted average based on the size of the claim payments. Estimate how the length has changed over the last ten years.

(c) Provide composite asset, liability, and income information from each of the latest two Annual Statements for which aggregate data are available for the 50 largest writers of North Carolina nonfleet private passenger automobile insurance, including the following (in the same format and detail as the exhibits in individual company statements):

(i) Page 2 (Assets);

(ii) Page 3 (Liabilities, Surplus and Other Funds);

(iii) Page 4 (Underwriting and Investment Exhibit);

(iv) Insurance Expense Exhibit, Part II, columns 19.1, 19.2 and 21.1.

(11) Identification of applicable statistical plans and programs and a certification of compliance with them:

(a) Identify all statistical plans used or consulted in preparing this filing and describe the data compiled by each plan.

(b) Provide a certification that there is no evidence known to the Bureau or to the statistical agencies involved that the data that were collected in accordance with such statistical plans and were used in the rate filing are not true and accurate representations of each company's experience to the best of that company's knowledge.

(c) Provide general descriptions of the editing procedures used to verify that the data were collected in accordance with the statistical plans, and concise summaries of the adjustments and corrections made to the consolidated ratemaking data.

(12) Investment earnings on capital and surplus. Given the selected underwriting profit and contingencies provisions contained in the filing, calculate the resulting rates of return (including consideration of investment income) on equity capital, on statutory surplus, and on total assets. Show the derivation of all factors used in producing these calculations and justify the fairness and reasonableness of these rates of return.

(13) Level of capital/surplus needed to support premium writings without endangering the solvency of member companies:

(a) Provide aggregate premium to surplus ratios for the latest ten available calendar years for those companies writing North Carolina nonfleet private passenger automobile insurance during that entire period.

(b) Provide estimates of the comparable ratios for all companies writing North Carolina nonfleet private passenger automobile insurance for all years during which the proposed rates are expected to be in effect.

(c) Provide information on the amount of surplus needed to support the writing of North Carolina nonfleet private passenger automobile insurance, taking into consideration the riskiness of the lines, and describe the assumptions used in the derivation of that amount.

(d) Provide all information relating to any explicit or implicit allocation of surplus by state and by line undertaken in the filing, including the following:

(i) A description of all data reviewed and all worksheets used;

(ii) A complete description of the methodology used to produce this allocation;

(iii) A description of alternative methodologies used or considered for use in the last three years;

(iv) A description of the criteria used to select a methodology;

(v) Specific details on the application of these criteria in the selection of a methodology for this filing;

(vi) Details on the application of the methodology to this filing.

(14) Such other information that may be required by any rule adopted by the Commissioner:

(a) Provide all information relating to the derivation of the underwriting profit and contingencies provisions contained in the filing, including the following:

(i) A description of all data reviewed and all worksheets used;

(ii) A complete description of the methodology used to derive these provisions;

(iii) A description of alternative methodologies used or considered for use in the last three years;

(iv) A description of the criteria used to select a methodology;

(v) Specific details on the application of these criteria in the selection of a methodology for this filing;

(vi) Details on the application of the methodology to this filing.

(b) Include copies of all agendas and minutes of meetings of the North Carolina Rate Bureau and the North Carolina Reinsurance Facility affecting the filing, as well as a list of all attendees at these meetings, their titles, and their affiliations.

(c) Except in filings made by the North Carolina Reinsurance Facility, describe all payments made to all consultants (including lawyers, actuaries, and economists) related to this filing and the previous one on nonfleet private passenger automobile insurance. If payments can not be specifically identified as related to particular filings, estimate them.

(d) Identify and describe all changes in methodologies from the previous North Carolina nonfleet private passenger automobile rate filing made by the same filer.

History

  • Authority G.S. 58-2-40; 58-36-15(h)
  • Eff. June 1, 1989
  • Amended Eff. October 1, 1990
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 3, 2017.
11 NCAC 10 .1105 Other Rate Bureau Lines {#sec-11-ncac-10-.1105 omnilex-key=us-nc-regs-official--title-11--11 NCAC 10 .1105}

The information required by N.C.G.S. 58-36-15(h) for rate filings made by the North Carolina Rate Bureau affecting other than workers' compensation or nonfleet private passenger automobile policies shall be presented as follows:

Note: If the data required by this Rule are not currently being collected or reported, or are not currently readily available, the insurers shall commence prospectively collecting and reporting such data beginning on January 1, 1993. If certain data are not regularly collected through the statistical plan, a special call for such data to companies whose aggregate written premium is at least two-thirds of the total North Carolina written premium for the coverages affected by the filing may be substituted. Thereafter, such required data as have accrued shall be included in each filing until enough data are available to satisfy fully this Rule. If in addition to the full years of data specified in any of the Subparagraphs in this Rule, more recent data of less than a full year are available, such data shall also be provided. If updates to the information specified in any of the Subparagraphs in this Rule become available before the close of evidence relating to the filing, they shall also be provided.

(1) North Carolina earned premiums at the actual and current rate level: losses and loss adjustment expenses, each on paid and incurred bases without trending or other modification for the experience period, including the loss ratio anticipated at the time the rates were promulgated for the experience period.

(a) Include premium, loss, and loss adjustment expense, and expense data from all companies writing a coverage affected by the filing. In addition, if exposures are used in the calculation of premiums at present rates, provide all available exposure data from these companies. If the experience of any of the 50 largest writers (based on North Carolina written premium) of such insurance has been excluded from any rate level, trend, loss development, relativity, or investment income calculations for that coverage, identify the company and its market share and provide an explanation for its exclusion. Also estimate the aggregate market share of other companies whose experience is excluded from such calculations.

(b) In filings producing an overall rate level change for farmowners policies, use only the experience from coverages under the jurisdiction of the North Carolina Rate Bureau when calculating that change. Indicate if and how non-Bureau data has been segregated and if and how such data has affected any aspect of the filing (e.g., trend, expense provisions, etc.).

(c) Clearly describe all adjustments to premiums, losses, loss adjustment expenses, expenses, and exposures included in the filing. Show the unadjusted amounts to which adjustments were made, identify the specific adjustments, provide details on the derivation and application of the adjustment factors, and describe all intermediate calculations. Where identical adjustments are applied to a set of similar data, an example of one of these adjustments is sufficient.

(d) Include actual earned premiums, and calculate earned premiums at present rates. Also indicate how such calculations were produced, supply supporting documentation for a sample of the calculations, and justify all aggregate factors used.

(e) Provide the latest written and earned premiums and market shares for the ten largest writers (based on North Carolina written premium) of the coverages affected by the filing.

(f) In filings producing an overall rate level change for either homeowners or farmowners policies, provide composite loss and premium information from each of the latest two Annual Statements for which aggregate data are available for the 50 largest writers (based on North Carolina written premium) of the coverages affected by the filing, including the following:

(i) Underwriting and Investment Exhibit, Part 2;

(ii) Underwriting and Investment Exhibit, Part 3A;

(iii) North Carolina Page 14 (for all such companies).

For homeowners filings, provide the information on line 4; for farmowners filings, the information on line 3.

(g) In filings affecting either homeowners or farmowners policies, provide to the extent possible the following information on companies deviating from the homeowners or farmowners rates of the North Carolina Rate Bureau for each of the latest five calendar years:

(i) A list of all companies writing at deviated rates;

(ii) The estimated premium written at deviated rates;

(iii) The estimated percentage of statewide premium written at deviated rates;

(iv) The amount of deviations in dollars;

(v) The average percentage deviation for companies writing at deviated rates;

(vi) The average percentage deviation for all companies.

(h) In filings affecting either homeowners or farmowners policies, provide to the extent possible the following information on companies issuing dividends on North Carolina homeowners or farmowners policies for each of the latest five calendar years:

(i) A list of all companies issuing dividends;

(ii) The estimated premium of companies issuing dividends;

(iii) The estimated percentage of statewide premium written by companies issuing dividends;

(iv) The amount of dividends in dollars;

(v) The average percentage dividend issued by companies issuing dividends;

(vi) The average percentage dividend issued by all companies.

(i) In filings producing an overall rate level change, provide the following information on losses and loss adjustment expenses, separately for liability and property losses, for each year of loss experience used in calculating that change:

(i) Paid losses and number of paid claims;

(ii) Case basis reserves and number of outstanding claims;

(iii) Applied loss development factor;

(iv) Loss adjustment expense factor;

(v) Applied trend factor;

(vi) Trended incurred losses and loss adjustment expenses;

(vii) The expected loss ratios that were anticipated in the rates in effect during that year.

(j) If data from monoline coverages is used in the determination of package rate levels or vice versa, provide to the extent possible the following information:

(i) A clear description of the differences between the types of data;

(ii) A description of which causes of loss are included or excluded;

(iii) Information on whether any companies have been excluded from either monoline or package data;

(iv) Comparable loss data for all years included in the filing, if available. (For example, if monoline experience before a certain date supplements package experience after that date, also include the monoline experience after that date.)

(k) Whenever North Carolina losses are separated into excess (catastrophe) and nonexcess (noncatastrophe) losses, provide a clear description and justification of the standard used to separate such losses. Include as many years of data as possible. If the number of years included differs from the number available, indicate the years excluded and provide an explanation. Also provide an explanation if the data from which the excess loading is derived differs from that on which the rate level change is based.

(l) In filings producing an overall rate level change, provide loss data by cause of loss in as much statistical detail as is available for each year used in calculating that change and describe any adjustment procedures or factors applied to the separated data.

(2) Credibility factor development and application. Provide all information relating to the derivation of all credibility factors contained in the filing, including the following:

(a) A description of all data reviewed and all worksheets used.

(b) A complete description of the methodology used to derive these factors.

(c) A description of alternative methodologies used or considered for use in the last three years.

(d) A description of the criteria used to select a methodology.

(e) Specific details on the application of these criteria in the selection of a methodology for the filing.

(f) Details on the application of the methodology to the filing.

(3) Loss development factor derivation and application on both paid and incurred bases and in both numbers and dollars of claims. In filings producing an overall rate level change for homeowners policies, provide the information requested in Subparagraphs (3)(a) through (3)(g). For farmowners policies that include losses on other than a calendar year basis, provide the information requested in Paragraphs (3)(a) and (3)(g).

(a) All information relating to the derivation of all loss development factors contained in the filing, including the following:

(i) A description of all data reviewed and all worksheets used;

(ii) A complete description of the methodology used to derive these factors;

(iii) A description of alternative methodologies used or considered for use in the last three years;

(iv) A description of the criteria used to select a methodology;

(v) Specific details on the application of these criteria in the selection of a methodology for the filing;

(vi) Details on the application of the methodology to the filing.

(b) Complete (including the upper left portion) paid loss development triangles for matching companies, separately for property and liability losses, for the latest ten available years at all available development points and also the loss development factors and five-year average factors derivable from these triangles. Also provide the estimated earned premium and exposures corresponding to each year.

(c) The same information in Subparagraph (3)(b) for incurred losses.

(d) The same information in Subparagraph (3)(b) for the number of paid claims.

(e) The same information in Subparagraph (3)(b) for the number of outstanding claims.

(f) If available, the information in Subparagraphs (3)(b), (3)(c), (3)(d), and (3)(e) by cause of loss.

(g) Statements regarding any changes in reserve adequacy that have occurred in the latest five years from each of the ten largest writers (based on North Carolina written premium) of the line affected by the filing.

(4) Trending factor development and application:

(a) Provide all information relating to the derivation of all loss trend factors contained in the filing, including the following:

(i) A description of all data reviewed and all worksheets used;

(ii) A complete description of the methodology used to derive these factors;

(iii) A description of alternative methodologies used or considered for use in the last three years;

(iv) A description of the criteria used to select a methodology;

(v) Specific details on the application of these criteria in the selection of a methodology for the filing;

(vi) Details on the application of the methodology to the filing.

(b) If external indices are used for trending purposes, provide evidence that such indices are appropriate indicators of the selected cost changes. Include comparisons between the actual changes in loss costs and those estimated by the indices.

(c) In filings producing an overall rate change for either homeowners or farmowners policies, provide all available industry data for North Carolina on changes in loss frequency and severity, by cause of loss for each of the latest five calendar years.

(5) Changes in premium base resulting from rating exposure trends.

(a) Provide all information relating to the derivation of all premium trend factors contained in the filing, including the following:

(i) A description of all data reviewed and all worksheets used;

(ii) A complete description of the methodology used to derive these factors;

(iii) A description of alternative methodologies used or considered for use in the last three years;

(iv) A description of the criteria used to select a methodology;

(v) Specific details on the application of these criteria in the selection of a methodology for the filing;

(vi) Details on the application of the methodology to the filing.

(b) In filings producing an overall rate level change for either homeowners or farmowners policies, provide all available exposure distributions by policy term for each of the latest five calendar years and estimate any changes to those distributions that are expected during the years during which the proposed rates are expected to be in effect. Also estimate for the same period the premium distribution by policy term.

(6) Limiting factor development and application. Provide information on the following items:

(a) Limitations on the losses included in the statistical plans used in the filing.

(b) Limitations on the extent of the rate level change by coverage, by coverage amount, by form, by protection class, by construction, and by deductible.

(c) Limitations on the extent of territorial rate changes.

(d) Any other limitations.

(7) Overhead expense development and application of commission and brokerage, other acquisition expenses, general expenses, taxes, licenses, and fees.

(a) Provide all information relating to the derivation of all expense provisions contained in the filing, including the following:

(i) A description of all data reviewed and all worksheets used;

(ii) A complete description of the methodology used to derive these provisions;

(iii) A description of alternative methodologies used or considered for use in the last three years;

(iv) A description of the criteria used to select a methodology;

(v) Specific details on the application of these criteria in the selection of a methodology for the filing;

(vi) Details on the application of the methodology to the filing.

(b) In filings producing an overall rate level change for either homeowners or farmowners policies, provide earned premium and unallocated loss adjustment expenses for each of the latest five available calendar years.

(c) In filings producing an overall rate level change for either homeowners or farmowners policies, provide statements regarding any activities affecting expense or service levels undertaken in the last five years by each of ten largest writers (based on North Carolina written premium) of the line affected by the filing.

(8) Percent rate change.

(a) Provide the overall statewide rate change and also the changes by coverage, coverage amount, form, protection class, construction, and deductible.

(b) If the proposed rate changes are dependent on the actual implementation date(s) of the new rates, indicate the number of days after the issuing of the Commissioner's order that are required for an orderly implementation of a change in rates. Also indicate all aspects of the rate filing that will vary with a change in implementation date(s).

(c) If the rate changes eventually implemented differ from those included in the filing, submit a supplement to the filing that describes the implemented changes and the modifications made to the filing to produce them. This supplement shall be submitted as soon as possible after a decision is reached to implement rates other than those that were originally filed and in any case no later than the first implementation date of the rates.

(9) Final proposed rates.

(a) Provide the proposed average rates for each coverage, coverage amount, form, protection class, construction, and deductible. (In filings involving a large number of possible rates, information on rating factors and their application may be substituted for the actual rates.)

(b) If the rates eventually implemented differ from those included in the filing, submit a supplement to the filing that describes the implemented rates in the same detail as described in Subparagraph (9)(a). This supplement shall be submitted as soon as possible after a decision is reached to implement rates other than those that were originally filed and in any case no later than the first implementation date of the rates.

(10) Investment earnings, consisting of investment income and realized plus unrealized capital gains, from loss, loss expense, and unearned premium reserves.

(a) In filings producing an overall rate level change, calculate the amount of investment income earned on loss, loss expense, and unearned premium reserves (as a ratio to earned premium) from North Carolina policies affected by the filing, for each of the latest five available calendar years, and estimate that income for the current year and for all years during which the proposed rates are expected to be in effect. Provide the details of such calculations including the amount of the composite reserves of each type at the beginning and at the end of each of the latest five available calendar years. Also describe and justify all assumptions used in such calculations.

(b) In filings producing an overall rate change for either homeowners or farmowners policies, provide information on the estimated average length of time that elapses between the occurrence of a loss or accident in North Carolina and the payment of a claim on that loss or accident. The average shall be a weighted average based on the size of the claim payments. Estimate how the length has changed over the latest ten available calendar years.

(c) In filings producing an overall rate change for either homeowners or farmowners policies, provide composite asset, liability, and income information from each of the latest two Annual Statements for which aggregate data are available for the 50 largest writers of the line affected by the filing (based on North Carolina written premium), including the following (in the same format and detail as the exhibits in individual company statements):

(i) Page 2 (Assets);

(ii) Page 3 (Liabilities, Surplus and Other Funds);

(iii) Page 4 (Underwriting and Investment Exhibit);

(iv) Insurance Expense Exhibit, Part II, column 4 or column 3.

(11) Identification of applicable statistical plans and programs and certification of compliance with them.

(a) Identify all statistical plans used or consulted in preparing the filing and describe the data compiled by each plan.

(b) Provide a certification that there is no evidence known to the Bureau or to the statistical agencies involved that the data that were collected in accordance with such statistical plans and were used in the filing are not true and accurate representations of each company's experience to the best of that company's knowledge.

(c) Provide general descriptions of editing procedures used to verify that the data were collected in accordance with the statistical plans and concise summaries of the adjustments and corrections made to the consolidated ratemaking data.

(12) Investment earnings on capital and surplus. In filings producing an overall rate level change for either homeowners or farmowners policies, calculate the resulting rates of return (including consideration of investment income) on equity capital, on statutory surplus, and on total assets produced by the selected underwriting profit and contingencies provisions. Show the derivation of all factors used in these calculations and justify the fairness and reasonableness of these rates of return.

(13) Level of capital/surplus needed to support premium writings without endangering the solvency of member companies. In filings producing an overall rate level change, include information on the needed level of capital/surplus, including the following:

(a) Aggregate premium to surplus ratios for each of the latest ten available calendar years for those companies writing the coverages affected by the filing during that entire period.

(b) Estimates of the comparable ratios for all companies writing the coverages affected by the filing for the years during which the proposed rates are expected to be in effect.

(c) Information on the amount of surplus needed to support the writing of the particular coverages affected by the filing, taking into consideration the riskiness of such coverages and a description of the assumptions used in the derivation of that amount.

(d) All information relating to any explicit or implicit allocation of surplus by state and by line undertaken in the filing, including the following:

(i) A description of all data reviewed and all worksheets used;

(ii) A complete description of the methodology used to produce this allocation;

(iii) A description of alternative methodologies used or considered for use in the last three years;

(iv) A description of the criteria used to select a methodology;

(v) Specific details on the application of these criteria in the selection of a methodology for the filing;

(vi) Details on the application of the methodology to the filing.

(14) Such other information that may be required by any rule adopted by the Commissioner.

(a) Provide all information related to the derivation of the profit and contingencies provisions contained in the filing, including the following:

(i) A description of all data reviewed and all worksheets used;

(ii) A complete description of the methodology used to derive these provisions;

(iii) A description of alternative methodologies used or considered for use in the last three years;

(iv) A description of the criteria used to select a methodology;

(v) Specific details on the application of these criteria in the selection of a methodology for the filing;

(vi) Details on the application of the methodology to the filing.

(b) In filings producing an overall rate level change for either homeowners or farmowners policies, include agendas and minutes of meetings of the North Carolina Rate Bureau affecting the filing and a list of all attendees at these meetings, their titles, and their affiliations.

(c) In filings producing an overall rate level change for either homeowners or farmowners policies, describe all payments to all consultants (including lawyers, actuaries, and economists) related to the current and previous filing of the same type. If payments cannot be specifically identified as relating to particular filings, estimate them.

(d) Identify and describe all changes in methodologies from any previous North Carolina filings affecting the same coverages made within the last five years.

History

  • Authority G.S. 58-2-40; 58-36-15(h)
  • Eff. October 1, 1990
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 3, 2017.
11 NCAC 10 .1106 Deviations from Rates of the North Carolina Rate Bureau {#sec-11-ncac-10-.1106 omnilex-key=us-nc-regs-official--title-11--11 NCAC 10 .1106}

(a) Definitions:

(1) Rate deviation refers to the entire collection of differences from the Rate Bureau rates and rating plan that a company has implemented or proposes to implement. Deviation and aggregate deviation are used synonymously. A company shall have only one rate deviation from each Rate Bureau filing and rating plan.

(2) Deviation component refers to any individual part of the aggregate deviation. A deviation component may involve a coverage difference, a different territorial relativity, a different class relativity, a different rate for a particular type of insured, etc. Proposed differences in territorial and class relativities (and other similarly related sets of rating factors) shall be treated as one deviation component.

(3) Introduction of a deviation means that a company has no current rate deviation on file for the particular line but is proposing to implement one.

(4) Modification of a deviation means that a company has a current rate deviation on file for the particular line and that the company proposes to add, change, or eliminate one of the components of the deviation.

(5) Withdrawal of a deviation means that a company has a rate deviation on file that it proposes to withdraw in its entirety.

(b) Filing Guidelines:

(1) All rate deviation filings must be made in triplicate.

(A) The original and one copy shall be sent to the Department.

(B) The second copy shall be sent to the North Carolina Rate Bureau.

(2) A rate deviation shall be introduced, modified, or withdrawn on an individual company basis even if the company is part of a group.

(3) All proposed rate deviations shall be expressed in terms of North Carolina Rate Bureau rates, either as percentages or as dollar amounts.

(4) Filing requirements differ by type of deviation action:

(A) To introduce a deviation, see Paragraph (d) of this Rule.

(B) To modify a deviation, see Paragraph (e) of this Rule.

(C) To withdraw a deviation, see Paragraph (f) of this Rule.

(c) Application of Deviations:

(1) On approval of the introduction, modification, or withdrawal of one or more rate deviations, the department shall transmit to the company a letter of approval listing all the components in effect for that line and company.

(2) All deviation components listed shall be applied to all eligible insureds and deviation components not listed shall not be applied to any insured.

(3) Rate deviations remain in effect until modified or withdrawn.

(4) Modifications of existing rate deviations are permitted at any time.

(5) An unmodified rate deviation may be withdrawn only if both of the following conditions have been met:

(A) The deviation has been in effect for at least six months.

(B) Application for withdrawal is submitted to the department 15 days before the proposed withdrawal date.

(6) A modified rate deviation may be withdrawn only if both of the following conditions have been met:

(A) The deviation has been in effect for at least six months since the date of the last modification.

(B) Application for withdrawal is submitted to the department 15 days before the proposed withdrawal date.

(d) Filings to introduce rate deviations shall contain only the following information:

(1) A cover letter containing the following:

(A) Company name;

(B) Company's Federal Employer's Number;

(C) Line of business involved.

(2) A completed deviation questionnaire obtained from the Property and Casualty Division.

(e) Filings to modify rate deviations shall contain only the following information:

(1) A cover letter containing the following:

(A) Company name;

(B) Company's Federal Employer's Number;

(C) Line of business involved;

(D) Department file number.

(2) A completed deviation questionnaire obtained from the Property and Casualty Division.

(f) Filing letters for withdrawals of rate deviations. Filing letters for withdrawal shall contain only the following information:

(1) A cover letter including the following information:

(A) Company name;

(B) Company's Federal Employer's Number;

(C) Line of business involved;

(D) Department file number.

(2) A statement that the deviation has been in effect for at least six months.

(g) Deviation questionnaires shall contain the following information (if applicable):

(1) Company Name;

(2) Company's Federal Employer's Number;

(3) Company's file number;

(4) Line of insurance;

(5) Subline/Program title;

(6) Previous Department file number, if applicable;

(7) Proposed effective date and rules of implementation;

(8) Company's N.C. volume of business;

(9) Company's N.C. market share;

(10) Company's countrywide volume of business;

(11) Number of N.C. insureds affected;

(12) Percentage of N.C. insureds affected;

(13) Total dollar amount of premiums that will not be collected on an annual basis as a result of this deviation;

(14) Average dollar difference per exposure from manual rates;

(15) Maximum deviation;

(16) If the deviation produces a premium greater than manual for an individual insured, explain;

(17) List of individual deviation components and the proposed action;

(18) Certification by a company officer or filings department head; and

(19) Actuarial certification.

History

  • Authority G.S. 58-2-190; 58-36-30(a) and (c)
  • Eff. January 1, 1989
  • Amended Eff. October 1, 2004; April 1, 2003; February 1, 1991; January 1, 1990
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 3, 2017.
11 NCAC 10 .1107 Commercial Lines Questionnaire {#sec-11-ncac-10-.1107 omnilex-key=us-nc-regs-official--title-11--11 NCAC 10 .1107}

The information required by G.S. 58-41-50 for those lines of business described in 11 NCAC 10 .1102 (5) shall be submitted by the completion of a Rate/Loss Cost Filing Questionnaire and the necessary supplementary exhibits to which the questionnaire refers.

(1) The Rate/Loss Cost Filing Questionnaire may contain the following information:

(a) Name of company/Licensed rating organization;

(b) Filer's Federal Employer's number;

(c) Filer's file number;

(d) Type of filing;

(e) Line(s) of insurance, as shown on Page 14 of the Annual Statement;

(f) Subline/Program title;

(g) Type of policies involved;

(h) Reasons for the filing;

(i) Proposed effective date and rules of implementation;

(j) Filer's approximate market share of North Carolina written premium for the line(s) involved;

(k) Percentage rate change proposed;

(l) Estimated total dollar impact of the filing upon North Carolina policyholders;

(m) Whether the filing will increase the premium of any North Carolina policyholder;

(n) Type of premium data included;

(o) Exposure unit used;

(p) Type of loss data included;

(q) Permissible loss ratio, permissible loss and LAE ratio, or permissible loss, LAE, and fixed expense ratio;

(r) Whether any expenses are treated as fixed;

(s) Credibility information;

(t) Loss development information;

(u) Trend information;

(v) Underwriting profit information;

(w) Changes in methodologies;

(x) Certification of accuracy.

(2) Also submit supplementary exhibits containing the following information:

(a) The effect of the proposed filing on active filings affecting the line or subline;

(b) A comparison of current and proposed rates;

(c) Five-year rate filing history;

(d) Premium and loss data (North Carolina and countrywide);

(e) Expense data (North Carolina and countrywide);

(3) In filings derived from a rate filing made by a licensed rating organization and in filings that incorporate without modification loss costs that have been filed by a licensed rating organization, substitute a supplementary exhibit for the items in the questionnaire containing the information described in Subparagraphs (1)(n) through (1)(v).

(a) For both these types of filings, this exhibit shall contain the following information:

(i) The name of the licensed rating organization;

(ii) The relationship of the company to the licensed rating organization;

(iii) The applicable licensed rating organization filing;

(iv) The type of licensed rating organization filing;

(v) Eligibility requirements and restrictions applicable to the company's filing.

(b) In cases where the licensed rating organization files final rates, this exhibit shall also identify the basis for the differences between the company's proposed rates and those filed by the rating organization.

(c) In cases where the licensed rating organization files loss costs, this exhibit shall also contain the following information:

(i) Permissible loss ratio, permissible loss and LAE ratio, or permissible loss, LAE, and fixed expense ratio;

(ii) Whether any expenses are treated as fixed;

(iii) An explanation of the derivation of the expense provisions and of their incorporation into the final rates;

(iv) Underwriting profit information.

(4) For loss cost filings made by licensed rating organizations, the following modifications apply to the requirements in this Rule:

(a) Substitute percentage loss cost change proposed in Subparagraph (1)(k).

(b) Omit the information described in Subparagraphs (1)(j) through (1)(n), (1)(q), (1)(r), and (1)(v) and the items in Subparagraph (1)(u) relating to premium trend.

(c) In the exhibit described in Subparagraph (2)(b), compare current and proposed loss costs.

(d) In the exhibit described in Subparagraph (2)(c), provide a five-year loss cost filing history.

(e) In the exhibit described in Subparagraph (2)(d), omit those items relating to premium.

(f) Omit the exhibit described in Subparagraph (2)(e).

(5) For installment premium payment plan filings, substitute a different questionnaire, containing the following information:

(a) Name of Company/Licensed rating organization;

(b) Filer's Federal Employer Number;

(c) Filer's file number;

(d) Type of filing;

(e) Line(s) of insurance;

(f) Reasons for the filing;

(g) Proposed effective date and rules of implementation;

(h) Filer's approximate market share of North Carolina written premium for the line(s) involved;

(i) Percentage rate change proposed;

(j) Estimated total dollar impact of the filing upon North Carolina policyholders;

(k) A comparison of the current and proposed installment fees;

(l) Filer's distribution of number of policies and premium by installment payment options;

(m) Certification of accuracy.

History

  • Authority G.S. 58-2-40; 58-41-50
  • Eff. January 1, 1990
  • Amended Eff. April 1, 1992; December 1, 1990
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 3, 2017.
11 NCAC 10 .1108 Nonessential Lines Additional Data {#sec-11-ncac-10-.1108 omnilex-key=us-nc-regs-official--title-11--11 NCAC 10 .1108}

For those filings meeting one or more of the criteria described in Rule .1102(5) of this Section, the Commissioner may request, in addition to the Rate Filing Questionnaire described in Rule .1107 of this Section, that all or part of the information required by G.S. 58-41-50(e) shall be presented as follows:

Note: If the data required by this Rule are not being collected or are not readily available to insurers prior to January 1, 1990, the insurers shall commence collecting such data as of July 1, 1990. Such required data as have accrued shall be included in each filing until enough data are available to fully satisfy this Rule. If in addition to the full years of data specified in any of the below requests, more recent data of less than a full year are available, that data shall also be provided. If updates to the information requested below become available before a decision is reached on the filing, they shall also be provided. Such data are for ratemaking purposes only and should be collected only by those companies to whom this regulation will apply. If any part of the data requested is inapplicable to the review of a particular filing and is therefore excluded, an explanation for the exclusion shall be given. If the filing is being made by a rating organization using all or part of the data of its member or subscriber companies, the information provided shall be aggregate or industrywide information and the individual companies whose data is being used shall be identified. If the filing is being made by an individual company and is based on an approved filing made by a rating organization, that approved filing shall be identified and also the aspects that the company is incorporating in its own filing. It is not necessary to reproduce the data included in the rating organization's filing.

(1) North Carolina premium, loss and loss adjustment experience:

(a) For each coverage, premium at present rates shall be calculated. Indicate how such calculations were produced and supply supporting documentation for a sample of such calculations and an explanation of any aggregate factors used.

(b) Information from the Annual Statement on losses and premiums shall be included. Provide such information separately from the latest five Annual Statements for the individual line(s) affected by the filing:

(i) North Carolina Page 14;

(ii) Part 2;

(iii) Part 2B;

(iv) Part 3A.

(c) The following information on overall rate level for individual coverages shall be calculated or estimated:

(i) The experience rating plan and schedule rating plan off-balance;

(ii) The average deviation from bureau rates;

(iii) The average dividend granted.

(d) For each coverage and each year used in setting the overall rate level, the following information on dollars of incurred losses shall be provided:

(i) Paid losses;

(ii) Case basis reserves;

(iii) Loss development;

(iv) Incurred allocated loss adjustment expense (if collected separately from losses);

(v) Incurred unallocated (or combined allocated and unallocated) loss adjustment expense;

(vi) Applied trend factor;

(vii) Trended total incurred losses and LAE.

(e) Whenever North Carolina or countrywide losses are separated into excess (catastrophe) and nonexcess (noncatastrophe) losses, a clear description and explanation of the standard used to separate such losses shall be included. In determining an excess (catastrophe) loading, supply as many years of data as possible. If the number of years used differs from the number available, provide an explanation. Also provide an explanation if the data from which the excess loading is derived differs from that on which the rate level change is based.

(f) Territorial and class rate calculations shall include earned premiums, incurred losses, and the number of claims for each of the years used to determine relativities.

(2) Credibility factor development and application. All relevant information related to the derivation of credibility factors contained in the filing shall be provided. Include the following information:

(a) A description of all data reviewed and of all worksheets used;

(b) A complete description of the methodology used to derive the factors;

(c) A description of alternative methodologies used or considered for use in the last three years;

(d) A description of the criteria used to select one of the various methodologies for inclusion in a particular filing;

(e) Specific details regarding the application of these criteria in the selection of a methodology for this filing;

(f) Details on the application of the methodology to this filing.

(3) Loss development factor development and application.

(a) All relevant information related to the derivation of the loss development factors contained in the filing shall be provided. Include the following information:

(i) A description of all data reviewed and of all worksheets used;

(ii) A complete description of the methodology used to derive the factors;

(iii) A description of alternative methodologies used or considered for use in the last three years;

(iv) A description of the criteria used to select one of the various methodologies for inclusion in a particular filing;

(v) Specific details regarding the application of these criteria in the selection of a methodology for this filing;

(vi) Details on the application of the methodology to this filing.

(b) If accident, report, or notice year data is used in the rate filing, provide for each coverage sufficient total limits paid loss development data so that at least five loss development factors can be calculated for each interval for which there has been significant historical development. Also provide the corresponding loss development factors and five-year average factors derived from the data.

(c) The same information in Subparagraph (b) of this Paragraph for basic and total limits incurred losses.

(d) The same information in Subparagraph (b) of this Paragraph for number of paid claims.

(e) The same information in Subparagraph (b) of this Paragraph for number of outstanding claims.

(f) A statement regarding any strengthening or weakening of company reserves that has occurred in the last five years. (If the filing is by a rating organization, include statements from the ten largest writers of the coverage in North Carolina whose data has been included in the filing.)

(4) Trending factor development and application:

(a) Available trend data (both countrywide and for North Carolina) for the latest available five years shall be provided for all coverages.

(b) All relevant information related to the derivation of the trend factors contained in the filing should be provided. Include the following information:

(i) A description of all data reviewed and of all worksheets used;

(ii) A complete description of the methodology used to derive the factors;

(iii) A description of alternative methodologies used or considered for use in the last three years;

(iv) A description of the criteria used to select one of the various methodologies for inclusion in a particular filing;

(v) Specific details regarding the application of these criteria in the selection of a methodology for this filing;

(vi) Details on the application of the methodology to this filing.

(5) Changes in premium base and exposures:

(a) Data on the mix of policies by different policy terms shall be submitted. For the latest five years, include both the number of policies and the amount of earned premium for different policy terms.

(b) Data on changes in distribution of insureds by class and territory shall be submitted. Submit all information available on such groupings for the latest five years.

(c) Data on changes in any inflation sensitive premium bases for the coverage during the latest five years shall also be included.

(6) Limiting factor development and application. Information on the following items shall be provided:

(a) Limitations on losses included in the statistical data used in the filing;

(b) Limitations on the extent of the rate level change by coverage or subline;

(c) Limitations on the extent of territorial and class rate changes;

(d) Any other limitations applied.

(7) Expenses:

(a) All relevant information related to the derivation of the expense factors contained in the filing should be provided. Include the following information:

(i) A description of all data reviewed and of all worksheets used;

(ii) A complete description of the methodology used to arrive at the selected loading;

(iii) A description of alternative methodologies used or considered for use in the last three years;

(iv) A description of the criteria used to select one of the various methodologies for inclusion in a particular filing;

(v) Specific details regarding the application of these criteria in the selection of a methodology for this filing;

(vi) Details on the application of the methodology to this filing.

(b) Earned premium and paid and incurred unallocated loss adjustment expenses for each of the latest five years shall be included. If available, provide such information by coverage.

(c) The number of paid and incurred claims and allocated loss adjustment expenses (if such are available separately from losses) for each of the last five years shall also be included. If available, provide such information by coverage.

(d) For all incurred (or paid) loss adjustment expense data contained in the filing, the related incurred (or paid) losses shall be shown.

(e) A statement regarding any company expense cutting activities undertaken in the last five years shall be provided. (If the filing is by a rating organization, include statements from the ten largest writers of the coverage in North Carolina whose data has been included in the filing.)

(8) The percent rate change:

(a) The overall statewide rate change shall be estimated as well as the changes from the previous filing in each of the following: experience, annual trend factors, the expense provisions, the tax provision, and the underwriting profit and contingency provision. Also identify any recent law changes that have affected the calculation of the overall rate level and estimate their impact.

(b) The information described in Subparagraph (a) of this Paragraph shall also be estimated by coverage or subline.

(9) Proposed rates:

(a) Proposed rates for each territory, classification, and coverage shall be provided. (In filings involving a large number of possible rates, information on rating factors and their application may be substituted for the actual rates.)

(b) An explanation of how territorial average rates and classification rates are determined shall be included. Also provide a sample calculation for each.

(10) Investment earnings. Information on anticipated investment income is necessary to establish the provision for underwriting profit in the rates.

(a) Information on the amount of investment income earned on loss, loss expense, and unearned premium reserves in relation to earned premium for a particular line in North Carolina shall be calculated for the latest two years and estimated for the current year and all years during which the proposed rates will be in effect. Calculations shall be provided in detail including the amount of the reserves of each type at the beginning and end of each of the specified years.

(b) Information on the payout pattern of North Carolina losses shall be included, including information on the estimated average length of time that elapses between the occurrence of an insured loss and the payment of a claim. The average shall be a weighted average based on size of claim payments. Indicate how the length has changed in recent years.

(c) To evaluate recent insurer profitability, provide the following information separately from the latest two Annual Statements: (If the filing is for more than one company, composite information shall be provided).

(i) Page 2 (Assets);

(ii) Page 3 (Liabilities, Surplus and Other Funds);

(iii) Page 4 (Underwriting and Investment Exhibit);

(iv) Exhibit I (Analysis of Assets).

(11) Identification and Certification of Statistical Plans:

(a) All statistical plans used or consulted in preparing this filing shall be identified. Also describe the data compiled by each plan.

(b) A certification that all the data utilized in the rate filing was collected in accordance with such plans and is a true and accurate representation on the company's experience to the best of its knowledge shall also be provided.

(12) Investment Earnings on Capital and Surplus. Given the selected underwriting profit and contingencies loadings contained in the filing, indicate the resulting rate of return on equity capital, on total assets, and on assets assigned to insurance operations including consideration of investment income. Show the derivation of all factors used in producing the calculations. Provide justification that these rates of return are reasonable and fair.

(13) Level of Capital/Surplus Needed:

(a) Premium to surplus ratios for the latest five calendar years shall be shown.

(b) Estimates of comparable ratios for the years during which the rates will be in effect shall also be provided.

(c) Any methodology used to allocate surplus to individual lines or coverages shall be described.

(14) Other Information. All relevant information related to the derivation of the profit and contingencies loading contained in the filing shall be provided. Include the following information:

(a) A description of all data reviewed and of all worksheets used;

(b) A complete description of the methodology used to arrive at the selected loading;

(c) A description of alternative methodologies used or considered for use in the last three years;

(d) A description of the criteria used to select one of the various methodologies for inclusion in a particular filing;

(e) Specific details regarding the application of these criteria in the selection of a methodology for this filing;

(f) Details on the application of the methodology to this filing.

(15) Additional information. The Commissioner may require such other available information as he deems necessary for a proper review of the rate filing.

History

  • Authority G.S. 58-2-40; 58-41-50(e)
  • Eff. January 1, 1990
  • Amended Eff. April 8, 2002
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 3, 2017.
11 NCAC 10 .1109 Rating Organizations {#sec-11-ncac-10-.1109 omnilex-key=us-nc-regs-official--title-11--11 NCAC 10 .1109}

All rating organizations participating in a filing submitted by the North Carolina Rate Bureau or the North Carolina Reinsurance Facility shall provide the following items to the Department within 30 days after the filing has been made:

(1) General information. A description of all agendas and minutes of meetings of the rating organization affecting the filing explicitly, or implicitly through the adoption of a countrywide procedure.

(2) Selection of methodologies. The following information regarding credibility factors, loss development factors, trending factors, overhead expenses, and profitability shall be provided whenever the rating organization derives these factors for the Rate Bureau: (If the filing itself contains the information requested in all or some of the lettered sections, reference to the location of that information is sufficient).

(a) A description of all data reviewed and worksheets used;

(b) A complete description of the methodology used to arrive at the selected loading;

(c) A description of alternative methodologies used or explicitly considered for use by the rating organization in other states in the last three years;

(d) A description of the criteria used to select one of the various methodologies for inclusion in a particular filing;

(e) Specific details regarding the application of these criteria in the selection of a methodology for this filing.

(f) Details on the application of the methodology to this filing.

(3) Profit and contingency loading. Information shall also be provided on the underwriting profit and contingencies loading of all filings in which the rating organization has participated within the last five years in other states. For all such filings, list the state, the underwriting profit and contingencies loading submitted, any explicit loading approved, and the effective date of the rates.

History

  • Authority G.S. 58-2-40; 58-2-190
  • Eff. January 1, 1990
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 3, 2017.
11 NCAC 10 .1110 Workers' Compensation Loss Costs Questionnaire {#sec-11-ncac-10-.1110 omnilex-key=us-nc-regs-official--title-11--11 NCAC 10 .1110}

For those filings made in accordance with 11 NCAC 10 .1102(15), supporting information shall be presented as follows:

(1) Reference Filing Adoption Form:

(a) Insurer's name.

(b) Contact person for filing.

(c) Title of contact person.

(d) Phone number.

(e) Insurer's FEIN.

(f) Insurer's file number.

(g) Department file number.

(h) NCRB reference filing number.

(i) Effective date.

(j) Insurer's proposed effective date (if different from NCRB effective date).

(k) Insurer's approximate market share of North Carolina written premium.

(l) Whether the multiplier is applicable to this filing only or to subsequent reference filings.

(m) Statement of accuracy of information.

(n) Signature of company official.

(o) Date signed.

(2) Summary of Supporting Data Form:

(a) Statement of whether the filing applies uniformly to all workers' compensation classes.

(b) Loss costs modification:

(i) Without modification (factor equals 1.000).

(ii) With modification (supporting documentation required).

(c) Loss costs modification factor.

(d) Selected expenses (attach Expense Provision Exhibit):

(i) Commission and brokerage.

(ii) Other acquisition.

(iii) General expenses.

(iv) Taxes, licenses, fees, loss based assessments.

(v) Profit, contingencies, credit for investment income.

(vi) Other.

(vii) Total (i+ii+iii+iv+v+vi).

(e) Development of Expected Loss and Loss Adjustment Expense (Target Cost) Ratio: Expressed in decimal form: 1.000-(d)(vii).

(f) Overall effect of expense constant and minimum premiums: Expressed in decimal form, i.e., 1.2% overall effect would be 0.988.

(g) Overall effect of size-of-risk discounts plus expense gradation recognition in retrospective rating: Expressed in decimal form, i.e., 8.6% average discount would be 0.914.

(h) Provision for loss based assessments: See NCRB Reference Filing, Exhibit II.

(i) Company formula loss costs multiplier (b)(ii) x (1.000 - h)/ [(g) - (d)(vii)] x (f).

(j) Company selected loss costs multiplier. Explain any differences between (i) and (j).

(k) Rate level changes for the coverages to which this page applies.

(l) Statement of whether the insurer is amending the minimum premium formula.

(m) Statement of whether the insurer is amending the expense constant(s).

(n) Statement of whether the insurer is changing the premium discount schedules.

(o) If the answer to (l), (m), or (n) is yes, documentation is required.

(3) Expense Provisions Exhibit: For the following items, the insurer shall provide the three most recent years, the average, industry average, and the selected:

(a) Commissions and brokerage.

(b) Other acquisition.

(c) General expenses.

(d) Taxes, licenses, fees, and loss based assessments.

(e) Profit, contingencies, and investment income:

(i) Profit and contingencies.

(ii) Credit for investment income.

(f) Other.

(g) Total (a+b+c+d+e+f).

History

  • Authority G.S. 58-2-40; 58-36-15; 58-36-100
  • Eff. February 1, 1996
  • Temporary Amendment Eff. December 1, 1999
  • Amended Eff. July 1, 2000
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 3, 2017.
11 NCAC 10 .1111 Workers' Compensation {#sec-11-ncac-10-.1111 omnilex-key=us-nc-regs-official--title-11--11 NCAC 10 .1111}

The following information is required pursuant to G.S. 58-36-15(h) for those filings made under G.S. 58-36-100:

(1) North Carolina losses and loss adjustment expenses, each on paid and incurred bases without trending or other modification for the experience period.

(a) The filer shall include loss and loss adjustment expense data from all companies writing North Carolina workers' compensation insurance. In addition, if exposures are used in the calculation of premiums at present rates, the filer shall provide all available exposure data from these companies. If the experience of any company that writes more than one percent of the North Carolina workers' compensation written premium has been excluded from any trend or loss development calculations, the filer shall identify the company and its market share and provide an explanation for its exclusion. The filer shall also estimate the aggregate market share of other companies whose experience is excluded from such calculations.

(b) If any identifiable group of policies is excluded from the calculation of classification differentials, the filer shall describe those policies, indicate their market share, and provide an explanation for their exclusion.

(c) The filer shall clearly describe all adjustments to losses, loss adjustment expenses, expenses as defined in G.S. 58-36-100(c), and exposures included in the filing.

(d) The filer shall provide the latest available written and earned premiums and market shares for the 10 largest writers of North Carolina workers' compensation insurance.

(e) The filer shall provide the following information on losses and loss adjustment expenses:

(i) For each of the latest three available accident and calendar years, undeveloped and untrended losses and loss adjustment expenses;

(ii) For each accident and policy year included in the filing, paid losses, case basis reserves, loss development, incurred allocated loss adjustment expenses (if collected separately from losses), incurred unallocated (or combined allocated and unallocated) loss adjustment expenses, applied trend factors, and trended incurred losses and loss adjustment expenses.

(2) Credibility factor development and application. The filer shall provide all information related to the derivation of all credibility factors contained in the filing, including the following:

(a) A description of all data reviewed;

(b) A complete description of the methodology used to derive these factors;

(c) A description of alternative methodologies used in the last three years;

(d) A description of the criteria used to select a methodology;

(e) Specific details on the application of these criteria in the selection of a methodology for this filing;

(f) Details on the application of the methodology to this filing.

(3) Loss development factor development and application on both paid and incurred bases and in both numbers and dollars of claims:

(a) The filer shall provide all information related to the derivation of all loss development factors contained in the filing, including the following:

(i) A description of all data reviewed;

(ii) A complete description of the methodology used to derive these factors;

(iii) A description of alternative methodologies used in the last three years;

(iv) A description of the criteria used to select a methodology;

(v) Specific details on the application of these criteria in the selection of a methodology for this filing;

(vi) Details on the application of the methodology to this filing.

(b) The filer shall provide at least the latest five available years of the aggregate loss data described in Sub-items (3)(b)(i) through (iii) of this Rule for matching companies for all pairs of successive evaluation dates. The filer shall also provide the corresponding loss development factors and five-year average factors derivable from the data:

(i) Data on both a policy year and an accident year basis;

(ii) Data separated into indemnity and medical portions, as well as combined data;

(iii) Data separated into paid, case incurred and incurred but not reported portions, as well as combined data;

(c) The filer shall provide for each of the loss amounts in Sub-item (3)(b) of this Rule, paid claim counts, incurred claim counts, and outstanding claim counts.

(d) The filer shall provide at least the latest 10 available policy years of the incurred loss data described in Sub-items (3)(d)(i) through (ii) of this Rule from the Unit Statistical Plan for matching policies for all pairs of successive evaluation dates. The filer shall also provide the corresponding loss development factors and five-year average factors derivable from the data:

(i) Losses separated into indemnity and medical portions, as well as combined data;

(ii) Losses separated into deaths, permanent totals, major permanent partials, minor permanent partials, temporary totals, and medicals only.

(e) The filer shall provide for each of the loss amounts in Sub-item (3)(d) of this Rule the corresponding incurred claim counts and for each of the policy years in Sub-item (3)(d) of this Rule the aggregate earned exposures. Where small claims are reported in bulk, the filer shall provide such information as accurately as possible, given the imprecision inherent in such aggregate data.

(f) The filer shall provide for each of the policy periods in Sub-items (3)(b) and (3)(d) of this Rule the law amendment factors for adjusting past losses to current benefit levels.

(g) The filer shall include a description of the reasons for the differences between the policy year data provided in response to Sub-items (3)(b) and (3)(c) of this Rule and those provided in response to Sub-items (3)(d) and (3)(e) of this Rule.

(4) Trending factor development and application:

(a) The filer shall provide all information related to the derivation of all trend factors contained in the filing including the following:

(i) A description of all data reviewed;

(ii) A complete description of the methodology used to derive these factors;

(iii) A description of alternative methodologies used in the last three years;

(iv) A description of the criteria used to select a methodology;

(v) Specific details on the application of these criteria in the selection of a methodology for this filing;

(vi) Details on the application of the methodology to this filing.

(b) The filer shall calculate the following trend factors:

(i) Indemnity and medical trend factors based on the latest eight available policy years and accident years of North Carolina paid and paid plus case data;

(ii) Indemnity and medical trend factors based on the latest eight available accident years and policy years of multi-state paid and paid plus case data;

(5) Changes in premium base and exposures. The filer shall provide or estimate the following information on exposure trends:

(a) The statewide average weekly wage for the latest five available calendar years;

(b) The statewide average weekly wage for the latest 10 available policy years without the application of a payroll limitation;

(c) The statewide average weekly wage for the latest 10 available policy years after the application of payroll limitation; and

(d) The estimated statewide average weekly wage for the calendar and policy years during which the rates will be in effect.

(6) Limiting factor development and application. The filer shall provide information on the following items:

(a) Limitations on losses included in the statistical data used in the filing;

(b) Limitations on the extent of the rate or loss costs level change;

(c) Limitations on the extent of classification rate or loss costs changes; and

(d) Any other limitations applied.

(7) The percent rate or loss costs change:

(a) The filer shall provide the overall statewide rate or loss costs change, as well as the amount of the change attributable to each of the following: loss experience, a modification of the trend factor, law amendments, a change in the loss based assessment provision, and any other factors.

(b) The filer shall provide the rate or loss costs changes for each industry group and for each classification.

(8) For assigned risks rate filings, the filer shall include support for reasonable margin for underwriting profit and contingencies and investment income, including realized capital gains.

(9) For assigned risk rate filings, the filer shall provide investment earnings on capital and surplus. Given the selected underwriting profit and contingencies provision contained in the filing, the filer shall indicate the resulting rates of return (including consideration of investment income) on equity capital, on statutory surplus, and on total assets. The filer shall show the derivation of all factors used in producing these calculations and justify the fairness and reasonableness of these rates of return.

(10) As required by G.S. 58-36-15, the filer shall:

(a) Provide information on the following aspects of workers' compensation individual risk rating plans, including an explanation of their purpose and a detailed description of their derivation:

(i) For experience rating plans, the table of expected loss rate and discount ratios and table of weighting and ballast values.

(ii) For retrospective rating plans, table of insurance charges, multipliers (including the derivation of any assigned risk subsidy), and table of excess loss factors.

(b) Describe all payments made to all consultants (including lawyers, actuaries, and economists) related to this filing and the previous one on workers' compensation insurance. If payments cannot be specifically identified as related to particular filings, the filer shall estimate them.

(c) Identify and describe all changes in methodologies from the previous North Carolina workers' compensation rate filing. If any collected or reported data required by this Rule are provided within 30 days after the initial submittal of a filing, that data shall be made a part of the filing, provided the initial submittal acknowledges that it is incomplete and identifies specifically what further data are to be submitted within the time permitted. No filing otherwise complete shall be deemed to be proper until such time that all data required by this Rule have been submitted.

History

  • Authority G.S. 58-2-40; 58-36-15(h)
  • Eff. February 1, 1996
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 3, 2017.
11 NCAC 10 .1112 Actuarial Certification {#sec-11-ncac-10-.1112 omnilex-key=us-nc-regs-official--title-11--11 NCAC 10 .1112}

Each rate deviation filing made under G.S. 58-36-30 shall be accompanied by an actuarial certification that the deviation is based on sound actuarial principles.

History

  • Authority G.S. 58-2-40; 58-36-30
  • Eff. July 18, 2002
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 3, 2017.
11 NCAC 10 .1113 Reference Filings {#sec-11-ncac-10-.1113 omnilex-key=us-nc-regs-official--title-11--11 NCAC 10 .1113}

With the exception of flood insurance written in accordance with Federal Emergency Management Agency requirements, or with the requirements of any successor agency, rate filings, including loss costs multipliers, by reference are not permitted. Adoption of rates and loss costs that have been promulgated by a licensed bureau, licensed rating organization, licensed advisory organization, licensed joint underwriting association, or licensed reinsurance organization, of which the insurer is a member, subscriber, or service purchaser, are not deemed to be reference filings.

History

  • Authority G.S. 58-2-40; 58-36-15; 58-36-65; 58-36-70; 58-36-100; 58-40-30; 58-41-50
  • Eff. August 1, 2002
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 3, 2017.
11 NCAC 10 .1114 Transmittal Header {#sec-11-ncac-10-.1114 omnilex-key=us-nc-regs-official--title-11--11 NCAC 10 .1114}

All rate filings shall be accompanied by a transmittal header, which shall include the company name, company state of domicile, NAIC number, company filer contact information, and filing information. The transmittal header is available at the Department's Internet web site (www.ncdoi.com), by writing the N.C. Department of Insurance, Property & Casualty Division, 3200 Beechleaf Court, 1201 Mail Service Center, Raleigh, NC 27699-1201, or by calling the Division at (919) 807-6075.

History

  • Authority G.S. 58-2-40; 58-40-30; 58-41-50
  • Eff. August 1, 2002
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 3, 2017
  • Amended Eff. February 1, 2024; January 1, 2018.
11 NCAC 10 .1201 General Requirements {#sec-11-ncac-10-.1201 omnilex-key=us-nc-regs-official--title-11--11 NCAC 10 .1201}

(a) Insurers, licensed advisory organizations, joint underwriting associations, and reinsurance organizations shall submit form filings under independent cover separate from rate and rule filings, which shall be made under 11 NCAC 10 .1100. Forms intended for use in this state shall be filed with the Commissioner for approval prior to their use.

(b) Each insurer, licensed advisory organization, joint underwriting organization and reinsurance organization shall display a unique identifier on each form filed that differentiates that form from all other forms filed with the Commissioner by that insurer, licensed advisory organization, joint underwriting association, or reinsurance organization.

(c) Applications or declarations pages that are used with policy forms shall be submitted to and approved by the Commissioner.

History

  • Authority G.S. 58-2-40; 58-3-150; 58-6-5; 58-36-55; 58-37-35; 58-41-50; 58-44-15; 58-45-45; 58-46-55
  • Eff. January 1, 1989
  • Amended Eff. May 1, 1994
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 3, 2017.
11 NCAC 10 .1202 Reference Filings {#sec-11-ncac-10-.1202 omnilex-key=us-nc-regs-official--title-11--11 NCAC 10 .1202}

With the exception of Flood Insurance written in accordance with Federal Emergency Management Agency (FEMA) requirements, form filings by reference are not permitted. If an insurer adopts a form that has been promulgated by a licensed bureau, licensed advisory organizations, licensed joint underwriting association, or licensed reinsurance organization of which the insurer is a member, subscriber or service purchaser, the adoption of that form is not deemed to be a reference filing.

History

  • Authority G.S. 58-2-40; 58-3-150; 58-36-55; 58-37-35; 58-41-50; 58-44-15; 58-45-45; 58-46-55
  • Eff. January 1, 1989
  • Amended Eff. May 1, 1994
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 3, 2017.
11 NCAC 10 .1203 Letter of Transmittal {#sec-11-ncac-10-.1203 omnilex-key=us-nc-regs-official--title-11--11 NCAC 10 .1203}

History

  • Status: repealed
  • Authority G.S. 58-9; 58-54; 58-124.17; 58-124.28; 58-131.34; 58-131.60; 58-148; 58-157; 58-180.2; 58-248.2; 58-248.40
  • Eff. January 1, 1989
  • Repealed Eff. August 1, 2002.
11 NCAC 10 .1204 Prohibited Policy Provisions {#sec-11-ncac-10-.1204 omnilex-key=us-nc-regs-official--title-11--11 NCAC 10 .1204}

Policy forms will be disapproved if they contain any of the following kind of policy provisions:

(1) a provisions that the application is a consideration of coverage; unless the application is physically attached to the policy;

(2) a provision that the rules or bylaws of the company are a part of the contract; unless such rules or bylaws are actually written into or physically attached to the policy;

(3) a provision that a portion of the premium becomes due and payable only after the occurrence of a loss, for example, a premium retention policy;

(4) a provision in a liability policy that relieves the company of liability on account of insolvency of the insured;

(5) a provision that knowledge of the agent is not binding on the company;

(6) a provision purporting to limit to less than three years any suit on the contract by the policyholder.

History

  • Authority G.S. 58-2-40; 58-3-10; 58-3-15; 58-7-15
  • Eff. January 1, 1989
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 3, 2017.
11 NCAC 10 .1205 Essential Lines - N.c. Rate Bureau (bureau) {#sec-11-ncac-10-.1205 omnilex-key=us-nc-regs-official--title-11--11 NCAC 10 .1205}

(a) All policy forms used by members of the North Carolina Rate Bureau shall be filed by the bureau and approved by the commissioner prior to their use.

(b) When the bureau is filing a modification to an existing form, it will provide a "side-by-side" comparison of the old and proposed form(s) and explain all broadenings and restrictions of coverage.

(c) The bureau will provide the following information either in the letter of transmittal or as a filing memorandum:

(1) the subject of the filing by name, identification number or both;

(2) the purpose of the filing;

(3) the proposed effective date and rule of implementation;

(4) summary of the changes proposed by the filing;

(5) statement that the filing meets statutory requirements.

(d) Any dividend or participating endorsement to be used with a workers' compensation policy should be filed directly with this department in accordance with G.S. 58-3-150.

History

  • Authority G.S. 58-2-40; 58-3-150; 58-36-55; 58-36-60
  • Eff. January 1, 1989
  • Amended Eff. April 8, 2002
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 3, 2017.
11 NCAC 10 .1206 Commercial Lines {#sec-11-ncac-10-.1206 omnilex-key=us-nc-regs-official--title-11--11 NCAC 10 .1206}

All licensed insurance companies or any other licensed entity filing forms for coverages governed by G.S. 58, Articles 40 and 41 shall:

(1) complete a transmittal header as prescribed in 11 NCAC 10 .1209;

(2) complete the Questionnaire as prescribed in 11 NCAC 10 .1207;

(3) provide a side-by-side comparison of the existing and modified forms and explain all broadenings and restrictions of coverage if the filing is a modification of an existing form; and

(4) provide an index of forms contained in the filing.

History

  • Authority G.S. 58-2-40; 58-3-150; 58-41-50
  • Eff. January 1, 1989
  • Amended Eff. August 1, 2002; July 18, 2002; May 1, 1994
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 3, 2017.
11 NCAC 10 .1207 Form(s) Questionnaire {#sec-11-ncac-10-.1207 omnilex-key=us-nc-regs-official--title-11--11 NCAC 10 .1207}

All Property and Casualty Insurance Companies shall submit the following information with all forms filings on a form prescribed by the commissioner:

(1) name of the filer;

(2) Federal Employer's 11 Digit Number;

(3) filer's file number;

(4) program title;

(5) line(s) of insurance;

(6) how many new forms and/or revised forms are being filed;

(7) list all old form(s) being withdrawn and department file number(s);

(8) explain the purpose(s) of this filing;

(9) list the states where this filing has been made;

(10) action taken by domiciliary state if form has been filed in that state;

(11) list the states that have approved this filing;

(12) list the states that disapproved this filing and reason(s) for disapproval;

(13) copies of all required modifications referred to in Paragraph (12) of this Rule;

(14) if the filing is similar or identical to a filing made with the N.C. Department of Insurance by a licensed bureau or licensed rating organization, complete the following:

(a) name of affiliated bureau or rating organization;

(b) name of bureau or rating organization program;

(c) identification number of bureau of rating organization program;

(d) are you a member, subscriber or service purchaser.

(15) if the filing is similar or identical to a filing made with the N.C. Department of Insurance by a licensed insurance company in North Carolina, give the N.C. Insurance Department file number and approval date. Also, describe the difference(s) if any, between your form(s) and those of the previously approved program;

(16) computer printed declarations pages should be completed in "John Doe" fashion;

(17) proposed effective date and rule of implementation;

(18) a certification of the accuracy of the filing by an officer of the company or head of the filings department.

History

  • Authority G.S. 58-2-40; 58-2-190; 58-3-150; 58-41-50
  • Eff. January 1, 1989
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 3, 2017.
11 NCAC 10 .1208 Health Care Provider Defined; Cgl Policies {#sec-11-ncac-10-.1208 omnilex-key=us-nc-regs-official--title-11--11 NCAC 10 .1208}

As used in G.S. 54-40-140, "health care provider" includes any person who, under G.S. 90 is licensed, registered, or certified to engage in the practice of or performs duties associated with any of the following: medicine, surgery, dentistry, pharmacy, optometry, midwifery, osteopathy, podiatry, chiropractic, radiology, nursing, physiotherapy, pathology, anesthesiology, anesthesia, laboratory analysis, rendering assistance to a physician, dental hygiene, psychiatry, psychology; or a hospital as defined by G.S. 131E-76(3); or a nursing home as defined by G.S. 131E-101(6).

History

  • Authority G.S. 58-2-40; 58-40-140
  • Filed as a Temporary Adoption Eff. October 11, 1993 for a period of 180 days or until the permanent rule becomes effective, whichever is sooner
  • Eff. February 1, 1994
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 3, 2017.
11 NCAC 10 .1209 Transmittal Header {#sec-11-ncac-10-.1209 omnilex-key=us-nc-regs-official--title-11--11 NCAC 10 .1209}

All form filings shall be accompanied by a transmittal header, which shall include the company name, company state of domicile, NAIC number, company filer contact information, and filing information. The transmittal header is available at the Department's Internet web site (www.ncdoi.com), by writing the N.C. Department of Insurance, Property & Casualty Division, 3200 Beechleaf Court, 1201 Mail Service Center, Raleigh, NC 27699-1201, or by calling the Division at (919) 807-6075.

History

  • Authority G.S. 58-2-40; 58-3-150; 58-36-55; 58-45-45; 58-46-55
  • Eff. August 1, 2002
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 3, 2017
  • Amended Eff. February 1, 2024; January 1, 2018.
11 NCAC 10 .1301 Rates: Rating Plans: Rating Rules and Forms Applicable {#sec-11-ncac-10-.1301 omnilex-key=us-nc-regs-official--title-11--11 NCAC 10 .1301}

Unless otherwise approved by the commissioner, the rates, rating plans, rating rules and forms applicable shall be in accordance with the most recent manual rates, rating plans, rating rules and forms promulgated by either the North Carolina Rate Bureau or the Insurance Services Office, Inc. and approved for usage in North Carolina.

History

  • Authority G.S. 58-2-40; 58-46-1; 58-46-15; 58-46-20; 58-46-55
  • Eff. January 1, 1989
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 3, 2017.
11 NCAC 10 .1302 Change to Rates: Rating Plans: Rating Rules: Forms Applicable {#sec-11-ncac-10-.1302 omnilex-key=us-nc-regs-official--title-11--11 NCAC 10 .1302}

Unless otherwise approved by the commissioner, any changes to the manual rates, rating plans, rating rules and forms promulgated by either the North Carolina Rate Bureau or the Insurance Services Office, Inc. and approved for usage in North Carolina shall be implemented no later than 30 days after the earliest permitted date.

History

  • Authority G.S. 58-2-40; 58-46-1; 58-46-15; 58-46-20; 58-46-55
  • Eff. January 1, 1989
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 3, 2017.
11 NCAC 10 .1303 Loss Cost Rate Filings {#sec-11-ncac-10-.1303 omnilex-key=us-nc-regs-official--title-11--11 NCAC 10 .1303}

If the North Carolina Rate Bureau or the ISO Commercial Risk Services, Inc. makes a loss cost rate filing that requires the N.C. Joint Underwriting Association to make a filing in order to have final rates, the Association must make its filing within 60 days after the loss cost filing is a proper filing, as defined in G.S. 58-41-50(b) and (c), and is announced as available for use by the respective rating organization.

History

  • Authority G.S. 58-2-40; 58-46-55
  • Eff. May 1, 1994
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 3, 2017.
11 NCAC 10 .1401 Rates: Rating Plans: Rating Rules and Forms Applicable {#sec-11-ncac-10-.1401 omnilex-key=us-nc-regs-official--title-11--11 NCAC 10 .1401}

Unless otherwise approved by the commissioner, the rates, rating plans, rating rules and forms applicable shall be in accordance with the most recent manual rates, rating plans, rating rules and forms promulgated by either the North Carolina Rate Bureau or the Insurance Services Office, Inc. and approved for usage in North Carolina.

History

  • Authority G.S. 58-2-40; 58-45-5; 58-45-30; 58-45-35; 58-45-45; 58-45-75
  • Eff. January 1, 1989
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 3, 2017.
11 NCAC 10 .1402 Changes to Rates: Rating Plans: Rating Rules: Forms Applicable {#sec-11-ncac-10-.1402 omnilex-key=us-nc-regs-official--title-11--11 NCAC 10 .1402}

Unless otherwise approved by the commissioner, any change to the manual rates, rating plans, rating rules and forms promulgated by either the North Carolina Rate Bureau or the Insurance Services Office, Inc. and approved for usage in North Carolina shall be implemented no later than 30 days after the earliest permitted date.

History

  • Authority G.S. 58-2-40; 58-45-5; 58-45-30; 58-45-35; 58-45-45; 58-45-75
  • Eff. January 1, 1989
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 3, 2017.
11 NCAC 10 .1403 Loss Cost Rate Filings {#sec-11-ncac-10-.1403 omnilex-key=us-nc-regs-official--title-11--11 NCAC 10 .1403}

If the North Carolina Rate Bureau or ISO Commercial Risk Services, Inc. makes a loss cost rate filing that requires the N.C. Insurance Underwriting Association to make a filing in order to have final rates, the Association must make its filing within 60 days after the loss cost filing is a proper filing, as defined in G.S. 58-41-50(b) and (c), and is announced as available for use by the respective rating organization.

History

  • Authority G.S. 58-2-40; 58-45-45
  • Eff. May 1, 1994
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 3, 2017.
11 NCAC 10 .1501 Function of Section {#sec-11-ncac-10-.1501 omnilex-key=us-nc-regs-official--title-11--11 NCAC 10 .1501}

History

  • Status: repealed
  • Filed as an Emergency Repeal Eff. April 25, 1979, for a Period of 120 Days to be Reinstated
  • on August 23, 1979
  • Statutory Authority G.S. 57-10; 57A-18; 58-7.3; 58-9; 58-9.2; 58-18
  • 58-25; 58-16; 58-16.2; 58-63; 58-25.1; 58-26; 58-27; 58-296
  • Eff. February 1, 1976
  • Readopted Eff. March 16, 1979
  • Repealed Eff. August 23, 1979
  • Transferred from T11.04 .0200 Eff. August 14, 1986
  • Transferred from T11.11G Eff. July 25, 1989.
11 NCAC 10 .1502 Report and Collection Procedures {#sec-11-ncac-10-.1502 omnilex-key=us-nc-regs-official--title-11--11 NCAC 10 .1502}

History

  • Status: repealed
  • Filed as an Emergency Repeal Eff. April 25, 1979, for a Period of 120 Days to be Reinstated
  • on August 23, 1979
  • Statutory Authority G.S. 57-10; 57A-18; 58-7.3; 58-9; 58-9.2; 58-18
  • 58-25; 58-16; 58-16.2; 58-63; 58-25.1; 58-26; 58-27; 58-296
  • Eff. February 1, 1976
  • Readopted Eff. March 16, 1979
  • Repealed Eff. August 23, 1979
  • Transferred from T11.04 .0200 Eff. August 14, 1986
  • Transferred from T11.11G Eff. July 25, 1989.
11 NCAC 10 .1503 Maintenance of Records {#sec-11-ncac-10-.1503 omnilex-key=us-nc-regs-official--title-11--11 NCAC 10 .1503}

History

  • Status: repealed
  • Filed as an Emergency Repeal Eff. April 25, 1979, for a Period of 120 Days to be Reinstated
  • on August 23, 1979
  • Statutory Authority G.S. 57-10; 58-9; 58-9.2; 58-15; 58-16; 58-25; 58-25.1; 58-26; 58-27
  • Eff. March 16, 1979
  • Repealed Eff. August 23, 1979
  • Transferred from T11.04 .0200 Eff. August 14, 1986
  • Transferred from T11.11G Eff. July 25, 1989.
11 NCAC 10 .1504 Complaint Records {#sec-11-ncac-10-.1504 omnilex-key=us-nc-regs-official--title-11--11 NCAC 10 .1504}

History

  • Status: repealed
  • Filed as an Emergency Repeal Eff. April 25, 1979, for a Period of 120 Days to be Reinstated
  • on August 23, 1979
  • Statutory Authority G.S. 57-10; 58-9; 58-9.2; 58-15; 58-16; 58-25; 58-25.1; 58-26; 58-27
  • Eff. March 16, 1979
  • Repealed Eff. August 23, 1979
  • Transferred from T11.04 .0200 Eff. August 14, 1986
  • Transferred from T11.11G Eff. July 25, 1989.
11 NCAC 10 .1505 Function of Section {#sec-11-ncac-10-.1505 omnilex-key=us-nc-regs-official--title-11--11 NCAC 10 .1505}

History

  • Status: repealed
  • Authority G.S. 57-10; 57A-18; 58-7.3; 58-9; 58-9.2; 58-16; 58-25
  • 58-25.1; 58-26; 58-27; 58-296
  • Eff. December 15, 1979
  • Transferred from T11.04 .0200 Eff. August 14, 1986
  • Repealed Eff. July 1, 1988
  • Transferred from T11.11G Eff. July 25, 1989.
11 NCAC 10 .1506 Report and Collection Procedures {#sec-11-ncac-10-.1506 omnilex-key=us-nc-regs-official--title-11--11 NCAC 10 .1506}

History

  • Status: repealed
  • Authority G.S. 57-10; 58-9; 58-9.2; 58-15; 58-16; 58-16.2; 58-18; 58-25; 58-25.1
  • 58-26; 58-27; 58-63
  • Eff. December 15, 1979
  • T11.10 .1506 transferred from T11.04 .0200 Eff. August 14, 1986
  • T11.10 .1506 transferred from T11.11G Eff. July 25, 1989
  • T11.10 .1507 transferred from T11.04 .0200 Eff. August 14, 1986
  • T11.10 .1507 transferred from T11.11G Eff. July 25, 1989
  • T11.10 .1508 transferred from T11.04 .0200 Eff. August 14, 1986
  • T11.10 .1508 transferred from T11.11G Eff. July 25, 1989
  • Repealed Eff. March 1, 1993.
11 NCAC 10 .1507 Maintenance of Records {#sec-11-ncac-10-.1507 omnilex-key=us-nc-regs-official--title-11--11 NCAC 10 .1507}

History

  • Status: repealed
  • Authority G.S. 57-10; 58-9; 58-9.2; 58-15; 58-16; 58-16.2; 58-18; 58-25; 58-25.1
  • 58-26; 58-27; 58-63
  • Eff. December 15, 1979
  • T11.10 .1506 transferred from T11.04 .0200 Eff. August 14, 1986
  • T11.10 .1506 transferred from T11.11G Eff. July 25, 1989
  • T11.10 .1507 transferred from T11.04 .0200 Eff. August 14, 1986
  • T11.10 .1507 transferred from T11.11G Eff. July 25, 1989
  • T11.10 .1508 transferred from T11.04 .0200 Eff. August 14, 1986
  • T11.10 .1508 transferred from T11.11G Eff. July 25, 1989
  • Repealed Eff. March 1, 1993.
11 NCAC 10 .1508 Complaint Records {#sec-11-ncac-10-.1508 omnilex-key=us-nc-regs-official--title-11--11 NCAC 10 .1508}

History

  • Status: repealed
  • Authority G.S. 57-10; 58-9; 58-9.2; 58-15; 58-16; 58-16.2; 58-18; 58-25; 58-25.1
  • 58-26; 58-27; 58-63
  • Eff. December 15, 1979
  • T11.10 .1506 transferred from T11.04 .0200 Eff. August 14, 1986
  • T11.10 .1506 transferred from T11.11G Eff. July 25, 1989
  • T11.10 .1507 transferred from T11.04 .0200 Eff. August 14, 1986
  • T11.10 .1507 transferred from T11.11G Eff. July 25, 1989
  • T11.10 .1508 transferred from T11.04 .0200 Eff. August 14, 1986
  • T11.10 .1508 transferred from T11.11G Eff. July 25, 1989
  • Repealed Eff. March 1, 1993.
11 NCAC 10 .1601 Purpose; Scope; Applicability {#sec-11-ncac-10-.1601 omnilex-key=us-nc-regs-official--title-11--11 NCAC 10 .1601}

(a) This Section specifies the system under which rating organizations and their participating insurers that elect to adopt a prospective loss cost system will operate. Under this system, rating organizations shall not develop or file advisory final rates, but shall develop and file advisory prospective loss costs and supporting actuarial and statistical data. Each insurer must independently and individually determine and file the rates it will use. Rating organizations will continue to develop and file rules, relativities, and supplementary rating information on behalf of their participating insurers.

(b) 11 NCAC 10 .1603 applies when a rating organization files advisory prospective loss costs. 11 NCAC 10 .1604 applies when a rating organization files supplementary rating information. 11 NCAC 10 .1603 and 11 NCAC 10 .1604 both apply when a rating organization files both advisory prospective loss costs and supplementary rating information. Each of these submittals shall be treated separately because different procedures will apply.

(c) Nothing in this Section requires rating organizations to cease filing advisory rates or prevents their participating insurers from adopting such rates. Rating organizations that desire to file rates shall complete a rate filing questionnaire according to 11 NCAC 10 .1107.

(d) This Section does not apply to nonfleet private passenger motor vehicle, homeowners, or dwelling fire insurance.

History

  • Authority G.S. 58-2-40; 58-36-15; 58-37-35; 58-40-30; 58-41-50; 58-45-45; 58-46-55
  • Eff. February 1, 1991
  • Amended Eff. July 1, 1992
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 3, 2017.
11 NCAC 10 .1602 Definitions {#sec-11-ncac-10-.1602 omnilex-key=us-nc-regs-official--title-11--11 NCAC 10 .1602}

As used in this Section:

(1) "Developed losses" means losses (including loss adjustment expenses) adjusted, using standard actuarial techniques, to eliminate the effect of differences between current payment or reserve estimates and those needed to provide actual ultimate loss (including loss adjustment expenses) payments.

(2) "Expenses" means that portion of a rate attributable to acquisition, field supervision, and collection expenses; general expenses; and taxes, licenses, and fees.

(3) "Loss cost multipliers" means provisions for expenses, profit, and variations in loss experience added by an individual insurer to prospective loss costs in order to produce final rates.

(4) "Loss trending" means any procedure for projecting developed losses to the average date of loss for the period during which the policies are to be effective.

(5) "Prospective loss costs" means that portion of a rate that does not include provisions for expenses (other than loss adjustment expenses) or profit; and that is based on historical aggregate losses and loss adjustment expenses adjusted through development to their ultimate value and projected through trending to a future point in time.

(6) "Rate" means the cost of insurance per exposure unit, whether expressed as a single number or as a prospective loss cost with loadings for expenses, profit, and variations in loss experience; prior to any application of individual risk variations based on loss or expense considerations. "Rate" does not include minimum premiums.

(7) "Rating organization" includes a joint underwriting organization or a joint reinsurance organization.

(8) "Supplementary rating information" includes any rating information other than rates by territory and by class; including but not limited to classification and territory definitions, various rating rules, increased limits factors, experience rating plans, and minimum premiums.

History

  • Authority G.S. 58-2-40; 58-36-15; 58-37-35; 58-40-30; 58-41-50; 58-45-45; 58-46-55
  • Eff. February 1, 1991
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 3, 2017.
11 NCAC 10 .1603 Rate and Loss Costs {#sec-11-ncac-10-.1603 omnilex-key=us-nc-regs-official--title-11--11 NCAC 10 .1603}

(a) A rating organization may develop and file a reference filing with the Department, which filing shall contain the advisory prospective loss costs, the underlying loss data, and other supporting statistical and actuarial information for any calculations or assumptions underlying those loss costs.

(b) After a reference filing has been made with the Department and determined by the Commissioner to be proper, the rating organization shall provide its participating insurers with a copy of the reference filing.

(c) A rating organization may print and distribute manuals of prospective loss costs, as well as supplementary rating information as described in 11 NCAC 10 .1604. After an initial prospective loss costs reference filing has been made by a rating organization and has been determined by the Commissioner to be proper, that rating organization shall no longer file any minimum premiums in this State.

(d) Each insurer must individually determine the final rates it will file and the effective date of any rate changes through an independent company decision-making process.

(e) If an insurer that is a member, subscriber, or service purchaser of a rating organization decides to use the prospective loss costs in a proper reference filing in support of its own filing, the insurer must submit a proper rate filing in accordance with 11 NCAC 10 .1107. In that filing, the insurer shall provide justification for the loss cost multipliers used in producing the final rates. The insurer's rates are the combination of the prospective loss costs and the insurer's loss cost multipliers.

(f) If an insurer files a modification of the prospective loss costs in a proper reference filing based on its own anticipated experience, supporting documentation shall be required.

(g) An insurer may vary expense loads by individual classification, grouping or subline of insurance. An insurer may use variable or fixed expense loadings or a combination of these to establish its expense loadings.

(h) If an insurer wishes to use a minimum premium of any type, a proper rate filing must be submitted to the Department.

(i) An insurer may file such other information that it deems to be relevant and shall provide such other information that is requested by the Department.

(j) An insurer may have its loss costs multiplier remain on file with the Department and reference all subsequent prospective loss costs reference filings. Upon receipt of subsequent rating organization reference filings, the insurer's rates shall be the combination of the prospective loss costs and the loss cost multiplier on file with the Department, and will be effective on or after the effective date of the prospective loss costs. The insurer need not file anything further with the Department.

(k) If an insurer that has filed to have its loss costs multiplier remain on file with the Department intends to delay, modify, or not adopt a particular rating organization's reference filing, the insurer must make a filing with the Department before the effective date of the reference filing.

(l) To the extent that an insurer's final rates are determined solely by applying its loss costs multiplier to the prospective loss costs contained in a rating organization's reference filing and printed in the rating organization's manual, the insurer need not develop or file its final rate pages with the Department.

(m) If an insurer has filed to have its loss cost multiplier remain on file, applicable to subsequent reference filings, and a new proper reference filing is filed:

(1) If the insurer decides to use the prospective loss costs and effective date as filed, the insurer shall not file anything with the Department. The insurer's rates shall be the combination of the prospective loss costs and the on-file loss cost multiplier. The new rates shall become effective on the effective date of the loss costs.

(2) If the insurer decides to use the prospective loss costs as filed, but with a different effective date, the insurer must notify the Department of its effective date before the effective date of the loss costs.

(3) If the insurer decides to use the prospective loss costs, but wishes to change its loss cost multiplier, the insurer must make another filing in accordance with Paragraphs (d) through (f) of this Rule before the effective date of the loss costs.

(4) If the insurer decides not to revise its rates using the prospective loss costs, the insurer must notify the Department before the effective date of the loss costs.

(n) If the insurer has not elected to have its loss cost multiplier remain on file, applicable to the future prospective loss cost reference filings, and a new proper reference filing shall be filed:

(1) If the insurer decides to use the prospective loss costs to revise its rates, the insurer must file with the Department a rate filing in accordance with Paragraphs (d) through (f) of this Rule, including the effective date of the rates.

(2) If an insurer decides not to use the revisions, the insurer is not required to make any filing with the Department.

History

  • Authority G.S. 58-2-40; 58-36-15; 58-37-35; 58-40-30; 58-41-50; 58-45-45; 58-46-55
  • Eff. February 1, 1991
  • Amended Eff. February 1, 1996
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 3, 2017.
11 NCAC 10 .1604 Supplementary Rating Information {#sec-11-ncac-10-.1604 omnilex-key=us-nc-regs-official--title-11--11 NCAC 10 .1604}

(a) A rating organization may submit a proper rate filing to the Department containing a revision of rules, relativities, or other supplementary rating information, on behalf of those insurers that have authorized the rating organization to make such submittal on their behalves. A rating organization may print and distribute manuals of rules, relativities, and other supplementary rating information, excluding minimum premiums.

(b) When an insurer has authorized a rating organization to file on its behalf, and a new filing of rules, relativities, and other supplementary rating information is filed and determined to be proper:

(1) If the insurer decides to use the revisions and effective date as filed, the insurer is not required to make a filing with the Department.

(2) If the insurer decides to use the revisions as filed but with a different effective date, the insurer must notify the Department before the rating organization's effective date.

(3) If the insurer decides to use the revisions with modifications, the insurer must file supporting data for the changes with the Department for review and specify the basis for the modifications. This must be done before the rating organization's effective date.

(4) If the insurer decides not to use the revisions, the insurer must notify the Department before the rating organization's effective date.

History

  • Authority G.S. 58-2-40; 58-36-15; 58-37-35; 58-40-30; 58-40-40; 58-41-50; 58-45-45
  • 58-46-55
  • Eff. February 1, 1991
  • Amended Eff. April 1, 1992
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 3, 2017.
11 NCAC 10 .1701 General Requirements {#sec-11-ncac-10-.1701 omnilex-key=us-nc-regs-official--title-11--11 NCAC 10 .1701}

Licenses issued under G.S. 58-36-4 and G.S. 58-40-50 shall be either monoline or multiline licenses. Applications for licenses shall be submitted to the North Carolina Department of Insurance, Attention: Deputy Commissioner, Property and Casualty Division, 1201 Mail Service Center, Raleigh, N.C. 27699-1201.

History

  • Authority G.S. 58-2-40; 58-36-4; 58-40-50
  • Eff. October 1, 2006
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 3, 2017.
11 NCAC 10 .1702 Procedure for Application of New License {#sec-11-ncac-10-.1702 omnilex-key=us-nc-regs-official--title-11--11 NCAC 10 .1702}

In addition to the information required under G.S. 58-36-4 and G.S. 58-40-50, the following information shall accompany all license applications:

(1) The name and address of the statistical organization;

(2) A list of the insurers who are service purchasers;

(3) A list of the states where the organization is licensed;

(4) A list of the lines of insurance involved; and

(5) The names and addresses of all officers and managers.

History

  • Authority G.S. 58-2-40; 58-36-4; 58-40-50
  • Eff. October 1, 2006
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 3, 2017.

Chapter 11 Financial Evaluation Division

Subchapter A

11 NCAC 11A .0101 Statutory Financial Statement {#sec-11-ncac-11a-.0101 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0101}

History

  • Status: repealed
  • Authority G.S. 57-9; 58-9(3); 58-21
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. April 1, 1993.
11 NCAC 11A .0102 Unsound Condition {#sec-11-ncac-11a-.0102 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0102}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-3-100; 58-30-60(b)
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Amended Eff. July 1, 2004; April 1, 1993
  • Repealed Eff. June 1, 2007.
11 NCAC 11A .0103 Impaired Insurer {#sec-11-ncac-11a-.0103 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0103}

History

  • Status: repealed
  • Authority G.S. 58-38; 58-39(2); 58-77(10); 58-155.2(1)
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. April 1, 1993.
11 NCAC 11A .0104 Insolvent Insurer {#sec-11-ncac-11a-.0104 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0104}

History

  • Status: repealed
  • Authority G.S. 58-38; 58-39(2); 58-77(10); 58-155.2(1)
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. April 1, 1993.
11 NCAC 11A .0105 Multiple-Line Insurer {#sec-11-ncac-11a-.0105 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0105}

"Multiple-line Insurer" shall mean any insurance company having authority to write the kinds of insurance authorized by G.S. 58-7-75 for both a fire and marine company and a casualty, fidelity and surety company and as more specifically defined under G.S. 58-7-15(3) through (22).

History

  • Authority G.S. 58-2-40; 58-7-15; 58-7-75
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Amended Eff. April 1, 1993
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 20, 2015.
11 NCAC 11A .0106 Deemer Clause or Deemer Provision {#sec-11-ncac-11a-.0106 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0106}

"A Deemer Clause" or "Deemer Provision" shall mean any clause or provision that establishes a period of time certain, e.g., 30 days, 90 days etc., within which the Commissioner must disapprove a particular matter before him and which if no action is taken by the Commissioner within the period of time certain, said matter before the Commissioner is deemed approved.

History

  • Authority G.S. 58-2-40(1); 58-51-100
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 20, 2015.
11 NCAC 11A .0107 Mortgage Guaranty Insurance {#sec-11-ncac-11a-.0107 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0107}

History

  • Status: repealed
  • Authority G.S. 58-9; 58-9(1); 58-72(17)
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. April 1, 1993.
11 NCAC 11A .0108 Miscellaneous Insurer {#sec-11-ncac-11a-.0108 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0108}

History

  • Status: repealed
  • Authority G.S. 58-9; 58-9(1); 58-72(17)
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. April 1, 1993.
11 NCAC 11A .0201 Purpose of Division {#sec-11-ncac-11a-.0201 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0201}

History

  • Status: repealed
  • Authority G.S. 58-4; 58-7.3; 58-9
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. July 1, 1988.
11 NCAC 11A .0202 Personnel of Division {#sec-11-ncac-11a-.0202 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0202}

History

  • Status: repealed
  • Authority G.S. 58-4; 58-7.3; 58-9
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. July 1, 1988.
11 NCAC 11A .0301 Operational Units: Defined {#sec-11-ncac-11a-.0301 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0301}

History

  • Status: repealed
  • Authority G.S. 58-4; 58-9
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. July 1, 1988.
11 NCAC 11A .0302 Securities: Operational Unit {#sec-11-ncac-11a-.0302 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0302}

History

  • Status: repealed
  • Authority G.S. 58-4; 58-9
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. July 1, 1988.
11 NCAC 11A .0303 Examination: Operational Unit {#sec-11-ncac-11a-.0303 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0303}

History

  • Status: repealed
  • Authority G.S. 58-4; 58-9
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. July 1, 1988.
11 NCAC 11A .0304 Liquidation and Merger: Operational Unit {#sec-11-ncac-11a-.0304 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0304}

History

  • Status: repealed
  • Authority G.S. 58-4; 58-9
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. July 1, 1988.
11 NCAC 11A .0305 Tax: Audit and Statistical: Operational Unit {#sec-11-ncac-11a-.0305 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0305}

History

  • Status: repealed
  • Authority G.S. 58-4; 58-9
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. July 1, 1988.
11 NCAC 11A .0306 Actuarial: Operational Unit {#sec-11-ncac-11a-.0306 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0306}

History

  • Status: repealed
  • Authority G.S. 58-4; 58-9
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. July 1, 1988.
11 NCAC 11A .0401 Application for Admission to Do Business in Nc {#sec-11-ncac-11a-.0401 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0401}

History

  • Status: repealed
  • Authority G.S. 58-15; 58-63; 58-63(1); 58-66; 58-72; 58-150; 58-150(3); 58-153
  • 58-182.5; 105-228.4(a)
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. April 1, 1993.

History

  • Status: repealed
  • Authority G.S. 58-15; 58-63; 58-63(1); 58-66; 58-72; 58-150; 58-150(3); 58-153
  • 58-182.5; 105-228.4(a)
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. April 1, 1993.
11 NCAC 11A .0403 Power of Attorney for Sale of Securities {#sec-11-ncac-11a-.0403 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0403}

History

  • Status: repealed
  • Authority G.S. 58-15; 58-63; 58-63(1); 58-66; 58-72; 58-150; 58-150(3); 58-153
  • 58-182.5; 105-228.4(a)
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. April 1, 1993.
11 NCAC 11A .0404 Application for License: General {#sec-11-ncac-11a-.0404 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0404}

History

  • Status: repealed
  • Authority G.S. 58-15; 58-63; 58-63(1); 58-66; 58-72; 58-150; 58-150(3); 58-153
  • 58-182.5; 105-228.4(a)
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. April 1, 1993.
11 NCAC 11A .0405 Application for License: Hospitals: Medical Service {#sec-11-ncac-11a-.0405 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0405}

History

  • Status: repealed
  • Authority G.S. 58-15; 58-63; 58-63(1); 58-66; 58-72; 58-150; 58-150(3); 58-153
  • 58-182.5; 105-228.4(a)
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. April 1, 1993.
11 NCAC 11A .0406 Application for License: Dental Service Corporation {#sec-11-ncac-11a-.0406 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0406}

History

  • Status: repealed
  • Authority G.S. 58-15; 58-63; 58-63(1); 58-66; 58-72; 58-150; 58-150(3); 58-153
  • 58-182.5; 105-228.4(a)
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. April 1, 1993.
11 NCAC 11A .0407 Applications for License: Fraternal Order {#sec-11-ncac-11a-.0407 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0407}

History

  • Status: repealed
  • Authority G.S. 58-15; 58-63; 58-63(1); 58-66; 58-72; 58-150; 58-150(3); 58-153
  • 58-182.5; 105-228.4(a)
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. April 1, 1993.
11 NCAC 11A .0408 Affidavit: Education: Occupation: Business Experience {#sec-11-ncac-11a-.0408 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0408}

History

  • Status: repealed
  • Authority G.S. 58-73; 58-74; 58-150
  • Eff. February 1, 1976
  • Repealed Eff. February 28, 1978.
11 NCAC 11A .0409 Insurance Company License {#sec-11-ncac-11a-.0409 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0409}

History

  • Status: repealed
  • Authority G.S. 57-9; 58-9(3); 58-15; 58-21; 58-25.1; 58-72; 58-79.2; 58-130
  • 58-131.14; 58-134; 58-137; 58-144; 58-188.8; 58-292; 105-228.4
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. April 1, 1993.
11 NCAC 11A .0410 Deposit Bond Form {#sec-11-ncac-11a-.0410 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0410}

History

  • Status: repealed
  • Authority G.S. 57-9; 58-9(3); 58-15; 58-21; 58-25.1; 58-72; 58-79.2; 58-130
  • 58-131.14; 58-134; 58-137; 58-144; 58-188.8; 58-292; 105-228.4
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. April 1, 1993.
11 NCAC 11A .0411 Fire and Casualty Annual Statement Blank {#sec-11-ncac-11a-.0411 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0411}

History

  • Status: repealed
  • Authority G.S. 57-9; 58-9(3); 58-15; 58-21; 58-25.1; 58-72; 58-79.2; 58-130
  • 58-131.14; 58-134; 58-137; 58-144; 58-188.8; 58-292; 105-228.4
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. April 1, 1993.
11 NCAC 11A .0412 Completing Fire and Casualty Annual Statement Blank {#sec-11-ncac-11a-.0412 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0412}

History

  • Status: repealed
  • Authority G.S. 57-9; 58-9(3); 58-15; 58-21; 58-25.1; 58-72; 58-79.2; 58-130
  • 58-131.14; 58-134; 58-137; 58-144; 58-188.8; 58-292; 105-228.4
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. April 1, 1993.
11 NCAC 11A .0413 Consolidated Annual Statement: Fire and Casualty Insurers {#sec-11-ncac-11a-.0413 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0413}

History

  • Status: repealed
  • Authority G.S. 57-9; 58-9(3); 58-15; 58-21; 58-25.1; 58-72; 58-79.2; 58-130
  • 58-131.14; 58-134; 58-137; 58-144; 58-188.8; 58-292; 105-228.4
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. April 1, 1993.
11 NCAC 11A .0414 Fire and Casualty Quarterly Statement Blank {#sec-11-ncac-11a-.0414 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0414}

History

  • Status: repealed
  • Authority G.S. 57-9; 58-9(3); 58-15; 58-21; 58-25.1; 58-72; 58-79.2; 58-130
  • 58-131.14; 58-134; 58-137; 58-144; 58-188.8; 58-292; 105-228.4
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. April 1, 1993.
11 NCAC 11A .0415 Life and Accident and Health Annual Statement Blank {#sec-11-ncac-11a-.0415 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0415}

History

  • Status: repealed
  • Authority G.S. 57-9; 58-9(3); 58-15; 58-21; 58-25.1; 58-72; 58-79.2; 58-130
  • 58-131.14; 58-134; 58-137; 58-144; 58-188.8; 58-292; 105-228.4
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. April 1, 1993.
11 NCAC 11A .0416 Annual Statement Blank: Instructions {#sec-11-ncac-11a-.0416 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0416}

History

  • Status: repealed
  • Authority G.S. 57-9; 58-9(3); 58-15; 58-21; 58-25.1; 58-72; 58-79.2; 58-130
  • 58-131.14; 58-134; 58-137; 58-144; 58-188.8; 58-292; 105-228.4
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. April 1, 1993.
11 NCAC 11A .0417 Life and Accident and Health Quarterly Statement Blank {#sec-11-ncac-11a-.0417 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0417}

History

  • Status: repealed
  • Authority G.S. 57-9; 58-9(3); 58-15; 58-21; 58-25.1; 58-72; 58-79.2; 58-130
  • 58-131.14; 58-134; 58-137; 58-144; 58-188.8; 58-292; 105-228.4
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. April 1, 1993.
11 NCAC 11A .0418 Annual Statement Blank: Separate Account Business {#sec-11-ncac-11a-.0418 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0418}

History

  • Status: repealed
  • Authority G.S. 57-9; 58-9(3); 58-15; 58-21; 58-25.1; 58-72; 58-79.2; 58-130
  • 58-131.14; 58-134; 58-137; 58-144; 58-188.8; 58-292; 105-228.4
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. April 1, 1993.
11 NCAC 11A .0419 Title Annual Statement Blank {#sec-11-ncac-11a-.0419 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0419}

History

  • Status: repealed
  • Authority G.S. 57-9; 58-9(3); 58-15; 58-21; 58-25.1; 58-72; 58-79.2; 58-130
  • 58-131.14; 58-134; 58-137; 58-144; 58-188.8; 58-292; 105-228.4
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. April 1, 1993.
11 NCAC 11A .0420 Instructions for Completing Title Annual Statement Blank {#sec-11-ncac-11a-.0420 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0420}

History

  • Status: repealed
  • Authority G.S. 57-9; 58-9(3); 58-15; 58-21; 58-25.1; 58-72; 58-79.2; 58-130
  • 58-131.14; 58-134; 58-137; 58-144; 58-188.8; 58-292; 105-228.4
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. April 1, 1993.
11 NCAC 11A .0421 Title Quarterly Statement Blank {#sec-11-ncac-11a-.0421 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0421}

History

  • Status: repealed
  • Authority G.S. 57-9; 58-9(3); 58-15; 58-21; 58-25.1; 58-72; 58-79.2; 58-130
  • 58-131.14; 58-134; 58-137; 58-144; 58-188.8; 58-292; 105-228.4
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. April 1, 1993.
11 NCAC 11A .0422 Hospital: Medical and Dental Service or Indemnity Corp {#sec-11-ncac-11a-.0422 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0422}

History

  • Status: repealed
  • Authority G.S. 57-9; 58-9(3); 58-15; 58-21; 58-25.1; 58-72; 58-79.2; 58-130
  • 58-131.14; 58-134; 58-137; 58-144; 58-188.8; 58-292; 105-228.4
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. April 1, 1993.
11 NCAC 11A .0423 Instructions/Annual Statement Blank: Hospital: Medical: Dental {#sec-11-ncac-11a-.0423 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0423}

History

  • Status: repealed
  • Authority G.S. 57-9; 58-9(3); 58-15; 58-21; 58-25.1; 58-72; 58-79.2; 58-130
  • 58-131.14; 58-134; 58-137; 58-144; 58-188.8; 58-292; 105-228.4
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. April 1, 1993.
11 NCAC 11A .0424 Fraternal Annual Statement Blank {#sec-11-ncac-11a-.0424 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0424}

History

  • Status: repealed
  • Authority G.S. 57-9; 58-9(3); 58-15; 58-21; 58-25.1; 58-72; 58-79.2; 58-130
  • 58-131.14; 58-134; 58-137; 58-144; 58-188.8; 58-292; 105-228.4
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. April 1, 1993.
11 NCAC 11A .0425 Instructions for Completing Fraternal Statement Blank {#sec-11-ncac-11a-.0425 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0425}

History

  • Status: repealed
  • Authority G.S. 57-9; 58-9(3); 58-15; 58-21; 58-25.1; 58-72; 58-79.2; 58-130
  • 58-131.14; 58-134; 58-137; 58-144; 58-188.8; 58-292; 105-228.4
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. April 1, 1993.
11 NCAC 11A .0426 Fraternal Quarterly Statement Blank {#sec-11-ncac-11a-.0426 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0426}

History

  • Status: repealed
  • Authority G.S. 57-9; 58-9(3); 58-15; 58-21; 58-25.1; 58-72; 58-79.2; 58-130
  • 58-131.14; 58-134; 58-137; 58-144; 58-188.8; 58-292; 105-228.4
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. April 1, 1993.
11 NCAC 11A .0427 Accident and Health Policy Experience Exhibit {#sec-11-ncac-11a-.0427 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0427}

History

  • Status: repealed
  • Authority G.S. 57-9; 58-9(3); 58-15; 58-21; 58-25.1; 58-72; 58-79.2; 58-130
  • 58-131.14; 58-134; 58-137; 58-144; 58-188.8; 58-292; 105-228.4
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. April 1, 1993.
11 NCAC 11A .0428 Credit Life and Accident and Health Exhibit {#sec-11-ncac-11a-.0428 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0428}

History

  • Status: repealed
  • Authority G.S. 57-9; 58-9(3); 58-15; 58-21; 58-25.1; 58-72; 58-79.2; 58-130
  • 58-131.14; 58-134; 58-137; 58-144; 58-188.8; 58-292; 105-228.4
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. April 1, 1993.
11 NCAC 11A .0429 Credit Life Insurance Statistical Report {#sec-11-ncac-11a-.0429 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0429}

History

  • Status: repealed
  • Authority G.S. 57-9; 58-9(3); 58-15; 58-21; 58-25.1; 58-72; 58-79.2; 58-130
  • 58-131.14; 58-134; 58-137; 58-144; 58-188.8; 58-292; 105-228.4
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. April 1, 1993.
11 NCAC 11A .0430 Insurance Expense Exhibit {#sec-11-ncac-11a-.0430 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0430}

History

  • Status: repealed
  • Authority G.S. 57-9; 58-9(3); 58-15; 58-21; 58-25.1; 58-72; 58-79.2; 58-130
  • 58-131.14; 58-134; 58-137; 58-144; 58-188.8; 58-292; 105-228.4
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. April 1, 1993.
11 NCAC 11A .0431 Stockholder Information Supplement {#sec-11-ncac-11a-.0431 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0431}

History

  • Status: repealed
  • Authority G.S. 57-9; 58-9(3); 58-15; 58-21; 58-25.1; 58-72; 58-79.2; 58-130
  • 58-131.14; 58-134; 58-137; 58-144; 58-188.8; 58-292; 105-228.4
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. April 1, 1993.
11 NCAC 11A .0432 Town or County Farm Mutual Annual Statement Blank {#sec-11-ncac-11a-.0432 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0432}

History

  • Status: repealed
  • Authority G.S. 57-9; 58-9(3); 58-15; 58-21; 58-25.1; 58-72; 58-79.2; 58-130
  • 58-131.14; 58-134; 58-137; 58-144; 58-188.8; 58-292; 105-228.4
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. April 1, 1993.
11 NCAC 11A .0433 Fire and/or Casualty Abstract {#sec-11-ncac-11a-.0433 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0433}

History

  • Status: repealed
  • Authority G.S. 58-9(4); 58-63(2)
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. July 1, 1988.
11 NCAC 11A .0434 Life Abstract {#sec-11-ncac-11a-.0434 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0434}

History

  • Status: repealed
  • Authority G.S. 58-9(4); 58-63(2)
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. July 1, 1988.
11 NCAC 11A .0435 Annual Gross Premium Tax Return: Retaliatory Tax Return {#sec-11-ncac-11a-.0435 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0435}

History

  • Status: repealed
  • Authority G.S. 57-14; 58-9; 58-79.2; 58-124.2(b); 97-107; 97-114; 105-228.5
  • 118-1 to -4
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. April 1, 1993.
11 NCAC 11A .0436 Statement of Installment Gross Premium Tax {#sec-11-ncac-11a-.0436 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0436}

History

  • Status: repealed
  • Authority G.S. 57-14; 58-9; 58-79.2; 58-124.2(b); 97-107; 97-114; 105-228.5
  • 118-1 to -4
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. April 1, 1993.
11 NCAC 11A .0437 Annual Additional Gross Premium Tax Return {#sec-11-ncac-11a-.0437 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0437}

History

  • Status: repealed
  • Authority G.S. 57-14; 58-9; 58-79.2; 58-124.2(b); 97-107; 97-114; 105-228.5
  • 118-1 to -4
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. April 1, 1993.
11 NCAC 11A .0438 Statement/Installment Additional Annual Gross Premium Tax {#sec-11-ncac-11a-.0438 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0438}

History

  • Status: repealed
  • Authority G.S. 57-14; 58-9; 58-79.2; 58-124.2(b); 97-107; 97-114; 105-228.5
  • 118-1 to -4
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. April 1, 1993.
11 NCAC 11A .0439 Nc Firemen's Relief Fund Tax Annual Return {#sec-11-ncac-11a-.0439 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0439}

History

  • Status: repealed
  • Authority G.S. 57-14; 58-9; 58-79.2; 58-124.2(b); 97-107; 97-114; 105-228.5
  • 118-1 to -4
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. April 1, 1993.
11 NCAC 11A .0440 Annual Franchise or Privilege Tax: Hosp and Medical Corp {#sec-11-ncac-11a-.0440 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0440}

History

  • Status: repealed
  • Authority G.S. 57-14; 58-9; 58-79.2; 58-124.2(b); 97-107; 97-114; 105-228.5
  • 118-1 to -4
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. April 1, 1993.
11 NCAC 11A .0441 Annual Franchise or Privilege Tax: Dental Service Corp {#sec-11-ncac-11a-.0441 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0441}

History

  • Status: repealed
  • Authority G.S. 57-14; 58-9; 58-79.2; 58-124.2(b); 97-107; 97-114; 105-228.5
  • 118-1 to -4
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. April 1, 1993.
11 NCAC 11A .0442 Nc Domestic Corporation Franchise and Income Tax Return {#sec-11-ncac-11a-.0442 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0442}

History

  • Status: repealed
  • Authority G.S. 57-14; 58-9; 58-79.2; 58-124.2(b); 97-107; 97-114; 105-228.5
  • 118-1 to -4
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. April 1, 1993.
11 NCAC 11A .0443 Automatic Extension of Time to File {#sec-11-ncac-11a-.0443 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0443}

History

  • Status: repealed
  • Authority G.S. 57-14; 58-9; 58-79.2; 58-124.2(b); 97-107; 97-114; 105-228.5
  • 118-1 to -4
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. April 1, 1993.
11 NCAC 11A .0444 Additional Extension of Time to File {#sec-11-ncac-11a-.0444 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0444}

History

  • Status: repealed
  • Authority G.S. 57-14; 58-9; 58-79.2; 58-124.2(b); 97-107; 97-114; 105-228.5
  • 118-1 to -4
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. April 1, 1993.
11 NCAC 11A .0445 Refund for Corporation Franchise and Income Taxes {#sec-11-ncac-11a-.0445 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0445}

History

  • Status: repealed
  • Authority G.S. 57-14; 58-9; 58-79.2; 58-124.2(b); 97-107; 97-114; 105-228.5
  • 118-1 to -4
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. April 1, 1993.
11 NCAC 11A .0446 Certification of Workmen's Compensation Loss Reserves {#sec-11-ncac-11a-.0446 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0446}

History

  • Status: repealed
  • Authority G.S. 57-14; 58-9; 58-79.2; 58-124.2(b); 97-107; 97-114; 105-228.5
  • 118-1 to -4
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. April 1, 1993.
11 NCAC 11A .0447 Workmen's Compensation Assessment Form {#sec-11-ncac-11a-.0447 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0447}

History

  • Status: repealed
  • Authority G.S. 57-14; 58-9; 58-79.2; 58-124.2(b); 97-107; 97-114; 105-228.5
  • 118-1 to -4
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. April 1, 1993.
11 NCAC 11A .0448 Form Hc: Insurer Holding Company Registration Statement {#sec-11-ncac-11a-.0448 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0448}

History

  • Status: repealed
  • Authority G.S. 57-14; 58-9; 58-79.2; 58-124.2(b); 97-107; 97-114; 105-228.5
  • 118-1 to -4
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. April 1, 1993.
11 NCAC 11A .0449 Sale of Variable Annuity Contracts in North Carolina {#sec-11-ncac-11a-.0449 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0449}

History

  • Status: repealed
  • Authority G.S. 57-14; 58-9; 58-79.2; 58-124.2(b); 97-107; 97-114; 105-228.5
  • 118-1 to -4
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. April 1, 1993.
11 NCAC 11A .0450 Annual Report of Escheat: Abandoned Property {#sec-11-ncac-11a-.0450 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0450}

History

  • Status: repealed
  • Authority G.S. 58-9(3); 116A
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. July 1, 1988.
11 NCAC 11A .0451 Instructions for Completing the Annual Report {#sec-11-ncac-11a-.0451 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0451}

History

  • Status: repealed
  • Authority G.S. 58-9(3); 116A
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. July 1, 1988.
11 NCAC 11A .0452 The Form A: Insider Trading of Equity Securities {#sec-11-ncac-11a-.0452 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0452}

History

  • Status: repealed
  • Authority G.S. 58-37; 58-44.4(a); 58-86.2; 58-182.6
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. April 1, 1993.
11 NCAC 11A .0453 Form B: Insider Trading of Equity Securities {#sec-11-ncac-11a-.0453 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0453}

History

  • Status: repealed
  • Authority G.S. 58-37; 58-44.4(a); 58-86.2; 58-182.6
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. April 1, 1993.
11 NCAC 11A .0454 Initial Statement of Beneficial Ownership of Securities {#sec-11-ncac-11a-.0454 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0454}

History

  • Status: repealed
  • Authority G.S. 58-37; 58-44.4(a); 58-86.2; 58-182.6
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. April 1, 1993.
11 NCAC 11A .0455 Statement of Changes in Beneficial Ownership of Securities {#sec-11-ncac-11a-.0455 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0455}

History

  • Status: repealed
  • Authority G.S. 58-37; 58-44.4(a); 58-86.2; 58-182.6
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. April 1, 1993.
11 NCAC 11A .0456 Revocation or Suspension of License: Foreign Insurance {#sec-11-ncac-11a-.0456 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0456}

History

  • Status: repealed
  • Authority G.S. 58-37; 58-44.4(a); 58-86.2; 58-182.6
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. April 1, 1993.
11 NCAC 11A .0457 Official Receipt of Securities {#sec-11-ncac-11a-.0457 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0457}

History

  • Status: repealed
  • Authority G.S. 58-37; 58-44.4(a); 58-86.2; 58-182.6
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. April 1, 1993.
11 NCAC 11A .0458 Check Sheet and Analysis of Application for Admission {#sec-11-ncac-11a-.0458 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0458}

History

  • Status: repealed
  • Authority G.S. 58-63; 58-75; 58-77; 58-150
  • Eff. February 1, 1976
  • Repealed Eff. February 28, 1978.
11 NCAC 11A .0459 Information Sheets: Admission of a Foreign Insurance {#sec-11-ncac-11a-.0459 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0459}

History

  • Status: repealed
  • Authority G.S. 58-63; 58-75; 58-77; 58-150
  • Eff. February 1, 1976
  • Repealed Eff. February 28, 1978.
11 NCAC 11A .0460 Taxes and Fees Applicable to Insurance Companies {#sec-11-ncac-11a-.0460 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0460}

History

  • Status: repealed
  • Authority G.S. 57-10; 58-9; 58-9(1); 58-9(3); 58-11; 58-16; 58-21; 58-34.1
  • 58-54.4; 58-62; 58-63(3); 58-63.3; 58-72; 58-79; 58-79(a); 58-79(a)(14); 58-79.1; 58-86.4
  • 58-155.1; 58-182.5; 58-201; 105-288.4
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Amended Eff. January 14, 1980
  • Repealed Eff. April 1, 1993.
11 NCAC 11A .0461 Town or County Farm Mutual Examination Report Blank {#sec-11-ncac-11a-.0461 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0461}

History

  • Status: repealed
  • Authority G.S. 57-10; 58-9; 58-9(1); 58-9(3); 58-11; 58-16; 58-21; 58-34.1
  • 58-54.4; 58-62; 58-63(3); 58-63.3; 58-72; 58-79; 58-79(a); 58-79(a)(14); 58-79.1; 58-86.4
  • 58-155.1; 58-182.5; 58-201; 105-288.4
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Amended Eff. January 14, 1980
  • Repealed Eff. April 1, 1993.
11 NCAC 11A .0462 Certificate of Compliance: Mutual Agreement {#sec-11-ncac-11a-.0462 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0462}

History

  • Status: repealed
  • Authority G.S. 57-10; 58-9; 58-9(1); 58-9(3); 58-11; 58-16; 58-21; 58-34.1
  • 58-54.4; 58-62; 58-63(3); 58-63.3; 58-72; 58-79; 58-79(a); 58-79(a)(14); 58-79.1; 58-86.4
  • 58-155.1; 58-182.5; 58-201; 105-288.4
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Amended Eff. January 14, 1980
  • Repealed Eff. April 1, 1993.
11 NCAC 11A .0463 Power of Attorney: Sale of Deposited Securities {#sec-11-ncac-11a-.0463 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0463}

History

  • Status: repealed
  • Authority G.S. 57-10; 58-9; 58-9(1); 58-9(3); 58-11; 58-16; 58-21; 58-34.1
  • 58-54.4; 58-62; 58-63(3); 58-63.3; 58-72; 58-79; 58-79(a); 58-79(a)(14); 58-79.1; 58-86.4
  • 58-155.1; 58-182.5; 58-201; 105-288.4
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Amended Eff. January 14, 1980
  • Repealed Eff. April 1, 1993.
11 NCAC 11A .0464 Certificate of Deposit {#sec-11-ncac-11a-.0464 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0464}

History

  • Status: repealed
  • Authority G.S. 57-10; 58-9; 58-9(1); 58-9(3); 58-11; 58-16; 58-21; 58-34.1
  • 58-54.4; 58-62; 58-63(3); 58-63.3; 58-72; 58-79; 58-79(a); 58-79(a)(14); 58-79.1; 58-86.4
  • 58-155.1; 58-182.5; 58-201; 105-288.4
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Amended Eff. January 14, 1980
  • Repealed Eff. April 1, 1993.
11 NCAC 11A .0465 Certificate of Compliance: Accident and Health Advertising {#sec-11-ncac-11a-.0465 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0465}

History

  • Status: repealed
  • Authority G.S. 57-10; 58-9; 58-9(1); 58-9(3); 58-11; 58-16; 58-21; 58-34.1
  • 58-54.4; 58-62; 58-63(3); 58-63.3; 58-72; 58-79; 58-79(a); 58-79(a)(14); 58-79.1; 58-86.4
  • 58-155.1; 58-182.5; 58-201; 105-288.4
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Amended Eff. January 14, 1980
  • Repealed Eff. April 1, 1993.
11 NCAC 11A .0466 Certificate of Retaliatory Provisions {#sec-11-ncac-11a-.0466 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0466}

History

  • Status: repealed
  • Authority G.S. 57-10; 58-9; 58-9(1); 58-9(3); 58-11; 58-16; 58-21; 58-34.1
  • 58-54.4; 58-62; 58-63(3); 58-63.3; 58-72; 58-79; 58-79(a); 58-79(a)(14); 58-79.1; 58-86.4
  • 58-155.1; 58-182.5; 58-201; 105-288.4
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Amended Eff. January 14, 1980
  • Repealed Eff. April 1, 1993.
11 NCAC 11A .0467 Certificate of Good Standing {#sec-11-ncac-11a-.0467 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0467}

History

  • Status: repealed
  • Authority G.S. 57-10; 58-9; 58-9(1); 58-9(3); 58-11; 58-16; 58-21; 58-34.1
  • 58-54.4; 58-62; 58-63(3); 58-63.3; 58-72; 58-79; 58-79(a); 58-79(a)(14); 58-79.1; 58-86.4
  • 58-155.1; 58-182.5; 58-201; 105-288.4
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Amended Eff. January 14, 1980
  • Repealed Eff. April 1, 1993.
11 NCAC 11A .0468 Certificate of Similarity: Report on Examination {#sec-11-ncac-11a-.0468 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0468}

History

  • Status: repealed
  • Authority G.S. 57-10; 58-9; 58-9(1); 58-9(3); 58-11; 58-16; 58-21; 58-34.1
  • 58-54.4; 58-62; 58-63(3); 58-63.3; 58-72; 58-79; 58-79(a); 58-79(a)(14); 58-79.1; 58-86.4
  • 58-155.1; 58-182.5; 58-201; 105-288.4
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Amended Eff. January 14, 1980
  • Repealed Eff. April 1, 1993.
11 NCAC 11A .0469 Certificate of Similarity: Annual Statement {#sec-11-ncac-11a-.0469 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0469}

History

  • Status: repealed
  • Authority G.S. 57-10; 58-9; 58-9(1); 58-9(3); 58-11; 58-16; 58-21; 58-34.1
  • 58-54.4; 58-62; 58-63(3); 58-63.3; 58-72; 58-79; 58-79(a); 58-79(a)(14); 58-79.1; 58-86.4
  • 58-155.1; 58-182.5; 58-201; 105-288.4
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Amended Eff. January 14, 1980
  • Repealed Eff. April 1, 1993.
11 NCAC 11A .0470 Certificate of Reserve Valuation {#sec-11-ncac-11a-.0470 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0470}

History

  • Status: repealed
  • Authority G.S. 57-10; 58-9; 58-9(1); 58-9(3); 58-11; 58-16; 58-21; 58-34.1
  • 58-54.4; 58-62; 58-63(3); 58-63.3; 58-72; 58-79; 58-79(a); 58-79(a)(14); 58-79.1; 58-86.4
  • 58-155.1; 58-182.5; 58-201; 105-288.4
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Amended Eff. January 14, 1980
  • Repealed Eff. April 1, 1993.
11 NCAC 11A .0471 Certificate of Compliance: Insurance Laws {#sec-11-ncac-11a-.0471 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0471}

History

  • Status: repealed
  • Authority G.S. 57-10; 58-9; 58-9(1); 58-9(3); 58-11; 58-16; 58-21; 58-34.1
  • 58-54.4; 58-62; 58-63(3); 58-63.3; 58-72; 58-79; 58-79(a); 58-79(a)(14); 58-79.1; 58-86.4
  • 58-155.1; 58-182.5; 58-201; 105-288.4
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Amended Eff. January 14, 1980
  • Repealed Eff. April 1, 1993.
11 NCAC 11A .0472 Stat Information: Life Ins Companies and Frat Orders {#sec-11-ncac-11a-.0472 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0472}

History

  • Status: repealed
  • Authority G.S. 57-10; 58-9; 58-9(1); 58-9(3); 58-11; 58-16; 58-21; 58-34.1
  • 58-54.4; 58-62; 58-63(3); 58-63.3; 58-72; 58-79; 58-79(a); 58-79(a)(14); 58-79.1; 58-86.4
  • 58-155.1; 58-182.5; 58-201; 105-288.4
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Amended Eff. January 14, 1980
  • Repealed Eff. April 1, 1993.
11 NCAC 11A .0473 Stat Info/Fire and Cas/Reciprocals/Factory/Co Farm {#sec-11-ncac-11a-.0473 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0473}

History

  • Status: repealed
  • Authority G.S. 57-10; 58-9; 58-9(1); 58-9(3); 58-11; 58-16; 58-21; 58-34.1
  • 58-54.4; 58-62; 58-63(3); 58-63.3; 58-72; 58-79; 58-79(a); 58-79(a)(14); 58-79.1; 58-86.4
  • 58-155.1; 58-182.5; 58-201; 105-288.4
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Amended Eff. January 14, 1980
  • Repealed Eff. April 1, 1993.
11 NCAC 11A .0474 Statistical Information: Accident and Health Business {#sec-11-ncac-11a-.0474 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0474}

History

  • Status: repealed
  • Authority G.S. 57-10; 58-9; 58-9(1); 58-9(3); 58-11; 58-16; 58-21; 58-34.1
  • 58-54.4; 58-62; 58-63(3); 58-63.3; 58-72; 58-79; 58-79(a); 58-79(a)(14); 58-79.1; 58-86.4
  • 58-155.1; 58-182.5; 58-201; 105-288.4
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Amended Eff. January 14, 1980
  • Repealed Eff. April 1, 1993.
11 NCAC 11A .0475 Authorized Investments Pursuant to G.s. 58-79(a) {#sec-11-ncac-11a-.0475 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0475}

History

  • Status: repealed
  • Authority G.S. 57-10; 58-9; 58-9(1); 58-9(3); 58-11; 58-16; 58-21; 58-34.1
  • 58-54.4; 58-62; 58-63(3); 58-63.3; 58-72; 58-79; 58-79(a); 58-79(a)(14); 58-79.1; 58-86.4
  • 58-155.1; 58-182.5; 58-201; 105-288.4
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Amended Eff. January 14, 1980
  • Repealed Eff. April 1, 1993.
11 NCAC 11A .0476 Investments Made Pursuant to G.s. 58-79(a)(14) {#sec-11-ncac-11a-.0476 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0476}

History

  • Status: repealed
  • Authority G.S. 57-10; 58-9; 58-9(1); 58-9(3); 58-11; 58-16; 58-21; 58-34.1
  • 58-54.4; 58-62; 58-63(3); 58-63.3; 58-72; 58-79; 58-79(a); 58-79(a)(14); 58-79.1; 58-86.4
  • 58-155.1; 58-182.5; 58-201; 105-288.4
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Amended Eff. January 14, 1980
  • Repealed Eff. April 1, 1993.
11 NCAC 11A .0477 Authorized Investments Pursuant to G.s. 58-79.1 {#sec-11-ncac-11a-.0477 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0477}

History

  • Status: repealed
  • Authority G.S. 57-10; 58-9; 58-9(1); 58-9(3); 58-11; 58-16; 58-21; 58-34.1
  • 58-54.4; 58-62; 58-63(3); 58-63.3; 58-72; 58-79; 58-79(a); 58-79(a)(14); 58-79.1; 58-86.4
  • 58-155.1; 58-182.5; 58-201; 105-288.4
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Amended Eff. January 14, 1980
  • Repealed Eff. April 1, 1993.
11 NCAC 11A .0478 Corporate Resolution and Conflict of Interest {#sec-11-ncac-11a-.0478 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0478}

History

  • Status: repealed
  • Authority G.S. 57-10; 58-9; 58-9(1); 58-9(3); 58-11; 58-16; 58-21; 58-34.1
  • 58-54.4; 58-62; 58-63(3); 58-63.3; 58-72; 58-79; 58-79(a); 58-79(a)(14); 58-79.1; 58-86.4
  • 58-155.1; 58-182.5; 58-201; 105-288.4
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Amended Eff. January 14, 1980
  • Repealed Eff. April 1, 1993.
11 NCAC 11A .0479 Contribution for Domestic Insurance Companies {#sec-11-ncac-11a-.0479 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0479}

History

  • Status: repealed
  • Authority G.S. 57-10; 58-9; 58-9(1); 58-9(3); 58-11; 58-16; 58-21; 58-34.1
  • 58-54.4; 58-62; 58-63(3); 58-63.3; 58-72; 58-79; 58-79(a); 58-79(a)(14); 58-79.1; 58-86.4
  • 58-155.1; 58-182.5; 58-201; 105-288.4
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Amended Eff. January 14, 1980
  • Repealed Eff. April 1, 1993.
11 NCAC 11A .0480 Public Hearing on Plan of Exchange of Capital Stock {#sec-11-ncac-11a-.0480 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0480}

History

  • Status: repealed
  • Authority G.S. 57-10; 58-9; 58-9(1); 58-9(3); 58-11; 58-16; 58-21; 58-34.1
  • 58-54.4; 58-62; 58-63(3); 58-63.3; 58-72; 58-79; 58-79(a); 58-79(a)(14); 58-79.1; 58-86.4
  • 58-155.1; 58-182.5; 58-201; 105-288.4
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Amended Eff. January 14, 1980
  • Repealed Eff. April 1, 1993.
11 NCAC 11A .0481 Public Hearing on Plan of Merger or Consolidation {#sec-11-ncac-11a-.0481 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0481}

History

  • Status: repealed
  • Authority G.S. 57-10; 58-9; 58-9(1); 58-9(3); 58-11; 58-16; 58-21; 58-34.1
  • 58-54.4; 58-62; 58-63(3); 58-63.3; 58-72; 58-79; 58-79(a); 58-79(a)(14); 58-79.1; 58-86.4
  • 58-155.1; 58-182.5; 58-201; 105-288.4
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Amended Eff. January 14, 1980
  • Repealed Eff. April 1, 1993.
11 NCAC 11A .0482 Examiners' Expense and Days Worked Reports {#sec-11-ncac-11a-.0482 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0482}

History

  • Status: repealed
  • Authority G.S. 57-10; 58-9; 58-9(1); 58-9(3); 58-11; 58-16; 58-21; 58-34.1
  • 58-54.4; 58-62; 58-63(3); 58-63.3; 58-72; 58-79; 58-79(a); 58-79(a)(14); 58-79.1; 58-86.4
  • 58-155.1; 58-182.5; 58-201; 105-288.4
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Amended Eff. January 14, 1980
  • Repealed Eff. April 1, 1993.
11 NCAC 11A .0483 Statement of Examination Charges {#sec-11-ncac-11a-.0483 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0483}

History

  • Status: repealed
  • Authority G.S. 57-10; 58-9; 58-9(1); 58-9(3); 58-11; 58-16; 58-21; 58-34.1
  • 58-54.4; 58-62; 58-63(3); 58-63.3; 58-72; 58-79; 58-79(a); 58-79(a)(14); 58-79.1; 58-86.4
  • 58-155.1; 58-182.5; 58-201; 105-288.4
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Amended Eff. January 14, 1980
  • Repealed Eff. April 1, 1993.
11 NCAC 11A .0484 Form of Model Custodial Agreement {#sec-11-ncac-11a-.0484 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0484}

History

  • Status: repealed
  • Authority G.S. 57-10; 58-9; 58-9(1); 58-9(3); 58-11; 58-16; 58-21; 58-34.1
  • 58-54.4; 58-62; 58-63(3); 58-63.3; 58-72; 58-79; 58-79(a); 58-79(a)(14); 58-79.1; 58-86.4
  • 58-155.1; 58-182.5; 58-201; 105-288.4
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Amended Eff. January 14, 1980
  • Repealed Eff. April 1, 1993.
11 NCAC 11A .0485 Form of Model Custodial and Fiscal Agency Agreement {#sec-11-ncac-11a-.0485 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0485}

History

  • Status: repealed
  • Authority G.S. 57-10; 58-9; 58-9(1); 58-9(3); 58-11; 58-16; 58-21; 58-34.1
  • 58-54.4; 58-62; 58-63(3); 58-63.3; 58-72; 58-79; 58-79(a); 58-79(a)(14); 58-79.1; 58-86.4
  • 58-155.1; 58-182.5; 58-201; 105-288.4
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Amended Eff. January 14, 1980
  • Repealed Eff. April 1, 1993.
11 NCAC 11A .0486 Reconciliation: Statutory Capital and Stockholders Equity {#sec-11-ncac-11a-.0486 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0486}

History

  • Status: repealed
  • Authority G.S. 57-10; 58-9; 58-9(1); 58-9(3); 58-11; 58-16; 58-21; 58-34.1
  • 58-54.4; 58-62; 58-63(3); 58-63.3; 58-72; 58-79; 58-79(a); 58-79(a)(14); 58-79.1; 58-86.4
  • 58-155.1; 58-182.5; 58-201; 105-288.4
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Amended Eff. January 14, 1980
  • Repealed Eff. April 1, 1993.
11 NCAC 11A .0487 Reconciliation: Statutory Net Gain and Net Income {#sec-11-ncac-11a-.0487 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0487}

History

  • Status: repealed
  • Authority G.S. 57-10; 58-9; 58-9(1); 58-9(3); 58-11; 58-16; 58-21; 58-34.1
  • 58-54.4; 58-62; 58-63(3); 58-63.3; 58-72; 58-79; 58-79(a); 58-79(a)(14); 58-79.1; 58-86.4
  • 58-155.1; 58-182.5; 58-201; 105-288.4
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Amended Eff. January 14, 1980
  • Repealed Eff. April 1, 1993.
11 NCAC 11A .0488 Valuations of Securities Manual {#sec-11-ncac-11a-.0488 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0488}

History

  • Status: repealed
  • Authority G.S. 57-10; 58-9; 58-9(1); 58-9(3); 58-11; 58-16; 58-21; 58-34.1
  • 58-54.4; 58-62; 58-63(3); 58-63.3; 58-72; 58-79; 58-79(a); 58-79(a)(14); 58-79.1; 58-86.4
  • 58-155.1; 58-182.5; 58-201; 105-288.4
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Amended Eff. January 14, 1980
  • Repealed Eff. April 1, 1993.
11 NCAC 11A .0489 Affidavit for Return of Deposit {#sec-11-ncac-11a-.0489 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0489}

History

  • Status: repealed
  • Authority G.S. 57A; 57A-3; 57A-4; 57A-9; 57A-21; 58-9
  • Eff. February 28, 1978
  • Repealed Eff. April 1, 1993.
11 NCAC 11A .0490 Application for License: Health Maintenance Organization {#sec-11-ncac-11a-.0490 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0490}

History

  • Status: repealed
  • Authority G.S. 57A; 57A-3; 57A-4; 57A-9; 57A-21; 58-9
  • Eff. February 28, 1978
  • Repealed Eff. April 1, 1993.
11 NCAC 11A .0491 Health Maintenance Organization: Annual Statement {#sec-11-ncac-11a-.0491 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0491}

History

  • Status: repealed
  • Authority G.S. 57A; 57A-3; 57A-4; 57A-9; 57A-21; 58-9
  • Eff. February 28, 1978
  • Repealed Eff. April 1, 1993.
11 NCAC 11A .0492 Instructions for Completing Statement {#sec-11-ncac-11a-.0492 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0492}

History

  • Status: repealed
  • Authority G.S. 57A; 57A-3; 57A-4; 57A-9; 57A-21; 58-9
  • Eff. February 28, 1978
  • Repealed Eff. April 1, 1993.
11 NCAC 11A .0493 Health Maintenance Organization: Quarterly Statement {#sec-11-ncac-11a-.0493 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0493}

History

  • Status: repealed
  • Authority G.S. 57A; 57A-3; 57A-4; 57A-9; 57A-21; 58-9
  • Eff. February 28, 1978
  • Repealed Eff. April 1, 1993.
11 NCAC 11A .0501 Purpose and Scope {#sec-11-ncac-11a-.0501 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0501}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-2-131; 58-2-131; 58-2-133; 58-2-205; 150B-21.1(a3)
  • Eff. December 1, 1990
  • Amended Eff. June 1, 2007; July 1, 2004; August 1, 2004; April 1, 1993
  • Temporary Amendment Eff. February 15, 2003
  • Repealed Eff. January 1, 2011.
11 NCAC 11A .0502 Definitions {#sec-11-ncac-11a-.0502 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0502}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-2-131; 58-2-131; 58-2-133; 58-2-205; 150B-21.1(a3)
  • Eff. December 1, 1990
  • Amended Eff. June 1, 2007; July 1, 2004; August 1, 2004; April 1, 1993
  • Temporary Amendment Eff. February 15, 2003
  • Repealed Eff. January 1, 2011.
11 NCAC 11A .0503 Filing and Extensions for Filing Reports {#sec-11-ncac-11a-.0503 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0503}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-2-131; 58-2-131; 58-2-133; 58-2-205; 150B-21.1(a3)
  • Eff. December 1, 1990
  • Amended Eff. June 1, 2007; July 1, 2004; August 1, 2004; April 1, 1993
  • Temporary Amendment Eff. February 15, 2003
  • Repealed Eff. January 1, 2011.
11 NCAC 11A .0504 Contents of Annual Audited Financial Report {#sec-11-ncac-11a-.0504 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0504}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-2-131; 58-2-131; 58-2-133; 58-2-205; 150B-21.1(a3)
  • Eff. December 1, 1990
  • Amended Eff. June 1, 2007; July 1, 2004; August 1, 2004; April 1, 1993
  • Temporary Amendment Eff. February 15, 2003
  • Repealed Eff. January 1, 2011.
11 NCAC 11A .0505 Designation of Cpa {#sec-11-ncac-11a-.0505 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0505}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-2-131; 58-2-131; 58-2-133; 58-2-205; 150B-21.1(a3)
  • Eff. December 1, 1990
  • Amended Eff. June 1, 2007; July 1, 2004; August 1, 2004; April 1, 1993
  • Temporary Amendment Eff. February 15, 2003
  • Repealed Eff. January 1, 2011.
11 NCAC 11A .0506 Qualifications of Independent Cpa {#sec-11-ncac-11a-.0506 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0506}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-2-131; 58-2-131; 58-2-133; 58-2-205; 150B-21.1(a3)
  • Eff. December 1, 1990
  • Amended Eff. June 1, 2007; July 1, 2004; August 1, 2004; April 1, 1993
  • Temporary Amendment Eff. February 15, 2003
  • Repealed Eff. January 1, 2011.
11 NCAC 11A .0507 Approval of Cpa {#sec-11-ncac-11a-.0507 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0507}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-2-131; 58-2-131; 58-2-133; 58-2-205; 150B-21.1(a3)
  • Eff. December 1, 1990
  • Amended Eff. June 1, 2007; July 1, 2004; August 1, 2004; April 1, 1993
  • Temporary Amendment Eff. February 15, 2003
  • Repealed Eff. January 1, 2011.
11 NCAC 11A .0508 Scope of Examination and Report of Cpa {#sec-11-ncac-11a-.0508 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0508}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-2-131; 58-2-131; 58-2-133; 58-2-205; 150B-21.1(a3)
  • Eff. December 1, 1990
  • Amended Eff. June 1, 2007; July 1, 2004; August 1, 2004; April 1, 1993
  • Temporary Amendment Eff. February 15, 2003
  • Repealed Eff. January 1, 2011.
11 NCAC 11A .0509 Notification of Adverse Financial Condition {#sec-11-ncac-11a-.0509 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0509}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-2-131; 58-2-131; 58-2-133; 58-2-205; 150B-21.1(a3)
  • Eff. December 1, 1990
  • Amended Eff. June 1, 2007; July 1, 2004; August 1, 2004; April 1, 1993
  • Temporary Amendment Eff. February 15, 2003
  • Repealed Eff. January 1, 2011.

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-2-131; 58-2-131; 58-2-133; 58-2-205; 150B-21.1(a3)
  • Eff. December 1, 1990
  • Amended Eff. June 1, 2007; July 1, 2004; August 1, 2004; April 1, 1993
  • Temporary Amendment Eff. February 15, 2003
  • Repealed Eff. January 1, 2011.
11 NCAC 11A .0511 Cpa Workpapers {#sec-11-ncac-11a-.0511 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0511}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-2-131; 58-2-131; 58-2-133; 58-2-205; 150B-21.1(a3)
  • Eff. December 1, 1990
  • Amended Eff. June 1, 2007; July 1, 2004; August 1, 2004; April 1, 1993
  • Temporary Amendment Eff. February 15, 2003
  • Repealed Eff. January 1, 2011.
11 NCAC 11A .0512 Exemptions and Effective Dates {#sec-11-ncac-11a-.0512 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0512}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-2-131; 58-2-131; 58-2-133; 58-2-205; 150B-21.1(a3)
  • Eff. December 1, 1990
  • Amended Eff. June 1, 2007; July 1, 2004; August 1, 2004; April 1, 1993
  • Temporary Amendment Eff. February 15, 2003
  • Repealed Eff. January 1, 2011.
11 NCAC 11A .0513 Examinations {#sec-11-ncac-11a-.0513 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0513}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-2-131; 58-2-131; 58-2-133; 58-2-205; 150B-21.1(a3)
  • Eff. December 1, 1990
  • Amended Eff. June 1, 2007; July 1, 2004; August 1, 2004; April 1, 1993
  • Temporary Amendment Eff. February 15, 2003
  • Repealed Eff. January 1, 2011.
11 NCAC 11A .0514 Seasoning Requirements {#sec-11-ncac-11a-.0514 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0514}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-2-205
  • Temporary Adoption Eff. October 1, 2000
  • Eff. July 18, 2002
  • Repealed Eff. January 1, 2011.
11 NCAC 11A .0515 Notes to Financial Statements {#sec-11-ncac-11a-.0515 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0515}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-2-205
  • Temporary Adoption Eff. October 1, 2000
  • Eff. July 18, 2002
  • Repealed Eff. January 1, 2011.
11 NCAC 11A .0601 Definitions {#sec-11-ncac-11a-.0601 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0601}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-2-225
  • Eff. December 1, 1992
  • Repealed Eff. May 1, 1994.
11 NCAC 11A .0602 Licensure {#sec-11-ncac-11a-.0602 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0602}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-2-225
  • RRC Objection Eff. November 19, 1992 due to ambiguity
  • Eff. December 29, 1992
  • Repealed Eff. May 1, 1994.
11 NCAC 11A .0603 Required Contract Provisions - Brokers {#sec-11-ncac-11a-.0603 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0603}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-2-225
  • Eff. December 1, 1992
  • Repealed Eff. May 1, 1994.
11 NCAC 11A .0604 Duties of Insurers Using Services of Brokers {#sec-11-ncac-11a-.0604 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0604}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-2-225
  • Eff. December 1, 1992
  • Repealed Eff. May 1, 1994.
11 NCAC 11A .0605 Required Contract Provisions - Managers {#sec-11-ncac-11a-.0605 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0605}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-2-225
  • Eff. December 1, 1992
  • Repealed Eff. May 1, 1994.
11 NCAC 11A .0606 Prohibited Acts {#sec-11-ncac-11a-.0606 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0606}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-2-225
  • Eff. December 1, 1992
  • Repealed Eff. May 1, 1994.
11 NCAC 11A .0607 Duties of Reinsurers Using Services of a Manager {#sec-11-ncac-11a-.0607 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0607}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-2-225
  • Eff. December 1, 1992
  • Repealed Eff. May 1, 1994.
11 NCAC 11A .0608 Examination Authority {#sec-11-ncac-11a-.0608 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0608}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-2-225
  • Eff. December 1, 1992
  • Repealed Eff. May 1, 1994.
11 NCAC 11A .0609 Penalties and Liabilities {#sec-11-ncac-11a-.0609 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11A .0609}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-2-225
  • Eff. December 1, 1992
  • Repealed Eff. May 1, 1994.

Subchapter B

11 NCAC 11B .0101 Deposits of Multiple Line Insurer {#sec-11-ncac-11b-.0101 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11B .0101}

History

  • Status: repealed
  • Authority G.S. 58-9(1); 58-150; 58-182; 58-182(1); 58-182.7
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Amended Eff. July 1, 1986
  • Repealed Eff. April 1, 1993.
11 NCAC 11B .0102 Deposits: Life Companies for Admission {#sec-11-ncac-11b-.0102 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11B .0102}

History

  • Status: repealed
  • Authority G.S. 58-9(1); 58-150; 58-182; 58-182(1); 58-182.7
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Amended Eff. July 1, 1986
  • Repealed Eff. April 1, 1993.
11 NCAC 11B .0103 Deposit by Insurance Company Waiver Operational Gain {#sec-11-ncac-11b-.0103 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11B .0103}

History

  • Status: repealed
  • Authority G.S. 58-9(1); 58-150; 58-182; 58-182(1); 58-182.7
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Amended Eff. July 1, 1986
  • Repealed Eff. April 1, 1993.
11 NCAC 11B .0104 Replacement Upon Reduction of Market Value Securities {#sec-11-ncac-11b-.0104 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11B .0104}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-5-25
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Amended Eff. April 1, 1993; July 1, 1986
  • Repealed Eff. March 1, 2004.
11 NCAC 11B .0105 Purpose of Deposit of General or Special {#sec-11-ncac-11b-.0105 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11B .0105}

History

  • Status: repealed
  • Authority G.S. 58-182.4
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. April 1, 1993.
11 NCAC 11B .0106 Deposits Required: Revocation/License: Foreign Companies {#sec-11-ncac-11b-.0106 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11B .0106}

History

  • Status: repealed
  • Authority G.S. 58-2-40(1); 58-3-100; 58-5-40; 58-5-45
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. March 1, 2004.
11 NCAC 11B .0107 Deposits of Domestic Companies {#sec-11-ncac-11b-.0107 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11B .0107}

History

  • Status: repealed
  • Authority G.S. 58-182 through 58-182.8
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Amended Eff. July 1, 1986
  • Repealed Eff. April 1, 1993.
11 NCAC 11B .0108 Right of Company to Receive Interest {#sec-11-ncac-11b-.0108 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11B .0108}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-5-1; 58-5-60; 58-5-65; 58-5-75; 58-183
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Amended Eff. February 1, 1996; July 1, 1986
  • Repealed Eff. March 1, 2004.
11 NCAC 11B .0109 Right of the Commissioner to Receive and Hold Interest {#sec-11-ncac-11b-.0109 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11B .0109}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-5-1; 58-5-60; 58-5-65; 58-5-75; 58-183
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Amended Eff. February 1, 1996; July 1, 1986
  • Repealed Eff. March 1, 2004.
11 NCAC 11B .0110 Sale of Deposit for Payment of Liabilities {#sec-11-ncac-11b-.0110 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11B .0110}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-5-1; 58-5-60; 58-5-65; 58-5-75; 58-183
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Amended Eff. February 1, 1996; July 1, 1986
  • Repealed Eff. March 1, 2004.
11 NCAC 11B .0111 Conversion to Cash Master Trust {#sec-11-ncac-11b-.0111 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11B .0111}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-5-1; 58-5-60; 58-5-65; 58-5-75; 58-183
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Amended Eff. February 1, 1996; July 1, 1986
  • Repealed Eff. March 1, 2004.
11 NCAC 11B .0112 Return of Securities on Deposit {#sec-11-ncac-11b-.0112 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11B .0112}

History

  • Status: repealed
  • Authority G.S. 58-9(1); 58-187
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. April 1, 1994.
11 NCAC 11B .0113 Deposit Required Upon Initial Licensing {#sec-11-ncac-11b-.0113 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11B .0113}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-5-1; 58-5-5; 58-5-10; 58-5-40; 58-5-50; 58-5-90; 58-5-95
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Amended Eff. April 1, 1993; July 1, 1986
  • Repealed Eff. March 1, 2004.
11 NCAC 11B .0114 Deposits Held in Trust by Commissioner of Insurance {#sec-11-ncac-11b-.0114 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11B .0114}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-5-1; 58-5-5; 58-5-10; 58-5-40; 58-5-50; 58-5-90; 58-5-95
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Amended Eff. April 1, 1993; July 1, 1986
  • Repealed Eff. March 1, 2004.
11 NCAC 11B .0115 Registration of Bonds Deposited in Name of Treasurer {#sec-11-ncac-11b-.0115 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11B .0115}

History

  • Status: repealed
  • Authority G.S. 58-182.6; 58-188.1; 58-188.5
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. July 1, 1986.
11 NCAC 11B .0116 Surety Bond in Lieu of Deposit of Securities {#sec-11-ncac-11b-.0116 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11B .0116}

History

  • Status: repealed
  • Authority G.S. 58-9(1); 58-188.8
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Amended Eff. July 1, 1986
  • Repealed Eff. April 1, 1993.
11 NCAC 11B .0117 Surety Bond in Lieu of Deposit of Securities {#sec-11-ncac-11b-.0117 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11B .0117}

History

  • Status: repealed
  • Authority G.S. 58-9(1); 58-188.8
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Amended Eff. July 1, 1986
  • Repealed Eff. April 1, 1993.
11 NCAC 11B .0118 Surety Bond in Lieu of Deposit of Securities: Not Allowed {#sec-11-ncac-11b-.0118 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11B .0118}

History

  • Status: repealed
  • Authority G.S. 58-9(1); 58-188.8
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Amended Eff. July 1, 1986
  • Repealed Eff. April 1, 1993.
11 NCAC 11B .0119 Continuation of Deposits of Securities of Merging Companies {#sec-11-ncac-11b-.0119 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11B .0119}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-5-40; 58-5-55
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Amended Eff. April 1, 1993
  • Repealed Eff. March 1, 2004.
11 NCAC 11B .0120 Expenses of Registered Mail {#sec-11-ncac-11b-.0120 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11B .0120}

History

  • Status: repealed
  • Authority G.S. 58-9(1)
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. July 1, 1986.
11 NCAC 11B .0121 Surety Bonds: Deposit of Securities: Special Requirement {#sec-11-ncac-11b-.0121 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11B .0121}

History

  • Status: repealed
  • Authority G.S. 58-188.8
  • Eff. February 28, 1978
  • Repealed Eff. April 1, 1993.
11 NCAC 11B .0122 Exchange of Deposit: Procedural Handling {#sec-11-ncac-11b-.0122 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11B .0122}

History

  • Status: repealed
  • History Note Authority G.S. 58-7.5; 58-9
  • Eff. February 28, 1978
  • Repealed Eff. March 1, 2004.
11 NCAC 11B .0123 Sale of Securities by the Insurance Company Prohibited {#sec-11-ncac-11b-.0123 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11B .0123}

History

  • Status: repealed
  • History Note Authority G.S. 58-7.5; 58-9
  • Eff. February 28, 1978
  • Repealed Eff. March 1, 2004.
11 NCAC 11B .0124 Master Trust Creation Thereof {#sec-11-ncac-11b-.0124 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11B .0124}

History

  • Status: repealed
  • Authority G.S. 58-7.5; 58-9; 58-2-40; 58-5-1; 58-5-5; 58-5-10; 5-5-50
  • Eff. July 1, 1986
  • Amended Eff. July 1, 1986
  • Amended Eff. April 1, 1993
  • Repealed Eff. March 1, 2004.
11 NCAC 11B .0125 Master Trust Use Procedural Handling Step 1 {#sec-11-ncac-11b-.0125 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11B .0125}

History

  • Status: repealed
  • Authority G.S. 58-7.5; 58-9; 58-2-40; 58-5-1; 58-5-5; 58-5-10; 5-5-50
  • Eff. July 1, 1986
  • Amended Eff. July 1, 1986
  • Amended Eff. April 1, 1993
  • Repealed Eff. March 1, 2004.
11 NCAC 11B .0126 Master Trust Use Procedural Handling Step 2 {#sec-11-ncac-11b-.0126 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11B .0126}

History

  • Status: repealed
  • Authority G.S. 58-7.5; 58-9; 58-2-40; 58-5-1; 58-5-5; 58-5-10; 5-5-50
  • Eff. July 1, 1986
  • Amended Eff. July 1, 1986
  • Amended Eff. April 1, 1993
  • Repealed Eff. March 1, 2004.
11 NCAC 11B .0127 Master Trust Use Procedural Handling Step 3 {#sec-11-ncac-11b-.0127 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11B .0127}

History

  • Status: repealed
  • Authority G.S. 58-7.5; 58-9; 58-2-40; 58-5-1; 58-5-5; 58-5-10; 5-5-50
  • Eff. July 1, 1986
  • Amended Eff. July 1, 1986
  • Amended Eff. April 1, 1993
  • Repealed Eff. March 1, 2004.
11 NCAC 11B .0128 Master Trust Use Procedural Handling Step 4 {#sec-11-ncac-11b-.0128 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11B .0128}

History

  • Status: repealed
  • Authority G.S. 58-7.5; 58-9; 58-2-40; 58-5-1; 58-5-5; 58-5-10; 5-5-50
  • Eff. July 1, 1986
  • Amended Eff. July 1, 1986
  • Amended Eff. April 1, 1993
  • Repealed Eff. March 1, 2004.
11 NCAC 11B .0129 Master Trust Use Procedural Handling Step 5 {#sec-11-ncac-11b-.0129 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11B .0129}

History

  • Status: repealed
  • Authority G.S. 58-7.5; 58-9; 58-2-40; 58-5-1; 58-5-5; 58-5-10; 5-5-50
  • Eff. July 1, 1986
  • Amended Eff. July 1, 1986
  • Amended Eff. April 1, 1993
  • Repealed Eff. March 1, 2004.
11 NCAC 11B .0130 Master Trust Solvent Companies {#sec-11-ncac-11b-.0130 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11B .0130}

History

  • Status: repealed
  • Authority G.S. 58-7.5; 58-9; 58-2-40; 58-5-1; 58-5-5; 58-5-10; 5-5-50
  • Eff. July 1, 1986
  • Amended Eff. July 1, 1986
  • Amended Eff. April 1, 1993
  • Repealed Eff. March 1, 2004.
11 NCAC 11B .0131 Master Trust Insolvent Companies {#sec-11-ncac-11b-.0131 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11B .0131}

History

  • Status: repealed
  • Authority G.S. 58-7.5; 58-9; 58-2-40; 58-5-1; 58-5-5; 58-5-10; 5-5-50
  • Eff. July 1, 1986
  • Amended Eff. July 1, 1986
  • Amended Eff. April 1, 1993
  • Repealed Eff. March 1, 2004.
11 NCAC 11B .0132 Deposit Required Amount Foreign Life Insurers {#sec-11-ncac-11b-.0132 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11B .0132}

History

  • Status: repealed
  • Authority G.S. 58-7.5; 58-9
  • Eff. July 1, 1986
  • Repealed Eff. April 1, 1993.
11 NCAC 11B .0133 Deposit/Amount Foreign Fire and/or Casualty Insurers {#sec-11-ncac-11b-.0133 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11B .0133}

History

  • Status: repealed
  • Authority G.S. 58-7.5; 58-9
  • Eff. July 1, 1986
  • Repealed Eff. March 1, 2004.
11 NCAC 11B .0134 Deposit Required Amount Domestic Life Insurers {#sec-11-ncac-11b-.0134 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11B .0134}

History

  • Status: repealed
  • Authority G.S. 58-7.5; 58-9
  • Eff. July 1, 1986
  • Repealed Eff. March 1, 2004.
11 NCAC 11B .0135 Deposit/Amount Domestic Fire and/or Casualty Insurers {#sec-11-ncac-11b-.0135 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11B .0135}

History

  • Status: repealed
  • Authority G.S. 58-7.5; 58-9
  • Eff. July 1, 1986
  • Repealed Eff. March 1, 2004.
11 NCAC 11B .0136 Foreign Deposit Required Amount Foreign Misc Insurers {#sec-11-ncac-11b-.0136 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11B .0136}

History

  • Status: repealed
  • Authority G.S. 58-7.5; 58-9
  • Eff. July 1, 1986
  • Repealed Eff. March 1, 2004.
11 NCAC 11B .0137 Deposit Required Amount Domestic Miscellaneous Insurers {#sec-11-ncac-11b-.0137 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11B .0137}

History

  • Status: repealed
  • Authority G.S. 58-7.5; 58-9
  • Eff. July 1, 1986
  • Repealed Eff. March 1, 2004.
11 NCAC 11B .0138 Types of Securities Eligible for Deposit {#sec-11-ncac-11b-.0138 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11B .0138}

History

  • Status: repealed
  • Authority G.S. 58-7.5; 58-9
  • Eff. July 1, 1986
  • Repealed Eff. April 1, 1994.
11 NCAC 11B .0139 Deposit Use of Master Trust All New Companies {#sec-11-ncac-11b-.0139 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11B .0139}

History

  • Status: repealed
  • Authority G.S. 58-7.5; 58-9
  • Eff. July 1, 1986
  • Repealed Eff. March 1, 2004.
11 NCAC 11B .0140 Use of Master Trust All Existing Companies Transferred {#sec-11-ncac-11b-.0140 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11B .0140}

History

  • Status: repealed
  • Authority G.S. 58-7.5; 58-9
  • Eff. July 1, 1986
  • Repealed Eff. February 1, 1996.
11 NCAC 11B .0141 Use of Master Trust Increase Deposit Existing Companies {#sec-11-ncac-11b-.0141 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11B .0141}

History

  • Status: repealed
  • Authority G.S. 58-7.5; 58-9
  • Eff. July 1, 1986
  • Repealed Eff. April 1, 1996.
11 NCAC 11B .0142 Conversion from State Treasurer to Master Trust Bank {#sec-11-ncac-11b-.0142 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11B .0142}

History

  • Status: repealed
  • Authority G.S. 58-7.5; 58-9
  • Eff. July 1, 1986
  • Repealed Eff. February 1, 1996.
11 NCAC 11B .0143 Master Trust Purpose of Deposit {#sec-11-ncac-11b-.0143 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11B .0143}

History

  • Status: repealed
  • Authority G.S. 58-7.5; 58-9; 58-82.4
  • Eff. July 1, 1986
  • Repealed Eff. April 1, 1993.
11 NCAC 11B .0144 Master Trust Dk Transaction {#sec-11-ncac-11b-.0144 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11B .0144}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-5-1; 58-7.5; 58-9; 58-9(1); 58-5-30; 58-5-63
  • Eff. July 1, 1986
  • Amended Eff. February 1, 1996
  • Repealed Eff. March 1, 2004.
11 NCAC 11B .0145 Master Trust Charges {#sec-11-ncac-11b-.0145 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11B .0145}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-5-1; 58-7.5; 58-9; 58-9(1); 58-5-30; 58-5-63
  • Eff. July 1, 1986
  • Amended Eff. February 1, 1996
  • Repealed Eff. March 1, 2004.
11 NCAC 11B .0146 Master Trust Bank Ability to Register Securities {#sec-11-ncac-11b-.0146 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11B .0146}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-5-1; 58-7.5; 58-9; 58-9(1); 58-5-30; 58-5-63
  • Eff. July 1, 1986
  • Amended Eff. February 1, 1996
  • Repealed Eff. March 1, 2004.
11 NCAC 11B .0147 Use of Federal Book Entry/Depository Trust Corp/Shipping {#sec-11-ncac-11b-.0147 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11B .0147}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-5-1; 58-7.5; 58-9; 58-9(1); 58-5-30; 58-5-63
  • Eff. July 1, 1986
  • Amended Eff. February 1, 1996
  • Repealed Eff. March 1, 2004.
11 NCAC 11B .0148 Master Trust Conversion to Cash {#sec-11-ncac-11b-.0148 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11B .0148}

History

  • Status: repealed
  • Authority G.S. 58-7.5; 58-9
  • Eff. July 1, 1986
  • Repealed Eff. February 1, 1996.
11 NCAC 11B .0149 Master Trust Use of Dtc {#sec-11-ncac-11b-.0149 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11B .0149}

History

  • Status: repealed
  • Authority G.S. 58-7.5; 58-9
  • Eff. July 1, 1986
  • Repealed Eff. March 1, 2004.
11 NCAC 11B .0150 Master Trust-Release of Securities {#sec-11-ncac-11b-.0150 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11B .0150}

History

  • Status: repealed
  • Authority G.S. 58-7.5; 58-9
  • Eff. July 1, 1986
  • Repealed Eff. March 1, 2004.
11 NCAC 11B .0151 Master Trust - Payment of Interest {#sec-11-ncac-11b-.0151 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11B .0151}

History

  • Status: repealed
  • Authority G.S. 58-7.5; 58-9
  • Eff. July 1, 1986
  • Repealed Eff. March 1, 2004.
11 NCAC 11B .0152 Custody Agreement for Securities and Other Assets Deposited with the Commissioner {#sec-11-ncac-11b-.0152 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11B .0152}

The agreement between the Commissioner and the master trustee shall provide for the deposit of securities and other assets required by the Commissioner, pursuant to G.S. 58 and G.S. 97-185, to be transferred to and held by the master trustee. The securities and other assets held in the respective accounts of the companies shall be pledged and held on behalf of the Commissioner for the protection of the companies' policyholders in accordance with the North Carolina General Statutes. The agreement shall set forth procedures and policies that shall be followed by the master trustee to safeguard the interests of policyholders of the companies in the safekeeping of the securities and other assets received and held on behalf of the Commissioner.

History

  • Authority G.S. 58-2-40; 58-5-1
  • Eff. July 1, 2004
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 20, 2015.
11 NCAC 11B .0201 Holding Companies: General Nature {#sec-11-ncac-11b-.0201 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11B .0201}

History

  • Status: repealed
  • Authority G.S. 58-9
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. July 1, 1988.
11 NCAC 11B .0202 Registration: Statement of Applicability or Exemption {#sec-11-ncac-11b-.0202 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11B .0202}

History

  • Status: repealed
  • Authority G.S. 58-124.1; 58-124.2; 58-124.3(c); 58-124.6
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. April 1, 1993.
11 NCAC 11B .0203 Dividends: Distributions in Violation of G.s. 58-124.3(c) {#sec-11-ncac-11b-.0203 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11B .0203}

History

  • Status: repealed
  • Authority G.S. 58-124.1; 58-124.2; 58-124.3(c); 58-124.6
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. April 1, 1993.
11 NCAC 11B .0204 Materiality {#sec-11-ncac-11b-.0204 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11B .0204}

History

  • Status: repealed
  • Authority G.S. 58-124.1; 58-124.2; 58-124.3(c); 58-124.6
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. April 1, 1993.
11 NCAC 11B .0205 Registration: Requirement and Form {#sec-11-ncac-11b-.0205 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11B .0205}

History

  • Status: repealed
  • Authority G.S. 58-124.1; 58-124.2; 58-124.3(c); 58-124.6
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. April 1, 1993.
11 NCAC 11B .0206 Copies: Size and Form of Form Hc {#sec-11-ncac-11b-.0206 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11B .0206}

History

  • Status: repealed
  • Authority G.S. 58-124.1; 58-124.2; 58-124.3(c); 58-124.6
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. April 1, 1993.
11 NCAC 11B .0207 Amendments to Form Hc {#sec-11-ncac-11b-.0207 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11B .0207}

History

  • Status: repealed
  • Authority G.S. 58-124.1; 58-124.2; 58-124.3(c); 58-124.6
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. April 1, 1993.
11 NCAC 11B .0208 Exemptions from Filing Form Hc {#sec-11-ncac-11b-.0208 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11B .0208}

History

  • Status: repealed
  • Authority G.S. 58-124.1; 58-124.2; 58-124.3(c); 58-124.6
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. April 1, 1993.
11 NCAC 11B .0209 Alternative and Consolidated Registrations: Form Hc {#sec-11-ncac-11b-.0209 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11B .0209}

History

  • Status: repealed
  • Authority G.S. 58-124.1; 58-124.2; 58-124.3(c); 58-124.6
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. April 1, 1993.
11 NCAC 11B .0210 Disclaimers and Termination of Registration Under Form Hc {#sec-11-ncac-11b-.0210 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11B .0210}

History

  • Status: repealed
  • Authority G.S. 58-124.1; 58-124.2; 58-124.3(c); 58-124.6
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. April 1, 1993.
11 NCAC 11B .0211 Who Must File the Initial Statement Form Hc {#sec-11-ncac-11b-.0211 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11B .0211}

History

  • Status: repealed
  • Authority G.S. 58-124.1 to 58-124.11
  • Eff. February 28, 1978
  • Repealed Eff. April 1, 1993.
11 NCAC 11B .0212 Foreign Companies Exempt If Applicable {#sec-11-ncac-11b-.0212 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11B .0212}

History

  • Status: repealed
  • Authority G.S. 58-124.1 to 58-124.11
  • Eff. February 28, 1978
  • Repealed Eff. April 1, 1993.
11 NCAC 11B .0213 When to File the Hc Statement Initial {#sec-11-ncac-11b-.0213 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11B .0213}

History

  • Status: repealed
  • Authority G.S. 58-124.1 to 58-124.11
  • Eff. February 28, 1978
  • Repealed Eff. April 1, 1993.
11 NCAC 11B .0214 When to File Amendments to the Initial Statement Form Hc {#sec-11-ncac-11b-.0214 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11B .0214}

History

  • Status: repealed
  • Authority G.S. 58-124.1 to 58-124.11
  • Eff. February 28, 1978
  • Repealed Eff. April 1, 1993.
11 NCAC 11B .0215 Definitions {#sec-11-ncac-11b-.0215 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11B .0215}

History

  • Status: expired
  • Authority G.S. 58-2-40; 58-19-15; 58-19-25; 58-19-30
  • Eff. April 1, 1993
  • Amended Eff. June 1, 2007
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 20, 2015
  • Expired Eff. January 1, 2026 pursuant G.S. 150B-21.3A.
11 NCAC 11B .0216 Forms - General Requirements {#sec-11-ncac-11b-.0216 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11B .0216}

History

  • Status: expired
  • Authority G.S. 58-2-40; 58-19-15; 58-19-25; 58-19-30
  • Eff. April 1, 1993
  • Amended Eff. June 1, 2007
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 20, 2015
  • Expired Eff. January 1, 2026 pursuant G.S. 150B-21.3A.
11 NCAC 11B .0217 Acquisition of Control - Statement Filing {#sec-11-ncac-11b-.0217 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11B .0217}

History

  • Status: expired
  • Authority G.S. 58-2-40; 58-19-15; 58-19-25; 58-19-30
  • Eff. April 1, 1993
  • Amended Eff. June 1, 2007
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 20, 2015
  • Expired Eff. January 1, 2026 pursuant G.S. 150B-21.3A.
11 NCAC 11B .0218 Acquisition of Control - Source of Consideration {#sec-11-ncac-11b-.0218 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11B .0218}

History

  • Status: expired
  • Authority G.S. 58-2-40; 58-19-15; 58-19-25; 58-19-30
  • Eff. April 1, 1993
  • Amended Eff. June 1, 2007
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 20, 2015
  • Expired Eff. January 1, 2026 pursuant G.S. 150B-21.3A.
11 NCAC 11B .0219 Annual Registration of Insurers - Statement Filing {#sec-11-ncac-11b-.0219 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11B .0219}

History

  • Status: expired
  • Authority G.S. 58-2-40; 58-19-15; 58-19-25; 58-19-30
  • Eff. April 1, 1993
  • Amended Eff. June 1, 2007
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 20, 2015
  • Expired Eff. January 1, 2026 pursuant G.S. 150B-21.3A.
11 NCAC 11B .0220 Alternative and Consolidated Registrations {#sec-11-ncac-11b-.0220 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11B .0220}

History

  • Status: expired
  • Authority G.S. 58-2-40; 58-19-15; 58-19-25; 58-19-30
  • Eff. April 1, 1993
  • Amended Eff. June 1, 2007
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 20, 2015
  • Expired Eff. January 1, 2026 pursuant G.S. 150B-21.3A.
11 NCAC 11B .0221 Disclaimers and Termination of Registration {#sec-11-ncac-11b-.0221 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11B .0221}

History

  • Status: expired
  • Authority G.S. 58-2-40; 58-19-15; 58-19-25; 58-19-30
  • Eff. April 1, 1993
  • Amended Eff. June 1, 2007
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 20, 2015
  • Expired Eff. January 1, 2026 pursuant G.S. 150B-21.3A.
11 NCAC 11B .0222 Transactions Subject to Prior Notice - Notice Filing {#sec-11-ncac-11b-.0222 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11B .0222}

History

  • Status: expired
  • Authority G.S. 58-2-40; 58-19-15; 58-19-25; 58-19-30
  • Eff. April 1, 1993
  • Amended Eff. June 1, 2007
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 20, 2015
  • Expired Eff. January 1, 2026 pursuant G.S. 150B-21.3A.
11 NCAC 11B .0223 aDEQUACY OF SURPLUS {#sec-11-ncac-11b-.0223 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11B .0223}

History

  • Status: expired
  • Authority G.S. 58-2-40; 58-19-15; 58-19-25; 58-19-30
  • Eff. April 1, 1993
  • Amended Eff. June 1, 2007
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 20, 2015
  • Expired Eff. January 1, 2026 pursuant G.S. 150B-21.3A.
11 NCAC 11B .0301 Variable Annuities: General Nature {#sec-11-ncac-11b-.0301 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11B .0301}

History

  • Status: repealed
  • Authority G.S. 58-4; 58-9; 58-79(2)
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. July 1, 1988.
11 NCAC 11B .0302 Qualification to Issue Variable Annuities {#sec-11-ncac-11b-.0302 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11B .0302}

History

  • Status: repealed
  • Authority G.S. 58-79.2
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. February 1, 1996.
11 NCAC 11B .0303 Information Required Prior to Approval {#sec-11-ncac-11b-.0303 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11B .0303}

Any licensed life insurance company desiring permission to amend its license to include the authority to write variable contracts shall file the following with the Commissioner:

(1) copies of all laws and regulations under which the company is authorized in its state of domicile to issue variable contracts;

(2) a description of the method of operations of the company in its state of domicile as regarding variable contracts, the description to include, method or methods of marketing the variable contracts and the number of years the company has issued such contracts;

(3) a description of the company's proposed method of operation in the State of North Carolina; which description shall include the method or methods of marketing the variable contracts, the types of contracts to be issued, and the criteria followed by the company in the selection of agents to sell the variable contracts;

(4) copies of all pertinent documents, including;

(a) corporate resolutions that indicate that one or more separate accounts have been established and funded by the company for the purpose of issuing variable contracts;

(b) the prospectus or offering memorandum filed with and declared effective by the Securities and Exchange Commission.

(5) certified copies of the separate accounts annual statements as filed with domiciliary state for the three years prior to the request for such authority in the State of North Carolina;

(6) a statement from the company indicating the other states in which the company has applied for permission to write variable contracts and further indicating if the state has approved or disapproved the application; and if disapproved, the reason or reasons for disapproval.

The Commissioner may deny permission to any company failing to submit the information in this Rule; however, companies who cannot comply with Item (5) of this Rule will be considered on a case by case basis if all other information is satisfactory.

History

  • Authority G.S. 58-2-40; 58-7-95
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Amended Eff. February 1, 1996
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 20, 2015.
11 NCAC 11B .0304 Foreign Companies: Variable Annuity Laws {#sec-11-ncac-11b-.0304 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11B .0304}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-7-95
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Amended Eff. April 1, 1993
  • Repealed Eff. February 1, 1996.
11 NCAC 11B .0305 Separate Accounts of Domestic Life Insurance Company {#sec-11-ncac-11b-.0305 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11B .0305}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-7-95
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Amended Eff. April 1, 1993
  • Repealed Eff. February 1, 1996.
11 NCAC 11B .0401 Workmen's Compensation: General Nature {#sec-11-ncac-11b-.0401 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11B .0401}

History

  • Status: repealed
  • Authority G.S. 58-9
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. July 1, 1988.
11 NCAC 11B .0402 Stock Workmen's Compensation Security Fund Created {#sec-11-ncac-11b-.0402 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11B .0402}

History

  • Status: repealed
  • Authority G.S. 97-107; 97-108; 97-109; 97-111; 97-112; 97-114; 97-115; 97-116
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. April 1, 1993.
11 NCAC 11B .0403 Mutual Workmens' Compensation Security Fund Created {#sec-11-ncac-11b-.0403 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11B .0403}

History

  • Status: repealed
  • Authority G.S. 97-107; 97-108; 97-109; 97-111; 97-112; 97-114; 97-115; 97-116
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. April 1, 1993.
11 NCAC 11B .0404 Investments of Funds to Be in Coupon Form {#sec-11-ncac-11b-.0404 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11B .0404}

History

  • Status: repealed
  • Authority G.S. 97-107; 97-108; 97-109; 97-111; 97-112; 97-114; 97-115; 97-116
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. April 1, 1993.
11 NCAC 11B .0405 Verified Reports of Premiums to Be Filed {#sec-11-ncac-11b-.0405 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11B .0405}

History

  • Status: repealed
  • Authority G.S. 97-107; 97-108; 97-109; 97-111; 97-112; 97-114; 97-115; 97-116
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. April 1, 1993.
11 NCAC 11B .0406 Contributions: Stock and Mutual Carriers {#sec-11-ncac-11b-.0406 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11B .0406}

History

  • Status: repealed
  • Authority G.S. 97-107; 97-108; 97-109; 97-111; 97-112; 97-114; 97-115; 97-116
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. April 1, 1993.
11 NCAC 11B .0407 Call for One Percent Assessment Stock and Mutual {#sec-11-ncac-11b-.0407 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11B .0407}

History

  • Status: repealed
  • Authority G.S. 97-107; 97-108; 97-109; 97-111; 97-112; 97-114; 97-115; 97-116
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. April 1, 1993.
11 NCAC 11B .0501 Promoting and Holding Companies: General Nature {#sec-11-ncac-11b-.0501 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11B .0501}

History

  • Status: repealed
  • Authority G.S. 58-120 to 58-124
  • Eff. February 28, 1978
  • Repealed Eff. April 1, 1993.
11 NCAC 11B .0502 Foreign Promoting: Holding Companies Licensed Subsidiaries {#sec-11-ncac-11b-.0502 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11B .0502}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-18-1 to 58-18-25; 58-120 to 58-124
  • Eff. February 28, 1978
  • Amended Eff. April 1, 1993
  • Repealed Eff. September 1, 2002.
11 NCAC 11B .0503 Foreign and Holding Companies: Unlicensed Subsidiaries {#sec-11-ncac-11b-.0503 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11B .0503}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-18-1 to 58-18-25; 58-120 to 58-124
  • Eff. February 28, 1978
  • Amended Eff. April 1, 1993
  • Repealed Eff. September 1, 2002.
11 NCAC 11B .0504 Sale of Securities by Foreign Corporation {#sec-11-ncac-11b-.0504 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11B .0504}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-18-1 to 58-18-25; 58-120 to 58-124
  • Eff. February 28, 1978
  • Amended Eff. April 1, 1993
  • Repealed Eff. September 1, 2002.
11 NCAC 11B .0505 Foreign Promoting and Holding Companies Definitions {#sec-11-ncac-11b-.0505 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11B .0505}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-18-1 to 58-18-25; 58-120 to 58-124
  • Eff. February 28, 1978
  • Amended Eff. April 1, 1993
  • Repealed Eff. September 1, 2002.
11 NCAC 11B .0506 Foreign Company Securities Sale: "position Letter" {#sec-11-ncac-11b-.0506 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11B .0506}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-2-100; 58-2-133; 58-18-1 to 58-18-25; 78A-17-(8)
  • Eff. April 1, 1993
  • Repealed Eff. September 1, 2002.
11 NCAC 11B .0507 Foreign Company Securities: Private Placement {#sec-11-ncac-11b-.0507 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11B .0507}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-2-100; 58-2-133; 58-18-1 to 58-18-25; 78A-17-(8)
  • Eff. April 1, 1993
  • Repealed Eff. September 1, 2002.
11 NCAC 11B .0508 Foreign Company Securities: Verifiable Capital/Surplus {#sec-11-ncac-11b-.0508 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11B .0508}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-2-100; 58-2-133; 58-18-1 to 58-18-25; 78A-17-(8)
  • Eff. April 1, 1993
  • Repealed Eff. September 1, 2002.
11 NCAC 11B .0509 Foreign Company Securities: Inconsequential Insurance Ratios {#sec-11-ncac-11b-.0509 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11B .0509}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-2-100; 58-2-133; 58-18-1 to 58-18-25; 78A-17-(8)
  • Eff. April 1, 1993
  • Repealed Eff. September 1, 2002.
11 NCAC 11B .0510 Foreign Company Securities: Confidentiality of Material {#sec-11-ncac-11b-.0510 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11B .0510}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-2-100; 58-2-133; 58-18-1 to 58-18-25; 78A-17-(8)
  • Eff. April 1, 1993
  • Repealed Eff. September 1, 2002.
11 NCAC 11B .0511 Foreign Company Securities: Shelf Registration {#sec-11-ncac-11b-.0511 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11B .0511}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-2-100; 58-2-133; 58-18-1 to 58-18-25; 78A-17-(8)
  • Eff. April 1, 1993
  • Repealed Eff. September 1, 2002.
11 NCAC 11B .0512 Foreign Company Securities: Disclaimer Offshore {#sec-11-ncac-11b-.0512 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11B .0512}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-2-100; 58-2-133; 58-18-1 to 58-18-25; 78A-17-(8)
  • Eff. April 1, 1993
  • Repealed Eff. September 1, 2002.
11 NCAC 11B .0513 Foreign Company Securities: Disclaimer General {#sec-11-ncac-11b-.0513 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11B .0513}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-2-100; 58-2-133; 58-18-1 to 58-18-25; 78A-17-(8)
  • Eff. April 1, 1993
  • Repealed Eff. September 1, 2002.
11 NCAC 11B .0514 Formation of Domestic Companies: Procedural Handling Step 1 {#sec-11-ncac-11b-.0514 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11B .0514}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-2-100; 58-2-133; 58-18-1 to 58-18-25; 78A-17-(8)
  • Eff. April 1, 1993
  • Repealed Eff. September 1, 2002.
11 NCAC 11B .0515 Foreign Company Securities: Institutional Investors {#sec-11-ncac-11b-.0515 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11B .0515}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-2-100; 58-2-133; 58-18-1 to 58-18-25; 78A-17-(8)
  • Eff. April 1, 1993
  • Repealed Eff. September 1, 2002.
11 NCAC 11B .0516 Domestic Company: Projection {#sec-11-ncac-11b-.0516 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11B .0516}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-2-100; 58-2-133; 58-18-1 to 58-18-25; 78A-17-(8)
  • Eff. April 1, 1993
  • Repealed Eff. September 1, 2002.
11 NCAC 11B .0517 Domestic Company: Background Investigation Report {#sec-11-ncac-11b-.0517 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11B .0517}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-2-100; 58-2-133; 58-18-1 to 58-18-25; 78A-17-(8)
  • Eff. April 1, 1993
  • Repealed Eff. September 1, 2002.
11 NCAC 11B .0518 Domestic Company: Escrow Agreement {#sec-11-ncac-11b-.0518 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11B .0518}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-2-100; 58-2-133; 58-18-1 to 58-18-25; 78A-17-(8)
  • Eff. April 1, 1993
  • Repealed Eff. September 1, 2002.
11 NCAC 11B .0601 Definitions {#sec-11-ncac-11b-.0601 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11B .0601}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-2-131; 58-2-132; 58-2-133; 58-2-145; 58-2-171; 58-2-205; 97-93; 97-136
  • 105-228.9
  • Eff. October 1, 1990
  • Amended Eff. April 1, 1996; February 1, 1996; April 1, 1993
  • Repealed Eff. August 1, 1998.
11 NCAC 11B .0602 Administration - All Self-Insurers {#sec-11-ncac-11b-.0602 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11B .0602}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-2-131; 58-2-132; 58-2-133; 58-2-145; 58-2-171; 58-2-205; 97-93; 97-136
  • 105-228.9
  • Eff. October 1, 1990
  • Amended Eff. April 1, 1996; February 1, 1996; April 1, 1993
  • Repealed Eff. August 1, 1998.
11 NCAC 11B .0603 Excess Insurance Policies - All Self-Insurers {#sec-11-ncac-11b-.0603 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11B .0603}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-2-131; 58-2-132; 58-2-133; 58-2-145; 58-2-171; 58-2-205; 97-93; 97-136
  • 105-228.9
  • Eff. October 1, 1990
  • Amended Eff. April 1, 1996; February 1, 1996; April 1, 1993
  • Repealed Eff. August 1, 1998.
11 NCAC 11B .0604 Reports - All Self-Insurers {#sec-11-ncac-11b-.0604 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11B .0604}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-2-131; 58-2-132; 58-2-133; 58-2-145; 58-2-171; 58-2-205; 97-93; 97-136
  • 105-228.9
  • Eff. October 1, 1990
  • Amended Eff. April 1, 1996; February 1, 1996; April 1, 1993
  • Repealed Eff. August 1, 1998.
11 NCAC 11B .0605 Deposits or Surety Bonds - All Self-Insurers {#sec-11-ncac-11b-.0605 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11B .0605}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-2-131; 58-2-132; 58-2-133; 58-2-145; 58-2-171; 58-2-205; 97-93; 97-136
  • 105-228.9
  • Eff. October 1, 1990
  • Amended Eff. April 1, 1996; February 1, 1996; April 1, 1993
  • Repealed Eff. August 1, 1998.
11 NCAC 11B .0606 Securities Withdrawal or Exchange - All Self-Insurers {#sec-11-ncac-11b-.0606 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11B .0606}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-2-131; 58-2-132; 58-2-133; 58-2-145; 58-2-171; 58-2-205; 97-93; 97-136
  • 105-228.9
  • Eff. October 1, 1990
  • Amended Eff. April 1, 1996; February 1, 1996; April 1, 1993
  • Repealed Eff. August 1, 1998.
11 NCAC 11B .0607 Application - Employers {#sec-11-ncac-11b-.0607 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11B .0607}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 97-93
  • ARRC Objection Lodged August 16, 1990
  • Eff. January 1, 1991
  • Amended Eff. February 1, 1996; May 1, 1993
  • Repealed Eff. August 1, 1998.
11 NCAC 11B .0608 Deposits: Bonds: Excess Insurance - Employers {#sec-11-ncac-11b-.0608 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11B .0608}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-2-145; 97-93
  • Eff. October 1, 1990
  • Amended Eff. April 1, 1993
  • Repealed Eff. August 1, 1998.
11 NCAC 11B .0609 Reports - Employers {#sec-11-ncac-11b-.0609 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11B .0609}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-2-145; 97-93
  • Eff. October 1, 1990
  • Amended Eff. April 1, 1993
  • Repealed Eff. August 1, 1998.
11 NCAC 11B .0610 Application - Groups {#sec-11-ncac-11b-.0610 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11B .0610}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-2-145; 97-93
  • ARRC Objection Lodged August 16, 1990
  • Eff. January 1, 1991
  • Amended Eff. February 1, 1996; May 1, 1993
  • Repealed Eff. August 1, 1998.
11 NCAC 11B .0611 Deposits: Bonds: Excess Insurance - Groups {#sec-11-ncac-11b-.0611 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11B .0611}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-2-145; 58-2-165; 58-2-171; 97-93
  • Eff. October 1, 1990
  • Amended Eff. February 1, 1996; January 1, 1994; April 1, 1993
  • Repealed Eff. August 1, 1998.
11 NCAC 11B .0612 Reports - Groups {#sec-11-ncac-11b-.0612 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11B .0612}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-2-145; 58-2-165; 58-2-171; 97-93
  • Eff. October 1, 1990
  • Amended Eff. February 1, 1996; January 1, 1994; April 1, 1993
  • Repealed Eff. August 1, 1998.
11 NCAC 11B .0613 Group Responsibilities {#sec-11-ncac-11b-.0613 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11B .0613}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-2-145; 58-2-165; 58-2-171; 97-93
  • Eff. October 1, 1990
  • Amended Eff. February 1, 1996; January 1, 1994; April 1, 1993
  • Repealed Eff. August 1, 1998.
11 NCAC 11B .0614 Admission and Termination of Group Members {#sec-11-ncac-11b-.0614 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11B .0614}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-2-145; 58-2-165; 58-2-171; 97-93
  • Eff. October 1, 1990
  • Amended Eff. February 1, 1996; January 1, 1994; April 1, 1993
  • Repealed Eff. August 1, 1998.
11 NCAC 11B .0615 Payment of Dividends by Group Funds or Associations {#sec-11-ncac-11b-.0615 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11B .0615}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 97-93(b)
  • Eff. April 1, 1993
  • Repealed Eff. August 1, 1998.
11 NCAC 11B .0616 Insolvency or Hazardous Financial Condition {#sec-11-ncac-11b-.0616 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11B .0616}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-2-145; 58-30-60; 97-93; 97-136
  • Eff. February 1, 1996
  • Repealed Eff. August 1, 1998.
11 NCAC 11B .0617 Group Assessments, Disclosure, Deviations, and Dividends {#sec-11-ncac-11b-.0617 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11B .0617}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-2-145; 58-8-35; 58-30-60; 58--36-30; 97-93; 97-136
  • Eff. April 1, 1996
  • Repealed Eff. August 1, 1998.

Subchapter C

11 NCAC 11C .0101 General Provisions {#sec-11-ncac-11c-.0101 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11C .0101}

History

  • Status: repealed
  • Authority G.S. 58-9
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. July 1, 1988.
11 NCAC 11C .0102 Form of Report on Examination {#sec-11-ncac-11c-.0102 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11C .0102}

History

  • Status: expired
  • Authority G.S. 58-2-40; 58-2-131; 58-2-140; 58-65-105
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Amended Eff. April 1, 1993
  • Expired Eff. January 1, 2016 pursuant to G.S. 150B-21.3A.
11 NCAC 11C .0103 Reproduction of Reports on Examination {#sec-11-ncac-11c-.0103 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11C .0103}

History

  • Status: expired
  • Authority G.S. 58-2-40; 58-2-131; 58-2-140; 58-65-105
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Amended Eff. April 1, 1993
  • Expired Eff. January 1, 2016 pursuant to G.S. 150B-21.3A.
11 NCAC 11C .0104 Record of Business to Be Kept by Company {#sec-11-ncac-11c-.0104 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11C .0104}

Every insurance company licensed to transact business in the State of North Carolina must make and keep a full and correct record of the business done by it including, the policy number, date of issue, term, amount insured, premiums, full name and complete address of policyholder and other pertinent information as may be required by the Commissioner of Insurance.

History

  • Authority G.S. 58-2-40; 58-2-185
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 20, 2015.
11 NCAC 11C .0105 Retention of Records of Domestic Insurance Companies {#sec-11-ncac-11c-.0105 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11C .0105}

(a) All records of domestic insurance companies shall be maintained by the company for the years for which a statutory examination has not yet been completed. All books of original entry and corporate records shall be retained by the company or its successor for a period of 25 years after the company ceases to exist.

(b) Any claim file wherein a minor is involved shall be maintained until that minor has attained the age of majority for third-party liability coverage. All tax and tax related questions or litigation shall be resolved or finally adjudicated before the destruction of any records related thereto.

(c) All records that are required to be maintained by this Rule shall be either original or duplicate records, as defined in this Rule.

(d) For the purpose of this Rule, an "original record" is the writing or recording itself or any counterpart intended to have the same effect by a person executing or issuing it. An "original" of a photograph includes the negative or any print therefrom. If data are, in the normal and ordinary course of business, stored in a computer or similar device, any printout or other output readable by sight, shown to reflect the data accurately, is an "original record".

(e) For the purpose of this Rule, a "duplicate record" is a counterpart produced by the same impression as the original record, or from the same matrix, or by mechanical or electronic re-recording or by chemical reproduction, or by equivalent techniques, such as imaging or image processing, that accurately reproduce the original record.

(f) If only duplicate records are maintained, the following requirements must be met:

(1) The data must be easily accessible to the Department in readable form; and readable, reproduced copies must be obtainable;

(2) Before the destruction of any original records, the company in possession of the original records shall:

(A) Verify that the records stored consist of all information contained in the original records and that the original records can be reconstructed therefrom in a form acceptable to the Department; and

(B) Implement disaster preparedness or disaster recovery procedures that include provisions for the maintenance of duplicate records at another location; and

(3) Adequate controls must be established with respect to the transfer and maintenance of data.

(g) Every foreign insurer licensed in North Carolina shall be in substantial compliance with this Rule.

History

  • Authority G.S. 58-2-40(1); 58-2-50; 58-2-131; 58-2-132; 58-2-133; 58-2-145; 58-2-155; 58-19-35
  • 58-20-30; 58-22-20(6); 58-23-25; 58-24-135; 58-27-10; 58-39-70; 58-48-65; 58-49-55; 58-62-66
  • 58-63-20; 58-64-55; 58-65-105; 58-67-100
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Amended Eff. September 1, 1993; March 1, 1993
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 20, 2015.
11 NCAC 11C .0106 Unearned Premium Reserve: in Force Premiums {#sec-11-ncac-11c-.0106 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11C .0106}

History

  • Status: repealed
  • Authority G.S. 58-35
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. March 1, 1993.
11 NCAC 11C .0107 Reinsurance: When Permitted {#sec-11-ncac-11c-.0107 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11C .0107}

History

  • Status: repealed
  • Authority G.S. 58-59.3
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. April 1, 1993.
11 NCAC 11C .0108 Dividends to Policyholders: Department Interpretation {#sec-11-ncac-11c-.0108 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11C .0108}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-7-130; 58-8-25
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Amended Eff. April 1, 1993
  • Repealed Eff. August 1, 1998.
11 NCAC 11C .0109 Dividends to Stockholders: Department Interpretation {#sec-11-ncac-11c-.0109 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11C .0109}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-7-130; 58-8-25
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Amended Eff. April 1, 1993
  • Repealed Eff. August 1, 1998.
11 NCAC 11C .0110 Investment in Gold or Gold Futures by Insurance Companies {#sec-11-ncac-11c-.0110 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11C .0110}

History

  • Status: repealed
  • Authority G.S. 58-9(I); 58-79; 58-79.1
  • Eff. February 1, 1976
  • Repealed Eff. March 1, 2004.
11 NCAC 11C .0111 Investment in the International Bank for Reconst and Dev {#sec-11-ncac-11c-.0111 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11C .0111}

History

  • Status: repealed
  • Authority G.S. 58-9(1); 58-79; 58-79.1
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. April 1, 1993.
11 NCAC 11C .0112 Model Custodial Agreement {#sec-11-ncac-11c-.0112 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11C .0112}

History

  • Status: repealed
  • Authority G.S. 58-79; 58-79.1
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. April 1, 1996.
11 NCAC 11C .0113 Model Custodial and Fiscal Agency Agreement {#sec-11-ncac-11c-.0113 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11C .0113}

History

  • Status: repealed
  • Authority G.S. 58-79; 58-79.1
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. February 1, 1996.
11 NCAC 11C .0114 Certificates of Contribution {#sec-11-ncac-11c-.0114 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11C .0114}

Every domestic insurance company may, upon petition to the Commissioner and upon receipt of his approval thereof, issue certificates of contribution of surplus for the reasons and purposes set forth in the petition to the Commissioner.

Approval of the issuance of certificates of contributions may be granted only upon the following conditions and will be effective only as to transactions performed in conformity therewith:

(1) No certificate evidencing the contribution under authorization hereof shall be issued except substantially in the form and text as may be approved by the Commissioner.

(2) No commission, selling or other expense is to be paid or incurred in respect to any transaction authorized, except that regular salaried employees of the petitioner may perform any and all acts necessary, convenient or advisable in connection with the transactions authorized, fees may be paid for legal counsel, accounting and related services, and petitioner may incur and pay other normal expense incurred in connection with the issuance of the certificates of contribution.

(3) No advertisement, prospectus, or other writing relating to the certificates of contribution, except regular business correspondence relating to specific problems peculiar to the parties thereto, shall be issued, circulated or published until after the same has been filed with and authorized in writing by the Commissioner.

(4) At any time upon the request of the Commissioner and in any event within 30 days from and after the issuance of any certificate of contribution and after the completion of the transactions authorized, petitioner shall make and file with said commissioner its verified report setting forth the transactions accomplished pursuant to the authority granted, and setting forth the date of issuance of the certificate of contribution, the proceeds derived therefrom and the disposition of such proceeds, and petitioner shall attach to such report a conformed copy of the contribution certificates issued pursuant to said authorization.

(5) In any financial statement required by law to be filed by petitioner with the Commissioner, or which may be published or distributed by petitioner, the principal sum of and accrued interest of these and any other outstanding certificates of contribution, which has not become a liability in accordance with the terms thereof and is not reported in such financial statement as a liability, shall be reported according to the instructions for completing the appropriate NAIC financial statement blank. Such amount shall be reported on the appropriate line on page 3 of the financial statement as "certificates of contribution". Other descriptions, such as "debentures", "surplus notes", "guaranty fund", or "guaranteed certificates", are deemed misleading and are not permitted.

(6) The Commissioner may, from time to time, for cause amend, continue or alter his approval or temporarily suspend the rights of the petitioner hereunder or may revoke this authority.

(7) Unless revoked, suspended, or amended or continued upon due petition therefor filed before the expiration date hereof the authority granted hereunder is valid for a period of five years and such authority shall automatically terminate on the close of business on the last day of the month in which this authority was originally granted.

Certificates of contribution issued hereunder are not to be construed as guaranty fund certificates as specifically provided for under G.S. 58-12-1 and 58-8-20.

History

  • Authority G.S. 58-2-40; 58-7-163
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Amended Eff. April 1, 1993
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 20, 2015.
11 NCAC 11C .0115 Valuation of Bonds and Other Evidences of Debt {#sec-11-ncac-11c-.0115 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11C .0115}

History

  • Status: repealed
  • Authority G.S. 58-80
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. April 1, 1993.
11 NCAC 11C .0116 Amortized Values of Bonds or Other Evidences of Debt {#sec-11-ncac-11c-.0116 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11C .0116}

History

  • Status: repealed
  • Authority G.S. 58-80
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. April 1, 1993.
11 NCAC 11C .0117 Conflict of Interest Statements Must Be Executed Annually {#sec-11-ncac-11c-.0117 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11C .0117}

Conflict of interest statements shall be executed annually by the officers, directors, trustees, attorneys-in-fact, and administrative personnel of every domestic insurer subject to G.S. 58, Articles 1 through 67.

Any conflicts of interest disclosed thereon shall be presented to the board of directors or trustees of the company for a determination of its acceptability or the remedial disposition thereof.

History

  • Authority G.S. 58-2-40
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Amended Eff. April 1, 1993
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 20, 2015.
11 NCAC 11C .0118 Collection Procedures for Examination Expense {#sec-11-ncac-11c-.0118 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11C .0118}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-2-133(c)
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Amended Eff. April 1, 1993; January 14, 1980
  • Repealed Eff. February 1, 1996.
11 NCAC 11C .0119 Mortgage Loans to Be Sold Without Recourse {#sec-11-ncac-11c-.0119 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11C .0119}

First mortgage loans on unencumbered fee simple real estate, whether permanent term loans or construction loans, may not be sold to a third party unless the evidence of debt and the mortgage or deed of trust is physically endorsed to reflect that said mortgage loan is being sold without recourse to the insurer.

History

  • Authority G.S. 58-2-40(1); 58-7-85; 58-7-90
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 20, 2015.
11 NCAC 11C .0120 Valuation of Investments: Valuations of Securities Manual {#sec-11-ncac-11c-.0120 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11C .0120}

History

  • Status: repealed
  • Authority G.S. 58-9; 58-79; 58-79.1
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. April 1, 1994.
11 NCAC 11C .0121 Stock Options: General {#sec-11-ncac-11c-.0121 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11C .0121}

History

  • Status: repealed
  • Authority G.S. 58-79; 58-79.1
  • Eff. February 28, 1978
  • Repealed Eff. April 1, 1993.
11 NCAC 11C .0122 Sale of Exchange: Traded Call Options {#sec-11-ncac-11c-.0122 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11C .0122}

History

  • Status: repealed
  • Authority G.S. 58-79; 58-79.1
  • Eff. February 28, 1978
  • Repealed Eff. March 1, 2004.
11 NCAC 11C .0123 Purchase of Exchange: Traded Call Options {#sec-11-ncac-11c-.0123 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11C .0123}

History

  • Status: repealed
  • Authority G.S. 58-79; 58-79.1
  • Eff. February 28, 1978
  • Repealed Eff. April 1, 1993.
11 NCAC 11C .0124 Accounting Procedures {#sec-11-ncac-11c-.0124 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11C .0124}

History

  • Status: repealed
  • Authority G.S. 58-79; 58-79.1
  • Eff. February 28, 1978
  • Repealed Eff. March 1, 2004.
11 NCAC 11C .0125 Valuation {#sec-11-ncac-11c-.0125 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11C .0125}

History

  • Status: repealed
  • Authority G.S. 58-79; 58-79.1
  • Eff. February 28, 1978
  • Repealed Eff. March 1, 2004.
11 NCAC 11C .0126 Prohibition Against Speculating in Options {#sec-11-ncac-11c-.0126 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11C .0126}

History

  • Status: repealed
  • Authority G.S. 58-79; 58-79.1
  • Eff. February 28, 1978
  • Repealed Eff. March 1, 2004.
11 NCAC 11C .0127 Severability {#sec-11-ncac-11c-.0127 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11C .0127}

History

  • Status: repealed
  • Authority G.S. 58-79; 58-79.1
  • Eff. February 28, 1978
  • Repealed Eff. April 1, 1993.
11 NCAC 11C .0128 Definitions {#sec-11-ncac-11c-.0128 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11C .0128}

History

  • Status: repealed
  • Authority G.S. 58-79; 58-79.1
  • Eff. February 28, 1978
  • Repealed Eff. April 1, 1993.
11 NCAC 11C .0129 Form of Reports of Examination: Foreign Companies {#sec-11-ncac-11c-.0129 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11C .0129}

The reports on examination prepared by the domiciliary insurance department of a foreign company as a result of a triennial examination, special examination or any other type of examination of a foreign insurance company licensed to do business in North Carolina shall be certified.

History

  • Authority G.S. 58-2-40; 58-2-132
  • Eff. February 28, 1978
  • Amended Eff. April 1, 1993
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 20, 2015.
11 NCAC 11C .0130 Credit for Reinsurance {#sec-11-ncac-11c-.0130 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11C .0130}

History

  • Status: expired
  • Filed as a Temporary Adoption Eff. September 12, 1991, for a period of 180 days to expire on
  • March 10, 1992
  • Authority G.S. 58-2-40(1); 58-7-1
  • Expired March 10, 1992.
11 NCAC 11C .0131 Valuation of Debt Securities {#sec-11-ncac-11c-.0131 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11C .0131}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-7-190
  • Temporary Adoption Eff. January 1, 1992 for a period of 180 days to expire on
  • June 29, 1992
  • Eff. May 1, 1992
  • Repealed Eff. March 1, 2004.
11 NCAC 11C .0132 Accounting for Salvage and Subrogation {#sec-11-ncac-11c-.0132 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11C .0132}

History

  • Status: expired
  • Authority G.S. 58-2-40; 58-7-162
  • Eff. April 1, 1993
  • Amended Eff. February 1, 1996
  • Expired Eff. January 1, 2016 pursuant to G.S. 150B-21.3A.
11 NCAC 11C .0133 Accounting for Life and Health Reinsurance Agreements {#sec-11-ncac-11c-.0133 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11C .0133}

History

  • Status: expired
  • Authority G.S. 58-2-40; 58-7-31
  • Temporary Adoption Eff. January 21, 1994 for a period of 180 days or until the permanent rule becomes effective, whichever is sooner
  • Eff. April 1, 1994
  • Expired Eff. January 1, 2016 pursuant to G.S. 150B-21.3A.
11 NCAC 11C .0201 General Nature {#sec-11-ncac-11c-.0201 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11C .0201}

History

  • Status: repealed
  • Authority G.S. 58-9
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. July 1, 1988.
11 NCAC 11C .0202 Inventory of Capital Surplus and Reserve Investments {#sec-11-ncac-11c-.0202 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11C .0202}

History

  • Status: repealed
  • Authority G.S. 58-9(1); 58-79.1; 58-79(d)(1)
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. April 1, 1993.
11 NCAC 11C .0203 Foreign Fire: Casualty and Misc Companies: Compliance {#sec-11-ncac-11c-.0203 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11C .0203}

History

  • Status: repealed
  • Authority G.S. 58-9(1); 58-79.1; 58-79(d)(1)
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. April 1, 1993.
11 NCAC 11C .0204 Investments in Electronic Data Processing Equipment {#sec-11-ncac-11c-.0204 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11C .0204}

History

  • Status: repealed
  • Authority G.S. 58-9(1); 58-79.1; 58-79(d)(1)
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. April 1, 1993.
11 NCAC 11C .0205 Accounting for Salvage and Subrogation {#sec-11-ncac-11c-.0205 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11C .0205}

History

  • Status: repealed
  • Authority G.S. 58-16; 58-9
  • Eff. February 28, 1978
  • Repealed Eff. April 1, 1993.
11 NCAC 11C .0206 Accounting for Premium Over 90 Days Past Due {#sec-11-ncac-11c-.0206 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11C .0206}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-7-162(5)
  • Eff. April 1, 1993
  • Repealed Eff. March 1, 2004.
11 NCAC 11C .0301 General Nature {#sec-11-ncac-11c-.0301 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11C .0301}

History

  • Status: repealed
  • Authority G.S. 58-9
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. July 1, 1988.
11 NCAC 11C .0302 Inventory of Reserve: Capital and Surplus Investments {#sec-11-ncac-11c-.0302 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11C .0302}

History

  • Status: repealed
  • Authority G.S. 58-79; 58-79(a)(14)
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. April 1, 1993.
11 NCAC 11C .0303 Explanation of Basket Clause N.c.g.s. 58-79(a)(14) {#sec-11-ncac-11c-.0303 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11C .0303}

History

  • Status: repealed
  • Authority G.S. 58-79; 58-79(a)(14)
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. April 1, 1993.
11 NCAC 11C .0304 Inventory of Basket Clause Investment {#sec-11-ncac-11c-.0304 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11C .0304}

History

  • Status: repealed
  • Authority G.S. 58-79; 58-79(a)(14)
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. April 1, 1993.
11 NCAC 11C .0305 Calculation of Limitations on Basket Clause Investments {#sec-11-ncac-11c-.0305 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11C .0305}

History

  • Status: repealed
  • Authority G.S. 58-79; 58-79(a)(14)
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. April 1, 1993.
11 NCAC 11C .0306 Limitations Under Basket Clause to Previous Investments {#sec-11-ncac-11c-.0306 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11C .0306}

History

  • Status: repealed
  • Authority G.S. 58-79; 58-79(a)(14)
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. April 1, 1993.
11 NCAC 11C .0307 Financial Certification: Hmo {#sec-11-ncac-11c-.0307 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11C .0307}

After the applicant has performed, or caused to be performed, a feasibility study on the proposed operations of the HMO and has developed a specific plan of operation, this information shall be submitted to the applicant's staff actuary, a recognized actuarial consultant, or a recognized health care consultant for completion of an actuarial projection of the anticipated operational results for a three-year period based on the initial working capital of the applicant, any additional sources of funds to be provided, the proposed rate schedules, the expected number of enrollees during the period, and the applicant's plan of operation. This projection shall include the following:

(1) Certification that the amount of money actually available for working capital is sufficient to carry all acquisition costs and operating expenses for at least the three-year period and that the applicant is financially responsible and may reasonably be expected to meet its obligations to enrollees and prospective enrollees on a continuing basis;

(2) Certification that the rates to be charged by the applicant for prepaid health services are neither excessive, inadequate nor unfairly discriminatory;

(3) Determination of an adequate reinsurance program to amply protect the applicant against large claims arising in cases of major health care needs of enrollees, if the financial condition of the applicant requires such a program; and

(4) Consideration be given in the three year projection to the possible effects of adverse selection and over-utilization of services by enrollees of the applicant.

History

  • Authority G.S. 58-2-40; 58-67-10
  • Eff. April 1, 1993
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 20, 2015.
11 NCAC 11C .0308 Foreign Hmo: Successful Operation {#sec-11-ncac-11c-.0308 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11C .0308}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-67-10
  • Eff. April 1, 1993
  • Amended Eff. April 1, 1994
  • Repealed Eff. February 1, 2010.
11 NCAC 11C .0309 Admitted Assets: Hmo {#sec-11-ncac-11c-.0309 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11C .0309}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-2-40(1); 58-67-20; 58-67-110(b)
  • Eff. April 1, 1993
  • Repealed Eff. March 1, 2004.
11 NCAC 11C .0310 Reinsurance Agreements: Hmo {#sec-11-ncac-11c-.0310 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11C .0310}

Reinsurance Agreements entered into in accordance with G.S. 58-67-110(e) shall be issued by insurance carriers licensed to do business in North Carolina.

History

  • Authority G.S. 58-2-40; 58-67-110(e)
  • Eff. April 1, 1993
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 20, 2015.
11 NCAC 11C .0311 Expansion of Service Area: Hmo {#sec-11-ncac-11c-.0311 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11C .0311}

(a) Applications for expansion of service area shall provide current data stated in G.S. 58-67-10(c)(1) along with a feasibility study and market survey of the proposed area as stated in 11 NCAC 11C .0307.

(b) Applications for expansion of service area must demonstrate at least a minimum of one year of net operational gains by the applicant in the current approved service area.

(c) The requirement of Paragraph (b) may be waived by the Commissioner if additional capital as determined by the Commissioner is placed in the HMO, or if a guaranty agreement approved in writing by the Commissioner, to pay for any loss to enrollees claiming reimbursement due to the insolvency of the HMO is made. In order to qualify, the guaranteeing organization shall:

(1) submit to the jurisdiction of this State for actions arising under the guarantee;

(2) submit certified, audited annual financial statements to the Commissioner; and

(3) appoint the Commissioner to receive service of process in this State.

History

  • Authority G.S. 58-2-40; 58-67-10
  • Eff. April 1, 1993
  • Amended Eff. April 1, 1994
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 20, 2015.
11 NCAC 11C .0312 Financial Statements: Hmo {#sec-11-ncac-11c-.0312 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11C .0312}

History

  • Status: expired
  • Authority G.S. 58-2-40; 58-67-55
  • Eff. April 1, 1993
  • Expired Eff. January 1, 2016 pursuant to G.S. 150B-21.3A.
11 NCAC 11C .0313 Net Earned Income Definition: Hmo {#sec-11-ncac-11c-.0313 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11C .0313}

History

  • Status: expired
  • Authority G.S. 58-2-40; 58-67-5(i)
  • Eff. February 1, 1996
  • Expired Eff. January 1, 2016 pursuant to G.S. 150B-21.3A.
11 NCAC 11C .0401 General Nature {#sec-11-ncac-11c-.0401 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11C .0401}

History

  • Status: repealed
  • Authority G.S. 58-9; 58-9(1)
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. July 1, 1988.
11 NCAC 11C .0402 Mortgage Guaranty Insurance: Purpose {#sec-11-ncac-11c-.0402 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11C .0402}

History

  • Status: repealed
  • Authority G.S. 58-9; 58-9(1)
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. July 1, 1988.
11 NCAC 11C .0403 Accounting for Mortgage Guaranty Insurance {#sec-11-ncac-11c-.0403 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11C .0403}

Eff. February 1, 1976;

Readopted Eff. February 28, 1978;

Amended Eff. April 1, 1993;

Repealed Eff. June 1, 2007.

History

  • Authority G.S. 58-2-40; 58-2-165
11 NCAC 11C .0404 Contingency Reserve: Mortgage Guaranty Insurance {#sec-11-ncac-11c-.0404 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11C .0404}

History

  • Status: repealed
  • Authority G.S. 58-2-40(1)
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. June 1, 2007.
11 NCAC 11C .0405 Policy Forms: Mortgage Guaranty Insurance {#sec-11-ncac-11c-.0405 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11C .0405}

All policy forms and endorsements of mortgage guaranty insurance companies shall be filed with and be subject to approval of the Commissioner of Insurance.

History

  • Authority G.S. 58-2-40(1)
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 20, 2015.
11 NCAC 11C .0406 Appraisal Review Fees Are Part of Premium Charge {#sec-11-ncac-11c-.0406 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11C .0406}

Appraisal review fees, as charged by mortgage guaranty insurance companies, are considered to be a part of the premium charge for all purposes, including unearned premium reserve, and are to be included as part of the gross premiums as defined in North Carolina General Statute 105-228.5.

History

  • Authority G.S. 58-2-40(1)
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 20, 2015.
11 NCAC 11C .0407 Report of Policyholders Position – Mortgage Guaranty Insurers {#sec-11-ncac-11c-.0407 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11C .0407}

Each mortgage guaranty insurance company doing business in this State shall file with the Commissioner a Mortgage Guaranty Insurers Report of Policyholders Position form, which is available at www.ncdoi.com.

History

  • Authority G.S. 58-2-40; 58-10-120; 58-10-125
  • Eff. July 1, 2004
  • Amended Eff. June 1, 2007
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 20, 2015.
11 NCAC 11C .0501 Accredited Reinsurer - Application {#sec-11-ncac-11c-.0501 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11C .0501}

History

  • Status: expired
  • Authority G.S. 58-2-40; 58-7-21(b)(2)
  • Eff. April 1, 1993
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 20, 2015
  • Expired Eff. January 1, 2026 pursuant G.S. 150B-21.3A.
11 NCAC 11C .0502 Accredited Reinsurer - Filing Requirements {#sec-11-ncac-11c-.0502 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11C .0502}

History

  • Status: expired
  • Authority G.S. 58-2-40; 58-7-21(b)(2)
  • Eff. April 1, 1993
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 20, 2015
  • Expired Eff. January 1, 2026 pursuant G.S. 150B-21.3A.
11 NCAC 11C .0503 Accredited Reinsurer - Revocation of Accreditation {#sec-11-ncac-11c-.0503 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11C .0503}

History

  • Status: expired
  • Authority G.S. 58-2-40; 58-7-21(b)(2)
  • Eff. April 1, 1993
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 20, 2015
  • Expired Eff. January 1, 2026 pursuant G.S. 150B-21.3A.
11 NCAC 11C .0504 Trust Agreements Qualified Under G.s. 58-7-26 {#sec-11-ncac-11c-.0504 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11C .0504}

(a) As used in this Rule:

(1) "Beneficiary" means the entity for whose sole benefit the trust has been established and any successor of the beneficiary by operation of law. If a court of law appoints a receiver as successor in interest to the named beneficiary, then the named beneficiary is the court -appointed domiciliary conservator, rehabilitator, or liquidator.

(2) "Financial institution" means a qualified United States financial institution as defined in G.S. 58-7-26(c).

(3) "Grantor" means the entity that has established a trust for the sole benefit of the beneficiary. When established in conjunction with a reinsurance agreement, the grantor is the unlicensed, unaccredited assuming insurer.

(4) "Obligations" means:

(A) Reinsured losses and allocated loss expenses paid by the ceding company, but not recovered from the assuming insurer;

(B) Reserves for reinsured losses reported and outstanding;

(C) Reserves for reinsured losses incurred but not reported; and

(D) Reserves for allocated reinsured loss expenses and unearned premiums.

(b) Required conditions for trust agreements pursuant to G.S. 58-7-26.

(1) The trust agreement shall be entered into between the beneficiary, the grantor, and a trustee, which trustee shall be a qualified financial institution.

(2) The trust agreement shall create a trust account into which assets shall be deposited.

(3) All assets in the trust account shall be held by the trustee at the trustee's office in the United States.

(4) The trust agreement shall provide that:

(A) The beneficiary may withdraw assets from the trust account at any time, without notice to the grantor, subject only to written notice from the beneficiary to the trustee;

(B) No other statement or document is required to be presented in order to withdraw assets, except that the beneficiary may be required to acknowledge receipt of withdrawn assets;

(C) It is not subject to any conditions or qualifications outside of the trust agreement; and

(D) It shall not contain references to any other agreements or documents except as provided for under Subparagraph (11) of this Paragraph.

(5) The trust agreement shall be established for the sole benefit of the beneficiary.

(6) The trust agreement shall require the trustee to:

(A) Receive assets and hold all assets in a safe place;

(B) Determine that all assets are in such form that the beneficiary, or the trustee upon direction by the beneficiary, may whenever necessary negotiate any such assets, without consent or signature from the grantor or any other person;

(C) Furnish to the grantor and the beneficiary a statement of all assets in the trust account upon its inception and at intervals no less frequent than the end of each calendar quarter;

(D) Notify the grantor and the beneficiary within 10 days after the making of any deposits to or withdrawals from the trust account;

(E) Upon written demand of the beneficiary, immediately take all steps to transfer all right, title, and interest in the assets held in the trust account to the beneficiary and deliver physical custody of the assets to the beneficiary; and

(F) Allow no substitutions or withdrawals of assets from the trust account, except on written instructions from the beneficiary; except that the trustee may, without the consent of, but with notice to, the beneficiary and upon the call or maturity of any trust asset, withdraw the asset upon the condition that the proceeds are paid into the trust account.

(7) The trust agreement shall provide that at least 30 days, but not more 45 days, before termination of the trust account, that written notification of termination shall be delivered by the trustee to the beneficiary.

(8) The trust agreement shall be made subject to and governed by the laws of the state in which the trust is established.

(9) The trust agreement shall prohibit invasion of the trust corpus for the purpose of paying compensation to, or reimbursing the expense of, the trustee.

(10) The trust agreement shall provide that the trustee shall be liable for its own negligence, willful misconduct or lack of good faith.

(11) When a trust agreement is established in conjunction with a reinsurance agreement covering risks other than life, annuities, or accident and health, where it is customary practice to provide a trust agreement for a specific purpose, such a trust agreement may provide that the ceding insurer shall undertake to use and apply amounts drawn upon the trust account, without diminution because of the insolvency of the ceding insurer or the assuming insurer, for the following purposes:

(A) To pay or reimburse the ceding insurer for the assuming insurer=s share under the specific reinsurance agreement regarding any losses and allocated loss expenses paid by the ceding insurer, but not recovered from the assuming insurer, or for unearned premiums due to the ceding insurer if not otherwise paid by the assuming insurer;

(B) To make payment to the assuming insurer of any amounts held in the trust account that exceed 102 percent of the actual amount required to fund the assuming insurer=s obligations under the specific reinsurance agreement; or

(C) Where the ceding insurer has received notification of termination of the trust account and where the assuming insurer=s entire obligations under the specific reinsurance agreement remain unliquidated and undischarged 10 days before termination date, to withdraw amounts equal to the obligations and deposit those amounts in a separate account, in the name of the ceding insurer in any qualified United States financial institution as defined in G.S. 58-7-26(c) apart from its general assets, in trust for such uses and purposes specified in Parts (b)(11)(A) and (B) of this Rule as may remain executory after such withdrawal and for any period after the termination date.

(12) The reinsurance agreement entered into in conjunction with the trust agreement may, but need not, contain the provisions required by Part (d)(1)(B) of this Rule, as long as these required conditions are included in the trust agreement.

(c) Permitted conditions for trust agreements.

(1) The trust agreement may provide that the trustee may resign upon delivery of a written notice of resignation, effective not less than 90 days after receipt by the beneficiary and grantor of the notice; and that the trustee may be removed by the grantor by delivery to the trustee and the beneficiary of a written notice of removal, effective not less than 90 days after receipt by the trustee and the beneficiary of the notice; provided that no such resignation or removal shall be effective until a successor trustee has been duly appointed and approved by the beneficiary and the grantor and all assets in the trust have been duly transferred to the new trustee.

(2) The grantor may have the unqualified right to vote any shares of stock in the trust account and to receive from time to time payments of any dividends or interest upon any shares of stock or obligations included in the trust account. Any such interest or dividends shall be either forwarded promptly upon receipt to the grantor or deposited in a separate account established in the grantor's name.

(3) The trustee may be given authority to invest, and accept substitutions of, any funds in the account; provided that no investment or substitution shall be made without prior approval of the beneficiary, unless the trust agreement specifies categories of investments acceptable to the beneficiary and authorizes the trustee to invest funds and to accept substitutions which the trustee determines are at least equal in market value to the assets withdrawn and that are consistent with the restrictions in Part (d)(1)(B) of this Rule.

(4) The trust agreement may provide that the beneficiary may at any time designate a party to which all or part of the trust assets are to be transferred. Such transfer may be conditioned upon the trustee receiving, prior to or simultaneously, other specified assets.

(5) The trust agreement may provide that, upon termination of the trust account, all assets not previously withdrawn by the beneficiary shall, with written approval by the beneficiary, be delivered over to the grantor.

(d) Additional conditions applicable to reinsurance agreements.

(1) A reinsurance agreement that is entered into in conjunction with a trust agreement and the establishment of a trust account, may contain provisions that:

(A) Require the assuming insurer to enter into a trust agreement and to establish a trust account for the benefit of the ceding insurer, and specifying what the agreement is to cover;

(B) Stipulate that assets deposited in the trust account shall be valued according to their current fair market value and shall consist only of cash (United States legal tender), certificates of deposit (issued by a United States bank and payable in United States legal tender), or investments of the types permitted by G.S. 58, Article 7 or any combination of the above; provided that such investments are issued by an entity that is not the parent, subsidiary, or affiliate of either the grantor or the beneficiary. The reinsurance agreement may further specify the types of investments to be deposited. Where a trust agreement is entered into in conjunction with a reinsurance agreement covering risks other than life, annuities, and accident and health, the trust agreement may contain the provisions required by this paragraph in lieu of including such provisions in the reinsurance agreement;

(C) Require the assuming insurer, prior to depositing assets with the trustee, to execute assignments or endorsements in blank; or to transfer legal title to the trustee of all shares, obligations, or any other assets requiring assignments, in order that the ceding insurer, or the trustee upon the direction of the ceding insurer, may whenever necessary negotiate these assets without consent or signature from the assuming insurer or any other entity;

(D) Require that all settlements of account between the ceding insurer and the assuming insurer be made in cash or its equivalent; and

(E) Stipulate that the assuming insurer and the ceding insurer agree that the assets in the trust account, established pursuant to the provisions of the reinsurance agreement, may be withdrawn by the ceding insurer at any time, notwithstanding any other provisions in the reinsurance agreement; and shall be utilized and applied by the ceding insurer or its successors in interest by operation of law, including any liquidator, rehabilitator, receiver, or conservator of such company, without diminution because of insolvency on the part of the ceding insurer or the assuming insurer, only for the following purposes:

(i) To reimburse the ceding insurer for the assuming insurer=s share of premiums returned to the owners of policies reinsured under the reinsurance agreement because of cancellations of such policies;

(ii) To reimburse the ceding insurer for the assuming insurer's share of surrenders and benefits or losses paid by the ceding insurer pursuant to the provisions of the policies reinsured under the reinsurance agreement;

(iii) To fund an account with the ceding insurer in an amount at least equal to the deduction, for reinsurance ceded, from the ceding insurer liabilities for policies ceded under the agreement. The account shall include, but not be limited to, amounts for policy reserves, claims and losses incurred (including losses incurred but not reported), loss adjustment expenses, and unearned premium reserves; and

(iv) To pay any other amounts the ceding insurer claims are due under the reinsurance agreement.

(2) The reinsurance agreement may also contain provisions that:

(A) Give the assuming insurer the right to seek approval from the ceding insurer to withdraw from the trust account all or any part of the trust assets and transfer those assets to the assuming insurer, provided:

(i) The assuming insurer shall, at the time of withdrawal, replace the withdrawn assets with other qualified assets having a market value equal to the market value of the assets withdrawn so as to maintain at all times the deposit in the required amount, or

(ii) After withdrawal and transfer, the market value of the trust account is no less than 102 percent of the required amount.

The ceding insurer shall not unreasonably or arbitrarily withhold its approval.

(B) Provide for:

(i) The return of any amount withdrawn in excess of the actual amounts required for Subparts (d)(1)(E)(i), (ii) and (iii), or in the case of Subpart (d)(1)(E)(iv) of this Rule, any amounts that are subsequently determined not to be due; and

(ii) Interest payments, at a rate not in excess of the prime rate of interest, on the amounts held pursuant to Subpart (d)(1)(E)(iii) of this Rule.

(C) Permit the award by any arbitration panel or court of competent jurisdiction of:

(i) Interest at a rate different from that provided in Subpart (d)(2)(B)(ii) of this Rule,

(ii) Court of arbitration costs,

(iii) Attorney's fees, and

(iv) Any other reasonable expenses.

(3) Financial reporting. A trust agreement may be used to reduce any liability for reinsurance ceded to an unauthorized assuming insurer in financial statements required to be filed with the Department in compliance with the provisions of this Rule when established on or before the date of filing of the financial statement of the ceding insurer. Further, the reduction for the existence of an acceptable trust account may be up to the current fair market value of acceptable assets available to be withdrawn from the trust account at that time, but such reduction shall be no greater than the specific obligations under the reinsurance agreement that the trust account was established to secure.

(4) Existing agreements. Notwithstanding the effective date of this Rule, any trust agreement in existence before January 1, 1996, will continue to be acceptable until June 30, 1996, at which time the agreements will have to be in full compliance with this Rule for the trust agreement to be acceptable.

(5) The failure of any trust agreement to specifically identify the beneficiary as defined in Paragraph (a) of this Rule shall not be construed to affect any actions or rights that the Commissioner may take or possess pursuant to the provisions of the laws of this State.

History

  • Authority G.S. 58-2-40; 58-7-21; 58-7-26
  • Eff. February 1, 1996
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 20, 2015.
11 NCAC 11C .0505 Letters of Credit {#sec-11-ncac-11c-.0505 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11C .0505}

(a) As used in this Rule:

(1) "Beneficiary" means the entity for whose benefit the letter of credit has been established and any successor of the beneficiary by operation of law. If a court of law appoints a receiver as successor in interest to the named beneficiary, then the named beneficiary is the court-appointed domiciliary conservator, rehabilitator, or liquidator.

(2) "Financial Institution" means a qualified United States financial institution as defined in G.S. 58-7-26(b).

(b) In order to qualify under G.S. 58-7-26(a)(3), a letter of credit must be clean, irrevocable, unconditional and issued or confirmed by a qualified United States financial institution as defined in G.S. 58-7-26(b). The letter of credit shall contain an issue date and date of expiration and shall stipulate that the beneficiary need only draw a sight draft under the letter of credit and present it to obtain funds and that no other document need be presented. The letter of credit shall indicate that it is not subject to any condition or qualifications outside of the letter of credit. The letter of credit itself shall not contain reference to any other agreements, documents, or entities, except as provided in Subparagraph (i)(1) of this Rule.

(c) The heading of the letter of credit may include a boxed section that contains the name of the applicant and other appropriate notations to provide a reference for the letter of credit. The boxed section shall be clearly marked to indicate that such information is for internal identification purposes only.

(d) The letter of credit shall contain a statement to the effect that the obligation of the qualified United States financial institution under the letter of credit is in no way contingent upon reimbursement with respect thereto.

(e) The term of the letter of credit shall be for at least one year and shall contain an "evergreen clause" which prevents the expiration of the letter of credit without due notice from the issuer. The "evergreen clause" shall provide for a period of not less than thirty 30 days' notice before the expiration or non-renewal date.

(f) The letter of credit shall state whether it is subject to and governed by the laws of this State or the Uniform Customs and Practice for Documentary Credits of the International Chamber of Commerce (Publication 400), and all drafts drawn thereunder shall be presentable at an office in the United States of a qualified United States financial institution.

(g) If the letter of credit is made subject to the Uniform Customs and Practice for Documentary Credits of the International Chamber of Commerce (Publication 400); then the letter of credit shall specifically address and make provision for an extension of time to draw against the letter of credit in the event that one or more of the occurrences specified in Article 19 of Publication 400 occur.

(h) The letter of credit shall be issued or confirmed by a qualified United States financial institution authorized to issue letters of credit, pursuant to G.S. 58-7-26(b).

(i) Reinsurance agreement provisions:

(1) The reinsurance agreement in conjunction with which the letter of credit is obtained may contain provisions that:

(A) Require the assuming insurer to provide letters of credit to the ceding insurer and specify what they are to cover.

(B) Stipulate that the assuming insurer and ceding insurer agree that the letter of credit provided by the assuming insurer pursuant to the provisions of the reinsurance agreement may be drawn upon at any time, notwithstanding any other provisions in the agreement, and shall be utilized by the ceding insurer or its successors in interest only for one or more of the following reasons:

(i) To reimburse the ceding insurer for the assuming insurer's share of premiums returned to the owners of policies reinsured under the reinsurance agreement on account of cancellations of such policies;

(ii) To reimburse the ceding insurer for the assuming insurer's share of surrenders and benefits or losses paid by the ceding insurer under the terms and provisions of the policies reinsured under the reinsurance agreement;

(iii) To fund an account with the ceding insurer in an amount at least equal to the deduction, for reinsurance ceded, from the ceding insurer's liabilities for policies ceded under the agreement (such amount shall include, but not be limited to, amounts for policy reserves, claims and losses incurred and unearned premium reserves); and

(iv) To pay any other amounts the ceding insurer claims are due under the reinsurance agreement.

(C) All of the provisions of Subparagraph (1) of this Paragraph shall be applied without diminution because of insolvency on the part of the ceding insurer or assuming insurer.

(2) Nothing contained in Subparagraph (1) of this Paragraph shall preclude the ceding insurer and assuming insurer from providing for:

(A) An interest payment, at a rate not in excess of the prime rate of interest, on the amounts held pursuant to Subaragraph (1)(B)(iii) of this Paragraph; or

(B) The return of any amounts drawn down on the letters of credit in excess of the actual amounts required for the above or, in the case of Subpart (1)(B)(iv) of this Paragraph, any amounts that are subsequently determined not to be due.

(3) When a letter of credit is obtained in conjunction with a reinsurance agreement covering risks other than life, annuities, and accident and health, where it is customary practice to provide a letter of credit for a specific purpose, then the reinsurance agreement may, in lieu of Part (1)(B) of this Paragraph, require that the parties enter into a "Trust Agreement", which may be incorporated into the reinsurance agreement or be a separate document.

(j) A letter of credit may not be used to reduce any liability for reinsurance ceded to an unauthorized assuming insurer in financial statements filed with the Department unless an acceptable letter of credit with the filing ceding insurer as beneficiary has been issued on or before the date of filing of the financial statement. The reduction for the letter of credit may be up to the amount available under the letter of credit but no greater than the specified obligation under the reinsurance agreement that the letter of credit was intended to secure.

History

  • Authority G.S. 58-2-40; 58-7-26
  • Eff. February 1, 1996
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 20, 2015.
11 NCAC 11C .0601 Definitions {#sec-11-ncac-11c-.0601 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11C .0601}

The definitions contained in G.S. 58-19-5 are incorporated into this Section by reference.

History

  • Authority G.S. 58-2-40; 58-7-162
  • Eff. April 1, 1993
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 20, 2015.
11 NCAC 11C .0602 Applicability {#sec-11-ncac-11c-.0602 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11C .0602}

G.S. 58-7-162(6) applies when a person solely or in combination with the person's affiliates owes, in any two of three consecutive months, an insurer an amount that exceeds five percent of the insurer's total premiums in course of collection.

History

  • Authority G.S. 58-2-40; 58-7-162
  • Eff. April 1, 1993
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 20, 2015.
11 NCAC 11C .0603 Compliance-Trust Account {#sec-11-ncac-11c-.0603 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11C .0603}

(a) When G.S. 58-7-162(6) applies under 11 NCAC 11C .0602, the premiums collected by the person or the person and its affiliates and not remitted to the insurer may be held in a trust account with a bank so that those premiums will qualify as allowable or admitted assets.

(b) The trust account shall be an account held in the trust department of a bank and evidenced by a written trust agreement that is in substantial compliance with the Department's Model Trust Agreement.

(c) The trustee bank shall be a national bank or a state chartered bank that is a member of the Federal Deposit Insurance Corporation and be independent from control of either the person, the person's affiliates, or the insurer.

(d) The trust account must be established within 60 days after the end of the month in which the insurer becomes subject to G.S. 58-7-162(6) under 11 NCAC 11C .0602. The trust agreement must be submitted to and approved by the Commissioner before becoming effective, and within that 60-day period.

(e) The person and its affiliates must maintain separate trust accounts, evidenced by written trust agreements, for each insurer subject to G.S. 58-7-162(6).

(f) Once a trust account is established, it shall be maintained:

(1) for as long as the person or its affiliates produce business for the insurer, regardless of whether the person or its affiliates continue to owe the insurer at least five percent of the insurer's total premiums in course of collection; or

(2) until the insurer requests and receives authority from the Commissioner to cease using the trust account for the person or its affiliates. Such request shall not be made before 12 months after establishing the trust account.

History

  • Authority G.S. 58-2-40; 58-7-162
  • Eff. April 1, 1993
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 20, 2015.
11 NCAC 11C .0604 Compliance: Letter of Credit {#sec-11-ncac-11c-.0604 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11C .0604}

(a) When G.S. 58-7-162(6) applies under 11 NCAC 11C .0602, the premiums collected by the person or the person and its affiliates and not remitted to the insurer may be secured by an unexpired, clean, irrevocable letter of credit, payable to the insurer, so that those premiums will qualify as allowable or admitted assets.

(b) The amount of the letter of credit shall at all times equal or exceed 125 percent of the liability of the person or the person and its affiliates to the insurer for the premiums collected.

(c) The letter of credit must be issued within 30 days after the end of the month in which the insurer becomes subject to G.S. 58-7-162(6) under 11 NCAC 11C .0602. A certified copy of the executed letter of credit shall be provided to the Commissioner.

(d) The letter of credit shall be issued by a banking institution whose financial condition has been determined by either the Commissioner or the Securities Valuation Office of the NAIC to be acceptable to issue such a letter of credit.

History

  • Authority G.S. 58-2-40; 58-7-162
  • Eff. April 1, 1993
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 20, 2015.
11 NCAC 11C .0605 Compliance: Financial Guaranty Bond {#sec-11-ncac-11c-.0605 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11C .0605}

(a) When G.S. 58-7-162(6) applies under 11 NCAC 11C .0602, the premiums collected by the person or the person and its affiliates and not remitted to the insurer may be secured by a financial guaranty bond acceptable to the Department, payable to the insurer, so that those premiums will qualify as allowable or admitted assets.

(b) The amount of the financial guaranty bond shall at all times equal or exceed 125 percent of the liability of the person or the person and its affiliates to the insurer for the premiums collected.

(c) The financial guaranty bond must be issued within 30 days after the end of the month in which the insurer becomes subject to G.S. 58-7-162(6) under 11 NCAC 11C .0602. A certified copy of the executed financial guaranty bond shall be provided to the Commissioner.

History

  • Authority G.S. 58-2-40; 58-7-162
  • Eff. April 1, 1993
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 20, 2015.

Subchapter D

11 NCAC 11D .0101 General Provisions {#sec-11-ncac-11d-.0101 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11D .0101}

History

  • Status: repealed
  • Authority G.S. 58-9
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. July 1, 1988.
11 NCAC 11D .0102 Revocation or Suspension of License: Foreign Insurance {#sec-11-ncac-11d-.0102 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11D .0102}

History

  • Status: repealed
  • Authority G.S. 58-37
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. April 1, 1994.
11 NCAC 11D .0103 Publication of Notice of Revocation or Suspension {#sec-11-ncac-11d-.0103 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11D .0103}

History

  • Status: repealed
  • Authority G.S. 58-37
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. April 1, 1994.
11 NCAC 11D .0104 Applicability of Laws After Revocation or Suspension {#sec-11-ncac-11d-.0104 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11D .0104}

If the Commissioner of Insurance of this state revokes or suspends the license of a foreign insurance company to do any new business in this state, said company shall remain subject to the provisions of Chapter 58 of the General Statutes of North Carolina for the intent and purpose of properly servicing the existing business within this state. Specifically, such company having been suspended from doing any new business in this state, shall remain subject to the provisions of Article 48, "Insurance Guaranty Association Act" and Article 62, "North Carolina Life and Health Insurance Guaranty Association Act," whichever is applicable.

History

  • Authority G.S. 58-2-40; 58-3-90
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Amended Eff. April 1, 1993
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 20, 2015.
11 NCAC 11D .0105 Revocation of License of Reciprocal Insurer {#sec-11-ncac-11d-.0105 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11D .0105}

History

  • Status: repealed
  • Authority G.S. 58-77(10); 58-82; 58-147
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. April 1, 1993.
11 NCAC 11D .0106 Extension for Elimination: Impairment of Cap and Surplus {#sec-11-ncac-11d-.0106 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11D .0106}

History

  • Status: repealed
  • Authority G.S. 58-77(10); 58-82; 58-147
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. April 1, 1993.
11 NCAC 11D .0107 Business in Own Name: Emblems: Insignias: Etc {#sec-11-ncac-11d-.0107 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11D .0107}

Every insurance company must conduct its business in the state in its proper or corporate name which must be prominently displayed, together with any emblem, insignia or anything other than the true and corporate name, and which must not so closely resemble any other company's proper or corporate name, emblem or insignia as to confuse the true identity of the company or companies responsible for the payment of losses under the policy.

History

  • Authority G.S. 58-2-40; 58-3-50
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 20, 2015.
11 NCAC 11D .0108 Notice of Hearing on Plan of Exchange of Capital Stock {#sec-11-ncac-11d-.0108 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11D .0108}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-9-5
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Amended Eff. April 1, 1993
  • Repealed Eff. February 1, 1996.
11 NCAC 11D .0109 Charges for Hearing Conducted Pursuant to G.s. 58-9-5 {#sec-11-ncac-11d-.0109 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11D .0109}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-9-5
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Amended Eff. April 1, 1993
  • Repealed Eff. February 1, 1996.
11 NCAC 11D .0110 Size of Type of All Notices Required to Be Published {#sec-11-ncac-11d-.0110 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11D .0110}

Any notices required by the insurance laws of North Carolina to be published in newspapers within this state shall be printed in type which shall not be smaller than six point type and may be published under the legal notice section of the designated newspapers or displayed in a manner specified by the Commissioner as the circumstances may require.

History

  • Authority G.S. 58-2-40; 58-8-5
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 20, 2015.
11 NCAC 11D .0111 Certificate of Incorporation and Amendments: Approval {#sec-11-ncac-11d-.0111 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11D .0111}

To insure compliance with the provisions of Article 26 of Chapter 58, the certificate of incorporation of a proposed domestic title insurance company must be approved by the Commissioner before filing with the Office of the Secretary of State.

In order that the corporate files of the Department of Insurance will properly reflect the corporate changes of a domestic title insurance company, all amendments to the certificate of incorporation must be approved by the Commissioner before filing with the Office of the Secretary of State.

History

  • Authority G.S. 58-2-40; 58-26-1; 58-26-5
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Amended Eff. April 1, 1993
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 20, 2015.
11 NCAC 11D .0112 Domestic Stock Title Ins Companies: Capital Requirements {#sec-11-ncac-11d-.0112 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11D .0112}

In order that the corporate files of the Department of Insurance will properly reflect all capital stock changes, domestic stock title insurance companies must comply with the provisions of G.S. 58-7-105 through 58-7-120.

History

  • Authority G.S. 58-2-40; 58-7-105 to 58-7-120; 58-26-5
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Amended Eff. April 1, 1993
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 20, 2015.
11 NCAC 11D .0113 Subscribers of Reciprocal or Inter-Insurance Exchanges {#sec-11-ncac-11d-.0113 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11D .0113}

History

  • Status: repealed
  • Authority G.S. 58-139(6); 58-142
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. April 1, 1993.
11 NCAC 11D .0114 Minimum Requirements: Reciprocal or Inter-Ins Exchanges {#sec-11-ncac-11d-.0114 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11D .0114}

History

  • Status: repealed
  • Authority G.S. 58-139(6); 58-142
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. April 1, 1993.
11 NCAC 11D .0115 Proxies: Etc Domestic Insurers: Application of Rules {#sec-11-ncac-11d-.0115 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11D .0115}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-9(2); 58-7-145; 58-86.2
  • Eff. February 1, 1976
  • Repealed Eff March 1, 2004
11 NCAC 11D .0116 Proxies: Consents and Authorizations {#sec-11-ncac-11d-.0116 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11D .0116}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-9(2); 58-7-145; 58-86.2
  • Eff. February 1, 1976
  • Repealed Eff March 1, 2004
11 NCAC 11D .0117 Proxies: Disclosure of Equivalent Information {#sec-11-ncac-11d-.0117 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11D .0117}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-9(2); 58-7-145; 58-86.2
  • Eff. February 1, 1976
  • Repealed Eff March 1, 2004
11 NCAC 11D .0118 Proxies: Definitions and Instructions {#sec-11-ncac-11d-.0118 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11D .0118}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-9(2); 58-7-145; 58-86.2
  • Eff. February 1, 1976
  • Repealed Eff March 1, 2004
11 NCAC 11D .0119 Proxies: Information to Be Furnished to Security Holders {#sec-11-ncac-11d-.0119 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11D .0119}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-9(2); 58-7-145; 58-86.2
  • Eff. February 1, 1976
  • Repealed Eff March 1, 2004
11 NCAC 11D .0120 Proxies: Requirements as to Proxy {#sec-11-ncac-11d-.0120 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11D .0120}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-9(2); 58-7-145; 58-86.2
  • Eff. February 1, 1976
  • Repealed Eff March 1, 2004
11 NCAC 11D .0121 Proxies: Material Required to Be Filed {#sec-11-ncac-11d-.0121 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11D .0121}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-9(2); 58-7-145; 58-86.2
  • Eff. February 1, 1976
  • Repealed Eff March 1, 2004
11 NCAC 11D .0122 Proxies: False or Misleading Statements {#sec-11-ncac-11d-.0122 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11D .0122}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-9(2); 58-7-145; 58-86.2
  • Eff. February 1, 1976
  • Repealed Eff March 1, 2004
11 NCAC 11D .0123 Proxies: Prohibition of Certain Solicitations {#sec-11-ncac-11d-.0123 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11D .0123}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-9(2); 58-7-145; 58-86.2
  • Eff. February 1, 1976
  • Repealed Eff March 1, 2004
11 NCAC 11D .0124 Proxies: Special Provisions Applicable to Election Contest {#sec-11-ncac-11d-.0124 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11D .0124}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-9(2); 58-7-145; 58-86.2
  • Eff. February 1, 1976
  • Repealed Eff March 1, 2004
11 NCAC 11D .0125 Proxy Information Required: Revocability of Proxy {#sec-11-ncac-11d-.0125 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11D .0125}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-9(2); 58-7-145; 58-86.2
  • Eff. February 1, 1976
  • Repealed Eff March 1, 2004
11 NCAC 11D .0126 Proxy Information Required: Dissenters' Right of Appraisal {#sec-11-ncac-11d-.0126 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11D .0126}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-9(2); 58-7-145; 58-86.2
  • Eff. February 1, 1976
  • Repealed Eff March 1, 2004
11 NCAC 11D .0127 Proxy Information Required: Subject to 11 Ncac 11d .0124 {#sec-11-ncac-11d-.0127 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11D .0127}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-9(2); 58-7-145; 58-86.2
  • Eff. February 1, 1976
  • Repealed Eff March 1, 2004
11 NCAC 11D .0128 Proxy Info Required: Interest in Matters to Be Acted Upon {#sec-11-ncac-11d-.0128 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11D .0128}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-9(2); 58-7-145; 58-86.2
  • Eff. February 1, 1976
  • Repealed Eff March 1, 2004
11 NCAC 11D .0129 Proxy Information Required: Voting Securities {#sec-11-ncac-11d-.0129 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11D .0129}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-9(2); 58-7-145; 58-86.2
  • Eff. February 1, 1976
  • Repealed Eff March 1, 2004
11 NCAC 11D .0130 Proxy Information Required: Nominee and Directors {#sec-11-ncac-11d-.0130 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11D .0130}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-9(2); 58-7-145; 58-86.2
  • Eff. February 1, 1976
  • Repealed Eff March 1, 2004
11 NCAC 11D .0131 Proxy Information Required: Transactions with Management {#sec-11-ncac-11d-.0131 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11D .0131}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-9(2); 58-7-145; 58-86.2
  • Eff. February 1, 1976
  • Repealed Eff March 1, 2004
11 NCAC 11D .0132 Proxy Info Required: Bonus: Profit Sharing: Remuneration {#sec-11-ncac-11d-.0132 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11D .0132}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-9(2); 58-7-145; 58-86.2
  • Eff. February 1, 1976
  • Repealed Eff March 1, 2004
11 NCAC 11D .0133 Proxy Information Required: Pension and Retirement Plans {#sec-11-ncac-11d-.0133 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11D .0133}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-9(2); 58-7-145; 58-86.2
  • Eff. February 1, 1976
  • Repealed Eff March 1, 2004
11 NCAC 11D .0134 Proxy Information Required: Options: Warrants or Rights {#sec-11-ncac-11d-.0134 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11D .0134}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-9(2); 58-7-145; 58-86.2
  • Eff. February 1, 1976
  • Repealed Eff March 1, 2004
11 NCAC 11D .0135 Proxy Info Required: Authorization or Issuance of Stock {#sec-11-ncac-11d-.0135 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11D .0135}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-9(2); 58-7-145; 58-86.2
  • Eff. February 1, 1976
  • Repealed Eff March 1, 2004
11 NCAC 11D .0136 Proxy Info Required: Merger: Consolidation: Acquisition {#sec-11-ncac-11d-.0136 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11D .0136}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-9(2); 58-7-145; 58-86.2
  • Eff. February 1, 1976
  • Repealed Eff March 1, 2004
11 NCAC 11D .0137 Proxy Information Required: Restatement of Accounts {#sec-11-ncac-11d-.0137 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11D .0137}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-9(2); 58-7-145; 58-86.2
  • Eff. February 1, 1976
  • Repealed Eff March 1, 2004
11 NCAC 11D .0138 Proxy Info Required: Matters Not Required to Be Submitted {#sec-11-ncac-11d-.0138 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11D .0138}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-9(2); 58-7-145; 58-86.2
  • Eff. February 1, 1976
  • Repealed Eff March 1, 2004
11 NCAC 11D .0139 Proxy Information Required: Amendment of Charter: by-Laws {#sec-11-ncac-11d-.0139 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11D .0139}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-9(2); 58-7-145; 58-86.2
  • Eff. February 1, 1976
  • Repealed Eff March 1, 2004
11 NCAC 11D .0140 Proxy Information Required: in Election Contest {#sec-11-ncac-11d-.0140 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11D .0140}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-9(2); 58-7-145; 58-86.2
  • Eff. February 1, 1976
  • Repealed Eff March 1, 2004
11 NCAC 11D .0141 Proxy Statement in Elec: Insurer: Identity and Background {#sec-11-ncac-11d-.0141 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11D .0141}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-9(2); 58-7-145; 58-86.2
  • Eff. February 1, 1976
  • Repealed Eff March 1, 2004
11 NCAC 11D .0142 Proxy Statement in Election: Interest in Equity Security {#sec-11-ncac-11d-.0142 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11D .0142}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-9(2); 58-7-145; 58-86.2
  • Eff. February 1, 1976
  • Repealed Eff March 1, 2004
11 NCAC 11D .0143 Proxy Statement in Election Contest: Further Matters {#sec-11-ncac-11d-.0143 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11D .0143}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-9(2); 58-7-145; 58-86.2
  • Eff. February 1, 1976
  • Repealed Eff March 1, 2004
11 NCAC 11D .0144 Proxy Statement in Election Contest: Signature {#sec-11-ncac-11d-.0144 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11D .0144}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-9(2); 58-7-145; 58-86.2
  • Eff. February 1, 1976
  • Repealed Eff March 1, 2004
11 NCAC 11D .0145 Insider Trading of Stock: Definitions {#sec-11-ncac-11d-.0145 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11D .0145}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-9(2); 58-7-145; 58-86.2
  • Eff. February 1, 1976
  • Repealed Eff March 1, 2004
11 NCAC 11D .0146 Who Must File Under Insider Trading of Stock {#sec-11-ncac-11d-.0146 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11D .0146}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-9(2); 58-7-145; 58-86.2
  • Eff. February 1, 1976
  • Repealed Eff March 1, 2004
11 NCAC 11D .0147 What Must Be Filed Under Insider Trading of Stock {#sec-11-ncac-11d-.0147 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11D .0147}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-9(2); 58-7-145; 58-86.2
  • Eff. February 1, 1976
  • Repealed Eff March 1, 2004
11 NCAC 11D .0148 Determining Beneficial Ownership: Insider Trading of Stock {#sec-11-ncac-11d-.0148 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11D .0148}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-9(2); 58-7-145; 58-86.2
  • Eff. February 1, 1976
  • Repealed Eff March 1, 2004
11 NCAC 11D .0149 Disclaimer of Beneficial Ownership: Insider Trading {#sec-11-ncac-11d-.0149 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11D .0149}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-9(2); 58-7-145; 58-86.2
  • Eff. February 1, 1976
  • Repealed Eff March 1, 2004
11 NCAC 11D .0150 Exemptions from Subsections (a) and (b) of the Act {#sec-11-ncac-11d-.0150 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11D .0150}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-9(2); 58-7-145; 58-86.2
  • Eff. February 1, 1976
  • Repealed Eff March 1, 2004
11 NCAC 11D .0151 Securities Bought or Sold by Odd-Lot Dealers: Exemption {#sec-11-ncac-11d-.0151 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11D .0151}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-9(2); 58-7-145; 58-86.2
  • Eff. February 1, 1976
  • Repealed Eff March 1, 2004
11 NCAC 11D .0152 CERTAIN TRANSACTIONS SUBJECT TO SUBSECTION (a) OF THE ACT {#sec-11-ncac-11d-.0152 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11D .0152}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-9(2); 58-7-145; 58-86.2
  • Eff. February 1, 1976
  • Repealed Eff March 1, 2004
11 NCAC 11D .0153 Ownership of Securities Held in Trust: Insider Trading {#sec-11-ncac-11d-.0153 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11D .0153}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-9(2); 58-7-145; 58-86.2
  • Eff. February 1, 1976
  • Repealed Eff March 1, 2004
11 NCAC 11D .0154 Exemption for Small Transactions: Insider Trading of Stock {#sec-11-ncac-11d-.0154 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11D .0154}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-9(2); 58-7-145; 58-86.2
  • Eff. February 1, 1976
  • Repealed Eff March 1, 2004
11 NCAC 11D .0155 Exemptions in General: Insider Trading of Stock {#sec-11-ncac-11d-.0155 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11D .0155}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-9(2); 58-7-145; 58-86.2
  • Eff. February 1, 1976
  • Repealed Eff March 1, 2004
11 NCAC 11D .0156 Exemption Effected in Connection with a Distribution {#sec-11-ncac-11d-.0156 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11D .0156}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-9(2); 58-7-145; 58-86.2
  • Eff. February 1, 1976
  • Repealed Eff March 1, 2004
11 NCAC 11D .0157 Exemption Stock Options: Stock Bonus or Similar Plans {#sec-11-ncac-11d-.0157 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11D .0157}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-9(2); 58-7-145; 58-86.2
  • Eff. February 1, 1976
  • Repealed Eff March 1, 2004
11 NCAC 11D .0158 Other Securities: Exemption Received by Redeeming {#sec-11-ncac-11d-.0158 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11D .0158}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-9(2); 58-7-145; 58-86.2
  • Eff. February 1, 1976
  • Repealed Eff March 1, 2004
11 NCAC 11D .0159 Exemption of Long Term Profits Within Six Months of Option {#sec-11-ncac-11d-.0159 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11D .0159}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-9(2); 58-7-145; 58-86.2
  • Eff. February 1, 1976
  • Repealed Eff March 1, 2004
11 NCAC 11D .0160 Exemptions: Acquisitions: Dispositions Pursuant to Merger {#sec-11-ncac-11d-.0160 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11D .0160}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-9(2); 58-7-145; 58-86.2
  • Eff. February 1, 1976
  • Repealed Eff March 1, 2004
11 NCAC 11D .0161 Exemption: Deposit or Withdrawal of Equity Securities {#sec-11-ncac-11d-.0161 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11D .0161}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-9(2); 58-7-145; 58-86.2
  • Eff. February 1, 1976
  • Repealed Eff March 1, 2004
11 NCAC 11D .0162 Exemption Involving the Conversion of Equity Securities {#sec-11-ncac-11d-.0162 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11D .0162}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-9(2); 58-7-145; 58-86.2
  • Eff. February 1, 1976
  • Repealed Eff March 1, 2004
11 NCAC 11D .0163 Exemption Involving the Sale of Subscription Rights {#sec-11-ncac-11d-.0163 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11D .0163}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-9(2); 58-7-145; 58-86.2
  • Eff. February 1, 1976
  • Repealed Eff March 1, 2004
11 NCAC 11D .0164 EXEMPTION OF SECURITIES FROM SUBSECTION (c) OF THE ACT {#sec-11-ncac-11d-.0164 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11D .0164}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-9(2); 58-7-145; 58-86.2
  • Eff. February 1, 1976
  • Repealed Eff March 1, 2004
11 NCAC 11D .0165 EXEMPTION FROM SUBSECTION (c): DISTRIBUTION {#sec-11-ncac-11d-.0165 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11D .0165}

Any security shall be exempt from the operation of subsection (c) of the act to the extent necessary to render lawful under such section any sale made by or on behalf of a dealer in connection with a distribution of a substantial block of securities, upon the following conditions:

(1) The sale is represented by an over-allotment in which the dealer is participating as a member of an underwriting group, or the dealer or a person acting on his behalf intends in good faith to offset such sale with a security to be acquired by or on behalf of the dealer as a participant in an underwriting, selling or soliciting-dealer group of which the dealer is a member at the time of the sale, whether or not the security to be so acquired is subject to prior offering to existing security holders or some other class of persons; and

(2) Other persons not within the purview of subsection (c) of the act are participating in the distribution of such block of securities on terms at least as favorable as those on which such dealer is participating and to an extent at least equal to the aggregate participation of all persons exempted from the provisions of subsection (c) of the act by this Rule. However, the performance of the functions of manager of a distributing group and the receipt of a bona fide payment for performing such functions shall not preclude an exemption which would otherwise be available under this Rule.

History

  • Authority G.S. 58-2-40; 58-7-145
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 20, 2015.
11 NCAC 11D .0166 EXEMPTION FROM SUBSECTION (c) SALES OF SECURITIES {#sec-11-ncac-11d-.0166 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11D .0166}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-9(2); 58-7-145; 58-86.2
  • Eff. February 1, 1976
  • Repealed Eff March 1, 2004.
11 NCAC 11D .0167 Arbitrage Transactions Under Subsection (e) of the Act {#sec-11-ncac-11d-.0167 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11D .0167}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-9(2); 58-7-145; 58-86.2
  • Eff. February 1, 1976
  • Repealed Eff March 1, 2004.
11 NCAC 11D .0168 Guaranty Capital Certificates: When Permitted {#sec-11-ncac-11d-.0168 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11D .0168}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-8-20
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Amended Eff. April 1, 1993
  • Repealed Eff. June 1, 2007.
11 NCAC 11D .0169 Notice of Hearing on Revocation or Suspension of License {#sec-11-ncac-11d-.0169 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11D .0169}

(a) If the Commissioner of Insurance is of the opinion, upon examination or receipt of evidence from other sources, that a foreign insurance company is in an unsound condition, or, if a life insurance company, that its actual funds, exclusive of its capital, are less than its liabilities; or that it has failed to comply with the law, or if it, its officers or agents, refuse to submit to examination or to perform any legal obligation in relation thereto, the Commissioner shall give notice to the company of a hearing to be held in the office of the Commissioner of Insurance to show cause why the company's license to transact business in the State of North Carolina should not be revoked or suspended.

(b) Written notice at least 10 days before the date of such hearing as designated therein, shall be given to the company.

History

  • Authority G.S. 58-2-40; 58-3-95; 58-3-100
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 20, 2015.
11 NCAC 11D .0170 Written Order: Hearing on Revocation or Suspension {#sec-11-ncac-11d-.0170 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11D .0170}

(a) If after concluding the hearing on the revocation or suspension of a foreign company's license as required by 11 NCAC 11D .0169, the company has not satisfied the Commissioner that the conditions which prompted the hearing have not been resolved or corrected, the Commissioner shall issue an order which shall, among other things, set forth a period of time, not to exceed 90 days, within which time the conditions which prompted the hearing shall have been resolved or corrected.

(b) If at the expiration of the time period designated in the order said conditions have not been resolved or corrected, the company's license to transact business in the State of North Carolina shall be revoked or suspended and the Commissioner shall cause notice of the revocation or suspension to be published in accordance with the provisions of 11 NCAC 11D .0103.

History

  • Authority G.S. 58-2-40; 58-3-100
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 20, 2015.
11 NCAC 11D .0201 General Nature {#sec-11-ncac-11d-.0201 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11D .0201}

History

  • Status: repealed
  • Authority G.S. 58-9
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. July 1, 1988.
11 NCAC 11D .0202 Replacement Policies {#sec-11-ncac-11d-.0202 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11D .0202}

History

  • Status: repealed
  • Authority G.S. 58-9.1
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. April 1, 1993.
11 NCAC 11D .0301 General Nature {#sec-11-ncac-11d-.0301 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11D .0301}

History

  • Status: repealed
  • Authority G.S. 58-9
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. July 1, 1988.
11 NCAC 11D .0302 Procedure for Submission of Plan of Merger - Stock Company {#sec-11-ncac-11d-.0302 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11D .0302}

History

  • Status: repealed
  • Authority G.S. 55-107 et seq.; 58-2-40; 58-7-150
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Amended Eff. April 1, 1993
  • Repealed Eff. February 1, 1996.
11 NCAC 11D .0303 Notice of Public Hearing on Plan of Merger for Stock Companies {#sec-11-ncac-11d-.0303 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11D .0303}

History

  • Status: repealed
  • Authority G.S. 55-107 et seq.; 58-2-40; 58-7-150
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Amended Eff. April 1, 1993
  • Repealed Eff. February 1, 1996.
11 NCAC 11D .0304 Procedure for Submission of Plan of Merger - Mutual Company {#sec-11-ncac-11d-.0304 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11D .0304}

History

  • Status: repealed
  • Authority G.S. 55-107 et seq.; 58-2-40; 58-7-150
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Amended Eff. April 1, 1993
  • Repealed Eff. February 1, 1996.
11 NCAC 11D .0305 Notice of Public Hearing on Plan of Merger for Mutual Companies {#sec-11-ncac-11d-.0305 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11D .0305}

History

  • Status: repealed
  • Authority G.S. 55-107 et seq.; 58-2-40; 58-7-150
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Amended Eff. April 1, 1993
  • Repealed Eff. February 1, 1996.

Subchapter E

11 NCAC 11E .0101 General Provisions {#sec-11-ncac-11e-.0101 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11E .0101}

History

  • Status: repealed
  • Authority G.S. 58-9
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. July 1, 1988.
11 NCAC 11E .0102 Annual Statements to Be Filed with Department of Insurance {#sec-11-ncac-11e-.0102 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11E .0102}

History

  • Status: repealed
  • Authority G.S. 57-9; 57A-9; 57A-21; 58-9(3); 58-21; 58-34.1; 58-134; 58-292
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. April 1, 1993.
11 NCAC 11E .0103 Instructions for Completion of Annual Statement Forms {#sec-11-ncac-11e-.0103 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11E .0103}

History

  • Status: repealed
  • Authority G.S. 57-9; 57A-9; 57A-21; 58-9(3); 58-21; 58-34.1; 58-134; 58-292
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. April 1, 1993.
11 NCAC 11E .0104 Form of Quarterly Financial Statements {#sec-11-ncac-11e-.0104 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11E .0104}

History

  • Status: repealed
  • Authority G.S. 57-9; 57A-9; 57A-21; 58-9(3); 58-21; 58-34.1; 58-134; 58-292
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. April 1, 1993.
11 NCAC 11E .0105 Applicability of Financial Statements {#sec-11-ncac-11e-.0105 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11E .0105}

History

  • Status: repealed
  • Authority G.S. 57-9; 57A-9; 57A-21; 58-9(3); 58-21; 58-34.1; 58-134; 58-292
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. April 1, 1993.
11 NCAC 11E .0106 Microfilming of Company Records {#sec-11-ncac-11e-.0106 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11E .0106}

History

  • Status: repealed
  • Authority G.S. 58-9.1
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. March 1, 1993.
11 NCAC 11E .0107 Escheats: Abandoned Property: Report Required {#sec-11-ncac-11e-.0107 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11E .0107}

History

  • Status: repealed
  • Authority G.S. 116A; 116A-5
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. July 1, 1988.
11 NCAC 11E .0108 Escheats: Abandoned Property: Where: When to File {#sec-11-ncac-11e-.0108 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11E .0108}

History

  • Status: repealed
  • Authority G.S. 116A; 116A-5
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. July 1, 1988.
11 NCAC 11E .0109 Escheats: Abandoned Property: Escheat Codes {#sec-11-ncac-11e-.0109 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11E .0109}

History

  • Status: repealed
  • Authority G.S. 116A; 116A-5
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. July 1, 1988.
11 NCAC 11E .0110 Reduced Installment Payments {#sec-11-ncac-11e-.0110 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11E .0110}

History

  • Filed as a Temporary Rule Eff. July 22, 1988 For a Period of 180 Days to Expire on
  • January 18, 1989
  • Statutory Authority G.S. 105-228.5
  • Eff. January 1, 1989
  • Transferred & Recodified to 17 NCAC 5E .0101 Eff. January 15, 1998.
11 NCAC 11E .0201 General Nature {#sec-11-ncac-11e-.0201 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11E .0201}

History

  • Status: repealed
  • Authority G.S. 58-9
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. April 1, 1993.
11 NCAC 11E .0202 Tax on Receipts for Premiums {#sec-11-ncac-11e-.0202 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11E .0202}

History

  • Authority G.S. 58-2-40; 118-2
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Amended Eff. April 1, 1993
  • Transferred & Recodified to 17 NCAC 5E .0102 Eff. January 15, 1998.
11 NCAC 11E .0203 Premium Finance Charges {#sec-11-ncac-11e-.0203 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11E .0203}

History

  • Authority G.S. 58-2-40; 105-228.5
  • Eff. April 1, 1993
  • Transferred & Recodified to 17 NCAC 5E .0103 Eff. January 15, 1998.
11 NCAC 11E .0301 General Nature {#sec-11-ncac-11e-.0301 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11E .0301}

History

  • Status: repealed
  • Authority G.S. 58-9
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. July 1, 1988.
11 NCAC 11E .0302 Dividends Applied to Purchase Additional Paid-Up Life {#sec-11-ncac-11e-.0302 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11E .0302}

History

  • Authority G.S. 105-228.5
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Transferred & Recodified to 17 NCAC 5E .0104 Eff. January 15, 1998.
11 NCAC 11E .0303 Premium Taxes on Annuities {#sec-11-ncac-11e-.0303 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11E .0303}

History

  • Status: repealed
  • Authority G.S. 105-228.5
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. January 1, 1995.
11 NCAC 11E .0304 Gross Premium Taxation of Group Premiums {#sec-11-ncac-11e-.0304 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11E .0304}

History

  • Authority G.S. 105-228.5
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Transferred & Recodified to 17 NCAC 5E .0105 Eff. January 15, 1998.
11 NCAC 11E .0305 Employee Benefits Plans: Life and Accident and Health {#sec-11-ncac-11e-.0305 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11E .0305}

History

  • Authority G.S. 105-228.5
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Transferred & Recodified to 17 NCAC 5E .0106 Eff. January 15, 1998.
11 NCAC 11E .0306 Financial Reporting: Differing Statements {#sec-11-ncac-11e-.0306 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11E .0306}

History

  • Status: repealed
  • Authority G.S. 58-34.1
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. April 1, 1993.
11 NCAC 11E .0307 Financial Reporting: Form of Reconciliations {#sec-11-ncac-11e-.0307 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11E .0307}

History

  • Status: repealed
  • Authority G.S. 58-34.1
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. April 1, 1993.
11 NCAC 11E .0308 Financial Reporting: Definitions {#sec-11-ncac-11e-.0308 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11E .0308}

History

  • Status: repealed
  • Authority G.S. 58-34.1
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. April 1, 1993.
11 NCAC 11E .0309 Financial Reporting: Differing Statements {#sec-11-ncac-11e-.0309 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11E .0309}

History

  • Status: repealed
  • Authority G.S. 58-34.1
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. April 1, 1993.
11 NCAC 11E .0310 Financial Reporting: Parent or Affiliated Insurers {#sec-11-ncac-11e-.0310 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11E .0310}

History

  • Status: repealed
  • Authority G.S. 58-34.1
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. April 1, 1993.
11 NCAC 11E .0401 General Nature {#sec-11-ncac-11e-.0401 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11E .0401}

History

  • Status: repealed
  • Authority G.S. 58-9
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. July 1, 1988.
11 NCAC 11E .0402 Extension of Filing Date {#sec-11-ncac-11e-.0402 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11E .0402}

History

  • Status: repealed
  • Authority G.S. 57-9; 57A-9; 57A-21; 58-21
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. April 1, 1993.
11 NCAC 11E .0403 Renewal Certificate of Authority: Hmo {#sec-11-ncac-11e-.0403 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11E .0403}

History

  • Status: repealed
  • Authority G.S. 57A-3(c)(8); 57A-6, -8(b)(2), -9; 57A-20; 58-9
  • Eff. January 22, 1980
  • Repealed Eff. April 1, 1993.
11 NCAC 11E .0404 Filing Annual Statements for Hmo's {#sec-11-ncac-11e-.0404 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11E .0404}

History

  • Status: repealed
  • Authority G.S. 57A-3(c)(8); 57A-6, -8(b)(2), -9; 57A-20; 58-9
  • Eff. January 22, 1980
  • Repealed Eff. April 1, 1993.
11 NCAC 11E .0405 Independent Certified Public Accountant Audits: Hmo {#sec-11-ncac-11e-.0405 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11E .0405}

History

  • Status: repealed
  • Authority G.S. 57A-3(c)(8); 57A-6, -8(b)(2), -9; 57A-20; 58-9
  • Eff. January 22, 1980
  • Repealed Eff. April 1, 1993.

Subchapter F

11 NCAC 11F .0101 General Nature {#sec-11-ncac-11f-.0101 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11F .0101}

History

  • Status: repealed
  • Authority G.S. 58-9
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. July 1, 1988.
11 NCAC 11F .0102 Reserves on Credit Life Insurance {#sec-11-ncac-11f-.0102 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11F .0102}

History

  • Status: repealed
  • Authority G.S. 58-9(1); 58-143
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. April 1, 1993.
11 NCAC 11F .0103 Reserves on Credit Accident and Health Insurance {#sec-11-ncac-11f-.0103 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11F .0103}

History

  • Status: repealed
  • Authority G.S. 58-9(1); 58-143
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. April 1, 1993.
11 NCAC 11F .0104 Audit Trails on Reserves Required {#sec-11-ncac-11f-.0104 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11F .0104}

History

  • Status: repealed
  • Authority G.S. 58-9(1); 58-143
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. April 1, 1993.
11 NCAC 11F .0105 Reserves for Annuities {#sec-11-ncac-11f-.0105 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11F .0105}

History

  • Status: repealed
  • Authority G.S. 58-9(1); 58-201.1
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. December 1, 1985.
11 NCAC 11F .0106 Reserves for Present Value of Future Benefits Required {#sec-11-ncac-11f-.0106 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11F .0106}

History

  • Status: repealed
  • Authority G.S. 58-9
  • Eff. February 1, 1976
  • Readopted Eff. February 28, 1978
  • Repealed Eff. April 1, 1993.
11 NCAC 11F .0107 Purpose {#sec-11-ncac-11f-.0107 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11F .0107}

History

  • Status: repealed
  • Authority G.S. 58-9; 58-201.1
  • Eff. December 1, 1985
  • Repealed Eff. April 1, 1993.
11 NCAC 11F .0108 Definitions {#sec-11-ncac-11f-.0108 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11F .0108}

History

  • Status: repealed
  • Authority G.S. 58-9; 58-201.1
  • Eff. December 1, 1985
  • Repealed Eff. April 1, 1993.
11 NCAC 11F .0109 Individual Annuity or Pure Endowment Contracts {#sec-11-ncac-11f-.0109 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11F .0109}

History

  • Status: repealed
  • Authority G.S. 58-9; 58-201.1
  • Eff. December 1, 1985
  • Repealed Eff. April 1, 1993.
11 NCAC 11F .0110 Group Annuity or Pure Endowment Contracts {#sec-11-ncac-11f-.0110 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11F .0110}

History

  • Status: repealed
  • Authority G.S. 58-9; 58-201.1
  • Eff. December 1, 1985
  • Repealed Eff. April 1, 1993.
11 NCAC 11F .0201 Definitions {#sec-11-ncac-11f-.0201 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11F .0201}

As used in this section and in the Statement of Actuarial Opinion required by the NAIC Annual Statement Instructions pursuant to G.S. 58-2-165:

(1) "Annual claim cost" means the net annual cost per unit of benefit before the addition of expenses, including claim settlement expenses, and a margin for profit or contingencies. For example, the annual claim cost for a one hundred dollar ($100.00) monthly disability benefit, for a maximum disability benefit period of one year, with an elimination period of one week, with respect to a male at age 35, in a certain occupation might be twelve dollars ($12.00), while the gross premium for this benefit might be eighteen dollars ($18.00). The additional six dollars ($6.00) would cover expenses and profit or contingencies.

(2) "Claims accrued" means that portion of claims incurred on or before the valuation date that result in liability of the insurer for the payment of benefits for medical services that have been rendered on or before the valuation date, and for the payment of benefits for days of hospitalization and days of disability that have occurred on or before the valuation date, that the insurer has not paid as of the valuation date, but for which it is liable, and will have to pay after the valuation date. This liability is sometimes referred to as a liability for "accrued" benefits. A claim reserve, which represents an estimate of this accrued claim liability, must be established.

(3) "Claims reported" means when an insurer has been informed that a claim has been incurred, if the date reported is on or before the valuation date, the claim is considered as a reported claim for annual statement purposes.

(4) "Claims unaccrued" means that portion of claims incurred on or before the valuation date that result in liability of the insurer for the payment of benefits for medical services expected to be rendered after the valuation date, and for benefits expected to be payable for days of hospitalization and days of disability occurring after the valuation date. This liability is sometimes referred to as a liability for "unaccrued" benefits. A claim reserve, which represents an estimate of the unaccrued claim payments expected to be made (that may or may not be discounted with interest), must be established.

(5) "Claims unreported" means when an insurer has not been informed, on or before the valuation date, concerning a claim that has been incurred on or before the valuation date, the claim is considered as an unreported claim for annual statement purposes.

(6) "Date of disablement" means the earliest date the insured is considered as being disabled under the definition of disability in the contract, based on a doctor's evaluation or other evidence. Normally this date will coincide with the start of any elimination period.

(7) "Elimination period" means a specified number of days, weeks, or months starting at the beginning of each period of loss, during which no benefits are payable.

(8) "Gross premium" means the amount of premium charged by the insurer. It includes the net premium (based on claim-cost) for the risk, together with any loading for expenses, profit or contingencies.

(9) "Group insurance" means blanket insurance and franchise insurance and any other forms of group insurance.

(10) "Level premium" means a premium calculated to remain unchanged throughout either the lifetime of the policy, or for some shorter projected period of years. The premium need not be guaranteed; in which case, although it is calculated to remain level, it may be changed if any of the assumptions on which it was based are revised at a later time. Generally, the annual claim costs are expected to increase each year and the insurer, instead of charging premiums that correspondingly increase each year, charges a premium calculated to remain level for a period of years or for the lifetime of the contract. In this case the benefit portion of the premium is more than needed to provide for the cost of benefits during the earlier years of the policy and less than the actual cost in the later years. The building of a prospective contract reserve is a natural result of level premiums.

(11) "Long-term care insurance" has the same meaning as in G.S. 58-55-20(4); and also means a policy or certificate that provides for payment of benefits based upon cognitive impairment or the loss of functional capacity.

(12) "Modal premium" means the premium paid on a contract based on a premium term that could be annual, semi-annual, quarterly, monthly, or weekly. Thus if the annual premium is one hundred dollars ($100.00) and if, instead, monthly premiums of nine dollars ($9.00) are paid then the modal premium is nine dollars ($9.00).

(13) "Negative reserve" means a terminal reserve that has a value of less than zero resulting from benefits that decrease with advancing age or duration.

(14) "Preliminary term reserve method" means the method of valuation under which the valuation net premium for each year falling within the preliminary term period is exactly sufficient to cover the expected incurred claims of that year, so that the terminal reserves will be zero at the end of the year. As of the end of the preliminary term period, a new constant valuation net premium (or stream of changing valuation premiums) becomes applicable such that the present value of all such premiums is equal to the present value of all claims expected to be incurred following the end of the preliminary term period.

(15) "Qualified Actuary" means an individual who:

(a) is a member in good standing of the American Academy of Actuaries; and

(b) is qualified to sign statements of actuarial opinion for life and health insurance company annual statements in accordance with the American Academy of Actuaries qualification standards for actuaries signing such statements; and

(c) is familiar with the valuation requirements applicable to life and health insurance companies; and

(d) has not been found by the Commissioner (or if so found has subsequently been reinstated as a qualified actuary), following appropriate notice and hearing to have:

(i) violated any provision of, or any obligation imposed by, the insurance law or other law in the course of his or her dealings as a qualified actuary; or

(ii) been found guilty of fraudulent or dishonest practices; or

(iii) demonstrated his or her incompetency, lack of cooperation, or untrustworthiness to act as a qualified actuary; or

(iv) submitted to the Commissioner during the past five years, pursuant to this rule, an actuarial opinion or memorandum that the Commissioner rejected because it did not meet the provisions of this rule including standards set by the Actuarial Standards Board; or

(v) resigned or been removed as an actuary within the past five years as a result of acts or omissions indicated in any adverse report on examination or as a result of failure to adhere to generally acceptable actuarial standards; and

(e) has not failed to notify the Commissioner of any action taken by any commissioner of any other state similar to that under Sub-item (15)(d) of this Paragraph.

(16) "Rating block" means a grouping of contracts determined by the valuation actuary based on common characteristics filed with the Commissioner, such as a policy form or forms having similar designs.

(17) "Reserve" means all items of benefit liability, whether in the nature of incurred claim liability or in the nature of contract liability relating to future periods of coverage, and whether the liability is accrued or unaccrued. An insurer under its contracts promises benefits that result in:

(a) Claims that have been incurred, that is, for which the insurer has become obligated to make payment, on or before the valuation date. On these claims, payments expected to be made after the valuation date for accrued and unaccrued benefits are liabilities of the insurer that should be provided for by establishing claim reserves; or

(b) Claims that are expected to be incurred after the valuation date. Any present liability of the insurer for these future claims should be provided for by the establishment of contract reserves and unearned premium reserves.

(18) "Terminal reserve" means the reserve at the end of a contract year, and is defined as the present value of benefits expected to be incurred after that contract year minus the present value of future valuation net premiums.

(19) "Unearned premium reserve" means the value of that portion of the premium paid or due to the insurer that is applicable to the period of coverage extending beyond the valuation date. Thus if an annual premium of one hundred twenty dollars ($120.00) was paid on November 1, twenty dollars ($20.00) would be earned as of December 31 and the remaining one hundred dollars ($100.00) would be unearned. The unearned premium reserve could be on a gross basis as in this example, or on a valuation net premium basis.

(20) "Valuation net modal premium" means the modal fraction of the valuation net annual premium that corresponds to the gross modal premium in effect on any contract to which contract reserves apply. Thus if the mode of payment in effect is quarterly, the valuation net modal premium is the quarterly equivalent of the valuation net annual premium.

History

  • Authority G.S. 58-2-40; 58-58-50(k)
  • Temporary Adoption Eff. January 21, 1994 for a period of 180 days or until the Permanent Rule becomes effective, whichever is sooner
  • Eff. April 1, 1994
  • Amended Eff. August 1, 2004
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 20, 2015.
11 NCAC 11F .0202 General {#sec-11-ncac-11f-.0202 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11F .0202}

(a) This Section applies to all accident and health insurance coverages under G.S. 58, Articles 50 through 55.

(b) When an insurer determines that adequacy of its insurance reserves requires reserves in excess of the minimum standards specified in this Section, such increased reserves shall be held and shall be considered the minimum reserves for that insurer.

(c) With respect to any block of contracts, or with respect to an insurer's accident and health business as a whole, a prospective gross premium valuation is the ultimate test of reserve adequacy as of a given valuation date. Such a gross premium valuation shall take into account, for contracts in force, in a claims status, or in a continuation of benefits status on the valuation date, the present value as of the valuation date of: all expected benefits unpaid, all expected expenses unpaid, and all unearned or expected premiums, adjusted for future premium increases reasonably expected to be put into effect. Such a gross premium valuation shall be performed whenever a significant doubt exists as to reserve adequacy with respect to any major block of contracts or with respect to the insurer's accident and health business as a whole. If inadequacy is found to exist, immediate loss recognition shall be made and the reserves restored to adequacy. Adequate reserves (inclusive of claim, premium, and contract reserves, if any) shall be held with respect to all contracts, regardless of whether contract reserves are required for such contracts under this Section.

(d) Whenever minimum reserves, as specified in this Section, exceed reserve requirements as determined by a prospective gross premium valuation, such minimum reserves remain the minimum requirement under this Section.

(e) Adequacy of an insurer's accident and health insurance reserves shall be determined on the basis of claim reserves, premium reserves, and contract reserves, as required in 11 NCAC 11F .0203 through 11 NCAC 11F .0205, combined.

History

  • Filed as a Temporary Adoption Eff. January 21, 1994 For a Period of 180 Days or Until the
  • Permanent Rule Becomes Effective, Whichever is Sooner
  • Statutory Authority G.S. 58-2-40; 58-58-50(k)
  • Eff. April 1, 1994
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 20, 2015.
11 NCAC 11F .0203 Claim Reserves {#sec-11-ncac-11f-.0203 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11F .0203}

(a) General:

(1) Claim reserves are required for all incurred but unpaid claims on all accident and health insurance contracts.

(2) Appropriate claim expense reserves are required with respect to the estimated expense of settlement of all incurred but unpaid claims.

(3) All such reserves for prior valuation years shall be tested for adequacy and reasonableness along the lines of claim runoff schedules in accordance with the statutory financial statement including consideration of any residual unpaid liability.

(b) Minimum Standards for Claim Reserves:

(1) Disability Income:

(A) The maximum interest rate for claim reserves is specified in 11 NCAC 11F .0207.

(B) Minimum standards with respect to morbidity are those specified in 11 NCAC 11F .0207; except that, at the option of the insurer:

(i) For claims with a duration from date of disablement of less than two years, reserves may be based on the insurer's experience, if such experience is considered credible, or upon other assumptions designed to place a sound value on the liabilities.

(ii) For group disability income claims with a duration from date of disablement of more than two years but less than five years, reserves may, with the approval of the Commissioner, be based on the insurer's experience for which the insurer maintains underwriting and claim administration control. The request for such approval of a plan of modification to the reserve basis must include:

(I) An analysis of the credibility of the experience;

(II) A description of how all the insurer's experience is proposed to be used in setting reserves;

(III) A description and quantification of the margins to be included;

(IV) A summary of the financial impact that the proposed plan of modification would have had on the insurer's last filed annual statement; and

(V) A copy of the approval of the proposed plan of modification by the Commissioner of the state of domicile.

(C) For contracts with an elimination period, the duration of disablement shall be measured as dating from the time that benefits would have begun to accrue had there been no elimination period.

(2) All Other Benefits:

(A) The maximum interest rate for claim reserves is specified in 11 NCAC 11F .0207.

(B) The reserve, with respect to morbidity or other contingency, shall be based on the insurer's experience, if such experience is considered credible, or upon other assumptions designed to place a sound value on the liabilities.

(c) Any generally accepted or reasonable actuarial method or combination of methods may be used to estimate all claim liabilities. The methods used for estimating liabilities may be aggregate methods; or various reserve items may be separately valued. Approximations based on groupings and averages may also be employed. Adequacy of the claim reserves, however, shall be determined in the aggregate.

History

  • Filed as a Temporary Adoption Eff. January 21, 1994 For a Period of 180 Days or Until the
  • Permanent Rule Becomes Effective, Whichever is Sooner
  • Statutory Authority G.S. 58-2-40; 58-58-50(k)
  • Eff. April 1, 1994
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 20, 2015.
11 NCAC 11F .0204 Premium Reserves {#sec-11-ncac-11f-.0204 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11F .0204}

(a) General:

(1) Unearned premium reserves are required for all contracts with respect to the period of coverage for which premiums, other than premiums paid in advance, have been paid beyond the date of valuation.

(2) If premiums due and unpaid are carried as an asset, such premiums must be treated as premiums in force, subject to unearned premium reserve determination. The value of unpaid commissions, premium taxes, and the cost of collection associated with due and unpaid premiums must be carried as an offsetting liability.

(3) The gross premiums paid in advance for a period of coverage commencing after the next premium due date that follows the date of valuation may be appropriately discounted to the valuation date and shall be held either as a separate liability or as an addition to the unearned premium reserve that would otherwise be required as a minimum.

(b) Minimum Standards for Unearned Premium Reserves:

(1) The minimum unearned premium reserve with respect to any contract is the pro rata unearned modal premium that applies to the premium period beyond the valuation date, with such premium determined on the basis of:

(A) The valuation net modal premium on the contract reserve basis applying to the contract; or

(B) The gross modal premium for the contract if no contract reserve applies.

(2) However, in no event may the sum of the unearned premium and contract reserves for all contracts of the insurer subject to contract reserve requirements be less than the gross modal unearned premium reserve on all such contracts, as of the date of valuation. Such reserve shall never be less than the expected claims for the period beyond the valuation date represented by such unearned premium reserve, to the extent not provided for elsewhere.

(c) The insurer may employ suitable approximations and estimates, including groupings, averages, and aggregate estimation, in computing premium reserves. Such approximations or estimates shall be tested periodically to determine their continuing adequacy and reliability.

History

  • Filed as a Temporary Adoption Eff. January 21, 1994 For a Period of 180 Days or Until the
  • Permanent Rule Becomes Effective, Whichever is Sooner
  • Statutory Authority G.S. 58-2-40; 58-58-50(k)
  • Eff. April 1, 1994
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 20, 2015.
11 NCAC 11F .0205 Contract Reserves {#sec-11-ncac-11f-.0205 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11F .0205}

(a) General:

(1) Contract reserves are required, unless otherwise specified in this Rule for:

(A) All individual and group contracts with which level premiums are used; or

(B) All individual and group contracts with respect to which, due to the gross premium pricing structure at issue, the value of the future benefits at any time exceeds the value of any appropriate future valuation net premiums at that time. This evaluation may be applied on a rating block basis if the total premiums for the block were developed to support the total risk assumed and expected expenses for the block each year, and a qualified actuary certifies the premium development. The actuary shall state in the certification that premiums for the rating block were developed such that each year's premium was intended to cover that year's costs without any prefunding. If the premium is also intended to recover costs for any prior years, the actuary shall also disclose the reasons for and magnitude of such recovery. The values specified in this Subparagraph shall be determined on the basis specified in 11 NCAC 11F .0205(b).

(2) Contracts not requiring a contract reserve are:

(A) Contracts that cannot be continued after one year from issue; or

(B) Contracts already in force on the effective date of these standards for which no contract reserve was required under the immediately preceding standards.

(3) The contract reserve is in addition to claim reserves and premium reserves.

(4) The methods and procedures for contract reserves shall be consistent with those for claim reserves for any contract, or else appropriate adjustment must be made when necessary to assure provision for the aggregate liability. The definition of the date of incurral must be the same in both determinations.

(b) Minimum Standards for Contract Reserves:

(1) Basis:

(A) Minimum standards with respect to morbidity are those set forth in 11 NCAC 11F .0207. Valuation net premiums used under each contract must have a structure consistent with the gross premium structure at issue of the contract as this relates to advancing age of insured, contract duration and period for which gross premiums have been calculated. Contracts for which tabular morbidity standards are not specified in 11 NCAC 11F .0207 shall be valued using tables established for reserve purposes by a qualified actuary and acceptable to the Commissioner.

(B) The maximum interest rate is specified in 11 NCAC 11F .0207.

(C) Termination rates used in the computation of reserves shall be on the basis of a mortality table as specified in 11 NCAC 11F .0207 except as noted in Subparagraphs (b)(1)(C)(i) and (ii) of this Rule.

(i) Under contracts for which premium rates are not guaranteed, and where the effects of insurer underwriting are specifically used by contract duration in the valuation morbidity standard, or for return of premium or other deferred cash benefits, total termination rates may be used at ages and durations where these exceed specified mortality table rates, but not in excess of the lesser of:

(I) 80 percent of the total termination rate used in the calculation of the gross premiums; or

(II) Eight percent.

(ii) For long-term care individual policies or group certificates issued after August 1, 2004, the contract reserve may be established on a basis of separate mortality and other terminations, where the other terminations are not to exceed:

(I) For policy years one through four, the lesser of 80 percent of the voluntary lapse rate used in the calculation of gross premiums and eight percent;

(II) For policy years five and later, the lesser of 100 percent of the voluntary lapse rate used in the calculation of gross premiums and four percent.

Where a morbidity standard specified in 11 NCAC 11F .0207 is on an aggregate basis, such morbidity standard may be adjusted to reflect the effect of insurer underwriting by contract duration. The adjustments must be appropriate to the underwriting.

(2) Reserve Method:

(A) For insurance except long-term care and return of premium or other deferred cash benefits, the minimum reserve is the reserve calculated on the two-year full preliminary term method; that is, under which the terminal reserve is zero at the first and also the second contract anniversary.

(B) For long-term care insurance, the minimum reserve is the reserve calculated on the one-year full preliminary term method.

(C) For return of premium or other deferred cash benefits, the minimum reserve is the reserve calculated as follows:

(i) On the one-year preliminary term method if such benefits are provided at any time before the 20th anniversary;

(ii) On the two-year preliminary term method if such benefits are only provided on or after the 20th anniversary.

(D) The preliminary term method may be applied only in relation to the date of issue of a contract. Reserve adjustments introduced later, as a result of rate increases, revisions in assumptions (e.g., projected inflation rates) or for other reasons, are to be applied immediately as of the effective date of adoption of the adjusted basis.

(3) Negative reserves on any benefit may be offset against positive reserves for other benefits in the same contract, but the total contract reserve with respect to all benefits combined may not be less than zero.

(4) For long-term care insurance with nonforfeiture benefits, the contract reserve on a policy basis shall not be less than the net single premium for the nonforfeiture benefits at the appropriate policy duration, where the net single premium is computed according to the standards specified in this Rule.

(c) Provided the contract reserve on all contracts to which an alternative method or basis is applied is not less in the aggregate than the amount determined according to the applicable standards specified in this Rule, an insurer may use any reasonable assumptions as to interest rates, termination or mortality rates, and rates of morbidity or other contingency. Also, subject to the preceding condition, the insurer may employ methods other than the methods stated in this rule in determining a sound value of its liabilities under such contracts, including, but not limited to the following:

(1) the net level premium method;

(2) the one-year full preliminary term method;

(3) prospective valuation on the basis of actual gross premiums with reasonable allowance for future expenses;

(4) the use of approximations such as those involving age groupings, groupings of several years of issue, average amounts of indemnity, grouping of similar contract forms;

(5) the computation of the reserve for one contract benefit as a percentage of, or by other relation to, the aggregated contract reserves exclusive of the benefit or benefits so valued; and

(6) the use of a composite annual claim cost for all or any combination of the benefits included in the contracts valued.

(d) Annually, a review shall be made of the insurer's prospective contract liabilities on contracts valued by tabular reserves, to determine the continuing adequacy and reasonableness of the tabular reserves giving consideration to future gross premiums. The insurer shall make appropriate increments to such tabular reserves if such tests indicated that the basis of such reserves is no longer adequate; subject, however, to the minimum standards of 11 NCAC 11F .0205(b). If an insurer has a contract or a group of related similar contracts, for which future gross premiums will be restricted by contract, insurance department rules, or for other reasons, such that the future gross premiums reduced by expenses for administration, commissions and taxes will be insufficient to cover future claims, the insurer shall establish contract reserves for such shortfall in the aggregate.

History

  • Authority G.S. 58-2-40; 58-58-50(k)
  • Temporary Adoption Eff. January 21, 1994 for a period of 180 days or until the Permanent Rule becomes effective, whichever is sooner
  • Eff. April 1, 1994
  • Amended Eff. August 1, 2004
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 20, 2015.
11 NCAC 11F .0206 Reinsurance {#sec-11-ncac-11f-.0206 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11F .0206}

Increases to, or credits against reserves carried, arising because of reinsurance assumed or reinsurance ceded, must be determined in a manner consistent with the minimum reserve standards set out in 11 NCAC 11F .0200 and with all applicable provisions of the reinsurance contracts that affect the insurer's liabilities.

History

  • Filed as a Temporary Adoption Eff. January 21, 1994 For a Period of 180 Days or Until the
  • Permanent Rule Becomes Effective, Whichever is Sooner
  • Statutory Authority G.S. 58-2-40; 58-58-50(k)
  • Eff. April 1, 1994
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 20, 2015.
11 NCAC 11F .0207 Specific Standards for Morbidity, Interest and Mortality {#sec-11-ncac-11f-.0207 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11F .0207}

(a) Minimum standard morbidity tables for valuation of specified individual contract accident and health insurance benefits are as follows:

(1) Disability Income Benefits Due to Accident or Sickness.

(A) Contract Reserves:

(i) Contracts issued on or after January 1, 1965 and before January 1, 1986: The 1964 Commissioners Disability Table (64 CDT).

(ii) Contracts issued on or after January 1, 1994: The 1985 Commissioners Individual Disability Tables A (85CIDA); or The 1985 Commissioners Individual Disability Tables B (85CIDB).

(iii) Contracts issued during the years 1986 through 1993:

Optional use of either the 1964 or the 1985 Tables.

(iv) Each insurer shall elect, with respect to all individual contracts issued in any one statement year, whether it will use Tables A or Tables B as the minimum standard. The insurer may, however, elect to use the other tables with respect to any subsequent statement year.

(B) Claim Reserves:

(i) For claims incurred on or after August 1, 2004:

The 1985 Commissioners Individual Disability Tables A (85CIDA) with claim termination rates multiplied by the following adjustment factors:

Duration Adjustment Factor Adjusted Termination Rates*

Week 1 0.366 0.04831

Week 2 0.366 0.04172

Week 3 0.366 0.04063

Week4 0.366 0.04355

Week 5 0.365 0.04088

Week 6 0.365 0.04271

Week 7 0.365 0.04380

Week 8 0.365 0.04344

Week 9 0.370 0.04292

Week 10 0.370 0.04107

Week 11 0.370 0.03848

Week 12 0.370 0.03478

Week 13 0.370 0.03034

Month 4 0.391 0.08758

Month 5 0.371 0.07346

Month 6 0.435 0.07531

Month 7 0.500 0.07245

Month 8 0.564 0.06655

Month 9 0.613 0.05520

Month 10 0.663 0.04705

Month 11 0.712 0.04486

Month 12 0.756 0.04309

Month 13 0.800 0.04080

Month 14 0.844 0.03882

Month 15 0.888 0.03730

Month 16 0.932 0.03448

Month 17 0.976 0.03026

Month 18 1.020 0.02856

Month 19 1.049 0.02518

Month 20 1.078 0.02264

Month 21 1.107 0.02104

Month 22 1.136 0.01932

Month 23 1.165 0.01865

Month 24 1.195 0.01792

Year 3 1.369 0.16839

Year 4 1.204 0.10114

Year 5 1.199 0.07434

Year 6 & later 1.000 **

  • The adjusted termination rates derived from the application of the adjustment factors to the DTS Valuation Table termination rates shown in Exhibits 3a, 3b, 3c, 4, and 5 of Transactions of the Society of Actuaries (TSA) XXXVII, pp. 457-463) are displayed. The adjustment factors for age, elimination period, class, sex, and cause displayed in Exhibits 3a, 3b, 3c, and 4 shall be applied to the adjusted termination rates shown in this table.

**Applicable DTS Valuation Table duration rate from exhibits 3c and 4 (TSA XXXVII, pp. 462-463).

The 85 CIDA table so adjusted for the computation of claim reserves shall be known as 85 CIDC (The 1985 Commissioners individual disability Table C).

(ii) For claims incurred prior to August 1, 2004:

Each insurer may elect which of the following to use as the minimum standard for claims incurred prior to August 1, 2004:

(I) The minimum morbidity standard in effect for contract reserves on currently issued contracts, as of the date the claim is incurred, or

(II) The standard as defined in Subparagraph (a)(1)(B)(i) of this Rule, applied to all open claims.

(III) Once an insurer elects to calculate reserves for all open claims on the standard defined in Subparagraph (a)(1)(B)(i) of this Rule, all future valuations must be on that basis.

(2) Hospital Benefits, Surgical Benefits and Maternity Benefits (Scheduled benefits or fixed time period benefits only).

(A) Contract Reserves:

(i) Contracts issued on or after January 1, 1955, and before January 1, 1982: The 1956 Intercompany Hospital-Surgical Tables.

(ii) Contracts issued on or after January 1, 1982: The 1974 Medical Expense Tables, Table A.

(B) Claim Reserves: See 11 NCAC 11F .0207(a)(5).

(3) Cancer Expense Benefits (Scheduled benefits or fixed time period benefits only).

(A) Contract Reserves: Contracts issued on or after January 1, 1986: The 1985 NAIC Cancer Claim Cost Tables.

(B) Claim Reserves: See 11 NCAC 11F .0207(a)(5).

(4) Accidental Death Benefits.

(A) Contract Reserves: Contracts issued on or after January 1, 1965: The 1959 Accident Death Benefits Table.

(B) Claim Reserves: Actual amount incurred.

(5) Single Premium Credit Disability

(A) Contract Reserves:

(i) For contracts issued on or after August 1, 2004:

(I) For plans having less than a 30 day elimination period, the 1985 Commissioners Individual Disability Table A (85 CIDA) with claim incidence rates increased by 12 percent.

(II) For plans having a 30 day and greater elimination period, the 85 CIDA for a 14 day elimination period with the adjustment in Subparagraph (a)(5)(A)(i)(I) of this Rule.

(ii) For contracts issued prior to August 1, 2004, each insurer may elect either Subparagraph (a)(5)(A)(ii)(I) or Subparagraph (a)(5)(A)(ii)(II) of this Rule to use as the minimum standard. Once an insurer elects to calculate reserves for all contracts on the standard defined in Subparagraph (a)(5)(A)(i) of this Rule, all future valuations must be on that basis.

(I) The minimum morbidity standard in effect for contract reserves on currently issued contracts, as of the date the contract was issued, or

(II) The standard as defined in Subparagraph (a)(5)(A)(i) of this Rule, applied to all contracts.

(B) Claim Reserves: Claim reserves are to be determined as provided in 11 NCAC 11F .0203.

(6) Other Individual Contract Benefits.

(A) Contract Reserves: For all other individual contract benefits, morbidity assumptions are to be determined which will produce contract reserves that place a sound value on the liabilities of each such benefit.

(B) Claim Reserves: For all benefits other than disability, claim reserves are to be determined as provided in the standards as set out in this rule.

(b) Minimum standard morbidity tables for valuation of specified group contract accident and health insurance benefits are as follows:

(1) Disability Income Benefits Due to Accident or Sickness.

(A) Contract Reserves:

(i) Contracts issued before January 1, 1994: The same basis, if any, as that employed by the insurer as of December 31, 1993.

(ii) Contracts issued on or after January 1, 1994: The 1987 Commissioners Group Disability Income Table (87CGDT).

(B) Claim Reserves:

(i) For claims incurred on or after January 1, 1994: The 1987 Commissioners Group Disability Income Table (87CGDT);

(ii) For claims incurred before January 1, 1994: See 11 NCAC 11F .0207(b)(2).

(2) Single Premium Credit Disability

(A) Contract Reserves:

(i) For contracts issued on or after August 1, 2004:

(I) For plans having less than a 30 day elimination period, the 1985 Commissioners Individual Disability Table A (85 CIDA) with claim incidence rates increased by 12 percent.

(II) For plans having a thirty-day and greater elimination period, the 85 CIDA for a 14 day elimination period with the adjustment in Subparagraph (b)(2)(A)(i)(I) of this Rule.

(ii) For contracts issued prior to August 1, 2004, each insurer may elect either Subparagraph (b)(2)(A)(ii)(I) or Subparagraph (b)(2)(A)(ii)(II) of this Rule to use as the minimum standard. Once an insurer elects to calculate reserves for all contracts on the standard defined in Subparagraph (b)(2)(A)(i) of this Rule, all future valuations must be on that basis.

(I) The minimum morbidity standard in effect for contract reserves on currently issued contracts, as of the date the contract was issued, or

(II) The standard as defined in Subparagraph (b)(2)(A)(i) of this Rule, applied to all contracts.

(B) Claim Reserves: Claim reserves are to be determined as provided in 11 NCAC 11F .0203.

(3) Other Group Contract Benefits.

(A) Contract Reserves: For all other group contract benefits, morbidity assumptions are to be determined which will produce contract reserves that place a sound actuarial value on the liabilities of each such benefit.

(B) Claim Reserves: For all benefits other than disability, claim reserves are to be determined as provided in the standards as set out in this Rule.

(c) Maximum interest rate standards for valuation of accident and health insurance benefits are as follows:

(1) For contract reserves the maximum interest rate is the maximum rate permitted by law in the valuation of whole life insurance issued on the same date as the accident and health insurance contract.

(2) For claim reserves on contracts that require contract reserves, the maximum interest rate is the maximum rate permitted by law in the valuation of whole life insurance issued on the same date as the claim incurral date.

(3) For claim reserves on contracts not requiring contract reserves, the maximum interest rate is the maximum rate permitted by law in the valuation of single premium immediate annuities issued on the same date as the claim incurral date, reduced by one hundred basis points.

(d) Minimum standard mortality tables for valuation of accident and health insurance benefits are as follows:

(1) Except as provided for in 11 NCAC 11F .0207(d)(2) or (3), the mortality basis used for all policies except long-term care individual policies and group certificates issued after August 1, 2004, shall be according to a table (but without use of selection factors) permitted by law for the valuation of whole life insurance issued on the same date as the accident and health insurance contract. For long-term care insurance individual policies or group certificates issued on or after August 1, 2004, the mortality basis used shall be the 1983 Group Annuity Mortality Table without projection.

(2) Other mortality tables adopted by the NAIC and promulgated by the Commissioner in accordance with G.S. 150B may be used in the calculation of the minimum reserves if appropriate for the type of benefits and if requested by a qualified actuary. The request must include the proposed mortality table and the reason that the standard specified in 11 NCAC 11F .0207(d)(1) is inappropriate.

(3) For single premium credit insurance using the 85 CIDA table, no separate mortality shall be assumed.

(e) The tables referenced in 11 NCAC 11F .0207 may be found as follows:

(1) The 1964 Commissioners Disability Table, 1965 Proceedings of the National Association of Insurance Commissioners, Vol. I, pgs. 78-80;

(2) The 1985 Commissioners Individual Disability Tables A, 1986 Proceedings of the National Association of Insurance Commissioners, Vol. I, pgs. 574-589;

(3) The 1985 Commissioners Individual Disability Tables B, 1985 Proceedings of the National Association of Insurance Commissioners, Vol. I, pgs. 486-540;

(4) The 1956 Intercompany Hospital-Surgical Tables, 1957 Proceedings of the National Association of Insurance Commissioners, Vol. I, pgs. 83-85;

(5) The 1974 Medical Expense Tables, Table A, Transactions of the Society of Actuaries, Vol. XXX, pg. 63. Refer to the paper (in the same volume, page 9), to which this table is appended, including its discussions for methods of adjustment for benefits not directly valued in Table A: "Development of the 1974 Medical Expense Benefits", Houghton and Wolf;

(6) The 1985 NAIC Cancer Claim Cost Tables, 1986 Proceedings of the National Association of Insurance Commissioners, Vol. I, pgs. 609-623;

(7) The 1959 Accident Death Benefit Tables, Transactions of the Society of Actuaries, Vol. XI, pg. 754; and

(8) The 1987 Commissioners Group Disability Income Table, 1987 Proceedings of the National Association of Insurance Commissioners, Vol. II, pgs. 557-619.

(9) The 1983 Group Annuity Mortality Table, Transactions of the Society of Actuaries, Vol. XXXV, pgs. 880-881.

Copies of the above-referenced tables can be obtained at a cost prescribed in G.S. 58-6-5(3) from the Actuarial Service Division of the North Carolina Department of Insurance, P.O. Box 26387, Raleigh, N.C. 27611. The above-referenced tables are hereby incorporated by reference and do not incorporate any amendments or editions.

History

  • Authority G.S. 58-2-40; 58-58-50(k)
  • Temporary Adoption Eff. January 21, 1994 for a period of 180 days or until the Permanent Rule becomes effective, whichever is sooner
  • Eff. April 1, 1994
  • Amended Eff. August 1, 2004
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 20, 2015.
11 NCAC 11F .0208 Reserves for Waiver of Premium {#sec-11-ncac-11f-.0208 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11F .0208}

(a) Tabular reserves using the 1964 CDT, 1985 CIDA or 1985 CIDB tables, i.e. disability valuation tables based on exposures that include contracts on premium waiver as in-force contracts, shall value reserves on the following basis:

(1) Claim reserves shall include reserves for premiums expected to be waived, valuing as a minimum the valuation net premium being waived.

(2) Premium reserves shall include contracts on premium waiver as in-force contracts, valuing as a minimum the unearned modal valuation net premium being waived.

(3) Contract reserves shall include recognition of the waiver of premium benefit in addition to other contract benefits provided for, valuing as a minimum the valuation net premium to be waived.

(b) If an insurer is valuing reserves on what is truly an active life table, or if a specific valuation table is not being used but the insurer's gross premiums are calculated on a basis that includes in the projected exposure only those contracts for which premiums are being paid, then it shall still be necessary to provide specifically for waiver of premium reserves.

History

  • Filed as a Temporary Adoption Eff. January 21, 1994, For a Period of 180 Days or Until
  • the Permanent Rule Becomes Effective, Whichever is Sooner
  • Statutory Authority G.S. 58-2-40; 58-58-50(k)
  • Eff. April 1, 1994
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 20, 2015.
11 NCAC 11F .0301 Applicability and Scope {#sec-11-ncac-11f-.0301 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11F .0301}

(a) This Section applies to all life insurance companies and fraternal benefit societies doing business in this State and to all life insurance companies and fraternal benefit societies that are authorized to reinsure life insurance, annuities, or accident and health insurance business in this State. This Section shall be applied in a manner that allows the appointed actuary to utilize his or her professional judgment in performing the asset analysis and developing the actuarial opinion and supporting memoranda, consistent with relevant Actuarial Standards of Practice. However, the Commissioner may require specific methods of actuarial analysis and actuarial assumptions when these specifications are necessary for an acceptable opinion to be rendered relative to the adequacy of reserves and related items. All cross references to rule numbers are to rules within this Section.

(b) This Section applies to all annual statements filed with the Commissioner after December 31, 2004. A statement of opinion on the adequacy of the reserves and related actuarial items based on an asset adequacy analysis in accordance with Rule .0306 of this Section and a supporting memorandum in accordance with Rule .0307 of this Section are required each year.

History

  • Authority G.S. 58-2-40; 58-24-120; 58-58-50(i); 58-58-50(j)
  • Eff. December 1, 1994
  • Amended Eff. August 1, 2004
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 20, 2015.
11 NCAC 11F .0302 Definitions {#sec-11-ncac-11f-.0302 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11F .0302}

(a) "Annual statement" means that statement required to be filed each year under G.S. 58-2-165.

(b) "Appointed actuary" means any individual who is appointed or retained in accordance with Rule .0303(c) of this Section to provide the actuarial opinion and supporting memorandum as required by G.S. 58-58-50(i) and this Section.

(c) "Asset adequacy analysis" means an analysis that meets the standards and other requirements referred to in Rule .0303(d) of this Section.

(d) "Board" means the Actuarial Standards Board established by the American Academy of Actuaries to develop and promulgate standards of actuarial practice, and its successors.

(e) "Company" means a life insurance company, fraternal benefit society, or reinsurer subject to this Section.

(f) "Opinion" means the statement of actuarial opinion of an appointed actuary regarding the adequacy of the reserves and related actuarial items based on an asset adequacy analysis in accordance with Rule .0306 of this Section and with applicable actuarial standards of practice.

(g) "Qualified actuary" means any individual who meets the requirements set forth in Rule .0303(b) of this Section.

History

  • Authority G.S. 58-2-40; 58-24-120; 58-58-50(i); 58-58-50(j)
  • Eff. December 1, 1994
  • Amended Eff. August 1, 2004
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 20, 2015.
11 NCAC 11F .0303 General Requirements {#sec-11-ncac-11f-.0303 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11F .0303}

(a) Submission of Opinion:

(1) There shall be included on or attached to page 1 of the annual statement for each year beginning with calendar year 2004, the statement of an appointed actuary, entitled "Statement of Actuarial Opinion," setting forth an opinion relating to reserves and related actuarial items held in support of policies and contracts, in accordance with Rule .0306 of this Section.

(2) Upon written request by the company the Commissioner shall grant a 45-day extension of the date for submission of the opinion. In the written request, the company shall state the reason that such extension is needed.

(b) A "qualified actuary" is an individual who:

(1) Is a member in good standing of the American Academy of Actuaries;

(2) Is qualified to sign opinions for life and health insurance company annual statements in accordance with the American Academy of Actuaries qualification standards for actuaries signing such opinions;

(3) Is familiar with the valuation requirements applicable to life and health insurance companies;

(4) Has not been found by the Commissioner (or if so found has subsequently been reinstated as a qualified actuary), to have:

(A) Violated any provision of, or any obligation imposed by, any law or rule in the course of his or her dealings as a qualified actuary;

(B) Been found by a court of competent jurisdiction to be guilty of a fraudulent or dishonest practice;

(C) Failed to comply with the Code of Professional Conduct as published by the Board;

(D) Submitted to the Commissioner during the past five years, under this Section, an opinion or memorandum that the Commissioner rejected because it did not meet the provisions of this Section, including standards set by the Board; or

(E) Resigned or been removed as an actuary within the past five years as a result of acts or omissions indicated in any adverse report on an examination or as a result of failure to adhere to generally acceptable actuarial standards; and

(5) Has not failed to notify the Commissioner of any action taken by any insurance regulator of any other state similar to that under Subparagraph (b)(4) of this Rule.

(c) An "appointed actuary" is a qualified actuary who is appointed or retained to prepare the opinion required by this Section, either directly by or by the authority of the board of directors through an executive officer of the company. The company shall, within 45 days after the date of the appointment, give the Commissioner written notice of the name, title (and, in the case of a consulting actuary, the name of the firm), and manner of appointment or retention of each person appointed or retained by the company as an appointed actuary and shall state in such notice that the person meets the requirements of Paragraph (b) of this Rule. Once notice is furnished, no further notice is required for the actuary, provided that the company gives the Commissioner written notice if the actuary ceases to be appointed or retained as an appointed actuary or no longer meets the requirements of Paragraph (b) of this Rule. If any person appointed or retained as an appointed actuary replaces a previously appointed actuary, the notice shall so state and give the reasons for replacement.

(d) The asset adequacy analysis required by this Section:

(1) Shall conform to the standards of practice as promulgated from time to time by the Board and on any additional standards under this Section, which standards are to form the basis of the opinion in accordance with Rule .0306 of this Section; and

(2) Shall be based on methods of analysis that are consistent with Actuarial Standards of Practice adopted by the Board.

(e) Liabilities to be Covered:

(1) The opinion shall apply to all in force business on the annual statement date regardless of when or where issued, e.g., aggregate reserves for life insurance and annuity policies and contracts, aggregate reserves for accident and health contracts, aggregate reserves for deposit-type contracts, and policy and contract claims liabilities for life and accident and health policies and contracts, and equivalent items in the separate account statement or statements.

(2) If the appointed actuary determines as the result of asset adequacy analysis that a reserve should be held in addition to the aggregate reserve held by the company and calculated in accordance with methods set forth in G.S. 58-58-50(d), 58-58-50(d-1), 58-58-50(g), 58-58-50(h), and 58-58-50(k), the company shall establish such additional reserve.

(3) Additional reserves established under Subparagraph (e)(2) of this Rule and deemed by a qualified actuary to be unnecessary in later years may be released. Any amounts released must be disclosed in the opinion for the applicable year. The release of such reserves is not an adoption of a lower standard of valuation.

History

  • Authority G.S. 58-2-40; 58-58-50(i); 58-58-50(j)
  • Eff. December 1, 1994
  • Amended Eff. August 1, 2004
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 20, 2015.
11 NCAC 11F .0304 Required Opinions {#sec-11-ncac-11f-.0304 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11F .0304}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-58-50(i); 58-58-50(j)
  • Eff. December 1, 1994
  • Repealed Eff. August 1, 2004.
11 NCAC 11F .0305 Opinion Without Asset Adequacy Analysis {#sec-11-ncac-11f-.0305 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11F .0305}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-58-50(i); 58-58-50(j)
  • Eff. December 1, 1994
  • Repealed Eff. August 1, 2004.
11 NCAC 11F .0306 Opinion Based on Asset Adequacy Analysis {#sec-11-ncac-11f-.0306 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11F .0306}

(a) The opinion submitted in accordance with this Rule shall consist of:

(1) A paragraph identifying the appointed actuary and his or her qualifications as prescribed by Subparagraph (b)(1) of this Rule;

(2) A scope paragraph identifying the subjects on which an opinion is to be expressed and describing the scope of the appointed actuary's work, including a tabulation delineating the reserves and related actuarial items that have been analyzed for asset adequacy and the method of analysis, as prescribed by Subparagraph (b)(2) of this Rule and identifying the reserves and related actuarial items covered by the opinion that have not been so analyzed;

(3) A reliance paragraph describing those areas, if any, where the appointed actuary has deferred to other experts in developing data, procedures or assumptions, (for example, anticipated cash flows from currently owned assets, including variation in cash flows according to economic scenarios as prescribed by Subparagraph (b)(3) of this Rule), supported by a statement of each such expert in the form prescribed by Paragraph (e) of this Rule; and

(4) An opinion paragraph expressing the appointed actuary's opinion with respect to the adequacy of the supporting assets to mature the liabilities as prescribed by Subparagraph (b)(6) of this Rule;

(5) One or more additional paragraphs shall be needed in individual company cases if the appointed actuary:

(A) Considers it necessary to state a qualification of his or her opinion;

(B) Must disclose an inconsistency in the method of analysis or basis of asset allocation used at the prior opinion date with that used for this opinion.

(C) Must disclose whether additional reserves of the prior opinion date are released as of this opinion date, and the extent of the release.

(D) Chooses to add a paragraph briefly describing the assumptions that form the basis for the actuarial opinion.

(b) The following paragraphs are to be included in the opinion in accordance with this Rule. The appointed actuary shall use language that expresses his or her own professional judgement. The opinion shall retain all pertinent aspects of the language provided in this Section.

(1) The opening paragraph shall indicate the appointed actuary's relationship to the company and his or her qualifications to sign the opinion.

(A) For a company actuary, the opening paragraph of the actuarial opinion shall read as follows:

"I [name], am [title] of [insurance company name] and a member of the American Academy of Actuaries. I was appointed by, or by the authority of, the Board of Directors of the insurer to render this opinion as stated in the letter to the Commissioner dated [insert date]. I meet the Academy qualification standards for rendering the opinion and am familiar with the valuation requirements applicable to life and health insurance companies."

(B) For a consulting actuary, the opening paragraph shall contain a sentence similar to the following:

"I, [name], a member of the American Academy of Actuaries, am associated with the firm of [name of consulting firm]. I have been appointed by, or by the authority of, the Board of Directors of [name of company] to render this opinion as stated in the letter to the Commissioner dated [insert date]. I meet the Academy qualification standards for rendering the opinion and am familiar with the valuation requirements applicable to life and health insurance companies."

(2) The scope paragraph shall include a statement similar to the following:

"I have examined the actuarial assumptions and actuarial methods used in determining reserves and related actuarial items listed below, as shown in the annual statement of the company, as prepared for filing with state regulatory officials, as of December 31, [year]. Tabulated below are those reserves and related actuarial items that have been subjected to asset adequacy analysis.

(Include reserves and related actuarial items that correspond to the Asset Adequacy Tested Amounts Reserves and Liabilities Table listed in the NAIC Model Regulation titled, "Actuarial Opinion and Memorandum Regulation," and any subsequent amendments and editions. A copy of the Table may be obtained from the North Carolina Department of Insurance at a cost prescribed in G.S. 58-6-5(3)).

(3) If the appointed actuary has relied on other experts to develop certain portions of the analysis, the reliance paragraph shall include a statement similar to one of the following:

(A) "I have relied on [name], [title] for [e.g., anticipated cash flows from currently owned assets, including variations in cash flows according to economic scenarios] as certified in the attached statement. I have reviewed the information relied upon for reasonableness....", or

(B) "I have relied on personnel as cited in the supporting memorandum for certain critical aspects of the analysis in reference to the accompanying statement. I have reviewed the information relied upon for reasonableness."

Such a statement of reliance on other experts shall be accompanied by a statement by each of such experts of the form prescribed by Paragraph (e) of this Rule.

(4) If the appointed actuary has examined the underlying asset and liability records, the reliance paragraph shall also include the following:

"My examination included such review of the actuarial assumptions and actuarial methods and of the underlying basic asset and liability records and such tests of the actuarial calculations as I considered necessary. I also reconciled the underlying basic asset and liability records to [exhibits and schedules listed as applicable] of the company’s current annual statement. "

(5) If the appointed actuary has not examined the underlying records, but has relied upon data (e.g., listings and summaries of policies in force or asset records) prepared by the company or a third party, the reliance paragraph shall include a statement similar to the following:

"In forming my opinion on [specify types of reserves] I relied upon data prepared by [name and title of company officer certifying in-force records or other data] as certified in the attached statement. I evaluated that data for reasonableness and consistency. I also reconciled that data to [exhibits and schedules to be listed as applicable] of the company's current annual statement. In other respects my examination included such review of the actuarial assumptions and actuarial methods used and such tests of the actuarial calculations as I considered necessary.”

Such a sentence must be accompanied by a statement by each person relied upon of the form prescribed by Paragraph (e) of this Rule.

(6) The opinion paragraph of an unqualified opinion shall include the following:

(A) "In my opinion the reserves and related actuarial values concerning the statement items identified above:

  1. Are computed in accordance with presently accepted actuarial standards consistently applied and are fairly stated, in accordance with sound actuarial principles;

  2. Are based on actuarial assumptions that produce reserves at least as great as those called for in any contract provision as to reserve basis and method, and are in accordance with all other contract provisions;

  3. Meet the requirements of the insurance laws and rules of the state of [state of domicile] and are at least as great as the minimum aggregate amounts required by the state in which this statement is filed;

  4. Are computed on the basis of assumptions consistent with those used in computing the corresponding items in the annual statement of the preceding year-end (with any exceptions noted below); and

  5. Include provision for all actuarial reserves and related statement items that ought to be established.

The reserves and related items, when considered in light of the assets held by the company with respect to such reserves and related actuarial items including, but not limited to, the investment earnings on such assets, and the considerations anticipated to be received and retained under such policies and contracts, make adequate provision, according to presently accepted actuarial standards of practice, for the anticipated cash flows required by the contractual obligations and related expenses of the company.

The actuarial methods, considerations and analyses used in forming my opinion conform to the appropriate Standards of Practice as promulgated by the Actuarial Standards Board, which standards form the basis of this statement of opinion."

(B) Select one of the following two paragraphs:

(i) "This opinion is updated annually as required by law. To the best of my knowledge, there have been no material changes from the applicable date of the annual statement to the date of the rendering of this opinion that should be considered in reviewing this opinion;" or

(ii) "The following material change(s) that occurred between the date of the statement for which this opinion is applicable and the date of this opinion should be considered in reviewing this opinion." (Describe the change or changes.)

(C) "The effect of unanticipated events after the date of this opinion is beyond the scope of this opinion. The analysis of asset adequacy portion of this opinion should be viewed recognizing that the company's future experience may not follow all the assumptions used in the analysis.

Signature of Appointed Actuary

Address of Appointed Actuary

Telephone Number of Appointed

Actuary

Date"

(c) The adoption for new issues or new claims or other new liabilities of an actuarial assumption that differs from a corresponding assumption used for prior new issues or new claims or other new liabilities is not a change in actuarial assumptions within the meaning of this Rule.

(d) If the appointed actuary is unable to form an opinion, then he or she shall refuse to issue an opinion. If the appointed actuary's opinion is adverse or qualified, then he or she shall issue an adverse or qualified opinion explicitly stating the reason or reasons for such opinion. This statement shall follow the scope paragraph and precede the opinion paragraph. If the appointed actuary's opinion is adverse or qualified, the appointed actuary shall modify the language prescribed in Rule .0306(b)(6) of this Section as made necessary by the reason or reasons for the qualified opinion, and shall label the opinion paragraph with the words "Qualified Opinion."

(e) If the appointed actuary relies on the certification of others on matters concerning the accuracy or completeness of any data underlying the opinion, or the appropriateness of any other information used by the appointed actuary in forming the opinion, the opinion shall so indicate the persons the actuary is relying upon and a precise identification of the items subject to reliance. In addition, the persons on whom the appointed actuary relies shall provide a certification that precisely identifies the items on which the person is providing information and a statement as to the accuracy, completeness or reasonableness, as applicable, of the items. This certification shall include the signature, title, company, address, and telephone number of the person rendering the certification, as well as the date on which it is signed.

History

  • Authority G.S. 58-2-40; 58-58-50(i); 58-58-50(j)
  • Eff. December 1, 1994
  • Amended Eff. August 1, 2004
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 20, 2015.
11 NCAC 11F .0307 Actuarial Memorandum with Asset Adequacy Analysis {#sec-11-ncac-11f-.0307 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11F .0307}

(a) General:

(1) In accordance with G.S. 58-58-50(i) and (j), the appointed actuary shall prepare a memorandum to the company describing the analysis done in support of his or her opinion regarding the reserves under an opinion prescribed by Rule .0306 of this Section. The memorandum shall be made available for examination by the Commissioner upon request and shall be returned to the company after the examination and shall not be subject to automatic filing with the Commissioner.

(2) In preparing the memorandum, the appointed actuary may rely on, and include as a part of his or her own memorandum, memoranda prepared and signed by other actuaries who are qualified within the meaning of Rule .0303(b) of this Section, with respect to the areas covered in such memoranda, and so state in their memoranda.

(3) If the Commissioner requests a memorandum and no such memorandum exists or if the Commissioner finds that the analysis described in the memorandum fails to meet the standards of the Board or the standards and requirements of this Section, the Commissioner shall designate a qualified actuary to review the opinion and prepare such supporting memorandum as is required for review. The reasonable and necessary expense of the independent review shall be paid by the company but shall be directed and controlled by the Commissioner.

(4) The reviewing actuary shall have the same status as an examiner for purposes of obtaining data from the company and the work papers and documentation of the reviewing actuary shall be retained by the Commissioner; provided, however, that any information provided by the company to the reviewing actuary and included in the work papers shall be considered as material provided by the company to the Commissioner and shall be kept confidential to the same extent as is prescribed by law with respect to other material provided by the company to the Commissioner under G.S. 58-58-50(j). The reviewing actuary shall not be an employee of a consulting firm involved with the preparation of any prior memorandum or opinion for the company under this Section for any one of the current year or the preceding three years.

(5) In accordance with G.S. 58-58-50(j), the appointed actuary shall prepare a regulatory asset adequacy issues summary, the contents of which are specified in Paragraph (c) of this Rule. The regulatory asset adequacy issues summary shall be submitted no later than March 15 of the year following the year for which a statement of actuarial opinion based on asset adequacy is required. The regulatory asset adequacy issues summary shall be kept confidential to the same extent and under the same conditions as the actuarial memorandum.

(b) When an actuarial opinion under Rule .0306 of this Section is provided, the memorandum shall demonstrate that the analysis has been done in accordance with the standards for asset adequacy referred to in Rule .0303(d) of this Section and any additional standards under this Section. It shall specify:

(1) For reserves:

(A) Product descriptions, including market description, underwriting, and other aspects of a risk profile, and the specific risks the appointed actuary deems to be significant;

(B) Source of liability in force;

(C) Reserve method and basis;

(D) Investment reserves;

(E) Reinsurance arrangements;

(F) Identification of any explicit or implied guarantees made by the general account in support of benefits provided through a separate account or under a separate account policy or contract and the methods used by the appointed actuary to provide for the guarantees in the asset adequacy analysis;

(G) Documentation of assumptions to test reserves for the following:

(i) Lapse rates (both base and excess);

(ii) Interest crediting rate strategy;

(iii) Mortality;

(iv) Policyholder dividend strategy;

(v) Competitor or market interest rate;

(vi) Annuitization rates;

(vii) Commissions and expenses; and

(viii) Morbidity.

The documentation of assumptions shall be such that an actuary reviewing the actuarial memorandum could form a conclusion as to the reasonableness of the assumptions.

(2) For assets:

(A) Portfolio descriptions, including a risk profile disclosing the quality, distribution, and types of assets;

(B) Investment and disinvestment assumptions;

(C) Source of asset data;

(D) Asset valuation bases; and

(E) Documentation of assumptions made for:

(i) Default costs;

(ii) Bond call function;

(iii) Mortgage prepayment function;

(iv) Determining market value for assets sold due to disinvestment strategy; and

(v) Determining yield on assets acquired through the investment strategy.

The documentation of the assumptions shall be such that an actuary reviewing the actuarial memorandum could form a conclusion as to the reasonableness of the assumptions.

(3) For the analysis basis:

(A) Methodology;

(B) Rationale for inclusion or exclusion of different blocks of business and how pertinent risks were analyzed;

(C) Rationale for degree of rigor in analyzing different blocks of business (including in the rationale the level of "materiality" that was used in determining how rigorously to analyze different blocks of business);

(D) Criteria for determining asset adequacy (including in the criteria the precise basis for determining if assets are adequate to cover reserves under "moderately adverse conditions" or other conditions as specified in relevant actuarial standards of practice); and

(E) Effect of federal income taxes, reinsurance, and other actuarially or financially relevant factors.

(4) Summary of any changes in methods, procedures, or assumptions from the prior year's asset adequacy analysis which the appointed actuary considers to be material.

(5) Summary of results.

(6) Conclusions.

(c) The regulatory asset adequacy issues summary shall include:

(1) Descriptions of the scenarios tested (including whether those scenarios are stochastic or deterministic) and the sensitivity testing done relative to those scenarios. If negative ending surplus results under any tests in the aggregate, the actuary shall describe those tests and the amount of additional reserve as of the valuation date that, if held, would eliminate the negative aggregate surplus values. Ending surplus values shall be determined by either extending the projection period until the in force and associated assets and liabilities at the end of the projection period are considered by the appointed actuary to be immaterial or by adjusting the surplus amount at the end of the projection period by an amount that appropriately estimates the value that can reasonably be expected to arise from the assets and liabilities remaining in force;

(2) The extent to which the appointed actuary uses assumptions in the asset adequacy analysis that are considered by the appointed actuary to be materially different than the assumptions used in the previous asset adequacy analysis;

(3) The amount of reserves and the identity of the product lines that had been subjected to asset adequacy analysis in the prior opinion but were not subject to analysis for the current opinion;

(4) Comments on any interim results that may be of concern to the appointed actuary, such as the effect of the insufficiency of assets to support the payment of benefits and expenses and the establishment of statutory reserves during one or more interim periods;

(5) The methods used by the actuary to recognize the impact of reinsurance on the company's cash flows, including both assets and liabilities, under each of the scenarios tested; and

(6) Whether the actuary has been satisfied that all options whether explicit or embedded, in any asset or liability (including those affecting cash flows embedded in fixed income securities) and equity-like features in any investments have been appropriately considered in the asset adequacy analysis.

(d) The regulatory asset adequacy issues summary shall contain the name of the company for which the regulatory asset adequacy issues summary is being supplied, and shall be signed and dated by the appointed actuary rendering the actuarial opinion.

(e) The memorandum shall include a statement:

"Actuarial methods, considerations and analyses used in the preparation of this memorandum conform to the appropriate Standards of Practice as promulgated by the Actuarial Standards Board, which standards form the basis for this memorandum."

(f) An appropriate allocation of assets in the amount of the interest maintenance reserve (IMR), whether positive or negative, shall be used in any asset adequacy analysis. Analysis of risks regarding asset default may include an appropriate allocation of assets supporting the asset valuation reserve (AVR); these AVR assets may not be applied for any other risks with respect to reserve adequacy. Analysis of these and other risks may include assets supporting other mandatory or voluntary reserves available to the extent not used for risk analysis and reserve support. The amount of the assets used for the AVR shall be disclosed in the table of reserves and liabilities of the opinion and in the memorandum. The method used for selecting particular assets or allocated portions of assets shall be disclosed in the memorandum.

(g) The appointed actuary shall retain on file, for at least seven years, all documentation necessary to determine the procedures followed, the analyses performed, the bases for the assumptions, and the results obtained.

History

  • Authority G.S. 58-2-40; 58-58-50(i); 58-58-50(j)
  • Eff. December 1, 1994
  • Amended Eff. March 1, 2010; August 1, 2004
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 20, 2015.
11 NCAC 11F .0308 Additional Considerations for Analysis {#sec-11-ncac-11f-.0308 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11F .0308}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-58-50(i); 58-58-50(j)
  • Eff. December 1, 1994
  • Repealed Eff. August 1, 2004.
11 NCAC 11F .0401 Applicability {#sec-11-ncac-11f-.0401 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11F .0401}

(a) This Section does not apply to:

(1) Any individual life insurance policy issued on or after January 1, 2000, if the policy is issued in accordance with and as a result of the exercise of a reentry provision contained in the original life insurance policy of the same or greater face amount, issued before January 1, 2000, that guarantees the premium rates of the new policy; nor to subsequent policies issued as a result of the exercise of such a provision, or a derivation of the provision, in the new policy;

(2) Any universal life policy that meets all the following requirements:

(A) The secondary guarantee period, if any, is five years or less.

(B) The specified premium for the secondary guarantee period is not less than the net level reserve premium for the secondary guarantee period based on the CSO valuation tables as defined in 11 NCAC 11F .0402(6) and the applicable valuation interest rate.

(C) The initial surrender charge is not less than 100% of the first year annualized specified premium for the secondary guarantee period.

(3) Any variable life insurance policy that provides for life insurance, the amount or duration of which varies according to the investment experience of any separate account or accounts;

(4) Any variable universal life insurance policy that provides for life insurance, the amount or duration of which varies according to the investment experience of any separate account or accounts; and

(5) A group life insurance certificate unless the certificate provides for a stated or implied schedule of maximum gross premiums required in order to continue coverage in force for a period in excess of one year.

(b) Calculation of the minimum valuation standard for policies with guaranteed nonlevel gross premiums or guaranteed nonlevel benefits (other than universal life policies), or both, shall be in accordance with 11 NCAC 11F .0404.

(c) Calculation of the minimum valuation standard for flexible premium and fixed premium universal life insurance policies that contain provisions resulting in the ability of a policyholder to keep a policy in force over a secondary guarantee period shall be in accordance with 11 NCAC 11F .0405.

History

  • Authority G.S. 58-2-40; 58-58-50(d); 58-58-50(k)
  • Eff. January 1, 1998
  • Temporary Amendment Eff. January 1, 2000
  • Amended Eff. July 1, 2000
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 20, 2015.
11 NCAC 11F .0402 Definitions {#sec-11-ncac-11f-.0402 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11F .0402}

As used in this Section:

(1) "Basic reserves" means reserves calculated in accordance with G.S. 58-58-50(d).

(2) "Contract segmentation method" means the method of dividing the period from issue to mandatory expiration of a policy into successive segments, with the length of each segment being defined as the period from the end of the prior segment (from policy inception, for the first segment) to the end of the latest policy year as determined below. All calculations are made using the 1980 CSO valuation tables, as defined in 11 NCAC 11F .0402(6) (or any other valuation mortality table adopted by the NAIC after January 1, 2000, and adopted as a rule by the Commissioner for this purpose), and, if elected, the optional minimum mortality standard for deficiency reserves stipulated in 11 NCAC 11F .0403(b).

The length of a particular contract segment shall be set equal to the minimum of the value t for which Gt is greater than Rt (if Gt never exceeds Rt the segment length is deemed to be the number of years from the beginning of the segment to the mandatory expiration date of the policy), where Gt and Rt are defined as follows:

Gt = GPx+k+t

GPx+k+t-1

where:

x = original issue age;

k = the number of years from the date of issue to the beginning of the segment;

t = 1, 2, . . .; t is reset to 1 at the beginning of each segment;

GPx+k+t-1 = Guaranteed gross premium per thousand of face amount, for year t of the segment, ignoring policy fees only if level for the premium paying period of the policy.

Rt = qx+k+t

qx+k+t-1

However, Rt may be increased or decreased by one percent in any policy year, at the company's option, but Rt shall not be less than one;

where:

x, k and t are as defined above, and

qx+k+t-1 = valuation mortality rate for deficiency reserves in policy year k+t, but using the mortality of 11 NCAC 11F .0403(b)(2) if 11 NCAC 11F .0403(b)(3) is elected for deficiency reserves.

However, if GPx+k+t is greater than zero (0) and GPx+k+t-1 is equal to zero (0), Gt shall be deemed to be one thousand (1,000). If GPx+k+t and GPx+k+t-1 are both equal to zero (0), Gt shall be deemed to be zero (0).

(3) "Deficiency reserves" means the excess, if greater than zero, of minimum reserves calculated in accordance with G.S. 58-58-50(g) over basic reserves.

(4) "Guaranteed gross premiums" means the premiums under a policy of life insurance that are guaranteed and determined at issue.

(5) "Maximum valuation interest rates" means the interest rates specified in G.S. 58-58-50(c)(4) that are to be used in determining the minimum standard for the valuation of life insurance policies.

(6) "1980 CSO valuation tables" means the Commissioners' 1980 Standard Ordinary Mortality Table (1980 CSO Table) without ten-year selection factors, incorporated into the 1980 amendments to the NAIC Standard Valuation Law, and variations of the 1980 CSO Table approved by the NAIC, such as the smoker and nonsmoker versions approved in December 1983.

(7) "Scheduled gross premium" means the smallest illustrated gross premium at issue for other than universal life insurance policies. For universal life insurance policies, scheduled gross premium means the smallest specified premium described in 11 NCAC 11F .0405(a)(3), if any, or else the minimum premium described in 11 NCAC 11F .0405(a)(4).

(8) "Segmented reserves" means reserves, calculated using segments produced by the contract segmentation method, equal to the present value of all future guaranteed benefits less the present value of all future net premiums to the mandatory expiration of a policy, where the net premiums within each segment are a uniform percentage of the respective guaranteed gross premiums within the segment.

(a) The uniform percentage for each segment is such that, at the beginning of the segment, the present value of the net premiums within the segment equals:

(i) The present value of the death benefits within the segment, plus;

(ii) The present value of any unusual guaranteed cash value (see 11 NCAC 11F .0404(d)) occurring at the end of the segment, less;

(iii) Any unusual guaranteed cash value occurring at the start of the segment, plus; and

(iv) For the first segment only, the excess of the Item (A) over Item (B), as follows:

(A) A net level annual premium equal to the present value, at the date of issue, of the benefits provided for in the first segment after the first policy year, divided by the present value, at the date of issue, of an annuity of one per year payable on the first and each subsequent anniversary within the first segment on which a premium falls due. However, the net level annual premium shall not exceed the net level annual premium on the nineteen-year premium whole life plan of insurance of the same renewal year equivalent level amount at an age one year higher than the age at issue of the policy; and

(B) A net one-year term premium for the benefits provided for in the first policy year.

(b) The length of each segment is determined by the contract segmentation method.

(c) The interest rates used in the present value calculations for any policy may not exceed the maximum valuation interest rate, determined with a guarantee duration equal to the sum of the lengths of all segments of the policy.

(d) For both basic reserves and deficiency reserves computed by the segmented method, present values shall include future benefits and net premiums in the current segment and in all subsequent segments.

(9) "Tabular cost of insurance" means the net single premium at the beginning of a policy year for one-year term insurance in the amount of the guaranteed death benefit in that policy year.

(10) "Ten-year select factors" means the select factors adopted with the 1980 amendments to the NAIC Standard Valuation Law.

(11) "Unitary reserves" means the present value of all future guaranteed benefits less the present value of all future modified net premiums, where:

(a) Guaranteed benefits and modified net premiums are considered to the mandatory expiration of the policy;

(b) Modified net premiums are a uniform percentage of the respective guaranteed gross premiums, where the uniform percentage is such that, at issue, the present value of the net premiums equals the present value of all death benefits and pure endowments, plus the excess of Item (i) over Item (ii):

(i) A net level annual premium equal to the present value, at the date of issue, of the benefits provided for after the first policy year, divided by the present value, at the date of issue, of an annuity of one per year payable on the first and each subsequent anniversary of the policy on which a premium falls due. However, the net level annual premium shall not exceed the net level annual premium on the nineteen-year premium whole life plan of insurance of the same renewal year equivalent level amount at an age one year higher than the age at issue of the policy.

(ii) A net one-year term premium for the benefits provided for in the first policy year; and

(c) The interest rates used in the present value calculations for any policy may not exceed the maximum valuation interest rate, determined with a guarantee duration equal to the length from issue to the mandatory expiration of the policy.

(12) "Universal life insurance policy" means any individual life insurance policy under the provisions of which separately identified interest credits (other than in connection with dividend accumulations, premium deposit funds, or other supplementary accounts) and mortality or expense charges are made to the policy.

History

  • Authority G.S. 58-2-40; 58-58-50(d); 58-58-50(k)
  • Eff. January 1, 1998
  • Temporary Amendment Eff. January 1, 2000
  • Amended Eff. July 1, 2000
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 20, 2015.
11 NCAC 11F .0403 Basic and Premium Deficiency Reserves {#sec-11-ncac-11f-.0403 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11F .0403}

(a) At the election of the company for any one or more specified plans of life insurance, the minimum mortality standard for basic reserves may be calculated using the 1980 CSO valuation tables with select mortality factors (or any other valuation mortality table adopted by the NAIC after January 1, 2000, and adopted as a rule by the Commissioner for this purpose). If select mortality factors are elected, they may be:

(1) The ten-year select mortality factors incorporated into the 1980 amendments to the NAIC Standard Valuation Law;

(2) The select mortality factors in the NAIC Model Regulation entitled "Valuation of Life Insurance Policies Model Regulation"; or

(3) Any other table of select mortality factors adopted by the NAIC after January 1, 2000, and adopted as a rule by the Commissioner for the purpose of calculating basic reserves.

(b) Deficiency reserves, if any, are calculated for each policy as the excess, if greater than zero, of the quantity A over the basic reserve. The quantity A is obtained by recalculating the basic reserve for the policy using guaranteed gross premiums instead of net premiums when the guaranteed gross premiums are less than the corresponding net premiums. At the election of the company for any one or more specified plans of insurance, the quantity A and the corresponding net premiums used in the determination of quantity A may be based upon the 1980 CSO valuation tables with select mortality factors (or any other valuation mortality table adopted by the NAIC after January 1, 2000, and adopted as a rule by the Commissioner). If select mortality factors are elected, they may be any of the following:

(1) The ten-year select mortality factors incorporated into the 1980 amendments to the NAIC Standard Valuation Law;

(2) The select mortality factors in the NAIC Model Regulation entitled "Valuation of Life Insurance Policies Model Regulation";

(3) For durations in the first segment, X percent of the select mortality factors in the NAIC Model Regulation entitled "Valuation of Life Insurance Policies Model Regulation," subject to the following:

(A) X may vary by policy year, policy form, underwriting classification, issue age, or any other policy factor expected to affect mortality experience;

(B) X is such that, when using the valuation interest rate used for basic reserves, Item (i) is greater than or equal to Item (ii):

(i) The actuarial present value of future death benefits calculated using the mortality rates resulting from the application of X;

(ii) The actuarial present value of future death benefits calculated using anticipated mortality experience without recognition of mortality improvement beyond the valuation date;

(C) X is such that the mortality rates resulting from the application of X are at least as great as the anticipated mortality experience, without recognition of mortality improvement beyond the valuation date, in each of the first five years after the valuation date;

(D) The appointed actuary shall increase X at any valuation date where it is necessary to continue to meet all requirements of this Rule;

(E) The appointed actuary may decrease X at any valuation date as long as X continues to meet all the requirements of this Rule;

(F) The appointed actuary shall take into account the adverse effect on expected mortality and lapsation of any anticipated or actual increase in gross premiums; and

(G) If X is less than 100 percent at any duration for any policy, the following requirements shall be met:

(i) The appointed actuary shall annually prepare an actuarial opinion and memorandum for the company in conformance with the requirements of 11 NCAC 11F .0300;

(ii) The appointed actuary shall disclose, in the Regulatory Asset Adequacy Issues Summary, the effect of the insufficiency of assets to support the payment of benefits and expenses and the establishment of statutory reserves during one or more interim periods; and

(iii) The appointed actuary shall annually opine for all policies subject to this Section as to whether the mortality rates resulting from the application of X meet the requirements of this Rule. This opinion shall be supported by an actuarial report, subject to appropriate Actuarial Standards of Practice promulgated by the Actuarial Standards Board of the American Academy of Actuaries. The X factors shall reflect anticipated future mortality, without recognition of mortality improvement beyond the valuation date, taking into account relevant emerging experience;

(4) Any other table of select mortality factors adopted by the NAIC after January 1, 2000, and adopted as a rule by the Commissioner for the purpose of calculating deficiency reserves.

(c) This Rule applies to both basic reserves and deficiency reserves. Any set of select mortality factors may be used only for the first segment. However, if the first segment is less than 10 years, the appropriate 10-year select mortality factors, incorporated into the 1980 amendments to the NAIC Standard Valuation Law, may be used thereafter through the tenth policy year from the date of issue.

(d) In determining basic reserves or deficiency reserves, guaranteed gross premiums without policy fees may be used where the calculation involves the guaranteed gross premium, but only if the policy fee is a level dollar amount after the first policy year. In determining deficiency reserves, policy fees may be included in guaranteed gross premiums even if they are not included in the actual calculation of basic reserves.

(e) Reserves for policies that have changes to guaranteed gross premiums, guaranteed benefits, guaranteed charges, or guaranteed credits that are unilaterally made by the insurer after issue and that are effective for more than one year after the date of the change shall be the greatest of the following:

(1) Reserves calculated ignoring the guarantee;

(2) Reserves assuming the guarantee was made at issue; or

(3) Reserves assuming that the policy was issued on the date of the guarantee.

History

  • Authority G.S. 58-2-40; 58-58-50(d); 58-58-50(k)
  • Eff. January 1, 1998
  • Temporary Amended Eff. January 1, 2000
  • Amended Eff. March 1, 2010; July 1, 2000
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 20, 2015.
11 NCAC 11F .0404 CALCULATION OF 11 NCAC 11f .0401(b) {#sec-11-ncac-11f-.0404 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11F .0404}

(a) Basic reserves shall be calculated as the greater of the segmented reserves and the unitary reserves. Both the segmented reserves and the unitary reserves for any policy shall use the same valuation mortality table and selection factors. At the option of the insurer, in calculating segmented reserves and net premiums, either of the following adjustments may be made:

(1) Treat the unitary reserve, if greater than zero, applicable at the end of each segment as a pure endowment; and subtract the unitary reserve, if greater than zero, applicable at the beginning of each segment from the present value of guaranteed life insurance and endowment benefits for each segment; or

(2) Treat the guaranteed cash surrender value, if greater than zero, applicable at the end of each segment as a pure endowment; and subtract the guaranteed cash surrender value, if greater than zero, applicable at the beginning of each segment from the present value of guaranteed life insurance and endowment benefits for each segment.

(b) Deficiency Reserves:

(1) The deficiency reserve at any duration shall be calculated:

(A) On a unitary basis if the corresponding basic reserve determined by 11 NCAC 11F .0404(a) is unitary;

(B) On a segmented basis if the corresponding basic reserve determined by 11 NCAC 11F .0404(a) is segmented; or

(C) On the segmented basis if the corresponding basic reserve determined by 11 NCAC 11F .0404(a) is equal to both the segmented reserve and the unitary reserve.

(2) 11 NCAC 11F .0404(b) shall apply to any policy for which the guaranteed gross premium at any duration is less than the corresponding modified net premium calculated by the method used in determining the basic reserves, but using the minimum valuation standards of mortality (specified in 11 NCAC 11F .0403 (b)) and rate of interest.

(3) Deficiency reserves, if any, shall be calculated for each policy as the excess if greater than zero, for the current and all remaining periods, of the quantity A over the basic reserve, where A is obtained as indicated in 11 NCAC 11F .0403(b).

(4) For deficiency reserves determined on a segmented basis, the quantity A is determined using segment lengths equal to those determined for segmented basic reserves.

(c) Minimum Value - Basic reserves may not be less than the tabular cost of insurance for the balance of the policy year, if mean reserves are used. Basic reserves may not be less than the tabular cost of insurance for the balance of the current modal period or to the paid-to-date, if later, but not beyond the next policy anniversary, if mid-terminal reserves are used. The tabular cost of insurance shall use the same valuation mortality table and interest rates as those that are used for the calculation of the segmented reserves. However, if select mortality factors are used, they shall be the 10-year select factors incorporated into the 1980 amendments of the NAIC Standard Valuation Model Law. In no case may total reserves (including basic reserves, deficiency reserves and any reserves held for supplemental benefits that would expire upon contract termination) be less than the amount that the policyowner would receive (including the cash surrender value of the supplemental benefits, if any, referred to above), exclusive of any deduction for policy loans, upon termination of the policy.

(d) Unusual Pattern of Guaranteed Cash Surrender Values:

(1) For any policy with an unusual pattern of guaranteed cash surrender values, the reserves actually held prior to the first unusual guaranteed cash surrender value shall not be less than the reserves calculated by treating the first unusual guaranteed cash surrender value as a pure endowment and treating the policy as an n-year policy providing term insurance plus a pure endowment equal to the unusual cash surrender value, where n is the number of years from the date of issue to the date the unusual cash surrender value is scheduled.

(2) The reserves actually held subsequent to any unusual guaranteed cash surrender value shall not be less than the reserves calculated by treating the policy as an n-year policy providing term insurance plus a pure endowment equal to the next unusual guaranteed cash surrender value, and treating any unusual guaranteed cash surrender value at the end of the prior segment as a net single premium, where:

(A) n is the number of years from the date of the last unusual guaranteed cash surrender value prior to the valuation date to the earlier of:

(i) The date of the next unusual guaranteed cash surrender value, if any, that is scheduled after the valuation date; or

(ii) The mandatory expiration date of the policy;

(B) The net premium for a given year during the n-year period is equal to the product of the net to gross ratio and the respective gross premium; and

(C) The net to gross ratio is equal to Item (i) divided by Item (ii):

(i) The present value, at the beginning of the n-year period, of death benefits payable during the n-year period plus the present value, at the beginning of the n-year period, of the next unusual guaranteed cash surrender value, if any, minus the amount of the last unusual guaranteed cash surrender value, if any, scheduled at the beginning of the n-year period.

(ii) The present value, at the beginning of the n-year period, of the scheduled gross premiums payable during the n-year period.

(3) For the purposes of 11 NCAC 11F .0404(d) a policy is considered to have an unusual pattern of guaranteed cash surrender values if any future guaranteed cash surrender value exceeds the prior year's guaranteed cash surrender value by more than the sum of:

(A) One hundred ten percent (110%) of the scheduled gross premium for that year;

(B) One hundred ten percent (110%) of one year's accrued interest on the sum of the prior year's guaranteed cash surrender value and the scheduled gross premium using the nonforfeiture interest rate used for calculating policy guaranteed cash surrender values; and

(C) Five percent (5%) of the first policy year surrender charge, if any.

(e) Optional Exemption for Yearly Renewable Term Reinsurance - At the option of the company, the following approach for reserves on YRT reinsurance may be used:

(1) Calculate the valuation net premium for each future policy year as the tabular cost of insurance for that future year;

(2) Basic reserves shall never be less than the tabular cost of insurance for the appropriate period, as defined in 11 NCAC 11F .0404(c);

(3) Deficiency reserves:

(A) For each policy year, calculate the excess, if greater than zero, of the valuation net premium over the respective maximum guaranteed gross premium.

(B) Deficiency reserves shall never be less than the sum of the present values, at the date of valuation, of the excesses determined in accordance with Part (A) of this Subparagraph.

(4) For purposes of 11 NCAC 11F .0404(e), the calculations use the maximum valuation interest rate and the 1980 CSO mortality tables with or without ten-year select mortality factors, or any other table adopted after January 1, 2000, by the NAIC and adopted as a rule by the Commissioner for this purpose;

(5) A reinsurance agreement shall be considered YRT reinsurance for purposes of this Rule if only the mortality risk is reinsured.

(6) If the assuming company chooses this optional exemption, the ceding company's reinsurance reserve credit shall be limited to the amount of reserve held by the assuming company for the affected policies.

(f) Optional Exemption for Attained-Age-Based Yearly Renewable Term Life Insurance Policies - At the option of the company, the following approach for reserves for attained-age-based YRT life insurance policies may be used:

(1) Calculate the valuation net premium for each future policy year as the tabular cost of insurance for that future year;

(2) Basic reserves shall never be less than the tabular cost of insurance for the appropriate period, as defined in 11 NCAC 11F.0404(c);

(3) Deficiency reserves:

(A) For each policy year, calculate the excess, if greater than zero, of the valuation net premium over the respective maximum guaranteed gross premium.

(B) Deficiency reserves shall never be less than the sum of the present values, at the date of valuation, of the excesses determined in accordance with Part (A) of this Subparagraph;

(4) For purposes of 11 NCAC 11F .0404(f), the calculations use the maximum valuation interest rate and the 1980 CSO valuation tables with or without 10-year select mortality factors, or any other table adopted after January 1, 2000, by the NAIC and adopted as a rule by the Commissioner for this purpose;

(5) A policy shall be considered an attained-age-based YRT life insurance policy for purposes of this Rule if:

(A) The premium rates (on both the initial current premium scale and the guaranteed maximum premium scale) are based upon the attained age of the insured such that the rate for any given policy at a given attained age of the insured is independent of the year the policy was issued; and

(B) The premium rates (on both the initial current premium scale and the guaranteed maximum premium scale) are the same as the premium rates for policies covering all insureds of the same sex, risk class, plan of insurance and attained age;

(6) For policies that become attained-age-based YRT policies after an initial period of coverage, the approach of this Rule may be used after the initial period if:

(A) The initial period is constant for all insureds of the same sex, risk class and plan of insurance; or

(B) The initial period runs to a common attained age for all insureds of the same sex, risk class and plan of insurance; and

(C) After the initial period of coverage, the policy meets the conditions of Subparagraph (f)(5) of this Rule;

(7) If this election is made, this approach shall be applied in determining reserves for all attained-age-based YRT life insurance policies issued on or after January 1, 2000.

(g) Exemption from Unitary Reserves for Certain n-Year Renewable Term Life Insurance Policies - Unitary basic reserves and unitary deficiency reserves need not be calculated for a policy if the following conditions are met:

(1) The policy consists of a series of n-year periods, including the first period and all renewal periods, where n is the same for each period, except that for the final renewal period, n may be truncated or extended to reach the expiry age, provided that this final renewal period is less than 10 years and less than twice the size of the earlier n-year periods, and for each period, the premium rates on both the initial current premium scale and the guaranteed maximum premium scale are level;

(2) The guaranteed gross premiums in all n-year periods are not less than the corresponding net premiums based upon the 1980 CSO Table with or without the 10-year select mortality factors; and

(3) There are no cash surrender values in any policy year.

(h) Exemption from Unitary Reserves for Certain Juvenile Policies - Unitary basic reserves and unitary deficiency reserves need not be calculated for a policy if the following conditions are met, based upon the initial current premium scale at issue:

(1) At issue, the insured is age 24 or younger;

(2) Until the insured reaches the end of the juvenile period, which shall occur at or before age 25, the gross premiums and death benefits are level, and there are no cash surrender values; and

(3) After the end of the juvenile period, gross premiums are level for the remainder of the premium paying period, and death benefits are level for the remainder of the life of the policy.

History

  • Authority G.S. 58-2-40; 58-58-50(d); 58-58-50(k)
  • Eff. January 1, 1998
  • Temporary Amendment Eff. January 1, 2000
  • Amended Eff. July 1, 2000
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 20, 2015.
11 NCAC 11F .0405 CALCULATION OF 11 NCAC 11F .0401(c) {#sec-11-ncac-11f-.0405 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11F .0405}

(a) General

(1) Policies with a secondary guarantee include:

(A) A policy with a guarantee that the policy will remain in force at the original schedule of benefits, subject only to the payment of specified premiums;

(B) A policy in which the minimum premium at any duration is less than the corresponding one- year valuation premium, calculated using the maximum valuation interest rate and the 1980 CSO valuation tables with or without ten-year select mortality factors, or any other table adopted after January 1, 2000, by the NAIC and adopted as a rule by the Commissioner for this purpose; or

(C) A policy with any combination of Parts (A) and (B).

(2) A secondary guarantee period is the period for which the policy is guaranteed to remain in force subject only to a secondary guarantee. When a policy contains more than one secondary guarantee, the minimum reserve shall be the greatest of the respective minimum reserves at that valuation date of each unexpired secondary guarantee, ignoring all other secondary guarantees. Secondary guarantees that are unilaterally changed by the insurer after issue shall be considered to have been made at issue. Reserves described in Paragraphs (b) and (c) of this Rule shall be recalculated from issue to reflect these changes.

(3) Specified premiums mean the premiums specified in the policy, the payment of which guarantees that the policy will remain in force at the original schedule of benefits, but which otherwise would be insufficient to keep the policy in force in the absence of the guarantee if maximum mortality and expense charges and minimum interest credits were made and any applicable surrender charges were assessed.

(4) For purposes of this Rule, the minimum premium for any policy year is the premium that, when paid into a policy with a zero account value at the beginning of the policy year, produces a zero account value at the end of the policy year. The minimum premium calculation shall use the policy cost factors (including mortality charges, loads and expense charges) and the interest crediting rate, which are all guaranteed at issue.

(5) The one-year valuation premium means the net one-year premium based upon the original schedule of benefits for a given policy year. The one-year valuation premiums for all policy years are calculated at issue. The select mortality factors defined in 11 NCAC 11F .0403(b)(2), .0403(b)(3), and .0403(b)(4) may not be used to calculate the one-year valuation premiums.

(6) The one-year valuation premium shall reflect the frequency of fund processing, as well as the distribution of deaths assumption employed in the calculation of the monthly mortality charges to the fund.

(b) Basic reserves for the secondary guarantees shall be the segmented reserves for the secondary guarantee period. In calculating the segments and the segmented reserves, the gross premiums shall be set equal to the specified premiums, if any, or otherwise to the minimum premiums, that keep the policy in force and the segments will be determined according to the contract segmentation method as defined in 11 NCAC 11F .0402(2).

(c) Deficiency reserves, if any, for the secondary guarantees shall be calculated for the secondary guarantee period in the same manner as described in 11 NCAC 11F .0404(b) with gross premiums set equal to the specified premiums, if any, or otherwise to the minimum premiums that keep the policy in force.

(d) The minimum reserves during the secondary guarantee period are the greater of:

(1) The basic reserves for the secondary guarantee plus the deficiency reserve, if any, for the secondary guarantees; or

(2) The minimum reserves required by other rules or regulations governing universal life plans.

History

  • Authority G.S. 58-2-40; 58-58-50(d); 58-58-50(k)
  • Eff. January 1, 1998
  • Temporary Amendment Eff. January 1, 2000
  • Amended Eff. July 1, 2000
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 20, 2015.
11 NCAC 11F .0406 Limited Use of Anticipated Withdrawal Rates {#sec-11-ncac-11f-.0406 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11F .0406}

(a) This Rule applies to universal life insurance policies and certificates issued after December 31, 2006, and before January 1, 2014, that contain a secondary guarantee that the death benefits will remain in effect as long as the accumulation of premiums paid satisfies the secondary guarantee requirement stated in the policy or certificate.

(b) For purposes of applying 11 NCAC 11F .0405(b) and 11 NCAC 11F .0405(c), a withdrawal rate of no more than two percent per year for the first five policy years, followed by no more than one percent per year to the policy anniversary specified in the following table, and zero percent thereafter shall be used. If the duration determined by reference to the table is less than five policy years, a withdrawal rate of no more than two percent per year shall be used through that duration, with zero percent per year used thereafter.

Issue Age Duration

0-50 Policy Duration 30 years.

51-60 Duration at which policyholder reaches attained age 80.

61-70 Policy Duration 20 years.

71-89 Duration at which policyholder reaches attained age 90.

90 and over No withdrawal rate assumption allowed.

History

  • Authority G.S. 58-2-40; 58-58-50(b); 58-58-50(l)
  • Eff. December 1, 2007
  • Amended Eff. March 1, 2011
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 20, 2015.
11 NCAC 11F .0501 Definitions {#sec-11-ncac-11f-.0501 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11F .0501}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-58-50(k)
  • Temporary Adoption Eff. December 1, 1999
  • Eff. July 1, 2000
  • Repealed Eff. January 1, 2015.
11 NCAC 11F .0502 Individual Annuity or Pure Endowment Contracts {#sec-11-ncac-11f-.0502 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11F .0502}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-58-50(k)
  • Temporary Adoption Eff. December 1, 1999
  • Eff. July 1, 2000
  • Repealed Eff. January 1, 2015.
11 NCAC 11F .0503 Group Annuity or Pure Endowment Contracts {#sec-11-ncac-11f-.0503 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11F .0503}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-58-50(k)
  • Temporary Adoption Eff. December 1, 1999
  • Eff. July 1, 2000
  • Repealed Eff. January 1, 2015.
11 NCAC 11F .0504 Application of the 1994 Gar Table {#sec-11-ncac-11f-.0504 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11F .0504}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-58-50(k)
  • Temporary Adoption Eff. December 1, 1999
  • Eff. July 1, 2000
  • Repealed Eff. January 1, 2015.
11 NCAC 11F .0505 Model Rule for Recognizing a New Annuity Mortality Table for Use in Determining Reserve Liabilities for Annuities {#sec-11-ncac-11f-.0505 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11F .0505}

(a) The North Carolina Department of Insurance incorporates by reference, including subsequent amendments and editions, the National Association of Insurance Commissioners Model No. 821, NAIC Model Rule (Regulation) for Recognizing a New Annuity Mortality Table for Use in Determining Reserve Liabilities for Annuities. Copies of Model No. 821 may be obtained from: The National Association of Insurance Commissioners, 1100 Walnut Street, Suite 1500, Kansas City, MO 64106-2197; the North Carolina Department of Insurance, Actuarial Services Division, 1201 Mail Service Center, Raleigh, NC 27699-1201; and from the Department of Insurance web page at http://www.ncdoi.com/.

(b) For purposes of this Rule, Subsection A of Section 4 of Model No. 821 shall read as follows:

Except as provided in Subsections B and C of this section, the 1983 Table "a" is recognized and approved as an individual annuity mortality table for valuation and, at the option of the company, may be used for purposes of determining the minimum standard of valuation for any individual annuity or pure endowment contract issued on or after April 19, 1979.

(c) For purposes of this Rule, Subsection B of Section 4 of Model No. 821 shall read as follows:

Except as provided in Subsection C of this section, either the 1983 Table "a" or the Annuity 2000 Mortality Table shall be used for determining the minimum standard of valuation for any individual annuity or pure endowment contract issued on or after January 1, 1987.

(d) For purposes of this Rule, Subsection C of Section 4 of Model No. 821 shall read as follows:

Except as provided in Subsection D of this section, the Annuity 2000 Mortality Table shall be used for determining the minimum standard of valuation for any individual annuity or pure endowment contract issued on or after January 1, 2000.

(e) For purposes of this Rule, Subsection D of Section 4 of Model No. 821 shall read as follows:

Except as provided in Subsection E of this section, the 2012 IAR Mortality Table shall be used for determining the minimum standard of valuation for any individual annuity or pure endowment contract issued on or after January 1, 2015.

(f) For purposes of this Rule, Subsection E of Section 4 of Model No. 821 shall read as follows:

The 1983 Table "a" without projection is to be used for determining the minimum standards of valuation for an individual annuity or pure endowment contract issued on or after January 1, 2000, solely when the contract is based on life contingencies and is issued to fund periodic benefits arising from:

(1) Settlements of various forms of claims pertaining to court settlements or out of court settlements from tort actions;

(2) Settlements involving similar actions such as worker's compensation claims; or

(3) Settlements of long term disability claims where a temporary or life annuity has been used in lieu of continuing disability payments.

(g) For purposes of this Rule, Subsection A of Section 6 of Model No. 821 shall read as follows:

Except as provided in Subsections B and C of this section, the 1983 GAM Table, the 1983 Table "a" and the 1994 GAR Table are recognized and approved as group annuity mortality tables for valuation and, at the option of the company, any one of these tables may be used for purposes of valuation for an annuity or pure endowment purchased on or after April 19, 1979, under a group annuity or pure endowment contract.

(h) For purposes of this Rule, Subsection B of Section 6 of Model No. 821 shall read as follows:

Except as provided in Subsection C of this section, either the 1983 GAM Table or the 1994 GAR Table shall be used for determining the minimum standard of valuation for any annuity or pure endowment purchased on or after January 1, 1987, under a group annuity or pure endowment contract.

(i) For purposes of this Rule, Subsection C of Section 6 of Model No. 821 shall read as follows:

The 1994 GAR Table shall be used for determining the minimum standard of valuation for any annuity or pure endowment purchased on or after January 1, 2000, under a group annuity or pure endowment contract.

(j) For purposes of this Rule, Section 1, Section 8, and Section 9 of Model No. 821 are not applicable.

History

  • Authority G.S. 58-2-40; 58-58-50(k)
  • Eff. January 1, 2015.
11 NCAC 11F .0601 Definitions {#sec-11-ncac-11f-.0601 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11F .0601}

As used in this Section:

(1) "2001 CSO Mortality Table" means that mortality table, consisting of separate rates of mortality for male and female lives, developed by the American Academy of Actuaries CSO Task Force from the Valuation Basic Mortality Table developed by the Society of Actuaries Individual Life Insurance Valuation Mortality Task Force, and adopted by the NAIC in December 2002. The 2001 CSO Mortality Table is included in the Proceedings of the NAIC (2nd Quarter 2002). Unless the context indicates otherwise, the "2001 CSO Mortality Table" includes both the ultimate form of that table and the select and ultimate form of that table and includes both the smoker and nonsmoker mortality tables and the composite mortality tables. It also includes both the age-nearest-birthday and age-last-birthday bases of the mortality tables.

(2) "2001 CSO Mortality Table (F)" means that mortality table consisting of the rates of mortality for female lives from the 2001 CSO Mortality Table.

(3) "2001 CSO Mortality Table (M)" means that mortality table consisting of the rates of mortality for male lives from the 2001 CSO Mortality Table.

(4) "Composite mortality tables" means mortality tables with rates of mortality that do not distinguish between smokers and nonsmokers.

(5) "Preneed life insurance" means a life insurance policy which, whether by assignment or otherwise, has for a purpose the funding of a preneed funeral contract or an insurance-funded funeral or burial prearrangement, the insured being the person for whose service the funds were paid.

(6) "Smoker and nonsmoker mortality tables" means mortality tables with separate rates of mortality for smokers and nonsmokers.

History

  • Authority G.S. 58-2-40; 58-58-50(k); 58-58-50(l); 58-58-55(e)
  • Eff. March 1, 2004
  • Amended Eff. December 1, 2008
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 20, 2015.
11 NCAC 11F .0602 2001 Cso Mortality Table as Minimum Standard {#sec-11-ncac-11f-.0602 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11F .0602}

(a) At the election of the company for any one or more specified plans of insurance and subject to the conditions stated in this Section, the 2001 CSO Mortality Table may be used as the minimum standard for policies issued on or after January 1, 2005, and before the date specified in Paragraph (b) of this Rule to which G.S. 58-58-50(c)(2)(a), G.S. 58-58-55(e)(4)h.6, 11 NCAC 11F .0403(a) or 11 NCAC 11F .0403(b) are applicable. If the company elects to use the 2001 CSO Mortality Table, it shall do so for both valuation and nonforfeiture purposes.

(b) Subject to the conditions stated in this rule, the 2001 CSO Mortality Table shall be used in determining minimum standards for policies issued on or after January 1, 2009, to which G.S. 58-58-50(c)(2)(a), G.S. 58-58-55(e)(4)h.6, 11 NCAC 11F.0403(a) or 11 NCAC 11F.0403(b) are applicable, except for preneed life insurance as specified in 11 NCAC 11F .0606.

(c) The 2001 CSO Mortality Table shall be the basis for computation of minimum values related to extended term benefits for policies for which the 2001 CSO Mortality Table is the minimum standard for valuation and nonforfeiture purposes.

History

  • Authority G.S. 58-2-40; 58-58-50(k); 58-58-50(l); 58-58-55(e)
  • Eff. March 1, 2004
  • Amended Eff. December 1, 2008
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 20, 2015.
11 NCAC 11F .0603 Conditions {#sec-11-ncac-11f-.0603 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11F .0603}

(a) For each plan of insurance with separate rates for smokers and nonsmokers an insurer shall use one of the following:

(1) Composite mortality tables to determine minimum reserve liabilities and minimum cash surrender values and amounts of paid-up nonforfeiture benefits;

(2) Smoker and nonsmoker mortality tables to determine the valuation net premiums and additional minimum reserves, if any, required by G.S. 58-58-50(g) and use composite mortality tables to determine the basic minimum reserves, minimum cash surrender values and amounts of paid-up nonforfeiture benefits; or

(3) Smoker and nonsmoker mortality to determine minimum reserve liabilities and minimum cash surrender values and amounts of paid-up nonforfeiture benefits.

(b) For plans of insurance without separate rates for smokers and nonsmokers the composite mortality tables shall be used.

(c) When the 2001 CSO Mortality Table is used for the purpose of determining minimum reserve liabilities and minimum cash surrender values and amounts of paid-up nonforfeiture benefits, it may, at the option of the company for each plan of insurance, be used in its ultimate or select and ultimate form, subject to the restrictions of 11 NCAC 11F .0604 and 11 NCAC 11F .0400, relative to use of the select and ultimate form.

(d) When the 2001 CSO Mortality Table is the minimum reserve standard for any plan for a company, the actuarial opinion in the annual statement filed with the Commissioner shall be based on an asset adequacy analysis as specified in 11 NCAC 11F .0303.

History

  • Authority G.S. 58-2-40; 58-58-50(k); 58-58-50(l); 58-58-55(e)
  • Eff. March 1, 2004
  • Amended Eff. December 1, 2008
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 20, 2015.
11 NCAC 11F .0604 Applicability of the 2001 Cso Mortality Table to 11 Ncac 11f .0400 {#sec-11-ncac-11f-.0604 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11F .0604}

(a) For policies for which the 2001 CSO Mortality Table is the minimum standard for valuation and nonforfeiture purposes, 11F .0400 shall be applied in the following manner:

(1) To comply with 11 NCAC 11F .0401(a)(2)(B), the net level reserve premium shall be based on the ultimate mortality rates in the 2001 CSO Mortality Table;

(2) To comply with 11 NCAC 11F .0402(2), all calculations shall be made using the 2001 CSO Mortality Rate, and, if elected, the optional minimum mortality standard for deficiency reserves stipulated in Subparagraph (a)(4) of this Rule; The value of "qx+k+t-1" is the valuation mortality rate for deficiency reserves in policy year k+t, but using the unmodified select mortality rates if modified select mortality rates are used in the computation of deficiency reserves.

(3) To comply with 11 NCAC 11F .0403(a), the 2001 CSO Mortality Table shall be the minimum standard for basic reserves;

(4) To comply with 11 NCAC 11F .0403(b), the 2001 CSO Mortality Table shall be the minimum standard for deficiency reserves. If select mortality rates are used, they may be multiplied by X percent for durations in the first segment, subject to the conditions specified in 11 NCAC 11F .0403(b)(3). In demonstrating compliance with those conditions, the demonstrations may not combine the results of tests that utilize the 1980 CSO Mortality Table with those tests that utilize the 2001 CSO Mortality Table, unless the combination is explicitly required by rule or necessary to be in compliance with relevant Actuarial Standards of Practice;

(5) To comply with 11 NCAC 11F .0404(c), the valuation mortality table used in determining the tabular cost of insurance shall be the ultimate mortality rates in the 2001 CSO Mortality Table;

(6) To comply with 11 NCAC 11F .0404(e)(4), the calculations specified in 11 NCAC 11F .0404(e) shall use the ultimate mortality rates in the 2001 CSO Mortality Table;

(7) To comply with 11 NCAC 11F .0404(f)(4), the calculations specified in 11 NCAC 11F .0404(f) shall use the ultimate rates in the 2001 CSO Mortality Table;

(8) To comply with 11 NCAC 11F .0404(g)(2), the calculations specified in 11 NCAC 11F .0404(g) shall use the ultimate mortality rates in the 2001 CSO Mortality Table; and

(9) To comply with 11 NCAC 11F .0405(a)(1)(B), the one-year valuation premium shall be calculated using the ultimate mortality rates in the 2001 CSO Mortality Table.

(b) Nothing in this Rule shall be construed to expand the applicability of 11 NCAC 11F .0400 to include life insurance policies exempted under 11 NCAC 11F .0401(a).

History

  • History Note Authority G.S. 58-2-40; 58-58-50(k); 58-58-50(l); 58-58-55(e)
  • Eff. March 1, 2004
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 20, 2015.
11 NCAC 11F .0605 Gender-Blended Tables {#sec-11-ncac-11f-.0605 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11F .0605}

(a) For any ordinary life insurance policy delivered or issued for delivery in this state on or after January 1, 2005 that utilizes the same premium rates and charges for male and female lives or is issued in circumstances where applicable law does not permit distinctions on the basis of gender, a mortality table that is a blend of the 2001 CSO Mortality Table (M) and the 2001 CSO Mortality Table (F) may, at the option of the company for each plan of insurance, be substituted for the 2001 CSO Mortality Table for use in determining minimum cash surrender values and amounts of paid-up nonforfeiture benefits, except for preneed life insurance policies issued after December 31, 2008, as provided in 11 NCAC 11F .0606. Notwithstanding this rule, the 2001 CSO Mortality Table, consisting of separate rates of mortality for male and female lives, shall be the minimum valuation standard even if blended tables are used in determining minimum cash surrender values and nonforfeiture benefits.

(b) When using a gender-blended table based on the 2001 CSO Mortality Table for determining minimum cash surrender values and amounts of paid-up nonforfeiture benefits, the company shall choose from among the blended tables developed by the American Academy of Actuaries CSO Task Force and adopted by the NAIC in December 2002.

(c) An insurer's issuance of the same kind of policy of life insurance on both a sex-distinct and a sex-neutral basis shall not solely constitute a violation of Article 63 of Chapter 58 of the North Carolina General Statutes.

History

  • Authority G.S. 58-2-40; 58-58-50(k); 58-58-50(l); 58-58-55(e)
  • Eff. March 1, 2004
  • Amended Eff. December 1, 2008
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 20, 2015.
11 NCAC 11F .0606 Minimum Standards for Preneed Life Insurance {#sec-11-ncac-11f-.0606 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11F .0606}

(a) For preneed life insurance, the minimum mortality standard for determining reserve liabilities and nonforfeiture values for policies issued after December 31, 2008, shall be the Commissioners' 1980 Standard Ordinary Life Valuation Mortality Tables (1980 CSO), without ten-year selection factors, incorporated into the 1980 amendments to the NAIC Standard Valuation Law approved in December 1983. If the policy utilizes the same premium rates and charges for male and female lives or is issued in circumstances where applicable law does not permit distinctions on the basis of gender, a table that is a blend of the 1980 CSO Table (M) and the 1980 CSO Table (F), without ten-year selection factors may, at the option of the insurer, be substituted for the 1980 CSO Table to determine minimum cash surrender values and nonforfeiture benefits. For the Commissioners' 1980 Extended Term Insurance Table (1980 CET), a mortality table which is the same blend of the 1980 CET Table (M) and 1980 CET Table (F) may be substituted. The blended tables must be selected from those published in the 1984 Proceedings of the NAIC, Vol. I., or in the 1987 Proceedings of the NAIC, Volume I.

(b) Notwithstanding 11 NCAC 11F .0606(a), for preneed life insurance policies issued after December 31, 2008 and before January 1, 2012, the 2001 CSO Mortality Table may be used as the minimum standard for reserves and nonforfeiture values. If an insurer elects to use the 2001 CSO Mortality Table as a minimum standard for any preneed life insurance policy issued after December 31, 2008 and before January 1, 2012, the insurer shall provide, as a part of the actuarial memorandum submitted in support of the insurer's asset adequacy testing, an annual written notification to the domiciliary commissioner. The notification shall include:

(1) A complete list of all preneed policy forms that use the 2001 CSO Mortality Table as a minimum standard;

(2) A certification signed by the appointed actuary stating that the reserve methodology employed by the insurer in determining reserves for the preneed life insurance policies issued after December 31, 2008 and using the 2001 CSO Mortality Table as a minimum standard, develops adequate reserves for these policies without being aggregated with any other policies; and

(3) Supporting information regarding the adequacy of reserves for preneed life insurance policies issued after December 31, 2008 and using the 2001 CSO Mortality Table as a minimum standard for reserves. The supporting information shall include documentation of the actuarial assumptions and methods used in testing these reserves for adequacy.

History

  • Authority G.S. 58-2-40; 58-58-50(k); 58-58-50(l); 58-58-55(e)
  • Eff. December 1, 2008
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 20, 2015.
11 NCAC 11F .0701 Determining Reserve Liabilities for Credit Life Insurance Model Regulation {#sec-11-ncac-11f-.0701 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11F .0701}

(a) The North Carolina Department of Insurance incorporates by reference, including subsequent amendments and editions, the National Association of Insurance Commissioners Model No. 818, Determining Reserve Liabilities for Credit Life Insurance Model Regulation. Copies of Model No. 818 may be obtained from: The National Association of Insurance Commissioners, 2301 McGee Street, Kansas City, MO 64108-1662; the North Carolina Department of Insurance, Actuarial Services Division, 1201 Mail Service Center, Raleigh, NC 27699-1201; and from the Department of Insurance web page at http://www.ncdoi.com/.

(b) For purposes of this Rule, Section 4.C. of Model No. 818 shall read as follows:

"Credit life insurance" means insurance on the life of a debtor pursuant to or in connection with a specific loan or other credit transaction as defined in G.S. 58-58-10.

(c) For purposes of this Rule, Section 6.A. of Model No. 818 shall read as follows:

11 NCAC 11F .0400 shall not apply to credit life insurance.

(d) For purposes of this Rule, Section 6.B. of Model No. 818 shall read as follows:

The interest rates used in determining the minimum standard for valuation shall be the calendar year statutory valuation interest rates as defined in G.S. 58-58-50(c)(4).

(e) For purposes of this Rule, Section 6.C. of Model No. 818 shall read as follows:

The method used in determining the minimum standard for valuation shall be the Commissioner's Reserve Valuation Method as defined in G.S. 58-58-50(d).

(f) This Rule applies to credit life insurance policies and certificates issued on or after January 1, 2006. For credit life insurance policies and certificates issued prior to January 1, 2006, the minimum standard mortality tables and interest rates shall be those provided by the statutes and rules in effect as of the issue date of those policies and certificates.

History

  • Authority G.S. 58-2-40; 58-58-50(k)
  • Eff. September 1, 2005
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 20, 2015.
11 NCAC 11F .0801 Model Regulation Permitting the Recognition of Preferred Mortality Tables for Use in Determining Minimum Reserve Liabilities {#sec-11-ncac-11f-.0801 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11F .0801}

(a) The North Carolina Department of Insurance incorporates by reference, including subsequent amendments and editions, the National Association of Insurance Commissioners Model No. 815, Model Regulation Permitting the Recognition of Preferred Mortality Tables for Use in Determining Minimum Reserve Liabilities. Copies of Model No. 815 may be obtained from: The National Association of Insurance Commissioners, 2301 McGee Street, Kansas City, MO 64108-1662; the North Carolina Department of Insurance, Actuarial Services Division, 1201 Mail Service Center, Raleigh, NC 27699-1201; and from the Department of Insurance web page at http://www.ncdoi.com/.

(b) For purposes of this Rule, Section 2 of Model No. 815 shall read as follows:

The purpose of this regulation is to recognize, permit and prescribe the use of mortality tables that reflect differences in mortality between Preferred and Standard lives in determining minimum reserve liabilities in accordance with G.S. 58-58-50 (c)(2)(a), 11 NCAC 11F .0403(a), and 11 NCAC 11F .0403(b).

(c) For purposes of this Rule, Section 4 of Model No. 815 shall read as follows:

At the election of the company, for each calendar year of issue, for any one or more specified plans of insurance and subject to satisfying the conditions stated in this regulation, the 2001 CSO Preferred Class Structure Mortality Table may be substituted in place of the 2001 CSO Smoker or Nonsmoker Mortality Table as the minimum valuation standard for policies issued on or after January 1, 2007. For policies issued on or after January 1, 2005 and before January 1, 2007, these tables may be substituted with the consent of the Commissioner and subject to the conditions of Section 5. In determining such consent, the Commissioner shall consider the consent of the insurance regulator of the company's state of domicile. No such election shall be made until the company demonstrates that at least 20% of the business to be valued on this table is in one or more of the preferred classes. A table from the 2001 CSO Preferred Class Structure Mortality Table used in place of a 2001 CSO Mortality Table, pursuant to the requirements of this regulation, shall be treated as part of the 2001 CSO Mortality Table only for purposes of reserve valuation pursuant to the requirements of 11 NCAC 11F .0601, 11 NCAC 11F .0602, 11 NCAC 11F .0603, and 11 NCAC 11F .0604.

(d) For purposes of this Rule, Paragraph C of Section 3, and Paragraph C of Section 5 of Model No. 815 are not applicable.

(e) For purposes of this Rule, Sections 1 and 7 of Model No. 815 are not applicable.

History

  • Authority G.S. 58-2-40; 58-58-50(k)
  • Eff. April 1, 2007
  • Amended Eff. March 1, 2010
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 20, 2015.

Subchapter H

11 NCAC 11H .0101 Definitions {#sec-11-ncac-11h-.0101 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11H .0101}

(a) As used in this Section, unless the context clearly indicates otherwise:

(1) "Break-even" means confirmation of sufficient executed resident's agreements to assure the facility's financial stability and which further indicate that projected revenues will at least be equal to projected expenses.

(2) "Health related services" also means domiciliary (rest home) care or Homes for the Aged, skilled or intermediate nursing, nursing home or rest home admission, or priority admission into a facility, unit, or bed providing any of the above-named services.

(3) "Lodging" means independent living without the need or use of health related services.

(b) The definitions contained in G.S. 58-64-1 are incorporated into this Section by reference.

History

  • Authority G.S. 58-2-40; 58-64-1; 58-64-65
  • Eff. June 1, 1993
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 20, 2015.
11 NCAC 11H .0102 License - Steps {#sec-11-ncac-11h-.0102 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11H .0102}

An applicant shall apply for licensure in accordance with the following steps:

(1) For new or development stage facilities:

(a) The applicant shall initially submit the following items to the Commissioner for review:

(i) The applicant's name, address and telephone number;

(ii) A copy of a non-binding reservation agreement form;

(iii) Escrow agreement;

(iv) Narrative describing the facility, its mode of operation, and its location; and

(v) Any advertising materials to be used.

(b) Upon completion of step (1)(a), the applicant may:

(i) Disseminate materials describing the intent to develop a Continuing Care facility; and

(ii) Enter into fully refundable non-binding reservation agreements for up to one thousand dollars ($1,000.00). All funds received shall be escrowed.

(2) Start-Up Certificate:

(a) In order to obtain a Start-Up Certificate, the applicant or provider shall submit the following to the Commissioner for review:

(i) Application for Licensure, as required by G.S. 58-64-5(b);

(ii) A Disclosure Statement, as required by G.S. 58-64-20;

(iii) A copy of a binding reservation agreement or resident agreement; and

(iv) A market feasibility study.

(b) Upon issuance of the Start-Up Certificate, the applicant or provider may:

(i) Enter into binding; reservation agreements or resident agreements;

(ii) Accept entrance fees and entrance fee deposits over one thousand dollars ($1,000.00). Any funds received shall be escrowed and shall be released only in accordance with G.S. 58-64-35;

(iii) Begin site preparation work; and

(iv) Construct model units for marketing.

(3) Preliminary Certificate:

(a) In order to obtain a Preliminary Certificate, the applicant or provider shall submit the following to the Commissioner for review:

(i) An explanation of any material differences between actual costs and projected costs contained in the Start-Up Certificate submission (not required for existing operational Continuing Care facilities that are expanding);

(ii) An updated Disclosure Statement;

(iii) Current interim financial statements; and

(iv) Confirmation of signed agreements for at least 50 percent of the new units, reserved by a deposit equal to at least 10 percent of the entrance fee or by a non-refundable deposit equal to the periodic fee for at least two months for facilities that have no entrance fee. Applicants that do not accept presale entrance fees shall place a deposit with the Commissioner. The deposit shall be either one hundred dollars ($100.00) for each unit for 50 percent of the total proposed units, or one hundred thousand dollars ($100,000), whichever amount is more. The deposit shall be made in accordance with G.S. 58-5-20. The deposit shall be refunded to the applicant upon receipt of a permanent license.

(b) Upon issuance of the Preliminary Certificate, the applicant or provider may:

(i) Purchase or construct a Continuing Care facility;

(ii) Renovate or develop structure(s) not already licensed as a Continuing Care facility; and

(iii) Expand existing Continuing Care facilities in excess of 10 percent of the current number of available Independent Living Units (ILU's) or available health related units/beds.

(4) Permanent License:

(a) In order to obtain a Permanent License, the applicant or provider shall submit the following to the Commissioner for review at least 60 days before the facility opening:

(i) An updated Application for Licensure;

(ii) An updated Disclosure Statement; and

(iii) Confirmation of signed agreements for new units required by the Continuing Care facility to break-even, reserved by a deposit equal to at least 10 percent of the entrance fee or by a non-refundable deposit equal to the periodic fee for at least two months for facilities that have no entrance fee.

(b) Upon issuance of the Permanent License and satisfaction of all other legal requirements, the applicant or provider may:

(i) Open the Continuing Care facility; and

(ii) Provide Continuing Care.

(5) Restricted or Conditional License:

(a) If all other licensing requirements are met, the Commissioner shall, in lieu of denying the issuance of a Permanent License, issue a Restricted or Conditional License to an applicant when one or more of the following conditions exist:

(i) A hazardous financial condition.

(ii) Occupancy at the facility, or the number of executed agreements for new units at the facility, is below the level at which the facility would break-even.

(b) Upon issuance of the Restricted or Conditional License, the provider may operate the facility under the conditions or restrictions established by the Commissioner until such time as the Commissioner alters the conditions for continued operations or issues a Permanent License.

(c) Upon issuance of the Restricted or Conditional License, the provider shall file with the Commissioner quarterly financial statements and an occupancy report. These shall be due no later than 45 days following the end of each fiscal quarter.

History

  • Authority G.S. 58-2-40; 58-64-5; 58-64-65
  • Eff. April 1, 1993
  • Amended Eff. September 1, 2007; July 1, 2004
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 20, 2015.
11 NCAC 11H .0103 Revocation of License {#sec-11-ncac-11h-.0103 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11H .0103}

The revocation process, as provided by G.S. 58-64-10, shall also apply to the Start-Up Certificate, the Preliminary Certificate, and the Restricted or Conditional License.

History

  • Authority G.S. 58-2-40; 58-64-10; 58-64-65
  • Eff. April 1, 1993
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 20, 2015.
11 NCAC 11H .0104 Sale or Transfer of Ownership {#sec-11-ncac-11h-.0104 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11H .0104}

The sale or transfer process, as provided by G.S. 58-64-15, shall also apply to the Start-Up Certificate, the Preliminary Certificate, and the Restricted or Conditional License.

History

  • Authority G.S. 58-2-40; 58-64-15; 58-64-65
  • Eff. April 1, 1993
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 20, 2015.
11 NCAC 11H .0105 Standardized Disclosure Statement Format {#sec-11-ncac-11h-.0105 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11H .0105}

As per G.S. 58-64-20(d), the Commissioner may prescribe a standardized format for the Disclosure Statement. The format shall be maintained by the Commissioner, and may be updated as necessary.

History

  • Authority G.S. 58-2-40; 58-64-20; 58-64-65
  • Eff. April 1, 1993
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 20, 2015.
11 NCAC 11H .0106 Health and Financial Conditions for Acceptance {#sec-11-ncac-11h-.0106 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11H .0106}

The health and financial conditions for acceptance as a resident shall appear within the Disclosure Statement, as provided by G.S. 58-64-20(a)(8). The Disclosure Statement shall also include any conditions related to the acceptance conditions required by the provider or facility, such as age, ability to move or communicate, minimum assistance levels necessary to perform daily activities, prepared wills, and ability to pay under specified conditions.

History

  • Authority G.S. 58-2-40; 58-64-20; 58-64-65
  • Eff. April 1, 1993
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 20, 2015.
11 NCAC 11H .0107 Financial Statements and Compiled Five Year Forecasts {#sec-11-ncac-11h-.0107 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11H .0107}

Certified financial statements, as required by G.S. 58-64-20(a)(10), and compiled five year forecasts, as required by G.S. 58-64-20(a)(12), shall be of the provider's corporation or other legal entity that owns the Continuing Care facility. The Commissioner may also require the provider to supply supplementary financial data or other appropriate disclosure under the requirements of G.S. 58-64-20(a)(10) and G.S. 58-64-20(a)(12) on individual Continuing Care facilities, where a corporation or other legal entity owns various Continuing Care facilities or is engaged in various enterprises.

History

  • Authority G.S. 58-2-40; 58-64-20; 58-64-65
  • Eff. April 1, 1993
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 20, 2015.
11 NCAC 11H .0108 Compiled Five Year Forecast {#sec-11-ncac-11h-.0108 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11H .0108}

(a) The compiled five year forecast shall consist of the following:

(1) a balance sheet;

(2) a statement of operations;

(3) a statement of cash flows; and

(4) a narrative detailing all significant assumptions.

(b) The balance sheet shall include individual categories or line items that sum into the following sub-totals, at a minimum:

(1) current assets;

(2) restricted assets, including a line item for operating reserve assets;

(3) fixed assets, including property, plant, and equipment;

(4) total assets;

(5) current liabilities;

(6) long-term debt;

(7) total liabilities;

(8) deferred revenue-refundable;

(9) deferred revenue-nonrefundable;

(10) equity or fund balance-unrestricted; and

(11) equity or fund balance-restricted.

(c) The statement of operations shall include the following individual categories or line items, at a minimum:

(1) monthly fee revenues;

(2) amortization of entrance fees;

(3) health care revenues;

(4) investment/interest income;

(5) contributions/gifts;

(6) health care expenses;

(7) operations expenses, consisting of at least maintenance, laundry, and housekeeping;

(8) dietary expenses;

(9) administrative expenses;

(10) interest expenses; and

(11) depreciation.

History

  • Authority G.S. 58-2-40; 58-64-20; 58-64-65
  • Eff. April 1, 1993
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 20, 2015.
11 NCAC 11H .0109 Proposed or Development Stage Facilities {#sec-11-ncac-11h-.0109 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11H .0109}

The Commissioner may apply all or part of G.S. 58-64-20(a)(14) to existing Continuing Care facilities that are expanding.

History

  • Authority G.S. 58-2-40; 58-64-20; 58-64-65
  • Eff. April 1, 1993
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 20, 2015.
11 NCAC 11H .0110 Contract Specification - Living Unit {#sec-11-ncac-11h-.0110 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11H .0110}

A "living unit," as described in G.S. 58-64-25(a)(2), means an independent living unit or a health care unit/bed, or as otherwise defined by the annual North Carolina State Medical Facilities Plan.

History

  • Authority G.S. 58-2-40; 58-64-25; 58-64-65
  • Eff. April 1, 1993
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 20, 2015.
11 NCAC 11H .0111 Insolvency or Hazardous Financial Condition {#sec-11-ncac-11h-.0111 omnilex-key=us-nc-regs-official--title-11--11 NCAC 11H .0111}

(a) A negative fund balance is a financial position of a provider or facility in which the assets of a provider or facility do not exceed its liabilities, as required under generally accepted accounting principles. The Commissioner may deem a provider or facility that has a negative fund balance to be insolvent or in imminent danger of becoming insolvent if any of the following hazardous financial condition standards or factors are applicable or present:

(1) There are findings or conditions reported in the provider's or facility's financial statements that the Commissioner determines to be adverse to the financial stability of the provider or facility.

(2) The current or projected ratios of total assets, including required reserve levels, to total liabilities indicate an impairment or a deterioration of the provider's or facility's operations or equity; or demonstrate a trend that could lead to an impairment or a deterioration of the provider's or facility's operations, working capital, or equity.

(3) The current or projected ratios of current assets to current liabilities indicate an impairment or a deterioration of the provider's or facility's operations, working capital, or equity; or demonstrate a trend that could lead to an impairment or a deterioration of the provider's or facility's operations, working capital, or equity.

(4) The provider or facility is unable to perform normal daily activities and meet its obligations as they become due, considering the provider's or facility's current or projected cash flow and liquidity position.

(5) The provider's or facility's operating losses for the past year or projected operating losses are of such magnitude as to jeopardize normal daily activities or continued provider or facility operations.

(6) The insolvency of an affiliated provider or facility or other affiliated person results in legal liability of the provider or facility for payments and expenses of such magnitude as to jeopardize the provider's or facility's ability to meet its obligations as they become due, without substantial disposition of assets outside the ordinary course of business, any restructuring of debt, or externally forced revisions of its operations.

(7) The provider or facility has receivables that are more than 90 days old.

(8) The insolvency is not temporary and the provider or facility cannot demonstrate that the insolvency is materially reduced or eliminated.

(9) There is an adverse effect on the provider or facility of reporting entrance fees as deferred revenues, with consideration given to all reporting requirements required under generally accepted accounting principles and the ultimate net income component of those revenues.

(10) A start-up provider or facility or any operational provider or facility undergoing plant expansion or refinancing of its debt has a financial condition as a result of such action that could otherwise seriously jeopardize present or future operations.

(b) The provider or facility shall prepare a plan to address and correct any condition that has led to a determination of insolvency or imminent danger of insolvency by the Commissioner. The plan must be presented to the Commissioner within 90 days after the date of the insolvency determination. If the plan to correct the condition is disapproved by the Commissioner, the plan does not correct the condition leading to the Commissioner's determination of insolvency, or the provider's or facility's hazardous condition is such that it cannot be significantly corrected or eliminated, the Commissioner may then proceed under G.S. 58-64-10 or G.S. 58-64-45.

History

  • Authority G.S. 58-2-40; 58-64-10; 58-64-45; 58-64-65
  • Eff. January 1, 1994
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 20, 2015.

Chapter 12 Life and Health Division

11 NCAC 12 .0101 General Provisions {#sec-11-ncac-12-.0101 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0101}

In this Chapter, unless the context otherwise requires:

(1) "Deemer clause" or "deemer provision" shall mean any clause or provision which establishes a period of time certain, e.g. 90 days, etc., within which time the commissioner must disapprove a particular matter before him or set a hearing and which if no action is taken by the commissioner within the period of time certain, said matter before the commissioner is deemed approved.

(2) "Division" shall mean the life, accident and health division of the North Carolina Department of Insurance.

(3) "Form" shall consist of but not be limited to the application, rider, certificate, policy, etc.

History

  • Authority G.S. 58-9; 58-54; 58-254.7; 58-347
  • Eff. February 1, 1976
  • Readopted Eff. September 26, 1978
  • Amended Eff. April 1, 1989
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0102 Purpose of Division {#sec-11-ncac-12-.0102 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0102}

History

  • Status: repealed
  • Authority G.S. 58-4; 58-9
  • Eff. February 1, 1976
  • Readopted Eff. September 26, 1978
  • Repealed Eff. July 1, 1988.
11 NCAC 12 .0103 Personnel of Division {#sec-11-ncac-12-.0103 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0103}

History

  • Status: repealed
  • Authority G.S. 58-4; 58-9
  • Eff. February 1, 1976
  • Readopted Eff. September 26, 1978
  • Repealed Eff. July 1, 1988.
11 NCAC 12 .0201 Pre-Existing Conditions and Renewable at Company Option {#sec-11-ncac-12-.0201 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0201}

The notices for pre-existing conditions and policies renewable at the option of the company are used as examples of acceptable wording for stickers placed on or notices printed on the face of accident and health policies identifying the pre-existing condition exclusions and the provisions for a policy renewable at the option of the company. These forms include a heading, descriptive paragraph and other pertinent information.

History

  • Authority G.S. 58-2-40; 58-65-1; 58-65-40
  • Eff. February 1, 1976
  • Readopted Eff. September 26, 1978
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0202 Comparative Information Form {#sec-11-ncac-12-.0202 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0202}

History

  • Status: repealed
  • Authority G.S. 58-9; 59-42; 58-42.1; 58-54.4; 58-195; 58-199
  • Eff. February 1, 1976
  • Readopted Eff. September 26, 1978
  • Amended Eff. July 1, 1982; July 5, 1979
  • Repealed Eff. October 1, 1985.
11 NCAC 12 .0203 Replacement Notice {#sec-11-ncac-12-.0203 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0203}

History

  • Status: repealed
  • Authority G.S. 58-9; 59-42; 58-42.1; 58-54.4; 58-195; 58-199
  • Eff. February 1, 1976
  • Readopted Eff. September 26, 1978
  • Amended Eff. July 1, 1982; July 5, 1979
  • Repealed Eff. October 1, 1985.
11 NCAC 12 .0204 Notice for Revision of Rates for Non-Profit Service Corp {#sec-11-ncac-12-.0204 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0204}

The form of notice of public hearing on revision of rates of nonprofit hospital, medical or dental service corporations is a guide for the preparation and publication of the notice of public hearing pursuant to G.S. 58-65-45 on the revision of rates of a nonprofit hospital, medical or dental service corporation. This form includes the time, date and location of the public hearing, the company proposing the revision, a complete description of the proposed revision and any other pertinent information.

History

  • Authority G.S. 58-2-40; 58-65-45
  • Eff. February 1, 1976
  • Readopted Eff. September 26, 1978
  • Amended Eff. April 8, 2002
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0205 Nc Buyer's Guide to Life Insurance {#sec-11-ncac-12-.0205 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0205}

History

  • Status: repealed
  • Authority G.S. 58-9; 58-25.1; 58-26; 58-33; 58-42; 58-42.1
  • 58-54.4; 58-195; 58-198; 58-199
  • Eff. April 26, 1979
  • Repealed Eff. June 16, 1979.
11 NCAC 12 .0206 Preliminary Policy Summary: Whole Life {#sec-11-ncac-12-.0206 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0206}

History

  • Status: repealed
  • Authority G.S. 58-9; 58-25.1; 58-26; 58-33; 58-42; 58-42.1
  • 58-54.4; 58-195; 58-198; 58-199
  • Eff. April 26, 1979
  • Repealed Eff. June 16, 1979.
11 NCAC 12 .0207 Preliminary Policy Summary: Term Policies {#sec-11-ncac-12-.0207 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0207}

History

  • Status: repealed
  • Authority G.S. 58-9; 58-25.1; 58-26; 58-33; 58-42; 58-42.1
  • 58-54.4; 58-195; 58-198; 58-199
  • Eff. April 26, 1979
  • Repealed Eff. June 16, 1979.
11 NCAC 12 .0208 Medicare and Medicaid - Buyer's Guide {#sec-11-ncac-12-.0208 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0208}

(a) The North Carolina Buyer's Guide to Health Insurance and Medicare and Medicaid is provided pursuant to 11 NCAC 12 .0548. This form consists of information regarding North Carolina law and regulations pertaining to the people eligible for Medicare and Medicaid and other pertinent information.

(b) The Buyer's Guide shall be printed in at least 14 point type in a 16 point base in contrasting colors of red and black on matte paper with dull ink. The format shall be as prescribed by the commissioner. The commissioner shall consider written requests for deviations on a case by case basis.

History

  • Authority G.S. 58-2-40; 58-54-25; 58-249; 58-250.1; 58-252; 58-254.5; 58-254.7
  • Eff. October 24, 1981
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0301 General Provisions {#sec-11-ncac-12-.0301 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0301}

History

  • Status: repealed
  • Authority G.S. 58-9
  • Eff. February 1, 1976
  • Readopted Eff. September 26, 1978
  • Repealed Eff. July 1, 1988.
11 NCAC 12 .0302 Application for Insurance Required {#sec-11-ncac-12-.0302 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0302}

History

  • Status: repealed
  • Authority G.S. 58-344
  • Eff. February 1, 1976
  • Readopted Eff. September 26, 1978
  • Amended Eff. July 1, 1986
  • Repealed Eff. April 1, 1989.
11 NCAC 12 .0303 Rebates on Insurance Companies Employees: Prohibited {#sec-11-ncac-12-.0303 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0303}

History

  • Status: repealed
  • Authority G.S. 58-54.4(8)
  • Eff. February 1, 1976
  • Readopted Eff. September 26, 1978
  • Repealed Eff. February 1, 1992.
11 NCAC 12 .0304 Sex Discrimination on Applications {#sec-11-ncac-12-.0304 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0304}

An insurer may not discriminate based on sex in any manner on a life or accident and health insurance application.

History

  • Authority G.S. 57-1; 57-4; 58-9; 58-44
  • Eff. February 1, 1976
  • Readopted Eff. September 26, 1978
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0305 Twisting or Other Practices Injurious to the Public {#sec-11-ncac-12-.0305 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0305}

History

  • Status: repealed
  • Authority G.S. 58-9(1); 58-42.1; 58-54.4
  • Eff. February 1, 1976
  • Readopted Eff. September 26, 1978
  • Repealed Eff. February 1, 1992.
11 NCAC 12 .0306 Life: Health and Accident Coverages: Policy Out of State {#sec-11-ncac-12-.0306 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0306}

Where a group master policy is written upon application taken outside this jurisdiction covering individuals in this state the certificate covering lives within this state shall be considered "North Carolina business" and reported through the office of some general agent, resident in or having territory within the state. This Rule does not apply to group mortgage and blanket scholastic policies where the policy must be issued in North Carolina.

History

  • Authority G.S. 58-3-1; 58-2-40
  • Eff. February 1, 1976
  • Readopted Eff. September 26, 1978
  • Amended Eff. February 1, 1992; July 1, 1986
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0307 Filing Approval: Life: Accident and Health Forms {#sec-11-ncac-12-.0307 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0307}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-6-5; 58-51-1; 58-54-35; 58-55-30; 58-58-1; 58-65-1; 58-65-40; 58-67-50; 58-67-150
  • Eff. February 1, 1976
  • Amended Eff. November 1, 1976
  • Readopted Eff. September 26, 1978
  • Amended Eff. August 1, 2002; February 1, 1996; February 1, 1992; April 1, 1989
  • Repealed Eff. July 1, 2006.
11 NCAC 12 .0308 Bank Credit Card Facility Available for Premium Payment {#sec-11-ncac-12-.0308 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0308}

History

  • Status: repealed
  • Authority G.S. 58-61.2
  • Eff. February 1, 1976
  • Readopted Eff. September 26, 1978
  • Amended Eff. April 1, 1989
  • Temporary Repeal Eff. December 1, 1999
  • Repealed Eff. July 1, 2000.
11 NCAC 12 .0309 Application: Bylaws: Rules: Part of the Policy Contract {#sec-11-ncac-12-.0309 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0309}

The bylaws or constitution of a mutual insurance company, association, order, society, or reciprocal exchange need not be attached to each policy in order to be a part of the policy contract if the policy contract contains all of the benefits available to the insured.

History

  • Authority G.S. 58-2-40; 58-51-1; 58-51-15; 58-58-1
  • Eff. February 1, 1976
  • Readopted Eff. September 26, 1978
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0310 Industrial Insurance {#sec-11-ncac-12-.0310 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0310}

The following is departmental policy on industrial insurance.

With respect to industrial business in this state an agent shall not be permitted to accept any money in payment of the premiums which are in arrears on any industrial insurance policy that has lapsed and which the insured seeks to reinstate unless the insured is enabled thereby to reinstate the policy. In other words, the agent cannot accept payment of part of the arrears and hold the money in his hands until he can collect the balance.

Any advance premium which is paid by an industrial policyholder shall be recorded in the receipt book of the insured and the record book of the agent in exactly the same manner as current premiums are recorded. There shall be no such things as blind entries in either book and the policyholder's receipt book and the record book of the agent shall be in exact agreement at all times.

Violation of this Rule will result in the initiation of license revocation proceedings. Companies will be expected to report any violation of this Rule to the commissioner.

History

  • Authority G.S. 58-9(1)
  • Eff. February 1, 1976
  • Readopted Eff. September 26, 1978
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0311 Limitation on Amount of Credit Insurance Written {#sec-11-ncac-12-.0311 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0311}

History

  • Status: repealed
  • Authority G.S. 57-1; 57-4; 58-9; 58-344
  • Eff. February 1, 1976
  • Readopted Eff. September 26, 1978
  • Repealed Eff. April 1, 1989.
11 NCAC 12 .0312 Accidental Death Benefit: Inhalation of Gas: Etc {#sec-11-ncac-12-.0312 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0312}

A policy or rider providing benefits for accidental death may not exclude the following:

(1) The involuntary inhalation of gas and fumes and the involuntary taking of poison.

(2) Accidental death as a result of involuntary exposure to nuclear explosion, nuclear energy or nuclear elements.

(3) The involuntary exposure to hazardous waste and other toxins.

(4) Unintentionally self-inflicted bodily injury.

(5) Bacterial infection resulting from accidental injury.

(6) Accidental ptomaine poisoning.

History

  • Authority G.S. 58-2-40; 58-3-30; 58-3-150; 58-51-1; 58-51-95
  • Eff. February 1, 1976
  • Readopted Eff. September 26, 1978
  • Amended Eff. February 1, 1992; April 1, 1989
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0313 Disability Benefit: Confinement Indoors {#sec-11-ncac-12-.0313 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0313}

A policy or rider providing benefits for disability may not require confinement indoors or at home.

History

  • Authority G.S. 58-2-40(1)
  • Eff. February 1, 1976
  • Readopted Eff. September 26, 1978
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0314 Insurer Liability: Premium Accepted from Ineligible Debtor {#sec-11-ncac-12-.0314 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0314}

History

  • Status: repealed
  • Authority G.S. 57-1; 57-4; 58-9; 58-344
  • Eff. February 1, 1976
  • Readopted Eff. September 26, 1978
  • Repealed Eff. April 1, 1989.
11 NCAC 12 .0315 Calculation of Unearned Premium Refunds: Credit Insurance {#sec-11-ncac-12-.0315 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0315}

History

  • Status: repealed
  • Authority G.S. 58-346; 58-351
  • Eff. February 1, 1976
  • Readopted Eff. September 26, 1978
  • Repealed Eff. April 1, 1989.
11 NCAC 12 .0316 Misstatement of Age: Credit {#sec-11-ncac-12-.0316 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0316}

History

  • Status: repealed
  • Authority G.S. 58-346; 58-351
  • Eff. February 1, 1976
  • Readopted Eff. September 26, 1978
  • Repealed Eff. April 1, 1989.
11 NCAC 12 .0317 Origin of Sickness: Description {#sec-11-ncac-12-.0317 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0317}

The use of a term more restrictive than "first manifested" in the determination of when a disease or sickness begins is prohibited. The term "prudent person" cannot be used as a condition to establish when a disease or sickness begins.

History

  • Authority G.S. 58-2-40; 58-51-95; 58-58-1; 58-65-1; 58-65-40; 58-67-50; 58-67-150
  • Eff. September 26, 1978
  • Amended Eff. February 1, 1992
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0318 Premium Increases: Group {#sec-11-ncac-12-.0318 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0318}

History

  • Status: repealed
  • Authority G.S. 57-1; 57-4; 58-9; 58-195; 58-249; 58-254.7; 58-293
  • Eff. September 26, 1978
  • Repealed Eff. February 1, 1992.
11 NCAC 12 .0319 Subrogation Prohibited {#sec-11-ncac-12-.0319 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0319}

Life or accident and health insurance forms shall not contain a provision allowing subrogation of benefits.

History

  • Authority G.S. 58-2-40; 58-51-1; 58-51-85; 58-51-95; 58-58-1; 58-65-1; 58-65-40
  • Eff. September 26, 1978
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0320 Sound Health Shall Be Defined {#sec-11-ncac-12-.0320 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0320}

An application for life and accident and health insurance shall not contain a question asking if the applicant is in sound or good health unless the term is defined.

History

  • Authority G.S. 58-2-40; 58-58-1; 58-65-1; 58-65-40
  • Eff. September 26, 1978
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0321 Rate Filing: Hmo {#sec-11-ncac-12-.0321 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0321}

History

  • Status: repealed
  • Authority G.S. 58-67-50; 58-67-150
  • Eff. January 22, 1980
  • Amended Eff. February 1, 1992
  • Repealed Eff. July 1, 2020.
11 NCAC 12 .0322 Regular Care and Attendance of a Physician {#sec-11-ncac-12-.0322 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0322}

As used in life, accident and health and disability policies, "regular care and attendance of a physician" shall not be construed to require insureds to see or be under the care of a physician on a regular basis if it can be shown that the insured has reached his maximum point of recovery yet is still disabled under the terms of the insurance contract. This requirement shall not, however, restrict the right of the insurer, at its own expense, to periodically examine or cause to have examined the insured according to the terms of the contract of insurance.

History

  • Authority G.S. 58-2-40; 58-51-1; 58-65-1
  • Eff. April 1, 1989
  • Amended Eff. February 1, 1992
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0323 Complication of Pregnancy {#sec-11-ncac-12-.0323 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0323}

Complications of pregnancy may not be treated differently from any other illness or sickness under the contract. A non-elective cesarean section is considered a complication of pregnancy.

History

  • Authority G.S. 58-2-40; 58-3-120; 58-51-1; 58-51-95; 58-63-15(7)
  • Eff. April 1, 1989
  • Amended Eff. February 1, 1992
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0324 Hiv and Aids Discrimination Prohibited {#sec-11-ncac-12-.0324 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0324}

Human Immunodeficiency Virus (HIV) infection (symptomatic and asymptomatic) and Acquired Immune Deficiency Syndrome (AIDS) must be treated as any other illness or sickness under health insurance policy provisions and policy applications. HIV and AIDS must be defined within the application if any questions are asked about HIV and AIDS.

History

  • Authority G.S. 58-2-40; 58-3-150; 58-51-1; 58-51.85; 58-51-95
  • Eff. April 1, 1989
  • Amended Eff. October 1, 1994
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0325 Occupational Injuries or Diseases {#sec-11-ncac-12-.0325 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0325}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-3-150; 58-51-1; 58-51-85; 58-51-95
  • Eff. February 1, 1992
  • Amended Eff. October 1, 1994
  • Repealed Eff. July 1, 2012.
11 NCAC 12 .0326 Application for Insurance Required {#sec-11-ncac-12-.0326 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0326}

(a) Applications for individual life, and accident or health insurance and annuities intended to insure North Carolina residents shall, except in the case of direct response business, be signed by a North Carolina licensed agent. The signature of the licensed agent must be his or her actual signature.

(b) Applications for insurance shall not include questions related to membership in substance or chemical dependency support groups. The applicant may be required to complete any medical question related to actual treatment, confinement, or diagnosis of such conditions.

History

  • Authority G.S. 58-2-40; 58-33-25(o)(5); 58-50-5
  • Eff. February 1, 1992
  • Amended Eff. February 1, 1996
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0327 y2k interim claim payments {#sec-11-ncac-12-.0327 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0327}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-2-235
  • Temporary Adoption Eff. January 1, 2000
  • Amended Eff. July 1, 2000
  • Repealed Eff. September 1, 2002.
11 NCAC 12 .0328 Eligible individual coverage {#sec-11-ncac-12-.0328 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0328}

(a) As used in this Rule, "designated health plan" means a guaranteed available plan an insurer must issue to an eligible individual under G.S. 58-68-60.

(b) As used in this Rule, "eligible individual" has the same meaning as in G.S. 58-68-60(b).

(c) As used in this Rule, "insurer" means an entity licensed under G.S. Chapter 58 that offers health insurance coverage in the individual market in this State.

(d) An insurer shall market each of its designated health plan(s) to eligible individuals.

(e) In marketing the designated health plan(s) to eligible individuals, an insurer shall use at least the same sources and methods of distribution that it uses to market other health benefit plans to individuals. An agent authorized by an insurer to market health benefit plans to individuals in this State shall also be authorized to market to eligible individuals.

(f) An insurer shall offer at least the designated health plan(s) to any eligible individual who applies for or makes an inquiry regarding health insurance coverage from the insurer. The offer may be provided directly to the eligible individual or delivered through an agent. The offer shall be in writing and shall include at least the following information:

(1) A general description of the benefits contained in the designated health plan(s) and any other health benefit plan being offered to the eligible individual; and

(2) Information describing how the eligible individual may enroll in the plans.

(g) An insurer shall provide a price quote to an eligible individual (directly or through an authorized agent) within 10 working days of receiving a request for a quote and information necessary to provide the quote. An insurer shall notify an eligible individual within five working days of receiving a request for a quote of any additional information needed by the insurer to provide the quote.

(h) An insurer shall not apply more stringent or detailed requirements related to the application process for an eligible individual than are applied for other individual applicants for other health benefit plans offered by the insurer.

(i) If an insurer denies coverage under a health benefit plan to an eligible individual, the denial shall be in writing and shall state with specificity the reasons for the denial, subject to any restrictions related to confidentiality of medical information. The written denial shall be accompanied by a written explanation of the guaranteed availability of coverage under the designated health plan(s) from the insurer. The explanation shall include at least the following:

(1) A general description of the benefit contained in each designated health plan;

(2) A price quote for each designated health plan; and

(3) Information describing how the eligible individual may enroll in a designated health plan.

(j) The written information described in Paragraph (i) of this Rule shall be provided within the time periods provided in Paragraph (g) of this Rule and may be provided directly to the eligible individual or delivered through an authorized agent.

(k) An insurer shall maintain a toll-free telephone service that answers its telephone calls in a timely manner to provide information to eligible individuals about the availability of the designated health plan(s) in this State. The service shall provide information to callers on how to apply for designated health plan coverage from the insurer. The information may include the names and telephone numbers of agents located near to the caller or other information designed to assist the caller to locate an authorized agent or to otherwise apply for coverage.

(l) An insurer shall not require, as a condition to the offer or sale of a designated health plan to an eligible individual, that the eligible individual purchase or qualify for any other insurance product or service.

(m) An insurer shall not create financial incentives or disincentives for agents to sell or to not sell any of its individual heath benefit plans, including designated health plans.

History

  • Authority G.S. 58-2-40(1); 58-68-60
  • Eff. April 1, 2003
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0329 Submission Requirements: Form and Rate Filings {#sec-11-ncac-12-.0329 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0329}

Any insurer, as defined by G.S. 58-1-5(3), that files with the Commissioner for review or approval product forms of life, annuity, accident and health, multiple employer welfare arrangements or managed care provider contract forms and supporting documents, or premium rates, shall comply with the following:

(1) Include a cover letter, or the NAIC Adopted Uniform Transmittal Document in lieu thereof, that:

(a) Includes the name and address of the submitting company.

(b) States the company issuing the form.

(c) Includes the toll-free telephone number and valid electronic e-mail address of the filer.

(d) Provides a unique identifying form number of each form submitted and its descriptive title.

(e) Indicates whether the form is new or a form revision.

(f) Identifies, for any revised forms, the form being replaced by its form number, assigned tracking number, and approval date.

(2) Submitted either via:

(a) Paper.

(b) Electronic E-Mail compressed in Adobe Acrobat.

(c) The National Association of Insurance Commissioners system for electronic rate and form filings (SERFF).

(3) Using the following forms and formats:

(a) Variable text or benefit ranges shall be in brackets.

(b) If applications, riders, endorsements or certificates are filed separately, the filer shall indicate policy forms with which they are used.

(c) Rates by age and mode of payment, including a signed actuarial memorandum, shall be attached to each form requiring a premium.

(d) Forms shall include a unique form number located in the lower left-hand corner of the first page.

(e) Filing shall be comprised of one clean copy of the entire submission.

(f) Electronic submissions shall be formatted in Portable Document Format Adobe Acrobat.

(g) Red-line side by side comparisons shall be provided with initial submissions that are revising previously-approved forms. An officer of the company shall provide a statement certifying that no changes, other than those red-lined, were made to the form(s).

(h) Red-line side by side comparisons shall be provided with each resubmission of forms revised during the review process as requested by the Commissioner.

(4) Rates:

(a) Individual or non-group accident and health products subject to Chapter 58 of the General Statutes shall demonstrate and describe the development of the requested premium. All 30 of the State's "Additional Data Requirements" as required in 11 NCAC 16 .0205 shall be addressed.

(b) Credit involuntary unemployment insurance, credit life, credit accident and health, and credit property products subject to Article 57 of Chapter 58 of the General Statutes shall demonstrate and describe the development of the requested premium. All applicable data elements as required in 11 NCAC 16. 0400 or 16 .0500 shall be addressed;

(c) Health maintenance organizations subject to Article 67 of Chapter 58 of the General Statutes shall demonstrate and describe the development of the requested premium. All data elements as required in 11 NCAC 16 .0400 and 16 .0600 shall be addressed;

(d) Service Corporations subject to Article 65 of Chapter 58 of the General Statutes shall demonstrate and describe the development of the requested premium adjustment in accordance with sound actuarial principles and standards.

(5) No form or rate shall be deemed approved by statute unless the filer provides the Commissioner with written notice.

(6) Submissions that have been disapproved and are not brought into compliance within 60 days of initial receipt shall be closed. File closure shall not prevent revised subsequent submissions but such will be treated as a new filing.

(7) The Commissioner may reject and disapprove incomplete submissions.

History

  • Authority G.S. 58-2-40; 58-51-1; 58-51-95; 58-54-20; 58-54-35; 58-55-30; 58-55-31; 58-57-30; 58-58-1; 58-65-1; 58-65-40; 58-67-50; 58-67-150
  • Eff. July 1, 2006
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0330 NOTICE OF A CLOSED BLOCK OF INDIVIDUAL business {#sec-11-ncac-12-.0330 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0330}

(a) Definitions. As used in this rule:

(1) "Accident and health coverage" has the same meaning as in G.S. 58-3-275.

(2) "Block of business" has the same meaning as in G.S. 58-3-275.

(3) "Closed block of business" has the same meaning as in G.S. 58-3-275.

(4) "Insurer" has the same meaning as in G.S. 58-3-275.

(5) "Policyholder" means the primary insured under an individual accident and health coverage and includes an applicant as described in G.S. 58-3-275(c)(6).

(6) "Qualified actuary" means a member in good standing of the American Academy of Actuaries.

(b) Notices required under G.S. 58-3-275 shall conform to the following:

(1) The notice to the Commissioner shall be submitted to the Life & Health Division of the Department; as applicable, be accompanied by a sample copy of the notices required by G.S. 58-3-275(a)(2) and G.S. 58-3-275(a)(3), in accordance with paragraphs (b)(2) and (b)(3) of this Rule; and include:

(A) Identification of the policy form(s) for which the insurer has determined to cease active marketing, sale and issuance.

(B) The date the cessation of sales will be effective.

(C) The number of North Carolina policyholders and covered individuals currently covered under the listed forms and riders. The number of covered individuals may be estimated by the company.

(D) At the option of the company, a statement by a qualified actuary that the actuary estimates that the expected impact of ceasing sales of the policy form(s) will not result in premium increases in excess of 5.0% per annum, as provided in G.S. 58-3-275(a)(1).

(2) The notice to a policyholder shall be provided by first-class mail to the policyholder's current address or, if not known, to the policyholder's last known address; if the policyholder is an applicant, as defined in G.S. 58-3-275(c)(6), the notice shall be provided no later than the date the policy is delivered to the policyholder; and the notice shall include:

(A) Identification of the policy form(s) of the policyholder for which the insurer has determined to cease active marketing.

(B) The effective date of the cessation of sales, and the closure date as defined in G.S. 58-3-275(c)(4).

(C) Information regarding the availability of the Commissioner's office for assistance, including the telephone number and address of the office.

(D) A toll-free telephone number for the insurer to which a policyholder may direct questions and inquiries regarding the closure.

(E) An explanation of the insurer's decision to cease the sales of the affected products and the possible effects upon future premiums.

(F) A general explanation of the 12-month premium rate guarantee required by G.S. 58-51-95(f).

(G) Language similar in content and meaning to the following:

"<INSERT INSURER'S NAME> has decided to stop selling the health insurance policy that you own, creating a closed block of business. With no new sales of this product, future premium rate increases may be greater than they would have been if sales of this product had continued."

(3) The notice to an agent/broker shall include:

(A) Identification of the policy form(s) for which the insurer has determined to cease active marketing, sale and issuance.

(B) The date the cessation of sales will be effective and the closure date as defined in G.S. 58-3-275(c)(4).

(C) An explanation of the insurer's decision to cease the sales of the affected products and the possible effects upon future premiums.

(c) The company's performance of contractual obligations that are contained in policies that are in the closed block of business, including coverage continuation, conversion, or replacement obligations, are not activities inconsistent with the term "closed block of business."

History

  • Authority G.S. 58-2-40(1); 58-3-275; 58-51-95
  • Eff. July 1, 2006
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0331 Health Insurance Risk Pool Notice Language Requirements {#sec-11-ncac-12-.0331 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0331}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-3-276
  • Eff. February 1, 2010
  • Repealed Eff. August 23, 2013 pursuant to G.S. 150B-21.7
  • Expired Eff. June 1, 2018 pursuant to G.S. 150B-21.3A.
11 NCAC 12 .0332 review/audit of third party administrators {#sec-11-ncac-12-.0332 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0332}

(a) Definitions. As used in this rule:

(1) "Certification" means the certification required by G.S. 58-56-26(c).

(2) "Insurer" has the same meaning as in G.S. 58-56-2(4).

(3) "Third party administrator" or "TPA" has the same meaning as in G.S. 58-56-2(5).

(b) The insurer shall submit a certification signed by an officer of the insurer, and the certification shall contain the following language:

"I, (name and title of the officer of the insurer), am familiar with the requirements of G.S. 58-56-26(c), and hereby certify that (insurance company full licensed name and federal tax identification number) performed a review and an audit in accordance with G.S. 58-56-26(c) for every third party administrator identified in or attached to this certification for the reporting calendar year."

(c) For all certifications submitted on or after July 1, 2011 and each subsequent year, each insurer shall certify that the insurer's review and audit include:

(1) An assessment of the TPA's business practices and procedures and evaluations of all of the following:

(A) The TPA's compliance with provisions of the written agreement with the insurer;

(B) The TPA's compliance and adherence to the TPA's internal policies and procedures for contract management, claims administration, and general administration, if applicable;

(C) The TPA's performance of claims adjudication and payment, if applicable;

(D) The TPA's performance of underwriting services, if applicable; and

(E) The TPA's performance of collecting premiums or other monies; and

(2) A written summary of the objectives and scope of the review or audit and the results of the review or audit, including a corrective action plan addressing any deficiencies found during the review or audit.

(d) An audit may be conducted either on-site or virtually and shall verify the accuracy, integrity, and completeness of the information received during a review conducted by the insurer under G.S. 58-56-26(c). An on-site audit shall also include an inspection of the TPA's place of business.

(e) In addition to a statement certifying compliance with the requirements of Paragraphs (c) and (d) of this Rule, a certification submitted on or after July 1, 2011 and each subsequent year shall be dated and include:

(1) The insurer's name as it appears on the insurer's license or certificate of authority and the insurer's federal tax identification number;

(2) The name and federal tax identification number of every TPA with which the insurer has a written administrative agreement under G.S. 58-56-6;

(3) Any exceptions to the certification identifying each excepted TPA by name and federal tax identification number and an explanation for the exception of the TPA;

(4) The year for which the certification is made; and

(5) The name, title and signature of an officer of the insurer making the certification.

(f) A sample format for the certification is available free of charge from the Life and Health Division at the Department of Insurance Web site at www.ncdoi.com.

(g) An insurer that did not have any written administrative agreements with TPAs during the reporting year for which the certification is required shall submit a report instead of a certification. This report shall include the information required under Paragraph (e) of this Rule; except the information required by Subparagraphs (e)(2) and (e)(3) of this Rule need not be included.

(h) A review may be conducted on the premises of the insurer or at another location designated by the insurer and may be conducted by electronic means. A review or audit may be performed by either the insurer or the insurer's designated representative. The insurer's designated representative shall not be an employee of or independent contractor with the TPA and shall be an independent, disinterested person or entity.

(i) The certification shall be submitted annually to the Life and Health Division through the NAIC system for electronic rate and form filings ("SERFF" or its successor system or program). If an insurer is unable to use the NAIC system or program, the insurer shall submit the certification by way of the U.S. Postal Service or other mail delivery service or by way of electronic mail, compressed in Adobe Acrobat (PDF).

History

  • Authority G.S. 58-2-40; 58-56-26
  • Eff. July 1, 2010
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018
  • Amended Eff. April 1, 2026.
11 NCAC 12 .0401 Life: General Nature {#sec-11-ncac-12-.0401 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0401}

History

  • Status: repealed
  • Authority G.S. 58-9
  • Eff. February 1, 1976
  • Readopted Eff. September 26, 1978
  • Repealed Eff. July 1, 1988.
11 NCAC 12 .0402 Family Life Policies and Dependent Term Riders {#sec-11-ncac-12-.0402 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0402}

History

  • Status: repealed
  • Authority G.S. 58-195
  • Eff. February 1, 1976
  • Readopted Eff. September 26, 1978
  • Repealed Eff. February 1, 1992.
11 NCAC 12 .0403 Termination of Life Insurance: Employee-Employer Contracts {#sec-11-ncac-12-.0403 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0403}

Individual life policies issued pursuant to G.S. 58-58-150 may be terminated by the insurance company when the following conditions occur:

(1) All like policies issued to employees of an employer are terminated;

(2) When the employee terminates his employment with that employer.

History

  • Authority G.S. 58-2-40; 58-58-150
  • Eff. February 1, 1976
  • Readopted Eff. September 26, 1978
  • Amended Eff. April 8, 2002
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0404 Applications Which Finance the First Year's Premium {#sec-11-ncac-12-.0404 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0404}

(a) Applications to be used with the sale of life insurance in which the first year's premium is financed shall comply with 11 NCAC 4 .0318.

(b) The information required in Subsection (a) of this Rule may be attached to instead of printed on the application. A rubber stamp shall not be used.

History

  • Authority G.S. 58-2-40; 58-58-1
  • Eff. February 1, 1976
  • Readopted Eff. September 26, 1978
  • Amended Eff. February 1, 1992
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0405 Life Insurance: Total and Permanent Disability Benefits {#sec-11-ncac-12-.0405 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0405}

Departmental policy with regard to total and permanent disability provisions of life insurance policies is as follows:

(1) Total and permanent disability provisions of individual or group life insurance and individual or group annuities, whether contained in the policies or in supplementary contracts, shall satisfy in substance the requirements set forth below. In construing these requirements:

(a) Waiver of premium includes refund of waived premiums if paid;

(b) The term "income payments" means monthly payments made in addition to waiver of premium and all benefits otherwise provided by the contract;

(c) The term "disability benefits" means waiver of premium, or both waiver of premium and income payments, whichever may be specified in the provision;

(d) The term "maturity" means, in the case of endowment policies, the date at which the policy becomes payable as an endowment, and in the case of deferred annuities, the date on which payment of annuity commences;

(e) The term "age 60" means either actual or rated age 60 of the insured or the policy anniversary nearest thereto as may be specified in the provision, and the term "age 65" shall be similarly construed.

(2) The following provisions or those more favorable to the insured are prescribed:

(a) Language defining total disability shall be included in the policy;

(b) That total disability which has been continuous for a period specified in the provisions (not less than four months nor more than one year) shall be presumed permanent;

(c) That written notice of claim must be given to the company:

(i) during the lifetime of the insured; and

(ii) during the period of disability; Failure to give notice within the time provided in the policy shall not invalidate any claim if it shall be shown not to have been reasonably possible to give such notice and that notice was given as soon as was reasonably possible;

(d) That if total and permanent disability is established pursuant to this Rule, any premium or installment thereof which fell due during such total continuous disability and during a period specified in the provision of the policy contract (not less than six months) immediately preceding notice of claim shall be waived;

(e) That if total and permanent disability is established pursuant to this Rule, which began after the due date of a premium or installment thereof in default, but not later than the last day of grace, provided such due date was within a period specified in the provision (not less than six months) immediately preceding notice of claim, disability benefits shall be allowed as if the default has not occurred, but the insured shall be liable for the premium in default with interest thereon, if any;

(f) That any dividends which would otherwise have become payable during disability shall be allowed as though the disability has not occurred, unless an annuity is provided as permitted by Subsection (3)(d) of this Rule;

(g) That upon recovery of the insured from total disability, disability benefits shall cease and premiums or installments thereof becoming due after such recovery shall be payable.

(3) The following provisions are permitted:

(a) that the entire and irrecoverable loss of sight of both eyes or the severance of (or alternatively, the entire and irrecoverable loss of the use of) both hands or of both feet, or of one hand and one foot, shall be deemed total disability;

(b) that disability occasioned by certain risks or hazards specified in the provisions shall be excluded from the coverage;

(c) that disability benefits shall be payable either to the insured or to a beneficiary;

(d) that in lieu of income payments, there shall be payable an annuity certain for a period of not more than 10 years, the present value of which shall be equal to the amount of insurance, but that upon recovery such annuity shall cease, and the insurance shall be restored at a proportionate premium for an amount equal to the present value of the unpaid installments;

(e) that in the case of endowment policies or deferred annuities income payments shall be made during the continuance of disability, after maturity, provided disability occurred prior to maturity and prior to the insured's attaining age 62;

(f) any other provision not inconsistent with these requirements which may be necessary to the efficient administration of the coverage provided and the protection of the interests of the insurer or the insured; The intention is to permit, among others, provisions such as the following:

(i) that proof of disability shall be made at the time and in the form and manner as specified in the provisions;

(ii) that the insurer may require proof of continuance of disability, including examination of the insured by the insurer at reasonable intervals;

(iii) that the insured may not convert the policy to a higher premium plan during continuance of disability;

(iv) that the insured may not change the mode of premium payment during the continuance of disability;

(v) that a proportionate reduction of income payments, accompanied by return of premiums paid on the amount of such reduction, may be made in case the aggregate monthly amount payable to the insured on account of disability exceeds the percentage specified in the provision (not to exceed 100 percent) of monthly earned income at date of disability, or alternatively at date of application.

(4) The following provisions are prohibited:

(a) the requirement of house or room confinement in the definition of total disability;

(b) that the face amount of insurance shall be reduced by the amount of any disability benefits (except in accordance with Subsection (3)(d) of this Rule);

(c) that in the case of deferred annuities with maturity at age 70 or earlier the monthly disability income payment shall not exceed one-twelfth of the annual annuity or in the case of deferred annuities with maturity at a later age a monthly income disability payment shall be allowed.

History

  • Authority G.S. 58-2-40; 58-51-1
  • Eff. February 1, 1976
  • Readopted Eff. September 26, 1978
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0406 Group Life Insurance: Collection Fee {#sec-11-ncac-12-.0406 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0406}

No insurance company licensed in North Carolina will be permitted to pay a collection fee to any person for the collection of premiums under group life insurance contracts, salary savings plans, or any other plan of group life insurance who does not devote a majority of his or her time to the life insurance business and who is not licensed by this department.

History

  • Authority G.S. 58-2-40; 58-33-25(j); 58-33-85
  • Eff. February 1, 1976
  • Readopted Eff. September 26, 1978
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0407 Group Life Insurance: Dependent Benefit {#sec-11-ncac-12-.0407 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0407}

Dependent life insurance may be written in connection with group life insurance in amounts as allowed by an insurer's underwriting practices.

History

  • Authority G.S. 58-2-40; 58-58-135
  • Eff. February 1, 1976
  • Readopted Eff. September 26, 1978
  • Amended Eff. April 1, 1989; April 2, 1979
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0408 Rules for Replacement of Life Insurance: Purpose {#sec-11-ncac-12-.0408 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0408}

History

  • Status: repealed
  • Temporary Restraining Order Issued Eff. May 8, 1979
  • Authority G.S. 58-9; 58-9(1); 58-42; 58-42.1; 58-54.4; 58-195; 58-199; 58-210
  • Eff. February 1, 1976
  • Amended Eff. January 1, 1978
  • Readopted Eff. September 26, 1978
  • Amended Eff. July 5, 1979
  • TRO dissolved June 30, 1981
  • Amended Eff. July 1, 1982
  • Repealed Eff. October 1, 1985.
11 NCAC 12 .0409 Replacement of Life Insurance: Defined {#sec-11-ncac-12-.0409 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0409}

History

  • Status: repealed
  • Temporary Restraining Order Issued Eff. May 8, 1979
  • Authority G.S. 58-9; 58-9(1); 58-42; 58-42.1; 58-54.4; 58-195; 58-199; 58-210
  • Eff. February 1, 1976
  • Amended Eff. January 1, 1978
  • Readopted Eff. September 26, 1978
  • Amended Eff. July 5, 1979
  • TRO dissolved June 30, 1981
  • Amended Eff. July 1, 1982
  • Repealed Eff. October 1, 1985.
11 NCAC 12 .0410 Replacement of Life Insurance: Exemptions {#sec-11-ncac-12-.0410 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0410}

History

  • Status: repealed
  • Temporary Restraining Order Issued Eff. May 8, 1979
  • Authority G.S. 58-9; 58-9(1); 58-42; 58-42.1; 58-54.4; 58-195; 58-199; 58-210
  • Eff. February 1, 1976
  • Amended Eff. January 1, 1978
  • Readopted Eff. September 26, 1978
  • Amended Eff. July 5, 1979
  • TRO dissolved June 30, 1981
  • Amended Eff. July 1, 1982
  • Repealed Eff. October 1, 1985.
11 NCAC 12 .0411 Duties of Soliciting Agent {#sec-11-ncac-12-.0411 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0411}

History

  • Status: repealed
  • Temporary Restraining Order Issued Eff. May 8, 1979
  • Authority G.S. 58-9; 58-9(1); 58-42; 58-42.1; 58-54.4; 58-195; 58-199; 58-210
  • Eff. February 1, 1976
  • Amended Eff. January 1, 1978
  • Readopted Eff. September 26, 1978
  • Amended Eff. July 5, 1979
  • TRO dissolved June 30, 1981
  • Amended Eff. July 1, 1982
  • Repealed Eff. October 1, 1985.
11 NCAC 12 .0412 Duties of Insurers {#sec-11-ncac-12-.0412 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0412}

History

  • Status: repealed
  • Temporary Restraining Order Issued Eff. May 8, 1979
  • Authority G.S. 58-9; 58-9(1); 58-42; 58-42.1; 58-54.4; 58-195; 58-199; 58-210
  • Eff. February 1, 1976
  • Amended Eff. January 1, 1978
  • Readopted Eff. September 26, 1978
  • Amended Eff. July 5, 1979
  • TRO dissolved June 30, 1981
  • Amended Eff. July 1, 1982
  • Repealed Eff. October 1, 1985.
11 NCAC 12 .0413 Violations {#sec-11-ncac-12-.0413 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0413}

History

  • Status: repealed
  • Temporary Restraining Order Issued Eff. May 8, 1979
  • Authority G.S. 58-9; 58-9(1); 58-42; 58-42.1; 58-54.4; 58-195; 58-199; 58-210
  • Eff. February 1, 1976
  • Amended Eff. January 1, 1978
  • Readopted Eff. September 26, 1978
  • Amended Eff. July 5, 1979
  • TRO dissolved June 30, 1981
  • Amended Eff. July 1, 1982
  • Repealed Eff. October 1, 1985.
11 NCAC 12 .0414 Group Life: State Employees: Other Political Subdivision {#sec-11-ncac-12-.0414 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0414}

History

  • Status: repealed
  • Authority G.S. 58-210(6)
  • Eff. February 1, 1976
  • Readopted Eff. September 26, 1978
  • Repealed Eff. February 1, 1992.
11 NCAC 12 .0415 Life Application {#sec-11-ncac-12-.0415 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0415}

All life and annuity applications used to solicit life insurance or annuities in North Carolina shall inquire whether or not the replacement of existing life insurance or annuities is involved in the transaction.

History

  • Authority G.S. 58-2-40(1); 58-3-150; 58-33-75; 58-58-1
  • Eff. February 1, 1976
  • Readopted Eff. September 26, 1978
  • Amended Eff. February 1, 1996
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0416 Life Application: Guaranteed Issue {#sec-11-ncac-12-.0416 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0416}

When a life insurance policy or certificate is sold on a guaranteed issue basis, the application for such life insurance used in the solicitation may not contain questions or statements regarding an applicant's health.

History

  • Authority G.S. 58-2-40(1); 58-3-150; 58-58-1
  • Eff. February 1, 1976
  • Readopted Eff. September 26, 1978
  • Amended Eff. February 1, 1996
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0417 Refund of Unearned Premium at Death: Credit Insurance {#sec-11-ncac-12-.0417 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0417}

History

  • Status: repealed
  • Authority G.S. 58-9; 58-349; 58-351
  • Eff. February 1, 1976
  • Readopted Eff. September 26, 1978
  • Repealed Eff. April 1, 1989.
11 NCAC 12 .0418 Suicide: Credit {#sec-11-ncac-12-.0418 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0418}

History

  • Status: repealed
  • Authority G.S. 58-9; 58-349; 58-351
  • Eff. February 1, 1976
  • Readopted Eff. September 26, 1978
  • Repealed Eff. April 1, 1989.
11 NCAC 12 .0419 Filing and Approval of Variable Annuity Contracts {#sec-11-ncac-12-.0419 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0419}

After a life insurance company has been granted the authority to write variable annuities the company must submit its variable annuity contract forms to the department for approval. The same requirements which are applicable under existing statutes and rules with respect to the filing and approval of individual and group life insurance and annuity contract forms shall apply to variable annuity contracts.

No company may submit variable annuity contracts for approval until its license has been amended to include the authority to write such variable annuity contracts.

History

  • Authority G.S. 58-2-40; 58-7-95
  • Eff. February 1, 1976
  • Readopted Eff. September 26, 1978
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0420 Approval of Contracts: Additional Information Required {#sec-11-ncac-12-.0420 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0420}

A company submitting variable annuity contracts to the Department for approval shall furnish the following information with each variable annuity contract filing:

(1) Evidence that a copy of all appropriate information has been registered with the Securities and Exchange Commission,

(2) A copy of all sales promotion material to be used in North Carolina,

(3) A copy of the variable annuity application form,

(4) A copy of the "Suitability Questionnaire" form, and

(5) A copy of all proposed riders to be used with the variable annuity contract.

The "Suitability Questionnaire" form required by this Rule may be a separate form or a part of the policy application and shall contain questions designed to determine whether the proposed variable annuity contract meets the reasonable objectives and needs of the applicant.

History

  • Authority G.S. 58-2-40; 58-7-95
  • Eff. February 1, 1976
  • Readopted Eff. September 26, 1978
  • Amended Eff. February 1, 1992; April 1, 1989
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0421 Preparation of Variable Annuity Contract Filings {#sec-11-ncac-12-.0421 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0421}

A company submitting variable annuity contracts to the department for approval must prepare such filings in the following manner:

(1) Separate filings should be made for individual and group contracts, with all supplementary material grouped accordingly.

(2) The filing letter should include a listing of all form numbers and a description of the contracts being filed.

(3) The filing letter should state whether or not the annuity mortality table developed from the company's experience is used, and if so, a copy of such table should accompany the filing.

(4) The filing letter should clearly indicate the states in which the subject contract has been filed and approved.

History

  • Authority G.S. 58-2-40; 58-7-95
  • Eff. February 1, 1976
  • Readopted Eff. September 26, 1978
  • Amended Eff. April 1, 1989
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0422 Contracts Providing for Variable Benefits {#sec-11-ncac-12-.0422 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0422}

Any variable contract providing benefits payable in variable amounts delivered or issued for delivery in this state shall contain a statement of the essential features of the procedures to be followed by the company in determining the dollar amount of such variable benefits. Any such contract, including a group contract and any certificate in evidence of variable benefits issued thereunder, shall state that such dollar amount will vary to reflect investment experience and shall contain on its first page a statement to the effect that the benefits thereunder are on a variable basis.

Illustrations of benefits payable under any variable contract shall not include projections of past investment experience into the future or attempted predictions of future investment experience; provided that nothing contained herein is intended to prohibit use of hypothetical assumed rates of return to illustrate possible levels of benefits. Any individual variable annuity contract delivered or issued for delivery in this state shall stipulate the investment increment factors to be used in computing the dollar amount of variable benefits or other contractual payments or values thereunder, and shall guarantee that expense and mortality results shall not adversely affect such dollar amounts.

In computing the dollar amount of variable benefits or other contractual payments or values under an individual variable annuity contract:

(1) The annual new investment increment assumption shall not exceed five percent, except with the approval of the commissioner.

(2) To the extent that the level of benefits may be affected by mortality results, the mortality factor shall be determined from the Annuity Mortality Table for 1949, Ultimate, or any modification of that table not having a lower life expectancy at any age, or, if approved by the commissioner, from another table.

"Expense," as used in this Rule, may exclude some or all taxes, as stipulated in the contract.

History

  • Authority G.S. 58-2-40; 58-7-95
  • Eff. February 1, 1976
  • Readopted Eff. September 26, 1978
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0423 Required Reports on Variable Annuity Business {#sec-11-ncac-12-.0423 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0423}

Any company issuing individual variable annuity contracts shall mail to the contract holder at least once in each contract year after the first year at his last address known to the company, a statement or statements reporting the investments held in the separate account, and in the case of contracts under which payments have not yet commenced, a statement reporting as of a date not more than four months previous to the date of mailing:

(1) the number of accumulation units credited to such contracts and the dollar value of a unit, or

(2) the value of the contract holder's account.

History

  • Authority G.S. 58-2-40; 58-7-95
  • Eff. February 1, 1976
  • Readopted Eff. September 26, 1978
  • Amended Eff. July 18, 2002
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0424 Life Insurance Advertising: Definitions {#sec-11-ncac-12-.0424 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0424}

For the purpose of 11 NCAC 12 .0424 to .0433:

(1) "Policy" shall include any policy, plan, certificate, contract, agreement, statement of coverage, rider, or endorsement which provides for life insurance or annuity benefits.

(2) "Insurer" shall include any individual, corporation, association, partnership, reciprocal exchange, inter-insurer, Lloyd's, fraternal benefit society, and any other legal entity which is defined as an "insurer" in the insurance code of this state or issues life insurance or annuities in this state and is engaged in the advertisement of a policy.

(3) "Advertisement" shall be material designed to create public interest in life insurance or annuities or in an insurer, or to induce the public to purchase, increase, modify, reinstate, borrow on, surrender, replace or retain a policy including:

(a) printed and published material, audiovisual material, and descriptive literature of an insurer used in direct mail, newspapers, magazines, radio, and television scripts, billboards, and similar displays;

(b) descriptive literature and sales aids of all kinds issued by an insurer or agent, including but not limited to, circulars, leaflets, booklets, depictions, illustrations, and form letters;

(c) material used for the recruitment, training, and education of an insurer's sales personnel, agents, solicitors, and brokers which is designed to be used or is used to induce the public to purchase, increase, modify, reinstate, borrow on, surrender, replace or retain a policy;

(d) prepared sales talks, presentations and material for use by sales personnel, agents, solicitors and brokers.

(4) "Advertisement" for the purpose of 11 NCAC 12 .0405 to .0433 shall not include:

(a) communications or materials used within an insurer's own organization and not intended for dissemination to the public;

(b) communications with policyholder other than material urging policyholders to purchase, increase, modify, reinstate, borrow on, surrender, replace or retain a policy;

(c) a general announcement from a group policyholder to eligible individuals on an employment or membership list that a policy or program has been written or arranged; provided the announcement clearly indicates that it is preliminary to the issuance of a booklet explaining the proposed coverage.

(5) "Nonguaranteed Policy Element" shall mean any premium, cash value, death benefit, endowment value, dividend or other policy benefit or pricing element or portion thereof whose amount is not guaranteed by the terms of the contract.

History

  • Authority G.S. 58-2-40; 58-3-150; 58-58-40
  • Eff. February 1, 1976
  • Readopted Eff. September 26, 1978
  • Amended Eff. April 1, 1989
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0425 Life Insurance Advertising: Applicability {#sec-11-ncac-12-.0425 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0425}

(a) These rules shall apply to any life insurance or annuity advertisement intended for dissemination in this state.

(b) Every insurer shall establish and at all times maintain a system of control over the content, form and method of dissemination of all advertisements of its policies. All such advertisements, regardless of by whom written, created, designed or presented, shall be the responsibility of the insurer.

History

  • Authority G.S. 58-2-40; 58-3-150; 58-58-40
  • Eff. February 1, 1976
  • Readopted Eff. September 26, 1978
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0426 Life Insurance Advertising: Form and Content {#sec-11-ncac-12-.0426 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0426}

(a) Advertisements shall be truthful and not misleading in fact or by implication. The form and content of an advertisement of a policy shall be sufficiently complete and clear so as to avoid deception. It shall not have the capacity or tendency to mislead or deceive.

Whether an advertisement has the capacity or tendency to mislead or deceive shall be determined by the Commissioner of Insurance from the overall impression that the advertisement may be reasonably expected to create upon a person of average education or intelligence within the segment of the public to which it is directed.

(b) No advertisement shall use the terms "investment," "investment plan," "founder's plan," "charter plan," "certificate of deposit," "expansion plan," "profit," "profits," "profit sharing," "interest plan," "savings," "savings plan" or other similar terms in connection with a policy in a context or under such circumstances or conditions as to have the capacity or tendency to mislead a purchaser or prospective purchaser of such policy to believe that he will receive, or that it is possible that he will receive, something other than a policy or some benefit not available to other persons of the same class and equal expectation of life.

History

  • Authority G.S. 58-2-40; 58-58-40; 58-63-15
  • Eff. February 1, 1976
  • Readopted Eff. September 26, 1978
  • Amended Eff. February 1, 1992
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0427 Life Insurance Advertising: Disclosure Requirements {#sec-11-ncac-12-.0427 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0427}

(a) The information required to be disclosed by 11 NCAC 12 .0424 to .0433 shall not be minimized, rendered obscure or presented in an ambiguous fashion or intermingled with the text of the advertisement so as to be confusing or misleading.

(b) No advertisement shall omit material information or use words or phrases in other than their customary insurance meaning or use words, phrases, statements, references or illustrations if such omission or such use has the capacity, tendency, or effect of misleading or deceiving purchasers or prospective purchasers as to the nature or extent of any policy benefit payable, loss covered, premium payable or state or federal tax consequences. The fact that the policy offered is made available to a prospective insured for inspection prior to consummation of the sale, or an offer is made to refund the premium if the purchaser is not satisfied, does not remedy misleading statements.

(c) In the event an advertisement uses "Non-Medical", "No Medical Examination Required" or similar terms where issue is not guaranteed, such terms shall be accompanied by a further disclosure of equal prominence and in juxtaposition thereto to the effect that issuance of the policy may depend upon the answers to the health questions.

(d) An advertisement shall not use as the name or title of a life insurance policy any phrase that does not include the words "life insurance" unless accompanied by other language clearly indicating it is life insurance.

(e) An advertisement shall prominently describe the type of policy advertised.

(f) An advertisement of a policy marketed by the direct response techniques shall not state or imply that because there is no agent or commission involved there will be cost saving to prospective purchasers unless such is the fact.

(g) An advertisement for a policy containing graded or modified benefits shall prominently display any limitation of benefits. If the premium is level and coverage decreases or increases with age or duration, such fact shall be prominently disclosed.

(h) An advertisement for a policy with non-level premiums shall prominently describe the premium changes.

(i) Nonguaranteed Policy Elements:

(1) An advertisement shall not utilize or describe nonguaranteed policy elements in a manner that is misleading or has the capacity or the tendency to mislead.

(2) An advertisement shall not state or imply that the payment or amount of nonguaranteed policy elements is guaranteed. If nonguaranteed policy elements are illustrated, they must be based on the insurer's current scale and the illustration must contain a statement to the effect that they are not to be construed as guarantees or estimates of amounts to be paid in the future.

(3) An advertisement that includes any illustrations or statements containing or based upon nonguaranteed elements shall set forth with equal prominence comparable illustrations or statements containing or based upon the guaranteed element.

(4) If an advertisement refers to any nonguaranteed policy element, it shall indicate that the insurer reserves the right to change any such element at any time and for any reason. However, if an insurer has agreed to limit this right in any way, such as, for example, if it has agreed to change these elements only at certain intervals or only if there is a change in the insurer's current or anticipated experience, the advertisement may indicate any such limitation of the insurer's right.

(5) An advertisement shall not refer to dividends as "tax free"use words of similar import, unless the tax treatment of dividends is fully explained and the nature of the dividend as a return of premium is indicated clearly.

(j) An advertisement shall not state that a purchaser of a policy will share in or receive a stated percentage or portion of the earnings on the general account assets of the company.

(k) Testimonials or Endorsements by Third Parties:

(1) Testimonials used in advertisements must be genuine; represent the current opinion of the author; be applicable to the policy advertised, if any; and be accurately reproduced. In using a testimonial, the insurer makes as its own all of the statements contained therein, and such statements are subject to all provisions of 11 NCAC 12 .0424 to .0433.

(2) If the individual making a testimonial or an endorsement has a financial interest in the insurer or a related entity as a stockholder, director, officer, employee or otherwise, or receives any benefit directly or indirectly other than required union scale wages, such fact shall be disclosed in the advertisement.

(3) An advertisement shall not state or imply that an insurer or a policy has been approved or endorsed by a group of individuals, society, association or other organization unless such is the fact and unless any proprietary relationship between an organization and the insurer is disclosed. If the entity making the endorsement or testimonial is owned, controlled or managed by the insurer, or receives any payment or other consideration from the insurer for making such endorsement or testimonial, such fact shall be disclosed in the advertisement.

(l) An advertisement shall not contain statistical information relating to any insurer or policy unless it accurately reflects recent and relevant facts. The source of any such statistics used in an advertisement shall be identified therein.

(m) Introductory, Initial or Special Offers and Enrollment Periods:

(1) An advertisement of an individual policy or combination of such policies shall not state or imply that such policy or combination of such policies is an introductory, initial or special offer, or that applicants will receive substantial advantages not available at a later date, or that the offer is available only to a specified group of individuals, unless such is the fact. An advertisement shall not describe an enrollment period as "special" or "limited" or use similar words or phrases in describing it when the insurer uses successive enrollment periods as its usual method of marketing of its policies.

(2) An advertisement shall not state or imply that only a specific number of policies will be sold, or that a time is fixed for the discontinuance of the sale of the particular policy advertised because of special advantages available in the policy.

(3) An advertisement shall not offer a policy that utilizes a reduced initial premium rate in a manner that overemphasizes the availability and the amount of the reduced initial premium. When an insurer charges an initial premium that differs in amount from the amount of the renewal premium payable on the same mode, all references to the reduced initial premium shall be followed by an asterisk or other appropriate symbol that refers the reader to that specific portion of the advertisement that contains the full rate schedule for the policy being advertised.

(4) An enrollment period during which a particular insurance policy may be purchased on an individual basis shall not be offered within this state unless there has been a lapse of not less than three months between the close of the immediately preceding enrollment period for the same policy and the opening of the new enrollment period with the number of enrollment periods being limited to no more than two in any one calendar year for a particular insurance product. The advertisement shall specify the date by which the applicant must mail the application, which shall not be later than 10 days and not more than 40 days on which such enrollment period is advertised for the first time. This shall apply to all advertising media--i.e., mail, newspapers, radio, television, magazines and periodicals--by any one insurer. The phrase "any one insurer" includes all the affiliated companies of a group of insurance companies under common management or control. This does not apply to the use of a termination of cutoff date beyond which an individual application for a guaranteed issue policy will not be accepted by an insurer in those instances where the application has been sent to the applicant in response to his request. It is also inapplicable to solicitations of employees or members of a particular group or association which otherwise would be eligible under specific provisions of the insurance code for group insurance. In cases where an insurance product is marketed on a direct mail basis to prospective insureds by reason of some common relationship with a sponsoring organization, this shall be applied separately to each such sponsoring organization.

(n) An advertisement of a particular policy shall not state or imply that prospective insureds shall be or become members of a special class, group or quasi-group and as such enjoy special rates, dividends or underwriting privileges unless such is the fact.

(o) An advertisement shall not make unfair or incomplete comparisons of policies, benefits, dividends or rates of other insurers. An advertisement shall not falsely or unfairly describe other insurers, their policies, services or methods of marketing.

(p) An advertisement shall not make use of any method of marketing that fails to disclose in a conspicuous manner that a purpose of the method of marketing is solicitation of insurance and that contact will be made by an insurance agent or insurance agency.

History

  • Authority G.S. 58-2-40; 58-58-40; 58-63-15
  • Eff. February 1, 1976
  • Readopted Eff. September 26, 1978
  • Amended Eff. February 1, 1992; April 1, 1989
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0428 Life Insurance Advertising: Identity of Insurer {#sec-11-ncac-12-.0428 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0428}

(a) The name of the insurer shall be clearly identified in all advertisements, and if any specific individual policy is advertised it shall be identified either by form number or other appropriate description. If an application is a part of the advertisement, the name of the insurer shall be shown on the application. An advertisement shall not use a trade name, an insurance group designation, name of the parent company of the insurer, name of a particular division of the insurer, service mark, slogan, symbol or other device or reference without disclosing the name of the insurer, if the advertisement would have the capacity or tendency to mislead or deceive as to the true identity of the insurer or create the impression that a company other than the insurer would have any responsibility for the financial obligation under a policy.

(b) No advertisement shall use any combination of words, symbols or physical materials which by their content, phraseology, shape, color or other characteristics are so similar to a combination of words, symbols or physical materials used by a governmental program or agency or otherwise appear to be of such nature that they tend to mislead prospective insureds into believing that the solicitation is in some manner connected with such governmental program or agency.

History

  • Authority G.S. 58-2-40; 58-58-40; 58-63-15
  • Eff. February 1, 1976
  • Readopted Eff. September 26, 1978
  • Amended Eff. April 1, 1989
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0429 Life Insurance Advertising: Licensing: Status of Insurer {#sec-11-ncac-12-.0429 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0429}

(a) An advertisement which is intended to be seen or heard beyond the limits of the jurisdiction in which the insurer is licensed shall not imply licensing beyond such limits.

(b) An advertisement may state that an insurer is licensed in the state where the advertisement appears, provided it does not exaggerate such fact or suggest or imply that competing insurers may not be so licensed.

(c) An advertisement shall not create the impression that the insurer, its financial condition or status, the payment of its claims, or the merits, desirability, or advisability of its policy forms or kinds of plans of insurance are recommended or endorsed by any governmental entity. However, where a governmental entity has recommended or endorsed a policy form or plan, such recommendation or endorsement may be stated if the entity authorizes such use.

History

  • Authority G.S. 58-2-40; 58-58-40; 58-63-15
  • Eff. February 1, 1976
  • Readopted Eff. September 26, 1978
  • Amended Eff. April 1, 1989
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0430 Life Insurance Advertising: Statements About the Insurer {#sec-11-ncac-12-.0430 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0430}

An advertisement shall not contain statements, pictures or illustrations which are false or misleading, in fact or by implication, with respect to the assets, liabilities, insurance in force, corporate structure, financial condition, age or relative position of the insurer in the insurance business. An advertisement shall not contain a recommendation by any commercial rating system unless it clearly defines the scope and extent of the recommendation.

History

  • Authority G.S. 58-2-40; 58-58-40; 58-63-15
  • Eff. February 1, 1976
  • Readopted Eff. September 26, 1978
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0431 Life Insurance Advertising: Enforcement Procedures {#sec-11-ncac-12-.0431 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0431}

(a) Each insurer shall maintain at its home or principal office a complete file containing a specimen copy of every printed, published or prepared advertisement of its policies, hereafter disseminated in this state, with a notation indicating the manner and extent of distribution and the form number of any policy advertised. Such file shall be subject to inspection by this department. All such advertisements shall be maintained in said file for a period of either three years or until the filing of the next regular report on examination of the insurer, whichever is the longer period of time.

(b) Each insurer subject to the provisions of 11 NCAC 12 .0424 to .0433 shall file with this department with its annual statement a certificate of compliance executed by an authorized officer of the insurer wherein it is stated that to the best of his knowledge, information and belief the advertisements which were disseminated by or on behalf of the insurer in this state during the preceding statement year, or during the portion of such year when 11 NCAC 12 .0424 to .0433 were in effect, complied or were made to comply in all respects with the provisions of 11 NCAC 12 .0425 to .0433 and the insurance laws of this state as implemented and interpreted by 11 NCAC 12 .0424 to .0433.

(c) Every written advertisement created or developed by an insurance agent that describes a policy in any manner shall be filed with and approved by the home office of the insurance company offering the policy before the advertisement may be used by the agent.

History

  • Authority G.S. 58-2-40; 58-58-40; 58-63-15
  • Eff. February 1, 1976
  • Readopted Eff. September 26, 1978
  • Amended Eff. February 1, 1992; April 1, 1989
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0432 Life Insurance Advertising: Advertising Expense {#sec-11-ncac-12-.0432 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0432}

Total advertising expense incurred by the insurer or by an affiliated corporation on behalf of the insurer for the purposes of solicitation and conservation of life insurance business shall be included as line items in the expense exhibits of all statutory financial statements filed by a licensed insurer with the department.

History

  • Authority G.S. 58-2-40; 58-58-40; 58-63-15
  • Eff. February 1, 1976
  • Readopted Eff. September 26, 1978
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0433 Life Insurance Advertising: Prior Review or Prior Approval {#sec-11-ncac-12-.0433 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0433}

The commissioner may, when in his discretion he deems it in the public interest, require the filing of all or any part of the advertising material of an insurer with this department for review prior to its use. All advertising material subject to review prior to its use shall be filed with this department 30 days prior to its intended use. In instances where charges are pending against an insurer, the commissioner may, during the period such charges are pending but not to exceed 30 days unless extended by consent order, by order require all or any part of the advertising material be filed for review prior to its use or for prior approval. The commissioner may within his discretion refuse to approve all or any part of the advertising material so filed. All advertising material subject to prior approval shall be filed with this department 60 days prior to its intended use. When it has been determined by the commissioner after notice and hearing that an insurer has violated any of the insurance laws of this state or rules of the commissioner, the commissioner may in his discretion, by order require that all or any part of the advertising material be filed with this department for review prior to its use or for prior approval. The commissioner may within his discretion refuse to approve all or any part of the advertising material so filed. In any case where review prior to its use or prior approval is required, a shorter period of time may be allowed by the commissioner.

History

  • Authority G.S. 58-2-40; 58-58-40; 58-63-15
  • Eff. February 1, 1976
  • Readopted Eff. September 26, 1978
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0434 Variable Life Insurance: Definitions {#sec-11-ncac-12-.0434 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0434}

As used in this Rule and in 11 NCAC 12 .0435 through 11 NCAC 12 .0443:

(1) "Affiliate" of an insurer means any person, directly or indirectly, controlling, controlled by, or under common control with such insurer; any person who regularly furnishes investment advice to such insurer with respect to its variable life insurance separate accounts for which a specific fee or commission is charged; or any director, officer, partner, or employee of any such insurer, controlled person, or person providing investment advice or any member of the immediate family of such person.

(2) "Agent" means any person, corporation, partnership, or other legal entity which is licensed by this state as a life insurance agent.

(3) "Assumed investment rate" means the rate of investment return which would be required to be credited to a variable life insurance policy, after deduction of charges for taxes, investment expenses and mortality and expense guarantees to maintain the variable death benefit equal at all times to the amount of death benefit, other than incidental insurance benefits, which would be payable under the plan of insurance if the death benefit did not vary according to the investment experience of the separate account.

(4) "Benefit base" means the amount not less than the amount specified under 11 NCAC 12 .0438(b)(2), specified by the terms of the variable life insurance policy to which the difference between the net investment return and the assumed investment rate is applied in determining the variable benefits of the policy.

(5) "Commissioner" means the Insurance Commissioner of this state.

(6) "Control" (including the terms "controlling," "controlled by" and "under common control with") means the possession, direct or indirect, of the power to direct or cause the direction of the management and policies of a person, whether through the ownership of voting securities, by contract other than a commercial contract for goods or nonmanagement services, or otherwise, unless the power is the result of an official position with or corporate office held by the person. Control shall be presumed to exist if any person, directly or indirectly, owns, controls, holds with the power to vote, or holds proxies representing more than 10 percent of the voting securities of any other person. This presumption may be rebutted by a showing made to the satisfaction of the commissioner that control does not exist in fact. The commissioner may determine, after furnishing all persons in interest notice and opportunity to be heard and making specific findings of fact to support such determination, that control exists in fact, notwithstanding the absence of a presumption to that effect.

(7) "General account" means all assets of the insurer other than assets in separate accounts established pursuant to G.S. 58-7-95, or pursuant to the corresponding section of the insurance laws of the state of domicile of a foreign or alien insurer, whether or not for variable life insurance.

(8) "Incidental insurance benefit" means all insurance benefits in a variable life insurance policy, other than the variable death benefit and the minimum death benefit, including but not limited to accidental death and dismemberment benefits, disability income benefits, guaranteed insurability options, family income, or fixed benefit term riders.

(9) "May" is permissive.

(10) "Minimum death benefit" means the amount of the guaranteed death benefit, other than incidental insurance benefits, payable under a variable life insurance policy regardless of the investment performance of the separate account.

(11) "Net investment return" means the rate of investment return in a separate account to be applied to the benefit base after deduction of charges for taxes, investment expenses and mortality and expense guarantees in accordance with the terms of the policy.

(12) "Person" means an individual, corporation, partnership, association, trust, or fund.

(13) "Separate account" means a separate account established for variable life insurance pursuant to G.S. 58-7-95 or pursuant to the corresponding section of the insurance laws of the state of domicile of a foreign or alien insurer.

(14) "Shall" is mandatory.

(15) "Variable death benefit" means the amount of the death benefit, other than incidental insurance benefits, payable under variable life insurance policy dependent on the investment performance of the separate account, which the insurer would have to pay in the absence of the minimum death benefit.

(16) "Variable life insurance policy" means any individual or group policy which provides for life insurance the amount or duration of which varies according to the investment experience of any separate account or accounts established and maintained by the insurer as to such policy, pursuant to G.S. 58-7-95 or pursuant to the corresponding section of the insurance laws of the state of domicile of a foreign or alien insurer.

History

  • Authority G.S. 58-2-40; 58-7-95
  • Eff. January 1, 1978
  • Readopted Eff. September 26, 1978
  • Amended Eff. February 1, 1992
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0435 Qualification of Insurer to Issue Variable Life Insurance {#sec-11-ncac-12-.0435 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0435}

The following requirements are applicable to all insurers either seeking authority to issue variable life insurance in this state or which have authority to issue variable life insurance in this state:

(1) Licensing and Approval to do Business in This State. An insurer shall not deliver or issue for delivery in this state any variable life insurance policy unless:

(a) The insurer is licensed or organized to do a life insurance business in this state;

(b) Either:

(i) The state of domicile of such insurer requires that permissible investments be substantially the same as provided in .0438(c) of this Section and that changes in the investment policy of the variable life insurance separate account be regulated in a manner substantially similar to that required under .0438 of this Section for such separate accounts operated by insurers domiciled in this state; or

(ii) The insurer's investment policy, as described in the statement required to be filed under (2)(c) of this Rule conforms to .0438(c) of this Section, and the commissioner is satisfied that the procedures for changing the investment policy of a variable life insurance separate account, as described in the statement required to be filed under (2)(c) of this Rule, provide safeguards consistent with those provided under .0438(f) of this Section;

(c) The insurer has obtained the written approval of the commissioner for the issuance of variable life insurance policies in this state. The commissioner shall grant such written approval only after he has found that:

(i) The plan of operation for the issuance of variable life insurance policies is not unsound;

(ii) The general character, reputation, and experience of the management and those persons or firms proposed to supply consulting, investment, administrative, or custodial services to the insurer are such as to reasonably assure competent operation of the variable life insurance business of the insurer in this state; and

(iii) The present and foreseeable future financial condition of the insurer and its method of operation in connection with the issuance of such policies is not likely to render its operation hazardous to the public or its policyholders in this state. The commissioner shall consider, among other things:

(A) the history of operation and financial condition of the insurer;

(B) the qualification, fitness, character, responsibility, reputation, and experience of the officers and directors and other management of the insurer and those persons or firms proposed to supply consulting, investment, administrative, or custodial services to the insurer;

(C) the applicable law and regulations under which the insurer is authorized in its state of domicile to issue variable life insurance policies; The state of entry of an alien insurer shall be deemed its state of domicile for this purpose; and

(D) if the insurer is a subsidiary of, or is affiliated by common management or ownership with another company, its relationship to such other company and the degree to which the requesting insurer, as well as the other company, meet these standards.

(2) Filing for Approval to do Business in This State. Before any insurer shall deliver or issue for delivery any variable life insurance policy in this state, it must file with this department the following information for the consideration of the commissioner in making the determination required by (1)(c) of this Rule:

(a) copies of and a general description of the variable life insurance policies it intends to issue;

(b) a general description of the methods of operation of the variable life insurance business of the insurer, including the names of those persons or firms proposed to supply consulting, investment, administrative, or custodial services to the insurer;

(c) with respect to any separate account maintained by an insurer for any variable life insurance policy, a statement of the investment policy the insurer intends to follow for the investment of the assets held in such separate account, and a statement of the procedures for changing such investment policy; The statement of investment policy shall include a description of the investment objective and orientation intended for the separate account;

(d) a description of any investment advisory services contemplated as required by .0438(10) of this Section;

(e) if requested by the commissioner, a copy of the statutes and regulations of the state of domicile of the insurer under which it is authorized to issue variable life insurance policies; and

(f) if requested by the commissioner, biographical data with respect to officers and directors of the insurer on the National Association of Insurance Commissioners Uniform Biographical Data Form.

(3) Standards of Suitability. Every insurer seeking approval to enter into the variable life insurance business in this state shall adopt by formal action of its board of directors and file with the commissioner a written statement specifying the standards of suitability to be used by the insurer and applicable to its officers, directors, employees, affiliates, and agents with respect to the suitability of variable life insurance for the applicant. Such standards of suitability shall be binding on the insurer and those to whom it refers, and shall specify that no recommendation shall be made to an applicant to purchase a variable life insurance policy and that no variable life insurance policy shall be issued in the absence of reasonable grounds to believe that the purchase of such policy is not unsuitable for such applicant on the basis of information furnished after reasonable inquiry of such applicant concerning the applicant's insurance and investment objectives, financial situation and needs, and any other information known to the insurer or to the agent making the recommendation. Lapse rates for variable life insurance within the first two policy years which are significantly higher than both those encountered by the insurer or an affiliate thereof for corresponding fixed benefit life insurance policies and lapse rates of other insurers issuing variable life insurance policies shall be considered by the commissioner in determining whether the guidelines adopted by the insurer are reasonable and also whether the insurer and its agents are engaging, as a general business practice, in the sale of variable life insurance to persons for whom it is unsuitable. For purposes of this Subsection, conversions from variable life insurance policies pursuant to this Regulation shall not be considered lapses.

(4) Use of Sales Materials. An insurer authorized to transact variable life insurance business in this state shall not use any sales material, advertising material, or descriptive literature or other materials of any kind in connection with its variable life insurance business in those states which is false, misleading, deceptive, or inaccurate.

(5) Requirements Applicable to Contractual Services

(a) Any contract between an insurer and suppliers of consulting, investment, administrative, sales, marketing, custodial, or other services which are material with respect to variable life operations shall be in writing and provide that the supplier of such services shall furnish the commissioner with any information or reports in connection with such services which the commissioner may request in order to ascertain whether the variable life insurance operations of the insurer are being conducted in a manner consistent with these regulations and any other applicable law or regulations.

(b) Such contract shall be fair and equitable to all parties and not endanger any policyholders of the insurer in this state.

(c) Such contract shall not relieve the insurer from any responsibilities or obligations imposed upon the operations of its variable life insurance business by this Regulation or any other law or regulation.

(6) Reports to the Commissioner. Any insurer authorized to transact the business of variable life insurance in this state shall submit to the commissioner, in addition to any other materials which may be required by this Regulation or any other applicable laws or regulations:

(a) An annual statement of the business of its variable life insurance separate account or accounts in such form as may be prescribed by the National Association of Insurance Commissioners; and

(b) Prior to the use in this state any information furnished to applicants as provided for in .0439 of this Section; and

(c) Prior to the use in this state the form of any of the reports to policyholders as provided for in .0441 of this Section; and

(d) Such additional information concerning its variable life insurance separate accounts as the commissioner shall deem necessary;

(e) Any material submitted to the commissioner shall be disapproved if it is found to be false, misleading, deceptive, or inaccurate in any material respect and, if previously distributed, the commissioner shall require the distribution of an amended report.

(7) Authority of Commissioner to Disapprove. Any material required to be filed with the commissioner, or approved by him, shall be subject to disapproval if at any time it is found by him not to comply with the standards established by this Regulation.

History

  • Authority G.S. 58-2-40(1); 58-7-95
  • Eff. January 1, 1978
  • Readopted Eff. September 26, 1978
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0436 Insurance Policy Requirements {#sec-11-ncac-12-.0436 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0436}

The Commissioner shall not approve any variable life insurance form filed pursuant to this Rule unless it conforms to the requirements of this Section:

(1) Filing of Variable Life Insurance Policies. All variable life insurance policies, and all riders, endorsements, applications and other documents which are to be attached to and made a part of the policy and which relate to the variable nature of the policy, shall be filed with the Commissioner and approved by him in writing prior to delivery or issuance for delivery in this state:

(a) The procedures and requirements for such filing and approval shall be, to the extent appropriate and not inconsistent with this Rule, the same as those otherwise applicable to other life insurance policies.

(b) The Commissioner may approve variable life insurance policies and related forms with provisions the Commissioner deems to be not less favorable to the policyholder and the beneficiary than those required by this Rule.

(c) The requirements of Sub-item (3)(e) of this Rule shall not apply to variable life insurance policies and related forms issued in connection with pension, profit-sharing and retirement plans if separate accounts for such policies are exempt pursuant to Section 3(c)(11) of the Investment Company Act of 1940.

(2) Mandatory Policy Benefit and Design Requirements. Variable life insurance policies delivered or issued for delivery in this state shall comply with the following minimum requirements:

(a) The mortality and expense risk shall be borne by the insurer.

(b) Gross premiums for death benefits shall be a level amount for the duration of the premium payment period, but this Subsection shall not be construed to prohibit temporary or permanent additional premiums for incidental insurance benefits or substandard risks. This Subsection shall not be deemed to prohibit the use of fixed benefit preliminary term insurance for a period not to exceed 120 days from the date of the application for a variable life insurance policy. The premium rate for such preliminary term insurance shall be stated separately in the application or receipt.

(c) A minimum death benefit shall be provided in an amount at least equal to the initial face amount of the policy so long as premiums are duly paid [subject to the provisions of Sub-item (4)(b) of this Rule].

(d) The policy shall provide that the variable death benefit shall reflect the investment experience of the variable life insurance separate account established and maintained by the insurer and that the excess, positive or negative, of the net investment return over the assumed investment rate, as applied to the benefit base of each variable life insurance policy, shall be used to provide:

(i) fully paid-up variable life insurance providing coverage for the same period as the basic insurance under the policy or fully paid-up term insurance amounts for a term of annual periods of not less than one year nor more than five years, positive or negative, as the case may be, or a combination thereof; or

(ii) variable life insurance amounts, positive or negative, as the case may be, so that the reserve maintains the same percentage relationship to the variable death benefit as it would have on a corresponding fixed benefit policy; or

(iii) any other form of insurance benefits as the Commissioner may approve.

(e) Each variable life insurance policy shall be credited with the full amount of the net investment return applied to the benefit base.

(f) Changes in variable death benefits of each variable life insurance policy shall be determined at least annually.

(g) The cash value of each variable life insurance policy shall be determined at least monthly. The method of computation of cash values and other non-forfeiture benefits, as described either in the policy or in a statement filed with the Commissioner of the state in which the policy is delivered, or issued for delivery, shall be in accordance with actuarial procedures that recognize the variable nature of the policy. The method of computation must be such that, if the net investment return credited to the policy at all times from the date of issue should be equal to the assumed investment rate with premiums and benefits determined accordingly under the terms of the policy, then the resulting cash values and other non-forfeiture benefits must be at least equal to the minimum values required by G.S. 58-58-55 of the insurance laws of this state (Standard Non-forfeiture Law) for a fixed benefit policy with such premiums and benefits. The assumed investment rate shall not exceed the maximum interest rate permitted under the Standard Non-forfeiture Law of this state. The method of computation may disregard incidental minimum guarantees as to the dollar amounts payable. Incidental minimum guarantees include, for example, but are not to be limited to, a guarantee that the amount payable at death or maturity shall be at least equal to the amount that otherwise would have been payable if the net investment return credited to the policy at all times from the date of issue had been equal to the assumed investment rate.

(h) The computation of values required for each variable life insurance policy may be based upon such reasonable and necessary approximations as are acceptable to the Commissioner.

(i) In determining the net investment return to be applied to the benefit base the insurer may deduct only the charges described in Rule .0438(7)(a)(i), (ii), (iv), and (v) of this Section.

(3) Mandatory Policy Provisions. Every variable life insurance policy filed for approval in this state shall contain at least the following:

(a) The cover page or pages corresponding to the cover page of each such policy shall contain:

(i) a prominent statement in either contrasting color or in boldface type at least four points larger than the type size of the largest type used in the text of any provision of that page, that the death benefit may be variable for fixed under specified conditions;

(ii) a prominent statement in either contrasting color or in boldface type at least four points larger than the type size of the largest type size used in the text of any provision on that page that cash values may increase or decrease in accordance with the experience of the separate account subject to any specified minimum guarantees;

(iii) a statement that the minimum death benefit will be at least equal to the initial face amount at the date of issue if premiums are duly paid and if there are no outstanding policy loans, partial withdrawals, or partial surrenders;

(iv) the rule, or a reference to the policy provision which describes the method for determining the variable amount of insurance payable at death;

(v) a captioned provision which provides that the policyholder may return the variable life insurance policy within 45 days of the date of the execution of the application or within 10 days of receipt of the policy by the policyholder, whichever is later, and receive a refund of all premium payments for such policy; and

(vi) such other items as are currently required for fixed benefit life insurance policies and which are not inconsistent with this Rule;

(vii) for all variable life insurance policies, which do not provide, while in force, a death benefit at least equal to the amount specified at issue or at the most recent policy change requested by the policyholder, must contain an endorsement or sticker, printed in contrasting type or color which contains sufficient cautionary languages such as: "THIS POLICY DOES NOT HAVE A MINIMUM GUARANTEED DEATH BENEFIT. THE DEATH BENEFIT IN THIS POLICY MAY BE LESS THAN OR MAY EXCEED THE PROJECTED BENEFITS REPRESENTED BY THE SOLICITING AGENT."

(b) A provision for a grace period of not less than 31 days from the premium due date which shall provide that where the premium is paid within the grace period, policy values will be the same, except for the deduction of any overdue premium, as if the premium were paid on or before the due date;

(c) A provision that the policy will be reinstated at any time within two years from the date of default upon the written application of the insured and evidence of insurability, including good health, satisfactory to the insurer, unless the cash surrender value has been paid or the period of extended insurance has expired, upon the payment of any outstanding indebtedness arising subsequent to the end of the grace period following the date of default together with accrued interest thereon to the date of reinstatement and payment of an amount not exceeding the greater of:

(i) all overdue premiums with interest at a rate not exceeding eight percent per annum compounded annually and any indebtedness in effect at the end of the grace period following the date of default with interest at a rate not exceeding eight percent per annum compounded annually; or

(ii) 110 percent of the increase in cash surrender value resulting from reinstatement plus all overdue premiums for incidental insurance benefits with interest at a rate not exceeding eight percent per annum compounded annually;

(d) A full description of the benefit base and of the method of calculation and application of any factors used to adjust variable benefits under the policy;

(e) A provision designating the separate account to be used and stating that:

(i) Such separate account shall be used to fund only variable life insurance benefits, except to the extent permitted by Sub-item (5)(c)(vi) of this Rule;

(ii) The assets of such separate account shall be available to cover the liabilities of the general account of the insurer only to the extent that the assets of the separate account exceed the liabilities of the separate account arising under the variable life insurance policies supported by the separate account; and

(iii) The assets of such separate account shall be valued at least as often as any policy benefits vary but at least monthly;

(f) A provision that at any time during the first 24 months of the variable life insurance policy, so long as premiums are duly paid, the owner may exchange the policy, or any requested increase in face amount, for a life insurance policy providing benefits that do not vary with the investment experience of a variable account. The owner shall be given the option to exchange the variable life insurance policy for a policy of permanent fixed benefit, fixed premium life insurance, or the option to exchange the variable life insurance policy for a policy of flexible benefit, flexible premium life insurance. The new policy shall be on a plan of insurance specified in the policy, provided that the new policy:

(i) shall bear the same date of issue and age at issue as the original variable life insurance policy;

(ii) is issued on a substantially comparable plan of life insurance offered in this state by the insurer or an affiliate on the date of issue of the variable life insurance policy and at the premium rates in effect on that date for the same class of insurance;

(iii) include such riders and incidental insurance benefits as were included in the original policy if such riders and incidental insurance benefits are issued with the new policy;

(iv) shall be issued subject to an equitable premium or cash value adjustment that takes appropriate account of the premiums and cash values under the original and new policies; A detailed statement of the method of computing such adjustment shall be filed with the commissioner;

(v) shall not require evidence of insurability for this exchange;

(g) A provision that the policy and any papers attached hereto by the insurer, including the application if attached, constitute the entire insurance contract;

(h) A designation of the officers of the insurer who are empowered to make an agreement or representation on behalf of the insurer and an indication that statements by the insured, or on his behalf, shall be considered as representation and not warranties;

(i) An identification of the owner of the insurance contract;

(j) A provision setting forth conditions or requirements as to the designation, or change of designation, of a beneficiary and a provision for disbursement of benefits in the absence of a beneficiary designation;

(k) A statement of any conditions or requirements concerning the assignment of the policy;

(l) A description of any adjustment in policy values to be made in the event of misstatement of age or sex of the insured;

(m) A provision that the policy shall be incontestable by the insurer after it has been in force for two years during the life time of the insured;

(n) A provision stating that the investment policy of the separate account shall not be changed without the approval of the insurance commissioner of the state of domicile of the insurer, and that the approval process is on file with the Commissioner of this state;

(o) A provision that payment of variable death benefits in excess of the minimum death benefits, cash values, policy loans, or partial withdrawals (except when used to pay premiums) or partial surrenders may be deferred:

(i) for up to six months from the date of request, if such payments are based on policy values which do not depend on the investment performance of the separate account; or

(ii) otherwise, for any period during which the New York Stock Exchange is closed for trading (except for normal holiday closing) or when the Securities and Exchange Commission has determined that a state of emergency exists which may make such payment impractical;

(p) A description of the basis for computing the cash surrender value under the policy shall be included; Such surrender value may be expressed as either:

(i) a schedule of cash value amounts per one thousand dollars ($1,000) of variable face amount at each attained age or policy year for at least 20 years from issue, or for the premium paying period, if less than 20 years; or

(ii) one cash value schedule as described in Sub-item (3)(p)(i) of this Rule for the death benefit, or for each one thousand dollars ($1,000) of death benefit, which would be in effect if the net investment return is always equal to the assumed investment rate and a second schedule applicable to any adjustments to the death benefit (disregarding the minimum death benefit guarantee and term insurance amounts) if the net investment return does not equal the assumed investment rate at each age for at least 20 years from issue, or for the premium paying period if it is less than 20 years;

(q) Premiums for incidental insurance benefits shall be stated separately;

(r) Any other policy provisions required by this Rule;

(s) Such other items as are currently required for fixed benefit life insurance policies and are not inconsistent with this Rule.

(4) Non-forfeiture, Partial Withdrawal, Policy Loan and Partial Surrender Provisions. Every variable life insurance policy delivered or issued for delivery in this state shall contain provisions which are not less favorable to the policyholders than the following:

(a) a provision for non-forfeiture insurance benefits so that at least one such benefit is offered on a fixed basis from the due date of the premium in default:

(i) Variable extended term insurance may not be offered;

(ii) A given non-forfeiture option need not be offered on both a fixed and a variable basis;

(iii) The insurer may establish a reasonable minimum cash surrender value below which any such non-forfeiture insurance options will not be available;

(b) a provision for policy loans (which may at the option of the insurer be entitled and referred to as a partial withdrawal provision) not less favorable to the policyholder than the following:

(i) Up to 75 percent but if the loan is made from the general account not more than 90 percent of the policy's cash value may be borrowed;

(ii) The amount borrowed, or any repayment thereof, shall not affect the amount of the premium payable under the policy;

(iii) The amount borrowed shall bear interest at a rate not to exceed eight percent per year compounded annually;

(iv) Any indebtedness shall be deducted from the proceeds payable on death;

(v) Any indebtedness shall be deducted from the cash value upon surrender or in determining any non-forfeiture benefit;

(vi) Whenever the indebtedness exceeds the cash value, the insurer shall give notice of intent to cancel the policy if the excess indebtedness is not repaid within 31 days after the date of mailing of such notice;

(vii) The policy may provide that if, at any time, so long as premiums are duly paid, the variable death benefit is less than it would have been if no loan or withdrawal had ever been made, the policy holder may increase such variable death benefit up to what it would have been if there had been no loan or withdrawal by paying an amount not exceeding 110 percent of the corresponding increase in cash value and by furnishing such evidence of insurability as the insurer may request;

(viii) The policy may specify a reasonable minimum amount which may be borrowed at any time but such minimum shall not apply to any automatic premium loan provision;

(ix) No policy loan provision is required if the policy is under the extended insurance non-forfeiture option;

(x) In addition to the foregoing, the policy may contain partial surrender provision; however, any such provision shall provide that the policyholder may request part of the cash value and both the variable and minimum death benefits will be reduced in proportion to the percentage of the cash value received by the policyholder and the premium for the remaining amount of insurance will also be reduced to the appropriate rates for the reduced amount of insurance. The policy may provide that a partial surrender provision shall not require the insurer to reduce the amount of the minimum death benefit to less than the lowest amount of minimum death benefit which would have been issued to the insured under the insurance plans of the insurer at the time the policy was issued. The policy must clearly provide that the policyholder has the option of electing to exercise the cash value privileges of the policy loan or partial withdrawal provision rather than the partial surrender provision;

(xi) All policy loan, partial withdrawal, or partial surrender provisions shall be constructed so that variable life insurance policyholders who have not exercised such provision are not disadvantaged by the exercise thereof;

(xii) Monies paid to the policyholders upon the exercise of any policy loan, partial withdrawal, or partial surrender provision shall be withdrawn from the separate account and shall be returned to the separate account upon repayment except that a stock insurer may provide the monies for policy loans from the general account.

(5) Other Policy Provisions. The following provisions may in substance be included in a variable life insurance policy or related form delivered or issued for delivery in this state:

(a) An exclusion for suicide within two years of the policy issue date;

(b) Incidental insurance benefits may be offered on a fixed basis only;

(c) Policies issued on a participating basis shall offer to pay dividend amounts in cash. In addition, such policies may offer the following dividend options.

(i) The amount of the dividend may be credited against premium payments;

(ii) The amount of the dividend may be applied to provide paid-up amounts of additional fixed benefit whole life insurance;

(iii) The amount of the dividend may be applied to provide paid-up amounts of additional variable life insurance;

(iv) The amount of the dividend may be deposited in the general account at a specified minimum rate of interest;

(v) The amount of the dividend may be applied to provide paid-up amounts of fixed benefit one-year term insurance;

(vi) The amount of the dividend may be deposited as a variable deposit in the separate account if the separate account is exempt pursuant to Section 3(c)(11) of the Investment Company Act of 1940;

(d) A provision allowing the policyholder to elect in writing in the application for the policy or thereafter an automatic premium loan on a basis not less favorable than that required of policy loans or partial withdrawals under Item (4) of this Rule except that a restriction that no more than two consecutive premiums can be paid under this provision may be imposed.

History

  • Authority G.S. 58-2-40; 58-7-95
  • Eff. January 1, 1978
  • Readopted Eff. September 26, 1978
  • Amended Eff. February 1, 1996; September 1, 1994; April 1, 1989
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0437 Reserve Liabilities for Variable Life Insurance {#sec-11-ncac-12-.0437 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0437}

(a) Reserve liabilities for variable life insurance policies shall be established pursuant to G.S. 58-58-50 accordance with actuarial procedures that recognize the variable nature of the benefits provided and any mortality guarantees.

(b) Reserve liabilities for the guaranteed minimum death benefit shall be the reserve needed to provide for the contingency of death occurring when the guaranteed minimum death benefit exceeds the death benefit that would be paid in the absence of the guarantee, and shall be maintained in the general account of the insurer and shall be not less than the greater of the following minimum reserves:

(1) The aggregate total of the term costs, if any, covering a period of one full year from the valuation date, of the guarantee on each variable life insurance contract, assuming an immediate one-third depreciation in the current value of the assets of the separate account followed by a net investment return equal to the assumed investment rate; or

(2) The aggregate total of the "attained age level" reserves on each variable life insurance contract. The "attained age level" reserve on each variable life insurance contract shall not be less than zero and shall equal the "residue," as described in (A) of this Subsection of the prior year's "attained age level" reserve on the contract, with any such "residue" increased or decreased by a payment computed on an attained age basis as described in (B) of this Subsection:

(A) The residue of the prior year's "attained age level" reserve on each variable life insurance contract shall not be less than zero and shall be determined by adding interest at the valuation interest rate to such prior year's reserve, deducting the tabular claims based on the "excess," if any, of the guaranteed minimum death benefit over the death benefit that would be payable in the absence of such guarantee, and dividing the net result by the tabular probability of survival. The "excess" referred to in the preceding sentence shall be based on the actual level of death benefits that would have been in effect during the preceding year in the absence of the guarantee, taking appropriate account of the reserve assumptions regarding the distribution of death claim payments over the year.

(B) The payment referred to in this Subsection (b)(2) shall be computed so that the present value of a level payment of that amount each year over the future premium paying period of the contract is equal to "A" minus "B" minus "C" where "A" is the present value of the future guaranteed minimum death benefits, "B" is present value of the future death benefits that would be payable in the absence of such guarantee, and "C" is any "residue," as described in (A) of this Subsection of the prior year's "attained age level" reserve on such variable life insurance contract. If the contract is paid-up, the payment shall equal "A" minus "B" minus "C". The amounts of future death benefits referred to in "B" shall be computed assuming a net investment return of the separate account which may differ from the assumed investment rate and/or the valuation interest rate but in no event may exceed the maximum interest rate permitted for the valuation of life insurance contracts;

(3) The valuation interest rate and mortality table used in computing the two minimum reserves described in (1) and (2) of this Subsection shall conform to permissible standards for the valuation of life insurance contracts. In determining such minimum reserve, the company may employ suitable approximations and estimates, including but not limited to groupings and averages.

(c) Reserve liabilities for all fixed incidental insurance benefits shall be maintained in the general account in amounts determined in accordance with the actuarial procedures appropriate to such benefit.

History

  • Authority G.S. 58-2-40(1); 58-7-95
  • Eff. January 1, 1978
  • Readopted Eff. September 26, 1978
  • Amended Eff. April 8, 2002
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0438 Separate Accounts {#sec-11-ncac-12-.0438 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0438}

The following requirements apply to the establishment and administration of variable life insurance separate accounts:

(1) Establishment and Administration of Separate Accounts. An insurer issuing variable life insurance in this state shall establish one or more separate accounts pursuant to G.S. 58-7-95 of the insurance laws of this state:

(a) If no law or other regulation provides for the custody of separate account assets and if the insurer itself is not the custodian of such assets, all contracts for such custody shall be in writing and the commissioner of the insurer's state of domicile shall approve of both the terms of any such contract and the proposed custodian prior to the transfer of custody.

(b) An insurer shall not without the prior written approval of the commissioner employ in any material connection with the handling of separate account assets any person who:

(i) within the last 10 years has been convicted of any felony or a misdemeanor arising out of such person's conduct involving embezzlement, fraudulent conversion, or misappropriation of funds or securities or involving violation of Sections 1341 to 1343 of Title 18, United States Code; or

(ii) within the last 10 years has been found by any state regulatory authority to have violated or has acknowledged violation of any provision of any state insurance law involving fraud, deceit, or knowing misrepresentation; or

(iii) within the last 10 years has been found by federal or state regulatory authorities to have violated or has acknowledged violation of any provision of federal or state securities laws involving fraud, deceit, or knowing misrepresentation.

(c) All persons with access to the cash, securities, or other assets of the separate account shall be under good and sufficient bond.

(d) If an insurer establishes more than one separate account for variable life insurance, justification for the establishment of each additional separate account shall also be filed with the commissioner and shall be subject to his approval.

(e) The assets of such separate accounts established for variable life insurance policies shall be valued at least as often as variable benefits are determined but in any event at least monthly.

(f) A separate account exempt pursuant to Section 3(c)(11) of the Investment Company Act of 1940 because of the tax qualified status of the policies funded thereby shall not be used to fund other variable life insurance policies.

(g) Except for separate accounts exempt pursuant to Section 3(c)(11) of the Investment Company Act of 1940, variable life insurance separate accounts shall not be used for variable annuities or for the investment of funds corresponding to dividend accumulations or other policyholder liabilities not involving life contingencies.

(2) Amounts in the Separate Account

(a) The insurer shall maintain in each variable life insurance separate account assets with a fair market value at least equal to the greater of the valuation reserves for the variable portion of the variable life insurance policies or the benefit base for such policies.

(b) The benefit base of any variable life insurance policy as of the beginning of any valuation period shall not be less than the sum of the following factors after deducting amounts of any indebtedness pursuant to .0436(4)(b) of this Section:

(i) the valuation net premium for such period for the variable portion of the policy minus the discounted cost of term insurance for such period, based on the tabular mortality and interest rates used in determining valuation reserves; and

(ii) the valuation terminal reserve, for the variable portion of the policy, at the end of the immediately preceding valuation period adjusted for the net investment return of such preceding period.

(c) In lieu of the minimum benefit base requirement specified in (2)(b) of this Rule, an insurer may otherwise qualify if it can be demonstrated, to the satisfaction of the commissioner, that the policy benefits obtained over a 20-year period from the date of issue by the use of the insurer's benefit base are at least substantially equivalent in value to the benefits obtained by the use of the minimum benefit base. The commissioner may specify the range of net investment return to be used in this demonstration.

(d) Notwithstanding the actual reserve basis used for policies that do not meet standard underwriting requirements, the benefit base for such policies may be the same as for corresponding policies which do meet standard underwriting requirements.

(3) Investments by the Separate Account

(a) No sale, exchange, or other transfer of assets may be made by an insurer or any of its affiliates between any other investment account and one or more of its separate accounts unless:

(i) in case of a transfer into a separate account, such transfer is made solely to establish the account or to support the operation of the policies with respect to the separate account to which the transfer is made; and

(ii) such transfer, whether into or from a separate account, is made by a transfer of cash; but other assets may be transferred if approved by the commissioner in advance.

(b) Assets allocated to a variable life insurance separate account shall be held in cash or investments having a reasonably ascertainable market price. For purposes of this Rule, only the following shall be considered "investments having a reasonable ascertainable market price":

(i) liens in favor of the insurer against separate account policy reserves resulting from use by policyholders of cash values;

(ii) securities listed and traded on the New York Stock Exchange, the American Stock Exchange, or regional stock exchanges or successors to such exchanges having the same or similar qualifications;

(iii) securities listed on the NASDAQ System;

(iv) shares of an investment company registered pursuant to the Investment Company Act of 1940; Where such an investment company issues book shares in lieu of share certificates, such book shares shall be deemed to be adequate evidence of ownership;

(v) obligations of or guaranteed by the United States government, the Canadian government, any state, or municipality or governmental subdivision of a state;

(vi) commercial paper issued by business corporations when the total of such paper issued by the corporation does not exceed in value a guaranteed short line of credit by a bank;

(vii) certificates of deposit issued by financial institutions the deposits of which are insured by the FDIC or FSLIC; and

(viii) new bond or debt issued which may reasonably be expected to be listed on an exchange regulated by the Securities Exchange Act of 1934.

(c) Notwithstanding any other provision of law or the provisions of (b) of this Subsection, assets allocated to a variable life insurance separate account shall not be invested in:

(i) commodities or commodity contracts;

(ii) put and call options or combinations of such options;

(iii) short sales;

(iv) purchases on margins;

(v) letter or restrict stock;

(vi) units or other evidences of ownership of a separate account of another, except those registered under the Investment Company Act of 1940; or

(vii) real estate other than shares of a real estate investment trust listed as described in (b)(ii) of this Subsection.

(4) Limitations on Ownership

(a) A variable life insurance separate account shall not purchase or otherwise acquire the securities of any issuer, other than securities issued or guaranteed as to principal and interest by the United States, if immediately after such purchase or acquisition the value of such investment, together with prior investments of such separate account in such security valued as required by these regulations, would exceed 10 percent of the value of the assets of the separate account. The commissioner may waive this limitation in writing if he believes such waiver will not render the operation of the separate account hazardous to the public or the policyholders in this state.

(b) No separate account shall purchase or otherwise acquire the voting securities of any issuer and its separate accounts, in the aggregate, will own more than 10 percent of the total issued and outstanding voting securities of such issuer. The commissioner may waive this limitation in writing if he believes such waiver will not render the operation of the separate account hazardous to the public or the policyholders in this state or jeopardize the independent operation of the issuer of such securities.

(c) The percentage limitation specified in (a) of this Subsection shall not be construed to preclude the investment of the assets of separate accounts in shares of investment companies registered pursuant to the Investment Company Act of 1940 if the investments and investment policies of such investment companies comply substantially with provisions of (3) of this Rule and other applicable portions of this Regulation.

(5) Valuation of Assets of a Variable Life Insurance Separate Account

(a) Investments of the separate account shall be valued at their market value on the date of valuation:

(i) Market value for investments traded on the recognized exchanges means the last reported sale price on the date of valuation. If there has been no sale on that date, the market value means the last reported bid quotation on the date of valuation.

(ii) Market value for investments listed on the NASDAQ System means the last representative bid quotation on the valuation date. If an investment ceases to be listed but continues to be traded over the counter, it shall be valued at the lowest bid quotation as it appears on the National Quotation Bureau sheets.

(iii) If the valuation date referred to in (i) and (ii) of this Subsection is a day when the exchange or the NASDAQ System is not open for business, the valuation date shall be the last date when the exchange of the NASDAQ System was open for business.

(b) If an investment ceases to be traded, it shall be valued at fair value as determined in good faith by or at the direction of the committee of the separate account, or, if there is no such committee, the Board of directors of the insurer but not in excess of the last reported bid quotation. Within 30 days notification of cessation of trading of any investment shall be reported by the insurer to the insurance commissioner of the state of domicile of the insurer. Such commissioner shall within a reasonable period of time determine the method of valuation or disposition of such investment.

(6) Separate Account Investment Policy

(a) The investment policy of a separate account operated by a domestic insurer filed under .0435(2)(e) of this Section shall not be changed without the approval of the insurance commissioner and any approval of variable life insurance policyholders that may be required under the Investment Company Act of 1940.

(b) With respect to changes of investment policy for which the commissioner must give his approval, the following regulations shall apply:

(i) Such approval shall be deemed to be given 60 days after the date the request for approval was filed with the commissioner, unless he notifies the insurer before the end of such 60 day period of his determination that the proposed change is a material change in the investment policy.

(ii) If the change is deemed material by the commissioner, he shall approve such change only if he determines that the change does not appear detrimental to the interest of the policyholders of the insurer or adverse to the operations of the insurer.

(iii) If a proposed change of investment policy is deemed material by the commissioner, any policyholder objecting to such change shall be given the right to request that, within 60 days of the effective date of the change, his policy be converted without evidence of insurability, under one of the following options, to a fixed benefit life insurance policy issued by the insurer or an affiliate:

(A) If the policy is in force on a premium paying basis, either:

(I) conversion as of the original issue age to a substantially comparable permanent form of fixed benefit life insurance, based on the insurer's premium rates for fixed benefit life insurance at the original issue age, for an amount of insurance not exceeding the death benefit of the variable life insurance policy on the date of conversion; or

(II) conversion as of the attained age to a substantially comparable permanent form of fixed benefit life insurance for an amount of insurance not exceeding the excess of the death benefit of the variable life insurance policy on the date of conversion over its cash value on the date of conversion if the policyholder elects to surrender the variable life policy for its cash value, or the death benefit payable under any paid-up insurance option if the policyholder elects such nonforfeiture option under the variable life policy.

(B) If the policy is in force as paid-up variable life insurance, then conversion will be to a substantially comparable paid-up fixed benefit life insurance policy for an amount of insurance not exceeding the death benefit of the variable life insurance policy on the date of conversion. If conversion is made pursuant to (A)(I) or (II) of this Subsection, then there will be an equitable premium or cash value adjustment that takes appropriate account of the premiums and cash values under the original and new policies. A detailed statement of the method of computing such adjustment shall be filed with the commissioner.

(7) Charges Against a Variable Life Insurance Separate Account

(a) The insurer may deduct only the following from the separate account:

(i) taxes or reserves for taxes attributable to investment gains and income of the separate account;

(ii) actual cost of reasonable brokerage fees and similar direct acquisition and sales costs incurred in the purchase or sale of separate account assets;

(iii) actuarially determined costs of insurance (tabular costs) and the release of reserves and benefit base consistent with the release of separate account liabilities;

(iv) charges for investment management expenses, including internal costs attributable to the investment management of assets of the separate account at a rate not in excess of that stated in the policy;

(v) charges for mortality and expense guarantees at a rate not in excess of that stated in the policy;

(vi) any amounts in excess of those required to be held in the separate account.

(b) Any charges against the separate account made by either an affiliate of the insurer or an unaffiliated fund shall be considered part of the charges limited by (a)(iv) and (v) of this Subsection. Any charge against the separate account, excluding taxes, shall not vary in accordance with the difference between the investment performance of the separate account and any index of securities prices or other measure of investment performance.

(8) Standards of Conduct. Every insurer seeking approval to enter into the variable life insurance business in this state shall adopt by formal action of its board of directors and file with the commissioner a written statement specifying the standards of conduct of the insurer, its officers, directors, employees, and affiliates with respect to investments of variable life insurance separate accounts and variable life insurance operations. Such standards of conduct shall be binding on the insurer and those to whom it refers.

(9) Conflicts of Interest

(a) Rules under any provision of the insurance laws of this state or any regulation applicable to the officers and directors of insurance companies with respect to conflicts of interest shall also apply to members of any separate account's committee or other similar body. No officer or director of such company nor any member of any managing committee or body of a separate account shall receive directly or indirectly any commission or any other compensation with respect to the purchase or sale of assets of such separate account.

(b) No provision of this Regulation shall be construed to prohibit:

(i) the investment of separate account assets in securities issued by one or more investment companies registered pursuant to the Investment Company Act of 1940 which is sponsored or managed by the insurer or an affiliate, and the payment of investment management or advisory fees on such assets;

(ii) an insurer or an affiliate to act as a broker or dealer in connection with the sale of securities to or by such separate account;

(iii) the rendering of investment management or investment advisory services by an insurer or affiliate, for a fee, subject to the provisions of this Regulation.

(10) Investment Advisory Services to a Separate Account

(a) An insurer shall not enter into a contract under which any person undertakes, for a fee, to regularly furnish investment advice to such insurer with respect to any of its separate accounts maintained for variable life insurance policies unless:

(i) the person providing such advice is registered as an investment adviser under the Investment Advisers Act of 1940; or

(ii) the person providing such advice is an investment manager under the Employee Retirement Income Security Act of 1974 with respect to the assets of each employee benefit plan allocated to the separate account; or

(iii) the insurer has filed with the commissioner and continues to file annually the following information and statements concerning the proposed adviser:

(A) the name and form of organization, state of organization, and its principal place of business;

(B) the names and addresses of its partners, officers, directors, and persons performing similar functions or, if such an investment adviser by an individual, of such individual;

(C) a written standard of conduct complying in substance with the requirements of (9) of this Rule which has been adopted by the investment adviser and is applicable to the investment adviser, its officers, directors, and affiliates;

(D) a statement provided by the proposed adviser as to whether the adviser or any person associated therewith:

(I) has been convicted within 10 years of any felony or misdemeanor arising out of such person's conduct as an employee, salesman, officer or director of an insurance company, a bank, an insurance agent, a securities broker or an investment adviser; involving embezzlement, fraudulent conversion, or misappropriation of funds or securities, or involving the violation of Sections 1341, 1342, or 1343 or Title 18 of the United States Code;

(II) has been permanently or temporarily enjoined by order, judgment, or decree of any court of competent jurisdiction from acting as an investment adviser, underwriter, broker, or dealer, or as an affiliated person or as an employee of any investment company, bank, or insurance company, or from engaging in or continuing any conduct or practice in connection with any such activity;

(III) has been found by federal or state regulatory authorities to have willfully violated or has acknowledged willful violation of any provision of federal or state securities laws or state insurance laws or of any such laws; or

(IV) has been censured, denied an investment adviser registration, had a registration as an investment adviser revoked or suspended, or been barred or suspended from being associated with an investment adviser by order of federal or state regulatory authorities.

(b) The commissioner may, after notice and opportunity for hearing, by order require such investment advisory contract to be terminated if he deems continued operation thereunder to be hazardous to the public or the insurer's policyholders.

History

  • Authority G.S. 58-2-40(1); 58-7-95
  • Eff. January 1, 1978
  • Readopted Eff. September 26, 1978
  • Amended Eff. April 8, 2002
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0439 Information Furnished to Applicants {#sec-11-ncac-12-.0439 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0439}

An insurer delivering or issuing for delivery in this state any variable life insurance policies shall deliver to the applicant for the policy, and obtain a written acknowledgment of receipt from such applicant coincident with or prior to the execution of the application, a prospectus included in a registration statement relating to the policies which satisfied the requirements of the Securities Act of 1933 and which was declared effective by the Securities and Exchange Commission, or if the policies are exempted from the registration requirements of such act by section 3(a)(2) thereof, the insurer shall furnish all information and reports required by the Employee Retirement Income Security Act of 1974.

History

  • Authority G.S. 58-2-40(1); 58-7-95
  • Eff. January 1, 1978
  • Readopted Eff. September 26, 1978
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0440 Applications {#sec-11-ncac-12-.0440 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0440}

The application for a variable life insurance policy shall contain:

(1) a prominent statement that the death benefit may be variable or fixed under specified conditions;

(2) a prominent statement that cash values may increase or decrease in accordance with the experience of the separate account (subject to any specified minimum guarantees);

(3) questions designed to elicit information which enables the insurer to determine the suitability of variable life insurance for the applicant.

History

  • Authority G.S. 58-2-40(1); 58-7-95
  • Eff. January 1, 1978
  • Readopted Eff. September 26, 1978
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0441 Reports to Policyholders {#sec-11-ncac-12-.0441 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0441}

Any insurer delivering or issuing for delivery in this state any variable life insurance policies shall mail to each variable life insurance policyholder at his or her last known address the following reports:

(1) within 30 days after each anniversary of the policy, a statement or statements of the cash surrender value, death benefit, any partial withdrawal or policy loan, any interest charge, and any optional payments allowed pursuant to .0436(4) of this Section under the policy computed as of the policy anniversary date; provided, however, that such statement may be furnished within 30 days after a specified date in each policy year so long as the information contained therein is computed as of a date not more than 45 days prior to the mailing of such notice; This statement shall state in contrasting color or distinctive type that, in accordance with the investment experience of the separate account, the cash values and the variable death benefit may increase or decrease, and shall prominently identify any value described therein which may be recomputed prior to the next statement required by this Rule. If the policy guarantees that the variable death benefit on the next policy anniversary date will not be less than the variable death benefit specified in such statement, the statement shall be modified to so indicate;

(2) annually, if not already required by the Securities and Exchange Commission, a statement or statements including:

(a) a summary of the financial statement of the separate account based on the annual statement last filed with the commissioner;

(b) the net investment return of the separate account for the last year and, for each year after the first, a comparison of the investment rate of the separate account during the last year with the investment rate during prior years, up to a total of five years where available;

(c) a list of investments held by the separate account as of a date not earlier than the end of the last year for which an annual statement was filed with the commissioner;

(d) any charges, taxes, and brokerage fees determined on an accrual basis payable by the separate account during the previous year, each expressed as a dollar amount and a percentage and the total expressed as a dollar amount and as a percentage of the assets of the separate account;

(e) a statement of the portfolio turnover rate as defined herein during the preceding fiscal year of investments allocated to the separate account:

(i) The rate shall be calculated by dividing "A," the lesser of purchases or sales of portfolio securities for the particular fiscal year, by "B," the monthly average of the value of the portfolio securities owned by the separate account during the particular fiscal year. Such monthly average shall be calculated by totaling the values of the portfolio securities as of the beginning and end of the first month of the particular fiscal year and as the end of each of the succeeding 11 months, and dividing the sum by 13, except that the average value of securities for which market quotations are not available may be based upon the value of such securities as of the end of the preceding fiscal quarters.

(ii) For the purposes of this Rule, there shall be excluded from both the numerator and the denominator all U.S. Government securities (short-term and long-term) and all other securities whose maturities at the time of acquisition were one year or less. Purchases shall also include any cash paid upon the conversion of one portfolio security into another. Purchases shall also include the cost of rights or warrants purchased. Sales shall include the net proceeds of the sale of rights or warrants. Sales shall also include the net proceeds of redemptions of portfolio securities by call or maturity.

(iii) The insurer shall show, in addition to the calculated portfolio turnover rate, both the amount of the purchases and the amount of the sales [calculated as prescribed in (2)(e)(ii) of this Rule] and the monthly average (but not the individual monthly figures) of the value of the portfolio securities owned by the separate account during the fiscal year.

(iv) The insurer may, if it wishes, make any statement or explanation with respect to any significant variations in the portfolio turnover rate during the three fiscal years next preceding.

(f) a statement of any change, since the last report, in the investment objective and orientation of the separate account, in any investment restriction or material quantitative or qualitative investment requirement applicable to the separate account, or in the investment adviser or the separate account;

(g) the name of each broker or dealer handling portfolio transactions on behalf of the separate account in which the insurer or an affiliate has any material direct or indirect interest and the nature of such transactions and the amount of compensation received by each such broker or dealer from business originating with the separate account during the preceding fiscal year;

(h) the names and principal occupations of each principal executive officer and each director of the insurer; and

(i) the names of all parents of the insurer and the basis of control of the insurer, and the name of any person who is known to own, of record or beneficially, 10 percent or more of the outstanding voting securities of the company

(3) monthly, a report which describes the value of the insured's death benefits to policyholders whose policies, while in force do not provide a death benefit at least equal to the amount specified at issue or at the most recent policy change requested by the policyholder.

History

  • Authority G.S. 58-2-40(1); 58-7-95
  • Eff. January 1, 1978
  • Readopted Eff. September 26, 1978
  • Amended Eff. April 1, 1989
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0442 Foreign Companies {#sec-11-ncac-12-.0442 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0442}

If the law or regulation in the place of domicile of a foreign company provides a degree of protection to the policyholders and the public which is substantially equal to that provided by these regulations, the commissioner, to the extent deemed appropriate by him in his discretion may consider compliance with such law or regulation as compliance with the regulations.

History

  • Authority G.S. 58-2-40(1); 58-7-95
  • Eff. January 1, 1978
  • Readopted Eff. September 26, 1978
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0443 Qualification: for the Sale of Variable Life Insurance {#sec-11-ncac-12-.0443 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0443}

(a) Qualifications to Sell Variable Life Insurance

(1) No person may sell or offer for sale in this state any variable life insurance policy unless such person is an agent and has filed with the commissioner, in a form satisfactory to the commissioner, evidence that such person holds any license or authorization which may be required for the solicitation or sale of variable life insurance by any federal or state securities law.

(2) Any examination administered by the department for the purpose of determining the eligibility of any person for licensing as an agent shall, after the effective date of this Regulation, include such questions concerning the history, purpose, regulation, and sale of variable life insurance as the commissioner deems appropriate.

(b) Reports of Disciplinary Actions. Any person qualified in this state under this article to sell or offer to sell variable life insurance shall immediately report to the commissioner:

(1) any suspension or revocation of his agent's license in any other state or territory of the United States;

(2) the imposition of any disciplinary sanction, including suspension or expulsion from membership, suspension, or revocation of or denial of registration, imposed upon him by any national securities exchange, or national securities association, or any federal, state, or territorial agency with jurisdiction over securities or variable life insurance;

(3) any judgment or injunction entered against him on the basis of conduct deemed to have involved fraud, deceit, misrepresentation, or violation of any insurance or securities law or regulation.

(c) Refusal to Qualify Agent to Sell Variable Life Insurance; Suspension, Revocation, or Nonrenewal of Qualification. The commissioner may reject any application or suspend or revoke or refuse to renew any agent's qualification to sell or offer to sell variable life insurance upon any ground that would bar such applicant or such agent from being licensed to sell other life insurance contracts in this state. The rules governing any proceeding relating to the suspension or revocation or an agent's license shall also govern any proceeding for suspension or revocation of an agent's qualification to sell or offer to sell variable life insurance.

History

  • Authority G.S. 58-2-40(1); 58-7-95
  • Eff. January 1, 1978
  • Readopted Eff. September 26, 1978
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0444 Separability Article {#sec-11-ncac-12-.0444 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0444}

History

  • Status: repealed
  • Authority G.S. 58-9(1); 58-79.2
  • Eff. January 1, 1978
  • Readopted Eff. September 26, 1978
  • Repealed Eff. July 1, 1988.
11 NCAC 12 .0445 Interest Charges on Misstatement of Age or Sex {#sec-11-ncac-12-.0445 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0445}

Interests on overpayments made by an insurer because of misstatement of age or sex shall not be charged unless an equal rate of interest is paid by the insurer for under payments.

History

  • Authority G.S. 58-2-40; 58-58-1
  • Eff. September 26, 1978
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0446 Sound Health {#sec-11-ncac-12-.0446 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0446}

No policy of life insurance shall contain a provision that the policy will be voided if the insured is not in sound or good health on the effective date of the policy, or date of reinstatement unless such provision contains the following:

(1) The burden of proof as to whether the condition was material lies solely with the insurer;

(2) If voided, there will be a full refund of premium;

(3) Reference to such condition was not contained in the written application.

History

  • Authority G.S. 58-2-40; 58-58-1
  • Eff. September 26, 1978
  • Amended Eff. April 1, 1989
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0447 Free Look Provision {#sec-11-ncac-12-.0447 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0447}

(a) An insurer, prior to the time that any individual life insurance or annuity policy is issued for delivery or delivered, shall ensure that a "Ten Day Free Look" provision is displayed by sticker or printed on the face of each life insurance or annuity policy.

(b) The free look provision required by this Rule shall afford the policyholder a period of time, following receipt of the policy, during which the policy may be returned to the company for a prompt refund of the premium paid. This Rule also applies to any group life insurance or annuity policy or certificate that contains a free look provision.

History

  • Authority G.S. 58-2-40; 58-58-1
  • Eff. September 26, 1978
  • Amended Eff. August 1, 2004; February 1, 1992; April 1, 1989; July 1, 1982
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0448 Waiting Periods on Life Insurance Riders {#sec-11-ncac-12-.0448 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0448}

On all life insurance riders providing additional benefits, attached subsequent to the date of the policy, a sticker shall be attached in a prominent place on the rider stating, when appropriate, substantially the following: "PLEASE READ THIS RIDER CAREFULLY".

THE WAITING PERIODS IN THE SUICIDE AND/OR INCONTESTABILITY PROVISIONS ARE DIFFERENT FROM THOSE IN THE POLICY AND BEGIN ON THE EFFECTIVE DATE OF THE RIDER.

History

  • Authority G.S. 58-2-40; 58-58-1
  • Eff. September 26, 1978
  • Amended Eff. February 1, 1992
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0449 Limited Initial Death Benefit {#sec-11-ncac-12-.0449 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0449}

No policy or certificate of life insurance which provides a limited death benefit for a stated initial period shall be issued except on a guaranteed issue basis. Such policy shall have printed on the face in bold type Graded Death Benefit.

History

  • Authority G.S. 58-2-40; 58-3-150; 58-58-1
  • Eff. September 26, 1978
  • Amended Eff. February 1, 1996; July 1, 1986
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0450 Requirement for Modified Premium Life Insurance {#sec-11-ncac-12-.0450 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0450}

The application for a modified premium life insurance policy which has a higher first year premium shall contain an acknowledgment, signed by the applicant, stating that he understands:

(1) He is paying a higher first year premium; and

(2) If he discontinues the coverage, the only benefits available to him are those set forth in the non-forfeiture provision, regardless of the money paid in.

History

  • Authority G.S. 58-2-40; 58-58-1
  • Eff. September 26, 1978
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0451 Policy Loan Interest Rates {#sec-11-ncac-12-.0451 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0451}

History

  • Status: repealed
  • Authority G.S. 58-9; 58-195
  • Eff. September 26, 1978
  • Repealed Eff. July 1, 1988.
11 NCAC 12 .0452 Life Insurance Solicitation: General {#sec-11-ncac-12-.0452 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0452}

History

  • Status: repealed
  • Authority G.S. 58-9; 58-25.1; 58-26; 58-33; 58-42; 58-42.1; 58-54.4; 58-195; 58-198
  • 58-199
  • Eff. April 26, 1979
  • Repealed Eff. June 16, 1979.
11 NCAC 12 .0453 Life Insurance Solicitation: Definitions {#sec-11-ncac-12-.0453 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0453}

History

  • Status: repealed
  • Authority G.S. 58-9; 58-25.1; 58-26; 58-33; 58-42; 58-42.1; 58-54.4; 58-195; 58-198
  • 58-199
  • Eff. April 26, 1979
  • Repealed Eff. June 16, 1979.
11 NCAC 12 .0454 Life Insurance Solicitation: Disclosure {#sec-11-ncac-12-.0454 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0454}

History

  • Status: repealed
  • Authority G.S. 58-9; 58-25.1; 58-26; 58-33; 58-42; 58-42.1; 58-54.4; 58-195; 58-198
  • 58-199
  • Eff. April 26, 1979
  • Repealed Eff. June 16, 1979.
11 NCAC 12 .0455 Life Insurance Solicitation: General Rules {#sec-11-ncac-12-.0455 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0455}

History

  • Status: repealed
  • Authority G.S. 58-9; 58-25.1; 58-26; 58-33; 58-42; 58-42.1; 58-54.4; 58-195; 58-198
  • 58-199
  • Eff. April 26, 1979
  • Repealed Eff. June 16, 1979.
11 NCAC 12 .0456 Life Insurance Solicitation: Other {#sec-11-ncac-12-.0456 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0456}

History

  • Status: repealed
  • Authority G.S. 58-9; 58-25.1; 58-26; 58-33; 58-42; 58-42.1; 58-54.4; 58-195; 58-198
  • 58-199
  • Eff. April 26, 1979
  • Repealed Eff. June 16, 1979.
11 NCAC 12 .0457 Credit Insurance: Automobile Leases {#sec-11-ncac-12-.0457 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0457}

History

  • Status: repealed
  • Authority G.S. 58-9
  • Eff. July 1, 1986
  • Repealed Eff. April 1, 1989.
11 NCAC 12 .0458 Reserved for Future Codification {#sec-11-ncac-12-.0458 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0458}
11 NCAC 12 .0459 Reserved for Future Codification {#sec-11-ncac-12-.0459 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0459}
11 NCAC 12 .0460 Prearrangement Insurance Disclosure {#sec-11-ncac-12-.0460 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0460}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-58-1; 58-60-35
  • Eff. February 1, 1992
  • Repealed Eff. February 1, 1996.
11 NCAC 12 .0461 Use of Senior-Specific Certifications and Professional Designations {#sec-11-ncac-12-.0461 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0461}

(a) This Rule applies to the solicitation, sale, or purchase of, or advice made in connection with the solicitation, sale or purchase of a life insurance or annuity product.

(b) The NAIC Model Regulation on the Use of Senior-Specific Certifications and Professional Designations ("Model Regulation"), as adopted by the National Association of Insurance Commissioners at the Fall National Meeting of 2008, including subsequent amendments and editions, is hereby incorporated by reference. Copies of the Model Regulation are available free of charge from the Life and Health Division by email at l&hinbox@ncdoi.gov or the Department of Insurance Website at www.ncdoi.com.

(c) As used in the Model Regulation, "reference to State unfair trade practices act" means Article 63 of Chapter 58 of the General Statutes and "insert reference to enabling legislation" means G.S. 58-63-75.

History

  • Authority G.S. 58-2-40; 58-63-75
  • Eff. February 1, 2010
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0462 Suitability in Annuity Transactions {#sec-11-ncac-12-.0462 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0462}

(a) The NAIC Suitability in Annuity Transactions Model Regulation (#275) ("NAIC Model Regulation #275"), as adopted by the National Association of Insurance Commissioners at the Spring National Meeting of 2020, including subsequent amendments and editions, is hereby incorporated by reference. Copies of the Model Regulation are available free of charge from the Life and Health Division by email at l&hinbox@ncdoi.gov, the Department of Insurance website at www.ncdoi.com, or the NAIC Model Law website at https://content.naic.org/model-laws.

(b) As used in NAIC Model Regulation #275, "insert reference to enabling legislation" means S.L. 2017-136.

History

  • Authority G.S. 58-2-40; S.L. 2017-136
  • Eff. January 1, 2023.
11 NCAC 12 .0501 Accident and Health: General Nature {#sec-11-ncac-12-.0501 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0501}

History

  • Status: repealed
  • Authority G.S. 57-4; 57-7; 58-9
  • Eff. February 1, 1976
  • Readopted Eff. September 26, 1978
  • Repealed Eff. July 1, 1988.
11 NCAC 12 .0502 Rate Increases for Individual and Blanket Policies {#sec-11-ncac-12-.0502 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0502}

History

  • Status: repealed
  • Authority G.S. 58-251.2
  • Eff. February 1, 1976
  • Readopted Eff. September 26, 1978
  • Repealed Eff. April 1, 1989.
11 NCAC 12 .0503 Waiting Period {#sec-11-ncac-12-.0503 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0503}

(a) If a sickness or disease first manifests itself during the waiting period, it must be covered at the end of said waiting period.

(b) If the company can prove that the condition existed prior to the effective date of coverage, the company will not be required to pay benefits until the end of the time period prescribed in part b of "Time Limit on Certain Defenses."

(c) If the policy is issued to an individual over age 65, any condition not specifically excluded must be covered at the end of the waiting period.

History

  • Authority G.S. 58-2-40; 58-51-1; 58-51-60; 58-65-1; 58-65-40
  • Eff. February 1, 1976
  • Readopted Eff. September 26, 1978
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0504 Approval of Filing: 90 Day Deemer Not in Effect {#sec-11-ncac-12-.0504 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0504}

History

  • Status: repealed
  • Authority G.S. 58-254.7; 58-370(a)
  • Eff. February 1, 1976
  • Readopted Eff. September 26, 1978
  • Amended Eff. April 1, 1989
  • Repealed Eff. February 1, 1992.
11 NCAC 12 .0505 Mail Order Application: Accident and Health {#sec-11-ncac-12-.0505 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0505}

History

  • Status: repealed
  • Authority G.S. 58-257
  • Eff. February 1, 1976
  • Readopted Eff. September 26, 1978
  • Repealed Eff. July 1, 1986.
11 NCAC 12 .0506 Mass Marketing Application {#sec-11-ncac-12-.0506 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0506}

Applications used in the solicitation for accident and health insurance on a mass marketing basis may not require information on pre-existing conditions dating back further than five years prior to the date of the application.

History

  • Authority G.S. 58-2-40(1)
  • Eff. February 1, 1976
  • Readopted Eff. September 26, 1978
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0507 Fraternal Orders: Societies and Associations {#sec-11-ncac-12-.0507 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0507}

History

  • Status: repealed
  • Authority G.S. 58-9(1)
  • Eff. February 1, 1976
  • Readopted Eff. September 26, 1978
  • Repealed Eff. March 1, 1992.
11 NCAC 12 .0508 Accident and Health Travel: Newspaper Subscriptions {#sec-11-ncac-12-.0508 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0508}

Travel insurance procured in connection with newspaper subscriptions must comply with the following procedures:

(1) All advertising matters shall be published over the name of the regularly licensed agent.

(2) The policies shall be offered to all readers of the newspaper and not restricted to subscribers only and a subscription to the paper shall not be a prerequisite to obtaining these policies.

History

  • Authority G.S. 58-2-40(1); 58-51-1
  • Eff. February 1, 1976
  • Readopted Eff. September 26, 1978
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0509 Accident and Health Insurance: Natural Death Benefit {#sec-11-ncac-12-.0509 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0509}

No policy of accident and health insurance may be issued in North Carolina which contains a provision wherein the company promises to pay a funeral benefit, a fatal sickness benefit, a natural death benefit or other additional benefit, the payment of which is contingent upon the natural death of the insured. Provided, industrial weekly or monthly premium or assessment policies containing provision for payment of weekly indemnity on account of sickness and accident, and in addition to natural death benefit not in excess of one hundred fifty dollars ($150.00) are exempt from this ruling if such policies clearly set forth the additional premium or assessment (or proportion thereof) to be charged for continuation of the natural death benefit after termination of the accident and health provisions.

History

  • Authority G.S. 58-2-40(1); 58-51-1
  • Eff. February 1, 1976
  • Readopted Eff. September 26, 1978
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0510 Accident and Health Insurance: Total Temporary Disability {#sec-11-ncac-12-.0510 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0510}

Accident and health policies providing total temporary disability benefits must provide for the payment of at least three months benefits if the insured is prevented from performing the duties of his occupation.

History

  • Authority G.S. 58-2-40(1); 58-51-1
  • Eff. February 1, 1976
  • Readopted Eff. September 26, 1978
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0511 Group Accident and Health Insurance: Exclusions {#sec-11-ncac-12-.0511 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0511}

Individual accident and health certificates issued under a group accident and health policy must contain all exclusions that are set out in the master policy.

History

  • Authority G.S. 58-2-40(1); 58-51-1
  • Eff. February 1, 1976
  • Readopted Eff. September 26, 1978
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0512 Accident and Health Insurance: Effective Date {#sec-11-ncac-12-.0512 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0512}

The effective date of an accident and health policy shall be the date of issue when the premium or policy fee is paid in advance. This does not prevent the policy from containing some provision that coverage on the policy does not begin because of sickness for a certain period after the effective date, neither does it intend to interfere with provisions for the elimination of benefits for the first specified days of accident or illness.

History

  • Authority G.S. 58-2-40(1); 58-51-1
  • Eff. February 1, 1976
  • Readopted Eff. September 26, 1978
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0513 Accident and Health: Rider or Elimination Endorsement {#sec-11-ncac-12-.0513 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0513}

All companies writing non-group accident, health or hospitalization insurance policies shall print in bold type on the face of the policy a notification that a rider or elimination endorsement has been attached. The requirement shall be waived for individual health riders when the applicant signs the rider.

History

  • Authority G.S. 58-2-40; 58-65-1; 58-65-40
  • Eff. February 1, 1976
  • Readopted Eff. September 26, 1978
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0514 Coordination: Group a/H Contract Benefits: Group Coverages {#sec-11-ncac-12-.0514 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0514}

Purpose. In order to promote consistency in liability for claims and claims determination for group accident and health coverage, when a person has more than one type of group insurance and there is a basis for a claim under two or more group insurance plans, each group accident and health policy and any accident and health certificates issued under a group accident and health policy shall contain uniform order of benefit determination provisions as outlined in this Rule.

(1) Applicability:

(a) These Coordination of Benefits ("COB") provisions apply when an employee or the employee's covered dependent has health care coverage under This Plan and one or more other Health Plans as defined in Sub-item (2)(a) of these provisions and when there is a basis for a claim under This Plan and the other Health Plan(s).

(b) If these COB provisions apply, whether This Plan is the Primary Plan or the Secondary Plan is determined pursuant Item (3) of these provisions.

(c) When This Plan is a Primary Plan, its benefits shall be determined before those of the other Secondary Plan(s) and without considering the Secondary Plan's benefits. When there are more than two other Health Plans covering the person, This Plan may be a Primary Plan as to one or more other Health Plans and may be a Secondary Plan as to a different Health Plan or Health Plans.

(d) When This Plan is a Secondary Plan, its benefits shall be determined without considering the benefits of the Primary Plan or any other Secondary Plan and it shall credit to the deductible any amount that would otherwise be credited to it in the absence of coverage by another Health Plan. When This Plan is a Secondary Plan, any amount of those benefits paid for any Allowable Expense may be reduced to the amount of the Allowable Expense that is unpaid by the Primary Plan to prevent the payment of benefits under more than one Health Plan that would total more than 100 percent of the total expense for that claim.

(e) The benefits of This Plan:

(i) Shall not be reduced when, pursuant to Item (3) of these provisions, it is determined to be the Primary Plan; but

(ii) May be reduced when, pursuant to Item (3) of these provisions, it is determined to be the Secondary Plan.

(2) Definitions:

(a) "Allowable Expense" means any health care expense, including coinsurance or copayments, without reduction for an applicable deductible, that is covered in full or in part by any of the Health Plans covering the person. When a Health Plan provides benefits in the form of medical services, the reasonable cash value of each service rendered shall be considered both an allowable expense and a benefit paid.

(b) "Claim Determination Period" means a calendar year. However, it does not include any part of a year during which a person has no coverage under This Plan, or any part of a year before the date this COB provision or a similar provision takes effect.

(c) "Health Plan" means a plan which provides benefits or services for, or because of, medical or dental care or treatment:

(i) True group insurance. This includes prepayment, group practice or individual practice coverage. It does not include accident and health coverage for students, blanket, franchise individual, automobile and homeowner coverage.

(ii) Coverage under a governmental plan or required or provided by law. This does not include a state plan under Medicaid (Title XIX, Grants to States for Medical Assistance Programs, of the United States Social Security Act as amended from time to time). It also does not include any plan when, by law, its benefits are excess to those of any private insurance program or other non-governmental program.

Each coverage under Sub-items (2)(a)(i) or (ii) of these provisions is a separate Health Plan. Also, if there is more than one schedule of benefits, and COB provisions apply only to one, each of the schedule of benefits is a separate Health Plan.

(d) "Primary Plan" means a Health Plan whose benefits for a person's health care coverage has been determined to be the first claim payor taking the existence of any other Health Plan into consideration, pursuant to Item (3) of these provisions.

(e) "Secondary Plan" means a Health Plan that is not a Primary Plan.

(f) "This Plan" means this group accident and health policy.

(3) Order of Benefit Determination:

(a) When there is a basis for a claim under This Plan and another Health Plan, This Plan is a Secondary Plan which has its benefits determined after those of the other Health Plan, unless:

(i) the other Health Plan has provisions coordinating its benefits with those of This Plan; and

(ii) both the other Health Plan's provisions and This Plan's provisions in Sub-item (3)(b) of these provisions, require that This Plan's benefits be determined before those of the other Health Plan.

(b) This Plan determines its order of benefits using the first of the following rules which applies:

(i) Non-dependent/Dependent. The benefits of the Health Plan which covers the person as an employee, member or subscriber (that is, other than as a dependent) are determined before those of the Health Plan which covers the person as a dependent.

(ii) Dependent Child/Parents Not Separated or Divorced. Except as stated in Sub-item (3)(b)(iii) of these provisions, when This Plan and another Health Plan cover the same child as a dependent of different persons, called "parents":

(A) the benefits of the Health Plan of the parent whose birthday falls earlier in a year are determined before those of the Health Plan of the parent whose birthday falls later in that year; but

(B) if both parents have the same birthday, the benefits of the Health Plan that has covered a parent for a longer period of time are determined before those of the Health Plan that covered the other parent for a shorter period of time.

However, if the other Health Plan does not have the provision described in Sub-item (3)(b)(ii)(A) of these provisions, but instead has a provision based upon the gender of the parent, and if, as a result, the Health Plans do not agree on the order of benefits, the provision in the other Health Plan will determine the order of benefits.

(iii) Dependent Child/Separated or Divorced Parents. If two or more Health Plans cover a person as a dependent child of divorced or separated parents, benefits for the child are determined in this order:

(A) first, the Health Plan of the parent with custody of the child;

(B) then, the Health Plan of the spouse of the parent with custody of the child; and

(C) finally, the Health Plan of the parent not having custody of the child.

However, if the specific terms of a court decree state that one of the parents is responsible for the healthcare expenses or healthcare coverage and the Health Plan of the parent has actual knowledge of those terms, the benefits of that Health Plan are determined first. Sub-item (3)(b)(iii)(C) of these provisions does not apply with respect to any Claim Determination Period or plan-year during which any benefits are actually paid or provided before the Health Plan has that actual knowledge.

(iv) Active Inactive Employee. The benefits of a Health Plan which covers a person as an employee who is neither laid off nor retired (or as that employee's dependent) are determined before those of a Health Plan which covers that person as a laid off or retired employee (or as that employee's dependent). If the other Health Plan does not have a provision like Sub-item (3)(b)(iv), and if, as a result, the Health Plans do not agree on the order of benefits, Sub-item (3)(b)(iv) is ignored.

(v) Longer/Shorter Length of Coverage. If none of the other provisions of Item (3) determine the order of benefits, the benefits of the Health Plan which covered an employee, member or subscriber longer are determined before those of the Health Plan which covered that person for the shorter time.

History

  • Authority G.S. 58-2-40; 58-51-1; 58-51-80; 58-51-81; 58-65-1; 58-65-40
  • Eff. February 1, 1976
  • Readopted Eff. September 26, 1978
  • Amended Eff. February 1, 1992; April 1, 1989; July 1, 1986
  • Readopted Eff. July 1, 2020.
11 NCAC 12 .0515 Countersignature by Agent {#sec-11-ncac-12-.0515 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0515}

History

  • Status: repealed
  • Authority G.S. 58-9(1); 58-44
  • Eff. February 1, 1976
  • Readopted Eff. September 26, 1978
  • Repealed Eff. April 1, 1989.
11 NCAC 12 .0516 Accident and Health Advertising: Responsibility of Insurer {#sec-11-ncac-12-.0516 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0516}

Every insurer shall establish and at all times maintain a system of control over the content, form and method of dissemination of all advertisements of its policies. All such advertisements, regardless of by whom written, created, designed or presented, shall be the responsibility of the insurer whose policies are so advertised. Such advertisements shall be made in accordance with the provisions of 11 NCAC 12 .0516 to .0536.

History

  • Authority G.S. 58-2-40(1); 58-63-15
  • Eff. February 1, 1976
  • Readopted Eff. September 26, 1978
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0517 Accident and Health Advertising: Definitions {#sec-11-ncac-12-.0517 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0517}

The following definitions are applicable to accident and health advertising Rules 11 NCAC 12 .0516 to .0536 only:

(1) "Advertisement" is defined as:

(a) printed and published material, audio visual material, and descriptive literature of an insurer used in direct mail, newspapers, magazines, radio scripts, TV scripts, billboards and similar displays; and

(b) descriptive literature and sales aids of all kinds issued by an insurer, agent or broker for presentation to members of the insurance buying public, including but not limited to circulars, leaflets, booklets, depictions, illustrations, and form letters; and

(c) prepared sales talks, presentations and material for use by agents, brokers and solicitors.

(2) "Policy" is defined as any policy, plan, certificate, contract, agreement, statement of coverage, rider or endorsement which provides long term care, Medicare supplement, accident or sickness benefits or medical, surgical or hospital expense benefits, whether on an indemnity, reimbursement, service or prepaid basis, except when issued in connection with another kind of insurance other than life and except disability, waiver of premium and double indemnity benefits included in life insurance and annuity contracts.

(3) "Insurer" is defined as any individual, corporation, association, partnership, reciprocal exchange, inter-insurer, Lloyd's, fraternal benefit society, health maintenance organization, and any other legal entity which is defined as an "insurer" in the insurance code of this state and is engaged in the advertisement of a policy as "policy" is herein defined.

(4) "Exception" is defined as any provision in a policy whereby coverage for a specified hazard is entirely eliminated; it is a statement of a risk not assumed under the policy.

(5) "Reduction" is defined as any provision which reduces the amount of the benefit; a risk of loss is assumed but payment upon the occurrence of such loss is limited to some amount or period less than would be otherwise payable had such reduction not been used.

(6) "Limitation" is defined as any provision which restricts coverage under the policy other than an exception or a reduction.

(7) "Institutional advertisement" is defined as an advertisement having as its sole purpose the promotion of the reader's or viewer's interest in the concept of accident and sickness insurance, or the promotion of the insurer.

(8) "Invitation to inquire" is defined as advertisement having as its objective the creation of a desire to inquire further about the product and which is limited to a brief description of the loss for which the benefit is payable, and which may contain:

(a) the dollar amount of benefits payable; and

(b) the period of time during which the benefits are payable; provided the advertisement does not refer to cost; An advertisement which specified either the dollar amount of benefit payable or the period of time during which the benefit is payable shall contain a provision in effect as follows:

"For costs and further details of the coverage, including exclusions, any reductions or limitations and terms under which the policy may be continued in force, see your agent or write to the company."

(9) "Invitation to contract" is defined as an advertisement which is neither an invitation to inquire nor an institutional advertisement.

History

  • Authority G.S. 58-2-40; 58-54-10; 58-54-25; 58-54-35; 58-55-30; 58-63-15; 58-65-1; 58-65-40; 58-67-50; 58-67-150
  • Eff. February 1, 1976
  • Readopted Eff. September 26, 1978
  • Amended Eff. February 1, 1992
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0518 Advertising: Disclosure of Required Information {#sec-11-ncac-12-.0518 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0518}

All information required to be disclosed shall be set out conspicuously and in close conjunction with the statements to which such information relates or under appropriate captions of such prominence that it shall not be minimized, rendered obscure or presented in an ambiguous fashion or intermingled with the context of the advertisement so as to be confusing or misleading.

History

  • Authority G.S. 58-2-40(1); 58-63-15
  • Eff. February 1, 1976
  • Readopted Eff. September 26, 1978
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0519 Accident and Health Advertising: Form and Content {#sec-11-ncac-12-.0519 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0519}

The format and content of an advertisement of an accident or sickness insurance policy shall be sufficiently complete and clear to avoid deception or the capacity or tendency to mislead or deceive. Whether an advertisement has a capacity or tendency to mislead or deceive shall be determined by the commissioner, from the overall impression that the advertisement may be reasonably expected to create upon a person of average education or intelligence, within the segment of the public to which it is directed.

Advertisements shall be truthful and not misleading in fact or in implication. Words or phrases, the meaning of which is clear only by implication or by familiarity with insurance terminology, shall not be used.

History

  • Authority G.S. 58-2-40(1); 58-63-15
  • Eff. February 1, 1976
  • Readopted Eff. September 26, 1978
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0520 Accident and Health Advertising: Prohibitions {#sec-11-ncac-12-.0520 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0520}

No advertisement shall omit information or use words, phrases, statements, references or illustrations if the omission of such information or use of such words, phrases, statements, references or illustrations has the capacity, tendency or effect of misleading or deceiving purchasers or prospective purchasers as to the nature or extent of any policy benefit payable, loss covered or premium payable. The fact that the policy offered is made available to a prospective insured for inspection prior to consummation of the sale or an offer is made to refund the premium if the purchaser is not satisfied, does not remedy misleading statements.

No advertisement shall contain or use words or phrases such as, "all"; "full"; "complete"; "comprehensive"; "unlimited"; "up to"; "as high as"; "this policy will help fill some of the gaps that Medicare and your present insurance leave out"; "this policy will help to replace your income" (when used to express loss of time benefits); or similar words and phrases, in a manner which exaggerates any benefits beyond the terms of the policy.

An advertisement shall not contain descriptions of a policy limitation, exception, or reduction, worded in a positive manner to imply that it is a benefit, such as, describing a waiting period as a "benefit builder," or stating "even pre-existing conditions are covered after two years." Words and phrases used in an advertisement to describe such policy limitations, exceptions and reductions shall fairly and accurately describe the negative features of such limitations, exceptions and reductions of the policy offered.

No advertisement of a benefit for which payment is conditional upon confinement in a hospital or similar facility shall use words or phrases such as "tax free"; "extra income"; "extra pay"; or substantially similar words or phrases because such words and phrases have the capacity, tendency or effect to mislead the public into believing that the policy advertised will, in some way, enable them to make a profit from being hospitalized.

No advertisement of a hospital or other similar facility confinement benefit shall advertise that the amount of the benefit is payable on a monthly or weekly basis when, in fact, the amount of the benefit payable is based upon a daily pro rata basis relating to the number of days of confinement unless such statement of such monthly or weekly benefit amounts are followed immediately by equally prominent statements of benefit payable on a daily basis. When the policy contains a limit on the number of days of coverage provided, such limit must appear in the advertisement.

No advertisement of a policy covering only one disease or a list of specified diseases shall imply coverage beyond the terms of the policy. Synonymous terms shall not be used to refer to any disease so as to imply broader coverage than is the fact.

An advertisement for a policy providing benefits for specified illnesses only, such as cancer, or for specified accidents only, such as automobile accidents, shall clearly and conspicuously in prominent type state the limited nature of the policy. The statement shall be worded in language identical to, or substantially similar to the following: "this is a limited policy"; "this is a cancer only policy"; "this is an automobile accident only policy."

An advertisement of a direct response insurance product shall not imply that because "no insurance agent will call and no commissions will be paid to agents" that it is "a low cost plan" or use other similar words or phrases because the cost of advertising and servicing such policies is a substantial cost in the marketing of a direct response insurance product.

History

  • Authority G.S. 58-2-40(1); 58-63-15
  • Eff. February 1, 1976
  • Readopted Eff. September 26, 1978
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0521 Accident: Health Advertising: Exceptions and Limitations {#sec-11-ncac-12-.0521 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0521}

When an advertisement which is an invitation to contract refers to either a dollar amount, or a period of time for which any benefit is payable, or the cost of the policy, or specific policy benefit, or the loss for which such benefit is payable, it shall also disclose those exceptions, reductions and limitations affecting the basic provisions of the policy without which the advertisement would have the capacity or tendency to mislead or deceive.

When a policy contains a waiting, elimination, probationary or similar time period between the effective date of the policy and the effective date of coverage under the policy or at a time period between the date a loss occurs and the date benefits begin to accrue for such loss, an advertisement which is subject to the requirements of the preceding Paragraph shall disclose the existence of such periods.

An advertisement shall not use the words "only"; "just"; "merely"; "minimum" or similar words or phrases to describe the applicability of any exceptions and reductions, such as: "This policy is subject to the following minimum exceptions and reductions."

History

  • Authority G.S. 58-2-40(1); 58-63-15
  • Eff. February 1, 1976
  • Readopted Eff. September 26, 1978
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0522 Accident and Health Advertising: Pre-Existing Conditions {#sec-11-ncac-12-.0522 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0522}

An advertisement which is subject to the requirements of 11 NCAC 12 .0521 shall, in negative terms, disclose the extent to which any loss is not covered if the cause of such loss is traceable to a condition existing prior to the effective date of the policy. The use of the term "pre-existing condition" without an appropriate definition or description shall not be used.

When a policy does not cover losses resulting from pre-existing conditions, no advertisement of the policy shall state or imply that the applicant's physical condition or medical history will not affect the issuance of the policy or payment of a claim thereunder. This Rule prohibits the use of the phrase "no medical examination required" and phrases of similar import, but does not prohibit explaining "automatic issue." If an insurer requires a medical examination for a specified policy, the advertisement, if it is an invitation to contract, shall disclose that a medical examination is required.

When an advertisement contains an application form to be completed by the applicant and returned by mail for a direct response insurance product, such application form shall contain a question or statement which reflects the pre-existing condition provision of the policy immediately preceding the blank space for the applicant's signature. For example, such an application form shall contain a question or statement substantially as follows:

Do you understand that this policy will not pay benefits during the first _____year(s) after the issue date for a disease or physical condition which you now have or have had in the past?_____YES.

Or substantially the following statement:

I understand that the policy applied for will not pay benefits for any loss incurred during the first ______year(s) after the issue date on account of disease or physical condition which I now have or have had in the past.

History

  • Authority G.S. 58-2-40(1); 58-63-15
  • Eff. February 1, 1976
  • Readopted Eff. September 26, 1978
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0523 Advertising: Renewability and Termination {#sec-11-ncac-12-.0523 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0523}

When an advertisement which is an invitation to contract refers to either a dollar amount or a period of time for which any benefit is payable, or the cost of the policy, or the loss for which such benefit is payable, it shall disclose the provisions relating to renewability, cancellability and termination and any modification of benefits, losses covered or premiums because of age or for other reasons, in a manner which shall not minimize or render obscure the qualifying conditions.

History

  • Authority G.S. 58-2-40(1); 58-63-15
  • Eff. February 1, 1976
  • Readopted Eff. September 26, 1978
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0524 Accident and Health Advertising: Testimonials {#sec-11-ncac-12-.0524 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0524}

Testimonials used in advertisements must be genuine, represent the current opinion of the author, be applicable to the policy advertised and be accurately reproduced. The insurer, in using a testimonial, makes as its own all of the statements contained therein and the advertisement including such statements, is subject to all the provisions of these Rules.

If the person making a testimonial, an endorsement or an appraisal has a financial interest in the insurer or a related entity as a stockholder, director, officer, employee, or otherwise, such fact shall be disclosed in the advertisement. If a person is compensated for making a testimonial, endorsement or appraisal, such fact shall be disclosed in the advertisement by language substantially as follows: "Paid Endorsement." This Rule does not require disclosure of union "scale" wages required by union rules if the payment is actually for such "scale" for TV or radio performances. The payment of substantial amounts, directly or indirectly, for "travel and entertainment" for filming or recording of TV or radio advertisements remove the filming or recording from the category of an unsolicited testimonial and require disclosure of such compensation. This Rule does not apply to an institutional advertisement which has as its sole purpose the promotion of the insurer.

An advertisement shall not state or imply that an insurer or a policy has been approved or endorsed by any individual or group of individuals, society, association or other organizations, unless such is the fact, and unless any proprietary relationship between an organization and the insurer is disclosed. If the entity making the endorsement or testimonial has been formed by the insurer or is owned or controlled by the insurer or the person or persons who own or control the insurer, such fact shall be disclosed in the advertisement.

When a testimonial refers to benefits received under a policy, the specific claim data, including claim number, date of loss, and other pertinent information shall be retained by the insurer for inspection for a period of four years or until the filing of the next regular report on examination of the insurer, whichever is the longer period of time.

History

  • Authority G.S. 58-2-40(1); 58-63-15
  • Eff. February 1, 1976
  • Readopted Eff. September 26, 1978
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0525 Accident and Health Advertising: Use of Statistics {#sec-11-ncac-12-.0525 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0525}

An advertisement relating to the dollar amounts of claims paid, the number of persons insured, or similar statistical information relating to any insurer or policy shall not use irrelevant facts, and shall not be used unless it accurately reflects all of the relevant facts. Such an advertisement shall not imply that such statistics are derived from the policy advertised unless such is the fact, and when applicable to other policies or plans shall specifically so state.

An advertisement shall not represent or imply that claim settlements by the insurer are "liberal" or "generous," or use words of similar import, or that claim settlements are or will be beyond the actual terms of the contract. An unusual amount paid for a unique claim for the policy advertised is misleading and shall not be used.

The source of any statistics used in an advertisement shall be identified in such advertisement.

History

  • Authority G.S. 58-2-40(1); 58-63-15
  • Eff. February 1, 1976
  • Readopted Eff. September 26, 1978
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0526 Accident and Health Advertising of Plan or Policies {#sec-11-ncac-12-.0526 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0526}

When a choice of the amount of benefits is referred to, an advertisement which is an invitation to contract shall disclose that the amount of benefits provided depends upon the plan selected and that the premium will vary with the amount of the benefits selected.

When an advertisement refers to various benefits which may be contained in two or more policies, other than group master policies, the advertisement shall disclose that such benefits are provided only through a combination of such policies.

History

  • Authority G.S. 58-2-40; 58-63-15
  • Eff. February 1, 1976
  • Readopted Eff. September 26, 1978
  • Amended Eff. February 1, 1992
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0527 Accident and Health Advertising: Comparisons: Statements {#sec-11-ncac-12-.0527 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0527}

History

  • Status: repealed
  • Authority G.S. 58-9(1); 58-54.4
  • Eff. February 1, 1976
  • Readopted Eff. September 26, 1978
  • Repealed Eff. February 1, 1992.
11 NCAC 12 .0528 Accident and Health Advertising: Licensing and Status {#sec-11-ncac-12-.0528 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0528}

An advertisement which is intended to be seen or heard beyond the limits of the jurisdiction in which the insurer is licensed shall not imply licensing beyond those limits.

An advertisement shall not create the impression directly or indirectly that the insurer, its financial condition or status, or the payment of its claims, or the merits, desirability, or advisability of its policy forms or kinds or plans of insurance are approved, endorsed, or accredited by any division or agency of this state or the United States Government.

History

  • Authority G.S. 58-2-40(1); 58-63-15
  • Eff. February 1, 1976
  • Readopted Eff. September 26, 1978
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0529 Accident and Health Advertising: Identity of Insurer {#sec-11-ncac-12-.0529 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0529}

The name of the actual insurer shall be stated in all of its advertisements and the form number of the policy advertised shall be stated in an advertisement which is an invitation to contract. An advertisement shall not use a trade name, any insurance group designation, name of the parent company of the insurer, name of a particular division of the insurer, service mark, slogan, symbol or other device which without disclosing the name of the actual insurer would have the capacity and tendency to mislead or deceive as to the true identity of the insurer.

No advertisement shall use any combination of words, symbols, or physical materials which by their content, phraseology, shape, color or other characteristics are so similar to combinations of words, symbols, or physical materials used by agencies of the federal government or of this state, or otherwise appear to be of such a nature that it tends to confuse or mislead prospective insureds into believing that the solicitation is in some manner connected with an agency of the municipal, state, or federal government.

History

  • Authority G.S. 58-2-40(1); 58-63-15
  • Eff. February 1, 1976
  • Readopted Eff. September 26, 1978
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0530 Accident and Health Advertising: Group Implications {#sec-11-ncac-12-.0530 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0530}

An advertisement of a particular policy shall not state or imply that prospective insureds become group or quasi-group members covered under a group policy and as such enjoy special rates or underwriting privileges, unless such is the fact.

History

  • Authority G.S. 58-2-40(1); 58-63-15
  • Eff. February 1, 1976
  • Readopted Eff. September 26, 1978
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0531 Advertising: Introductory or Special Offers {#sec-11-ncac-12-.0531 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0531}

An advertisement of an individual policy shall not directly or by implication represent that a contract or combination of contracts is an introductory, initial or special offer, or that applicants will receive substantial advantages not available at a later date, or that the offer is available only to a specified group of individuals, unless such is the fact. An advertisement shall not contain phrases describing an enrollment period as "special," "limited," or similar words or phrases when the insurer uses such enrollment periods as the usual method of advertising accident and sickness insurance.

An enrollment period during which a particular insurance product may be purchased on an individual basis shall not be offered within this state unless there has been a lapse of not less than three months between the close of the immediately preceding enrollment period for the same product and the opening of the new enrollment period with the number of enrollment periods being limited to no more than two in any one calendar year for a particular insurance product. The advertisement shall indicate the date by which the applicant must mail the application, which shall be not less than 10 days and not more than 40 days from the date that such enrollment period is advertised for the first time. This Rule applies to all advertising media, i.e., mail, newspapers, radio, television, magazines and periodicals, by any one insurer. It is inapplicable to solicitations of employees or members of a particular group or association which otherwise would be eligible under specific provisions of the insurance code for group, blanket or franchise insurance. The phrase "any one insurer" includes all the affiliated companies of a group of insurance companies under common management or control.

This Rule prohibits any statement or implication to the effect that only a specific number of policies will be sold, or that a time is fixed for the discontinuance of the sale of the particular policy advertised because of special advantages available in the policy, unless such is the fact.

The phrase "a particular insurance product" in the second paragraph of this Rule means an insurance policy which provides substantially different benefits than those contained in any other policy. Different terms of renewability; an increase in the dollar amounts of benefits; an increase or decrease in any elimination period or waiting period from those available during an enrollment period for another policy shall not be sufficient to constitute the product being offered as a different product eligible for concurrent or overlapping enrollment periods.

An advertisement shall not offer a policy which utilizes a reduced initial premium rate in a manner which overemphasizes the availability and the amount of the initial reduced premium. When an insurer charges an initial premium that differs in amount from the amount of the renewal premium payable on the same mode, the advertisement shall not display the amount of the reduced initial premium either more frequently or more prominently than the renewal premium, and both the initial reduced and the renewal premium must be stated in juxtaposition in each portion of the advertisement where the initial reduced premium appears.

Special awards, such as a "safe drivers' award" shall not be used in connection with advertisements of accident or accident and sickness insurance.

History

  • Authority G.S. 58-2-40(1); 58-63-15
  • Eff. February 1, 1976
  • Readopted Eff. September 26, 1978
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0532 Accident: Health Advertising: Statement About an Insurer {#sec-11-ncac-12-.0532 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0532}

An advertisement shall not contain statements which are untrue in fact, or by implication misleading, with respect to the assets, corporate structure, financial standing, age or relative position of the insurer in the insurance business. An advertisement shall not contain a recommendation by a commercial rating system unless it clearly indicates the purpose of the recommendation and the limitations of the scope and extent of the recommendation.

History

  • Authority G.S. 58-2-40(1); 58-63-15
  • Eff. February 1, 1976
  • Readopted Eff. September 26, 1978
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0533 Accident and Health Advertising: Advertising File {#sec-11-ncac-12-.0533 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0533}

Each insurer shall maintain at its home or principal office a complete file containing every printed, published or prepared advertisement of its individual policies and typical printed, published or prepared advertisements of its blanket, franchise and group policies hereafter disseminated in this or any other state, whether or not licensed in such other state, with a notation attached to each such advertisement which shall indicate the manner and extent of distribution and the form number of any policy advertised. Such file shall be subject to regular and periodical inspection by this department. All such advertisements shall be maintained in said file for a period of either four years or until the filing of the next regular report on examination of the insurer, whichever is the longer period of time.

History

  • Authority G.S. 58-2-40(1); 58-63-15
  • Eff. February 1, 1976
  • Readopted Eff. September 26, 1978
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0534 Accident and Health Advertising: Certificate of Compliance {#sec-11-ncac-12-.0534 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0534}

Each insurer required to file an annual statement which is now or which hereafter becomes subject to the provisions of these rules must file with this department, with its annual statement, a certificate of compliance executed by an authorized officer of the insurer wherein it is stated that, to the best of his knowledge, information and belief, the advertisements which were disseminated by the insurer during the preceding statement year complied or were made to comply in all respects with the provisions of these Rules and insurance laws of this state as implemented and interpreted by these Rules.

History

  • Authority G.S. 58-2-40(1); 58-63-15
  • Eff. February 1, 1976
  • Readopted Eff. September 26, 1978
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0535 Accident and Health Advertising: Advertising Expense {#sec-11-ncac-12-.0535 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0535}

Total advertising expense incurred by the insurer or by an affiliated corporation on behalf of the insurer for the purposes of solicitation and conservation of accident and health insurance business shall be included as line items in the expense exhibits of all statutory financial statements filed by a licensed insurer with the Department.

History

  • Authority G.S. 58-2-40(1); 58-63-15
  • Eff. February 1, 1976
  • Readopted Eff. September 26, 1978
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0536 Accident and Health Advertising: Prior Review or Approval {#sec-11-ncac-12-.0536 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0536}

The commissioner may, when in his discretion he deems it in the public interest, require the filing of all or any part of the advertising material of an insurer with this department for review prior to its use. All advertising material subject to review prior to its use shall be filed with this department 30 days prior to its intended use. In instances where charges are pending against an insurer, the commissioner may, during the period such charges are pending but not to exceed 30 days unless extended by consent order, by order require all or any part of the advertising material be filed for review prior to its use or for prior approval. The commissioner may within his discretion refuse to approve all or any part of the advertising material so filed. All advertising material subject to prior approval shall be filed with this department 60 days prior to its intended use. When it has been determined by the commissioner after notice and hearing that an insurer has violated any of the insurance laws of this state or Rules of the commissioner, the commissioner may in his discretion, by order require that all or any part of the advertising material be filed with this department for review prior to its use or for prior approval. The commissioner may within his discretion refuse to approve all or any part of the advertising material so filed. In any case where review prior to its use or prior approval is required, a shorter period of time may be allowed by the commissioner.

History

  • Authority G.S. 58-2-40(1); 58-63-15
  • Eff. February 1, 1976
  • Readopted Eff. September 26, 1978
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0537 Pre-Existing Conditions: Insured's Age Over 65 {#sec-11-ncac-12-.0537 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0537}

History

  • Status: repealed
  • Authority G.S. 58-251.1; 58-252
  • Eff. February 1, 1976
  • Readopted Eff. September 26, 1978
  • Repealed Eff. February 1, 1992.
11 NCAC 12 .0538 Accident: Health Promotional Material: Stickers Required {#sec-11-ncac-12-.0538 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0538}

For all accident and health insurance promotional material of all kinds for presentation in person, by mail or otherwise by an insurer, or its representative to the insurance buying public, including but not limited to circulars, leaflets and booklets, the same procedure as outlined in 11 NCAC 12 .0543 and .0544 shall be used and similar wording such as that required by these rules and be placed in a prominent place on all of such material.

History

  • Authority G.S. 58-2-40; 58-63-15; 58-65-1; 58-65-40
  • Eff. February 1, 1976
  • Readopted Eff. September 26, 1978
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0539 Notice for Revision of Rates for Non-Profit Service Corp {#sec-11-ncac-12-.0539 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0539}

Notice of a public hearing on the revision of an existing schedule of rates or establishment of a new schedule of rates for a non-profit hospital, medical or dental service corporation shall be published once a week for two consecutive weeks, with the last publication date not more than 10 days before the date of the hearing, in the major morning newspapers in the Cities of Wilmington, Raleigh, Greensboro, Charlotte and Asheville, North Carolina and the cities wherein the principal office of the corporation is located, if other than the aforementioned.

The notice shall be in the form designated as 11 NCAC 12 .0204.

History

  • Authority G.S. 58-2-40; 58-65-45
  • Eff. February 1, 1976
  • Readopted Eff. September 26, 1978
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0540 Blanket and Franchise Policies {#sec-11-ncac-12-.0540 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0540}

A group disability policy as interpreted under G.S. 58-14-5(4) does not include blanket and franchise policies.

History

  • Authority G.S. 58-2-40; 58-14-5(4)
  • Eff. February 1, 1976
  • Readopted Eff. September 26, 1978
  • Amended Eff. April 8, 2002
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0541 Notice of Claim: Credit Insurance {#sec-11-ncac-12-.0541 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0541}

The claimant shall have a minimum of 30 days to give written notice of claim.

History

  • Authority G.S. 58-2-40; 58-57-25
  • Eff. February 1, 1976
  • Readopted Eff. September 26, 1978
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0542 Accident and Health Application: Guaranteed Issue {#sec-11-ncac-12-.0542 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0542}

When an accident and health policy is sold on a guaranteed issue basis, the application for such insurance used in the solicitation may not contain health questions on the application.

History

  • Authority G.S. 58-2-40
  • Eff. February 1, 1976
  • Readopted Eff. September 26, 1978
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0543 Policies Containing a Pre-Existing Condition Exclusion {#sec-11-ncac-12-.0543 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0543}

All individual or franchise insurance policy forms and group certificates containing an exclusion for pre-existing conditions, or other language substantially similar to that set forth in form 11 NCAC 12 .0201, shall display a sticker or printed notice on the face of the policy and the outline of coverage. Such sticker shall be in red bold face type the size of which shall not be less than 14 point. The use of a rubber stamp will not satisfy this requirement.

Laser printed policies may be excused from this red print requirement provided the notice is in bold face print. Companies must certify that policy forms are produced by laser print in order to exercise this excuse.

History

  • Authority G.S. 58-2-40; 58-51-1; 58-65-1; 58-65-40
  • Eff. September 26, 1978
  • Amended Eff. April 1, 1989
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0544 Policies Renewable at the Option of the Company {#sec-11-ncac-12-.0544 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0544}

All individual or franchise insurance policy forms and group certificates that are renewable at the option of the company or other language substantially similar to that set forth in form 11 NCAC 12 .0201 shall display a sticker or printed notice on the face of the policy and the outline of coverage. Such sticker or notice shall be in red bold face type the size of which shall not be less than 14 point. The use of a rubber stamp will not satisfy this requirement.

Laser printed policies may be excused from this red print requirement provided the notice is in bold face print. Companies must certify that policy forms are produced by laser print in order to exercise this excuse.

History

  • Authority G.S. 58-2-40; 58-51-1; 58-65-1; 58-65-40
  • Eff. September 26, 1978
  • Amended Eff. April 1, 1989
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0545 Offset of Increased Social Security: Group Disability {#sec-11-ncac-12-.0545 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0545}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-51-1; 58-65-1; 58-65-40
  • Eff. September 26, 1978
  • Repealed Eff. July 1, 2012.
11 NCAC 12 .0546 Diagnosis of Cancer {#sec-11-ncac-12-.0546 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0546}

No insurer shall exclude a clinical diagnosis of cancer if, in the opinion of the attending physician, a positive diagnosis can not otherwise be made without jeopardizing the life of the claimant. The insurer may require that there be definitive treatment for cancer. The insurer may require confirmation of the diagnosis, at the insurer's expense, by a physician not associated with the attending physician.

History

  • Authority G.S. 58-2-40; 58-51-1; 58-51-95; 58-65-40
  • Eff. September 26, 1978
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0547 Waiting Period {#sec-11-ncac-12-.0547 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0547}

History

  • Status: repealed
  • Authority G.S. 57-1; 57-4; 58-249; 58-252
  • Eff. September 26, 1978
  • Repealed Eff. April 1, 1989.
11 NCAC 12 .0548 Insurance for Medicare Eligible {#sec-11-ncac-12-.0548 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0548}

(a) Direct response insurers providing accident and health insurance to persons eligible for Medicare by reason of age shall:

(1) guarantee to the policyholder an unconditional 30 day right to return the policy for a full refund of premium; and

(2) alert prospective policyholders, in advertisements or direct mail solicitations, of their right to obtain a copy of the NAIC-HHS Guide to Health Insurance for People with Medicare prior to sale.

(b) All insurers providing accident and health insurance to persons eligible for Medicare by reason of age shall annually report to the Commissioner the number of written complaints or inquiries received from these policyholders who are eligible for Medicare.

History

  • Authority G.S. 58-2-40; 58-2-190; 58-2-195; 58-3-100; 58-3-115; 58-3-150; 58-51-1; 58-51-15; 58-51-60; 58-51-85; 58-51-95; 58-54-1; 58-63-15; 58-65-1; 58-65-4; 58-65-105
  • Eff. October 24, 1981
  • Temporary Amendment Eff. October 16, 1991 for a period of 180 days to expire on April 13, 1992
  • Amended Eff. May 1, 1992
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0549 Conversion Policies: Hospital Room Rates {#sec-11-ncac-12-.0549 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0549}

The dollar amount for the maximum hospital room and board daily expense benefit for Plan A of conversion policies required by G.S. 58-53-90 shall be one hundred seventy dollars ($170.00).

History

  • Authority G.S. 58-2-40; 58-53-90; 58-53-115
  • Eff. February 1, 1982
  • Amended Eff. February 1, 1992
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0550 Orthodontic Coverage Limitations {#sec-11-ncac-12-.0550 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0550}

No insurer providing benefits for orthodontic services and supplies shall condition receipt of those benefits upon a determination of the class of malocclusion or any measurement of the position of the teeth or jaws, but shall rely upon the opinion of an orthodontist who has examined the patient.

History

  • Authority G.S. 58-2-40; 58-3-120; 58-3-150; 58-51-1; 58-51-95; 58-63-15; 58-65-40; 58-67-50
  • Eff. April 1, 1982
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0551 Cancer Insurance Requirements {#sec-11-ncac-12-.0551 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0551}

Cancer policy requirements. Cancer policies approved in this State shall comply with the following:

(1) The policy shall have a pre-existing conditions sticker that complies with 11 NCAC 12 .0543 and reads as follows: NO RECOVERY FOR PRE-EXISTING DIAGNOSED CANCER - READ CAREFULLY No benefits will be provided during the first 12 months of the policy for cancer diagnosed before the 30th day after the effective date shown in the policy schedule.

(2) In the definition of cancer, clinical diagnosis of cancer shall be accepted as evidence that cancer exists in an insured when a pathological diagnosis cannot be made, provided the medical evidence substantially documents the diagnosis of cancer and the insured received definitive treatment for cancer. If the requisite pathological clinical diagnosis can only be made postmortem, liability shall be assumed retroactively beginning with the date of the terminal admission to the hospital for not less than 45 days before the date of death.

(3) A cancer policy shall not have a waiting period any longer than 30 days after the effective date.

(4) Benefits shall be provided for unrelated cancers diagnosed after the effective date of the policy.

(5) Under the benefits provisions of the policy, provided the contract offers these benefits, the minimum standards are as follows:

(a) Benefits for blood and plasma shall cover actual charges incurred, including fees for administering the blood.

(b) The term "In-patient" shall precede the words "drugs" and "medicines" if the policy is an in-hospital indemnity contract or does not provide out-patient benefits.

(c) Ambulance benefits shall include transportation from one medical facility to another.

(d) First diagnosed or first occurrence cancer benefits shall be no less favorable than other generally offered cancer benefits and shall be offered in addition to core benefits.

(6) Cancer coverage may include other diseases or conditions; provided, however, it shall be properly labeled -- CANCER AND SPECIFIED DISEASE(S).

(7) Cancer and dread disease policies are defined as "Medical Expense" policies for the purposes of loss ratio requirements as set forth in the NAIC guidelines.

History

  • Authority G.S. 58-2-40; 58-51-1; 58-51-95
  • Eff. July 1, 1986
  • Amended Eff. April 1, 1997; April 1, 1989
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0552 Temporomandibular Joint Dysfunction {#sec-11-ncac-12-.0552 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0552}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-51-1; 58-51-95; 58-65-85
  • Eff. July 1, 1986
  • Repealed Eff. February 1, 1996.
11 NCAC 12 .0553 Excess Insurance: Non-Duplication of Coverage {#sec-11-ncac-12-.0553 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0553}

(a) An accident and health policy with a nonduplication of coverage benefit may be permitted, if it contains the following sticker on the face in red:

EXCESS INSURANCE

This policy is not intended to be issued where other medical insurance exists. If other medical insurance does exist at the time of the claim, then the amounts of benefit payable by such other medical insurance will become the deductible amount of this policy if such benefits exceed the deductible amount shown in the Schedule of Benefits.

Such sticker shall be in red bold face type the size of which shall not be less than 12 points. The use of a rubber stamp will not satisfy this requirement. The use of laser print shall exempt the use of red print.

(b) A non-duplication of coverage benefit in blanket insurance shall be permitted when premiums are non-contributory and 100 percent of the participants are covered.

History

  • Authority G.S. 58-2-40; 58-51-1; 58-65-1; 58-65-40
  • Eff. July 1, 1986
  • Amended Eff. February 1, 1992
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0554 Stop-Loss Coverage - Requirements {#sec-11-ncac-12-.0554 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0554}

History

  • Status: repealed
  • Authority G.S. 58-9; 58-249; 58-254.7
  • Eff. April 1, 1989
  • Repealed Eff. February 1, 1992.
11 NCAC 12 .0555 Long-Term Care Policy Requirements {#sec-11-ncac-12-.0555 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0555}

(a) Definitions:

(1) Long-Term Care Insurance is defined as any contract of insurance offering institutional or noninstitutional support in order to restore deteriorating health and to maintain functional independence. Such services for an acute or chronic physical or mental impairment, or short term illness or injury, include but are not limited to assistance with daily living, medical or rehabilitative care, and home health care.

(2) In regard to Skilled, Intermediate, Custodial, or Home Health Care, when the insured receives definitive treatment for these services regardless of the type of facility or setting the insured is confined in, benefits are payable for the service receive based on the benefits of the contract for that service.

(b) The following provisions are required:

(1) Long-term care insurance policies must provide benefits for at least three levels of care and provide the same duration for each level of care for a minimum of 12 months.

(2) Coordination or non-duplication of benefits is permitted between true group long-term care policies only.

(3) The loss ratio is required to be at least 60 percent for individual policies and at least 75 percent for group policies.

(4) Custodial care that is administered for assistance of the patient in performing the activities of daily living shall not be denied based on the type of facility in which the care is received; but rather must be provided as long as the insured is confined as an inpatient in any facility licensed by the State, regardless of whether or not that facility is commonly understood to be or is defined as a long-term care facility.

(5) No long-term care policy, contract, or certificate may use waivers to exclude, limit, or reduce benefits for specifically named or described pre-existing diseases or physical conditions.

History

  • Authority G.S. 58-2-40; 58-51-1; 58-51-95; 58-55-30
  • Eff. April 1, 1989
  • Amended Eff. February 1, 1992
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0556 Home Health Care Policy Requirement {#sec-11-ncac-12-.0556 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0556}

All Home Health Care Policies shall have the notice printed in contrasting type or color on the face of the policy as follows: "This Is Not A Long-Term Care Policy - This Policy Provides Home Health Care Benefits Only - Read Carefully". Home health care policies must comply with G.S. 58-51-60 and the following items:

(1) Prior hospitalization or skilled nursing home confinement shall not be required to satisfy eligibility for benefits.

(2) Benefits shall be provided without a physician certification that the insured or claimant would need medical care in a skilled nursing facility or hospital setting.

(3) Home health benefits shall not be limited to acute conditions.

History

  • Authority G.S. 58-2-40; 58-51-1; 58-51-95
  • Eff. April 1, 1989
  • Amended Eff. February 1, 1992
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0557 Policies Containing a Termination or Cancellation Provision {#sec-11-ncac-12-.0557 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0557}

(a) Any policy or certificate of insurance that may be terminated for reasons other than non-payment of premium or the insured's stated age must be affixed with a notice referring the insured to the renewal provision. Such notice must appear in 12 point bold red print and read as follows: Important Cancellation Information - Please Read The Provision Entitled, ".................", Found On Page "...".

(b) Laser printed policies are not subject to the red print requirement in Paragraph (a) of this Rule if the notice is in bold face print and if the insurer certifies that its policy forms are produced by laser print.

History

  • Authority G.S. 58-2-40; 58-51-1
  • Eff. April 1, 1989
  • Amended Eff. February 1, 1992
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0558 Premium Revision {#sec-11-ncac-12-.0558 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0558}

History

  • Status: repealed
  • Authority G.S. 58-9; 58-249; 58-254.7
  • Eff. April 1, 1989
  • Repealed Eff. February 1, 1992.
11 NCAC 12 .0559 Precertification {#sec-11-ncac-12-.0559 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0559}

Policies requiring precertification must contain a disclosure of penalties for benefits and services that are not precertified.

History

  • Authority G.S. 58-2-40; 58-50-60
  • Eff. February 1, 1992
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0560 Uniform Claim Forms {#sec-11-ncac-12-.0560 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0560}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-3-171
  • Filed as a Temporary Adoption Eff. January 1, 1994 for a period of 180 days or until the permanent rule becomes effective, whichever is sooner
  • Eff. April 1, 1994
  • Repealed Eff. July 1, 2012.
11 NCAC 12 .0561 Deductibles and Copayments Based on Real Cost {#sec-11-ncac-12-.0561 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0561}

(a) As used in this Rule:

(1) "Health benefit plan" means any accident and health insurance policy or certificate; a nonprofit hospital or medical service corporation contract; a health maintenance organization subscriber contract; a plan provided by a multiple employer welfare arrangement; or a plan provided by another benefit arrangement.

(2) "Health care provider" includes any person who, under Chapter 90 of the General Statutes is licensed, registered, or certified to engage in the practice of or performs duties associated with any of the following: medicine, surgery, dentistry, pharmacy, optometry, midwifery, osteopathy, podiatry, chiropractic, radiology, nursing, physiotherapy, pathology, anesthesiology, anesthesia, laboratory analysis, rendering assistance to a physician, dental hygiene, psychiatry, psychology; or a hospital as defined by G.S. 131E-76(3); or a nursing home as defined by G.S. 131E-101(6).

(3) "Health insurer" means any health insurance company subject to Articles 1 through 63 of Chapter 58, including a multiple employer welfare arrangement; any preferred provider plan; and any corporation subject to Articles 65 and 67 of Chapter 58; that provides a health benefit plan.

(b) If health insurers enter into contracts with health care providers for the provision of health care services at discounted rates of payment (including capitated and other alternative negotiated rates), and applicable deductibles or copayments paid by insureds are to be based upon a percentage of the fees for services rendered, the amounts of deductibles and copayments shall be computed based on such rates for the services rendered when such rates are less than the provider's ordinary charges for the services rendered.

(c) The following are deemed to be unfair and deceptive acts and practices in the business of insurance:

(1) Attempting to settle a claim or attempting to charge or to collect or charging or collecting copayments in amounts greater than those calculated in accordance with this Rule.

(2) Attempting to pay or settle or paying or settling a claim based upon the calculation of a deductible that is not calculated in accordance with this Rule.

(3) Attempting to calculate or calculating an annual, calendar, or lifetime maximum amount payable on any amounts other than as set forth in this Rule.

(4) Attempting to settle a claim involved in coordination of benefits in any manner not in accordance with this Rule.

(5) Attempting to collect a claim against a stop-loss or excess health insurer in any manner inconsistent with this Rule.

(d) Negotiating discounts with health care providers based upon the total volume of services and that is settled on a retrospective basis in which the discounts are not attributed to individual claimants, is not deemed to be an unfair and deceptive act or practice in the business of insurance.

History

  • Authority G.S. 58-2-40; 58-50-55; 58-63-65; 58-65-1; 58-65-40; 58-65-140; 58-67-150
  • Eff. January 1, 1995
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0562 Unearned Premium {#sec-11-ncac-12-.0562 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0562}

As used in this Rule, "unearned premium" means that portion of the premium representing the unexpired portion of the policy term. All insurers of individual health or accident and health insurance shall in the event of cancellation or the death of the insured return any portion of unearned premium.

History

  • Authority G.S. 58-2-40(1)
  • Eff. February 1, 1996
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0563 Weighted Average: Mental Illness Benefits Coverage {#sec-11-ncac-12-.0563 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0563}

(a) The definitions contained in G.S. 58-3-220(h) are incorporated into this rule by reference.

(b) To exercise the option under G.S. 58-3-220(f), at the time of submission for approval of a group health benefit plan policy form, certificate, or rider containing mental illness benefits, the insurer shall include in the submission a certification of compliance with this rule signed by a qualified actuary, as defined in 11 NCAC 16 .0401(17). The certification of compliance shall include a statement that:

(1) No more than 70 percent of the entire plan's actuarial value is contained in the selected physical illness and injury benefits that are subject to any limit.

(2) The weighted average calculation was performed and calculated as prescribed in paragraph (c) of this rule.

(c) The weighted average calculation shall be performed on a benefit-by-benefit basis. The weighted average for a limit shall be calculated by summing the product of the expected value of each physical illness and injury benefit and its applicable limit, and then dividing that summation by the sum of the expected values of each physical illness and injury benefit.

(d) An insurer shall make the information, documentation, and actuarial calculations described in this rule available to the Commissioner upon request.

History

  • Authority G.S. 58-2-40; 58-3-220
  • Eff. July 1, 2008
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0601 PURPOSE and scope {#sec-11-ncac-12-.0601 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0601}

The purpose of the rules in this Section are:

(1) To regulate the activities of insurers and producers with respect to the replacement of existing life insurance and annuities.

(2) To protect the interests of life insurance and annuity purchasers by establishing minimum standards of conduct to be observed in replacement or financed purchase transactions that will:

(a) assure that purchasers receive information with which a decision can be made in their own best interest;

(b) reduce the opportunity for misrepresentation and incomplete disclosures; and

(c) establish penalties for failure to comply with requirements of the rules in this section.

History

  • Authority G.S. 58-2-40; 58-3-115; 58-58-1; 58-58-40
  • Eff. October 1, 1985
  • Amended Eff. August 1, 2004
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0602 Definition of Replacement {#sec-11-ncac-12-.0602 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0602}

When used in the rules in this Section, "replacement" means a transaction in which a new policy or contract is to be purchased, and it is known or should be known to the proposing producer, or to the proposing insurer if there is no producer, that by reason of the transaction, an existing policy or contract has been or is to be:

(1) lapsed, forfeited, surrendered, or partially surrendered, assigned to the replacing insurer or otherwise terminated;

(2) converted to reduced paid-up insurance, continued as extended term insurance, or otherwise reduced in value by the use of nonforfeiture benefits or other policy values;

(3) amended so as to effect either a reduction in benefits or in the term for which coverage would otherwise remain in force or for which benefits would be paid;

(4) reissued with any reduction in cash value; or

(5) used in a financed purchase.

History

  • Authority G.S. 58-2-40; 58-3-115; 58-58-1; 58-58-40
  • Eff. October 1, 1985
  • Amended Eff. August 1, 2004
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0603 Other Definitions {#sec-11-ncac-12-.0603 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0603}

When used in the rules in this Section:

(1) "Direct-response solicitation" means a solicitation through a sponsoring or endorsing entity, or individually, solely through mails, telephone, the Internet or other mass communication media.

(2) "Existing insurer" means the insurance company whose policy or contract is or will be changed or affected in a manner described within the definition of "replacement" in 11 NCAC 12 .0602.

(3) "Existing policy or contract" means an individual life insurance policy (policy) or annuity contract (contract) in force, including a policy under a binding or conditional receipt or a policy or contract that is within an unconditional refund period.

(4) "Financed purchase" means the purchase of a new policy involving the actual or intended use of funds obtained by the withdrawal or surrender of, or by borrowing from values of an existing policy to pay all or part of any premium due on the new policy. For purposes of a regulatory review of an individual transaction only, if a withdrawal, surrender or borrowing involving the policy values of an existing policy is used to pay premiums on a new policy owned by the same policyholder and issued by the same company within four months before or 13 months after the effective date of the new policy, it shall be deemed prima facie evidence of the policyholder's intent to finance the purchase of the new policy with existing policy values. This prima facie standard is not intended to increase or decrease the monitoring obligations contained in 11 NCAC 12 .0607(1)(e).

(5) "Illustration" means a presentation or depiction that includes non-guaranteed elements of a policy of life insurance over a period of years as defined in 11 NCAC 04 .0501(b)(8).

(6) "Policy summary" means:

(a) For policies or contracts other than universal life policies, a written statement regarding a policy or contract which contains, to the extent applicable, the following information:

(i) current death benefit;

(ii) annual contract premium;

(iii) current cash surrender value;

(iv) current dividend;

(v) application of current dividend; and

(vi) amount of outstanding loan.

(b) For universal life policies, a written statement that contains the following information:

(i) the beginning and end date of the current report period;

(ii) the policy value at the end of the previous report period and at the end of the current report period;

(iii) the total amounts that have been credited or debited to the policy value during the current report period, identifying each by type (e.g., interest, mortality, expense and riders);

(iv) the current death benefit at the end of the current report period on each life covered by the policy;

(v) the net cash surrender value of the policy as of the end of the current report period; and

(vi) the amount of outstanding loans, if any, as of the end of the current report period.

(7) "Producer" includes duly licensed agents and brokers as defined by G.S. 58-33-10(7).

(8) "Replacing insurer" means the insurance company that issues or proposes to issue a new policy or contract that replaces an existing policy or contract or is a financed purchase.

(9) "Registered contract" means a variable annuity contract or variable life insurance policy subject to the prospectus delivery requirements of the Securities Act of 1933.

(10) "Sales material" means a sales illustration and any other written, printed or electronically presented information created, or completed or provided by the company or producer and used in the presentation to the policy or contract owner related to the policy or contract purchased.

History

  • Authority G.S. 58-2-40; 58-3-115; 58-58-1; 58-58-40
  • Eff. October 1, 1985
  • Amended Eff. August 1, 2004
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0604 Exemptions {#sec-11-ncac-12-.0604 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0604}

(a) Unless otherwise stated in Chapter 58 of the North Carolina General Statutes, this Section shall not apply to transactions involving:

(1) Credit life insurance;

(2) Group life insurance or group annuities where there is no direct solicitation of individuals by an insurance producer. Direct solicitation does not include any group meeting held by an insurance producer solely for the purpose of educating or enrolling individuals or, when initiated by an individual member of the group, assisting with the selection of investment options offered by a single insurer in connection with enrolling that individual. Group life insurance or group annuity certificates marketed through direct response solicitation is subject to the provisions of 11 NCAC 12 .0608;

(3) Group life insurance and annuities used to fund prearranged funeral contracts;

(4) An application to the existing insurer that issued the existing policy or contract when a contractual change or a conversion privilege is being exercised; or, when the existing policy or contract is being replaced by the same insurer pursuant to a program filed with and approved by the Commissioner; or, when a term conversion privilege is exercised among corporate affiliates;

(5) Proposed life insurance that is to replace life insurance under a binding or conditional receipt issued by the same company;

(6) Policies or contracts used to fund:

(A) An employee pension or welfare benefit plan that is covered by the Employee Retirement and Income Security Act (ERISA);

(B) A plan described by Sections 401(a), 401(k) or 403(b) of the Internal Revenue Code, where the plan, for purposes of ERISA, is established or maintained by an employer;

(C) A governmental or church plan defined in Section 414 of the Internal Revenue Code, a governmental or church welfare benefit plan, or a deferred compensation plan of a state or local government or tax exempt organization under Section 457 of the Internal Revenue Code; or

(D) As described in the Internal Revenue Code, a nonqualified deferred compensation arrangement established or maintained by an employer or plan sponsor.

(7) Where new coverage is provided under a life insurance policy or annuity contract and the cost is borne wholly by the insured's employer or by an association of which the insured is a member;

(8) Existing life insurance that is a non-convertible term life insurance policy that will expire in five years or less and cannot be renewed;

(9) Immediate annuities that are purchased with proceeds from an existing contract. Immediate annuities purchased with proceeds from an existing policy are not exempt from the rules in this Section; or

(10) Structured settlements.

(b) Notwithstanding 11 NCAC 12 .0604(a)(6), the rules in this Section apply to policies or contracts used to fund any plan or arrangement that is funded solely by contributions an employee elects to make, whether on a pre-tax or after tax-basis, and where the insurer has been notified that plan participants may chose from among two or more insurers and there is a direct solicitation of an individual employee by an insurance producer for the purchase of a contract or policy. As used in this Paragraph, direct solicitation does not include any group meeting held by an insurance producer solely for the purpose of educating individuals about the plan or arrangement or enrolling individuals in the plan or arrangement, or when initiated by an individual employee, assisting with the selection of investment options offered by a single insurer in connection with enrolling that individual employee.

(c) Registered contracts are exempt from the requirements of 11 NCAC 12 .0606(2) and 12 .0612(a)(2) with respect to the provision of illustrations or policy summaries; however, premium or contract contribution amounts and identification of the appropriate prospectus or offering circular are required instead.

History

  • Authority G.S. 58-2-40; 58-3-115; 58-58-1; 58-58-40
  • Eff. October 1, 1985
  • Amended Eff. February 1, 2008; August 1, 2004; April 8, 2002; November 1, 1989
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0605 DUTIES OF Producers {#sec-11-ncac-12-.0605 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0605}

(a) A producer who initiates an application shall submit to the insurer, with or as part of the application, a statement signed by both the applicant and the producer as to whether the applicant has existing policies or contracts. Electronic capture of signature is acceptable in accordance with The Uniform Electronic Transactions Act, G.S. 66, Article 40. If the answer is "no," the producer's duties with respect to replacement are complete.

(b) If the applicant answered "yes" to the question regarding existing coverage referred to in Paragraph (a) of this Rule, the producer shall present and read to the applicant, not later than at the time of taking the application, a notice regarding replacements in the format required by 11 NCAC 12 .0611. The notice shall be signed by both the applicant and the producer attesting that the notice has been read aloud by the producer or that the applicant did not wish the notice to be read aloud (in which case the producer need not have read the notice aloud) and left with the applicant. If the notice and any required signatures are captured electronically, the notice shall be delivered to the applicant within two business days of receipt by the home office of the insurer.

(c) The notice shall list all life insurance policies or annuities proposed to be replaced, identified by name of insurer, the insured or annuitant, and policy or contract number if available; and shall include a statement as to whether each policy or contract will be replaced or whether a policy will be used as a source of financing for the new policy or contract. If a policy or contract number has not been issued by the existing insurer, alternative identification, such as an application or receipt number, shall be listed.

(d) In connection with a replacement transaction, the producer shall leave with the applicant at the time an application for a new policy or contract is completed the original or a copy of all sales material. With respect to electronically presented sales material, it shall be provided to the policy or contract owner in printed form no later than at the time of policy or contract delivery.

(e) Except as provided in 11 NCAC 12 .0612(c), in connection with a replacement transaction the producer shall submit to the insurer to which an application for a policy or contract is presented, a copy of each document required by this Section, a statement identifying any preprinted or electronically presented company approved sales materials used, and copies of any individualized sales materials, including any illustrations related to the specific policy or contract purchased.

History

  • Authority G.S. 58-2-40; 58-3-115; 58-58-1; 58-58-40
  • Eff. October 1, 1985
  • Amended Eff. August 1, 2004; October 1, 1989
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0606 DUTIES OF the existing insurer {#sec-11-ncac-12-.0606 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0606}

Where a replacement is involved in the transaction, the existing insurer shall:

(1) Retain and be able to produce all replacement notifications received, indexed by replacing insurer, for at least five years or until the conclusion of the next regular examination conducted by the Insurance Department of its state of domicile, whichever is later.

(2) Send a letter to the policy or contract owner of the right to receive information regarding the existing policy or contract values including, if available, an in force illustration. If an in force illustration cannot be produced within five business days after receipt of a notice that an existing policy or contract is being replaced, the insurer shall provide a policy summary. The information shall be provided within five business days after receipt of the request from the policy or contract owner.

(3) Upon receipt of a request to borrow, surrender or withdraw any policy values, send a notice advising the policy owner that the release of policy values may affect the guaranteed elements, non-guaranteed elements, face amount or surrender value of the policy from which the values are released. The notice shall be sent separate from the check if the check is sent to anyone other than the policy owner. When consecutive automatic premium loans are made, the insurer is only required to send the notice at the time of the first loan.

History

  • Authority G.S. 58-2-40; 58-3-115; 58-58-1; 58-58-40
  • Eff. October 1, 1985
  • Amended Eff. August 1, 2004
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0607 DUTIES OF INSURERS THAT USE Producers {#sec-11-ncac-12-.0607 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0607}

Each insurer shall:

(1) Maintain a system of supervision and control to insure compliance with the requirements of the rules in this section that shall include the following:

(a) Information to its producers of the requirements of the rules in this section and incorporation of the requirements of the rules in this Section into all relevant producer training manuals prepared by the insurer;

(b) Provision to each producer of a written statement of the company's position with respect to the acceptability of replacements providing guidance to its producer as to the appropriateness of these transactions;

(c) A system to review the appropriateness of each replacement transaction that the producer does not indicate is in accord with Sub-item (1)(b) of this Rule.

(d) Procedures to confirm that the requirements of the rules in this Section have been met; and

(e) Procedures to detect transactions that are replacements of existing policies or contracts by the existing insurer, but that have not been reported as such by the applicant or producer. Compliance may include systematic customer surveys, interviews, confirmation letters, or programs of internal monitoring;

(2) Have the capacity to monitor each producer's life insurance policy and annuity contract replacements for that insurer, and shall produce, upon request, and make such records available to the Department. The capacity to monitor shall include the ability to produce records for each producer's:

(a) Life replacements, including financed purchases, as a percentage of the producer's total annual sales for life insurance;

(b) Number of lapses of policies by the producer as a percentage of the producer's total annual sales for life insurance;

(c) Annuity contract replacements as a percentage of the producer's total annual annuity contract sales;

(d) Number of transactions that are unreported replacements of existing policies or contracts by the existing insurer detected by the company's monitoring system as required by Sub-item (1)(e) of this Rule; and

(e) Replacements, indexed by replacing producer and existing insurer.

(3) Require with or as a part of each application for life insurance or an annuity a signed statement by both the applicant and the producer as to whether the applicant has existing policies or contracts;

(4) Require with each application for life insurance or an annuity that indicates an existing policy or contract, a completed notice regarding replacements as required in 11 NCAC 12 .0611;

(5) When the applicant has existing policies or contracts, be able to produce copies of any sales material required by 11 NCAC 12 .0605(e), the basic illustration and any supplemental illustrations related to the specific policy or contract that is purchased, and the producer's and applicant's signed statements with respect to financing and replacement for at least five years after the termination or expiration of the proposed policy or contract;

(6) Ascertain that the sales material and illustrations required by 11 NCAC 12 .0605(e) meet the requirements of the rules in this Section and are complete and accurate for the proposed policy or contract;

(7) If an application does not meet the requirements of the rules in this Section, notify the producer and applicant and fulfill the outstanding requirements; and

(8) Maintain records in paper, photograph, micro process, magnetic, mechanical or electronic media or by any process that accurately reproduces the actual document.

History

  • Authority G.S. 58-2-40; 58-3-115; 58-58-1; 58-58-40
  • Eff. October 1, 1985
  • Amended Eff. August 1, 2004; April 8, 2002; November 1, 1989
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0608 Duties of Insurers with Respect to Direct Response Solicitations {#sec-11-ncac-12-.0608 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0608}

(a) In the case of an application that is initiated as a result of a direct response solicitation, the insurer shall require, with or as part of each completed application for a policy or contract, a statement asking whether the applicant, by applying for the proposed policy or contract, intends to replace, discontinue, or change an existing policy or contract. If the applicant indicates a replacement or change is not intended or if the applicant fails to respond to the statement, the insurer shall send the applicant, with the policy or contract, a notice regarding replacement as required in 11 NCAC 12 .0611.

(b) If the insurer has proposed the replacement or if the applicant indicates a replacement is intended and the insurer continues with the replacement, the insurer shall:

(1) Provide to applicants or prospective applicants with the policy or contract a notice, as required in 11 NCAC 12 .0611. In these instances, the insurer may delete the reference to producer, including the producer's signature, and references not applicable to the product being sold or replaced, without having to obtain approval of the form from the Commissioner. The insurer's obligation to obtain the applicant's signature shall be satisfied if it can demonstrate that it has made a diligent effort to secure a signed copy of the notice referred to in this Paragraph. The requirement to make a diligent effort shall be deemed satisfied if the insurer includes in the mailing a self-addressed postage prepaid envelope with instructions for the return of the signed notice referred to in this Section; and

(2) Comply with the requirements of 11 NCAC 12 .0612(a)(2), if the applicant furnishes the names of the existing insurers, and the requirements of 11 NCAC 12 .0612(a)(3), 12 .0612(a)(4), and 12 .0612(b).

History

  • Authority G.S. 58-2-40; 58-3-115; 58-58-1; 58-58-40
  • Eff. October 1, 1985
  • Amended Eff. August 1, 2004; October 1, 1989
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0609 Violations and PENALTIES {#sec-11-ncac-12-.0609 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0609}

(a) Any failure to comply with the rules in this Section shall be considered a violation of G.S. 58-63-15(1). Violations include:

(1) Any deceptive or misleading information set forth in sales material;

(2) Failing to ask the applicant in completing the application the pertinent questions regarding the possibility of financing or replacement;

(3) The intentional incorrect recording of an answer;

(4) Advising an applicant to respond negatively to any question regarding replacement in order to prevent notice to the existing insurer; or

(5) Advising a policy or contract owner to write directly to the company in such a way as to attempt to obscure the identity of the replacing producer or company.

(b) Policy and contract owners may replace existing life insurance policies or annuity contracts after indicating in or as a part of applications for new coverage that replacement is not their intention; however, patterns of such action by policy or contract owners of the same producer shall be deemed prima facie evidence of the producer's knowledge that replacement was intended in connection with the identified transactions, and these patterns of action shall be deemed prima facie evidence of the producer's intent to violate the rules in this Section.

(c) Where it is determined that the requirements of the rules in this Section have not been met, the replacing insurer shall provide to the policy owner:

(1) Either:

(A) An in force illustration if available; or

(B) A policy summary for the replacement policy; or

(C) An available disclosure document for the replacement contract; and

(2) The appropriate notice regarding replacements as required in 11 NCAC 12 .0611.

(d) Violations of the rules in this Section shall subject the violators to penalties that may include the revocation or suspension of a producer's or company's license, monetary fines and the forfeiture of any commissions or compensation paid to a producer as a result of the transaction in connection with which the violations occurred.

History

  • Authority G.S. 58-2-40; 58-3-100; 58-3-115; 58-33-45; 58-33-75; 58-58-1; 58-58-40; 58-63-65
  • Eff. October 1, 1985
  • Amended Eff. August 1, 2004; October 1, 1989
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0610 Severability {#sec-11-ncac-12-.0610 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0610}

If any rule or portion of a rule of this Section, or the applicability thereof to any person or circumstance, is held invalid by a court, the remainder of this Section, or the applicability of such provision to other persons, shall not be affected thereby.

History

  • Authority G.S. 58-2-40; 58-3-115; 58-58-1; 58-58-40
  • Eff. October 1, 1985
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0611 Notice Regarding Replacement {#sec-11-ncac-12-.0611 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0611}

Notice regarding replacement shall be the most current format adopted by the NAIC Life Insurance and Annuities Replacement Model Regulation. A copy of the notice may be obtained at the Department's website: http//www.ncdoi.com/Industry/Life/LAH/RateFilings/Annuity/AppendixABC.pdf or in writing from the Life and Health Division of the North Carolina Department of Insurance at 1201 Mail Service Center, Raleigh, NC 27699-1201.

History

  • Authority G.S. 58-2-40; 58-3-115; 58-58-1; 58-58-40
  • Eff. October 1, 1985
  • Amended Eff. August 1, 2004
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0612 Duties of Replacing Insurers That Use Producers {#sec-11-ncac-12-.0612 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0612}

(a) Where a replacement is involved in a transaction, the replacing insurer shall:

(1) Verify that the required forms are received and are in compliance with the rules in this section.

(2) Notify any other existing insurer that may be affected by the proposed replacement within five business days of receipt of a completed application indicating replacement or when the replacement is identified if not indicated on the application, and mail a copy of the available illustration or policy summary for the proposed policy or available disclosure document for the proposed contract within five business days of a request from an existing insurer;

(3) Be able to produce copies of the notification regarding replacement required in 11 NCAC 12 .0605(b), indexed by producer, for at least five years or until the next regular examination by the insurance department of a company's state of domicile, whichever is later; and

(4) Provide to the policy or contract owner notice of the right to return the policy or contract within 30 days of the delivery of the contract and receive an unconditional full refund of all premiums or considerations paid on it, including any policy fees or charges; or, in the case of a variable or market value adjustment policy or contract, a payment of the cash surrender value provided under the policy or contract plus the fees and other charges deducted from the gross premiums or considerations, or imposed under such policy or contract; such notice may be included in the notice required by 11 NCAC 12 .0611.

(b) In transactions where the replacing insurer and the existing insurer are the same or subsidiaries or affiliates under common ownership or control, the replacing insurer shall allow credit for the period of time that has elapsed under the replaced policy's or contract's incontestability and suicide periods up to the face amount of the existing policy or contract. With regard to financed purchases, the credit may be limited to the amount the face amount of the existing policy is reduced by the use of existing policy values to fund the new policy or contract.

(c) If an insurer prohibits the use of sales material other than that approved by the company, as an alternative to the requirements made of an insurer pursuant to 11 NCAC 12 .0605(e), the insurer may:

(1) Require with each application a statement signed by the producer that:

(A) Represents that the producer used only company-approved sales material; and

(B) States that copies of all sales material were left with the applicant in accordance with 11 NCAC 12 .0605(d); and

(2) Within 10 days of the issuance of the policy or contract:

(A) Notify the applicant by sending a letter or by verbal communication with the applicant by a person whose duties are separate from the marketing area of the insurer, that the producer has represented that copies of all sales material have been left with the applicant in accordance with 11 NCAC 12 .0605(d);

(B) Provide the applicant with a toll free number to contact the company; and

(C) Stress the importance of retaining copies of the sales material for future reference.

(d) An insurer shall retain and be able to produce a copy of the letter or other verification referenced in Part (c)(2)(A) of this Rule in the policy or contract file for at least five years after the termination or expiration of the policy or contract.

History

  • Authority G.S. 58-2-40; 58-3-100; 58-3-115; 58-33-45; 58-33-75; 58-58-1; 58-58-40
  • Eff. August 1, 2004
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0701 Limitation on Amnt of Cr Life/Cr Accident/Health Ins Written {#sec-11-ncac-12-.0701 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0701}

The amount of Credit Life and/or Credit Accident and Health insurance to be written by an insurer may be limited by its underwriting practices.

History

  • Authority G.S. 58-2-40; 58-57-15
  • Eff. May 1, 1989
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0702 Insurer Liability: Premium Accepted from Ineligible Debtor {#sec-11-ncac-12-.0702 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0702}

If any premium is received for Credit Life and Credit Accident and Health insurance on an insured debtor who is not eligible under the terms of the policy, or for excess insurance not covered by the policy, the liability of the insurer may be limited to a refund of the premium or excess premium to the creditor policyholder or the insured debtor. Such refund shall be promptly paid or credited to the person entitled thereto, and the insured debtor shall be notified of such refund and termination of such excess or ineligible insurance; provided, however, that the insurer shall be liable for any valid claims arising prior to such refund of premium and notification to the insured debtor.

History

  • Authority G.S. 58-2-40; 58-57-15
  • Eff. May 1, 1989
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0703 CALCULATION - UNEARNED PREMium REFunds: CRedit LIFE & CRedit ACCIDENT/HEALTH INSurance {#sec-11-ncac-12-.0703 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0703}

For the purpose of calculating refunds on Credit Life and Credit Accident and Health insurance no charge for credit insurance may be made for the first 15 days of a loan month and a full may be charged for 16 days or more of a loan month; or a refund may be made on a pro rate basis for each day within the loan month.

History

  • Authority G.S. 58-2-40; 58-57-50
  • Eff. May 1, 1989
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0704 Misstatement of Age: Credit Life and Health Insurance {#sec-11-ncac-12-.0704 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0704}

The provision on misstatement of age is subject to the incontestible period of the policy.

History

  • Authority G.S. 58-2-40; 58-57-25
  • Eff. April 1, 1989
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0705 REFUND OF UNEARNED PREMium AT DEATH: CRedit LIFE/CRedit ACCIDENT/HEALTH INSurance {#sec-11-ncac-12-.0705 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0705}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-57-50
  • Eff. May 1, 1989
  • Amended Eff. April 8, 2002
  • Repealed Eff. September 1, 2009.
11 NCAC 12 .0706 Suicide: Credit Life Insurance {#sec-11-ncac-12-.0706 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0706}

In the event of the suicide of the insured debtor or the joint insured debtor, if any, sane or insane, within one year after the effective date of this certificate, the insurer shall have no liability with respect to such death except for a refund of the premium paid, provided, that in the event of joint life coverage a refund of premiums shall be forty percent of the premium paid.

History

  • Authority G.S. 58-2-40; 58-57-40
  • Eff. April 1, 1989
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0707 Notice of Claim: Credit Life/Credit Accident/Health Insurance {#sec-11-ncac-12-.0707 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0707}

The claimant under a Credit Life or Credit Accident and Health certificate or policy shall have a minimum of 30 days to give written notice of claim.

History

  • Authority G.S. 58-2-40; 58-57-25
  • Eff. May 1, 1989
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0708 AMOUNT/CRedit LIFE INSurance/TRANSactions OF GREATER THAN 120 MONTHS DURATION {#sec-11-ncac-12-.0708 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0708}

For transactions of greater than 120 months in duration, the initial amount of credit life insurance shall not exceed the amount of contractural indebtedness.

History

  • Authority G.S. 58-2-40; 58-57-15
  • Eff. May 1, 1989
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0709 Uniform Decreasing Coverage: Credit Life {#sec-11-ncac-12-.0709 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0709}

No policy written, on transactions of 60 months or greater in duration, shall incorporate a schedule of benefits which does not follow an amortization schedule.

History

  • Authority G.S. 58-2-40; 58-57-15
  • Eff. April 1, 1989
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0710 Actuarially Equivalent: Credit Life {#sec-11-ncac-12-.0710 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0710}

With respect to G.S. 58-57-40 entitled "Credit Life Insurance Rate Standards", for credit life insurance on a basis other than the foregoing, premiums charged shall be actuarially equivalent, is interpreted by the department to mean that the actuarially equivalent rates must maintain a sixty percent loss ration and must exhibit a composite rate equal to the appropriate prima facie rate. The loss ratio shall be calculated by dividing the present value of future benefits by the present value of future premiums. In calculating the present value both interest and mortality rate used should reflect anticipated company experience.

History

  • Authority G.S. 58-2-40; 58-57-40
  • Eff. April 1, 1989
  • Amended Eff. April 8, 2002
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0711 Motor Vehicle Leases {#sec-11-ncac-12-.0711 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0711}

(a) A motor vehicle lease is eligible for Credit Life and Credit Accident and Health insurance if:

(1) the lessee's has assumed a contractural obligation to make payments as compensation for use of the leased vehicle,

(2) the total of all payments which the lesses is contractually obligated to make for such use either exceeds or is substantially equal to the value of the property when leased, and

(3) the term of the lease does not exceed 15 years.

(b) Where the lessee's contractural obligation includes paying or guaranteeing a lump sum (the "residual amount") at the end of the periodic payment schedule, the insurance may cover the sum of all periodic payments plus the residual amount. The residual amount will be included in determining the total of all payments for purposes of (a) - (b) in this Rule.

(c) Where upon the lessee's death the lessee's estate is obligated to purchase the leased vehicle at a price stated in or determinable under the lease, Credit Life insurance may written to provide a death benefit equal to:

(1) the sum of all remaining periodic payments required under the lease plus any residual amount stated in or determinable under the lease; or

(2) the purchase price at the time of the lessee's death as stated in or determinable under the lease. The sum of all periodic payments together with any lump sum residual amount will be included in determining with the total of purposes of (a) - (b) in this Rule.

(d) Where neither the lessee's not the lessee's estate has any obligation with regard to purchase of the leased vehicle or payment or guarantee of any residual amount, Credit Life insurance may be written to provide a death benefit which is equal to the sum of all remaining periodic installments required under the terms of the lease.

(e) Credit Accident and Health insurance may be written to cover only the periodic payments required under the lease.

(f) In addition to all other applicable requirements for Credit Life insurance and Credit Accident and Health insurance, and subject to (a) - (e) in this Rule, the following information must be fully disclosed in the certificate or the policy of insurance and the lease contract when Credit Life or Credit Accident and Health insurance is provided in connection with a leasing contract:

(1) the identity of the lessee, designated as such;

(2) the identity of any co-lessee, designated as such;

(3) the identity of the lessor, designated as such;

(4) the amount of the periodic lease payment being insured;

(5) the residual amount, if any, insured for Credit Life insurance;

(6) the premium for Credit Life insurance on periodic payments under the lease (if provided);

(7) the premium for Credit Life insurance on any residual amount (if provided);

(8) the premium, if any, for Credit Accident and Health insurance under the lease (if provided).

(g) Whenever a Credit Life insurance certificate or policy provides or may provide Credit Life insurance applicable to a residual amount, such policy or certificate shall include a disclosure as to whether Credit Life insurance is or is not applicable to the residual amount or a statement describing the conditions under which Credit Life insurance will apply to the residual amount.

History

  • Authority G.S. 58-2-40; 58-57-1; 58-57-5
  • Eff. April 1, 1989
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0712 Truncated Coverage Notice {#sec-11-ncac-12-.0712 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0712}

The following notice must appear in bold print on the face of the individual policy or certificate of truncated credit insurance:

NOTICE: The death benefit in this policy may not completely pay off your loan. If the term of your loan is longer than the term of this insurance, the death benefit is only payable if death occurs during the term of the insurance. Total disability benefits will not be paid for any period of total disability continuing after the termination date shown in the schedule.

History

  • Authority G.S. 58-2-40; 58-57-20; 58-57-70
  • Eff. January 1, 1994
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0713 Revolving or Open-End Credit Insurance {#sec-11-ncac-12-.0713 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0713}

The following notice must appear in bold print on the face of an individual policy or certificate of credit insurance written under G.S. 58-57-105 to address the effective date and termination date of coverage:

NOTICE: Coverage will begin when your account has an open balance and will continue, subject to other provisions in this policy, as long as your account has an open balance. No premium will be charged when your account does not have an open balance. Premium charges will automatically resume when your account has another open balance, subject to the termination provisions in this policy.

History

  • Authority G.S. 58-2-40; 58-57-70; 58-57-105
  • Eff. January 1, 1994
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0714 Refund of Unearned Premium for Credit Insurance {#sec-11-ncac-12-.0714 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0714}

If credit life insurance coverage is sold together with any other credit insurance coverage, such as accident and health, and death occurs, then as of the date of death the credit life insurance premium is deemed to be fully earned, but the other credit insurance coverage(s) shall provide for a refund of unearned premium. Such refund shall be made in accordance with the provisions of G.S. 58-57-50.

History

  • Authority G.S. 58-2-40; 58-57-50
  • Eff. July 1, 2010
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0801 Purpose {#sec-11-ncac-12-.0801 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0801}

History

  • Status: repealed
  • Filed as a Temporary Repeal Eff. June 13, 1990, for a period of 180 days to expire on
  • December 10, 1990
  • Filed as a Temporary Rule Eff. August 31, 1989 for a period of 180 days to expire on
  • February 26, 1990
  • Authority G.S. 58-9; 58-710; 58-711; 58-712; 58-713; 58-714; 58-715; 58-717
  • Eff. February 1, 1990
  • Repealed Eff. December 1, 1990.
11 NCAC 12 .0802 Applicability and Scope {#sec-11-ncac-12-.0802 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0802}

History

  • Status: repealed
  • Filed as a Temporary Repeal Eff. June 13, 1990, for a period of 180 days to expire on
  • December 10, 1990
  • Filed as a Temporary Rule Eff. August 31, 1989 for a period of 180 days to expire on
  • February 26, 1990
  • Authority G.S. 58-9; 58-710; 58-711; 58-712; 58-713; 58-714; 58-715; 58-717
  • Eff. February 1, 1990
  • Repealed Eff. December 1, 1990.
11 NCAC 12 .0803 Definitions {#sec-11-ncac-12-.0803 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0803}

History

  • Status: repealed
  • Filed as a Temporary Repeal Eff. June 13, 1990, for a period of 180 days to expire on
  • December 10, 1990
  • Filed as a Temporary Rule Eff. August 31, 1989 for a period of 180 days to expire on
  • February 26, 1990
  • Authority G.S. 58-9; 58-710; 58-711; 58-712; 58-713; 58-714; 58-715; 58-717
  • Eff. February 1, 1990
  • Repealed Eff. December 1, 1990.
11 NCAC 12 .0804 Policy Definitions and Terms {#sec-11-ncac-12-.0804 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0804}

History

  • Status: repealed
  • Filed as a Temporary Repeal Eff. June 13, 1990, for a period of 180 days to expire on
  • December 10, 1990
  • Filed as a Temporary Rule Eff. August 31, 1989 for a period of 180 days to expire on
  • February 26, 1990
  • Authority G.S. 58-9; 58-710; 58-711; 58-712; 58-713; 58-714; 58-715; 58-717
  • Eff. February 1, 1990
  • Repealed Eff. December 1, 1990.
11 NCAC 12 .0805 Prohibited Policy Provisions {#sec-11-ncac-12-.0805 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0805}

History

  • Status: repealed
  • Filed as a Temporary Repeal Eff. June 13, 1990, for a period of 180 days to expire on
  • December 10, 1990
  • Filed as a Temporary Rule Eff. August 31, 1989 for a period of 180 days to expire on
  • February 26, 1990
  • Authority G.S. 58-9; 58-710; 58-711; 58-712; 58-713; 58-714; 58-715; 58-717
  • Eff. February 1, 1990
  • Repealed Eff. December 1, 1990.
11 NCAC 12 .0806 Minimum Benefit Standards {#sec-11-ncac-12-.0806 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0806}

History

  • Status: repealed
  • Filed as a Temporary Repeal Eff. June 13, 1990, for a period of 180 days to expire on
  • December 10, 1990
  • Filed as a Temporary Rule Eff. August 31, 1989 for a period of 180 days to expire on
  • February 26, 1990
  • Authority G.S. 58-9; 58-710; 58-711; 58-712; 58-713; 58-714; 58-715; 58-717
  • Eff. February 1, 1990
  • Repealed Eff. December 1, 1990.
11 NCAC 12 .0807 Standards for Claims Payment {#sec-11-ncac-12-.0807 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0807}

History

  • Status: repealed
  • Filed as a Temporary Repeal Eff. June 13, 1990, for a period of 180 days to expire on
  • December 10, 1990
  • Filed as a Temporary Rule Eff. August 31, 1989 for a period of 180 days to expire on
  • February 26, 1990
  • Authority G.S. 58-9; 58-710; 58-711; 58-712; 58-713; 58-714; 58-715; 58-717
  • Eff. February 1, 1990
  • Repealed Eff. December 1, 1990.
11 NCAC 12 .0808 Loss Ratio Standards {#sec-11-ncac-12-.0808 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0808}

History

  • Status: repealed
  • Filed as a Temporary Repeal Eff. June 13, 1990, for a period of 180 days to expire on
  • December 10, 1990
  • Filed as a Temporary Rule Eff. August 31, 1989 for a period of 180 days to expire on
  • February 26, 1990
  • Authority G.S. 58-9; 58-710; 58-711; 58-712; 58-713; 58-714; 58-715; 58-717
  • Eff. February 1, 1990
  • Repealed Eff. December 1, 1990.
11 NCAC 12 .0809 Filing Requirements for Out-of-State Group Policies {#sec-11-ncac-12-.0809 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0809}

History

  • Status: repealed
  • Filed as a Temporary Repeal Eff. June 13, 1990, for a period of 180 days to expire on
  • December 10, 1990
  • Filed as a Temporary Rule Eff. August 31, 1989 for a period of 180 days to expire on
  • February 26, 1990
  • Authority G.S. 58-9; 58-710; 58-711; 58-712; 58-713; 58-714; 58-715; 58-717
  • Eff. February 1, 1990
  • Repealed Eff. December 1, 1990.
11 NCAC 12 .0810 Prohibited Compensation for Replacement with the Same Co {#sec-11-ncac-12-.0810 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0810}

History

  • Status: repealed
  • Filed as a Temporary Repeal Eff. June 13, 1990, for a period of 180 days to expire on
  • December 10, 1990
  • Filed as a Temporary Rule Eff. August 31, 1989 for a period of 180 days to expire on
  • February 26, 1990
  • Authority G.S. 58-9; 58-710; 58-711; 58-712; 58-713; 58-714; 58-715; 58-717
  • Eff. February 1, 1990
  • Repealed Eff. December 1, 1990.
11 NCAC 12 .0811 Required Disclosure Provisions {#sec-11-ncac-12-.0811 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0811}

History

  • Status: repealed
  • Filed as a Temporary Repeal Eff. June 13, 1990, for a period of 180 days to expire on
  • December 10, 1990
  • Filed as a Temporary Rule Eff. August 31, 1989 for a period of 180 days to expire on
  • February 26, 1990
  • Authority G.S. 58-9; 58-710; 58-711; 58-712; 58-713; 58-714; 58-715; 58-717
  • Eff. February 1, 1990
  • Repealed Eff. December 1, 1990.
11 NCAC 12 .0812 Requirements for Replacement {#sec-11-ncac-12-.0812 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0812}

History

  • Status: repealed
  • Filed as a Temporary Repeal Eff. June 13, 1990, for a period of 180 days to expire on
  • December 10, 1990
  • Filed as a Temporary Rule Eff. August 31, 1989 for a period of 180 days to expire on
  • February 26, 1990
  • Authority G.S. 58-9; 58-710; 58-711; 58-712; 58-713; 58-714; 58-715; 58-717
  • Eff. February 1, 1990
  • Repealed Eff. December 1, 1990.
11 NCAC 12 .0813 Filing Requirements for Advertising {#sec-11-ncac-12-.0813 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0813}

History

  • Status: repealed
  • Filed as a Temporary Repeal Eff. June 13, 1990, for a period of 180 days to expire on
  • December 10, 1990
  • Filed as a Temporary Rule Eff. August 31, 1989 for a period of 180 days to expire on
  • February 26, 1990
  • Authority G.S. 58-9; 58-710; 58-711; 58-712; 58-713; 58-714; 58-715; 58-717
  • Eff. February 1, 1990
  • Repealed Eff. December 1, 1990.
11 NCAC 12 .0814 Forms {#sec-11-ncac-12-.0814 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0814}

History

  • Status: repealed
  • Filed as a Temporary Repeal Eff. June 13, 1990, for a period of 180 days to expire on
  • December 10, 1990
  • Filed as a Temporary Rule Eff. August 31, 1989 for a period of 180 days to expire on
  • February 26, 1990
  • Authority G.S. 58-9; 58-710; 58-711; 58-712; 58-713; 58-714; 58-715; 58-717
  • Eff. February 1, 1990
  • Repealed Eff. December 1, 1990.
11 NCAC 12 .0815 Purpose and Definitions {#sec-11-ncac-12-.0815 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0815}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-54-5; 58-54-10; 58-54-15; 58-54-25; 58-54-50
  • Temporary Adoption Eff. June 13, 1990, for a period of 180 days to expire on December 10, 1990
  • Eff. December 1, 1990
  • Temporary Amendment Eff. October 16, 1991 for a period of 180 days to expire on April 13, 1992
  • Amended Eff. March 1, 1992
  • Temporary Amendment Eff. February 1, 2002
  • Amended Eff. April 1, 2003
  • Repealed Eff. December 31, 2005.
11 NCAC 12 .0816 Applicability and Scope {#sec-11-ncac-12-.0816 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0816}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-54-5; 58-54-10; 58-54-15; 58-54-25; 58-54-50
  • Temporary Adoption Eff. June 13, 1990, for a period of 180 days to expire on December 10, 1990
  • Eff. December 1, 1990
  • Temporary Amendment Eff. October 16, 1991 for a period of 180 days to expire on April 13, 1992
  • Amended Eff. March 1, 1992
  • Temporary Amendment Eff. February 1, 2002
  • Amended Eff. April 1, 2003
  • Repealed Eff. December 31, 2005.
11 NCAC 12 .0817 Definitions {#sec-11-ncac-12-.0817 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0817}

History

  • Status: expired
  • Filed as a Temporary Adoption Eff. June 13, 1990, for a period of 180 days to expire on
  • December 10, 1990
  • ARRC Objection Lodged July 19, 1990
  • Authority G.S. 58-2-40; 58-54-1
  • Expired on December 10, 1990.
11 NCAC 12 .0818 Policy Definitions and Terms {#sec-11-ncac-12-.0818 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0818}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-54-5; 58-54-10; 58-54-15; 58-54-50
  • Temporary Adoption Eff. June13, 1990 for a period of 180 days to expire on December 10, 1990
  • Eff. December 1, 1990
  • Temporary Amendment Eff. October 16, 1991 for a period of 180 days to expire on April 13, 1992
  • Amended Eff. August 3, 1992; March 1, 1992
  • Temporary Amended Eff. February 1, 2002
  • Amended Eff. April 1, 2003
  • Repealed Eff. December 31, 2005.
11 NCAC 12 .0819 Policy Provisions {#sec-11-ncac-12-.0819 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0819}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-54-5; 58-54-10; 58-54-15; 58-54-50
  • Temporary Adoption Eff. June13, 1990 for a period of 180 days to expire on December 10, 1990
  • Eff. December 1, 1990
  • Temporary Amendment Eff. October 16, 1991 for a period of 180 days to expire on April 13, 1992
  • Amended Eff. August 3, 1992; March 1, 1992
  • Temporary Amended Eff. February 1, 2002
  • Amended Eff. April 1, 2003
  • Repealed Eff. December 31, 2005.
11 NCAC 12 .0820 Minimum Benefit Standards Before January 1, 1992 {#sec-11-ncac-12-.0820 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0820}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-54-5; 58-54-10; 58-54-15; 58-54-50
  • Temporary Adoption Eff. June13, 1990 for a period of 180 days to expire on December 10, 1990
  • Eff. December 1, 1990
  • Temporary Amendment Eff. October 16, 1991 for a period of 180 days to expire on April 13, 1992
  • Amended Eff. August 3, 1992; March 1, 1992
  • Temporary Amended Eff. February 1, 2002
  • Amended Eff. April 1, 2003
  • Repealed Eff. December 31, 2005.
11 NCAC 12 .0821 Standards for claims payment {#sec-11-ncac-12-.0821 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0821}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-54-5; 58-54-10; 58-54-15; 58-54-50
  • Temporary Adoption Eff. June13, 1990 for a period of 180 days to expire on December 10, 1990
  • Eff. December 1, 1990
  • Temporary Amendment Eff. October 16, 1991 for a period of 180 days to expire on April 13, 1992
  • Amended Eff. August 3, 1992; March 1, 1992
  • Temporary Amended Eff. February 1, 2002
  • Amended Eff. April 1, 2003
  • Repealed Eff. December 31, 2005.
11 NCAC 12 .0822 Loss Ratio Standards and Refund or Credit of Premium {#sec-11-ncac-12-.0822 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0822}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-54-5; 58-54-10; 58-54-15; 58-54-50
  • Temporary Adoption Eff. June13, 1990 for a period of 180 days to expire on December 10, 1990
  • Eff. December 1, 1990
  • Temporary Amendment Eff. October 16, 1991 for a period of 180 days to expire on April 13, 1992
  • Amended Eff. August 3, 1992; March 1, 1992
  • Temporary Amended Eff. February 1, 2002
  • Amended Eff. April 1, 2003
  • Repealed Eff. December 31, 2005.
11 NCAC 12 .0823 Filing Requirements for Out-of-State Group Policies {#sec-11-ncac-12-.0823 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0823}

History

  • Status: repealed
  • Filed as a Temporary Repeal Eff. October 16, 1991 for a period of 180 days to expire on
  • April 13, 1992
  • Filed as a Temporary Adoption Eff. June 13, 1990, for a period of 180 days to expire on
  • December 10, 1990
  • Authority G.S. 58-2-40; 58-54-20
  • Eff. December 1, 1990
  • Repealed Eff. March 1, 1992.
11 NCAC 12 .0824 Required Disclosure Provisions {#sec-11-ncac-12-.0824 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0824}

History

  • Status: repealed
  • Authority G.S. 58-2-40, 58-54-25; 58-54-35
  • Temporary Adoption Eff. June 13, 1990 for a period of 180 days to expire on December 10, 1990
  • Eff. December 1, 1990
  • Temporary Amendment Eff. October 16, 1991 for a period of 180 days to expire on April 13, 1992
  • Amended Eff. February 1, 1996; August 3, 1992; March 1, 1992
  • Repealed Eff. December 31, 2005.
11 NCAC 12 .0825 Requirements for Application Forms and Replacement Coverage {#sec-11-ncac-12-.0825 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0825}

History

  • Status: repealed
  • Authority G.S. 58-2-40, 58-54-25; 58-54-35
  • Temporary Adoption Eff. June 13, 1990 for a period of 180 days to expire on December 10, 1990
  • Eff. December 1, 1990
  • Temporary Amendment Eff. October 16, 1991 for a period of 180 days to expire on April 13, 1992
  • Amended Eff. February 1, 1996; August 3, 1992; March 1, 1992
  • Repealed Eff. December 31, 2005.
11 NCAC 12 .0826 Filing Requirements for Advertising {#sec-11-ncac-12-.0826 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0826}

History

  • Status: repealed
  • Authority G.S. 58-2-40, 58-54-25; 58-54-35
  • Temporary Adoption Eff. June 13, 1990 for a period of 180 days to expire on December 10, 1990
  • Eff. December 1, 1990
  • Temporary Amendment Eff. October 16, 1991 for a period of 180 days to expire on April 13, 1992
  • Amended Eff. February 1, 1996; August 3, 1992; March 1, 1992
  • Repealed Eff. December 31, 2005.
11 NCAC 12 .0827 Standards for Marketing {#sec-11-ncac-12-.0827 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0827}

History

  • Status: repealed
  • Authority G.S. 58-2-40, 58-54-25; 58-54-35
  • Temporary Adoption Eff. June 13, 1990 for a period of 180 days to expire on December 10, 1990
  • Eff. December 1, 1990
  • Temporary Amendment Eff. October 16, 1991 for a period of 180 days to expire on April 13, 1992
  • Amended Eff. February 1, 1996; August 3, 1992; March 1, 1992
  • Repealed Eff. December 31, 2005.

History

  • Status: repealed
  • Authority G.S. 58-2-40, 58-54-25; 58-54-35
  • Temporary Adoption Eff. June 13, 1990 for a period of 180 days to expire on December 10, 1990
  • Eff. December 1, 1990
  • Temporary Amendment Eff. October 16, 1991 for a period of 180 days to expire on April 13, 1992
  • Amended Eff. February 1, 1996; August 3, 1992; March 1, 1992
  • Repealed Eff. December 31, 2005.
11 NCAC 12 .0829 Reporting of Multiple Policies {#sec-11-ncac-12-.0829 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0829}

History

  • Status: repealed
  • Authority G.S. 58-2-40, 58-54-25; 58-54-35
  • Temporary Adoption Eff. June 13, 1990 for a period of 180 days to expire on December 10, 1990
  • Eff. December 1, 1990
  • Temporary Amendment Eff. October 16, 1991 for a period of 180 days to expire on April 13, 1992
  • Amended Eff. February 1, 1996; August 3, 1992; March 1, 1992
  • Repealed Eff. December 31, 2005.
11 NCAC 12 .0830 Prohibitions in Replacement Policies or Certificates {#sec-11-ncac-12-.0830 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0830}

History

  • Status: repealed
  • Authority G.S. 58-2-40, 58-54-25; 58-54-35
  • Temporary Adoption Eff. June 13, 1990 for a period of 180 days to expire on December 10, 1990
  • Eff. December 1, 1990
  • Temporary Amendment Eff. October 16, 1991 for a period of 180 days to expire on April 13, 1992
  • Amended Eff. February 1, 1996; August 3, 1992; March 1, 1992
  • Repealed Eff. December 31, 2005.
11 NCAC 12 .0831 Medicare Supplement Annual Report {#sec-11-ncac-12-.0831 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0831}

History

  • Status: repealed
  • Filed as a Temporary Repeal Eff. October 16, 1991 for a period of 180 days to expire on
  • April 13, 1992
  • Filed as a Temporary Adoption Eff. June 13, 1990, for a period of 180 days to expire on
  • December 10, 1990
  • Authority G.S. 58-2-40; 58-54-10; 58-54-15; 58-54-25; 58-54-35
  • Eff. December 1, 1990
  • Repealed Eff. March 1, 1992.
11 NCAC 12 .0832 Notice Forms {#sec-11-ncac-12-.0832 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0832}

History

  • Status: repealed
  • Filed as a Temporary Repeal Eff. October 16, 1991 for a period of 180 days to expire on
  • April 13, 1992
  • Filed as a Temporary Adoption Eff. June 13, 1990, for a period of 180 days to expire on
  • December 10, 1990
  • Authority G.S. 58-2-40; 58-54-10; 58-54-15; 58-54-25; 58-54-35
  • Eff. December 1, 1990
  • Repealed Eff. March 1, 1992.
11 NCAC 12 .0833 Benefit Conversion Requirements During Transition {#sec-11-ncac-12-.0833 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0833}

History

  • Status: repealed
  • Filed as a Temporary Repeal Eff. October 16, 1991 for a period of 180 days to expire on
  • April 13, 1992
  • Filed as a Temporary Adoption Eff. June 13, 1990, for a period of 180 days to expire on
  • December 10, 1990
  • Authority G.S. 58-2-40; 58-54-10; 58-54-15; 58-54-25; 58-54-35
  • Eff. December 1, 1990
  • Repealed Eff. March 1, 1992.
11 NCAC 12 .0834 Permitted Compensation Arrangements {#sec-11-ncac-12-.0834 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0834}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-54-15
  • Temporary Rule Eff. August 17, 1990, for a period of 180 days to expire on
  • February 13, 1991
  • Eff. February 1, 1991
  • Temporary Amendment Eff. October 16, 1991 for a period of 180 days to expire
  • on April 13, 1992
  • Amended Eff. March 1, 1992
  • Repealed Eff. December 31, 2005.
11 NCAC 12 .0835 Minimum Benefit Standards on or After January 1, 1992 {#sec-11-ncac-12-.0835 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0835}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-54-10; 58-54-15; 58-54-20; 58-54-50
  • Temporary Adoption Eff. October 16, 1991 for a period of 180 days to expire on April 13, 1992
  • Eff. March 1, 1992
  • Amended Eff. February 1, 1996
  • Temporary Amendment Eff. February 1, 2002
  • Amended Eff. April 1, 2003
  • Repealed Eff. December 31, 2005.
11 NCAC 12 .0836 Standard Medicare Supplement Benefit Plans {#sec-11-ncac-12-.0836 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0836}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-54-10; 58-54-15; 58-54-20; 58-54-50
  • Temporary Adoption Eff. October 16, 1991 for a period of 180 days to expire on April 13, 1992
  • Eff. March 1, 1992
  • Amended Eff. February 1, 1996
  • Temporary Amendment Eff. February 1, 2002
  • Amended Eff. April 1, 2003
  • Repealed Eff. December 31, 2005.
11 NCAC 12 .0837 Open Enrollment {#sec-11-ncac-12-.0837 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0837}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-54-10; 58-54-15; 58-54-20; 58-54-50
  • Temporary Adoption Eff. October 16, 1991 for a period of 180 days to expire on April 13, 1992
  • Eff. March 1, 1992
  • Amended Eff. February 1, 1996
  • Temporary Amendment Eff. February 1, 2002
  • Amended Eff. April 1, 2003
  • Repealed Eff. December 31, 2005.
11 NCAC 12 .0838 Filing and Approval of Policies/Certificates and Premium Rates {#sec-11-ncac-12-.0838 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0838}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-54-10; 58-54-15; 58-54-20; 58-54-50
  • Temporary Adoption Eff. October 16, 1991 for a period of 180 days to expire on April 13, 1992
  • Eff. March 1, 1992
  • Amended Eff. February 1, 1996
  • Temporary Amendment Eff. February 1, 2002
  • Amended Eff. April 1, 2003
  • Repealed Eff. December 31, 2005.
11 NCAC 12 .0839 Medicare Select Policies and Certificates {#sec-11-ncac-12-.0839 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0839}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-54-10; 58-54-15; 58-54-25
  • Eff. February 1, 1996
  • Repealed Eff. December 31, 2005.
11 NCAC 12 .0840 High Deductible Plans {#sec-11-ncac-12-.0840 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0840}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-54-10; 58-54-15; 58-54-25; 58-54-50
  • Temporary Adoption Eff. August 1, 1998
  • Eff. April 1, 1999
  • Temporary Amendment Eff. February 1, 2002
  • Amended Eff. April 1, 2003
  • Repealed Eff. December 31, 2005.
11 NCAC 12 .0841 creditable coverage {#sec-11-ncac-12-.0841 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0841}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-54-10; 58-54-15; 58-54-25; 58-54-50
  • Temporary Adoption Eff. August 1, 1998
  • Eff. April 1, 1999
  • Temporary Amendment Eff. February 1, 2002
  • Amended Eff. April 1, 2003
  • Repealed Eff. December 31, 2005.
11 NCAC 12 .0842 Guaranteed Issue for Eligible Persons {#sec-11-ncac-12-.0842 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0842}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-54-10; 58-54-15; 58-54-25; 58-54-50
  • Temporary Adoption Eff. August 1, 1998
  • Eff. April 1, 1999
  • Temporary Amendment Eff. February 1, 2002
  • Amended Eff. April 1, 2003
  • Repealed Eff. December 31, 2005.
11 NCAC 12 .0843 Naic Medicare Supplement Insurance Minimum Standards Model Act {#sec-11-ncac-12-.0843 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0843}

(a) The North Carolina Department of Insurance incorporates by reference, including subsequent amendments and editions, the National Association of Insurance Commissioners Medicare Supplement Insurance Minimum Standards Model Act, Model No. 651. Copies of this Act may be obtained from: The National Association of Insurance Commissioners, 2301 McGee Street, Kansas City, MO 64108-1662; the North Carolina Department of Insurance, Life & Health Division, 1201 Mail Service Center, Raleigh, NC 27699-1201; and from the Department of Insurance web page: http://www.ncdoi.com/.

(b) Section 7 of Model No. 651 shall apply to policies or certificates issued for delivery in North Carolina before January 1, 1992.

(c) Section 8 of Model No. 651 shall apply to policies or certificates issued for delivery in North Carolina on or after January 1, 1992.

(d) For purposes of this rule, Section 8A(7)(c) of Model No. 651 shall read as follows:

Each Medicare supplement policy shall provide that benefits and premiums under the policy shall be suspended (for any period that may be provided by federal regulation) at the request of the policyholder if the policyholder is entitled to benefits under Section 226(b) of the Social Security Act and is covered under a group health plan (as defined in Section 1862(b)(1)(A)(v) of the Social Security Act). If suspension occurs and if the policyholder or certificate holder loses coverage under the group health plan, the policy shall be automatically reinstituted (effective as of the date of loss of coverage) if the policyholder provides notice of loss of coverage within 90 days after the date of the loss and pays the premium attributable to the period effective as of the date of termination of enrollment in the group health plan.

(e) The applicable effective dates for Section 14B(3) of Model No. 651 are October 16, 1991, December 1, 1995, and May 31, 1997.

(f) Insurers shall use the Appendices of Model No. 651 for reporting and disclosure formats.

(g) This Rule applies to policies issued, renewed, or reinstated on or after January 1, 2006.

History

  • Authority G.S. 58-2-40; 58-54-10; 58-54-15; 58-54-25; 58-54-50
  • Eff. August 1, 2005
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .0901 Organizational Structure {#sec-11-ncac-12-.0901 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0901}

History

  • Status: repealed
  • Authority G.S. 58-2-40(1); 58-50-60
  • Eff. June 1, 1996
  • Repealed Eff. January 1, 1998 pursuant to S.L. 1997-5 s. 4.4.
11 NCAC 12 .0902 Definitions {#sec-11-ncac-12-.0902 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0902}

History

  • Status: repealed
  • Authority G.S. 58-2-40(1); 58-50-60
  • Eff. February 1, 1991
  • Repealed Eff. January 1, 1998 pursuant to S.L. 1997-5 s. 4.4.
11 NCAC 12 .0903 Application to and Compliance by Payers {#sec-11-ncac-12-.0903 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0903}

History

  • Status: repealed
  • Authority G.S. 58-2-40(1); 58-50-60
  • Eff. February 1, 1991
  • Repealed Eff. January 1, 1998 pursuant to S.L. 1997-5 s. 4.4.
11 NCAC 12 .0904 Requirements for Utilization Review {#sec-11-ncac-12-.0904 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0904}

History

  • Status: repealed
  • Authority G.S. 58-2-40(1); 58-50-60
  • Eff. March 1, 1991
  • Repealed Eff. January 1, 1998 pursuant to S.L. 1997-5 s. 4.4.
11 NCAC 12 .0905 Utilization Review Plan {#sec-11-ncac-12-.0905 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0905}

History

  • Status: repealed
  • Authority G.S. 58-2-40(1); 58-50-60
  • Eff. February 1, 1991
  • Repealed Eff. January 1, 1998 pursuant to S.L. 1997-5 s. 4.4.
11 NCAC 12 .0906 Minimum Standards for Utilization Review Entities {#sec-11-ncac-12-.0906 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0906}

History

  • Status: repealed
  • Authority G.S. 58-2-40(1); 58-50-60
  • Eff. February 1, 1991
  • Repealed Eff. January 1, 1998 pursuant to S.L. 1997-5 s. 4.4.
11 NCAC 12 .0907 Accessibility {#sec-11-ncac-12-.0907 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0907}

History

  • Status: repealed
  • Authority G.S. 58-2-40(1); 58-50-60
  • Eff. February 1, 1991
  • Repealed Eff. January 1, 1998 pursuant to S.L. 1997-5 s. 4.4.
11 NCAC 12 .0908 Standard Data Elements {#sec-11-ncac-12-.0908 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0908}

History

  • Status: repealed
  • Authority G.S. 58-2-40(1); 58-50-60
  • Eff. February 1, 1991
  • Repealed Eff. January 1, 1998 pursuant to S.L. 1997-5 s. 4.4.
11 NCAC 12 .0909 Medical Criteria {#sec-11-ncac-12-.0909 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0909}

History

  • Status: repealed
  • Authority G.S. 58-2-40(1); 58-50-60
  • Eff. February 1, 1991
  • Repealed Eff. January 1, 1998 pursuant to S.L. 1997-5 s. 4.4.
11 NCAC 12 .0910 Noncertification {#sec-11-ncac-12-.0910 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0910}

History

  • Status: repealed
  • Authority G.S. 58-2-40(1); 58-50-60
  • Eff. February 1, 1991
  • Repealed Eff. January 1, 1998 pursuant to S.L. 1997-5 s. 4.4.
11 NCAC 12 .0911 Emergencies; Waivers; Extensions; Confidentiality {#sec-11-ncac-12-.0911 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0911}

History

  • Status: repealed
  • Authority G.S. 58-2-40(1); 58-50-60
  • Eff. February 1, 1991
  • Repealed Eff. January 1, 1998 pursuant to S.L. 1997-5 s. 4.4.
11 NCAC 12 .0912 Education of Insureds About Review Requirements {#sec-11-ncac-12-.0912 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0912}

History

  • Status: repealed
  • Authority G.S. 58-2-40(1); 58-50-60
  • Eff. February 1, 1991
  • Repealed Eff. January 1, 1998 pursuant to S.L. 1997-5 s. 4.4.
11 NCAC 12 .0913 Identification Cards, Certificates, and Booklets {#sec-11-ncac-12-.0913 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0913}

History

  • Status: repealed
  • Authority G.S. 58-2-40(1); 58-50-60
  • Eff. February 1, 1991
  • Repealed Eff. January 1, 1998 pursuant to S.L. 1997-5 s. 4.4.
11 NCAC 12 .0914 Appeals of Noncertification {#sec-11-ncac-12-.0914 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0914}

History

  • Status: repealed
  • Authority G.S. 58-2-40(1); 58-50-60
  • Eff. February 1, 1991
  • Repealed Eff. January 1, 1998 pursuant to S.L. 1997-5 s. 4.4.
11 NCAC 12 .0915 Records; Examinations; Telephone Audits {#sec-11-ncac-12-.0915 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0915}

History

  • Status: repealed
  • Authority G.S. 58-2-40(1); 58-50-60
  • Eff. February 1, 1991
  • Repealed Eff. January 1, 1998 pursuant to S.L. 1997-5 s. 4.4.
11 NCAC 12 .0916 Prohibited Acts {#sec-11-ncac-12-.0916 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0916}

History

  • Status: repealed
  • Authority G.S. 58-2-40(1); 58-50-60
  • Eff. February 1, 1991
  • Repealed Eff. January 1, 1998 pursuant to S.L. 1997-5 s. 4.4.
11 NCAC 12 .0917 Report on Utilization Review Experience {#sec-11-ncac-12-.0917 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0917}

History

  • Status: repealed
  • Authority G.S. 58-2-40(1); 58-50-60
  • Eff. February 1, 1991
  • Repealed Eff. January 1, 1998 pursuant to S.L. 1997-5 s. 4.4.
11 NCAC 12 .0918 Written Utilization Review Plan {#sec-11-ncac-12-.0918 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0918}

History

  • Status: repealed
  • Authority G.S. 58-2-40(1); 58-50-60
  • Eff. June 1, 1996
  • Repealed Eff. January 1, 1998 pursuant to S.L. 1997-5 s. 4.4.
11 NCAC 12 .0919 Telephone Accessibility Standards {#sec-11-ncac-12-.0919 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .0919}

History

  • Status: repealed
  • Authority G.S. 58-2-40(1); 58-50-60
  • Eff. June 1, 1996
  • Repealed Eff. January 1, 1998 pursuant to S.L. 1997-5 s. 4.4.
11 NCAC 12 .1001 Applicability and Scope {#sec-11-ncac-12-.1001 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .1001}

History

  • Status: repealed
  • Authority G.S. 58-2-40(1); 58-55-30(a)
  • Eff. September 1, 1990
  • Repealed Eff. April 1, 1995.
11 NCAC 12 .1002 Definitions {#sec-11-ncac-12-.1002 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .1002}

(a) As used in this Section, "insurer" means an entity licensed under G.S. 58 that writes long-term care insurance.

(b) As used in this Section, "exceptional increase" means only those increases filed by an insurer as exceptional for which the Commissioner determines the need for the premium rate increase is justified: due to changes in laws or rules applicable to long-term care coverage in this state; or due to increased and unexpected utilization that affects the majority of insurers of similar products. Except as provided in 11 NCAC 12 .1028, exceptional increases are subject to the same requirements as other premium rate schedule increases. The Commissioner may request a review by an independent actuary or a professional actuarial body of the basis for a request that an increase be considered an exceptional increase. The Commissioner, in determining that the necessary basis for an exceptional increase exists, shall also determine any potential offsets to higher claim costs.

(c) As used in 11 NCAC 12 .1028(k), "incidental" means that the value of the long-term care benefits provided is less than ten percent of the total value of the benefits provided over the life of the policy. These values shall be measured as of the date of issue.

(d) As used in this Section, "qualified actuary" means a member in good standing of the American Academy of Actuaries.

(e) As used in this Section, "similar policy forms" means all of the long-term care insurance policies and certificates issued by an insurer in the same long-term care benefit classification as the policy form being considered. Certificates of groups that meet the definition in G.S. 58-55-20(3)a. are not considered similar to certificates or policies otherwise issued as long-term care insurance, but are similar to other comparable certificates with the same long-term care benefit classifications. For purposes of determining similar policy forms, long-term care benefit classifications are defined as follows: institutional long-term care benefits only, non-institutional long-term care benefits only, or comprehensive long-term care benefits.

(f) The definitions contained in G.S. 58-1-5 and in G.S. 58-55-20 are incorporated in this Section by reference.

History

  • Authority G.S. 58-2-40(1); 58-55-30(a)
  • Eff. September 1, 1990
  • Amended Eff. February 1, 1996; December 1, 1993; December 1, 1992
  • Amended Eff. August 1, 2002
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .1003 Policy Definitions; Appeals {#sec-11-ncac-12-.1003 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .1003}

(a) Unless otherwise required by federal law or regulation, no policy issued or issued for delivery in this State shall use the terms set forth below, unless the terms are defined in the policy and the definitions satisfy the following requirements:

(1) "Activities of daily living" means at least bathing, continence, dressing, eating, toileting, and transferring.

(2) "Acute condition" means that the individual is medically unstable and requires frequent monitoring by a medical doctor or registered nurse.

(3) "Bathing" means washing oneself by sponge bath, or in a tub or shower, including the task of getting into and out of the tub or shower.

(4) "Cognitive impairment" means a deficiency in a person's short or long-term memory; orientation as to person, place, and time; deductive or abstract reasoning; or judgment as it relates to safety awareness.

(5) "Continence" means the ability to maintain control of bowel and bladder function; or, when unable to maintain control of bowel or bladder function, the ability to perform associated personal hygiene (including caring for catheter or colostomy bag).

(6) "Dressing" means putting on and taking off all items of clothing and any necessary braces, fasteners, or artificial limbs.

(7) "Eating" means feeding oneself by getting food into the body from a receptacle (such as a plate, cup, or table); or by feeding tube or intravenously.

(8) "Hands-on-assistance" means physical assistance (minimal, moderate, or maximal) without which the individual would not be able to perform the activity of daily living.

(9) "Medicare" means the "Health Insurance for the Aged Act", Title XVIII of the Social Security Amendments of 1965, as amended.

(10) "Mental of nervous disorder" shall not be defined to include mroe than neurosis, psychoneurosis, psychopathy, psychosis, or mental or emotional disease or disorder.

(11) "Personal care" means the provision of hands-on services to assist an individual with activities of daily living.

(12) "Toileting" means getting to and from the toilet, getting on and off the toilet, and performing associated personal hygiene.

(13) "Transferring" means moving into our out of a bed, chair, or wheelchair.

(14) "Skilled nursing care," "intermediate care," "personal care," home care," and other services shall be defined in relation to the level of skill required, the nature of the care, and the setting in which care must be delivered.

(b) The definitions contained in G.S. 58-55-20 and G.S. 58-55-35(a) are incorporated by reference into this Section.

(c) A policy may condition the payment of benefits on a determination of the insured's ability to perform activities of daily living and on cognitive impairment as long as those conditions are defined in the policy. Assessments of activities of daily living and cognitive impairment shall be performed by licensed or certified professionals, such as medical doctors, nurses, or social workers. Policies shall include a description of the procedures for appealing and resolving benefit determinations.

History

  • Authority G.S. 58-2-40(1); 58-55-30(a)
  • Eff. September 1, 1990
  • Amended Eff. April 1, 1999
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .1004 Policy Practices and Provisions {#sec-11-ncac-12-.1004 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .1004}

(a) The terms "guaranteed renewable" or "noncancellable" may not be used in any individual policy without further explanatory language in accordance with the disclosure requirements of 11 NCAC 12 .1006. No such policy issued to an individual shall contain renewal provisions other than "guaranteed renewable" or "noncancellable".

(b) The term "guaranteed renewable" may be used only when the insured has the right to continue the policy in force by timely payments of premiums; during which period the insurer has no unilateral right to make any change in any provision of the policy while the policy is in force and can not refuse to renew: Provided that rates may be revised by the insurer on a class basis.

(c) The term "level premium" may be used only when the insurer does not have the right to change the premium.

(d) The word "noncancellable" may be used only when the insured has the right to continue the policy in force by timely payments of premiums and during which period the insurer has no right to unilaterally make any change in any provision of the policy or in the premium rate.

(e) No policy may limit or exclude coverage by type of illness, treatment, medical condition, or accident, except as follows:

(1) preexisting conditions as specified in G.S. 58-55-30;

(2) mental or nervous disorders, except for Alzheimer's Disease;

(3) alcoholism and drug addiction;

(4) illness, treatment, or medical condition arising out of:

(A) war or act of war (whether declared or undeclared);

(B) participation in a felony, riot, or insurrection;

(C) service in the armed forces or units auxiliary thereto;

(D) suicide, attempted suicide, or intentionally self-inflicted injury; or

(E) aviation activity as a nonfare-paying passenger;

(5) treatment provided in a government facility (unless otherwise required by law); services for which benefits are available under Medicare (unless otherwise required by law), under any other governmental program (except Medicaid), or under any state or federal workers' compensation, employer's liability, or occupational disease law; services provided by the insured's parents, spouse, children or siblings; and services for which no charge is normally made in the absence of insurance;

(6) exclusions and limitations for payment for services provided outside the United States; and

(7) legitimate variations in benefit levels to reflect differences in provider rates.

(f) Termination of a policy shall be without prejudice to any benefits payable for institutionalization if the institutionalization began while the policy was in force and continues without interruption after termination. Such extension of benefits beyond the period during which the policy was in force may be limited to the duration of the benefit period, if any, or to payment of the maximum benefits; and may be subject to any policy waiting period and all other applicable provisions of the policy.

History

  • Authority G.S. 58-2-40(1); 58-55-30(a)
  • Eff. September 1, 1990
  • Amended Eff. February 1, 1996; December 1, 1993; December 1, 1992
  • Amended Eff. August 1, 2002
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .1005 Continuation or Conversion {#sec-11-ncac-12-.1005 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .1005}

(a) Group long-term care insurance newly issued or renewed in North Carolina on or after September 1, 1990, shall provide covered individuals with a basis for continuation or conversion of coverage.

(b) As used in this Rule, "a basis for continuation of coverage" means a policy provision that maintains coverage under the existing group policy when such coverage would otherwise terminate and that is subject only to the continued timely payments of premiums when due. A group policy that lawfully restricts provisions of benefits and services to, or contains incentives to use, certain providers or facilities, may provide continuation benefits that are substantially equivalent to the benefits of the existing group policy. The Commissioner shall make a determination as to the substantial equivalency of benefits; and in doing so shall take into consideration the differences between managed care and non-managed care plans, including provider system arrangements, service availability, benefit levels, and administrative complexity.

(c) As used in this Rule, "a basis for conversion of coverage" means a policy provision that an individual:

(1) whose coverage under the group policy would otherwise terminate or has been terminated for any reason, including discontinuance of the group policy in its entirety or with respect to an insured class; and

(2) who has been continuously insured under the group policy, and any group policy that it replaced, for at least six months immediately prior to termination, shall be entitled to the issuance of a converted policy by the insurer under whose group policy he is covered, without evidence of insurability.

(d) As used in this Rule, "converted policy" means an individual policy providing benefits identical to or benefits determined by the commissioner to be substantially equivalent to or in excess of those provided under the group policy from which conversion is made. Where the group policy from which conversion is made lawfully restricts provision of benefits and services to, or contains incentives to use, certain providers or facilities, the commissioner, in making a determination as to the substantial equivalency of benefits, shall take into consideration the differences between managed care and non-managed care plans, including provider system arrangements, service availability, benefit levels, and administrative complexity.

(e) Written application for the converted policy shall be made and the first premium due, if any, shall be paid as directed by the insurer not later than 31 days after termination of coverage under the group policy. The converted policy shall be issued effective on the day following the termination of coverage under the group policy; and shall be renewable annually.

(f) Unless the group policy from which conversion is made replaced previous group coverage, the premium for the converted policy shall be calculated on the basis of the insured's age at inception of coverage under the group policy from which conversion is made. Where the group policy from which conversion is made replaced previous group coverage, the premium for the converted policy shall be calculated on the basis of the insured's age at inception of coverage under the group policy replaced.

(g) Continuation of coverage or issuance of a converted policy is mandatory, except where:

(1) termination of group coverage resulted from an individual's failure to make any required payment of premium or contribution when due; or

(2) the terminating coverage is replaced, not later than 31 days after termination, by group coverage that is effective on the day following the termination of coverage, that provides benefits identical to, or benefits determined by the commissioner to be substantially equivalent to or in excess of, those provided by the terminating coverage, and the premium for which group coverage is calculated in a manner consistent with the requirements of Paragraph (f) of this Rule.

(h) Notwithstanding any other provision of this Rule, a converted policy that is issued to an individual, who at the time of conversion is covered by another policy that provides benefits on the basis of incurred expenses, may contain a provision that results in a reduction of benefits payable if the benefits provided under the other policy, together with the full benefits provided by the converted policy, would result in payment of more than 100 percent of incurred expenses. Such provision shall only be included in the converted policy if the converted policy also provides for a premium decrease or refund that reflects the reduction in benefit payable.

(i) The converted policy may provide that the benefits payable under the converted policy, together with the benefits payable under the group policy from which conversion is made, shall not exceed those that would have been payable had the individual's coverage under the group policy remained in force and effect.

(j) Notwithstanding any other provision of this Rule, any insured individual, whose eligibility for group policy coverage is based upon his relationship to another person, is entitled to continuation of coverage under the group policy upon termination of the qualifying relationship by death or dissolution of marriage.

(k) As used in this Rule, a "managed care plan" is a health care or assisted living arrangement designed to coordinate patient care or control costs through utilization review, case management, or use of specific provider networks.

History

  • Authority G.S. 58-2-40(1); 58-55-30(a)
  • Eff. September 1, 1990
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .1006 Required Disclosure Provisions {#sec-11-ncac-12-.1006 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .1006}

(a) Renewability. Individual long-term care insurance policies shall contain a renewability provision. This provision shall be prominently displayed, shall appear on the first page of the policy, and shall clearly state that the coverage is guaranteed renewable or noncancellable. This provision does not apply to long-term care policies which are part of or combined with life insurance policies.

(b) Premium Rate Changes. A long-term care insurance policy or certificate, other than one where the insurer does not have the right to change the premium, shall include a statement that premium rates may change.

(c) Riders and Endorsements. Except for riders or endorsements by which the insurer effectuates a request made in writing by the insured under an individual long-term care insurance policy, all riders or endorsements added to an individual long-term care insurance policy after date of issue or at reinstatement or renewal that reduce or eliminate benefits or coverage in the policy shall require signed acceptance by the individual insured. After the date of policy issue, any rider or endorsement which increases benefits or coverage with a concomitant increase in premium during the policy term must be agreed to in writing signed by the insured, except if the increased benefits or coverage are required by law. Where a separate additional premium is charged for benefits provided in connection with riders or endorsements, the premium charge shall be set forth in the policy, rider or endorsement.

(d) Payment of Benefits. A long-term care insurance policy that provides for the payment of benefits based on standards described as "usual and customary," "reasonable and customary" or words of similar import shall include a definition of these terms and an explanation of the terms in its accompanying outline of coverage.

(e) Limitations. If a long-term care insurance policy or certificate contains any limitations with respect to preexisting conditions, the limitations shall appear as a separate paragraph of the policy or certificate and shall be labeled as "Preexisting Condition Limitations."

(f) Other Limitations or Conditions on Eligibility for Benefits. A long-term care insurance policy or certificate containing any limitations or conditions for eligibility other than those prohibited in 11 NCAC 12 .1008 and G.S. 58-55-30 shall set forth a description of the limitations or conditions, including any required number of days of confinement, in a separate paragraph of the policy or certificate and shall label such paragraph "Limitations or Conditions on Eligibility for Benefits."

(g) Disclosure of Tax Consequences. With regard to life insurance policies that provide an accelerated benefit for long-term care, a disclosure statement is required at the time of application for the policy or rider and at the time the accelerated benefit payment request is submitted that receipt of these accelerated benefits may be taxable, and that assistance should be sought from a personal tax advisor. The disclosure statement shall be prominently displayed on the first page of the policy or rider and any other related documents. This Paragraph shall not apply to tax qualified long-term care insurance contracts.

(h) Benefit Triggers. Activities of daily living and cognitive impairment shall be used to measure an insured's need for long term care and shall be described in the policy or certificate in a separate paragraph and shall be labeled "Eligibility for the Payment of Benefits." Any additional benefit triggers shall also be explained in this section. If these triggers differ for different benefits, explanation of the trigger shall accompany each benefit description. If an attending physician or other specified person must certify a certain level of functional dependency in order to be eligible for benefits, this too shall be specified.

(i) Tax Qualified. A qualified long-term care insurance contract shall include a disclosure statement in the policy and in the outline of coverage as contained in 11 NCAC 12 .1015(e) that the policy is intended to be a qualified long-term care insurance contract under Section 7702B(b) of the Internal Revenue Code of 1986, as amended.

(j) Tax Non-Qualified. A nonqualified long-term care insurance contract shall include a disclosure statement in the policy and in the outline of coverage as contained in 11 NCAC 12 .1015(e) that the policy is not intended to be a qualified long-term care insurance contract.

History

  • Authority G.S. 58-2-40(1); 58-55-30(a)
  • Eff. September 1, 1990
  • Amended Eff. August 1, 2002; December 1, 1992
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .1007 Prohibition of Post-Claims Underwriting {#sec-11-ncac-12-.1007 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .1007}

(a) All applications for policies except those that are guaranteed issue shall contain clear and unambiguous questions designed to ascertain the health condition of the applicant.

(b) If an application for a policy contains a questions that asks whether the applicant has had medication prescribed by a physician, it must also ask the applicant to list the medication that has been prescribed.

(c) If, at the time of the application, the medications listed in the application were known or should have been known by the insurer or by the insurer's agent or representative to be directly related to a medical condition for which coverage would otherwise be limited or denied, the policy shall not be rescinded nor shall coverage be denied or limited for that condition.

(d) Except for policies that are guaranteed issue:

(1) The following language shall be set out conspicuously and in close conjunction with the applicant's signature block on an application for a policy:

"Caution: If your answers on this application are incorrect or untrue, [name of company] has the right to deny benefits or rescind your policy".

(2) The following language, or language substantially similar to the following, shall be set out conspicuously on the policy at the time of delivery:

"Caution: The issuance of this long-term care insurance [policy] [certificate] is based upon your responses to the questions on your application. A copy of your [application] [enrollment form] [is enclosed] [was retained by you when you applied]. If your answers are incorrect or untrue, [name of company] has the right to deny benefits or rescind your policy. The best time to clear up any questions is now, before a claim arises. If, for any reason, any of your answers are incorrect, contact the company at this address: [insert address]"

(3) Prior to issuance of a policy to an applicant age 80 years or older, the insurer shall obtain one of the following: A report of a physical examination; an assessment of functional capacity; an attending physician's statements; or copies of medical records.

(e) A copy of the completed application or enrollment form shall be delivered to the insured no later than at the time of delivery of the policy unless it was retained by the applicant at the time of application.

(f) Every insurer selling or issuing policies shall maintain a record of all policy rescissions, both in North Carolina and countrywide, except those that insureds voluntarily effectuated; and shall annually furnish this information to the commissioner in the format prescribed by the National Association of Insurance Commissioners.

History

  • Authority G.S. 58-2-40(1); 58-55-30(a)
  • Eff. September 1, 1990
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .1008 Minimum Standards for Home Health Care Benefits {#sec-11-ncac-12-.1008 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .1008}

(a) A policy providing benefits for home health care services may not limit or exclude benefits by:

(1) requiring that the insured or claimant would need skilled care in a skilled nursing facility if home health care services were not provided;

(2) requiring that the insured or claimant first or simultaneously receive nursing or therapeutic services in a home or community setting before home health care services are covered;

(3) limiting eligible services to services provided by registered nurses or licensed practical nurses;

(4) requiring that a nurse or therapist provide services covered by the policy that can be provided by a home health aide or by another licensed or certified home care worker acting within the scope of his or her licensure or certification.

(5) requiring that the insured or claimant have an acute condition before home health care services are covered;

(6) limiting benefits to services provided by Medicare-certified agencies or providers; or

(7) excluding coverage for adult day care services.

(b) Home health care coverage may be applied to the non-home health care benefits provided in the policy when determining maximum coverage under the terms of the policy. Home health care benefits shall be offered in an amount of not less than twenty-five dollars ($25.00) per day.

History

  • Authority G.S. 58-2-40(1); 58-55-30(a)
  • Eff. September 1, 1990
  • Amended Eff. December 1, 1992
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .1009 Requirement to Offer Inflation Protection {#sec-11-ncac-12-.1009 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .1009}

(a) No insurer may offer a policy unless the insurer also offers to the applicant the option to purchase a policy that provides for benefit levels to increase with benefit maximums or reasonable durations that are meaningful to account for reasonably anticipated increases in the costs of long-term care services covered by the policy. Insurers must offer to each applicant, at the time of purchase, the option to purchase a policy with an inflation protection feature no less favorable than one of the following:

(1) Increases benefit levels annually, in a manner so that the increases are compounded annually at a minimum of 5 percent;

(2) Guarantees the insured individual the right to periodically increase benefit levels without providing evidence of insurability or health status as long as the option for the previous period has not been declined. The amount of the additional benefit shall be no less than the difference between the existing policy benefit and the existing policy benefit compounded annually at a rate of at least five percent for the period beginning with the purchase of the existing policy benefit and extending until the year in which the offer is made.

(3) Covers a specified percentage of actual or reasonable charges and does not include a maximum specified indemnity amount or limit.

(b) Where the policy is issued to a group, the required offer in Paragraph (a) of this Rule shall be made to the group policyholder; except, if the policy is issued to a group defined in G.S. 58-55-20(3)d other than to a continuing care facility, the offering shall be made to each proposed certificate holder.

(c) The offer in Paragraph (a) of this Rule is not required of life insurance policies or riders containing accelerated long-term care benefits.

(d) Insurers shall include the following information in or with the outline of coverage:

(1) a graphic comparison of the benefit levels of a policy that increases benefits over the policy period with a policy that does not increase benefits. The graphic comparison shall show benefit levels over at least a 20-year period.

(2) any expected premium increases or additional premiums to pay for automatic or optional benefit increases. If premium increases or additional premiums will be based on the attained age of the applicant at the time of the increase, the insurer shall also disclose the magnitude of the potential premiums the applicant would need to pay at ages 75 and 85 for benefit increases. An insurer may use a reasonable hypothetical or a graphic demonstration for the purposes of this disclosure.

(3) Inflation protection benefit increases under a policy that contains such benefits shall continue throughout the period of coverage without regard to an insured's age, an insured's claim status or claim history, or the length of time an insured has been covered under the policy.

(4) An offer of inflation protection that provides for automatic benefit increases shall include an offer of a premium that the insurer expects to remain constant. This offer shall disclose in bold faced print that the premium may change in the future unless the premium is guaranteed to remain constant.

(e) Inflation protection provided in this Rule shall be included in a policy unless an insurer obtains a rejection of inflation protection, signed by the applicant, as follows:

(1) The rejection shall be considered a part of the application by addendum or supplement to the application; and

(2) The rejection notice shall state:

"I have reviewed the outline of coverage and the graphs that compare the benefits and premiums of this policy with and without inflation protection. Specifically, I have reviewed Plans, and I reject inflation protection."

History

  • Authority G.S. 58-2-40(1); 58-55-30(a)
  • Eff. September 1, 1990
  • Amended Eff. December 1, 1992
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .1010 Requirements for Replacement {#sec-11-ncac-12-.1010 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .1010}

(a) Individual and direct response solicited long-term care insurance application forms shall include a question designed to elicit information as to whether the proposed policy is intended to replace any other accident and health or long-term care insurance policy presently in force. A supplementary applicant or other form to be signed by the applicant containing such a question may be used.

(b) Upon determining that a sale will involve replacement, an insurer, other than an insurer using direct response solicitation methods, or its agent, shall furnish the applicant, prior to issuance or delivery of the individual policy, a notice regarding replacement of accident and health or long-term care coverage. One copy of such notice shall be retained by the applicant and an additional copy signed by the applicant shall be retained by the insurer. The required notice shall be provided in the following manner:

"NOTICE TO APPLICANT REGARDING REPLACEMENT

OF INDIVIDUAL ACCIDENT AND HEALTH OR LONG-TERM CARE INSURANCE

According to [your application] [information you have furnished], you intend to lapse or otherwise terminate existing accident and health or long-term care insurance and replace it with an individual long-term care insurance policy to be issued by [company name]. Your new policy provides thirty (30) days within which you may decide, without cost, whether you desire to keep the policy. For your own information and protection, you should be aware of and seriously consider certain factors that may affect the insurance protection available to you under the new policy.

You should review this new coverage carefully, comparing it with all accident and sickness or long-term care insurance coverage you now have, and terminate your present policy only if, after due consideration, you find that purchase of this long-term care coverage is a wise decision.

I have reviewed your current medical or health insurance coverage. I believe the replacement of insurance involved in this transaction materially improves your position. My conclusion has taken into account the following considerations, which I call to your attention:

  1. Health conditions that you may presently have (preexisting conditions), may not be immediately or fully covered under the new policy. This could result in denial or delay in payment of benefits under the new policy, whereas a similar claim might have been payable under your present policy.

  2. State law provides that your replacement policy or certificate may not contain new pre-existing conditions or probationary periods. The insurer will waive any time periods applicable to pre-existing conditions or probationary periods in the new policy or certificate for similar benefits to the extent such time was spent under the original plan.

  3. You may wish to secure the advice of your present insurer or its agent regarding the proposed replacement of your present policy. This is not only your right, but it is also in your best interest to make sure you understand all the relevant factors involved in replacing your present coverage.

  4. If, after due consideration, you still wish to terminate your present policy and replace it with new coverage, be certain to truthfully and completely answer all questions on the application concerning your medical health history. Failure to include all material medical information on an application may provide a basis for the company to deny any future claims and to refund your premium as though your policy had never been in force. After the application has been completed and before you sign it, reread it carefully to be certain that all information has been properly recorded.

(Signature of Agent, Broker or Other Representative)

The above Notice to Applicant was delivered to me on:

(Date)

(Applicant's Signature) "

(c) Insurers using direct response solicitation methods shall deliver a notice regarding replacement of accident and health or long-term care coverage to the applicant upon issuance of the policy. The required notice shall be provided in the following manner:

"NOTICE TO APPLICANT REGARDING REPLACEMENT

OF ACCIDENT AND HEALTH OR LONG-TERM CARE INSURANCE

According to [your application] [information you have furnished], you intend to lapse or otherwise terminate existing accident and health or long-term care insurance and replace it with the long-term care insurance policy delivered with this notice and issued by [company name]. Your new policy provides thirty (30) days within which you may decide, without cost, whether you desire to keep the policy. For your own information and protection, you should be aware of and seriously consider certain factors that may affect the insurance protection available to you under the new policy.

You should review this new coverage carefully, comparing it with all accident and sickness or long-term care insurance coverage you now have, and terminate your present policy only if, after due consideration, you find that purchase of this long-term care coverage is a wise decision.

  1. Health conditions that you may presently have (preexisting conditions), may not be immediately or fully covered under the new policy. This could result in denial or delay in payment of benefits under the new policy, whereas a similar claim might have been payable under your present policy.

  2. State law provides that your replacement policy or certificate may not contain new pre-existing conditions or probationary periods. The insurer will waive any time periods applicable to pre-existing conditions or probationary periods in the new coverage for similar benefits to the extent such time was spent under the original policy.

  3. You may wish to secure the advice of your present insurer or its agent regarding the proposed replacement of your present policy. This is not only your right, but it is also in your best interest to make sure you understand all the relevant factors involved in replacing your present coverage.

  4. [To be included only if the application is attached to the policy.] If, after due consideration, you still wish to terminate your present policy and replace it with new coverage, read the copy of the application attached to your new policy and be sure that all questions are answered fully and correctly. Omissions or misstatements in the application could cause an otherwise valid claim to be denied. Carefully check the application and write to [company name and address] within thirty (30) days if any information is not correct and complete, or if any past medical history has been left out of the application.

(Company Name) "

(d) When replacement is intended, the replacing insurer shall give written notice of the proposed replacement to the existing insurer. The existing policy shall be identified by the insurer, name of the insured, and policy number or address, including zip code. This notice shall be made within five business days after the date the application is received by the insurer or the date the policy is issued, whichever date is sooner.

(e) The application shall include questions designed to elicit information as to whether or not another policy is intended to be replaced.

History

  • Authority G.S. 58-2-40(1); 58-55-30(a)
  • Eff. September 1, 1990
  • Amended Eff. December 1, 1992
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .1011 Discretionary Powers of Commissioner {#sec-11-ncac-12-.1011 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .1011}

The Commissioner may, upon written request and after an administrative hearing, issue an order to modify or suspend a specific provision or provisions of this Section with respect to a specific policy upon a written finding that:

(1) the modification or suspension would be in the best interest of the insureds; and

(2) the purposes to be achieved could not be effectively or efficiently achieved without the modification or suspension; and

(3) the modification or suspension is necessary to the development of an innovative and reasonable approach for insuring long-term care; or

(4) the policy is to be issued to residents of a continuing care facility or some other residential community for the elderly and the modification or suspension is reasonably related to the special needs or nature of such a community; or

(5) the modification or suspension is necessary to permit long-term care insurance to be sold as part of, or in conjunction with, another insurance product.

History

  • Authority G.S. 58-2-40(1); 58-55-30(a)
  • Eff. September 1, 1990
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .1012 Reserve Standards {#sec-11-ncac-12-.1012 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .1012}

(a) When long-term care benefits are provided through the acceleration of benefits under group or individual life insurance policies or riders to such policies, policy reserves for such benefits shall be determined in accordance with G.S. 58-58-50. Claim reserves must also be established in the case when such policy or rider is in claim status.

(b) Reserves for policies and riders subject to this Rule shall be based on the multiple decrement model utilizing all relevant decrements except for voluntary termination rates. Single decrement approximations are acceptable if the calculation produces essentially similar reserves, if the reserve is clearly more conservative, or if the reserve is immaterial. The calculations may take into account the reduction in life insurance benefits due to the payment of long-term care benefits. However, in no event shall the reserves for the long-term care benefit and the life insurance benefit be less than the reserves for the life insurance benefit assuming no long-term care benefit.

(c) In the development and calculation of reserves for policies and riders subject to this Rule, due regard shall be given to the applicable policy provisions, marketing methods, administrative procedures, and all other considerations that have an effect on projected claim costs, including the following: definition of insured events; covered long-term care facilities; existence of home convalescence care coverage; definition of facilities; existence or absence of barriers to eligibility; premium waiver provision; renewability; ability to raise premiums; marketing method; underwriting procedures; claims adjustment procedures; waiting period; maximum benefit; availability of eligible facilities; margins in claim costs; optional nature of benefit; delay in eligibility for benefit; inflation protection provisions; and guaranteed insurability option.

(d) Any applicable valuation morbidity table shall be certified as appropriate as a statutory valuation table by a member of the American Academy of Actuaries.

(e) When long-term care benefits are provided other than as in Paragraphs (a) through (d) of this Rule, reserves shall be determined in accordance with 11 NCAC 11F .0200.

History

  • Authority G.S. 58-2-40(1); 58-55-30(a)
  • Eff. September 1, 1990
  • Amended Eff. August 1, 2002
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .1013 Loss Ratio {#sec-11-ncac-12-.1013 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .1013}

(a) This Rule shall apply to all long-term care insurance policies except those subject to 11 NCAC 12 .1014 and .1028. Further, 11 NCAC 12 .0555(b)(3) shall not apply to policies or certificates covered under 11 NCAC 12 .1014 and .1028.

(b) Benefits under long-term care insurance policies shall be deemed to be reasonable in relation to premiums, provided that the expected loss ratio is at least 60 percent for individual policies and 75 percent for group policies, and is calculated in a manner that provides for reserving of the long-term care insurance risk. In evaluating the expected loss ratio, consideration shall be given to all relevant factors, including:

(1) statistical credibility of incurred claims experience and earned premiums;

(2) the period for which rates are computed to provide coverage;

(3) experienced and projected trends;

(4) concentration of experience within early policy duration;

(5) expected claim fluctuation;

(6) experience refunds, adjustments, or dividends;

(7) renewability features;

(8) expense factors;

(9) interest;

(10) experimental nature of the coverage;

(11) policy reserves;

(12) mix of business by risk classification; and

(13) product features such as long elimination periods, high deductibles, and high maximum limits.

(c) Paragraph (b) of this Rule shall not apply to life insurance policies that accelerate benefits for long-term care. A life insurance policy that funds long-term care benefits entirely by accelerating the death benefit is considered to provide reasonable benefits in relation to premiums paid, if the policy complies with all of the following provisions:

(1) The interest credited internally to determine cash value accumulations, including long-term care, if any, is guaranteed not to be less than the minimum guaranteed interest rate for cash value accumulations without long-term care set forth in the policy;

(2) The portion of the policy that provides life insurance benefits meets the nonforfeiture requirements of G.S. 58-58-55;

(3) The policy meets the disclosure requirements of G.S. 58-55-30;

(4) Any policy illustration meets the applicable requirements of 11 NCAC 04 .0500; and

(5) An actuarial memorandum is filed with the Commissioner that includes:

(A) A description of the basis on which the long-term care rates were determined;

(B) A description of the basis for the reserves;

(C) A summary of the type of policy, benefits, renewability, general marketing method, and limits on ages of issuance;

(D) A description and a table of each actuarial assumption used. For expenses, an insurer must include percent of premium dollars per policy and dollars per unit of benefits, if any;

(E) A description and a table of the anticipated policy reserves and additional reserves to be held in each future year for active lives;

(F) The estimated average annual premium per policy and the average issue age;

(G) A statement as to whether underwriting is performed at the time of application. The statement shall indicate whether underwriting is used and, if used, the statement shall include a description of the type or types of underwriting used, such as medical underwriting or functional assessment underwriting. Concerning a group policy, the statement shall indicate whether the enrollee or any dependent will be underwritten and when underwriting occurs; and

(H) A description of the effect of the long-term care policy provision on the required premiums, nonforfeiture values and reserves on the underlying life insurance policy, both for active lives and those in long-term care claim status.

History

  • Authority G.S. 58-2-40(1); 58-55-30(a)
  • Eff. September 1, 1990
  • Amended Eff. August 1, 2002
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .1014 Filing Requirement {#sec-11-ncac-12-.1014 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .1014}

(a) Before an insurer offers a group policy to a resident of North Carolina pursuant to G.S. 58-55-25, it shall file with the Commissioner evidence that the group policy has been approved by a state having statutory or regulatory long-term care insurance requirements substantially similar to those of North Carolina.

(b) This Rule applies to any long-term care policy issued in this state on or after February 1, 2003. An insurer shall provide the information listed in this paragraph to the commissioner 45 days prior to making a long-term care insurance form available for sale.

(1) A copy of the disclosure documents required in 11 NCAC 12 .1027, and

(2) An actuarial certification consisting of at least the following:

(A) A statement that the initial premium rate schedule is sufficient to cover anticipated costs under moderately adverse experience and that the premium rate schedule is reasonably expected to be sustainable over the life of the form with no future premium increases anticipated;

(B) A statement that the policy design and coverage provided have been reviewed and taken into consideration;

(C) A statement that the underwriting and claims adjudication processes have been reviewed and taken into consideration;

(D) A complete description of the basis for contract reserves that are anticipated to be held under the form to include:

(i) Sufficient detail or sample calculations provided so as to have a complete depiction of the reserve amounts to be held;

(ii) A statement that the assumptions used for reserves contain reasonable margins for adverse experience;

(iii) A statement that the net valuation premium for renewal years does not increase (except for attained-age rating where permitted); and

(iv) A statement that the difference between the gross premium and the net valuation premium for renewal years is sufficient to cover expected renewal expenses; or if such a statement cannot be made, a complete description of the situations where this does not occur. An aggregate distribution of anticipated issues may be used as long as the underlying gross premiums maintain a reasonably consistent relationship. If the gross premiums for certain age groups appear to be inconsistent with this requirement, the commissioner may request a demonstration based on a standard age distribution; and

(E) A statement that the premium rate schedule is not less than the premium rate schedule for existing similar policy forms also available from the insurer except for reasonable differences attributable to benefits; or a comparison of the premium schedules for similar policy forms that are currently available from the insurer with an explanation of the differences.

(c) The Commissioner may request an actuarial demonstration that benefits are reasonable in relation to premiums. The actuarial demonstration shall include either premium and claim experience on similar policy forms, adjusted for any premium or benefit differences; relevant and credible data from other studies; or both.

(d) In the event the Commissioner asks for additional information under this provision, the period in Paragraph (b) of this Rule does not include the period during which the insurer is preparing the requested information.

History

  • Authority G.S. 58-2-40(1); 58-55-30(a)
  • Eff. September 1, 1990
  • Amended Eff. August 1, 2002
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .1015 Standard Format Outline of Coverage {#sec-11-ncac-12-.1015 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .1015}

(a) The outline of coverage shall be a free-standing document, using no smaller than ten-point type.

(b) The outline of coverage shall contain no material of an advertising nature.

(c) Text that is capitalized or underscored in the standard format outline of coverage may be emphasized by other means that provide prominence equivalent to the capitalization or underscoring.

(d) Use of the text and sequence of text of the standard format outline of coverage is mandatory, unless otherwise specifically indicated.

(e) Format for outline of coverage:

[Except for policies or certificates which are guaranteed issue, the following caution statement, or language substantially similar, must appear as follows in the outline of coverage.]

Caution: The issuance of this long-term care insurance [policy] [certificate] is based upon your responses to the questions on your application. A copy of your [application] [enrollment form] [is enclosed] [was retained by you when you applied]. If your answers are incorrect or untrue, the company has the right to deny benefits or rescind your policy. The best time to clear up any questions is now, before a claim arises! If, for any reason, any of your answers are incorrect, contact the company at this address: [insert address]

  1. This policy is [an individual policy of insurance] ([a group policy] which was issued in the [indicate jurisdiction in which group policy was issued]).

  2. PURPOSE OF OUTLINE OF COVERAGE. This outline of coverage provides a very brief description of the important features of the policy. You should compare this outline of coverage to outlines of coverage for other policies available to you. This is not an insurance contract, but only a summary of coverage. Only the individual or group policy contains governing contractual provisions. This means that the policy or group policy sets forth in detail the rights and obligations of both you and the insurance company. Therefore, if you purchase this coverage, or any other coverage, it is important that you READ YOUR POLICY (OR CERTIFICATE) CAREFULLY!

  3. FEDERAL TAX CONSEQUENCES.

This [POLICY] [CERTIFICATE] is intended to be a federally tax-qualified long-term care insurance contract under Section 7702B(b) of the Internal Revenue Code of 1986, as amended.

OR

Federal Tax Implications of this [POLICY] [CERTIFICATE]. This [POLICY] [CERTIFICATE] is not intended to be a federally tax-qualified long-term care insurance contract under Section 7702B(b) of the Internal Revenue Code of 1986 as amended. Benefits received under the [POLICY] [CERTIFICATE] may be taxable as income.

  1. TERMS UNDER WHICH THE POLICY OR CERTIFICATE MAY BE CONTINUED IN FORCE OR DISCONTINUED.

(a) [For long-term care health insurance policies or certificates describe one of the following permissible policy renewability provisions:

(1) Policies and certificates that are guaranteed renewable shall contain the following statement:] RENEWABILITY: THIS POLICY [CERTIFICATE] IS GUARANTEED RENEWABLE. This means you have the right, subject to the terms of your policy, [certificate] to continue this policy as long as you pay your premiums on time. [Company Name] cannot change any of the terms of your policy on its own, except that, in the future, IT MAY INCREASE THE PREMIUM YOU PAY.

(2) [Policies and certificates that are noncancellable shall contain the following statement:] RENEWABILITY: THIS POLICY [CERTIFICATE] IS NONCANCELLABLE. This means that you have the right, subject to the terms of your policy, to continue this policy as long as you pay your premiums on time. [Company Name] cannot change any of the terms of your policy on its own and cannot change the premium you currently pay. However, if your policy contains an inflation protection feature where you choose to increase your benefits, [Company Name] may increase your premium at that time for those additional benefits.

(b) [For group coverage, specifically describe continuation/conversion provisions applicable to the certificate and group policy;]

(c) [Describe waiver of premium provisions or state that there are not such provisions.]

  1. TERMS UNDER WHICH THE COMPANY MAY CHANGE PREMIUMS.

[In bold type larger than the maximum type required to be used for the other provisions of the outline of coverage, state whether or not the company has a right to change the premium, and if a right exists, describe clearly and concisely each circumstance under which the premium may change.]

  1. TERMS UNDER WHICH THE POLICY OR CERTIFICATE MAY BE RETURNED AND PREMIUM REFUNDED.

(a) [Provide a brief description of the right to return–"free look" provision of the policy.]

(b) [Include a statement that the policy either does or does not contain provisions providing for a refund or partial refund of premium upon the death of an insured or surrender of the policy or certificate. If the policy contains such provisions, include a description of them.]

  1. THIS IS NOT MEDICARE SUPPLEMENT COVERAGE. If you are eligible for Medicare, review the Medicare Supplement Buyer's Guide available from the insurance company.

(a) [For agents] Neither [insert company name] nor its agents represent Medicare, the federal government or any state government.

(b) [For direct response] [insert company name] is not representing Medicare, the federal government or any state government.

  1. LONG-TERM CARE COVERAGE. Policies of this category are designed to provide coverage for one or more necessary or medically necessary diagnostic, preventive, therapeutic, rehabilitative, maintenance, or personal care services, provided in a setting other than an acute care unit of a hospital, such as in a nursing home, in the community or in the home.

This policy provides coverage in the form of a fixed dollar indemnity benefit for covered long-term care expenses, subject to policy [limitations] [waiting periods] and [coinsurance] requirements. [Modify this paragraph if the policy is not an indemnity policy.]

  1. BENEFITS PROVIDED BY THIS POLICY.

(a) [Covered services, related deductibles, waiting periods, elimination periods and benefit maximums.]

(b) [Institutional benefits, by skill level.]

(c) [Non-institutional benefits, by skill level.]

(d) Eligibility for Payment of Benefits

[Activities of daily living and cognitive impairment shall be used to measure an insured's need for

long-term care and must be defined and described as part of the outline of coverage.]

[Any additional benefit triggers must also be explained. If these triggers differ for different benefits, explanation of the triggers must accompany each benefit description. If an attending physician or other specified person must certify a certain level of functional dependency in order to be eligible for benefits, this too must be specified.]

  1. LIMITATIONS AND EXCLUSIONS.

[Describe:

(a) Preexisting conditions;

(b) Non-eligible facilities and provider;

(c) Non-eligible levels of care (e.g., unlicensed providers, care or treatment provided by a family member, etc.);

(d) Exclusions and exceptions;

(e) Limitations.]

[This section must provide a brief specific description of any policy provisions that limit, exclude, restrict, reduce, delay, or in any other manner operate to qualify payment of the benefits described in Number 6 above.]

THIS POLICY MAY NOT COVER ALL THE EXPENSES ASSOCIATED WITH YOUR LONG-TERM CARE NEEDS.

  1. RELATIONSHIP OF COST OF CARE AND BENEFITS. Because the costs of long-term care services will likely increase over time, you should consider whether and how the benefits of this plan may be adjusted. [As applicable, indicate the following:

(a) That the benefit level will not increase over time;

(b) Any automatic benefit adjustment provisions;

(c) Whether the insured will be guaranteed the option to buy additional benefits and the basis upon which benefits will be increased over time if not by a specified amount or percentage;

(d) If there is such a guarantee, include whether additional underwriting or health screening will be required, the frequency and amounts of the upgrade options, and any restrictions or limitations;

(e) And finally, describe whether there will be any additional premium charge imposed, and how that is to be calculated.]

  1. ALZHEIMER'S DISEASE AND OTHER ORGANIC BRAIN DISORDERS.

[State that the policy provides coverage for insureds clinically diagnosed as having Alzheimer's disease or related degenerative and dementing illnesses. Specifically describe each benefit screen or other policy provision which provides preconditions to the availability of policy benefits for such an insured.]

  1. PREMIUM.

[(a) State the total annual premium for the policy;

(b) If the premium varies with an applicant's choice among benefit options, indicate the portion of annual premium which corresponds to each benefit option.]

  1. ADDITIONAL FEATURES.

[(a) Indicate if medical underwriting is used;

(b) Describe other important features.]

  1. CONTACT THE NORTH CAROLINA SENIORS' HEALTH INSURANCE INFORMATION PROGRAM (SHIIP) IF YOU HAVE GENERAL QUESTIONS REGARDING LONG-TERM CARE INSURANCE. CONTACT THE INSURANCE COMPANY IF YOU HAVE SPECIFIC QUESTIONS REGARDING YOUR LONG-TERM CARE INSURANCE POLICY OR CERTIFICATE.

History

  • Authority G.S. 58-2-40(1); 58-55-30(a)
  • Eff. September 1, 1990
  • Amended Eff. August 1, 2002
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .1016 Permitted Compensation Arrangements {#sec-11-ncac-12-.1016 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .1016}

(a) As used in this Rule:

(1) "Compensation" means consideration or remuneration of any kind relating to the sale or renewal of a policy, including but not limited to commissions, bonuses, gifts, prizes, or awards.

(2) "Policy" includes a certificate.

(3) "Representative" includes an agent, general agent, manager, broker, or other producer.

(b) If a policy is replaced, no person shall provide and no representative shall receive compensation greater than that payable by the replacing insurer on renewal policies. This Paragraph does not apply if the benefits of the replacement policy are clearly and substantially greater than the benefits of the replaced policy.

(c) Each insurer shall establish marketing procedures that set forth a mechanism or formula for determining whether replacement policies contain benefits clearly and substantially greater than the benefits of replaced policies.

History

  • Authority G.S. 58-2-40; 58-54-15
  • Temporary Rule Eff. August 17, 1990 for a period of 180 days to expire on February 13, 1991
  • Eff. February 1, 1991
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .1017 Requirements for Advertising {#sec-11-ncac-12-.1017 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .1017}

Every insurer, health care service plan or other entity providing long-term care insurance or benefits in this State shall provide a copy of any long-term care insurance advertisement intended for use, whether through written, radio or television medium, to the Commissioner for approval. In addition, all advertisements shall be retained by the insurer, health care service plan or other entity for at least three years from the date the advertisement was first used.

History

  • Authority G.S. 58-2-40(1); 58-55-30(a); 58-55-30(j)
  • Eff. December 1, 1992
  • Amended Eff. August 1, 2002
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .1018 Standards for Marketing {#sec-11-ncac-12-.1018 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .1018}

(a) Every insurer, health care service plan or other entity marketing long-term care insurance coverage in this state, directly or through its producers, shall:

(1) Establish marketing procedures and agent training requirements to assure that:

(A) Any marketing activities, including any comparison of policies, by its agents or other producers will be fair and accurate; and

(B) Excessive insurance is not sold or issued.

(2) Display prominently by type, stamp or other means, on the first page of the outline of coverage and policy the following:

"Notice to buyer: This policy may not cover all of the costs associated with long-term care incurred by the buyer during the period of coverage. The buyer is advised to review carefully all policy limitations."

(3) Provide copies of the disclosure forms required in 11 NCAC 12 .1027(d) to the applicant.

(4) Inquire and otherwise make every reasonable effort to identify whether a prospective applicant or enrollee for long-term care insurance already has accident and sickness or long-term care insurance and the types and amounts of any such insurance, except that in the case of qualified long-term care insurance contracts, an inquiry into whether a prospective applicant or enrollee for long-term care insurance has accident and sickness insurance is not required.

(5) Every insurer or entity marketing long-term care insurance shall establish auditable procedures for verifying compliance with this Rule.

(6) Every insurer providing long-term care insurance in this State shall at the time of solicitation provide the address and toll-free telephone number of the North Carolina Seniors' Health Insurance Information Program (SHIIP).

(7) For long-term care health insurance policies and certificates, use the terms "noncancellable" or "level premium" only when the policy or certificate conforms to this Section.

(8) Provide an explanation of contingent benefit upon lapse as provided for in 11 NCAC 12 .1026.

(b) In addition to the practices prohibited in G.S. 58, Article 63, the following acts and practices are prohibited:

(1) Twisting. Knowingly making any misleading representation or incomplete or fraudulent comparison of any insurance policies or insurers for the purpose of inducing, or tending to induce, any person to lapse, forfeit, surrender, terminate, retain, pledge, assign, borrow on or convert any insurance policy or to take out a policy of insurance with another insurer.

(2) High pressure tactics. Employing any method of marketing having the effect of or tending to induce the purchase of insurance through force, fright, threat, whether explicit or implied, or undue influence. As used in this Subparagraph, "undue influence" means a fraudulent influence over the mind and will of another to the extent that the professed action is not freely done but is in truth the act of the one who procures the result.

(3) Cold lead advertising. Making use directly or indirectly of any method of marketing which fails to disclose in a conspicuous manner that a purpose of the method of marketing is solicitation of insurance and that contact will be made by an insurance agent or insurance company.

(4) Misrepresentation. Misrepresenting a material fact in selling or offering to sell a long-term care insurance policy.

(c) With respect to the obligations set forth in this Rule, the primary responsibility of an association, as defined in G.S. 58-55-20(3)(c), when endorsing or selling long-term care insurance shall be to educate its members concerning long-term care issues in general so that its members can make informed decisions. Associations shall provide objective information regarding long term care insurance policies or certificates endorsed or sold by such associations to ensure that members of such associations receive a balanced and complete explanation of the features in the policies or certificates that are being endorsed or sold. The insurer shall file with the Commissioner the following material:

(1) The policy and certificate,

(2) A corresponding outline of coverage, and

(3) All advertisements requested by the Commissioner.

(d) The association shall disclose in any long-term care insurance solicitation:

(1) The specific nature and amount of the compensation arrangements (including all fees, commissions, administrative fees and other forms of financial support) that the association receives from endorsement or sale of the policy or certificate to its members; and

(2) A brief description of the process under which the policies and the insurer issuing the policies were selected.

(3) If the association and the insurer have interlocking directorates or trustee arrangements, the association shall disclose that fact to its members.

(4) The board of directors of associations selling or endorsing long-term care insurance policies or certificates shall review and approve the insurance policies as well as the compensation arrangements made with the insurer.

(e) The association shall also:

(1) At the time of the association's decision to endorse, engage the services of a long term care insurance expert who is not affiliated with the insurer to conduct an examination of the policies, including its benefits, features, and rates and update the examination thereafter in the event of material change;

(2) Monitor the marketing efforts of the insurer and its agents; and

(3) Review and approve all marketing materials or other insurance communications used to promote sales or sent to members regarding the policies or certificates.

(4) Paragraphs (e)(1) through (e)(3) of this Rule shall not apply to qualified long-term care insurance contracts.

(f) No group long-term care insurance policy or certificate may be issued to an association unless the insurer files with the Commissioner the information required in this Rule.

(g) The insurer shall not issue a long-term care policy or certificate to an association or continue to market such a policy or certificate unless the insurer certifies annually that the association has complied with the requirements set forth in this rule.

(h) Failure to comply with the filing and certification requirements of this rule constitutes an unfair trade practice in violation of G.S. 58, Article 63.

History

  • Authority G.S. 58-2-40(1); 58-55-30(a); 58-63-15(9)
  • Eff. December 1, 1992
  • Amended Eff. August 1, 2002
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .1019 Replacement Policies {#sec-11-ncac-12-.1019 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .1019}

If a policy replaces another policy, the replacing insurer shall waive any time periods applicable to pre-existing conditions and probationary periods in the new policy for similar benefits to the extent that similar exclusions have been satisfied under the original policy.

History

  • Authority G.S. 58-2-40(1); 58-55-30(a)
  • Eff. December 1, 1992
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .1020 Shopper's Guide {#sec-11-ncac-12-.1020 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .1020}

Every insurer providing long-term care insurance in this State shall, before sale, deliver a shopper's guide to every applicant. The guide shall be in the format developed by the NAIC.

History

  • Authority G.S. 58-2-40(1); 58-55-30(a)
  • Eff. December 1, 1992
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .1021 Reporting {#sec-11-ncac-12-.1021 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .1021}

Each insurer shall on a statewide basis:

(1) Maintain records for each agent of that agent's amount of replacement sales as a percent of the agent's total annual sales.

(2) Maintain records of the amount of lapses of long-term care insurance policies sold by agents as a percent of the agent's total annual sales.

(3) Report annually by June 30th the 10 percent of its agents with the greatest percentages of lapses and replacements.

(4) Report annually by June 30th the number of lapsed policies as a percent of its total annual sales and as a percent of its total number of policies in force as of the end of the preceding calendar year.

(5) Report annually by June 30th the number of replacement policies sold as a percent of its total annual sales and as a percent of its total number of policies in force as of the end of the preceding calendar year.

History

  • Authority G.S. 58-2-40(1); 58-55-30(a); 58-2-195(a)
  • Eff. December 1, 1992
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .1022 Protection Against Unintentional Lapse {#sec-11-ncac-12-.1022 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .1022}

(a) No individual policy shall be issued until the insurer has received from the applicant either a written designation of at least one person, in addition to the applicant, who is to receive notice of lapse or termination of the policy for nonpayment of premium; or a written waiver dated and signed by the applicant electing not to designate additional persons to receive notice. Every applicant has the right to so designate at least one person. Designation does not constitute acceptance of any liability on the part of the designated person or persons for services provided to the insured. The form used for the designation must provide space clearly designated for listing at least one person. The designation shall include each person's full name and home address. If an applicant elects not to designate any person, a written, signed waiver shall state:

"Protection against unintended lapse. I understand that I have the right to designate at least one person other than myself to receive notice of lapse or termination of this long-term care insurance policy for nonpayment of premium. I understand that notice will not be given until thirty (30) days after a premium is due and unpaid. I elect NOT to designate any person to receive such notice."

The insurer shall notify the insured of the right to change this written designation no less often than once every two years.

(b) When a policyholder pays premium for a policy through a payroll or pension deduction plan, the requirements contained in Paragraph (a) of this Rule need not be met until 60 days after the policyholder is no longer on such a payment plan. The application or enrollment form for such policies shall clearly indicate the payment plan selected by the applicant.

(c) No individual policy shall lapse or be terminated for nonpayment of premium unless the insurer, at least 30 days before the effective date of the lapse or termination, has given notice to the insured and to any person or persons designated under Paragraph (a) of this Rule, at the addresses provided by the insured. Notice shall be given by first class United States mail, postage prepaid; and notice may not be given until 30 days after a premium is due and unpaid. Notice shall be deemed to have been given as of five days after the date of mailing.

(d) In addition to the requirement in Paragraph (a) of this Rule, each policy shall provide for reinstatement of coverage if the insurer is furnished proof of cognitive impairment or the loss of functional capacity of the insured. This option is available to the insured if requested within five months after lapse or termination; and the insurer may require payment of past due premium before reinstatement, where appropriate. The standard of proof of cognitive impairment or loss of functional capacity shall not be more stringent than the benefit eligibility criteria on cognitive impairment or the loss of functional capacity, if any, contained in the policy.

History

  • Authority G.S. 58-2-40(1); 58-55-30(a)
  • Eff. December 1, 1993
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .1023 Incontestability Period {#sec-11-ncac-12-.1023 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .1023}

(a) For a policy that has been in force for less than six months, an insurer may rescind the policy or deny an otherwise valid long-term care insurance claim upon a showing of misrepresentation by the insured that is material to the acceptance for coverage.

(b) For a policy that has been in force for at least six months but less than two years, an insurer may rescind the policy or deny an otherwise valid long-term care insurance claim upon a showing of misrepresentation by the insured that is both material to the acceptance for coverage and that pertains to the condition for which benefits are sought.

(c) After a policy has been in force for two years, the policy is not contestable upon the grounds of misrepresentation alone; that policy may be contested only upon a showing that the insured knowingly and intentionally misrepresented relevant facts relating to the insured's health.

(d) No policy may be field issued based on medical or health status. For purposes of this Paragraph, "field issued" means a policy or certificate issued by an agent or a third-party administrator pursuant to the underwriting authority granted to the agent or third party administrator by an insurer.

(e) If an insurer has paid benefits under a policy, the benefit payments may not be recovered by the insurer if the policy is rescinded.

History

  • Authority G.S. 58-2-40(1); 58-55-30(a)
  • Eff. December 1, 1994
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .1024 Prohibited Policy Practice {#sec-11-ncac-12-.1024 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .1024}

(a) No insurer may increase the rate or premium charged to an insured for a policy because of:

(1) the increasing age of the insured at ages beyond 65; or

(2) the amount of time the insured has been covered under a policy.

(b) This Rule applies only to policies newly issued on and after December 1, 1994.

History

  • Authority G.S. 58-2-40(1); 58-55-30(a)
  • Eff. December 1, 1994
  • Amended Eff. April 1, 1995
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .1025 Suitability {#sec-11-ncac-12-.1025 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .1025}

(a) Each insurer, except an insurer issuing life insurance that accelerates benefits for long-term care, shall:

(1) Train its agents in the use of its suitability standards.

(2) Maintain a copy of its suitability standards and make them available for inspection upon request by the Division.

(b) To determine whether the applicant meets the standards developed by the insurer, the agent and insurer shall develop procedures that take the following into consideration:

(1) The ability to pay for the proposed coverage and other pertinent financial information related to the purchase of the coverage.

(2) The applicant's goals or needs with respect to long-term care and the advantages and disadvantages of insurance to meet these goals of needs.

(3) The values, benefits, and costs of the applicant's existing insurance, if any, when compared to the values, benefits, and costs of the recommended purchase or replacement.

(c) The sale or dissemination of information obtained through the personal long-term care insurance worksheet referred to in G.S. 58-55-31(c)(1) by an insurer or an agent to any person outside of the insurance company or insurance agency is prohibited.

(d) Each year the insurer shall report to the Division the total number of applications received from residents of this State, the number of applicants who declined to provide information on the worksheet, the number of applicants who did not meet the suitability standards, the number of those who chose to confirm after receiving a suitability letter.

(e) An insurer may issue a policy to an applicant that does not meet the financial suitability standards if the applicant signs a waiver acknowledging the suitability results.

History

  • Authority G.S. 58-2-40(1); 58-55-30(a); 58-55-31
  • Eff. April 1, 1999
  • Amended Eff. November 1, 1999
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .1026 Nonforfeiture Benefit Requirements {#sec-11-ncac-12-.1026 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .1026}

(a) This Rule does not apply to life insurance policies or riders containing accelerated long-term care benefits.

(b) To comply with the requirement to offer a nonforfeiture benefit pursuant to the provisions of G.S. 58-55-31:

(1) A policy or certificate offered with nonforfeiture benefits shall have coverage elements, eligibility, benefit triggers and benefit length that are the same as coverage to be issued without nonforfeiture benefits. The nonforfeiture benefit included in the offer shall be the benefit described in Paragraph (g) of this Rule; and

(2) The offer shall be in writing if the nonforfeiture benefit is not otherwise described in the outline of coverage or other materials given to the prospective policyholder.

(c) If the offer required to be made under G.S. 58-55-31 is rejected, the insurer shall provide the contingent benefit upon lapse described in this Rule.

(d) In the event a group policyholder elects to make the nonforfeiture benefit an option to the certificate-holder, a certificate shall provide either the nonforfeiture benefit or the contingent benefit upon lapse.

(e) The contingent benefit on lapse shall be triggered every time an insurer increases the premium rates to a level which results in a cumulative increase of the annual premium equal to or exceeding the percentage of the insured's initial annual premium set forth in this Paragraph based on the insured's issue age, and the policy or certificate lapses within 120 days of the due date of the premium so increased. Unless otherwise required, policyholders shall be notified at least 45 days prior to the due date of the premium reflecting the rate increase.

(f) On or before the effective date of a substantial premium increase as defined in Paragraph (e) of this Rule, the insurer shall:

(1) Offer to reduce policy benefits provided by the current coverage without the requirement of additional underwriting so that required premium payments are not increased;

(2) Offer to convert the coverage to a paid-up status with a shortened benefit period in accordance with the terms of Paragraph (g) of this Rule. This option may be elected at any time during the 120-day period; and

(3) Notify the policyholder or certificate-holder that a default or lapse at any time during the 120-day period shall be deemed to be the election of the offer to convert.

(g) Benefits continued as nonforfeiture benefits, including contingent benefits upon lapse, shall satisfy the following criteria:

(1) For purposes of this Paragraph, attained age rating is defined as a schedule of premiums starting from the issue date increases at least one percent per year prior to age 50 and at least three percent per year beyond age 50.

(2) For purposes of this Paragraph, the nonforfeiture benefit shall be of a shortened benefit period providing paid-up long-term care insurance coverage after lapse. The same benefits (amounts and frequency in effect at the time of lapse but not increased thereafter) will be payable for a qualifying claim, but the lifetime maximum dollars or days of benefits shall be determined as specified in Paragraph (g)(3) of this Rule.

(3) The standard nonforfeiture credit will be equal to 100% of the sum of all premiums paid, including the premiums paid prior to any changes in benefits. The insurer may offer additional shortened benefit period options, as long as the benefits for each duration equal or exceed the standard nonforfeiture credit for that duration. However, the minimum nonforfeiture credit shall not be less than 30 times the daily nursing home benefit at the time of lapse. In either event, the calculation of the nonforfeiture credit is subject to the limitation of Paragraph (i) of this Rule.

(4) The nonforfeiture benefit shall begin not later than the end of the third year following the policy or certificate issue date. The contingent benefit upon lapse shall be effective during the first three years as well as thereafter. For a policy or certificate with attained age rating, the nonforfeiture benefit shall begin on the earlier of: the end of the tenth year following the policy or certificate issue date; or the end of the second year following the date the policy or certificate is no longer subject to attained age rating.

(h) Nonforfeiture credits may be used for all care and services qualifying for benefits under the terms of the policy or certificate, up to the limits specified in the policy or certificate.

(i) All benefits paid by the insurer while the policy or certificate is in premium paying status and in the paid up status will not exceed the maximum benefits which would be payable if the policy or certificate had remained in premium paying status.

(j) There shall be no difference in the minimum nonforfeiture benefits as required under this Rule for group and individual policies.

(k) The requirements set forth in this Rule shall become effective August 1, 2003, and shall apply as follows:

(1) Except as provided for in Paragraph (k)(2) of this Rule, the provisions of this Rule apply to any long-term care policy issued in this state on or after August 1, 2002.

(2) For certificates issued on or after August 1, 2002, under a group long-term care insurance policy as defined in G.S. 58-55-20(3), which policy was in force at the time this Rule became effective, the provisions of this Rule shall not apply.

(l) Premiums charged for a policy or certificate containing nonforfeiture benefits or a contingent benefit on lapse shall be subject to the loss ratio requirements of 11 NCAC 12 .1013 treating the policy as a whole.

(m) To determine whether contingent nonforfeiture upon lapse provisions are triggered under Paragraph (e) of this Rule, a replacing insurer that purchased or otherwise assumed a block or blocks of long-term care insurance policies from another insurer shall calculate the percentage increase based on the initial annual premium paid by the insured when the policy was first purchased from the original insurer.

(n) A nonforfeiture benefit for qualified long-term care insurance contracts that are level premium contracts shall be offered that meets the following requirements:

(1) The nonforfeiture provision shall be disclosed;

(2) The nonforfeiture provision shall provide a benefit available in the event of a default in the payment of any premiums and shall state that the amount of the benefit may be adjusted subsequent to being initially granted only as necessary to reflect changes in claims, persistency and interest as reflected in changes in rates for premium paying contracts approved by the commissioner for the same contract form; and

(3) The nonforfeiture provision shall provide at least one of the following:

(A) Reduced paid-up insurance; or

(B) Extended term insurance; or

(C) Shortened benefit period.

History

  • Authority G.S. 58-2-40(1); 58-55-30(a); 58-55-31
  • Eff. April 1, 1999
  • Amended Eff. August 1, 2002
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .1027 Required Disclosure of Rating Practices to Consumers {#sec-11-ncac-12-.1027 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .1027}

(a) This Rule shall apply as follows:

(1) To any long-term care policy or certificate issued in this state on or after February 1, 2003, except as provided in Paragraph (a)(2) of this Rule.

(2) For certificates issued on or after August 1, 2002 under a group long-term care insurance policy as defined in G.S. 58-55-20(3), which policy was in force at the time this Rule became effective, the provisions of this Rule shall apply on the policy anniversary following July 1, 2003.

(b) Other than policies for which no applicable premium rate or rate schedule increases can be made, insurers shall provide all of the information listed in this Paragraph to the applicant at the time of application or enrollment, unless the method of application does not allow for delivery at that time. In such a case, an insurer shall provide all required disclosure to the applicant no later than at the time of delivery of the policy or certificate. Required disclosure is as follows:

(1) A statement that the policy may be subject to rate increases in the future;

(2) An explanation of potential future premium rate revisions, and the policyholder's or certificate-holder's option in the event of a premium rate revision;

(3) The premium rate or rate schedules applicable to the applicant that will be in effect until a request is made for an increase;

(4) A general explanation for applying premium rate or rate schedule adjustments that shall include:

(A) A description of when premium rate or rate schedule adjustments will be effective on either the next anniversary date or the next billing date; and

(B) The right to a revised premium rate or rate schedule as provided if the premium rate or rate schedule is changed;

(5) Information regarding history of rate increases:

(A) Information regarding each premium rate increase on this policy form or similar policy forms over the past 10 years for this state or any other state that, at a minimum, identifies:

(i) The policy forms for which premium rates have been increased;

(ii) The calendar years when the form was available for purchase; and

(iii) The amount or percent of each increase. The percentage may be expressed as a percentage of the premium rate prior to the increase, and may also be expressed as minimum and maximum percentages if the rate increase is variable by rating characteristics;

(B) An insurer shall have the right to exclude from the disclosure premium rate increases that apply only to blocks of business acquired from other non-affiliated insurers or the long-term care policies acquired from other non-affiliated insurers when those increases occurred prior to the acquisition;

(C) If an acquiring insurer files for a rate increase on a long-term care policy form acquired from nonaffiliated insurers or a block of policy forms acquired from non-affiliated insurers on or before August 1, 2002 or the end of a 24 month period following the acquisition of the block or policies, the acquiring insurer may exclude that rate increase from the disclosure. However, the nonaffiliated selling company shall include the disclosure of that rate increase in accordance with this Rule; and

(D) If the acquiring insurer referenced in Paragraph (b)(5)(C) of this Rule files for a subsequent rate increase, even within the 24-month period, on the same policy form acquired from nonaffiliated insurers or block of policy forms acquired from nonaffiliated insurers referenced in Paragraph (b)(5)(C) of this Rule, the acquiring insurer must make all disclosures required by this Rule, including disclosure of the earlier rate increase.

(c) An applicant shall sign an acknowledgement at the time of application, unless the method of application does not allow for signature at that time, that the insurer made the disclosure required under this Rule. If due to the method of application the applicant cannot sign an acknowledgement at the time of application, the applicant shall sign no later than at the time of delivery of the policy or certificate.

(d) An insurer shall use the NAIC Long-Term Care Insurance Model Regulation forms identified as Appendices B and F to comply with the requirements of Paragraphs (b) and (c) of this Rule.

(e) An insurer shall provide notice of an upcoming premium rate schedule increase to all policyholders or certificate-holders, if applicable, at least 45 days prior to the implementation of the premium rate schedule increase by the insurer. The notice shall include the information required under this Rule when the rate increase is implemented.

History

  • Authority G.S. 58-2-40(1); 58-55-30(a); 58-63-15(9)
  • Eff. August 1, 2002
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .1028 Premium Rate Schedule Increases {#sec-11-ncac-12-.1028 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .1028}

(a) This Rule shall apply as follows:

(1) Except as provided in Paragraph (a)(2) of this Rule, this Rule applies to any long-term care policy or certificate issued in this state on or after February 1, 2003; and

(2) For certificates issued on or after August 1, 2002, under a group long-term care insurance policy as defined in G.S. 58-55-20(3), which policy was in force at the time this Rule became effective, the provisions of this Rule shall apply on the policy anniversary following August 1, 2003.

(b) An insurer shall request approval of a pending premium rate schedule increase, including an exceptional increase, from the Commissioner at least 90 days prior to the notice to the policyholders and shall include:

(1) Information required by 11 NCAC 12 .1027;

(2) Certification by an actuary who is a member in good standing with the American Academy of Actuaries that:

(A) If the requested premium rate schedule increase is implemented and the underlying assumptions, which reflect moderately adverse conditions, are realized, no further premium rate schedule increases are anticipated; and

(B) The premium rate filing is in compliance with the provisions of this Rule;

(3) An actuarial memorandum justifying the rate schedule change request that includes:

(A) Lifetime projections of earned premiums and incurred claims based on the filed premium rate schedule increase; and the method and assumptions used in determining the projected values, including reflection of any assumptions that deviate from those used for pricing other forms currently available for sale:

(i) Annual values for the five years preceding and the three years following the valuation date shall be provided separately;

(ii) The projections shall include the development of the lifetime loss ratio, unless the rate increase is an exceptional increase;

(iii) The projections shall demonstrate compliance with Paragraph (c) of this Rule; and

(iv) For exceptional increases:

(I) The projected experience shall be limited to the increases in claims expenses attributable to the approved reasons for the exceptional increase; and

(II) In the event the Commissioner determines, as provided in 11 NCAC 12 .1002 that offsets may exist, the insurer shall use net projected experience;

(B) Disclosure of how reserves have been incorporated in this rate increase whenever the rate increase will trigger contingent benefit upon lapse;

(C) Disclosure of the analysis performed to determine why a rate adjustment is necessary, which pricing assumptions were not realized and why, and what other actions taken by the company have been relied on by the actuary;

(D) A statement that policy design, underwriting and claims adjudication practices have been taken into consideration; and

(E) In the event that it is necessary to maintain consistent premium rates for new certificates and certificates receiving a rate increase, the insurer will need to file composite rates reflecting projections of new certificates;

(4) A statement that renewal premium rate schedules are not greater than new business premium rate schedules except for differences attributable to benefits, or underwriting criteria; and

(5) All projected premium rate schedule increases shall be filed with the Commissioner for review and approval under G.S. 58-51-95.

(c) All premium rate schedule increases shall be determined in accordance with the following requirements:

(1) Exceptional increases shall provide that 70 percent of the present value of projected additional premiums from the exceptional increase will be returned to policyholders in benefits;

(2) Premium rate schedule increases shall be calculated such that the sum of the accumulated value of incurred claims, without the inclusion of active life reserves, and the present value of future projected incurred claims, without the inclusion of active life reserves, will not be less than the sum of the following:

(A) The accumulated value of the initial earned premium times 58 percent;

(B) 85 percent of the accumulated value of prior premium rate schedule increases on an earned basis;

(C) The present value of future projected initial earned premiums times 58 percent; and

(D) 85 percent of the present value of future projected premiums not in Part (c)(2)(C) of this Rule on an earned basis;

(3) In the event that a policy form has both exceptional and other increases, the values in Subparagraphs (c)(2)(B) and (D) of this Rule will also include 70 percent for exceptional rate increase amounts; and

(4) All present and accumulated values used to determine rate increases shall use the maximum valuation interest rate for contract reserves as specified in 11 NCAC 11F .0207(c). The actuary shall disclose as part of the actuarial memorandum the use of any actuarially appropriate averages.

(d) For each rate increase that is implemented, the insurer shall file for review and approval under G.S. 58-51-95 by the Commissioner the updated projections, as defined in Part (b)(3)(A) of this Rule, annually for the next three years and include a comparison of actual results to projected values. The Commissioner may extend the period to greater than three years if actual results are not consistent with projected values from prior projections. For group insurance policies that meet the conditions in Paragraph (l) of this Rule, the projections required by this Paragraph shall be provided to the policyholder in lieu of filing with the Commissioner.

(e) If any premium rate in the revised premium rate schedule is greater than 200 percent of the comparable rate in the initial premium schedule, lifetime projections, as defined in Part (b)(3)(A) of this Rule, shall be filed for review and approval under G.S. 58-51-95 by the Commissioner every five years following the end of the required period in Paragraph (d) of this Rule. For group insurance policies that meet the conditions in Paragraph (l) of this Rule, the projections required by this Rule shall be provided to the policyholder in lieu of filing with the Commissioner.

(f) If the commissioner has determined that the actual experience following a rate increase does not adequately match the projected experience and that the current projections under moderately adverse conditions demonstrate that incurred claims will not exceed proportions of premiums specified in Paragraph (c) of this Rule, the Commissioner may require the insurer to implement any of the following:

(1) Premium rate schedule adjustments; or

(2) Other measures to reduce the difference between the projected and actual experience.

It is to be expected that the actual experience will not exactly match the insurer's projections. During the period that projections are monitored as described in Paragraphs (d) and (e) of this Rule, the Commissioner shall determine that there is not an adequate match if the differences in earned premiums and incurred claims are not in the same direction (both actual values higher or lower than projections) or the difference as a percentage of the projected is not of the same order. In determining whether the actual experience adequately matches the projected experience, consideration shall be given to Part (b)(3)(E) of this Rule, if applicable.

(g) If the majority of the policies or certificates to which the increase is applicable are eligible for the contingent benefit upon lapse, the insurer shall file:

(1) A plan, subject to the Commissioner's approval under G.S. 58-51-95 for improved administration or claims processing, or both, designed to eliminate the potential for further deterioration of the policy form requiring further premium rate increases; otherwise the Commissioner may impose the condition in Paragraph (i) of this Rule; and

(2) The original anticipated lifetime loss ratio, and the premium rate schedule increase that would have been calculated according to Paragraph (c) of this Rule had the greater of the original anticipated lifetime loss ratio or 58 percent been used in the calculations described in Parts (c)(2)(A) and (C) of this Rule.

(h) For a rate increase filing that meets the following criteria, the commissioner shall review, for all policies included in the filing, the projected lapse rates and past lapse rates during the 12 months following each increase to determine if adverse lapsation has occurred or is anticipated:

(1) The rate increase is not the first rate increase requested for the specific policy form or forms;

(2) The rate increase is not an exceptional increase; and

(3) The majority of the policies or certificates to which the increase is applicable are eligible for the contingent benefit upon lapse.

(i) In the event adverse lapsation has occurred, is anticipated in the filing, or is evidenced in the actual results as presented in the updated projections provided by the insurer following the requested rate increase, the Commissioner may determine that a rate spiral exists. Following the determination that a rate spiral exists, the Commissioner may require the insurer to offer, without underwriting, to all in force insureds subject to the rate increase the option to replace existing coverage with one or more reasonably comparable products being offered by the insurer or its affiliates.

(1) The offer shall:

(A) Be subject to the approval under G.S. 58-51-95 of the Commissioner;

(B) Be based on actuarially sound principles, but not be based on attained age; and

(C) Provide that maximum benefits under any new policy accepted by an insured shall be reduced by comparable benefits already paid under the existing policy;

(2) The insurer shall maintain the experience of all the replacement insureds separate from the experience of insureds originally issued the policy forms. In the event of a request for a rate increase on the policy form, the rate increase shall be limited to the lesser of:

(A) The maximum rate increase determined based on the combined experience; or

(B) The maximum rate increase determined based only on the experience of the insureds originally issued the form plus 10 percent.

(j) If the Commissioner determines that the insurer has exhibited a persistent practice of filing inadequate initial premium rates for long-term care insurance, the Commissioner may, in addition to the provisions of Paragraph (i) of this Rule, prohibit the insurer from either of the following:

(1) Filing and marketing comparable coverage for a period of up to five years; or

(2) Offering all other similar coverages and limiting marketing of new applications to the products subject to recent premium rate schedule increases.

A premium rate is inadequate if the rate is unreasonably low for the insurance provided and the use or continued use of the rate by the insurer has had or will have the effect of endangering the solvency of the insurer; destroying competition; creating a monopoly; or violating actuarial principles, practices, or soundness.

(k) Paragraphs (a) through (j) of this Rule shall not apply to policies for which the long-term care benefits provided by the policy are incidental, as defined in 11 NCAC 12 .1002, if the policy complies with all of the following provisions:

(1) The interest credited internally to determine cash value accumulations, including long-term care, if any, are guaranteed to be not less than the minimum guaranteed interest rate for cash value accumulations without long-term care set forth in the policy;

(2) The portion of the policy that provides insurance benefits other than long-term care coverage meets the nonforfeiture requirements as applicable in any of the following: G.S.58-58-55; 58-58-60; and 11 NCAC 12 .0436.

(3) The policy meets the disclosure requirements of 11 NCAC 12 .1006 and 11 NCAC 12 .1206;

(4) The portion of the policy that provides insurance benefits other than long-term care coverage meets the requirements as applicable in the following:

(A) Policy illustrations as required by 11 NCAC 04 .0500;

(B) Disclosure requirements in 11 NCAC 12 .1212;

(C) Disclosure requirements in 11 NCAC 12 .0420 and 12 .0422;

(D) Disclosure requirements in G.S. 58-7-95; and

(E) Disclosure requirements in G.S. 58-60-15;

(5) An actuarial memorandum is filed with the Commissioner that includes:

(A) A description of the basis on which the long-term care rates were determined;

(B) A description of the basis for the reserves;

(C) A summary of the type of policy, benefits, renewability, general marketing method, and limits on ages of issuance;

(D) A description and a table of each actuarial assumption used. For expenses, an insurer must include percent of premium dollars per policy and dollars per unit of benefits, if any;

(E) A description and a table of the anticipated policy reserves and additional reserves to be held in each future year for active lives;

(F) The estimated average annual premium per policy and the average issue age;

(G) A statement as to whether underwriting is performed at the time of application. The statement shall indicate whether underwriting is used and, if used, the statement shall include a description of the type or types of underwriting used, such as medical underwriting or functional assessment underwriting. Concerning a group policy, the statement shall indicate whether the enrollee or any dependent will be underwritten and when underwriting occurs; and

(H) A description of the effect of the long-term care policy provision on the required premiums, nonforfeiture values and reserves on the underlying insurance policy, both for active lives and those in long-term care claim status.

(l) Paragraphs (f) and (h) of this Rule shall not apply to group insurance policies as defined in G.S. 58-55-20(3) where:

(1) The policies insure 250 or more persons and the policyholder has 5,000 or more eligible employees of a single employer; or

(2) The policyholder, and not the certificate-holders, pays a material portion of the premium, which shall not be less than 20 percent of the total premium for the group in the calendar year prior to the year a rate increase is filed.

History

  • Authority G.S. 58-2-40; 58-51-95(f)
  • Eff. August 1, 2002
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .1029 Scope and Application {#sec-11-ncac-12-.1029 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .1029}

(a) Except as otherwise specifically provided, this Section applies to all long-term care insurance policies and life insurance policies that accelerate benefits for long-term care delivered or issued for delivery in this state on or after the effective date by insurers; fraternal benefit societies; nonprofit health, hospital and medical service corporations, prepaid health plans; health maintenance organizations and all similar organizations.

(b) This Section applies to policies having indemnity benefits that are triggered by activities of daily living and sold as disability income insurance if:

(1) The benefits of the disability income policy are dependent upon or vary in amount based on the receipt of long-term care services; or

(2) The disability income policy is advertised, marketed or offered as insurance for long-term care services; or

(3) Benefits under the policy may commence after the policyholder has reached Social Security's normal retirement age unless benefits are designed to replace lost income or pay for specific expenses other than long-term care services.

History

  • Authority G.S. 58-2-40; 58-2-210
  • Eff. August 1, 2002
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .1030 Long-Term Care Partnership Standards {#sec-11-ncac-12-.1030 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .1030}

(a) As used in this Rule:

(1) "Consumer Price Index" means the measure of the average change over time in the prices paid by urban consumers for a market basket of consumer goods and services as determined by the Bureau of Labor Statistics of the U. S. Department of Labor.

(2) "Qualified Policy" has the same meaning as in G.S. 58-55-55(6) and includes a certificate issued under a group policy as specified in G.S. 58-55-60.

(b) Inflation protections:

(1) A qualified policy that is sold to an individual who has not attained the age of 61 as of the date of purchase shall provide compound annual inflation benefit increase equal to:

(A) at least three percent; or

(B) the changes in the Consumer Price Index.

(2) A qualified policy that is sold to an individual who has attained the age of 61 but has not attained the age of 76 as of the date of purchase shall provide a level of inflation protection that:

(A) shall be disclosed to the applicant or enrollee at the time of application or enrollment; and

(B) meets the requirements of 58-55-60(5)(b).

(c) The disclosures required by G.S. 58-55-60 and G.S. 58-55-70 shall be provided by the insurer to the insured or applicant and to the additional person designated pursuant to 11 NCAC 12 .1022 at the last known address on record with the insurer within 30 calendar days of the day the insurer receives notification of the requested change from the insured that results in the status of a qualified policy changing to unqualified policy status.

History

  • Authority G.S. 58-2-40; 58-51-5; 58-51-95; 58-55-30; 58-55-55; 58-55-60; 58-55-65; 58-55-70
  • Eff. February 1, 2011
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .1101 Application {#sec-11-ncac-12-.1101 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .1101}

This Section applies to:

(1) All consolidations, whether the old coverage is provided under an individual or a group policy; and

(2) All mortgage insurance offered, issued, or delivered in this State, through the mail or otherwise, in connection with consolidations.

History

  • Authority G.S. 58-2-40; 58-2-210
  • Eff. February 1, 1992
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .1102 Definitions {#sec-11-ncac-12-.1102 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .1102}

In this Section, unless the context clearly indicates otherwise:

(1) "Consolidation" means any transaction in which a financial institution or servicer makes its premium collection services available to its mortgage debtors in connection with a particular insurer's ("new insurer") offer of mortgage insurance, which offer is made to debtors who, immediately prior to the offer, had mortgage insurance with another insurer ("old insurer") and were paying premiums for that insurance with their monthly mortgage payments.

(2) "Financial institution" or "servicer" means any entity or organization that services mortgage loans by collecting and accounting for monthly mortgage payments.

(3) "Loan transfer" means a transaction in which the servicing of a block of mortgage loans is transferred from one servicer to another. This includes, but is not limited to, a transfer of servicing to a new servicing location that occurs within a financial institution following, and as a result of, a merger or acquisition.

(4) "Loan transfer consolidation" means a consolidation involving debtors whose mortgage loans have been transferred from one servicer to another.

(5) "Mortgage" or "mortgage loan" means an indebtedness that is secured by real estate and that is not subject to Article 57 of General Statute Chapter 58.

(6) "Mortgage insurance" means group or individual life, individual accidental death, or individual disability insurance, or any combination thereof, designed to pay all or part of a mortgage loan in the event of the insured's death or disability. Group mortgage life insurance can only be written with contracts issued in North Carolina. Trust arrangements are not allowed for use for group mortgage life insurance.

(7) "New coverage" or "new plan" means the mortgage insurance coverage or mortgage insurance plan for which the financial institution collects premiums beginning on the effective date of a consolidation.

(8) "Old coverage" or "old plan" means the mortgage insurance coverage or mortgage insurance plan the financial institution collected premiums for immediately prior to the consolidation.

History

  • Authority G.S. 58-2-40; 58-2-210
  • Eff. February 1, 1992
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .1103 General Requirements {#sec-11-ncac-12-.1103 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .1103}

No insurer shall participate in any consolidation unless it complies with the following requirements:

(1) The offer of new coverage must be made on a timely basis:

(a) In a loan transfer consolidation, the offer of new coverage to the prospective insured must be made as soon as reasonably possible. If the offer of new coverage is not made at least 30 days before the proposed effective date of the new coverage, the insurer shall notify the debtor, in writing, that he has the right to an unconditional refund of all premiums paid since the transfer date provided he exercises the right, in writing, within 30 days after the date of the notification.

(b) In all other consolidations, the offer of new coverage shall be made to the prospective insured at least 30 days before the proposed effective date of the new coverage.

(2) A group certificate or individual policy shall be delivered to each debtor insured under the new plan. In addition to all other applicable requirements of General Statute Chapter 58, the group certificate or individual policy shall include the following information:

(a) The name or names of the single or joint insureds;

(b) Identification of the insured mortgage;

(c) The amount of insurance under the new plan;

(d) The premium for the new coverage;

(e) The effective date of the new coverage; and

(f) The beneficiary for the new coverage. If the insured had the right to name a beneficiary under the old contract, the insured shall retain this right under the new contract.

(3) No group certificate or individual policy evidencing the new coverage shall include a contestability clause or, in the case of mortgage life insurance, a provision excluding suicide.

(4) All group mortgage life insurance certificates issued in connection with any consolidation shall include a conversion privilege permitting an insured debtor to convert, without evidence of insurability, to an individual policy of decreasing term insurance within 30 days after the date the insured debtor's group coverage is terminated for reasons other than the nonpayment of premiums. The initial amount of coverage under the individual policy shall be an amount equal to the amount of coverage terminated under the group policy and shall decrease over a term that corresponds with the scheduled term of the insured debtor's mortgage loan. The premium for the individual policy shall be the same premium the insured debtor was paying under the group policy.

(5) Except for offers of new coverage made pursuant to 11 NCAC 12 .1104 and .1106, the new coverage shall be effectuated for the prospective insured only after the new insurer receives an application that has been signed by the prospective insured.

(6) Except as provided in 11 NCAC 12 .1104 and .1105, the new insurer must calculate premiums for the new coverage on the basis of its own rates, the prospective insured's then attained age, if applicable, and the amount of insurance offered.

History

  • Authority G.S. 58-2-40; 58-2-210
  • Eff. February 1, 1992
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .1104 Specific Requirements for Certain Offers {#sec-11-ncac-12-.1104 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .1104}

(a) The offer of new coverage may be based on the same premium the prospective insured was paying for his old coverage, and a signed application need not be obtained, if the new insurer complies with all applicable requirements of this Section and General Statute Chapter 58, and the following conditions are met:

(1) The old coverage is accidental death insurance, disability insurance, or group mortgage life insurance.

(2) The amount of insurance provided by the new plan must be the same or greater than provided by the old plan.

(3) All of the benefits provided by the old plan, including but not limited to accidental death riders and waiver-of-premium benefits, must be provided by the new plan.

(b) Individual policies of mortgage life insurance may only be consolidated pursuant to 11 NCAC 12 .0600.

History

  • Authority G.S. 58-2-40; 58-2-210
  • Eff. February 1, 1992
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .1105 Disclosure Requirements {#sec-11-ncac-12-.1105 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .1105}

In conjunction with any offer of new coverage made in any consolidation, the new insurer shall disclose in writing to each debtor the following:

(1) That the insured may have the right to continue or convert his old coverage by paying premium directly to the old insurer;

(2) That the new coverage is not conditioned upon either the termination or replacement of the old coverage;

(3) The name and address of the old and new insurer;

(4) The effective date of the new coverage;

(5) The beneficiary of the new coverage;

(6) Amount of coverage for both the new and old plans. If the amount of coverage for the old plan is not known, a statement that the amount may be scheduled and it may be less than or greater than the amount of the loan and the insured should check his old policy schedule for an exact amount of coverage;

(7) Material differences, if any, between the new plan and the old plan;

(8) A statement as to whether the old plan was an individual or group plan and a statement as to whether the new plan is an individual or a group policy.

(9) Cautionary language shall be affixed in sticker form in bold type upon the face or insert page of any policy/certificate issued pursuant to 11 NCAC 12 .1104 and .1106 with language substantially as follows:

IMPORTANT NOTICE

This certificate/policy is issued to you in connection with a mortgage insurance consolidation. It is the intention of the insurer to provide you coverage that is equal to or better than the coverage you had before. To the extent the benefits provided or the provisions of your prior certificate/policy are more liberal than those under this certificate/policy, the provisions of your prior certificate will control. This certificate/policy shall be incontestable from its date of issue.

History

  • Authority G.S. 58-2-40; 58-2-210
  • Eff. February 1, 1992
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .1106 Disability Insurance Plans {#sec-11-ncac-12-.1106 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .1106}

If the financial institution sponsors a mortgage life insurance plan and a disability insurance plan that are underwritten by the same insurer, and if the new insurer consolidates the mortgage life plan pursuant to 11 NCAC 12 .1104 by offering the same coverage at the old premium, the new insurer must also consolidate the disability insurance plan by offering the same coverage at the old premium.

History

  • Authority G.S. 58-2-40; 58-2-210
  • Eff. February 1, 1992
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .1107 Disclosure of Consolidation to the Department {#sec-11-ncac-12-.1107 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .1107}

(a) Except for loan transfer consolidations, the new insurer shall notify the Department of the intent to execute a mortgage insurance consolidation involving North Carolina financial institutions at least 30 days before the proposed effective date of the new coverage.

(b) If the consolidation is pursuant to a loan transfer, the Department shall be notified as soon as reasonably possible, but no later than 30 days after the date that the insurance company is notified by the financial institution that the loan transfer has occurred. Notifications required under this Rule shall be in writing and sent to:

North Carolina Department of Insurance

Life and Health Division

Post Office Box 26387

Raleigh, NC 27611

(c) Notifications required under this Rule shall contain the following information:

(1) Identification of financial institution(s) involved;

(2) Reason for transfer, i.e., loan transfer or other type of consolidation;

(3) Proposed effective date of the consolidation;

(4) Identification of the insurance companies whose coverages are being consolidated;

(5) A listing of the new insurer's form numbers to be used; and

(6) The approximate number of North Carolina insureds whose mortgages will be consolidated.

History

  • Authority G.S. 58-2-40; 58-2-210
  • Eff. February 1, 1992
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .1201 Purpose and Application {#sec-11-ncac-12-.1201 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .1201}

The purpose of this Section is to regulate accelerated benefit provisions of individual and group life insurance policies and annuities and to provide required standards of disclosure. This Section applies to all accelerated benefits provisions of individual and group life insurance policies and annuities, except those subject to Article 55 of General Statute Chapter 58, that are issued or delivered in this State on or after the effective date of this Section.

History

  • Authority G.S. 58-2-40; 58-3-150; 58-7-15(1); 58-58-1
  • Eff. March 1, 1992
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .1202 Definitions {#sec-11-ncac-12-.1202 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .1202}

(a) "Accelerated benefits" covered under this Section are benefits are payable under a life insurance or annuity contract:

(1) To a policyowner or certificateholder, during the lifetime of the insured, in anticipation of death or upon the occurrence of specified life-threatening or catastrophic conditions as defined by the policy or rider; and

(2) That reduce the death benefit otherwise payable under the life insurance or annuity contract; and

(3) That are payable upon the occurrence of a single qualifying event that results in the payment of a benefit amount fixed at the time of acceleration.

(b) "Qualifying event" means one or more of the following:

(1) A medical condition that a duly licensed health care provider predicts would result in a drastically limited life span as specified in the contract; or

(2) A medical condition that has required or requires extraordinary medical intervention, including a major organ transplant or continuous artificial life support, without which the insured would die; or

(3) Any condition that usually requires continuous confinement in an eligible institution as defined in the contract if the insured is expected to remain there for the rest of his or her life; or

(4) A medical condition that medical evidence indicates would, in the absence of extensive or extraordinary medical treatment, result in a drastically limited life span. Such condition may include one or more of the following:

(A) Coronary artery disease resulting in an acute infarction or requiring surgery;

(B) Permanent neurological deficit resulting from cerebral vascular accident;

(C) End stage renal failure; or

(D) Acquired Immune Deficiency Syndrome.

History

  • Authority G.S. 58-2-40; 58-3-150; 58-7-15(1); 58-58-1
  • Eff. March 1, 1992
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .1203 Type of Product {#sec-11-ncac-12-.1203 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .1203}

Accelerated benefit riders and life insurance policies and annuities with accelerated benefit provisions are primarily deemed to be mortality risks rather than morbidity risks.

History

  • Authority G.S. 58-2-40; 58-3-150; 58-7-15(1); 58-58-1
  • Eff. March 1, 1992
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .1204 Assignee/Beneficiary {#sec-11-ncac-12-.1204 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .1204}

Before the payment of any accelerated benefit, the insurer shall obtain from any assignee or irrevocable beneficiary a signed acknowledgement of concurrence for payment. If the insurer paying the accelerated benefit is the assignee under the policy, no such acknowledgement is required.

History

  • Authority G.S. 58-2-40; 58-3-150; 58-7-15(1); 58-58-1
  • Eff. March 1, 1992
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .1205 Criteria for Payment {#sec-11-ncac-12-.1205 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .1205}

(a) Lump Sum Settlement Option Required. Contract payment options shall include the option to take the benefit as a lump sum. The benefit shall not be made available as an annuity that is contingent upon the life of the insured.

(b) Restrictions on Use of Proceeds. No restrictions by the insurer are permitted on the use of the proceeds by the insured.

(c) Accidental Death Benefit Provisions. If any death benefit remains after payment of an accelerated benefit, any accidental death benefit provision in the policy or rider shall not be affected by the payment of the accelerated benefit.

History

  • Authority G.S. 58-2-40; 58-3-150; 58-7-15(1); 58-58-1
  • Eff. March 1, 1992
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .1206 Disclosures {#sec-11-ncac-12-.1206 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .1206}

(a) Descriptive Title. The term "accelerated benefit" shall be included in the descriptive title printed on the first page of the policy or rider. Products regulated under this Section shall not be described or marketed as long-term care insurance or as providing long-term care benefits.

(b) Tax Consequences. A disclosure statement is required at the time of application for the policy or rider and at the time the accelerated benefit payment request is submitted, which statement shall advise that receipt of accelerated benefits may be taxable and that assistance should be sought from a personal tax advisor. The statement shall be prominently displayed on the first page of the policy or rider and on any other related documents.

(c) Solicitation:

(1) A written disclosure including, but not limited to, a brief description of the accelerated benefit and definitions of the conditions or occurrences triggering payment of the benefits shall be given to the applicant. The description shall include an explanation of any effect of the payment of a benefit on the policy's cash value, accumulation account, death benefit, premium, policy loans and policy liens:

(A) In the case of agent solicited insurance, the agent shall provide the disclosure form to the applicant prior to or concurrently with the application. Acknowledgement of the disclosure shall be signed by the applicant and writing agent.

(B) In the case of a solicitation by direct response methods, the insurer shall incorporate the disclosure in the application or attach a disclosure form thereto.

(C) In the case of group insurance policies, the disclosure form shall be contained as part of the certificate of coverage or any related document furnished by the insurer for the certificate holder.

(2) If there is a premium or cost of insurance charge, the insurer shall give the applicant a generic illustration numerically demonstrating any effect of the payment of a benefit on the policy's cash value, accumulation account, death benefit, premium, policy loans and policy liens:

(A) In the case of agent solicited insurance, the agent shall provide the illustration to the applicant prior to or concurrently with the application.

(B) In the case of a solicitation by direct response methods, the insurer shall provide the illustration to the applicant at the time the policy is delivered.

(C) In the case of group insurance policies, the disclosure form shall be contained as part of the certificate of coverage or any related document furnished by the insurer for the certificate holder.

(3) Disclosure of Premium Charge:

(A) Insurers with financing options other than those described in 11 NCAC 12 .1210(a)(2) shall disclose to the policy owner any premium or cost of insurance charge for the accelerated benefit. Each insurer shall make a reasonable effort to assure that the certificate holder is aware of any additional premium or cost of insurance charge if the certificate holder is required to pay such charge.

(B) Each insurer shall furnish an actuarial demonstration to the Department when filing a policy form containing an accelerated benefit, which demonstration shall disclose the method of arriving at the insurer's cost for the accelerated benefit.

(4) Disclosure of Administrative Expense Charge. Each insurer shall disclose to each policy owner any administrative expense charge. Each insurer shall make a reasonable effort to assure that each certificate holder is aware of any administrative expense charge if the certificate holder is required to pay such charge.

(d) Effect of the Benefit Payment. When a policy owner or certificate holder requests an acceleration, the insurer shall send a statement to the policy owner or certificate holder and irrevocable beneficiary showing any effect that the payment of the accelerated benefit will have on the policy's cash value, accumulation account, death benefit, premium, policy loans and policy liens. The statement shall disclose that:

(1) receipt of accelerated benefit payments may adversely affect the recipient's eligibility for Medicaid or other government benefits or entitlement; and that

(2) receipt of an accelerated benefit payment may be taxable and assistance should be sought from a personal tax advisor.

Each time an accelerated benefit option is exercised the policy owner and certificate holder shall be given an endorsement, rider or schedule page that reflects any revisions to cash values, death benefits, accumulation accounts, premiums, policy loans, policy liens and any other values that change as a result of the payment or payments. When a previous disclosure statement becomes invalid as a result of an acceleration of the death benefit, the insurer shall send a revised disclosure statement to the policy owner or certificate holder and irrevocable beneficiary. When the insurer agrees to accelerate death benefits, the insurer shall issue an amended schedule page to the policyholder or notify the certificate holder under a group policy to reflect any new, reduced in-force face amount of the contract.

History

  • Authority G.S. 58-2-40; 58-3-150; 58-7-15(1); 58-58-1
  • Eff. March 1, 1992
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .1207 Effective Date of the Accelerated Benefits {#sec-11-ncac-12-.1207 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .1207}

An accelerated benefit provision shall be effective for qualifying events that occur on or after the effective date of the policy or rider. The accelerated benefit provision shall be effective for illness no more than 30 days after the effective date of the policy or rider.

History

  • Authority G.S. 58-2-40; 58-3-150; 58-7-15(1); 58-58-1
  • Eff. March 1, 1992
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .1208 Waiver of Premiums {#sec-11-ncac-12-.1208 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .1208}

The insurer may offer a waiver of premium for the accelerated benefit provision in the absence of a regular waiver of premium provision being in effect. At the time the benefit is claimed, the insurer shall explain any continuing premium requirement to keep the policy in force.

History

  • Authority G.S. 58-2-40; 58-3-150; 58-7-15(1); 58-58-1
  • Eff. March 1, 1992
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .1209 Discrimination {#sec-11-ncac-12-.1209 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .1209}

In addition to the requirements of G.S. 58-58-35 and G.S. 58-63-15(7)a, insurers shall not apply any additional conditions on the payment of the accelerated benefits other than those conditions specified in the policy or rider.

History

  • Authority G.S. 58-2-40; 58-3-120; 58-3-150; 58-7-15(1); 58-58-1; 58-58-35; 58-63-15(7)
  • Eff. March 1, 1992
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .1210 Actuarial Standards {#sec-11-ncac-12-.1210 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .1210}

(a) Financing Options:

(1) The insurer may require a premium charge or cost of insurance charge for the accelerated benefit. These charges shall be based on sound actuarial principles. In the case of group insurance, the additional cost may also be reflected in experience rating.

(2) The insurer may pay a present value of the face amount. The calculation shall be based on any applicable actuarial discount appropriate to the policy design. The interest rate or interest rate methodology used in the calculation shall be based on sound actuarial principles and disclosed in the contract or actuarial memorandum. The maximum interest rate used shall be no more than the greater of:

(A) The current yield on 90 day treasury bills; or

(B) The current maximum statutory adjustable policy loan interest rate.

(3) The insurer may accrue an interest charge on the amount of the accelerated benefits. The interest rate or interest rate methodology used in the calculation shall be based on sound actuarial principles and disclosed in the contract or actuarial memorandum. The maximum interest rate used shall be no more than the greater of:

(A) The current yield on 90 day treasury bills; or

(B) The current maximum statutory adjustable policy loan interest rate.

The interest rate on the portion of the lien that is equal in amount to the cash value of the contract at the time of the benefit acceleration shall be no more than the policy loan interest rate stated in the contract.

(b) Effect on Cash Value:

(1) Except as provided in Subparagraph (b)(2) of this Rule, when an accelerated benefit is payable, there shall be no more than a pro rata reduction in the cash value based on the percentage of death benefits accelerated to produce the accelerated benefit payment.

(2) Alternatively, the payment of accelerated benefits, any administrative expense charges, any future premiums and any accrued interest can be considered a lien against the death benefit of the policy or rider and the access to the cash value may be restricted to any excess of the cash value over the sum of any other outstanding loans and the liens. Future access to additional policy loans may also be limited to any excess of the cash value over the sum of the lien and any other outstanding policy loans.

(c) Effect of Any Outstanding Policy Loans on Accelerated Death Benefit Payment. When payment of an accelerated benefit results in a pro rata reduction in the cash value, the payment may not be applied toward repaying an amount greater than a pro rata portion of any outstanding policy loans.

History

  • Authority G.S. 58-2-40; 58-3-150; 58-7-15(1); 58-58-1
  • Eff. March 1, 1992
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .1211 Actuarial Disclosure and Reserves {#sec-11-ncac-12-.1211 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .1211}

(a) Actuarial Memorandum. A qualified actuary shall describe the accelerated benefits, the risks, the expected costs and the calculation of statutory reserves in an actuarial memorandum accompanying each filing with the Commissioner. The insurer shall maintain in its files descriptions of the bases and procedures used to calculate benefits payable under these provisions. These descriptions shall be made available for examination by the Commissioner or a designee upon request.

(b) Reserves:

(1) When benefits are provided through the acceleration of benefits under group or individual life policies or riders to such policies, policy reserves shall be determined in accordance with G.S. 58-58-50. All valuation assumptions used in constructing the reserves shall be determined as appropriate for statutory valuation purposes by a member in good standing of the American Academy of Actuaries. Mortality tables and interest rates currently recognized for life insurance reserves by the NAIC may be used as well as appropriate assumptions for the other provisions incorporated in the policy form. The actuary must follow both actuarial standards and certification for good and sufficient reserves. Reserves in the aggregate should be sufficient to cover:

(A) Policies upon which no claim has yet arisen.

(B) Policies upon which an accelerated claim has arisen.

(2) For policies and certificates that provide actuarially equivalent benefits, no additional reserves need to be established.

(3) Policy liens and policy loans, including accrued interest, represent assets of the insurer for statutory reporting purposes. For any policy on which the policy lien exceeds the policy's statutory reserve liability such excess must be held as a non-admitted asset.

History

  • Authority G.S. 58-2-40; 58-3-150; 58-7-15(1); 58-58-1
  • Eff. March 1, 1992
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .1212 Long-Term Care Benefits Acceleration {#sec-11-ncac-12-.1212 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .1212}

(a) An insurer that issues life insurance policies that accelerate benefits for long-term care shall comply with 11 NCAC 12 .1010 if the policy being replaced is a long-term care insurance policy. If the policy being replaced is a life insurance policy, the insurer shall comply with 11 NCAC 12 .0611. If a life insurance policy that accelerates benefits for long-term care is replaced by another life insurance policy that accelerates benefits for long-term care, the replacing insurer shall comply with 11 NCAC 12 .1010 AND 11 NCAC 12 .0611

(b) 11 NCAC 12 .1013 does not apply to life insurance policies that accelerate benefits for long-term care. A life insurance policy that funds long-term care benefits entirely by accelerating the death benefit is considered to provide reasonable benefits in relation to premiums paid, if the policy complies with all of the following provisions:

(1) The interest credited internally to determine cash value accumulations, including long-term care, in any, are guaranteed interest rate for cash value accumulations without long-term care set forth in the policy.

(2) The portion of the policy that provides life insurance benefits meets the nonforfeiture requirements of G.S. 58-58-30.

(3) The policy meets the disclosure requirements of G.S. 58-55-30.

(4) Any policy illustration that meets the applicable requirements of 11 NCAC 04. 0501

(5) An actuarial memorandum is filed with the Division that includes:

(A) A description of the basis on which the long-term care rates were determined.

(B) A description of the basis for the reserves.

(C) A summary of the type of policy, benefits, renewability, general marketing method, and limits on ages of issuance.

(D) A description and a table of each actuarial assumption used. For expenses, an insurer must include percent of premium dollars per policy and dollars per unit of benefits, if any.

(E) A description and a table of the anticipated policy reserves and additional reserves held in each future year for active lives.

(F) The estimated average annual premium per policy and the average issue age.

(G) A statement as to whether underwriting is performed at the time of application. The statement shall indicate whether underwriting is used and, if used, the statement shall include a description of the type or assessment underwriting. For a group policy, the statement shall indicate whether the enrollee or any dependent will be underwritten and when that underwriting occurs.

(H) A description of the effect of the long-term care policy provision on the required premiums, nonforfeiture values, and reserves on the underlying life insurance policy, both for the active lives and those in long-term care claim status.

History

  • Authority G.S. 58-2-40(1); 58-55-30(a); 58-58-1; 58-58-40
  • Eff. April 1, 1999
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .1301 Definitions {#sec-11-ncac-12-.1301 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .1301}

(a) As used in this Section, unless the context clearly indicates otherwise:

(1) "Act" means the North Carolina Small Employer Group Health Coverage Reform Act described in G.S. 58-50-100.

(2) "Carrier" means a small employer carrier.

(3) "Extra eligible" means an individual who is not an eligible employee or a dependent of an eligible employee who is insured under the health benefit plan of a small employer.

(4) "New entrant" means an eligible employee, or the dependent of an eligible employee, who becomes part of an employer group after the initial period for enrollment in a health benefit plan.

(5) "Nonstatutory plan" means any health benefit plan subject to the Act other than the statutory plans.

(6) "Policy anniversary" or "plan anniversary" means the annual anniversary of the issuance of a health benefit plan. If a plan is issued through a multiple employer trust, "policy anniversary" or "plan anniversary" means the annual anniversary of the issuance of the health benefit plan to the small employer.

(7) "Previously declined group" means a group whose application for coverage was declined for any reason by a carrier after January 1, 1992, and before August 14, 1992.

(8) "Previously declined individual" means an individual whose application for coverage for a health benefit plan was declined by a carrier before August 14, 1992.

(9) "Producer" means an insurance agent or insurance broker licensed under Article 33 of G.S. Chapter 58.

(10) "Statutory plan" means the basic or standard health care plan.

(b) The definitions contained in G.S. 58-50-110 are incorporated into this Section by reference.

History

  • Authority G.S. 58-2-40(1)
  • Temporary Adoption Eff. December 21, 1992 for a period of 180 days or until the permanent rule becomes effective, whichever is sooner
  • Eff. April 1, 1993
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .1302 Scope {#sec-11-ncac-12-.1302 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .1302}

(a) Any health benefit plan is subject to the Act if it is a health benefit plan under G.S. 58-50-115(a)(1) or (2) and is not excluded from the Act by G.S. 58-50-110(11).

(b) This Section does not apply to individual health insurance policies that are not subject to G.S. 58-50-115.

(c) The Act and this Section apply to a health benefit plan provided to a small employer or to the employees of a small employer without regard to whether the health benefit plan is offered under or provided through a group policy or trust arrangement.

History

  • Authority G.S. 58-2-40(1); 58-50-110(5); 58-50-113(a)(3); 58-50-115
  • Temporary Adoption Eff. December 21, 1992 for a period of 180 days or until the permanent rule becomes effective, whichever is sooner
  • Eff. April 1, 1993
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .1303 Policy Forms and Approvals {#sec-11-ncac-12-.1303 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .1303}

All carriers must file all health benefit plan policy forms with the Department for approval before they may be used. The following procedures apply to filing those policy forms:

(1) The filing cover letter shall include a certification by the carrier that specifies that the health benefit plan will be marketed to small employers. Each health benefit plan that will be marketed with payroll deduction shall include this certification.

(2) Carriers are not required to file new health benefit plan policy forms. Existing policy forms may be brought into compliance with the Act by means of amendments or variable language.

History

  • Authority G.S. 58-2-40(1); 58-50-125(b); 58-51-1
  • Temporary Adoption Eff. December 21, 1992 for a period of 180 days or until the permanent rule becomes effective, whichever is sooner
  • Eff. April 1, 1993
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .1304 Compliance {#sec-11-ncac-12-.1304 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .1304}

(a) Each carrier and third party administrator shall file a report on North Carolina small employer group insurance activity annually on or before March 15, which report shall describe case characteristics and numbers of health benefit plans in various categories marketed or issued to small employers. The report shall be in a format prescribed by the Commissioner.

(b) Each carrier shall provide the same health benefit plan to eligible employees and dependents; provided, however, under G.S. 58-67-35(a)(5) and (a)(6)b. and c., an HMO may offer its approved small employer health benefit plan in conjunction with an approved indemnity benefit plan to eligible employees and dependents, and the two plans must be of similar value in that the deductibles, copayments, and covered benefits must be comparable.

(c) A carrier shall not set contribution and participation requirements for the statutory plans that are more restrictive than those for the carrier's nonstatutory plans.

(d) If any eligible employee or dependent has qualifying existing coverage, as defined in G.S. 58-50-130(a)(5), and therefore does not participate in the employer's health benefit plan, a carrier is not required to issue or renew the employer's plan unless either:

(1) at least two eligible employees in a group of seven or less elect to participate; or

(2) at least 25 percent of eligible employees in a group of more than seven elect to participate.

(e) Each carrier shall offer both statutory plans to any small employer upon request or if the carrier is unable to issue a nonstatutory plan to the small employer applicant.

(f) A carrier shall provide an extension of benefits to any insured who is a hospital inpatient until the insured is released by the hospital if the insured's existing coverage would end during the insured's hospital stay and if replacement coverage is not available to the insured, subject to the continued payment of monthly premiums or dues by the insured.

(g) New business applications submitted to a carrier on and after September 1, 1992, shall be accompanied by a statement signed by the producer and the small employer applicant that certifies that the employer understands that the firm may elect coverage under the statutory plans. The disclosure form shall be made part of such statement. A copy of the signed statement and disclosure form must be provided to the small employer applicant. The disclosure form shall be in a form prescribed by the Commissioner.

(h) If a carrier establishes more than one class of business under G.S. 58-50-113, the carrier shall maintain at least one basic and standard health care plan in each class of business so established. Nothing in this Section prevents a carrier from offering the statutory plans through an association or multiple employer trust.

History

  • Authority G.S. 58-2-40(1); 58-50-105; 58-50-113; 58-50-120(c)(4); 58-50-120(c)(6); 58-50-125(d); 58-50-130(a)(2); 58-50-130(a)(5); 58-50-130(d); 58-50-130(f)
  • Temporary Adoption Eff. December 21, 1992 for a period of 180 days or until the permanent rule becomes effective, whichever is sooner
  • Eff. April 1, 1993
  • Temporary Amendment Eff. October 11, 1993 for a period of 180 days or until the permanent rule becomes effective, whichever is sooner
  • Amended Eff. October 1, 1994; February 1, 1994
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .1305 Prohibited Acts {#sec-11-ncac-12-.1305 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .1305}

(a) A carrier shall not unilaterally change a small employer group from one health benefit plan to another. A carrier shall not require an in-force health benefit plan risk to replace existing coverage with the basic or standard health care plans.

(b) No carrier, its agents or field representatives, a broker, nor a small employer shall discourage any employee or dependent from applying for coverage so that the small employer can be issued a more favorable premium rate or benefit package.

(c) No carrier shall set classes of employees in such a way as to exclude any employees who are eligible for insurance by definition. This Paragraph does not prevent a carrier from classifying ineligible employees or "extra-eligibles".

History

  • Authority G.S. 58-2-40(1); 58-50-125(d); 58-50-130(a)(3)
  • Temporary Adoption Eff. December 21, 1992 for a period of 180 days or until the permanent rule becomes effective, whichever is sooner
  • Eff. April 1, 1993
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .1306 Reinsurance Pool {#sec-11-ncac-12-.1306 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .1306}

History

  • Status: repealed
  • Authority G.S. 58-2-40(1); 58-50-130(b)(4); 58-50-150(a); 58-50-150(f)(5); 58-50-150(g)
  • Filed as a Temporary Adoption Eff. December 21, 1992 for a period of 180 days or until the permanent rule becomes effective, whichever is sooner
  • Eff. April 1, 1993
  • Filed as a Temporary Amendment Eff. October 11, 1993 for a period of 180 days or until the permanent rule becomes effective, whichever is sooner
  • Amended Eff. February 1, 1994
  • Repealed Eff. July 1, 2012.
11 NCAC 12 .1307 Guaranteed Issue and Renewal {#sec-11-ncac-12-.1307 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .1307}

(a) No carrier shall decline an application for coverage under the statutory plans. A carrier may continue to issue health benefit plans other than the statutory plans.

(b) If an eligible employee commits fraud or makes material misrepresentation to a carrier, the carrier may rescind coverage for that employee. If the small employer commits fraud or makes a material misrepresenta­tion to a carrier, the carrier may rescind coverage for that entire small employer group.

(c) The late enrollee provision in G.S. 58-50-130(a)(4) applies to all health benefit plans subject to the Act.

(d) Any health benefit plan covering an employer that by definition becomes a small employer is not subject to the Act until the next anniversary date of that plan.

(e) Any health benefit plan covering a small employer that by definition loses its status as a small employer is subject to the Act until the next anniversary date of that plan. At that time, the carrier shall determine if the employer is by definition a small employer. If the employer is not a small employer, the carrier may terminate the plan. If the carrier does not terminate the plan, the carrier shall amend the plan with riders or

endorsements to comply with requirements of statutes and rules that were not reflected in the plan before the anniversary date.

(f) Before a plan anniversary date, a small employer may request that coverage be changed from one statutory plan to another statutory plan.

(g) Previously declined individuals are not late enrollees unless they fail to enroll during their initial enrollment periods.

(h) On the next health benefit plan anniversary date that falls on or after August 14, 1992, a carrier shall remove all exclusionary riders or conditional modifications on any health benefit plan that is subject to the Act.

(i) A carrier may base termination on nonpayment of premium; and shall apply termination decisions uniformly to all of the carrier's small employer group business.

(j) A carrier is not required to issue a statutory plan to a small employer if within the prior 12 months the carrier terminated a health benefit plan of the small employer because the employer:

(1) failed to pay the premium;

(2) committed fraud or materially misrepresented information necessary to determine the group size, group participation rate, or the group premium rate; or

(3) failed to materially comply with a health benefit plan provision, including carrier requirements for employee group premium contributions.

(k) All health benefit plans subject to the Act that were delivered, issued for delivery, renewed, or continued in this State or covering persons residing in this State on or after January 1, 1992, must be guaranteed renewable, except for the reasons listed in G.S. 58-50-130(a)(3).

(l) Each carrier shall provide an open enrollment period for a new entrant to be added to the health benefit plan. The open enrollment period shall be at least 30 days in length. A new entrant who is a new eligible employee shall be added to the plan within 90 days of his or her employment. A new entrant who is a dependent shall have an open enrollment period of at least 30 days, beginning on the date he or she becomes a dependent of an eligible employee, if the eligible employee has coverage. If a new entrant does not apply for coverage by the end of the open enrollment period, he or she is a late enrollee unless he or she meets the requirements of G.S. 58-50-110(14)a, b, or c.

History

  • Authority G.S. 58-2-40(1); 58-50-105; 58-50-125(d); 58-50-125(e)(1); 58-50-130(a); 58-50-130(h)
  • Temporary Adoption Eff. December 21, 1992 for a period of 180 days or until the permanent rule becomes effective, whichever is sooner
  • Eff. April 1, 1993
  • Temporary Amendment Eff. October 11, 1993 for a period of 180 days or until the permanent rule becomes effective, whichever is sooner
  • Amended Eff. February 1, 1994
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .1308 Elections by Carriers {#sec-11-ncac-12-.1308 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .1308}

(a) If an election to be a risk assuming carrier is disapproved by the Commissioner, the carrier shall be considered a reinsuring carrier as of the date of the disapproval, unless the carrier is already so considered.

(b) An insurer that has previously notified the Commissioner that it is not a small employer carrier may enter the small employer group health insurance market upon notification to the Commissioner and the Commissioner's approval of the carrier's statutory health benefit plans; and that carrier shall be a reinsuring carrier.

History

  • Authority G.S. 58-2-40(1); 58-50-135(a); 58-50-135(c); 58-50-150(a)
  • Temporary Adoption Eff. December 21, 1992 for a period of 180 days or until the permanent rule becomes effective, whichever is sooner
  • Eff. April 1, 1993
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .1309 Fair Marketing Standards {#sec-11-ncac-12-.1309 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .1309}

(a) A carrier may select those agents with whom it chooses to contract. If a carrier chooses to contract with an agent, the carrier may not terminate or refuse to renew the agency contract for any reason related to the health status, claims experience, occupation, or geographic location of the small employer groups placed by the agent with the carrier. If the agent is directing statutory plan business to the carrier, the carrier may terminate the agency contract.

(b) No carrier shall, directly or indirectly, enter into any contract, agreement, or arrangement with an agent that provides for or results in any consideration provided to an agent for the issuance or renewal of a health benefit plan to vary on account of the health status, claims experience, industry, occupation, or geographic location of a small employer group covered by the plan.

(c) Each carrier shall provide all small employers in the same class of business an equal opportunity to obtain coverage under the statutory plans.

(d) No carrier shall apply more stringent application or informational requirements for enrollment for the statutory plans than are applied for other health benefit plans offered by the carrier.

(e) No carrier shall limit or discourage any producer marketing the statutory plans.

(f) A carrier shall provide a price quote to a small employer, directly or through an authorized producer, within seven business days after receiving a request for a quote and such information necessary to provide that quote. If additional information is necessary for the quote, a carrier shall notify a small employer, directly or through an authorized producer, within five business days after receiving the additional information.

History

  • Authority G.S. 58-2-40(1); 58-50-120(c)(7); 58-50-125(f)
  • Temporary Adoption Eff. December 21, 1992 for a period of 180 days or until the permanent rule becomes effective, whichever is sooner
  • Eff. April 1, 1993
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .1401 Applicability and Scope {#sec-11-ncac-12-.1401 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .1401}

This Section applies to any HMO that, under G.S. 58-67-35(a)(6)d, offers coverage to its enrollees for health care services that are received, other than in an emergency, from:

(1) Providers who are not employed by, under contract with, or otherwise affiliated with the HMO; or

(2) Providers who are employed by, under contract with, or otherwise affiliated with the HMO in instances when such services are not received in compliance with the HMO's health care plan requirements.

History

  • Authority G.S. 58-2-40; 58-67-35; 58-67-150
  • Eff. January 1, 1994
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .1402 Definitions {#sec-11-ncac-12-.1402 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .1402}

In this Section, unless the context clearly indicates otherwise:

(1) "Coinsurance" means the percentage of an allowed charge or expense for a covered health care service that an enrollee must pay.

(2) "Copayment" means a fixed dollar amount that an enrollee must pay each time a covered health care service is provided.

(3) "Deductible" means a specified amount of covered health care services, expressed in dollars, that must be incurred by an enrollee before the HMO will assume any financial liability for all or part of covered health care services.

(4) "In-plan covered services" means covered health care services that are received according to the rules of the health care plan from providers employed by, under contract with, or approved in advance by the HMO; and means emergency health care services.

(5) "Out-of-plan covered services" means non-emergency, medically necessary covered health care services that are not received according to the rules of the health care plan, including services from affiliated providers that are received without the approval of the HMO.

(6) "Out-of-pocket expense" means a specified dollar amount of coinsurance incurred and payable by an enrollee for covered health care services in a specified period; but does not include deductible amounts, copayment amounts, charges in excess of the amount allowed by the HMO, amounts exceeding the maximum benefits, nor any disallowed or noncovered expenses under the rules of the health care plan.

(7) "Point-of-service product" means a feature in a health care plan that provides benefits for both in-plan covered services and out-of-plan covered services.

(8) The definitions contained in G.S. 58-67-5 are incorporated into this Section by reference.

History

  • Authority G.S. 58-2-40; 58-67-35; 58-67-150
  • Eff. January 1, 1994
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .1403 General Requirements {#sec-11-ncac-12-.1403 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .1403}

No HMO shall provide any point-of-service product unless it complies with the following requirements and with G.S. 58-67-10(d)(1):

(1) Where the covered benefits of a point-of-service product include coinsurance, the difference in coinsurance rates between in-plan covered services and out-of-plan covered services shall not exceed 30 percentage points.

(2) If the schedule of benefits for a point-of-service product imposes a deductible for in-plan covered services, the amount of any annual deductible per enrollee or per family for out-of-plan covered services may not exceed five times the amount of the corresponding annual deductible applied to in-plan covered services.

(3) If the schedule of benefits for a point-of-service product does not include an annual deductible for in-plan covered services, the annual deductibles for out-of-plan covered services shall not exceed two thousand dollars ($2000) per enrollee and the family deductible may not exceed three times the amount of the corresponding annual deductible for the enrollee.

(4) The portion of any charge for out-of-plan covered services to be applied to an annual deductible may be based on the amount the HMO would have recognized as an allowable charge had the service been rendered as an in-plan covered service.

(5) If there is a lifetime maximum benefit for in-plan covered services, the amount of any annual and lifetime maximum limits for out-of-plan covered services shall not be less than one-half of the amount of any annual and lifetime maximum limits for in-plan covered services.

(6) If a point-of-service product includes copayments for both in-plan covered services and out-of-plan covered services, the amount of the copayment for an out-of-plan covered service shall not exceed the copayment for an in-plan covered service by more than fifty dollars ($50.00) or 100%, whichever is greater.

(7) A point-of-service product shall make all mandated benefits available in the form of in-plan covered services.

(8) Point-of-service products shall provide incentives, including financial incentives, for enrollees to use in-plan covered services.

(9) Any offered out-of-plan covered service must be available on an in-plan covered service basis.

(10) A HMO offering a point-of-service product may exclude coverage for preventive health care services provided on an out-of-plan basis.

(11) Point-of-service products shall give enrollees the option to choose in-plan covered services or out-of-plan covered services each time such covered services are authorized, obtained, or rendered.

History

  • Authority G.S. 58-2-40; 58-67-35; 58-67-150
  • Eff. January 1, 1994
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .1404 Disclosure Requirements {#sec-11-ncac-12-.1404 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .1404}

(a) Every explanation of benefits shall contain an explanation of coverage for out-of-plan covered services that allows each enrollee to determine his or her obligations with respect to such services.

(b) Marketing materials, evidences of coverage, enrollee handbooks, and other materials given to enrollees by an HMO that offers a point-of-service product shall contain an explanation of the point-of-service product. The explanation shall include:

(1) the method of reimbursement;

(2) applicable copayment and deductible amounts;

(3) any other uncovered costs or charges;

(4) the covered health care services that an enrollee may receive on an out-of-plan basis; and

(5) instructions for submittal of claims for out-of-plan covered services.

History

  • Authority G.S. 58-2-40; 58-67-35; 58-67-150
  • Eff. January 1, 1994
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .1501 Definitions {#sec-11-ncac-12-.1501 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .1501}

In this Section, unless the context indicates otherwise:

(1) "CPT-4 Codes" means the Physician Current Procedural Terminology published by the American Medical Association.

(2) "Current ADA Dental Claim Form" means the most recent health insurance claim form published by the American Dental Association.

(3) "Ethnic origin code" is the established Ethnic (Race) Code as used by the Economics and Statistics Administration, Bureau of Labor Statistics, U.S. Department of Commerce.

(4) "CMS" means Centers for Medicare and Medicaid Services of the U.S. Department of Health and Human Services.

(5) "CMS Form 1450 (UB-04)" means the health insurance claim form published by the CMS for use by institutional health care providers.

(6) "CMS Form 1500" means the health insurance claim form published by the CMS for use by individual health care providers.

(7) "HCPCS" means Healthcare Common Procedure Coding System, a coding system that describes products, supplies, procedures, and health care provider services; and includes the CPT-4 Codes, alphanumeric codes, and related modifiers. HCPCS includes:

(a) "HCPCS Level I Codes", which are the CPT-4 codes and modifiers for professional services and procedures;

(b) "HCPCS Level II Codes", which are national alphanumeric codes and modifiers for health care products and suppliers, as well as some codes for professional services not included in the CPT-4 Codes;

(c) "HCPCS Level III Codes", which are local alphanumeric codes and modifiers for items and services not included in HCPCS Level I or HCPCS Level II.

(8) "ICD-9-CM Codes" means the diagnosis and procedure codes in the International Classification of Diseases, Clinical Modifications, published by the U.S. Department of Health and Human Services.

(9) "Individual health care provider" includes any individual, who under Chapter 90 of the General Statutes is licensed, registered, or certified to engage in the practice of or performs duties associated with any of the following: medicine, surgery, dentistry, pharmacy, optometry, midwifery, osteopathy, podiatry, chiropractic, radiology, nursing, physiotherapy, pathology, anesthesiology, anesthesia, laboratory analysis, rendering assistance to a physician, dental hygiene, psychiatry, or psychology.

(10) "Institutional health care provider" includes:

(a) a hospital defined under G.S. 131E-176(13);

(b) an ambulatory surgical facility defined under G.S. 131E-176(1b);

(c) a health service facility defined under G.S. 131E-176(9b);

(d) a home health agency defined under G.S. 131E-176(12);

(e) any of the entities listed in G.S. 58-55-35.

(11) "Payor" means an entity that provides a "health benefit plan", as defined in G.S. 58-3-171(c).

(12) "Standard claim form" means the CMS Form 1450 (UB-04), CMS Form 1500, or the current ADA Dental Claim Form.

History

  • Authority G.S. 58-2-40; 58-3-171
  • Eff. October 1, 1994
  • Readopted Eff. May 1, 2020.
11 NCAC 12 .1502 REQUIREMENTS FOR USE OF CMS Form 1450 (UB-04) {#sec-11-ncac-12-.1502 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .1502}

(a) The CMS Form 1450 (UB-04) shall be the standard claim form for all manual billing by institutional health care providers, and the CMS Form 1450 shall be accepted by all payors conducting business in this State.

(b) The cause of injury code shall be located in form locator 72. This code shall be required on all CMS Form 1450 (UB-04) claims generated by institutional health care providers for claims of inpatients and of patients treated in emergency rooms or trauma centers; and where the diagnosis includes an injury diagnosis, which means a diagnostic code in the range or 800-999 as defined in the ICD-10 coding manual.

(c) Payors may require institutional health care providers to use only the following coding systems for the filing of claims for health care services:

(1) Codes to report all diagnoses, reasons for encounters, and procedures based upon code level changes made effective October 1 of each year or other effective date designated by the CMS.

(2) HCPCS Level I and II Codes based upon code level changes made effective October 1 of each year or other effective date designated by the CMS.

(3) CPT-4 Codes based upon code level changes made effective January 1 of each year or other effective date designated by the CMS.

(d) When there is no applicable HCPCS Level I or Level II Code or modifier, the payor may establish its own code or modifier. A complete list of all codes and modifiers established by payors shall be published by and available upon request from payors.

History

  • Authority G.S. 58-2-40; 58-3-171
  • Eff. October 1, 1994
  • Amended Eff. March 1, 1995
  • Readopted Eff. May 1, 2020.
11 NCAC 12 .1503 Requirements for Use of Cms Form 1500 {#sec-11-ncac-12-.1503 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .1503}

(a) The CMS Form 1500 shall be the standard claim form for all manual individual health care provider billing, and the CMS Form 1500 shall be accepted by all payors conducting business in this State.

(b) Payors may require individual health care providers to use only the following coding system for the filing of claims for health care services:

(1) ICD-9-CM Codes to report all diagnoses, reasons for encounters, and procedures based upon code level changes made effective October 1 of each year or other effective date designated by the CMS.

(2) HCPCS Level I and Level II Codes based upon code level changes made effective October 1 of each year or other effective date designated by the CMS.

(3) CPT-4 Codes based upon code level changes made effective January 1 of each year or other effective date designated by the CMS.

(c) When there is no applicable HCPCS Level I or Level II Code or modifier, the payor shall establish its own code or modifier. A complete list of all codes and modifiers established by payors shall be published by and available upon request from payors.

(d) Type of service codes may not be used.

(e) Place of service codes and descriptions shall be recognized by all payors processing claims for services rendered in North Carolina.

(f) CMS physician and specialty codes shall be recognized by payors processing claims for services rendered in North Carolina.

History

  • Authority G.S. 58-2-40; 58-3-171
  • Eff. October 1, 1994
  • Amended Eff. February 1, 1995
  • Readopted Eff. May 1, 2020.
11 NCAC 12 .1504 Requirements for Use of the Current Ada Dental Claim Form {#sec-11-ncac-12-.1504 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .1504}

Dentists shall use the current ADA Dental Claim Form and instructions for all manual claims filing with payors. The ADA Dental Claim Form is hereby incorporated by reference, including subsequent amendments and additions, and is available at no cost at https://www.ada.org/en/publications/cdt/ada-dental-claim-form.

History

  • Authority G.S. 58-2-40; 58-3-171
  • Eff. October 1, 1994
  • Amended Eff. February 1, 1995
  • Readopted Eff. May 1, 2020.
11 NCAC 12 .1505 Managed Care Forms {#sec-11-ncac-12-.1505 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .1505}

(a) As used in this Rule, "managed care plan" includes a health maintenance organization or a preferred provider organization.

(b) The following managed care forms may be used by managed care plans, but shall not be a part of the standard claim form:

(1) An "out-of-network" justification form shall be used by patients filing claims with their managed care plans when they have to justify the reasons they sought out-of-network health care services. This form shall be standardized, and the managed care plan industry shall develop and file this form with the Commissioner.

(2) A "patient encounter form and electronic format" shall be used by managed care plans to record and report encounter information. This form shall provide information similar to the CMS Form 1450 (UB-04) and CMS Form 1500 and shall include information on patient identification, dates of services provided, types of services provided, and identities of health care providers. This form and electronic formats shall be standardized, and the managed care plan industry shall develop and file these with the Commissioner.

History

  • Authority G.S. 58-2-40; 58-3-171
  • Eff. October 1, 1994
  • Readopted Eff. May 1, 2020.
11 NCAC 12 .1506 Electronic Format Standards {#sec-11-ncac-12-.1506 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .1506}

(a) As used in this Rule, "ASC X12 Standard Format" means the standards for electronic data interchange within the health care provider industry developed by the Accredited Standards Committee X12 Insurance Subcommittee of the American National Standards Institute.

(b) Payors and health care providers that receive or generate claims or send payments by electronic means shall accept or generate the appropriate ASC X12 Standard Format for their health care claims submission and remittance transactions.

History

  • Authority G.S. 58-2-40; 58-3-171
  • Eff. October 1, 1994
  • Readopted Eff. May 1, 2020.
11 NCAC 12 .1507 Attachment Form or Format {#sec-11-ncac-12-.1507 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .1507}

(a) As used in this Rule, "attachment form or format" means a form, document, or communication of any kind used by a payor to request additional information, other than that contained on the standard claim form, from a health care provider in connection with processing a claim for payment.

(b) Payors shall not require the submission of information already contained in the standard claim form.

History

  • Authority G.S. 58-2-40; 58-3-171
  • Eff. October 1, 1994
  • Readopted Eff. May 1, 2020.
11 NCAC 12 .1508 Medicare Supplement Payors {#sec-11-ncac-12-.1508 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .1508}

Medicare supplement insurance payors shall electronically interface claims data with the Medicare Section of CMS.

History

  • Authority G.S. 58-2-40; 58-3-171
  • Eff. October 1, 1994
  • Readopted Eff. May 1, 2020.
11 NCAC 12 .1509 Patient Submitted Claim Forms {#sec-11-ncac-12-.1509 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .1509}

The health care provider shall provide a patient the CMS-1500 and UB-04 (CMS-1450) standard claim forms, if the patient must submit a claim to a payor. The standard claim form shall be provided as the initial bill for payment of services and shall be used by the patient to request reimbursement from a payor. Health care providers shall also continue to provide patients billing statements for subsequent billing of the same services. A payor shall not require any additional documentation from a patient to support a claim for reimbursement payment by a patient if the information required is already contained on the standard claim form. No payor shall require any patient to submit claims or other information in an electronic format.

History

  • Authority G.S. 58-2-40; 58-3-171
  • Eff. October 1, 1994
  • Readopted Eff. May 1, 2020.
11 NCAC 12 .1601 Definitions {#sec-11-ncac-12-.1601 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .1601}

As used in this Section:

(1) "Policy" means any policy or certificate of insurance that provides a death benefit.

(2) "Retained asset account" or "account" means any mechanism whereby the settlement of proceeds payable under an insurance policy is accomplished through the use of a temporary repository of proceeds into a checking or draft account.

History

  • Authority G.S. 58-2-40; 58-3-150; 58-7-15; 58-58-1; 58-58-110
  • Eff. February 1, 1996
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .1602 General Requirements {#sec-11-ncac-12-.1602 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .1602}

No insurer shall offer retained asset accounts as a mode of settlement of proceeds unless the insurer complies with the following:

(1) The retained asset account shall be specifically identified as a settlement option within the terms of the claim form in conjunction with any other mode of settlement.

(2) The policy owner shall be provided the contractual right of selection from all available optional modes of settlement before death or death of the insured if the insured is not the policy owner.

(3) The insurer shall provide the beneficiary with information that clearly discloses the rights and obligations of both the beneficiary and the insurer with respect to the mode of settlement.

History

  • Authority G.S. 58-2-40; 58-3-150; 58-7-15; 58-58-1; 58-58-110
  • Eff. February 1, 1996
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .1603 Disclosure Requirements {#sec-11-ncac-12-.1603 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .1603}

In conjunction with the use of a retained asset account as a mode of settlement, the insurer shall disclose the following, in writing, to any beneficiary or, in the case of a group contract, to the policy owner:

(1) Any other settlement options available under the policy.

(2) Any interest being paid under other options.

(3) Whether the retained asset account is the equivalent of a checking or draft account.

(4) An explanation of the account's features, including:

(a) What banking services are provided to the account holder.

(b) Which services are provided at no charge and which services involve a fee and the amount of the fee.

(c) The nature and frequency of account statements.

(d) A telephone number and address where the beneficiary can obtain additional information regarding the account.

(e) Any minimum or maximum benefit payment requirements under the account.

(f) The number of withdrawals permitted within any time period.

(5) That payment of the total proceeds is accomplished by delivery of a "checkbook kit" or "draft kit" to the beneficiary.

(6) That one check or draft can be written to access the entire proceeds and that other settlement options are preserved until the entire balance is withdrawn or the balance drops below the insurer's minimum payment requirements.

(7) Any time delays the beneficiary should expect to encounter in completing any authorized transaction under a retained asset account and the anticipated amount of such time delay.

(8) That interest earned on the account may be taxable and the beneficiary should consult a tax advisor.

(9) The methodology used to determine the interest rate being paid under the retained asset account.

History

  • Authority G.S. 58-2-40; 58-3-150; 58-58-1; 58-58-110
  • Eff. February 1, 1996
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .1604 Accounting {#sec-11-ncac-12-.1604 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .1604}

Funds necessary to cover liabilities under retained asset accounts shall be reported on the annual statement.

History

  • Authority G.S. 58-2-40; 58-2-165; 58-58-1; 58-58-110
  • Eff. February 1, 1996
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .1701 Definitions {#sec-11-ncac-12-.1701 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .1701}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-16-30; 58-58-42; 58-58-42(e); 58-58-42(j); 58-63-15; 58-63-65
  • Eff. February 1, 1996
  • Amended Eff. January 1, 1998; May 1, 1997
  • Temporary Amendment Eff. December 1, 1999
  • Amended Eff. July 1, 2000
  • Temporary Repeal Eff. April 1, 2002
  • Repealed Eff. April 1, 2003.
11 NCAC 12 .1702 Viatical Settlement Providers {#sec-11-ncac-12-.1702 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .1702}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-16-30; 58-58-42; 58-58-42(e); 58-58-42(j); 58-63-15; 58-63-65
  • Eff. February 1, 1996
  • Amended Eff. January 1, 1998; May 1, 1997
  • Temporary Amendment Eff. December 1, 1999
  • Amended Eff. July 1, 2000
  • Temporary Repeal Eff. April 1, 2002
  • Repealed Eff. April 1, 2003.
11 NCAC 12 .1703 Viatical Settlement Brokers and Representatives {#sec-11-ncac-12-.1703 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .1703}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-16-30; 58-58-42; 58-58-42(e); 58-58-42(j); 58-63-15; 58-63-65
  • Eff. February 1, 1996
  • Amended Eff. January 1, 1998; May 1, 1997
  • Temporary Amendment Eff. December 1, 1999
  • Amended Eff. July 1, 2000
  • Temporary Repeal Eff. April 1, 2002
  • Repealed Eff. April 1, 2003.
11 NCAC 12 .1704 Standards for Evaluation of Reasonable Payments {#sec-11-ncac-12-.1704 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .1704}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-16-30; 58-58-42; 58-58-42(e); 58-58-42(j); 58-63-15; 58-63-65
  • Eff. February 1, 1996
  • Amended Eff. January 1, 1998; May 1, 1997
  • Temporary Amendment Eff. December 1, 1999
  • Amended Eff. July 1, 2000
  • Temporary Repeal Eff. April 1, 2002
  • Repealed Eff. April 1, 2003.
11 NCAC 12 .1705 Reporting {#sec-11-ncac-12-.1705 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .1705}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-16-30; 58-58-42; 58-58-42(e); 58-58-42(j); 58-63-15; 58-63-65
  • Eff. February 1, 1996
  • Amended Eff. January 1, 1998; May 1, 1997
  • Temporary Amendment Eff. December 1, 1999
  • Amended Eff. July 1, 2000
  • Temporary Repeal Eff. April 1, 2002
  • Repealed Eff. April 1, 2003.
11 NCAC 12 .1706 Contracts and Payment of Proceeds {#sec-11-ncac-12-.1706 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .1706}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-16-30; 58-58-42; 58-58-42(e); 58-58-42(j); 58-63-15; 58-63-65
  • Eff. February 1, 1996
  • Amended Eff. January 1, 1998; May 1, 1997
  • Temporary Amendment Eff. December 1, 1999
  • Amended Eff. July 1, 2000
  • Temporary Repeal Eff. April 1, 2002
  • Repealed Eff. April 1, 2003.
11 NCAC 12 .1707 Solicitation {#sec-11-ncac-12-.1707 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .1707}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-16-30; 58-58-42; 58-58-42(e); 58-58-42(j); 58-63-15; 58-63-65
  • Eff. February 1, 1996
  • Amended Eff. January 1, 1998; May 1, 1997
  • Temporary Amendment Eff. December 1, 1999
  • Amended Eff. July 1, 2000
  • Temporary Repeal Eff. April 1, 2002
  • Repealed Eff. April 1, 2003.
11 NCAC 12 .1708 Advertising Standards {#sec-11-ncac-12-.1708 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .1708}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-16-30; 58-58-42; 58-58-42(e); 58-58-42(j); 58-63-15; 58-63-65
  • Eff. February 1, 1996
  • Amended Eff. January 1, 1998; May 1, 1997
  • Temporary Amendment Eff. December 1, 1999
  • Amended Eff. July 1, 2000
  • Temporary Repeal Eff. April 1, 2002
  • Repealed Eff. April 1, 2003.
11 NCAC 12 .1709 Disclosure {#sec-11-ncac-12-.1709 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .1709}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-16-30; 58-58-42; 58-58-42(e); 58-58-42(j); 58-63-15; 58-63-65
  • Eff. February 1, 1996
  • Amended Eff. January 1, 1998; May 1, 1997
  • Temporary Amendment Eff. December 1, 1999
  • Amended Eff. July 1, 2000
  • Temporary Repeal Eff. April 1, 2002
  • Repealed Eff. April 1, 2003.
11 NCAC 12 .1710 Definitions {#sec-11-ncac-12-.1710 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .1710}

(a) The definitions contained in G.S. 58-58-205 apply to this Section.

(b) The following definitions shall apply to this Section:

(1) "Division" means the Life and Health Division of the Department of Insurance.

(2) "Insured" means the person covered under the policy being considered for viatication.

(3) "Life expectancy" means the mean of the number of months the individual insured under the life insurance policy to be viaticated can be expected to live as determined by the viatical settlement provider considering medical records and appropriate experiential data.

(4) "Net death benefit" means the amount of the life insurance policy or certificate to be viaticated less any outstanding debts or liens.

(5) "Patient identifying information" includes an insured's name, address, telephone number, facsimile number, electronic mail address, photograph or likeness, employer, employment status, or social security number.

History

  • Authority G.S. 58-2-40; 58-58-300
  • Temporary Adoption Eff. April 1, 2002
  • Eff. April 1, 2003
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .1711 license requirements {#sec-11-ncac-12-.1711 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .1711}

(a) In addition to the information required by G.S. 58-58-210, applicants for provider licenses shall submit the following:

(1) A plan of operation, including the manner in which the provider proposes to operate in North Carolina and the type or types of insurance policies or contracts it intends to viaticate.

(2) The provider's plan of operation shall be a narrative overview of the provider's business and shall include the following information:

(A) A certified copy of the provider's charter and by-laws, if a corporation or limited liability company, and a copy of the partnership agreement, if a partnership.

(B) A chart showing the relationship of the provider to any parent, affiliated, or subsidiary corporation.

(C) A description of the provider's marketing techniques, including a description of training programs for those individuals who will have direct contact with viators.

(D) A list of the names of the provider's directors and management personnel, including job titles and descriptions of the job duties.

(E) A schedule listing the names of financial institutions with which the provider has escrow trust agreements.

(F) A description of what steps through which the viator will have access to funds, including the source that will make such funds available.

(G) A financing plan.

(H) A statement disclosing the identities of all stockholders holding 10% or more of the provider, and all partners, directors, officers and members of the provider, depending on whether the provider is a partnership, corporation, or limited liability company.

(I) An antifraud plan, as specified in G.S. 58-58-268(b).

(3) Each provider shall notify the Division of any change in the items listed in Paragraph (a)(2) of this Rule within 30 business days after the change.

(4) Every nonresident provider shall file a power of attorney designating the Commissioner as the provider's agent for service of legal process in accordance with G.S. 58-58-210(g).

(b) A provider license may be renewed yearly by payment of the applicable fee, a notarized certification from the company's president attesting there has been no change to information on file required by G.S. 58-58-210 and this Rule, and a copy of a letter of good standing obtained from the provider's domiciliary regulator.

(c) If a provider's license expires under G.S. 58-58-210(c) and the provider has, on the license renewal date, viatical settlements where the insured has not died, it shall do one of the following:

(1) Renew or maintain its current license status until the earlier of the following events:

(A) The date the provider properly assigns, sells or otherwise transfers the viatical settlements where the insured has not died; or

(B) The date that the last insured covered by viatical settlement transaction has died; or

(2) Appoint, in writing, the broker who received commissions from the viatical settlement, if applicable, or any other provider or broker licensed in this State to make all inquiries to the viator, or the viator's designee, regarding health status of the viator or any other matters.

History

  • Authority G.S. 58-2-40; 58-58-210; 58-58-300
  • Temporary Adoption Eff. April 1, 2002
  • Eff. April 1, 2003
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .1712 Viatical settlement brokers {#sec-11-ncac-12-.1712 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .1712}

(a) Applications for broker licenses shall be made with the Agent Services Division of the Department of Insurance.

(b) A broker shall not, without the written agreement of the viator obtained before performing any services in connection with a viatical settlement, seek or obtain any compensation from the viator.

History

  • Authority G.S. 58-2-40; 58-16-30; 58-58-300
  • Temporary Adoption Eff. April 1, 2002
  • Eff. April 1, 2003
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .1713 Standards for evaluation of reasonable payments {#sec-11-ncac-12-.1713 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .1713}

(a) Insureds who are terminally or chronically ill shall receive no less than the following payouts for viaticating a policy. The percentage may be reduced by 5% for viaticating a policy written by an insurer rated less than the highest four categories by A.M. Best, or a comparable rating by another rating agency.

(b) Insureds who are not terminally or chronically ill shall receive at least the cash surrender value of the policy.

History

  • Authority G.S. 58-2-40; 58-58-300
  • Temporary Adoption Eff. April 1, 2002
  • Eff. April 1, 2003
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .1714 Reporting requirements {#sec-11-ncac-12-.1714 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .1714}

(a) On June 1 of each calendar year, each licensed provider shall make a report of all viatical settlement transactions in which the viators are residents of this State. The report shall contain the following information for the previous calendar year:

(1) For each viatical settlement entered into during the reporting period:

(A) Date of viatical settlement contract;

(B) Viator's state of residence at the time of the contract;

(C) Life expectancy of the insured at the time of contract in months;

(D) Face amount of policy viaticated;

(E) Net death benefit viaticated;

(F) Estimated total premiums to keep policy in force for mean life expectancy;

(G) Net amount paid to viator;

(H) Source of policy (B-Broker; D-Direct Purchase; O-Purchased from individual or entity other than the original viator);

(I) Type of coverage (I-Individual or G-Group);

(J) Whether or not the viatical settlement was entered into during the policy's contestable or suicide period, or both;

(K) Classification of the viator's or insured's diseases or injuries:

(i) Cardiovascular diseases;

(ii) Diseases of the central nervous system;

(iii) Diseases of the peripheral nervous system;

(iv) Elders with nonspecific disease processes;

(v) Infectious diseases and autoimmune diseases;

(vi) Liver and renal diseases;

(vii) Neoplasms;

(viii) Non-neoplastic pulmonary diseases;

(L) Type of funding (P-purchaser; L-licensee; I-accredited investor; F-financing entity; S-special purpose entity; R-related provider trust); and

(M) Rating of insurer that issued the policy at the time the policy was viaticated.

(2) For viatical settlements where death has occurred during the reporting period:

(A) Date of viatical settlement contract;

(B) Viator's state of residence at the time of the contract;

(C) Life expectancy of the insured at the time of contract in months;

(D) Net death benefit collected;

(E) Total premiums paid to maintain the policy (WP-Waiver of Premium; NA-Not Applicable);

(F) Net amount paid to viator;

(G) Classification of the viator's or insured's diseases or injuries:

(i) Cardiovascular diseases;

(ii) Diseases of the central nervous system;

(iii) Diseases of the peripheral nervous system;

(iv) Elders with nonspecific disease processes;

(v) Infectious diseases and autoimmune diseases;

(vi) Liver and renal diseases;

(vii) Neoplasms;

(viii) Non-neoplastic pulmonary diseases;

(H) Date of death;

(I) Amount of time between date of contract and date of death in months;

(J) Difference between the number of months that passed between the date of contract and the date of death and the mean life expectancy in months as determined by the reporting company;

(K) Type of coverage (I-Individual or G-Group); and

(L) Whether or not the viatical settlement was entered into during the policy's contestable or suicide period, or both;

(3) Name and address of each viatical settlement broker through whom the reporting provider purchased a policy from a viator who resided in this State at the time of contract; and

(4) Number of policies purchased from an individual or entity other than the original viator as a percentage of total policies purchased.

(b) On June 1 of each calendar year, each licensed broker shall make an annual report of all viatical settlement transactions during the previous calendar year in which the viators are residents of this State. The report shall be in the format prescribed by the NAIC in Appendix D of the model regulation. A copy of the format may be obtained from the Division.

History

  • Authority G.S. 58-2-40; 58-58-225; 58-58-300
  • Temporary Adoption Eff. April 1, 2002
  • Eff. April 1, 2003
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .1715 General rules {#sec-11-ncac-12-.1715 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .1715}

(a) With respect to a policy containing a provision for double or additional indemnity for accidental death, the additional payment shall remain payable to the beneficiary last named by the viator before entering into the viatical settlement contract, or to such other beneficiary, other than the provider, as the viator may thereafter designate, or in the absence of a beneficiary, to the estate of the viator.

(b) Payment of the proceeds of a viatical settlement under G.S. 58-58-250(i) shall be by means of wire transfer to the account of the viator or by certified check or cashier's check.

(c) Payment of the proceeds to the viator under a viatical settlement shall be made in a lump sum except where the provider has purchased an annuity or similar financial instrument issued by a licensed insurance company or bank, or an affiliate of either. Retention of a portion of the proceeds by the provider or escrow agent is not permissible.

(d) A provider or broker shall not pay or offer to pay any finder's fee, commission, or other compensation to any insured's physician, or to an attorney, accountant or other person providing medical, legal, or financial planning services to the viator, or to any other person acting as an agent of the viator, other than a broker, with respect to the viatical settlement.

(e) A provider shall not knowingly solicit purchasers who have treated or have been asked to treat the illness of the insured whose coverage would be the subject of the investment.

(f) If a provider enters into a viatical settlement that allows the viator to retain an interest in the policy, the viatical settlement contract shall contain the following provisions;

(1) A provision that the provider shall effect the transfer of the amount of the death benefit only to the extent or portion of the amount viaticated. The insurance company shall pay benefits in excess of the amount viaticated directly to the viator's beneficiary;

(2) A provision that the provider will, upon acknowledgment of the perfection of the transfer, either:

(A) Advise the insured, in writing, that the insurance company has confirmed the viator's interest in the policy; or

(B) Send a copy of the instrument sent from the insurance company to the viatical settlement provider that acknowledges the viator's interest in the policy; and

(3) A provision that apportions the premiums to be paid by the provider and the viator. It is permissible for the viatical settlement contract to specify that all premiums shall be paid by the provider. The contract may also require that the viator reimburse the provider for the premiums attributable to the retained interest.

History

  • Authority G.S. 58-2-40; 58-58-250; 58-58-300
  • Temporary Adoption Eff. April 1, 2002
  • Eff. April 1, 2003
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .1716 Contracts and Payment of Proceeds {#sec-11-ncac-12-.1716 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .1716}

(a) Two specimen copies of each contract, application, brochure, and proposal shall be filed with the Division for approval under G.S. 58-58-220.

(b) In addition to the requirements in G.S. 58-58-250, every contract shall include the following provisions:

(1) If the viator elects the right to rescind the contract, the provider's rights or interest in the policy will terminate immediately upon the viator giving notice of the rescission and tendering of the settlement proceeds together with any escrow interest received by the viator.

(2) The amount of the fee or fees to be paid by the viator to the provider in conjunction with the contract shall be clearly stated, along with any conditions of payment or receipt of the fee or fees.

(3) The contract together with the application constitutes the entire agreement between the parties.

(4) If the contract provides for the payment of an additional settlement amount to the viator upon the exercise of a guaranteed insurability option by the viator, the contract shall disclose the amount of the additional settlement and the terms upon which it shall be payable.

(5) If the policy to be viaticated provides a guaranteed insurability option, the option may only be exercised for the benefit of a person who has an insurable interest in the life to be insured.

(c) Every application for a contract shall:

(1) Contain the viator's printed name and signature;

(2) Be witnessed and notarized by a person who does not have a financial interest in the policy or viatical settlement contract; and

(3) Provide for an acknowledgment by the viator of receipt of the information booklet required by G.S. 58-58-245(a)(8).

History

  • Authority G.S. 58-2-40; 58-58-220; 58-58-300
  • Temporary Adoption Eff. April 1, 2002
  • Eff. April 1, 2003
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .1717 advertising MATERIAL {#sec-11-ncac-12-.1717 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .1717}

History

  • Status: expired
  • Authority G.S. 58-2-40; 58-58-220; 58-58-300
  • Temporary Adoption Eff. April 1, 2002
  • Temporary Adoption Expired December 27, 2002.
11 NCAC 12 .1718 disclosure {#sec-11-ncac-12-.1718 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .1718}

(a) The provider, upon receipt of an application to viaticate and after determining the value to be offered in return for the assignment or transfer of the death benefit or ownership of a policy to the provider, shall deliver a proposal to the viator before the contract is to be signed. The proposal shall disclose the following information:

(1) Amount of death benefit to be viaticated;

(2) Policy cash value before deducting any loan;

(3) Policy net cash value after deducting any loan;

(4) Policy death benefit less net cash value;

(5) Amount offered to viator;

(6) Whether any supplemental benefit or benefits including the following benefits, are present, will be continued and, if so, the source of premium payment and the beneficiary of the proceeds of such supplemental benefit, and the provider's interest in each benefit:

(A) Accidental death and dismemberment benefit, including the amount of the benefit;

(B) Disability income;

(C) Waiver of premium or of monthly deduction waiver;

(D) Guaranteed insurability options; or

(E) Children or spouse coverage;

(7) Name of the insurer, and whether the insurer does or does not have an accelerated death benefit program for which the viator qualifies;

(b) The provider shall disclose on the application or in the brochure that the identity of the viator will not be disclosed except under the conditions set forth in G.S. 58-58-225 or as otherwise allowed or required by law. The provider shall provide an explanation of the conditions in G.S. 58-58-225 to the viator.

History

  • Authority G.S. 58-2-40; 58-58-225; 58-58-245; 58-58-300
  • Temporary Adoption Eff. April 1, 2002
  • Eff. April 1, 2003
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .1719 prohibited practices {#sec-11-ncac-12-.1719 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .1719}

(a) A provider or broker shall obtain from a person that is provided with patient identifying information a signed affirmation that the person or entity will not further divulge the information without procuring the express, written consent of the insured for the disclosure.

(b) If a provider or broker is compelled by a court of competent jurisdiction by order or subpoena to produce records containing patient identifying information, the provider or broker shall notify the viator and the insured in writing at their last known addresses within five business days after receiving notice of the court's order or subpoena.

(c) A provider shall not act as a broker and provider in the same viatical settlement contract.

(d) A viatical settlement provider shall not use a longer life expectancy than is reasonable, based on all medical and actuarial information available at the time of a viatical settlement transaction, in order to reduce the payout to which the viator is entitled. A life expectancy that is determined by a trained life underwriter, or an independent company in the business of providing life expectancy estimates and which may be determined, in part, by reference to proprietary financial or actuarial models, shall be deemed to be "reasonable" for the purpose of this Rule.

History

  • Authority G.S. 58-2-40; 58-58-225; 58-58-245; 58-58-300
  • Temporary Adoption Eff. April 1, 2002
  • Eff. April 1, 2003
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .1720 insurance company practices {#sec-11-ncac-12-.1720 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .1720}

(a) Every life insurance company licensed in this State shall respond to a request for verification of coverage from a provider or a broker within 30 calendar days after the date a request is received. The insurer shall inform the provider or broker whether the insurer intends to pursue an investigation regarding possible fraud or the validity of the insurance contract. The following items shall accompany the request for verification of coverage:

(1) A current authorization signed by the insured;

(2) If the policy to be viaticated is an individual policy, a verification of coverage form, completed by the provider or broker, substantially similar to the format prescribed by the NAIC in Appendix B of the NAIC Viatical Settlements Model Regulation; and

(3) If the viatication involves a group insurance certificate, a verification of coverage form, completed by the provider or the broker, substantially similar to the format prescribed by the NAIC in Appendix C of the NAIC Viatical Settlements Model Regulation.

(b) A life insurance company shall not charge a fee for responding to a request for information from a provider or broker in accordance with this rule in excess of any usual and customary charges to insureds for similar services.

(c) A life insurance company may send an acknowledgment of receipt of the request for verification of coverage to the viator and, where the viator is not the insured, also to the insured. The acknowledgment shall contain a description of any accelerated death benefit that is available under a provision of or rider to the policy.

(d) Copies of the formats described in this Rule are on file at the Division.

History

  • Authority G.S. 58-2-40; 58-6-6; 58-58-250; 58-58-300
  • Temporary Adoption Eff. April 1, 2002
  • Eff. April 1, 2003
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .1801 Applicability {#sec-11-ncac-12-.1801 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .1801}

This Section applies to any insurer or service corporation that, under G.S. 58-50-56, offers a preferred provider benefit plan.

History

  • Authority G.S. 58-2-40; 58-50-56
  • Temporary Adoption Eff. January 1, 1998
  • Eff. August 1, 1998
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .1802 Definitions {#sec-11-ncac-12-.1802 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .1802}

The definitions contained in G.S. 58-50-56(a) are incorporated into this Section by reference and as used in this Section, the following terms have the meanings ascribed to them:

(1) "Coinsurance" means the percentage of an allowed charge or expense, or usual and customary charge for a covered health care service that an enrollee must pay.

(2) "Copayment" means a fixed dollar amount that an enrollee must pay each time a covered health care service is provided.

(3) "Deductible" means a specified amount of covered health care services, expressed in dollars, that must be incurred by an enrollee before the insurer will assume any financial liability for all or part of covered health care services.

(4) "Emergency health care services" means those services as defined and delivered in accordance with G.S. 58-3-190.

(5) "Enrollee" means an individual who is covered by a PPO benefit plan.

(6) "In-network covered services" means covered health care services that are received according to the rules of the health benefit plan from providers employed by, under contract with, or approved in advance by the insurer; and means emergency health care services regardless of the status or affiliation of the provider of such services.

(7) "Out-of-network covered services" means non-emergency, medically necessary covered health care services that are not received according to the rules of the health benefit plan, including services from affiliated providers that are received without the approval of the insurer.

(8) "Out-of-pocket expense" means a specified dollar amount of coinsurance incurred and payable by an enrollee for covered health care services in a specified period. Out-of-pocket expense may or may not include deductible amounts, copayment amounts, charges in excess of the amount allowed by the insurer, amounts exceeding the maximum benefits, or any other disallowed or noncovered expenses under the rules of the health benefit plan.

(9) "PPO benefit plan" has the same meaning as "preferred provider benefit plan" in G.S. 58-50-56(a)(3).

History

  • Authority G.S. 58-2-40; 58-50-56
  • Temporary Adoption Eff. January 1, 1998
  • Eff. August 1, 1998
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .1803 General Requirements {#sec-11-ncac-12-.1803 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .1803}

No insurer shall provide any PPO benefit plan unless it complies with the following:

(1) Where the covered benefits of a PPO benefit plan include coinsurance, the difference in coinsurance rates between in-network covered services and out-of-network covered services shall not exceed 30 percentage points.

(2) If the schedule of benefits for a PPO benefit plan imposes a deductible for in-network covered services, the amount of any separate annual deductible per enrollee or per family for out-of-network covered services may not exceed two times the amount of the annual per enrollee or per family deductible applied to in-network covered services.

(3) If the schedule of benefits for a PPO benefit plan does not include an annual deductible for in-network covered services, the annual deductibles for out-of-network covered services shall not exceed two hundred and fifty dollars ($250.00) per enrollee and the family deductible may not exceed seven hundred and fifty dollars ($750.00).

(4) The portion of any charge for out-of-network covered services to be applied to an annual deductible may be based on actual charges or the insurer's usual and customary charges.

(5) If there are benefit maximums for in-network covered services, the amount of any annual and lifetime maximum limits for out-of-network covered services shall not be less than one-half of the amount of any annual and lifetime maximum limits for in-network covered services.

(6) If a PPO benefit plan includes copayments for both in-network covered services and out-of-network covered services, the amount of the copayment for an out-of-network covered service shall not exceed the copayment for an in-network covered service by more than twenty dollars ($20.00) or 100%, whichever is greater.

(7) If the schedule of benefits for a PPO benefit plan limits the annual out-of-pocket expenses of enrollees to a maximum amount for in-network covered services, the amount of any separate annual out-of-pocket maximum for out-of-network covered services may not exceed two times the maximum amount for in-network covered services.

(8) If the schedule of benefits for a PPO benefit plan does not include an annual maximum limit on out-of-pocket expenses for in-network covered services, the maximum limit on out-of-pocket expenses for out-of-network covered services shall not exceed one thousand two hundred and fifty dollars ($1,250) per enrollee or three thousand seven hundred and fifty dollars ($3,750) per family.

(9) An insurer offering a PPO benefit plan may limit coverage for annual physicals and health screenings performed for preventative purposes to those services provided on an in-network basis, except that services provided in connection with mandated benefits must be available on both an in-network and out-of-network basis. An insurer shall provide coverage on both an in-network and out-of-network basis for all other covered services.

(10) PPO benefit plans shall give enrollees the option to choose in-network covered services or out-of-network covered services each time those covered services are authorized, obtained, or rendered; and shall not require enrollees to obtain insurer approval to exercise that option.

(11) An insurer offering a PPO benefit plan shall not impose different medical management requirements, including utilization review criteria or prior approval requirements, for out-of-network covered services than are imposed on in-network covered services. Those medical management requirements shall not restrict enrollees' abilities to seek covered services on out-of-network bases.

History

  • Authority G.S. 58-2-40; 58-50-56
  • Temporary Adoption Eff. January 1, 1998
  • Eff. August 1, 1998
  • Readopted Eff. May 1, 2020.
11 NCAC 12 .1804 Disclosure Requirements {#sec-11-ncac-12-.1804 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .1804}

(a) If an enrollee utilizes out-of-network covered services, the explanation of benefits shall contain an explanation of coverage for out-of-network covered services that allows each enrollee to determine his or her obligations with respect to those services.

(b) Marketing materials, evidences of coverage, enrollee handbooks, and other materials given to enrollees by an insurer that offers a PPO benefit plan shall contain a clear and comprehensive explanation of the PPO benefit plan. The explanation shall include the following information:

(1) the method of reimbursement, including whether actual charges or usual and customary charges are used in making all benefit calculations;

(2) applicable coinsurance, copayment, and deductible amounts;

(3) any other uncovered costs or charges;

(4) the covered health care services that an enrollee may receive on an out-of-network basis, including whether or not annual physicals and health screenings are available out-of-network; and

(5) instructions for submittal of claims for out-of-network covered services.

History

  • Authority G.S. 58-2-40; 58-3-191(b); 58-50-56
  • Temporary Adoption Eff. January 1, 1998
  • Eff. August 1, 1998
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .1901 Definitions {#sec-11-ncac-12-.1901 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .1901}

As used in this Section, the following terms have the meanings ascribed to them:

(1) "Abuse" means the occurrence of one or more of the following acts by a current or former family member, household member, intimate partner or caretaker:

(a) Attempting to cause or intentionally, knowingly or recklessly causing another person bodily injury, physical harm, severe emotional distress, psychological trauma, rape, sexual assault or involuntary sexual intercourse;

(b) Knowingly engaging in a course of conduct or repeatedly committing acts toward another person, including following the person or minor child, under circumstances that place the person or minor child in reasonable fear of bodily injury or physical harm;

(c) Subjecting another person to false imprisonment; or

(d) Attempting to cause or intentionally, knowingly, or recklessly causing damage to property so as to intimidate or attempt to control the behavior of another person.

(2) "Abuse-related medical condition" means a medical condition sustained by a subject of abuse that arises in whole or part out of an act or pattern of abuse.

(3) "Abuse status" means the fact or perception that a person is, has been, or may be a subject of abuse, irrespective of whether the person has sustained abuse-related medical conditions.

(4) "Health benefit plan" or "plan" means an accident and health insurance policy or certificate; a nonprofit hospital or medical service corporation contract; a health maintenance organization subscriber contract; a plan provided by a multiple employer welfare arrangement; a plan provided by a Professional Employer Organization; or a plan provided by another benefit arrangement, to the extent permitted by the Employee Retirement Income Security Act of 1974, as amended, or by any waiver of or other exception to that Act provided under federal law or regulation. "Health benefit plan" includes accident only, credit health, dental, vision, Medicare supplement or long-term care insurance, coverage issued as a supplement to liability insurance, short-term and catastrophic health insurance, coverage only for a specified disease or illness, hospital indemnity or other fixed indemnity insurance, disability income insurance, and a policy that pays on a cost-incurred basis. "Health benefit plan" does not mean the N.C. State Health Plan, workers' compensation insurance or any plan implemented or administered by the North Carolina or United States Department of Health and Human Services, or any successor agency, or its representatives.

(5) "Insurance professional" means an agent, broker, or adjuster as defined in G.S. 58-33-10 or a third party administrator as defined in G.S. 58-56-2.

(6) "Insurer" means an insurance company subject to Chapter 58 of the General Statutes, a service corporation organized under Article 65 of Chapter 58 of the General Statutes, a health maintenance organization organized under Article 67 of Chapter 58 of the General Statutes, a multiple employer welfare arrangement subject to Article 49 of Chapter 58 of the General Statutes, the North Carolina Health Insurance Risk Pool subject to Part 6 of Article 50 of Chapter 58 of the General Statutes, and a Professional Employee Organization subject to Article 89A of Chapter 58 of the General Statutes.

(7) "Insured" means a party named on a health benefit plan as the person with legal rights to the benefits provided by the health benefit plan. For group plans, "insured" includes a person who is a beneficiary covered by a group health benefit plan.

(8) "Subject of abuse" means a person against whom an act of abuse has been directed; who has current or prior injuries, illnesses or disorders that resulted from abuse; who seeks, may have sought, or had reason to seek medical or psychological treatment for abuse; or protection, court-ordered protection or shelter from abuse.

History

  • Authority G.S. 58-2-40; 58-63-65
  • Eff. April 1, 2010
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .1902 Unfair or Deceptive Acts or Practices {#sec-11-ncac-12-.1902 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .1902}

(a) The following are unfair or deceptive acts or practices in the business of insurance:

(1) To deny, refuse to issue, renew or reissue, cancel or otherwise terminate a health benefit plan, or restrict or exclude health benefit plan coverage or add a premium differential to any health benefit plan on the basis of the applicant's or insured's abuse status;

(2) To exclude or limit coverage for losses or deny a claim incurred by an insured on the basis of the insured's abuse status;

(3) To request information relating to acts of abuse or an applicant's or insured's abuse status, or make use of that information, however obtained, except for the limited purposes of complying with legal obligations or verifying a person's claim to be a subject of abuse; or

(4) To terminate group coverage for a subject of abuse because coverage was originally issued in the name of the abuser and the abuser has divorced, separated from, or lost custody of the subject of abuse, or the abuser's coverage has terminated voluntarily or involuntarily. Nothing in this Rule prohibits the insurer or insurance professional from requiring the subject of abuse to pay the full premium for coverage under the health benefit plan or from requiring as a condition of coverage that the subject of abuse reside or work within the insurer's service area, if the requirements are applied to all insureds of the insurer or insurance professional. The health carrier or insurance professional may terminate group coverage after the continuation coverage required by this subsection has been in force for 18 months, if it offers conversion to an individual plan as provided in Part 2 of Article 53 of Chapter 58 of the General Statutes. The continuation coverage required by this section shall be satisfied by coverage required under P.L. 99-272, the Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1985, or under state continuation coverage required under Part 1 of Article 53 of Chapter 58 of the General Statutes, and is not intended to be in addition to coverage provided under COBRA or state continuation. Nothing in this Subparagraph is intended to supersede or interfere with the provisions of G.S. 58-68-60 when the subject of abuse is an "eligible individual" as defined in G.S. 58-68-60(b).

(b) Subparagraph (a)(3) of this Rule does not prohibit an insurer or insurance professional from asking about a medical condition or from using medical information to underwrite or to carry out its duties under the policy, even if the medical information is related to a medical condition that the insurer or insurance professional knows or has reason to know is abuse-related, to the extent otherwise permitted under this Rule and other applicable law.

History

  • Authority G.S. 58-2-40; 58-53-5; 58-63-65; 58-68-60
  • Eff. April 1, 2010
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.
11 NCAC 12 .1903 Justification of Adverse Insurance Decisions {#sec-11-ncac-12-.1903 omnilex-key=us-nc-regs-official--title-11--11 NCAC 12 .1903}

An insurer or insurance professional that takes an action that adversely affects an applicant or insured on the basis of a medical condition that the health insurer or insurance professional knows or has reason to know is abuse-related shall explain the reason for its action to the applicant or insured in writing and shall be able to demonstrate that its action, and any applicable plan provision:

(1) Does not have the purpose or effect of treating abuse status as a medical condition or underwriting criterion;

(2) Is not based upon any actual or perceived correlation between a medical condition and abuse;

(3) Is otherwise permissible by law and applies in the same manner and to the same extent to all applicants and insureds with a similar medical condition without regard to whether the condition or claim is abuse-related; and

(4) Except for claim actions, is based on a determination, made in conformance with sound actuarial principles and supported by actual or reasonably anticipated experience, that there is a correlation between the medical condition and a material increase in insurance risk.

History

  • Authority G.S. 58-2-40; 58-63-65
  • Eff. April 1, 2010
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018.

Chapter 13 Agent Services Division - Non-Insurance Entities

11 NCAC 13 .0101 Definitions {#sec-11-ncac-13-.0101 omnilex-key=us-nc-regs-official--title-11--11 NCAC 13 .0101}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-7.3; 58-9; 58-9.2; 58-35-5(b); 58-35-15(a); 58-57; 58-57.1; 66-46; 66-48; 66-49.13; 85C-2; 85C-35
  • Eff. February 1, 1976
  • Readopted Eff. January 1, 1978
  • Amended Eff. April 8, 2002
  • Repealed Eff. October 1, 2010.
11 NCAC 13 .0102 Purpose of Division {#sec-11-ncac-13-.0102 omnilex-key=us-nc-regs-official--title-11--11 NCAC 13 .0102}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-7.3; 58-9; 58-9.2; 58-35-5(b); 58-35-15(a); 58-57; 58-57.1; 66-46; 66-48; 66-49.13; 85C-2; 85C-35
  • Eff. February 1, 1976
  • Readopted Eff. January 1, 1978
  • Amended Eff. April 8, 2002
  • Repealed Eff. October 1, 2010.
11 NCAC 13 .0103 Deputy Commissioner {#sec-11-ncac-13-.0103 omnilex-key=us-nc-regs-official--title-11--11 NCAC 13 .0103}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-7.3; 58-9; 58-9.2; 58-35-5(b); 58-35-15(a); 58-57; 58-57.1; 66-46; 66-48; 66-49.13; 85C-2; 85C-35
  • Eff. February 1, 1976
  • Readopted Eff. January 1, 1978
  • Amended Eff. April 8, 2002
  • Repealed Eff. October 1, 2010.
11 NCAC 13 .0104 Division Personnel {#sec-11-ncac-13-.0104 omnilex-key=us-nc-regs-official--title-11--11 NCAC 13 .0104}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-7.3; 58-9; 58-9.2; 58-35-5(b); 58-35-15(a); 58-57; 58-57.1; 66-46; 66-48; 66-49.13; 85C-2; 85C-35
  • Eff. February 1, 1976
  • Readopted Eff. January 1, 1978
  • Amended Eff. April 8, 2002
  • Repealed Eff. October 1, 2010.
11 NCAC 13 .0105 Field Investigations: Examinations {#sec-11-ncac-13-.0105 omnilex-key=us-nc-regs-official--title-11--11 NCAC 13 .0105}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-7.3; 58-9; 58-9.2; 58-35-5(b); 58-35-15(a); 58-57; 58-57.1; 66-46; 66-48; 66-49.13; 85C-2; 85C-35
  • Eff. February 1, 1976
  • Readopted Eff. January 1, 1978
  • Amended Eff. April 8, 2002
  • Repealed Eff. October 1, 2010.
11 NCAC 13 .0201 Forms {#sec-11-ncac-13-.0201 omnilex-key=us-nc-regs-official--title-11--11 NCAC 13 .0201}

History

  • Status: repealed
  • Authority G.S. 66-41.1; 66-42.1; 66-42.2; 66-44; 66-46
  • Eff. February 1, 1976
  • Amended Eff. October 26, 1977
  • Readopted Eff. January 1, 1978
  • Repealed Eff. July 1, 1988.
11 NCAC 13 .0202 Collection Agency Licensing Procedures {#sec-11-ncac-13-.0202 omnilex-key=us-nc-regs-official--title-11--11 NCAC 13 .0202}

History

  • Status: repealed
  • Authority G.S. 66-41.1; 66-42.1; 66-42.2; 66-44; 66-46
  • Eff. February 1, 1976
  • Amended Eff. October 26, 1977
  • Readopted Eff. January 1, 1978
  • Repealed Eff. July 1, 1988.
11 NCAC 13 .0203 Renewal of Collection Agency Permit {#sec-11-ncac-13-.0203 omnilex-key=us-nc-regs-official--title-11--11 NCAC 13 .0203}

History

  • Status: repealed
  • Authority G.S. 66-41.1; 66-42.1; 66-42.2; 66-44; 66-46
  • Eff. February 1, 1976
  • Amended Eff. October 26, 1977
  • Readopted Eff. January 1, 1978
  • Repealed Eff. July 1, 1988.
11 NCAC 13 .0204 Cancellation of Surety Bond {#sec-11-ncac-13-.0204 omnilex-key=us-nc-regs-official--title-11--11 NCAC 13 .0204}

History

  • Status: repealed
  • Authority G.S. 66-41.1; 66-42.1; 66-42.2; 66-44; 66-46
  • Eff. February 1, 1976
  • Amended Eff. October 26, 1977
  • Readopted Eff. January 1, 1978
  • Repealed Eff. July 1, 1988.
11 NCAC 13 .0205 Unauthorized Practice of Law {#sec-11-ncac-13-.0205 omnilex-key=us-nc-regs-official--title-11--11 NCAC 13 .0205}

History

  • Status: repealed
  • Authority G.S. 66-41.1; 66-42.1; 66-42.2; 66-44; 66-46
  • Eff. February 1, 1976
  • Amended Eff. October 26, 1977
  • Readopted Eff. January 1, 1978
  • Repealed Eff. July 1, 1988.
11 NCAC 13 .0206 Authorization to Forward an Account to an Attorney {#sec-11-ncac-13-.0206 omnilex-key=us-nc-regs-official--title-11--11 NCAC 13 .0206}

History

  • Status: repealed
  • Authority G.S. 66-41.1; 66-42.1; 66-42.2; 66-44; 66-46
  • Eff. February 1, 1976
  • Amended Eff. October 26, 1977
  • Readopted Eff. January 1, 1978
  • Repealed Eff. July 1, 1988.
11 NCAC 13 .0207 Forwarding Accounts to an Attorney {#sec-11-ncac-13-.0207 omnilex-key=us-nc-regs-official--title-11--11 NCAC 13 .0207}

History

  • Status: repealed
  • Authority G.S. 66-41.1; 66-42.1; 66-42.2; 66-44; 66-46
  • Eff. February 1, 1976
  • Amended Eff. October 26, 1977
  • Readopted Eff. January 1, 1978
  • Repealed Eff. July 1, 1988.
11 NCAC 13 .0208 Shared Office Space {#sec-11-ncac-13-.0208 omnilex-key=us-nc-regs-official--title-11--11 NCAC 13 .0208}

History

  • Status: repealed
  • Authority G.S. 66-41.1; 66-42.1; 66-42.2; 66-44; 66-46
  • Eff. February 1, 1976
  • Amended Eff. October 26, 1977
  • Readopted Eff. January 1, 1978
  • Repealed Eff. July 1, 1988.
11 NCAC 13 .0209 Office Hours {#sec-11-ncac-13-.0209 omnilex-key=us-nc-regs-official--title-11--11 NCAC 13 .0209}

History

  • Status: repealed
  • Authority G.S. 66-41.1; 66-42.1; 66-42.2; 66-44; 66-46
  • Eff. February 1, 1976
  • Amended Eff. October 26, 1977
  • Readopted Eff. January 1, 1978
  • Repealed Eff. July 1, 1988.
11 NCAC 13 .0210 Forms to Be Approved {#sec-11-ncac-13-.0210 omnilex-key=us-nc-regs-official--title-11--11 NCAC 13 .0210}

History

  • Status: repealed
  • Authority G.S. 66-41.1; 66-42.1; 66-42.2; 66-44; 66-46
  • Eff. February 1, 1976
  • Amended Eff. October 26, 1977
  • Readopted Eff. January 1, 1978
  • Repealed Eff. July 1, 1988.
11 NCAC 13 .0211 Statements to Be Furnished Each Collection Creditor {#sec-11-ncac-13-.0211 omnilex-key=us-nc-regs-official--title-11--11 NCAC 13 .0211}

History

  • Status: repealed
  • Authority G.S. 66-41.1; 66-42.1; 66-42.2; 66-44; 66-46
  • Eff. February 1, 1976
  • Amended Eff. October 26, 1977
  • Readopted Eff. January 1, 1978
  • Repealed Eff. July 1, 1988.
11 NCAC 13 .0212 Remittance Trust Account {#sec-11-ncac-13-.0212 omnilex-key=us-nc-regs-official--title-11--11 NCAC 13 .0212}

History

  • Status: repealed
  • Authority G.S. 66-41.1; 66-42.1; 66-42.2; 66-44; 66-46
  • Eff. February 1, 1976
  • Amended Eff. October 26, 1977
  • Readopted Eff. January 1, 1978
  • Repealed Eff. July 1, 1988.
11 NCAC 13 .0213 Records to Be Maintained {#sec-11-ncac-13-.0213 omnilex-key=us-nc-regs-official--title-11--11 NCAC 13 .0213}

History

  • Status: repealed
  • Authority G.S. 66-41.1; 66-42.1; 66-42.2; 66-44; 66-46
  • Eff. February 1, 1976
  • Amended Eff. October 26, 1977
  • Readopted Eff. January 1, 1978
  • Repealed Eff. July 1, 1988.
11 NCAC 13 .0214 Receipt Requirement {#sec-11-ncac-13-.0214 omnilex-key=us-nc-regs-official--title-11--11 NCAC 13 .0214}

History

  • Status: repealed
  • Authority G.S. 66-41.1; 66-42.1; 66-42.2; 66-44; 66-46
  • Eff. February 1, 1976
  • Amended Eff. October 26, 1977
  • Readopted Eff. January 1, 1978
  • Repealed Eff. July 1, 1988.
11 NCAC 13 .0215 Creditor May Request Return of Accounts {#sec-11-ncac-13-.0215 omnilex-key=us-nc-regs-official--title-11--11 NCAC 13 .0215}

History

  • Status: repealed
  • Authority G.S. 66-41.1; 66-42.1; 66-42.2; 66-44; 66-46
  • Eff. February 1, 1976
  • Amended Eff. October 26, 1977
  • Readopted Eff. January 1, 1978
  • Repealed Eff. July 1, 1988.
11 NCAC 13 .0216 Permit Termination: Accounts and Valuable Papers Return {#sec-11-ncac-13-.0216 omnilex-key=us-nc-regs-official--title-11--11 NCAC 13 .0216}

History

  • Status: repealed
  • Authority G.S. 66-41.1; 66-42.1; 66-42.2; 66-44; 66-46
  • Eff. February 1, 1976
  • Amended Eff. October 26, 1977
  • Readopted Eff. January 1, 1978
  • Repealed Eff. July 1, 1988.
11 NCAC 13 .0217 Evidence of Indebtedness Signed by Debtor {#sec-11-ncac-13-.0217 omnilex-key=us-nc-regs-official--title-11--11 NCAC 13 .0217}

History

  • Status: repealed
  • Authority G.S. 66-41.1; 66-42.1; 66-42.2; 66-44; 66-46
  • Eff. February 1, 1976
  • Amended Eff. October 26, 1977
  • Readopted Eff. January 1, 1978
  • Repealed Eff. July 1, 1988.
11 NCAC 13 .0218 Application of Funds: Debtor-Creditor Relationship {#sec-11-ncac-13-.0218 omnilex-key=us-nc-regs-official--title-11--11 NCAC 13 .0218}

History

  • Status: repealed
  • Authority G.S. 66-41.1; 66-42.1; 66-42.2; 66-44; 66-46
  • Eff. February 1, 1976
  • Amended Eff. October 26, 1977
  • Readopted Eff. January 1, 1978
  • Repealed Eff. July 1, 1988.
11 NCAC 13 .0219 Change in Ownership or Management and in Certain Employees {#sec-11-ncac-13-.0219 omnilex-key=us-nc-regs-official--title-11--11 NCAC 13 .0219}

History

  • Status: repealed
  • Authority G.S. 66-41.1; 66-42.1; 66-42.2; 66-44; 66-46
  • Eff. February 1, 1976
  • Amended Eff. October 26, 1977
  • Readopted Eff. January 1, 1978
  • Repealed Eff. July 1, 1988.
11 NCAC 13 .0220 Charges to Debtor Prohibited {#sec-11-ncac-13-.0220 omnilex-key=us-nc-regs-official--title-11--11 NCAC 13 .0220}

History

  • Status: repealed
  • Authority G.S. 66-41.1; 66-42.1; 66-42.2; 66-44; 66-46
  • Eff. February 1, 1976
  • Amended Eff. October 26, 1977
  • Readopted Eff. January 1, 1978
  • Repealed Eff. July 1, 1988.
11 NCAC 13 .0221 Prohibited Collection Practices {#sec-11-ncac-13-.0221 omnilex-key=us-nc-regs-official--title-11--11 NCAC 13 .0221}

History

  • Status: repealed
  • Authority G.S. 66-41.1; 66-42.1; 66-42.2; 66-44; 66-46
  • Eff. February 1, 1976
  • Amended Eff. October 26, 1977
  • Readopted Eff. January 1, 1978
  • Repealed Eff. July 1, 1988.
11 NCAC 13 .0222 Prohibited Employment Practices {#sec-11-ncac-13-.0222 omnilex-key=us-nc-regs-official--title-11--11 NCAC 13 .0222}

History

  • Status: repealed
  • Authority G.S. 66-46
  • Eff. January 1, 1978
  • Repealed Eff. July 1, 1988.
11 NCAC 13 .0301 Forms {#sec-11-ncac-13-.0301 omnilex-key=us-nc-regs-official--title-11--11 NCAC 13 .0301}

The following forms are provided by the division and are used by insurance premium finance companies for purposes as specified herein:

(1) Application for Insurance Premium Finance License. The form entitled "Application for Insurance Premium Finance License" shall include general interrogatories concerning the company's structure, employees' past business experience, address and proposed method of operation of the applicant as well as all other pertinent information.

(2) Premium Finance License Renewal Form. A "Premium Finance Renewal Application" shall include the name and address of the premium finance company, date of cancellation of the license if the application is not received by the Division, the amount of the proper license fee, a statement of any changes in the structure of the applicant since its last application, a computation of the bond amount specified in G.S. 58-35-15 and 11 NCAC 13 .0302, instructions for the completion and return of the application and other pertinent information.

(3) Premium Finance Surety Bond Form. The surety bond described in G.S 58-35-15 shall be executed on a form supplied by the Commissioner and shall be executed in accordance with the laws of North Carolina governing surety bonds. The surety bond form shall include the name of the premium finance company [corporation - use corporate name exactly as shown on the articles of incorporation; unincorporated - use name(s), trading as (T/A) the name of the premium finance company], name of the surety, amount of the bond, terms of cancellation of the bond and other pertinent information.

(4) Premium Finance Company Personnel Form. Each stockholder owning ten percent or more of the applicant's outstanding stock and each partner, director, officer, office manager or field representative employed by the applicant shall complete form DOI-5PF entitled "Personal Questionnaire." Form DOI-5PF will be furnished by the Commissioner and shall contain the name of the premium finance company, the name and address of the individual completing the form, the position(s) held by the individual, past business experience of the individual, the name and address of three people not related to the individual who can attest to the individual's reputation for honesty and fair dealings and other pertinent information. All "Personal Questionnaires" shall be attached to the applicant's "Application for Insurance Premium Finance License."

(5) Request by Insured for Separate Contracts Form. Each insured who expressly requests separate premium finance contracts authorized by 11 NCAC 13 .0325 shall complete form DOI-6PF entitled "Request by Insured for Separate Contracts."

History

  • Authority G.S. 58-2-40; 58-35-5(b); 58-35-15(a)
  • Eff. February 1, 1976
  • Readopted Eff. January 1, 1978
  • Amended Eff. April 8, 2002; May 1, 1989
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. June 25, 2016.
11 NCAC 13 .0302 Premium Finance Surety Bond Amount {#sec-11-ncac-13-.0302 omnilex-key=us-nc-regs-official--title-11--11 NCAC 13 .0302}

An "A" type premium finance company, as defined in G.S. 58-35-5(e)(1), shall post the surety bond as specified in G.S. 58-35-15(a) in an amount equal to one thousand dollars ($1,000) for each five thousand dollars ($5,000) in premium finance accounts receivable or fraction thereof. The accounts receivable shall be determined as of December 31 of the licensing year with a minimum bond of five thousand dollars ($5,000) and a maximum bond of twenty-five thousand dollars ($25,000) required. A "B" type premium finance company, as defined in G.S. 58-35-5, shall post the surety bond as specified in General Statute 58-35-15(a) in the amount of twenty-five thousand dollars ($25,000).

History

  • Authority G.S. 58-2-40; 58-35-15(a)
  • Eff. February 1, 1976
  • Readopted Eff. January 1, 1978
  • Amended Eff. April 8, 2002
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. June 25, 2016.
11 NCAC 13 .0303 Premium Finance Licensing Procedures {#sec-11-ncac-13-.0303 omnilex-key=us-nc-regs-official--title-11--11 NCAC 13 .0303}

(a) Applicants must meet minimum qualifications as stated in G.S. 58, Article 35.

(b) Applicants must submit a properly completed "Application for Insurance Premium Finance License" to the Division. The following items, where applicable, shall be attached to and made a part of the application:

(1) A certified copy of the board of directors' resolution that authorized the application to be made;

(2) A duly authenticated copy of the applicant's articles of incorporation, together with all amendments and supplements thereto;

(3) A duly authenticated copy of the applicant's by-laws;

(4) If the applicant is a foreign corporation, a copy of the certificate of authority to transact business in this state issued by the North Carolina Secretary of State;

(5) Certified copy of the current partnership agreement;

(6) If a trade name is used, a certificate showing that the trade name has been filed as required in General Statute 66-68;

(7) A surety bond as specified in G.S. 58-35-15(a) and 11 NCAC 13 .0302;

(8) Form number DOI-5PF completed on each individual specified in 11 NCAC 13 .0301;

(9) A sworn statement by a corporate officer, partner or individual proprietor giving a detailed description of the premium financing procedures to be employed in North Carolina. The detailed description should include procedures outlining the execution of a premium finance agreement, procedures for payment in full before the maturity of the agreement, and cancellation procedures. The cancellation procedures should indicate the dates of all notices, and the method of refund to the insured when applicable.

(10) Two copies each of a proposed Insurance Premium Finance Agreement, rate chart, ten-day notice, cancellation notice and all related forms to be mailed or given to North Carolina citizens;

(11) A current audited financial statement of the premium finance company, prepared by a certified public accountant or by a qualified independent accountant who is engaged in the public practice of accounting;

(12) Check in the amount of the permit fee as specified in G.S. 58-35-5 (made payable to the North Carolina Department of Insurance);

(13) Such other data and information as the Commissioner may deem reasonably necessary to assist him in determining whether the applicant is entitled to the license sought;

(14) If the applicant is a foreign company it shall appoint and maintain the Commissioner as an agent for the service of process on a form prescribed by the Commissioner.

History

  • Authority G.S. 58-2-40; 58-35-5(b); 58-35-35; 58-35-45
  • Eff. February 1, 1976
  • Readopted Eff. January 1, 1978
  • Amended Eff. April 8, 2002; May 1, 1989
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. June 25, 2016.
11 NCAC 13 .0304 Renewal of Insurance Premium Finance License {#sec-11-ncac-13-.0304 omnilex-key=us-nc-regs-official--title-11--11 NCAC 13 .0304}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-35-15(c)
  • Eff. February 1, 1976
  • Readopted Eff. January 1, 1978
  • Amended Eff. April 8, 2002
  • Repealed Eff. October 1, 2010.
11 NCAC 13 .0305 Cancellation of Surety Bond {#sec-11-ncac-13-.0305 omnilex-key=us-nc-regs-official--title-11--11 NCAC 13 .0305}

If the surety bond as specified in G.S. 58-35-15(a) is cancelled for any reason during the period a premium finance company holds a valid license from the Department, the licensee shall be notified in writing by the Commissioner that its license is void until such time as a proper surety bond is received by the Department.

History

  • Authority G.S. 58-2-40; 58-35-15(a)
  • Eff. February 1, 1976
  • Readopted Eff. January 1, 1978
  • Amended Eff. April 8, 2002; May 1, 1989
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. June 25, 2016.
11 NCAC 13 .0306 Forms to Be Approved {#sec-11-ncac-13-.0306 omnilex-key=us-nc-regs-official--title-11--11 NCAC 13 .0306}

All ten-day notices of intent to cancel forms, cancellation notices, additional premium notices, premium finance agreement revision notices, or all other notices or forms mailed or given to North Carolina insureds shall be filed with the Commissioner for approval. Such forms shall not be used in this state until written approval has been given by the Commissioner.

History

  • Authority G.S. 58-2-40; 58-35-45
  • Eff. February 1, 1976
  • Readopted Eff. January 1, 1978
  • Amended Eff. May 1, 1989
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. June 25, 2016.
11 NCAC 13 .0307 Change in Ownership or Management and in Certain Employees {#sec-11-ncac-13-.0307 omnilex-key=us-nc-regs-official--title-11--11 NCAC 13 .0307}

Each licensee shall furnish all the following information in writing to the Commissioner within 10 days after the occurrence of the event:

(1) form DOI-5PF on each stockholder who attains ten percent or more of any class of the licensee's outstanding capital stock;

(2) form DOI-5PF on each partner, officer or employee acting as office manager or field representative who is employed by the licensee; and

(3) the name and address of each partner, officer or employee acting as office manager or field representative who is terminated or has his status altered by the licensee.

History

  • Authority G.S. 58-2-40; 58-35-30(a)
  • Eff. February 1, 1976
  • Readopted Eff. January 1, 1978
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. June 25, 2016.
11 NCAC 13 .0308 analysis of contracts {#sec-11-ncac-13-.0308 omnilex-key=us-nc-regs-official--title-11--11 NCAC 13 .0308}

Each person licensed by the North Carolina Department of Insurance under G.S. 58-35-15 shall file a regular report entitled "Analysis of Contracts" with the Commissioner along with the annual renewal application required by G.S. 58-35-15(c). The analysis of contracts shall be a record of the premium finance company's business for the calendar year (January to December) immediately preceding the filing date. The analysis of contracts form shall be supplied by the commissioner and shall include:

(1) the name and address of the licensee;

(2) a list of the officers and directors of the licensee;

(3) the number of contracts written by month;

(4) the total premium for written contracts by month;

(5) the total down payment on contracts by month;

(6) the total principal balance of contracts by month; and

(7) the total service charges pertaining to written contracts by month.

History

  • Authority G.S. 58-2-40; 58-35-15; 58-35-30(a)
  • Eff. February 1, 1976
  • Readopted Eff. January 1, 1978
  • Amended Eff. March 1, 2012; May 1, 1989
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. June 25, 2016.
11 NCAC 13 .0309 Quarterly Report {#sec-11-ncac-13-.0309 omnilex-key=us-nc-regs-official--title-11--11 NCAC 13 .0309}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-35-30
  • Eff. February 1, 1976
  • Readopted Eff. January 1, 1978
  • Amended Eff. May 1, 1989
  • Repealed Eff. October 1, 2010.
11 NCAC 13 .0310 Books and Records {#sec-11-ncac-13-.0310 omnilex-key=us-nc-regs-official--title-11--11 NCAC 13 .0310}

Each licensee shall keep and maintain the following records, separate and apart from any other business, so as to be readily available for inspection by the Commissioner, or an employee designated by the Commissioner:

(1) a copy of each premium finance agreement entered into by the licensee and all original documents relating thereto; All such records shall have a common identifying number (agreement or contract number);

(2) an account card, ledger, register, or combination of records containing a summary of each premium finance agreement which shall contain:

(a) the date of the agreement;

(b) the name of the insured;

(c) the identifying number;

(d) the principal balance;

(e) the amount of service charge;

(f) the time balance;

(g) number and amount of payments due from the insured;

(h) date and amount of payments received from the insured;

(i) date and amount of return premium received from an insurance company;

(j) date, amount and check number of any refund returned to an insured;

(k) date the 10 day written notice of intent to cancel, required under G.S. 58-35-85(1), was mailed to the insured; and

(l) copy of form number DOI-6PF, if applicable;

(3) a copy of any additional balance notice mailed to the insured;

(4) a copy of any notice of cancellation mailed under G.S. 58-35-85(2);

(5) such journals, ledgers, check registers, receipt books and all other records as may be necessary to accurately and completely record all financial transactions of the licensee. Such books and records shall be posted up to date at least once each month and shall be used by the licensee in completing the annual statement;

(6) such other records, books, or accounts as will enable the Commissioner to determine whether the licensee is complying with all the provisions of G.S. 58, Article 35 and these Rules.

History

  • Authority G.S. 58-2-40; 58-35-30
  • Eff. February 1, 1976
  • Readopted Eff. January 1, 1978
  • Amended Eff. April 8, 2002; May 1, 1989
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. June 25, 2016.
11 NCAC 13 .0311 Branch Office Permit {#sec-11-ncac-13-.0311 omnilex-key=us-nc-regs-official--title-11--11 NCAC 13 .0311}

An insurance premium finance branch office license shall be required for each location (other than the home office) at which any books, records or files of the licensee are kept. No branch office license shall be required if all records are transmitted to the home office each business day.

History

  • Authority G.S. 58-2-40; 58-35-5(e)
  • Eff. February 1, 1976
  • Readopted Eff. January 1, 1978
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. June 25, 2016.
11 NCAC 13 .0312 Sale, Assignment or Transfer of Premium Finance Agreements {#sec-11-ncac-13-.0312 omnilex-key=us-nc-regs-official--title-11--11 NCAC 13 .0312}

A licensee shall not sell or transfer any ownership of any insurance premium finance agreement or power of attorney to cancel an insurance contract unless the terms and conditions of sale or transfer have been approved in writing by the Commissioner. (This is not intended to restrict the sales or transfer of stock certificates.) The Commissioner shall be notified by the licensee at the time any insurance premium finance agreement containing a power of attorney to cancel a contract of insurance is assigned or pledged to a creditor of the licensee.

History

  • Authority G.S. 58-2-40; 58-35-40(a)
  • Eff. February 1, 1976
  • Readopted Eff. January 1, 1978
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. June 25, 2016.
11 NCAC 13 .0313 Additional Balances Added to Finance Agreements {#sec-11-ncac-13-.0313 omnilex-key=us-nc-regs-official--title-11--11 NCAC 13 .0313}

Any additional balances may be added to a premium finance agreement unless the original or subsequent agreement specifically does not authorize such additions.

History

  • Authority G.S. 58-2-40; 58-35-50(a)
  • Eff. February 1, 1976
  • Readopted Eff. January 1, 1978
  • Amended Eff. May 1, 1989
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. June 25, 2016.
11 NCAC 13 .0314 Additional Balances Added to Finance Agreements: 60 Days {#sec-11-ncac-13-.0314 omnilex-key=us-nc-regs-official--title-11--11 NCAC 13 .0314}

All additional premiums on insurance contracts or all additional insurance contracts added to a premium finance agreement less than 60 days after the date of the premium finance agreement shall be added as if the additional balance had been known at the time the premium finance agreement was entered into. The additional service charge, if any, shall be the difference between the service charge shown on the premium finance agreement and the amount of service charge that would have been allowed under the licensee's approved rate chart.

History

  • Authority G.S. 58-2-40
  • Eff. February 1, 1976
  • Readopted Eff. January 1, 1978
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. June 25, 2016.
11 NCAC 13 .0315 Additional Balances Added to Agreement After 60 Days {#sec-11-ncac-13-.0315 omnilex-key=us-nc-regs-official--title-11--11 NCAC 13 .0315}

Any additional premiums on insurance contracts or additional insurance contracts added to a premium finance agreement 60 days or more after the date of the agreement (but prior to the expiration of the agreement) may be added with an additional service charge computed on the principal balance at a rate not exceeding twelve dollars ($12.00) per one hundred dollars ($100.00) per annum from the inception date of the additional insurance contract or the due date of the additional premium, to and including the date when the final installment of the premium finance agreement is payable. The service charge on an additional balance shall not begin more than 30 days prior to the advance of the additional monies by the premium finance company.

History

  • Authority G.S. 58-2-40; 58-35-55
  • Eff. February 1, 1976
  • Readopted Eff. January 1, 1978
  • Amended Eff. July 1, 1986
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. June 25, 2016.
11 NCAC 13 .0316 Additional Balance Notice to Insured {#sec-11-ncac-13-.0316 omnilex-key=us-nc-regs-official--title-11--11 NCAC 13 .0316}

When a premium finance agreement provides for the financing of additional balances and such additional balances are added to the agreement by the licensee, a notice of the additional balance shall be mailed to the insured, at his last known address as shown on the agreement, by the licensee. The notice shall be mailed prior to the next payment due date and include an explanation of the amount added, the service charge added, the new balance payable by the insured, the number of payments required, the amount of each payment, the date each payment is due and all other pertinent information.

History

  • Authority G.S. 58-2-40
  • Eff. February 1, 1976
  • Readopted Eff. January 1, 1978
  • Amended Eff. May 1, 1989
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. June 25, 2016.
11 NCAC 13 .0317 Ten-Day Notice {#sec-11-ncac-13-.0317 omnilex-key=us-nc-regs-official--title-11--11 NCAC 13 .0317}

The ten-day written notice of intent to cancel as described in G.S. 58-35-85(1) shall include the name and address of the premium finance company, the premium finance agreement number, the date the notice is delivered or sent, and the amount of the installment in default. A copy of the ten-day notice, or a listing of delinquent insureds showing the same general information shall be sent to the insurance agent shown on the premium finance agreement at the same time notice is given to the insured.

History

  • Authority G.S. 58-2-40; 58-35-85 (1)
  • Eff. February 1, 1976
  • Readopted Eff. January 1, 1978
  • Amended Eff. April 1, 1996; May 1, 1989
  • Temporary Amendment Eff. December 1, 1999
  • Amended Eff. July 1, 2000
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. June 25, 2016.
11 NCAC 13 .0318 Notice of Cancellation {#sec-11-ncac-13-.0318 omnilex-key=us-nc-regs-official--title-11--11 NCAC 13 .0318}

The notice of cancellation as described in G.S. 58-35-85(2) shall be signed by the owner or an officer of the premium finance company (the owner or officer's facsimile signature may be used), shall have in bold print at its top the wording "Notice of Cancellation" and shall include the name and address of the insured; the name and address of the insurance company; the name and address of the premium finance company; the insurance company policy number; a certification that the ten-days notice of intent to cancel has been furnished to the insured; the authority under which the policy is to be canceled; the date the notice of cancellation is delivered or sent to the insured and to the insurance company; the effective date of cancellation; and a notice stating, "If automobile liability insurance is included, you are cautioned that financial responsibility is required to be maintained continuously throughout the registration period and that operation of a motor vehicle without maintaining such financial responsibility is a misdemeanor, the penalty for which is loss of registration plate, and fine or imprisonment, in accordance with the motor vehicle laws of the State of North Carolina as they may be amended from time to time".

History

  • Authority G.S. 58-2-40; 58-35-85(2)
  • Eff. February 1, 1976
  • Readopted Eff. January 1, 1978
  • Amended Eff. December 1, 1993; September 1, 1991; May 1, 1989; July 1, 1986
  • Temporary Amendment Eff. December 1, 1999
  • Amended Eff. July 1, 2000
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. June 25, 2016.
11 NCAC 13 .0319 Effective Date of Cancellation {#sec-11-ncac-13-.0319 omnilex-key=us-nc-regs-official--title-11--11 NCAC 13 .0319}

When an insurance premium finance company cancels an insurance policy by using a power of attorney signed by the insured, the effective date of cancellation as stated in the notice of cancellation shall be no earlier than the date the notice of cancellation is sent to the insurance company.

History

  • Authority G.S. 58-2-40; 58-35-85(2)
  • Eff. February 1, 1976
  • Readopted Eff. January 1, 1978
  • Amended Eff. February 1, 1996; December 1, 1993; September 1, 1991
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. June 25, 2016.
11 NCAC 13 .0320 Installment Payments Made by Insured {#sec-11-ncac-13-.0320 omnilex-key=us-nc-regs-official--title-11--11 NCAC 13 .0320}

If an insurance premium finance company allows or authorizes an insurance agent, broker or any other representative to accept installment payments from the insured or if the premium finance company accepts installment payments made by the insured from an insurance agent, broker or any other representative, payment to the insurance agent, broker or any other representative shall be considered as payment to the premium finance company as of the date the installment payment was accepted by the insurance agent, broker or any other representative.

History

  • Authority G.S. 58-2-40; 58-35-50
  • Eff. February 1, 1976
  • Readopted Eff. January 1, 1978
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. June 25, 2016.
11 NCAC 13 .0321 Sight Draft and Check Forms {#sec-11-ncac-13-.0321 omnilex-key=us-nc-regs-official--title-11--11 NCAC 13 .0321}

The Department will not approve the use of sight draft or any check forms that are placed in the hands of the insurance agents unless they are made payable only to a licensed or authorized insurance company. Such sight draft or check forms shall not be used unless they have been filed with and written approval given by the Commissioner.

History

  • Authority G.S. 58-2-40; 58-35-45
  • Eff. February 1, 1976
  • Readopted Eff. January 1, 1978
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. June 25, 2016.
11 NCAC 13 .0322 Insurance Company Notified of Financed Policy {#sec-11-ncac-13-.0322 omnilex-key=us-nc-regs-official--title-11--11 NCAC 13 .0322}

The licensee shall give notice to the insurance company affected when an unearned premium has been assigned by the insured. The premium finance company may give the notice directly to the insurance company or instruct and supervise the insurance agent in giving all such notices.

History

  • Authority G.S. 58-2-40; 58-35-30(a); 58-35-90
  • Eff. February 1, 1976
  • Readopted Eff. January 1, 1978
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. June 25, 2016.
11 NCAC 13 .0323 Computation of Service Charges {#sec-11-ncac-13-.0323 omnilex-key=us-nc-regs-official--title-11--11 NCAC 13 .0323}

The service charges as provided in G.S. 58-35-55(c) shall be computed:

(1) from the inception date of the insurance contract, the premiums for which are advanced or to be advanced under the agreement, to and including the date when the final installment of the premium finance agreement is payable; If the premium finance agreement is executed later than 30 days after such inception date, there shall be deducted from the amount of the service charge an amount which bears the same proportion to the service charge, as the number of days from the 30th day after the policy inception date until the day of execution of the premium finance agreement, bears to the number of days from the policy inception to the date when the final installment of the premium finance agreement is payable. No deduction shall be required under this Paragraph, however, if the amount thereof is less than one dollar ($1.00);

(2) from the date the premium finance agreement is executed or any date after the premium finance agreement is executed, to and including the date when the final installment of the premium finance agreement is payable; provided the service charge does not begin prior to the inception date of the insurance contract, the premiums for which are advanced or to be advanced under the agreement.

History

  • Authority G.S. 58-2-40; 58-35-55
  • Eff. February 1, 1976
  • Readopted Eff. January 1, 1978
  • Amended Eff. April 8, 2002; May 1, 1989
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. June 25, 2016.
11 NCAC 13 .0324 Dishonored Checks {#sec-11-ncac-13-.0324 omnilex-key=us-nc-regs-official--title-11--11 NCAC 13 .0324}

If, for the premium being financed, an insurance agent holds a dishonored check given by the insured as down payment, certification to the premium finance company by the agent that he holds a dishonored check and that the agent agrees to hold the premium finance company harmless shall entitle the premium finance company to make any remittance due the insured to the agent and not to the insured, provided that no remittance of return premium due the insured shall be made to the agent in any amount in excess of the amount of the dishonored check. A copy of the dishonored check shall be submitted to the premium finance company by the agent at the time of certification.

History

  • Authority G.S. 58-2-40; 58-35-85
  • Eff. January 1, 1978
  • Amended Eff. May 1, 1989; July 1, 1986
  • Temporary Amendment Eff. December 1, 1999
  • Amended Eff. July 1, 2000
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. June 25, 2016.
11 NCAC 13 .0325 Multiple Contracts {#sec-11-ncac-13-.0325 omnilex-key=us-nc-regs-official--title-11--11 NCAC 13 .0325}

When a contract or series of contracts is written by more than one agent, or when the contracts are written and dated 60 days or more apart, or when the insured expressly requests, in writing, separate contracts, there is a presumption that the insurance agent or insurance premium finance company did not induce an insured to become obligated under more than one insurance premium finance agreement to earn additional fees.

History

  • Authority G.S. 58-2-40; 58-35-30(a); 58-35-55(e); 58-35-90
  • Eff. May 1, 1989
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. June 25, 2016.
11 NCAC 13 .0326 Premium Finance Agreement Type Standard {#sec-11-ncac-13-.0326 omnilex-key=us-nc-regs-official--title-11--11 NCAC 13 .0326}

The printed portion of each original premium finance agreement shall be in eight point type. An inadvertent change in the type size caused by facsimile or other electronic transmission, copying, or other means is not a violation of this Rule.

History

  • Authority G.S. 58-2-40; 58-35-50
  • Temporary Adoption Eff. December 1, 1999
  • Eff. July 1, 2000
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. June 25, 2016.
11 NCAC 13 .0401 Application Form for Motor Clubs {#sec-11-ncac-13-.0401 omnilex-key=us-nc-regs-official--title-11--11 NCAC 13 .0401}

The form entitled "Application for Motor Club License" shall include general interrogatories concerning the corporate structure, employees, past business experience, address, proposed services and plan of operation of the applicant as well as other pertinent information, including the nature of the business structure if the motor club is not a corporation.

History

  • Authority G.S. 58-2-40; 58-69-10; 58-69-20(5)
  • Eff. February 1, 1976
  • Readopted Eff. January 1, 1978
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. June 25, 2016.
11 NCAC 13 .0402 Motor Club License Renewal Form {#sec-11-ncac-13-.0402 omnilex-key=us-nc-regs-official--title-11--11 NCAC 13 .0402}

A "Motor Club License Renewal Application" shall include the name and address of the motor club, date of cancellation of the license if the application is not received by the Division, the proper license fee, instructions for the completion and return of the application, and other pertinent information.

History

  • Authority G.S. 58-2-40; 58-69-15; 58-69-20(5)
  • Eff. February 1, 1976
  • Readopted Eff. January 1, 1978
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. June 25, 2016.
11 NCAC 13 .0403 Motor Club Licensing Procedures {#sec-11-ncac-13-.0403 omnilex-key=us-nc-regs-official--title-11--11 NCAC 13 .0403}

(a) Applicants must meet minimum qualifications as set forth in G.S. 58, Article 69.

(b) Applicants must submit a properly completed "Application for Motor Club License" to the Division. The following items shall be attached to and made a part of the application:

(1) a duly authenticated copy of the applicant's articles of incorporation, together with all amendments and supplements thereto;

(2) a duly authenticated copy of the applicant's constitution and by-laws;

(3) if the applicant is a foreign corporation, a copy of the certificate of authority to transact business in this state issued by the North Carolina Secretary of State;

(4) copies of all membership solicitation material, insurance certificates, membership cards, emblems, service contracts and any other material supplied to members or prospective members by the applicant;

(5) a current audited financial statement of the applicant, proposed by a certified public accountant or by a qualified independent accountant who is engaged in the public practice of accounting, not more than three months prior to the date the application is submitted to the Department of Insurance;

(6) a surety bond or deposit of securities as specified in G.S. 58-69-10;

(7) a complete summary of the applicant's plan of operation in the State of North Carolina;

(8) a check in the amount of the license fee as specified in G.S. 58-69-10 (made payable to the North Carolina Department of Insurance); and

(9) such other data and information as the Commissioner of Insurance may deem reasonably necessary to enable him to determine, in accordance with the provisions of G.S. 58-69-15, whether or not a license should be issued to the applicant.

History

  • Authority G.S. 58-2-40; 58-69-10; 58-69-20(4), (5)
  • Eff. February 1, 1976
  • Readopted Eff. January 1, 1978
  • Amended Eff. April 8, 2002
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. June 25, 2016.
11 NCAC 13 .0404 Renewal of Motor Club License {#sec-11-ncac-13-.0404 omnilex-key=us-nc-regs-official--title-11--11 NCAC 13 .0404}

(a) The Division will mail to each licensed motor club a "Motor Club License Renewal Application."

(b) Each motor club shall complete the application and return it to the Division by the date specified on the form. The following items shall be attached to and made a part of the application:

(1) a current audited financial statement of the motor club, proposed by a certified public accountant or by a qualified independent accountant who is engaged in the public practice of accounting;

(2) an alphabetical listing of all persons authorized to sell memberships for the motor club in the State of North Carolina;

(3) a list of all district or branch office locations in North Carolina and the name of each district or branch office manager in this state;

(4) a check made payable to the North Carolina Department of Insurance for the proper fee specified in G.S. 58-59-10.

(c) Bonds must be in force at the time of renewal, where applicable.

History

  • Authority G.S. 58-2-40; 58-69-15; 58-69-20(5)
  • Eff. February 1, 1976
  • Readopted Eff. January 1, 1978
  • Amended Eff. April 8, 2002
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. June 25, 2016.
11 NCAC 13 .0405 Surety Bond {#sec-11-ncac-13-.0405 omnilex-key=us-nc-regs-official--title-11--11 NCAC 13 .0405}

The surety bond described in G.S. 58-69-10 shall be executed on the Bond-MC form supplied by the Commissioner of Insurance and shall be completed and executed in accordance with the laws of North Carolina governing surety bonds by a surety company authorized to transact business in this state.

History

  • Authority G.S. 58-2-40; 58-69-20(5)
  • Eff. February 1, 1976
  • Readopted Eff. January 1, 1978
  • Amended Eff. October 1, 2010; April 8, 2002
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. June 25, 2016.
11 NCAC 13 .0406 Use of Credit Cards Prohibited {#sec-11-ncac-13-.0406 omnilex-key=us-nc-regs-official--title-11--11 NCAC 13 .0406}

History

  • Status: repealed
  • Authority G.S. 66-49.13(5); 58-61.2
  • Eff. February 1, 1976
  • Readopted Eff. January 1, 1978
  • Temporary Repeal Eff. December 1, 1999
  • Repealed Eff. July 1, 2000.
11 NCAC 13 .0407 Claim Register to Be Maintained {#sec-11-ncac-13-.0407 omnilex-key=us-nc-regs-official--title-11--11 NCAC 13 .0407}

Each motor club must maintain a current "claims register" which shall include the date each claim for benefits under a motor club membership is received by the motor club, the claimant's name, the claimant's address, the amount of the claim, motor club certificate number under which the claim is made, the disposition of the claim, including the amount paid, and a notation concerning the reason any claim is denied.

History

  • Authority G.S. 58-2-40; 58-69-20(5)
  • Eff. February 1, 1976
  • Readopted Eff. January 1, 1978
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. June 25, 2016.
11 NCAC 13 .0408 Reserve to Be Maintained {#sec-11-ncac-13-.0408 omnilex-key=us-nc-regs-official--title-11--11 NCAC 13 .0408}

Each motor club shall maintain a constant reserve of assets, for the benefit of the motor club members who have paid membership fees in advance or when the motor club has a liability under any motor club membership. The reserve shall be maintained under such conditions and in such amounts as the Commissioner may reasonably require to assure the prompt payment of all just claims under any membership contract issued by the motor club.

History

  • Authority G.S. 58-2-40; 58-69-20(5)
  • Eff. February 1, 1976
  • Readopted Eff. January 1, 1978
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. June 25, 2016.
11 NCAC 13 .0409 Motor Club Not an Insurance Company {#sec-11-ncac-13-.0409 omnilex-key=us-nc-regs-official--title-11--11 NCAC 13 .0409}

No motor club nor any officer, director or employee of the motor club shall imply to anyone that the motor club is an insurance company or that it is in any way engaged in the insurance business.

History

  • Authority G.S. 58-2-40; 58-69-20(5)
  • Eff. February 1, 1976
  • Readopted Eff. January 1, 1978
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. June 25, 2016.
11 NCAC 13 .0410 Salesmen to Be Licensed Insurance Agents {#sec-11-ncac-13-.0410 omnilex-key=us-nc-regs-official--title-11--11 NCAC 13 .0410}

Any person acting in the capacity of employee, agent, or salesman who solicits or sells a motor club membership shall be a licensed insurance agent if the membership contract includes a contract of insurance to the member. The employee, agent, or salesman shall be licensed with the same insurance company that issues the contract of insurance.

History

  • Authority G.S. 58-2-40; 58-69-20(5)
  • Eff. February 1, 1976
  • Readopted Eff. January 1, 1978
  • Amended Eff. April 8, 2002; July 1, 1986
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. June 25, 2016
  • Amended Eff. August 1, 2021.
11 NCAC 13 .0411 Notice to Commissioner {#sec-11-ncac-13-.0411 omnilex-key=us-nc-regs-official--title-11--11 NCAC 13 .0411}

Each corporate motor club licensee shall advise the Commissioner in writing within ten days of:

(1) the name and resident address of each new stockholder owning ten percent or more of any class of outstanding capital stock of the motor club;

(2) each director or officer who terminates or alters his status with the motor club;

(3) the name and address of each person who becomes an officer or director of the motor club; and

(4) each new employee hired to act as a salesman, representative or agent.

History

  • Authority G.S. 58-2-40; 58-69-20(5)
  • Eff. February 1, 1976
  • Readopted Eff. January 1, 1978
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. June 25, 2016.
11 NCAC 13 .0501 Application for Bail Bondsmen or Runner License {#sec-11-ncac-13-.0501 omnilex-key=us-nc-regs-official--title-11--11 NCAC 13 .0501}

A form entitled "Bail Bondsman Application" shall include general interrogatories relating to applicant's qualifications, residence, prospective place of business, past business experience, and all other pertinent information.

History

  • Authority G.S. 58-2-40; 58-71-5(a); 58-71-40
  • Eff. February 1, 1976
  • Readopted Eff. January 1, 1978
  • Amended Eff. May 1, 1989
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. June 25, 2016.
11 NCAC 13 .0502 Bail Bondsmen or Runner Renewal Form {#sec-11-ncac-13-.0502 omnilex-key=us-nc-regs-official--title-11--11 NCAC 13 .0502}

The "Bail Bondsman Renewal Application" shall include the name and address of applicant, date of cancellation of the license if the application is not received by the Division, the amount of the proper fee, instructions for the completion and return of the application and other pertinent information.

History

  • Authority G.S. 58-2-40; 58-71-5(a); 58-71-40
  • Eff. February 1, 1976
  • Readopted Eff. January 1, 1978
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. June 25, 2016.
11 NCAC 13 .0503 Bail Bondsman or Runner Licensing Procedures {#sec-11-ncac-13-.0503 omnilex-key=us-nc-regs-official--title-11--11 NCAC 13 .0503}

(a) Applicants must meet minimum qualifications as stated in G.S. 58, Article 71.

(b) Applicants must submit a properly completed "Bail Bondsman Application" to the Division. The following items where applicable shall be attached to and made a part of the application:

(1) a certified copy of the power of attorney given to a runner applicant by the professional bondsman for whom he will sign bonds;

(2) a properly completed power of attorney as set forth in G.S. 58-71-155 if the applicant will make a security deposit with the Commissioner of Insurance;

(3) if the applicant will be employed by another bail bondsman, a sworn statement as set forth in G.S. 58-71-65;

(4) a complete set of the applicants fingerprints certified by an authorized law enforcement officer in compliance with G.S. 58-71-50;

(5) a security deposit as required under G.S. 58-71-145;

(6) check in the amount of the license fee as specified in G.S. 58-71-55 (made payable to the North Carolina Department of Insurance);

(7) check in the amount of the examination fee as specified in G.S. 58-71-70;

(8) such other data and information as the Commissioner of Insurance may deem reasonably necessary to assist him in determining whether or not the applicant is entitled to the license sought.

History

  • Authority G.S. 58-2-40; 58-71-40; 58-71-5(a); 58-71-50
  • Eff. February 1, 1976
  • Readopted Eff. January 1, 1978
  • Amended Eff. April 8, 2002
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. June 25, 2016.
11 NCAC 13 .0504 Renewal of Bail Bondsman or Runner License {#sec-11-ncac-13-.0504 omnilex-key=us-nc-regs-official--title-11--11 NCAC 13 .0504}

History

  • Status: expired
  • Authority G.S. 58-2-40; 58-71-5(a); 58-71-75
  • Eff. February 1, 1976
  • Readopted Eff. January 1, 1978
  • Amended Eff. April 8, 2002; July 1, 1989
  • Expired Eff. July 1, 2016 pursuant to G.S. 150B-21.3A.
11 NCAC 13 .0505 Bail Bond Certification Seal {#sec-11-ncac-13-.0505 omnilex-key=us-nc-regs-official--title-11--11 NCAC 13 .0505}

No professional bail bondsman or his duly appointed runner shall sign a bail bond unless he affixes thereto a "certification seal." The certification seal shall be affixed to the bail bond in the space provided for it on the bail bond form supplied by the Administrative Office of the Courts. Certification seals will be supplied to the professional bondsman by the Commissioner of Insurance upon request. Each certification seal shall bear the wording "North Carolina Department of Insurance" and an identifying number.

History

  • Authority G.S. 58-2-40; 58-71-5(a)
  • Eff. February 1, 1976
  • Readopted Eff. January 1, 1978
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. June 25, 2016.
11 NCAC 13 .0506 Bail Bond Register {#sec-11-ncac-13-.0506 omnilex-key=us-nc-regs-official--title-11--11 NCAC 13 .0506}

Each professional bail bondsman shall keep at his place of business a bail bond register which shall be a numerically ordered listing of each certification seal used by the professional bail bondsman or his duly appointed runner. The bail bond register shall contain the certification seal number, the name of the principal for whom the bond was signed, the county in which the bond was signed, the amount of the bond, the amount of the fee charged by the professional bail bondsman or his duly appointed runner and the number of the receipt given for amount of the fee charged by the bail bondsman. The bail bond register shall be kept up to date daily by the professional bondsman.

History

  • Authority G.S. 58-2-40; 58-71-5(a)
  • Eff. February 1, 1976
  • Readopted Eff. January 1, 1978
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. June 25, 2016.
11 NCAC 13 .0507 Security Deposit by Professional Bondsman {#sec-11-ncac-13-.0507 omnilex-key=us-nc-regs-official--title-11--11 NCAC 13 .0507}

(a) The first five thousand dollars ($5,000) of the security deposit required under G.S. 58-71-145 shall be certificates of deposit from a North Carolina bank or savings and loan association of the professional bondsman's choice or other negotiable securities satisfactory to the Commissioner. Such certificates of deposits or other securities received by the North Carolina Department of Insurance will be transferred to a master trust bank pursuant to G.S. 58-5-1. The registration of such securities should read as follows: "(Name of Master Trust Bank) as custodian for the North Carolina Department of Insurance for the benefit of (Name of Professional Bondsman)."

(b) Security over and above the first five thousand dollars ($5,000) may consist of bonds of the United States or the State of North Carolina, and other negotiable securities upon review and approval by the Commissioner of Insurance.

History

  • Authority G.S. 58-2-40; 58-71-5(a); 58-71-145
  • Eff. February 1, 1976
  • Readopted Eff. January 1, 1978
  • Amended Eff. April 8, 2002; May 1, 1988; September 14, 1978
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. June 25, 2016.
11 NCAC 13 .0508 Stocks or Bonds as Security {#sec-11-ncac-13-.0508 omnilex-key=us-nc-regs-official--title-11--11 NCAC 13 .0508}

When stocks or bonds are submitted to the Commissioner of Insurance by a professional bondsman as security deposit and are found satisfactory by the Commissioner, the professional bail bondsman shall sign and deliver to the Commissioner, in addition to the power of attorney specified in G.S. 58-71-155, an "irrevocable stock or bond power" on forms supplied by the Commissioner. The irrevocable stock or bond power shall contain a description of the stocks or bonds being deposited as security and a statement that the professional bondsman sells, assigns, and transfers the stocks or bonds to the (Name of the Master Trust Bank) as custodian for the North Carolina Department of Insurance for the benefit of (Name of Professional Bondsman). When satisfactory bonds are submitted to the Commissioner by a professional bail bondsman, the Commissioner will accept 80 percent of the fair market value of such bonds as the amount of security furnished. When satisfactory stocks are submitted by a professional bail bondsman, the Commissioner will accept 60 percent of the fair market value of such stocks as the amount of security furnished.

History

  • Authority G.S. 58-2-40; 58-5-1; 58-71-5(a); 58-71-145
  • Eff. February 1, 1976
  • Readopted Eff. January 1, 1978
  • Amended Eff. April 8, 2002; May 1, 1988
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. June 25, 2016.
11 NCAC 13 .0509 Real Estate as Security {#sec-11-ncac-13-.0509 omnilex-key=us-nc-regs-official--title-11--11 NCAC 13 .0509}

History

  • Status: repealed
  • Authority G.S. 85C-2(a); 85C-30
  • Eff. February 1, 1976
  • Readopted Eff. January 1, 1978
  • Repealed Eff. August 1, 1985.
11 NCAC 13 .0510 Multiple Charges Against a Single Defendant {#sec-11-ncac-13-.0510 omnilex-key=us-nc-regs-official--title-11--11 NCAC 13 .0510}

History

  • Status: repealed
  • Authority G.S. 85C-2(a); 85C-36
  • Eff. February 1, 1976
  • Readopted Eff. January 1, 1978
  • Repealed Eff. September 1, 1991.
11 NCAC 13 .0511 Licensed Professional Bondsman Affidavit of Surety {#sec-11-ncac-13-.0511 omnilex-key=us-nc-regs-official--title-11--11 NCAC 13 .0511}

Licensed professional bail bondsmen must file with the clerk of court having jurisdiction over the principal, an affidavit on a form furnished by the Administrative Office of the Courts (number AOC-L Form 277 or its successor) entitled "Affidavit of Surety (Bondsman)."

The affidavit shall include, but not be limited to:

(1) a statement that he has not, nor has anyone for his use, been promised or received any collateral, security or premium for executing this appearance bond; or

(2) if promised a premium, the amount of the premium promised and the due date; or

(3) if he has received a premium, the amount of premium received shall be entered; or

(4) if given collateral security the name of the person from whom it is received, and the nature and amount of the collateral security shall be listed in detail; or

(5) any applicable combination of the above.

History

  • Authority G.S. 58-2-40; 58-71-5(a)
  • Eff. August 1, 1976
  • Readopted Eff. January 1, 1978
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. June 25, 2016.
11 NCAC 13 .0512 Collateral Security Required by Bondsmen {#sec-11-ncac-13-.0512 omnilex-key=us-nc-regs-official--title-11--11 NCAC 13 .0512}

(a) The collateral security required by bail bondsmen shall be reasonable in relation to the amount of the bond in that any collateral security (including personal property, real property, indemnity agreement and guarantee) received by such licensee shall not, in the aggregate, exceed the amount of the bond.

(b) Any collateral security shall be returned to the person who deposited it with the bail bondsman immediately after the obligation, the satisfaction of which was secured by the collateral, is discharged.

(c) Any bail bondsman or runner who receives collateral security shall hold such collateral security in trust. No indemnity agreement or other security received as collateral security for a bond shall contain any provision whereby any liability or obligation under such agreement extends beyond the termination of liability under the bond.

(d) If the bondsman's liability is reduced at any time and for any reason, the collateral security and all obligations under collateral indemnity agreements or guarantees shall be reduced to the same extent that the liability under the bond was reduced, and any excess thereof shall be immediately returned to the depositor of the security.

(e) No indemnity agreement or other security agreement taken as collateral for bonds shall include any provision for the payment of interest or other additional fees or charges.

(f) All persons who sign any type of indemnity agreement or other type of security agreement to be used as collateral shall be furnished by the bondsman or runner with a copy of such agreement.

(g) The provisions of this Section relating to indemnity agreements or other security agreements apply to all such agreements whether set forth on the face of the bond or contained in a separate agreement.

(h) All indemnity agreements or other security agreements shall be considered as collateral security and shall be listed and described on the form provided by the Administrative Office of the Courts (Form AOC-CR-201 or its successor) entitled "Appearance Bond for Pretrial Release."

(i) Upon any modification or alteration of the collateral security, the bondsman shall comply with the provisions of 11 North Carolina Administrative Code 13 .0513.

(j) All agreements and contracts with defendants or anyone on behalf of the defendant, shall have a form number and the license number of the bail bondsman printed thereon and shall be submitted to the Department for approval according to the standards in these Rules. No such agreements or contracts shall be used by the licensee until written approval has been given by the Department.

History

  • Authority G.S. 58-2-40; 58-71-5(a); 58-71-95; 58-71-100
  • Eff. August 1, 1976
  • Readopted Eff. January 1, 1978
  • Amended Eff. March 1, 2011; October 1, 2010; September 14, 1978
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. June 25, 2016.
11 NCAC 13 .0513 Alteration of Affidavit of Surety {#sec-11-ncac-13-.0513 omnilex-key=us-nc-regs-official--title-11--11 NCAC 13 .0513}

Upon any modification or alteration of the collateral security, the bondsman shall execute a written amendment to the Affidavit of Surety setting forth the details of such modification or alteration. A copy of any such amendment shall be furnished to the principal and the person furnishing the collateral security or premium, and a copy shall be on file in the office of the bondsman.

History

  • Authority G.S. 58-2-40; 58-71-5(a)
  • Eff. August 1, 1976
  • Readopted Eff. January 1, 1978
  • Amended Eff. October 1, 2010
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. June 25, 2016.
11 NCAC 13 .0514 Collateral Security Returned on Termination of Liability {#sec-11-ncac-13-.0514 omnilex-key=us-nc-regs-official--title-11--11 NCAC 13 .0514}

History

  • Status: repealed
  • Authority G.S. 85C-2(a)
  • Eff. August 1, 1976
  • Readopted Eff. January 1, 1978
  • Amended Eff. May 1, 1989
  • Repealed Eff. July 1, 2000.
11 NCAC 13 .0515 Receipt for All Fees {#sec-11-ncac-13-.0515 omnilex-key=us-nc-regs-official--title-11--11 NCAC 13 .0515}

Whenever a fee is received by a bail bondsman a receipt shall be furnished to the defendant. Copies of all receipts issued shall be kept by the bail bondsman. All receipts issued must:

(1) be prenumbered by the printer and used and filed in consecutive numerical order,

(2) show the name and address of the bail bondsman,

(3) show the amount and date paid,

(4) show the name of the person accepting payment,

(5) show the total amount of the bond for which the fee is being charged and the name of the defendant.

History

  • Authority G.S. 58-2-40; 58-71-5(a)
  • Eff. January 1, 1978
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. June 25, 2016.
11 NCAC 13 .0516 Surety Bondsmen Licensing Procedures {#sec-11-ncac-13-.0516 omnilex-key=us-nc-regs-official--title-11--11 NCAC 13 .0516}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-71-5(a)
  • Eff. July 1, 1986
  • Amended Eff. April 8, 2002
  • Repealed Eff. October 1, 2010.
11 NCAC 13 .0517 Termination of Runner by Surety {#sec-11-ncac-13-.0517 omnilex-key=us-nc-regs-official--title-11--11 NCAC 13 .0517}

A bail bondsman terminating the appointment of a runner shall file, within five days from the date of termination, a written notice thereof with the Commissioner. In addition to the notice requirements set forth in G.S. 58-71-125, the notice shall also include a revocation of the power of attorney.

History

  • Authority G.S. 58-2-40; 58-71-5(a)
  • Eff. May 1, 1989
  • Amended Eff. April 8, 2002
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. June 25, 2016.
11 NCAC 13 .0518 Continuing Education {#sec-11-ncac-13-.0518 omnilex-key=us-nc-regs-official--title-11--11 NCAC 13 .0518}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-71-71(f)
  • Eff. July 1, 1994
  • Repealed Eff. July 1, 2000.
11 NCAC 13 .0519 Fingerprints Required for Criminal Record Checks {#sec-11-ncac-13-.0519 omnilex-key=us-nc-regs-official--title-11--11 NCAC 13 .0519}

(a) The following individuals shall furnish the Commissioner with a complete set of fingerprints as authorized by G.S. 58-71-51:

(1) An applicant for an initial professional bail bondsman, surety bail bondsman, or runner license;

(2) A licensed professional bail bondsman, surety bail bondsman, or runner applying for another type professional bail bondsman, surety bail bondsman, or runner license;

(3) A professional bail bondsman, surety bail bondsman, or runner license applicant applying for reinstatement of a license that has lapsed or expired;

(4) A professional bail bondsman, surety bail bondsman, or runner license applicant who has been disqualified in any manner under Chapter 58;

(5) A professional bail bondsman, surety bail bondsman, or runner license applicant whose license has been suspended or revoked for non-payment of child support pursuant to G.S. 110-142.1; and

(6) A licensed professional bail bondsman, surety bail bondsman, or runner submitting a renewal application in an even-year pursuant to G.S. 58-71-75.

(b) As authorized by G.S. 58-71-51, fingerprints shall be furnished in the following manner:

(1) Each applicant shall have a complete set of their fingerprints electronically captured by a criminal law enforcement agency approved by the State Bureau of Investigation to submit fingerprints via electronic means;

(2) The Electronic Fingerprint Submission Release of Information Form that has been completed and certified by a law enforcement officer that the applicant's fingerprints have been submitted via electronic means to the SBI shall be submitted with the application;

(3) The Authority For Release of Information form required by the SBI to release the criminal history record check information to the Department shall be submitted with the application;

(4) The cost for the state and national criminal history record fee that is set forth pursuant to G.S. 114-19.1(a) shall be submitted with the application; and

(5) All fingerprint impressions must be suitable for use by the SBI to conduct a state criminal history record check and for the Federal Bureau of Investigations (FBI) to conduct a national criminal history record check. If the SBI deems the electronic fingerprints are not suitable, the Commissioner shall notify the applicant and provide instructions for them to resubmit their fingerprints in the manner set forth in Subparagraph (1) of this Paragraph within 30 days.

(c) The professional bail bondsman, surety bail bondsman, or runner initial or renewal license application is not complete until the Department receives the state and national criminal history record information. In accordance with G.S. 58-71-50 and 58-71-75, the Commissioner shall not issue a license to a professional bail bondsman, surety bail bondsman, or runner license applicant who does not satisfy the initial and renewal license application requirements.

History

  • Authority G.S. 58-2-40; 58-71-50; 58-71-51; 58-71-75
  • Eff. October 1, 2010
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. June 25, 2016.
11 NCAC 13 .0520 Prelicensing Education: Definitions for Bail Bond Prelicensing and Continuing Education {#sec-11-ncac-13-.0520 omnilex-key=us-nc-regs-official--title-11--11 NCAC 13 .0520}

As used in this Section, unless the context indicates otherwise:

(1) "Agent Services Division" or "Division" means the Agent Services Division of the North Carolina Department of Insurance, the Division responsible for the licensing, education and regulation of professional bail bondsmen, surety bail bondsmen, and bail bond runners.

(2) "Bail bond continuing education" means instruction in subjects related to the duties and responsibilities of a runner or a bail bondsman.

(3) "Bail bond continuing education credit or "BCEC" means a value assigned to a course by the Commissioner after review and approval of course information. This terms means the same as "hours of continuing education" as used in G.S. 58-71-71(b).

(4) "Certificate Of Course Completion" means a document from the approved bail bond pre-licensing or continuing educational provider certifying that the applicant has met the requirements of pre-licensing or continuing education.

(5) "Compliance year" means the annual license period running from July 1 to June 30 in which the licensee is required to complete three hours of BCEC pursuant to G.S. 58-71-71(b).

(6) "Course" means a continuing education course directly related to bail bond principles and practices.

(7) "Instructor" means an individual who meets the qualifications required by 11 NCAC 13 .0542; teaches, lectures, leads, or otherwise instructs a course; and is responsible for the preparation and presentation of lesson plans to that school's students.

(8) "Instructional hour" means a 50 minute hour in the classroom.

(9) "Licensee" means a licensed professional bail bondsman, surety bail bondsman or runner.

(10) "Outline" means the content outline prepared and published by the Department that summarizes the specific bail bond subject areas on which the professional bail bondsman, surety bail bondsman or runner license examination is based.

(11) "Professional Testing Service" or "Service" means the organization specializing in the development and administration of licensing examinations on a contract basis for the Department.

(12) "Provider" means an entity that provides prelicensing or continuing education approved by the Department.

(13) "State Licensing Examination" or "Examination" means a collection of questions designed to test the professional bail bondsman, surety bail bondsman, or runner license knowledge of the basic concepts, principles and laws relevant to the bail bond profession to determine his competence to be licensed in North Carolina.

History

  • Authority G.S. 58-2-40; 58-71-5(a); 58-71-70; 58-71-71
  • Eff. October 1, 2010
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. June 25, 2016.
11 NCAC 13 .0521 Bail Bond Monthly Report {#sec-11-ncac-13-.0521 omnilex-key=us-nc-regs-official--title-11--11 NCAC 13 .0521}

A professional bail bondsman shall file the written report required by G.S. 58-71-165 electronically with the Commissioner or the Commissioner's designee.

History

  • Authority 58-2-40; 58-2-250; 58-71-165
  • Eff. October 1, 2010
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. June 25, 2016.
11 NCAC 13 .0522 Continuing Education Requirements {#sec-11-ncac-13-.0522 omnilex-key=us-nc-regs-official--title-11--11 NCAC 13 .0522}

(a) Each person holding a professional bail bondsman, surety bail bondsman or runner's license shall obtain three hours of continuing education pursuant to G.S. 58-71-71(b).

(b) An instructor shall receive the maximum BCEC awarded to a student for the course.

(c) Licensees shall maintain records of all BCECs for five years after obtaining the BCEC, and shall make them available for inspection by the Commissioner upon request.

(d) A licensee is exempt from the requirements of this Rule if the licensee provides proof of one of the following:

(1) active military service; or

(2) he or she is in compliance with G.S. 58-71-71(c).

(e) Courses completed before the issue date of a new license do not meet the requirements of this Section for that new license.

(f) No BCEC shall be given for courses taken before they have been approved by the Commissioner.

History

  • Authority G.S. 58-2-40; 58-2-185; 58-2-195; 58-71-71
  • Eff. October 1, 2010
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. June 25, 2016.
11 NCAC 13 .0523 Qualification for Bcec {#sec-11-ncac-13-.0523 omnilex-key=us-nc-regs-official--title-11--11 NCAC 13 .0523}

(a) The Commissioner shall award one BCEC for each instructional hour.

(b) Courses shall not be approved for less than one BCEC.

(c) Course providers shall monitor participants for attendance and ensure that licensees complete the BCEC hours approved by the Commissioner. Participants shall not read any material other than related to the course during instructional hours or use any electronic devices such as cell phones, laptops, computers other than what is provided by the instructor as part of the curriculum of the course.

(d) The licensee shall attend 100 percent of the course for BCEC.

History

  • Authority G.S. 58-2-40; 58-71-71
  • Eff. October 1, 2010
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. June 25, 2016.
11 NCAC 13 .0524 Bcec Extension of Time: Hardship {#sec-11-ncac-13-.0524 omnilex-key=us-nc-regs-official--title-11--11 NCAC 13 .0524}

(a) A licensee may request in writing to the Commissioner an extension of time in which to complete BCEC if the request is made 45 days prior to the expiration date of the license.

(b) The Commissioner shall deny or grant the requested extension no later than 30 days prior to the expiration date of the license.

History

  • Authority G.S. 58-2-40; 58-71-71
  • Eff. October 1, 2010
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. June 25, 2016.
11 NCAC 13 .0525 reserved for future codification {#sec-11-ncac-13-.0525 omnilex-key=us-nc-regs-official--title-11--11 NCAC 13 .0525}
11 NCAC 13 .0526 Approval of Bcec Courses {#sec-11-ncac-13-.0526 omnilex-key=us-nc-regs-official--title-11--11 NCAC 13 .0526}

(a) Providers of all courses shall file with the Commissioner copies of program catalogs, course outlines and copies of advertising literature before the course is approved pursuant to G.S. 58-71-71(d).

(b) A provider shall submit course attendance records electronically within 15 business days after course completion.

(c) An error on the licensee's record that is caused by the provider in submitting the course attendance records shall be resolved by the provider within 15 days after the discovery of the error by the provider.

History

  • Authority G.S. 58-2-40; 58-71-71
  • Eff. October 1, 2010
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. June 25, 2016.
11 NCAC 13 .0527 reserved for future codification {#sec-11-ncac-13-.0527 omnilex-key=us-nc-regs-official--title-11--11 NCAC 13 .0527}
11 NCAC 13 .0528 Sanctions for Bcec Noncompliance by Licensees, Course Providers and Instructors {#sec-11-ncac-13-.0528 omnilex-key=us-nc-regs-official--title-11--11 NCAC 13 .0528}

(a) The Commissioner shall proceed with administrative action under G.S. 58-71-80 against a professional bail bondsman, surety bail bondsman or runner licensee for any of the following causes:

(1) Failing to respond to Department inquiries, including continuing education audit requests, within seven calendar days after the receipt of the inquiry or request;

(2) Requesting an extension of time to complete BCEC under false pretenses; or

(3) Refusing to cooperate with Department employees in an investigation or inquiry.

(b) The Commissioner shall summarily suspend or terminate the provider or instructor's certificate of authority to provide or instruct a course for any of the following causes:

(1) Advertising that a course is approved before the Commissioner has granted such approval in writing;

(2) Submitting a course outline with material inaccuracies, either in length, presentation time, or topic content;

(3) Presenting or using materials in a course that were not previously filed with the Commissioner pursuant to 11 NCAC 13 .0526(a);

(4) Failing to conduct a course for the full time specified in the approval request submitted to the Commissioner;

(5) Preparing and distributing certificates of attendance or completion before the course has been approved;

(6) Issuing certificates of attendance or completion before the completion of the course;

(7) Failing to issue certificates of attendance or completion to any licensee who satisfactorily completes a course;

(8) Failing to notify the Commissioner in writing of suspected or known violations of the North Carolina General Statutes or Administrative Code within 30 days after becoming aware of the violations;

(9) Failing to comply with the rules in this Section or violating G.S. 58-71-80 and G.S. 58-71-95;

(10) Failing to monitor attendance and ensure that licensees complete the course hours approved by the Commissioner; or

(11) Preparing and distributing fraudulent certificates of attendance or completion.

(c) Course providers and instructors are responsible for the activities of persons conducting, supervising, instructing, proctoring, monitoring, moderating, facilitating, or in any way responsible for the conduct of any of the activities associated with the course.

(d) Upon a finding of a violation of this rule the Commissioner shall require the violator to:

(1) Refund all course tuition and fees to licensees;

(2) Provide licensees with a course to replace the course that was found in violation; or

(3) Cease all courses offered by the provider or instructor.

History

  • Authority G.S. 58-2-40; 58-71-71; 58-71-72
  • Eff. November 1, 2010
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. June 25, 2016.
11 NCAC 13 .0529 reserved for future codification {#sec-11-ncac-13-.0529 omnilex-key=us-nc-regs-official--title-11--11 NCAC 13 .0529}
11 NCAC 13 .0530 ISSUANCE of and CONTINUATION bcec OF PROVIDER APPROVAL {#sec-11-ncac-13-.0530 omnilex-key=us-nc-regs-official--title-11--11 NCAC 13 .0530}

(a) Any individual or entity intending to provide classes, seminars, or other forms of instruction as approved courses shall submit:

(1) an application provided by the Commissioner for provider approval; and

(2) an application provided by the Commissioner for course approval.

(b) The Commissioner shall provide any potential course provider who is denied approval a written explanation for the denial.

(c) Any provider receiving a provider approval denial has 15 business days from the date of the denial to respond to the denial.

(d) Providers shall retain continuing education records for five years and shall provide these records upon request to the Commissioner.

History

  • Authority G.S. 58-2-40; 58-71-71
  • Eff. October 1, 2010
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. June 25, 2016.
11 NCAC 13 .0531 reserved for future codification {#sec-11-ncac-13-.0531 omnilex-key=us-nc-regs-official--title-11--11 NCAC 13 .0531}
11 NCAC 13 .0532 Examinations: Special Accommodations (americans with Disabilities Act) {#sec-11-ncac-13-.0532 omnilex-key=us-nc-regs-official--title-11--11 NCAC 13 .0532}

An individual with a physical disability may have special assistance from other individuals acting as readers or recorders for the state licensing examination. Applicants requiring special assistance shall request the assistance from the professional testing service before registration for the examination. Verification of handicaps and a statement of all assistance needed shall be included at the time of application.

History

  • Authority G.S. 58-2-40; 58-71-70
  • Eff. October 1, 2010
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. June 25, 2016.
11 NCAC 13 .0533 Schedule of Examinations {#sec-11-ncac-13-.0533 omnilex-key=us-nc-regs-official--title-11--11 NCAC 13 .0533}

The Division shall publish or cause to have published the current schedules of state professional bail bondsman, surety bail bondsman, and runner examinations. The schedules shall include day, time and location of each examination.

History

  • Authority G.S. 58-2-40; 58-71-70
  • Eff. October 1, 2010
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. June 25, 2016.
11 NCAC 13 .0534 Certificate of Course Completion {#sec-11-ncac-13-.0534 omnilex-key=us-nc-regs-official--title-11--11 NCAC 13 .0534}

A Certificate of Course Completion shall be signed by an approved prelicensing provider or instructor indicating that the applicant has completed the mandatory prelicensing education requirements as specified in G.S. 58-71-71. Certificates of Course Completion expire six months from issuance.

History

  • Authority G.S. 58-2-40; 58-71-71
  • Eff. October 1, 2010
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. June 25, 2016.
11 NCAC 13 .0535 Examination Authorization Letter {#sec-11-ncac-13-.0535 omnilex-key=us-nc-regs-official--title-11--11 NCAC 13 .0535}

After review of the professional bail bondsman, surety bail bondsman, or runner license application and verification the applicant meets the qualifications for licensure as prescribed by G.S. 58-71-50 and has submitted license fees as specified in G.S. 58-71-55, the Division shall issue an Examination Authorization Letter which allows the professional bail bondsman, surety bail bondsman, and runner license applicant to make a reservation to sit for the bail bond examination. The Examination Authorization letter is valid for 30 days from date of issuance.

History

  • Authority G.S. 58-2-40; 58-71-70; 58-71-71
  • Eff. October 1, 2010
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. June 25, 2016.
11 NCAC 13 .0536 Responsibility of Applicant at Examination Site {#sec-11-ncac-13-.0536 omnilex-key=us-nc-regs-official--title-11--11 NCAC 13 .0536}

(a) Professional bail bondsman, surety bail bondsman, or runner license applicants shall bring to the examination site the Examination Authorization letter issued by the Division, the confirmation numbers obtained from the testing service at the time of examination reservation, and two forms of proof of identity, one of which shall be photo bearing.

(b) Applicants are allowed to bring the following examination supplies to the examination site:

(1) a simple function calculator;

(2) pens; and

(3) pencils.

(c) No applications shall be supplied at the examination site for completion by applicants and no supplies as described in Paragraph (b) of this Rule shall be furnished to applicants at the examination site.

(d) Applicants shall arrive at the examination site at the time specified in the examination schedule.

History

  • Authority G.S. 58-2-40; 58-71-70; 58-71-7
  • Eff. October 1, 2010
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. June 25, 2016.
11 NCAC 13 .0537 Administration of Examination {#sec-11-ncac-13-.0537 omnilex-key=us-nc-regs-official--title-11--11 NCAC 13 .0537}

(a) Professional bail bondsman, surety bail bondsman, or runner license applicants may use a simple function calculator during the examination.

(b) Applicants shall not take cellular telephones, textbooks, other books or papers into the examinations. Applicants found to have any of these materials shall not be allowed to continue the examination.

(c) Applicants may leave the examination room only after obtaining permission from the examination proctors and handing in exam materials. No extra time shall be allowed for completing the examination.

(d) Any applicant who gives or receives assistance during the examination shall turn in all exam materials and leave the room. Under these circumstances, the applicant's answer sheet shall not be scored and information regarding the giving of assistance shall be reported by the proctors to the Commissioner.

History

  • Authority G.S. 58-2-40; 58-71-70; 58-71-71
  • Eff. October 1, 2010
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. June 25, 2016.
11 NCAC 13 .0538 reserved for future codification {#sec-11-ncac-13-.0538 omnilex-key=us-nc-regs-official--title-11--11 NCAC 13 .0538}
11 NCAC 13 .0539 Bail Bond Prelicensing Education Provider {#sec-11-ncac-13-.0539 omnilex-key=us-nc-regs-official--title-11--11 NCAC 13 .0539}

(a) This Rule applies to all bail bond prelicensing providers offering a prelicensing course prescribed by G.S. 58-71-71. All providers desiring to conduct a prelicensing course shall be approved and issued a certificate of authority by the Commissioner before commencement of the courses.

(b) A provider seeking approval to conduct a prelicensing course shall make written application to the Commissioner for a certificate of authority.

(c) The Division shall approve a provider when:

(1) the provider has submitted all information required by the rules in this Section;

(2) the course to be conducted complies with Rule 11 NCAC 13 .0541 of this Section; and

(3) the provider has a qualified instructor to teach bail bonding for which it is seeking approval.

(d) The Commissioner shall deny, revoke, suspend, or terminate approval of any provider upon finding that:

(1) the provider has failed to comply with any of the provisions of this Section;

(2) any provider official or instructor has obtained or used, or attempted to obtain or use, in any manner or form, licensing examination questions for the state exam;

(3) the provider has not conducted at least one prelicensing course during any 12-month period; or

(4) the provider has refused or failed to submit information or forms prescribed by the rules in this Section.

(e) In all proceedings to deny, revoke, suspend, or terminate the certificate of authority of a provider, the provisions of Chapter 150B of the General Statutes are applicable.

(f) When a provider's approval is discontinued, the procedure for reinstatement is to apply as a new provider, with a statement of the reasons that the provider is now eligible for reconsideration.

(g) If a provider's approval has been suspended upon the Commissioner's finding that the provider has not conducted at least one prelicensing course during any 12-month period, that provider may reapply after one year of suspension. At such time, the Commissioner shall give the provider six months to conduct at least one prelicensing course.

(h) A provider shall notify the Commissioner in writing of any change of course location or schedule information no fewer than five business days before the change.

(i) A provider shall notify the Commissioner in writing of a change of textbook prior to use in an approved prelicensing course.

(j) An approved provider may use, for advertising or promotional purposes, examination performance data made available to the provider by the Commissioner, provided that any data disclosed by the provider shall be accurate, shall be presented in a manner that is not misleading, and shall:

(1) be limited to the annual examination performance data for the particular provider and for all examination candidates in the State; and

(2) include the type of examination, the time period covered, the number of candidates examined, and either the number or percentage of candidates passing the examination.

(k) A provider's facilities and equipment shall have been found by appropriate local building code inspectors to be in compliance with all applicable local, State and federal laws and regulations regarding safety, sanitation, and access by persons with disabilities.

(l) The provider is responsible for administrative matters such as recruiting instructors, evaluating and certifying the qualifications of instructors, developing educational programs, scheduling of classes, advertising, maintaining facilities and equipment, recordkeeping and supervising of the prelicensing program.

(m) A provider shall publish and provide to all prelicensing students before enrollment a publication that contains the following information:

(1) name of provider and publication date;

(2) name of sponsor;

(3) all associated costs; and

(4) an outline or description of all prelicensing courses offered.

(n) A provider shall file with the Commissioner a report that sets forth the exact dates, times, locations, and instructor name for each scheduled prelicensing course. This information shall be submitted at the beginning of each quarter or semester before the first class meeting of each prelicensing course.

(o) Providers shall retain the following material on file at one location for at least five years:

(1) class schedules;

(2) advertisements;

(3) bulletins, catalogues, and other official publications;

(4) grade reports, showing a numeric grade for each student;

(5) attendance records;

(6) master copy of each comprehensive course examination, indicating the answer key course location, course dates and name of instructor;

(7) list of student names and the name of the instructor; and

(8) student registration information.

(9) All files shall be made available to the Commissioner upon request.

(p) In the event of illness, injury or death of an instructor, the provider may use another instructor to complete a course.

History

  • Authority G.S. 58-2-40; 58-2-40, 58-71-71
  • Eff. October 1, 2010
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. June 25, 2016.
11 NCAC 13 .0540 reserved for future codification {#sec-11-ncac-13-.0540 omnilex-key=us-nc-regs-official--title-11--11 NCAC 13 .0540}
11 NCAC 13 .0541 Bail Bond Prelicensing Education Courses {#sec-11-ncac-13-.0541 omnilex-key=us-nc-regs-official--title-11--11 NCAC 13 .0541}

(a) Providers shall offer no less than 12 instructional hours of prelicensing education.

(b) The following requirements are course standards:

(1) All courses shall consist of instruction on bail bonding licensing, regulations, procedures for setting bail and forfeiture of bail as set forth in Chapter 58 Article 71 and Chapter 15A Article 26 and 37 of the North Carolina General Statutes.

(2) Courses may also include coverage of related subject areas not prescribed by the Commissioner; however, such courses must provide additional class time, above the minimum requirement stated in Paragraph (a) of this Rule, for the coverage of such subject areas.

(3) Prelicensing courses shall be for instructional purposes only and not for promoting the interests of or recruiting employees for any particular bail bond agency or surety insurance company.

(4) Providers shall establish and enforce academic standards for course completion that assure that students receiving a passing grade possess knowledge and understanding of the subject areas prescribed for the course.

(5) Providers shall conduct a comprehensive course examination that covers all subject areas prescribed by the Commissioner for each course. Providers may allow a student to make up a missed examination or to retake a failed examination in accordance with policies adopted by the provider. No comprehensive course examination shall be given until a student has completed the instructional requirement as prescribed in Subparagraph (1) of this Paragraph.

(6) Students shall attend the minimum 12 hours of bail bond instruction set forth in Paragraph (a) of this Rule. Time set aside for breaks, pop-tests, quizzes, the final comprehensive course examination and other non-instructional activities shall not count toward the minimum instructional requirement.

(c) The following requirements shall be met for scheduling purposes:

(1) Class meetings shall not exceed eight hours of instruction in any given day.

(2) Classroom courses shall have fixed beginning and ending dates and may not be conducted on an open-entry or open-exit basis.

(d) The choice of classroom course text is at the discretion of each provider.

(e) All prelicensing courses shall be taught by instructors who meet the qualifications described in Rule 11 NCAC 13 .0542.

(f) The following certification of course completion procedures apply:

(1) Providers shall validate each student who successfully completes a prelicensing course by issuing a Certificate of Course Completion. The Certificate of Course Completion shall not be validated for a student prior to the student completing all course requirements and passing the course's comprehensive examination; and

(2) A Certificate of Course Completion shall be attached to the application for bail bond license(s) and expires six months after issuance. If an applicant does not apply for a license within six months after receiving the Certificate of Course Completion, the applicant must complete the prelicensing education requirements again.

History

  • Authority G.S. 58-2-40; 58-2-40, 58-71-71
  • Eff. October 1, 2010
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. June 25, 2016.
11 NCAC 13 .0542 Bail Bond Prelicensing and Bcec Instructors {#sec-11-ncac-13-.0542 omnilex-key=us-nc-regs-official--title-11--11 NCAC 13 .0542}

(a) A person desiring approval as a bail bond prelicensing or BCEC instructor shall make written application to the Commissioner.

(b) Instructor applicants must be sponsored by a provider seeking to employ the applicant as an instructor. If the employing provider is not currently approved by the Commissioner, an application for prelicensing or BCEC provider approval shall be submitted along with the application for instructor approval.

(c) The Commissioner shall approve an applicant for a bail bond prelicensing instructor upon finding that the applicant has met the following qualifications:

(1) Has not been disqualified in any manner under Chapter 58 of the North Carolina General Statutes; and

(2) Has 10 years or more experience in the NC bail bond industry;

(d) The Commissioner shall approve an applicant for a BCEC instructor upon finding that the applicant has met the following qualifications:

(1) Has not been disqualified in any manner under Chapter 58 of the North Carolina General Statutes; and

(2) Has five or more total years experience in the following:

(A) NC bail bond industry;

(B) full time employee of a surety insurance company;

(C) NC law enforcement or the judicial system;

(D) Skip tracer;

(E) Private investigation; or

(F) Banking, certified public accountant or other profession related to business management principles.

(e) Instructor applicants shall submit to a personal interview by the Agent Services Division. A written history of courses taught by the applicant or other documentation is required to verify the applicant's qualifications to instruct approved courses.

(f) The Commissioner shall deny, summarily suspend, or terminate the approval of an instructor upon finding that:

(1) The instructor fails to meet the criteria for approval provided by this Rule;

(2) The instructor has failed to comply with statutes or rules regarding prelicensing or BCEC courses;

(3) The instructor provided false information to the Commissioner;

(4) The instructor has at any time been disqualified under Chapter 58 of the North Carolina Department of Insurance; or

(5) The instructor has obtained or used, or attempted to obtain or use examination questions, in any manner or form.

(g) In all proceedings to deny, revoke, suspend, or terminate approval of an instructor, the provisions of Chapter 150B of the General Statutes are applicable.

(h) When an instructor's approval is discontinued, the procedure for reinstatement is to apply as a new instructor, with a statement of reasons that he is now eligible for reconsideration. The Commissioner shall perform an investigation before new approval is granted.

History

  • Authority G.S. 58-2-40; 58-71-7
  • Eff. October 1, 2010
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. June 25, 2016.

Chapter 14 Admission Requirements

11 NCAC 14 .0101 Purpose of Division {#sec-11-ncac-14-.0101 omnilex-key=us-nc-regs-official--title-11--11 NCAC 14 .0101}

History

  • Status: repealed
  • Authority G.S. 58-4; 58-7.3; 58-9
  • Eff. February 1, 1976
  • Readopted Eff. January 22, 1980
  • Repealed Eff. July 1, 1988.
11 NCAC 14 .0102 Deputy Commissioner {#sec-11-ncac-14-.0102 omnilex-key=us-nc-regs-official--title-11--11 NCAC 14 .0102}

History

  • Status: repealed
  • Authority G.S. 58-4; 58-7.3; 58-9
  • Eff. February 1, 1976
  • Readopted Eff. January 22, 1980
  • Repealed Eff. July 1, 1988.
11 NCAC 14 .0103 Division Personnel {#sec-11-ncac-14-.0103 omnilex-key=us-nc-regs-official--title-11--11 NCAC 14 .0103}

History

  • Status: repealed
  • Authority G.S. 58-4; 58-7.3; 58-9
  • Eff. February 1, 1976
  • Readopted Eff. January 22, 1980
  • Repealed Eff. July 1, 1988.
11 NCAC 14 .0201 Information Required During Pre-Incorporation {#sec-11-ncac-14-.0201 omnilex-key=us-nc-regs-official--title-11--11 NCAC 14 .0201}

History

  • Status: expired
  • Authority G.S. 58-2-40; 58-2-165; 58-5-30; 58-7-35; 58-7-37; 58-7-40; 58-7-75; 58-7-80; 58-16-30
  • Eff. February 1, 1976
  • Readopted with Change Eff. January 22, 1980 (.0201, .0202)
  • Readopted Eff. January 22, 1980 (.0203)
  • Amended Eff. July 1, 2004; February 1, 1996; April 1, 1990
  • Pursuant to G.S. 150B-21.3A, rules Expired January 1, 2015.
11 NCAC 14 .0202 INFORMATION required after organizational meeting {#sec-11-ncac-14-.0202 omnilex-key=us-nc-regs-official--title-11--11 NCAC 14 .0202}

11 NCAC 14 .0203 INITIAL CAPITALIZATION

History

  • Authority G.S. 58-2-40; 58-2-165; 58-5-30; 58-7-35; 58-7-37; 58-7-40; 58-7-75; 58-7-80; 58-16-30
  • Eff. February 1, 1976
  • Readopted with Change Eff. January 22, 1980 (.0201, .0202)
  • Readopted Eff. January 22, 1980 (.0203)
  • Amended Eff. July 1, 2004; February 1, 1996; April 1, 1990
  • Pursuant to G.S. 150B-21.3A, rules Expired January 1, 2015.
11 NCAC 14 .0204 Application Forms: Foreign Insurance Companies {#sec-11-ncac-14-.0204 omnilex-key=us-nc-regs-official--title-11--11 NCAC 14 .0204}

History

  • Status: repealed
  • Authority G.S. 58-150; 58-150(1); 58-151(2); 58-151.1
  • Eff. February 1, 1976
  • Readopted Eff. January 22, 1980
  • Repealed Eff. April 1, 1990.
11 NCAC 14 .0205 Annual Statements: Reports: Foreign Companies {#sec-11-ncac-14-.0205 omnilex-key=us-nc-regs-official--title-11--11 NCAC 14 .0205}

History

  • Status: repealed
  • Authority G.S. 58-150; 58-150(1); 58-151(2); 58-151.1
  • Eff. February 1, 1976
  • Readopted Eff. January 22, 1980
  • Repealed Eff. April 1, 1990.
11 NCAC 14 .0206 Authorized Lines of Business for a Foreign Company {#sec-11-ncac-14-.0206 omnilex-key=us-nc-regs-official--title-11--11 NCAC 14 .0206}

History

  • Status: repealed
  • Authority G.S. 58-150; 58-150(1); 58-151(2); 58-151.1
  • Eff. February 1, 1976
  • Readopted Eff. January 22, 1980
  • Repealed Eff. April 1, 1990.
11 NCAC 14 .0207 Foreign Company Must Have Conducted Successful Business {#sec-11-ncac-14-.0207 omnilex-key=us-nc-regs-official--title-11--11 NCAC 14 .0207}

History

  • Status: repealed
  • Authority G.S. 58-150; 58-150(1); 58-151(2); 58-151.1
  • Eff. February 1, 1976
  • Readopted Eff. January 22, 1980
  • Repealed Eff. April 1, 1990.
11 NCAC 14 .0208 Waiver of Three-Year Operations Gain Requirement {#sec-11-ncac-14-.0208 omnilex-key=us-nc-regs-official--title-11--11 NCAC 14 .0208}

History

  • Status: repealed
  • Authority G.S. 58-150; 58-150(1); 58-151(2); 58-151.1
  • Eff. February 1, 1976
  • Readopted Eff. January 22, 1980
  • Repealed Eff. April 1, 1990.
11 NCAC 14 .0209 Exception to in Force Policy Requirements: Foreign Co. {#sec-11-ncac-14-.0209 omnilex-key=us-nc-regs-official--title-11--11 NCAC 14 .0209}

History

  • Status: repealed
  • Authority G.S. 58-150; 58-150(1); 58-151(2); 58-151.1
  • Eff. February 1, 1976
  • Readopted Eff. January 22, 1980
  • Repealed Eff. April 1, 1990.
11 NCAC 14 .0301 Feasibility Study and Market Survey: Hmo {#sec-11-ncac-14-.0301 omnilex-key=us-nc-regs-official--title-11--11 NCAC 14 .0301}

History

  • Status: repealed
  • Legislative Objection Lodged Eff. June 16, 1980
  • Statutory Authority G.S. 57A-3; 57A-3(c)(9); 57A-3(c)(10); 57A-4; 57A-4(b)(3); 57A-8(b)(2)
  • 57B-4; 57B-6; 57B-17; 57B-18; 58-150(2)
  • Eff. January 22, 1980
  • Amended Eff. August 25, 1980
  • Repealed Eff. April 1, 1993.
11 NCAC 14 .0302 Certificate of Authority: Hmo {#sec-11-ncac-14-.0302 omnilex-key=us-nc-regs-official--title-11--11 NCAC 14 .0302}

History

  • Status: repealed
  • Legislative Objection Lodged Eff. June 16, 1980
  • Statutory Authority G.S. 57A-3; 57A-3(c)(9); 57A-3(c)(10); 57A-4; 57A-4(b)(3); 57A-8(b)(2)
  • 57B-4; 57B-6; 57B-17; 57B-18; 58-150(2)
  • Eff. January 22, 1980
  • Amended Eff. August 25, 1980
  • Repealed Eff. April 1, 1993.
11 NCAC 14 .0303 Financial Certification: Hmo {#sec-11-ncac-14-.0303 omnilex-key=us-nc-regs-official--title-11--11 NCAC 14 .0303}

History

  • Status: repealed
  • Legislative Objection Lodged Eff. June 16, 1980
  • Statutory Authority G.S. 57A-3; 57A-3(c)(9); 57A-3(c)(10); 57A-4; 57A-4(b)(3); 57A-8(b)(2)
  • 57B-4; 57B-6; 57B-17; 57B-18; 58-150(2)
  • Eff. January 22, 1980
  • Amended Eff. August 25, 1980
  • Repealed Eff. April 1, 1993.
11 NCAC 14 .0304 Re-Insurance Requirements: Hmo {#sec-11-ncac-14-.0304 omnilex-key=us-nc-regs-official--title-11--11 NCAC 14 .0304}

History

  • Status: repealed
  • Legislative Objection Lodged Eff. June 16, 1980
  • Statutory Authority G.S. 57A-3; 57A-3(c)(9); 57A-3(c)(10); 57A-4; 57A-4(b)(3); 57A-8(b)(2)
  • 57B-4; 57B-6; 57B-17; 57B-18; 58-150(2)
  • Eff. January 22, 1980
  • Amended Eff. August 25, 1980
  • Repealed Eff. April 1, 1993.
11 NCAC 14 .0305 Issuance of Certificate of Authority: Hmo {#sec-11-ncac-14-.0305 omnilex-key=us-nc-regs-official--title-11--11 NCAC 14 .0305}

History

  • Status: repealed
  • Legislative Objection Lodged Eff. June 16, 1980
  • Statutory Authority G.S. 57A-3; 57A-3(c)(9); 57A-3(c)(10); 57A-4; 57A-4(b)(3); 57A-8(b)(2)
  • 57B-4; 57B-6; 57B-17; 57B-18; 58-150(2)
  • Eff. January 22, 1980
  • Amended Eff. August 25, 1980
  • Repealed Eff. April 1, 1993.
11 NCAC 14 .0306 Foreign Hmo: Successful Operation {#sec-11-ncac-14-.0306 omnilex-key=us-nc-regs-official--title-11--11 NCAC 14 .0306}

History

  • Status: repealed
  • Legislative Objection Lodged Eff. June 16, 1980
  • Statutory Authority G.S. 57A-3; 57A-3(c)(9); 57A-3(c)(10); 57A-4; 57A-4(b)(3); 57A-8(b)(2)
  • 57B-4; 57B-6; 57B-17; 57B-18; 58-150(2)
  • Eff. January 22, 1980
  • Amended Eff. August 25, 1980
  • Repealed Eff. April 1, 1993.
11 NCAC 14 .0307 Deposit Requirements: Hmo {#sec-11-ncac-14-.0307 omnilex-key=us-nc-regs-official--title-11--11 NCAC 14 .0307}

History

  • Status: repealed
  • Legislative Objection Lodged Eff. June 16, 1980
  • Statutory Authority G.S. 57A-3; 57A-3(c)(9); 57A-3(c)(10); 57A-4; 57A-4(b)(3); 57A-8(b)(2)
  • 57B-4; 57B-6; 57B-17; 57B-18; 58-150(2)
  • Eff. January 22, 1980
  • Amended Eff. August 25, 1980
  • Repealed Eff. April 1, 1993.
11 NCAC 14 .0308 Admitted Assets: Hmo {#sec-11-ncac-14-.0308 omnilex-key=us-nc-regs-official--title-11--11 NCAC 14 .0308}

History

  • Status: repealed
  • Filed as a Temporary Adoption Eff. December 18, 1990, For a Period of 180 Days to Expire
  • on June 15, 1991
  • Statutory Authority G.S. 58-2-40(1); 58-67-20; 58-67-110(b)
  • Eff. May 1, 1991
  • Repealed Eff. April 1, 1993.
11 NCAC 14 .0401 Petition for Admission {#sec-11-ncac-14-.0401 omnilex-key=us-nc-regs-official--title-11--11 NCAC 14 .0401}

History

  • Status: repealed
  • Authority G.S. 57A-3; 57A-4; 57A-18; 58-63; 58-63(1); 58-66; 58-72; 58-150
  • 58-150(3); 58-153; 58-182.5; 105-228.4(a)
  • Eff. January 22, 1980
  • Repealed Eff. July 1, 1988.

History

  • Status: repealed
  • Authority G.S. 57A-3; 57A-4; 57A-18; 58-63; 58-63(1); 58-66; 58-72; 58-150
  • 58-150(3); 58-153; 58-182.5; 105-228.4(a)
  • Eff. January 22, 1980
  • Repealed Eff. July 1, 1988.
11 NCAC 14 .0403 Power of Attorney for Sale of Securities {#sec-11-ncac-14-.0403 omnilex-key=us-nc-regs-official--title-11--11 NCAC 14 .0403}

History

  • Status: repealed
  • Authority G.S. 57A-3; 57A-4; 57A-18; 58-63; 58-63(1); 58-66; 58-72; 58-150
  • 58-150(3); 58-153; 58-182.5; 105-228.4(a)
  • Eff. January 22, 1980
  • Repealed Eff. July 1, 1988.
11 NCAC 14 .0404 Application for License: Insurance Company {#sec-11-ncac-14-.0404 omnilex-key=us-nc-regs-official--title-11--11 NCAC 14 .0404}

History

  • Status: repealed
  • Authority G.S. 57A-3; 57A-4; 57A-18; 58-63; 58-63(1); 58-66; 58-72; 58-150
  • 58-150(3); 58-153; 58-182.5; 105-228.4(a)
  • Eff. January 22, 1980
  • Repealed Eff. July 1, 1988.
11 NCAC 14 .0405 Application for License: Medical Service Corporation {#sec-11-ncac-14-.0405 omnilex-key=us-nc-regs-official--title-11--11 NCAC 14 .0405}

History

  • Status: repealed
  • Authority G.S. 57A-3; 57A-4; 57A-18; 58-63; 58-63(1); 58-66; 58-72; 58-150
  • 58-150(3); 58-153; 58-182.5; 105-228.4(a)
  • Eff. January 22, 1980
  • Repealed Eff. July 1, 1988.
11 NCAC 14 .0406 Application for License: Dental Service Corporation {#sec-11-ncac-14-.0406 omnilex-key=us-nc-regs-official--title-11--11 NCAC 14 .0406}

History

  • Status: repealed
  • Authority G.S. 57A-3; 57A-4; 57A-18; 58-63; 58-63(1); 58-66; 58-72; 58-150
  • 58-150(3); 58-153; 58-182.5; 105-228.4(a)
  • Eff. January 22, 1980
  • Repealed Eff. July 1, 1988.
11 NCAC 14 .0407 Application for License: Fraternal Order {#sec-11-ncac-14-.0407 omnilex-key=us-nc-regs-official--title-11--11 NCAC 14 .0407}

History

  • Status: repealed
  • Authority G.S. 57A-3; 57A-4; 57A-18; 58-63; 58-63(1); 58-66; 58-72; 58-150
  • 58-150(3); 58-153; 58-182.5; 105-228.4(a)
  • Eff. January 22, 1980
  • Repealed Eff. July 1, 1988.
11 NCAC 14 .0408 Application for License: Hmo {#sec-11-ncac-14-.0408 omnilex-key=us-nc-regs-official--title-11--11 NCAC 14 .0408}

History

  • Status: repealed
  • Authority G.S. 57A-3; 57A-4; 57A-18; 58-63; 58-63(1); 58-66; 58-72; 58-150
  • 58-150(3); 58-153; 58-182.5; 105-228.4(a)
  • Eff. January 22, 1980
  • Repealed Eff. July 1, 1988.
11 NCAC 14 .0409 Biographical Affidavit {#sec-11-ncac-14-.0409 omnilex-key=us-nc-regs-official--title-11--11 NCAC 14 .0409}

History

  • Status: expired
  • Authority G.S. 58-7-35; 58-7-40; 58-16-5
  • Eff. January 22, 1980
  • Amended Eff. April 1, 1990
  • Pursuant to G.S. 150B-21.3A, rule Expired January 1, 2015.
11 NCAC 14 .0410 Insurance Company License {#sec-11-ncac-14-.0410 omnilex-key=us-nc-regs-official--title-11--11 NCAC 14 .0410}

History

  • Status: repealed
  • Authority G.S. 58-72; 105-228.4
  • Eff. January 22, 1980
  • Repealed Eff. July 1, 1988.
11 NCAC 14 .0411 Certificate of Authority: Hmo {#sec-11-ncac-14-.0411 omnilex-key=us-nc-regs-official--title-11--11 NCAC 14 .0411}

History

  • Status: repealed
  • Authority G.S. 57A-3; 57A-4; 58-73; 58-77
  • Eff. January 22, 1980
  • Repealed Eff. April 1, 1990.
11 NCAC 14 .0412 Information Sheet: Formation of Domestic Company {#sec-11-ncac-14-.0412 omnilex-key=us-nc-regs-official--title-11--11 NCAC 14 .0412}

History

  • Status: repealed
  • Authority G.S. 57A-3; 57A-4; 58-73; 58-77
  • Eff. January 22, 1980
  • Repealed Eff. April 1, 1990.
11 NCAC 14 .0413 Admission Data Guidelines {#sec-11-ncac-14-.0413 omnilex-key=us-nc-regs-official--title-11--11 NCAC 14 .0413}

History

  • Status: repealed
  • Authority G.S. 58-6-5; 58-7-45; 58-7-75; 58-7-80; 58-16-5
  • Eff. January 22, 1980
  • Amended Eff. April 1, 1990
  • Repealed Eff. July 1, 2012.
11 NCAC 14 .0414 Check Sheet and Analysis of Application for Admission {#sec-11-ncac-14-.0414 omnilex-key=us-nc-regs-official--title-11--11 NCAC 14 .0414}

History

  • Status: repealed
  • Authority G.S. 58-6-5; 58-7-45; 58-7-75; 58-7-80; 58-16-5
  • Eff. January 22, 1980
  • Amended Eff. April 1, 1990
  • Repealed Eff. July 1, 2012.
11 NCAC 14 .0415 Petition for Admission {#sec-11-ncac-14-.0415 omnilex-key=us-nc-regs-official--title-11--11 NCAC 14 .0415}

History

  • Status: repealed
  • Authority G.S. 58-16-5(2)
  • Eff. April 1, 1990
  • Repealed Eff. March 1, 2004.

History

  • Status: expired
  • Authority G.S. 58-2-40; 58-5-30; 58-16-5(10); 58-16-30
  • Eff. April 1, 1990
  • Amended Eff. July 1, 2004
  • Pursuant to G.S. 150B-21.3A, rules Expired January 1, 2015.
11 NCAC 14 .0417 Power of Attorney for Sale of Securities {#sec-11-ncac-14-.0417 omnilex-key=us-nc-regs-official--title-11--11 NCAC 14 .0417}

History

  • Status: expired
  • Authority G.S. 58-2-40; 58-5-30; 58-16-5(10); 58-16-30
  • Eff. April 1, 1990
  • Amended Eff. July 1, 2004
  • Pursuant to G.S. 150B-21.3A, rules Expired January 1, 2015.
11 NCAC 14 .0418 Standard Questions for Applicant Insurance Co. {#sec-11-ncac-14-.0418 omnilex-key=us-nc-regs-official--title-11--11 NCAC 14 .0418}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-16-5; 58-21-20; 58-22-45(a); 58-40-30; 58-41-50
  • Eff. April 1, 1990
  • Repealed Eff. July 1, 2012.
11 NCAC 14 .0419 Marketing Questions for Applicant Life Insurance Co. {#sec-11-ncac-14-.0419 omnilex-key=us-nc-regs-official--title-11--11 NCAC 14 .0419}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-16-5; 58-21-20; 58-22-45(a); 58-40-30; 58-41-50
  • Eff. April 1, 1990
  • Repealed Eff. July 1, 2012.
11 NCAC 14 .0420 Marketing Questions for Applicant Fire/Casualty Insurance Co. {#sec-11-ncac-14-.0420 omnilex-key=us-nc-regs-official--title-11--11 NCAC 14 .0420}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-16-5; 58-21-20; 58-22-45(a); 58-40-30; 58-41-50
  • Eff. April 1, 1990
  • Repealed Eff. July 1, 2012.
11 NCAC 14 .0421 Unconditional Guaranty {#sec-11-ncac-14-.0421 omnilex-key=us-nc-regs-official--title-11--11 NCAC 14 .0421}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-16-5; 58-21-20; 58-22-45(a); 58-40-30; 58-41-50
  • Eff. April 1, 1990
  • Repealed Eff. July 1, 2012.
11 NCAC 14 .0422 Corporate Resolution of Guarantor {#sec-11-ncac-14-.0422 omnilex-key=us-nc-regs-official--title-11--11 NCAC 14 .0422}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-16-5; 58-21-20; 58-22-45(a); 58-40-30; 58-41-50
  • Eff. April 1, 1990
  • Repealed Eff. July 1, 2012.
11 NCAC 14 .0423 Eligibility Requirements for Surplus Lines Insurance Co. {#sec-11-ncac-14-.0423 omnilex-key=us-nc-regs-official--title-11--11 NCAC 14 .0423}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-16-5; 58-21-20; 58-22-45(a); 58-40-30; 58-41-50
  • Eff. April 1, 1990
  • Repealed Eff. July 1, 2012.
11 NCAC 14 .0424 Filing Requirements for Surplus Lines Insurance Co. {#sec-11-ncac-14-.0424 omnilex-key=us-nc-regs-official--title-11--11 NCAC 14 .0424}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-16-5; 58-21-20; 58-22-45(a); 58-40-30; 58-41-50
  • Eff. April 1, 1990
  • Repealed Eff. July 1, 2012.
11 NCAC 14 .0425 Bulletin 87-L-7 {#sec-11-ncac-14-.0425 omnilex-key=us-nc-regs-official--title-11--11 NCAC 14 .0425}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-16-5; 58-21-20; 58-22-45(a); 58-40-30; 58-41-50
  • Eff. April 1, 1990
  • Repealed Eff. July 1, 2012.
11 NCAC 14 .0426 Bulletin 87-L-6 {#sec-11-ncac-14-.0426 omnilex-key=us-nc-regs-official--title-11--11 NCAC 14 .0426}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-16-5; 58-21-20; 58-22-45(a); 58-40-30; 58-41-50
  • Eff. April 1, 1990
  • Repealed Eff. July 1, 2012.
11 NCAC 14 .0427 Application for Registration as a Purchasing Group {#sec-11-ncac-14-.0427 omnilex-key=us-nc-regs-official--title-11--11 NCAC 14 .0427}

History

  • Status: expired
  • Authority G.S. 58-22-20(1)a.; 58-22-20(1)b.; 58-22-40
  • Eff. April 1, 1990
  • Pursuant to G.S. 150B-21.3A, rules Expired January 1, 2015.
11 NCAC 14 .0428 Appl. for Reg. as a Foreign Liability Risk Retention Group {#sec-11-ncac-14-.0428 omnilex-key=us-nc-regs-official--title-11--11 NCAC 14 .0428}

History

  • Status: expired
  • Authority G.S. 58-22-20(1)a.; 58-22-20(1)b.; 58-22-40
  • Eff. April 1, 1990
  • Pursuant to G.S. 150B-21.3A, rules Expired January 1, 2015.
11 NCAC 14 .0429 Risk Retention Group Plan of Operation {#sec-11-ncac-14-.0429 omnilex-key=us-nc-regs-official--title-11--11 NCAC 14 .0429}

History

  • Status: expired
  • Authority G.S. 58-22-20(1)a.; 58-22-20(1)b.; 58-22-40
  • Eff. April 1, 1990
  • Pursuant to G.S. 150B-21.3A, rules Expired January 1, 2015.
11 NCAC 14 .0430 Annual Gross Premium Tax Return for Purchasing Groups {#sec-11-ncac-14-.0430 omnilex-key=us-nc-regs-official--title-11--11 NCAC 14 .0430}

History

  • Status: repealed
  • Authority G.S. 58-22-20(3); 58-22-35(b)
  • Eff. April 1, 1990
  • Repealed Eff. February 1, 1996.
11 NCAC 14 .0431 Annual Gross Premium Tax Return for Risk Retention Groups {#sec-11-ncac-14-.0431 omnilex-key=us-nc-regs-official--title-11--11 NCAC 14 .0431}

History

  • Status: repealed
  • Authority G.S. 58-22-20(3); 58-22-35(b)
  • Eff. April 1, 1990
  • Repealed Eff. February 1, 1996.
11 NCAC 14 .0432 Application for License: Insurance Company {#sec-11-ncac-14-.0432 omnilex-key=us-nc-regs-official--title-11--11 NCAC 14 .0432}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-7-40; 58-16-5
  • Eff. February 1, 1996
  • Repealed Eff. July 1, 2012.
11 NCAC 14 .0501 Application Forms {#sec-11-ncac-14-.0501 omnilex-key=us-nc-regs-official--title-11--11 NCAC 14 .0501}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-16-5
  • Eff. April 1, 1990
  • Amended Eff. July 1, 2004
  • Repealed Eff. July 1, 2012.
11 NCAC 14 .0502 Annual Statements, Reports on Examination {#sec-11-ncac-14-.0502 omnilex-key=us-nc-regs-official--title-11--11 NCAC 14 .0502}

11 NCAC 14 .0503 AUTHORIZED LINES OF BUSINESS FOR A FOREIGN COMPANY

History

  • Authority G.S. 58-2-40; 58-2-165; 58-16-5(1); 58-16-5(2)
  • Eff. April 1, 1990
  • Amended Eff. July 1, 2004; April 1, 1993
  • Pursuant to G.S. 150B-21.3A, rules Expired January 1, 2015.
11 NCAC 14 .0504 Foreign Company Must Have Conducted Successful Business {#sec-11-ncac-14-.0504 omnilex-key=us-nc-regs-official--title-11--11 NCAC 14 .0504}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-16-5(2)
  • Eff. April 1, 1990
  • Amended Eff. July 1, 2004; April 1, 1993
  • Repealed Eff. February 1, 2010.
11 NCAC 14 .0505 Waivers of Three-Year Net Income Requirement {#sec-11-ncac-14-.0505 omnilex-key=us-nc-regs-official--title-11--11 NCAC 14 .0505}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-16-5(2)
  • Eff. April 1, 1990
  • Amended Eff. July 1, 2004; April 1, 1993
  • Repealed Eff. February 1, 2010.
11 NCAC 14 .0506 Exception to in Force Policy Requirements {#sec-11-ncac-14-.0506 omnilex-key=us-nc-regs-official--title-11--11 NCAC 14 .0506}

History

  • Status: expired
  • Authority G.S. 58-16-15
  • Eff. April 1, 1990
  • Pursuant to G.S. 150B-21.3A, rule Expired January 1, 2015.
11 NCAC 14 .0601 List of Eligible Companies {#sec-11-ncac-14-.0601 omnilex-key=us-nc-regs-official--title-11--11 NCAC 14 .0601}

History

  • Status: expired
  • Authority G.S. 58-2-40; 58-2-165; 58-21-5; 58-21-20; 58-21-20(a); 58-21-20(b); 58-21-30
  • Eff. April 1, 1990
  • Amended Eff. July 1, 2004; February 1, 1996; April 1, 1993
  • Pursuant to G.S. 150B-21.3A, rules Expired January 1, 2015.
11 NCAC 14 .0602 Requests for Surplus Lines Eligibility {#sec-11-ncac-14-.0602 omnilex-key=us-nc-regs-official--title-11--11 NCAC 14 .0602}

History

  • Status: expired
  • Authority G.S. 58-2-40; 58-2-165; 58-21-5; 58-21-20; 58-21-20(a); 58-21-20(b); 58-21-30
  • Eff. April 1, 1990
  • Amended Eff. July 1, 2004; February 1, 1996; April 1, 1993
  • Pursuant to G.S. 150B-21.3A, rules Expired January 1, 2015.
11 NCAC 14 .0603 Financial Information Required {#sec-11-ncac-14-.0603 omnilex-key=us-nc-regs-official--title-11--11 NCAC 14 .0603}

History

  • Status: expired
  • Authority G.S. 58-2-40; 58-2-165; 58-21-5; 58-21-20; 58-21-20(a); 58-21-20(b); 58-21-30
  • Eff. April 1, 1990
  • Amended Eff. July 1, 2004; February 1, 1996; April 1, 1993
  • Pursuant to G.S. 150B-21.3A, rules Expired January 1, 2015.
11 NCAC 14 .0604 Requirements for Continued Eligibility {#sec-11-ncac-14-.0604 omnilex-key=us-nc-regs-official--title-11--11 NCAC 14 .0604}

History

  • Status: expired
  • Authority G.S. 58-2-40; 58-2-165; 58-21-5; 58-21-20; 58-21-20(a); 58-21-20(b); 58-21-30
  • Eff. April 1, 1990
  • Amended Eff. July 1, 2004; February 1, 1996; April 1, 1993
  • Pursuant to G.S. 150B-21.3A, rules Expired January 1, 2015.
11 NCAC 14 .0605 Deletion from Eligible Company List {#sec-11-ncac-14-.0605 omnilex-key=us-nc-regs-official--title-11--11 NCAC 14 .0605}

History

  • Status: expired
  • Authority G.S. 58-2-40; 58-2-165; 58-21-5; 58-21-20; 58-21-20(a); 58-21-20(b); 58-21-30
  • Eff. April 1, 1990
  • Amended Eff. July 1, 2004; February 1, 1996; April 1, 1993
  • Pursuant to G.S. 150B-21.3A, rules Expired January 1, 2015.
11 NCAC 14 .0701 Foreign Risk Retention Group Registration {#sec-11-ncac-14-.0701 omnilex-key=us-nc-regs-official--title-11--11 NCAC 14 .0701}

11 NCAC 14 .0702 PURCHASING GROUP FILING REQUIREMENTS

11 NCAC 14 .0703 Appointment of Commissioner as Attorney to Accept Service {#sec-11-ncac-14-.0703 omnilex-key=us-nc-regs-official--title-11--11 NCAC 14 .0703}

History

  • Status: expired
  • Authority G.S. 58-2-40; 58-22-20; 58-22-20(1)d; 58-22-40; 58-22-40(c); 58-22-45; 58-22-70
  • Eff. April 1, 1990
  • Amended Eff. July 1, 2004
  • Pursuant to G.S. 150B-21.3A, rules Expired January 1, 2015.
11 NCAC 14 .0704 Updates and Amendments to Filings {#sec-11-ncac-14-.0704 omnilex-key=us-nc-regs-official--title-11--11 NCAC 14 .0704}

History

  • Status: expired
  • Authority G.S. 58-2-40; 58-22-20; 58-22-20(1)d; 58-22-40; 58-22-40(c); 58-22-45; 58-22-70
  • Eff. April 1, 1990
  • Amended Eff. July 1, 2004
  • Pursuant to G.S. 150B-21.3A, rules Expired January 1, 2015.
11 NCAC 14 .0705 Filing and Payment of Premium Taxes {#sec-11-ncac-14-.0705 omnilex-key=us-nc-regs-official--title-11--11 NCAC 14 .0705}

History

  • Status: repealed
  • Authority G.S. 58-22-20; 58-22-35
  • Eff. April 1, 1990
  • Repealed Eff. March 1, 2004.

Chapter 15 Medical Database Commission

11 NCAC 15 .0101 Scope and Purpose {#sec-11-ncac-15-.0101 omnilex-key=us-nc-regs-official--title-11--11 NCAC 15 .0101}

History

  • Status: repealed
  • Authority G.S. 131E-212(b)
  • Eff. May 1, 1987
  • Amended Eff. December 1, 1994; November 1, 1994; February 1, 1993; April 1, 1991
  • Repealed Eff. September 1, 2002.
11 NCAC 15 .0102 Definitions {#sec-11-ncac-15-.0102 omnilex-key=us-nc-regs-official--title-11--11 NCAC 15 .0102}

History

  • Status: repealed
  • Authority G.S. 131E-212(b)
  • Eff. May 1, 1987
  • Amended Eff. December 1, 1994; November 1, 1994; February 1, 1993; April 1, 1991
  • Repealed Eff. September 1, 2002.
11 NCAC 15 .0103 Outside Contractor {#sec-11-ncac-15-.0103 omnilex-key=us-nc-regs-official--title-11--11 NCAC 15 .0103}

History

  • Status: repealed
  • Authority G.S. 131E-212(b)
  • Eff. May 1, 1987
  • Amended Eff. December 1, 1994; November 1, 1994; February 1, 1993; April 1, 1991
  • Repealed Eff. September 1, 2002.
11 NCAC 15 .0104 Uniform Billing Form {#sec-11-ncac-15-.0104 omnilex-key=us-nc-regs-official--title-11--11 NCAC 15 .0104}

History

  • Status: repealed
  • Authority G.S. 131E-212(b)
  • Eff. May 1, 1987
  • Amended Eff. December 1, 1994; November 1, 1994; February 1, 1993; April 1, 1991
  • Repealed Eff. September 1, 2002.
11 NCAC 15 .0105 Description of Data to Be Submitted {#sec-11-ncac-15-.0105 omnilex-key=us-nc-regs-official--title-11--11 NCAC 15 .0105}

History

  • Status: repealed
  • Authority G.S. 131E-212(b)
  • Eff. May 1, 1987
  • Amended Eff. December 1, 1994; November 1, 1994; February 1, 1993; April 1, 1991
  • Repealed Eff. September 1, 2002.
11 NCAC 15 .0106 Data Submission {#sec-11-ncac-15-.0106 omnilex-key=us-nc-regs-official--title-11--11 NCAC 15 .0106}

History

  • Status: repealed
  • Authority G.S. 131E-212(b)
  • Eff. May 1, 1987
  • Amended Eff. December 1, 1994; November 1, 1994; February 1, 1993; April 1, 1991
  • Repealed Eff. September 1, 2002.
11 NCAC 15 .0107 Provider Verification {#sec-11-ncac-15-.0107 omnilex-key=us-nc-regs-official--title-11--11 NCAC 15 .0107}

History

  • Status: repealed
  • Authority G.S. 131E-212(b)
  • Eff. May 1, 1987
  • Amended Eff. December 1, 1994; November 1, 1994; February 1, 1993; April 1, 1991
  • Repealed Eff. September 1, 2002.
11 NCAC 15 .0108 Compliance; Penalties for Noncompliance {#sec-11-ncac-15-.0108 omnilex-key=us-nc-regs-official--title-11--11 NCAC 15 .0108}

History

  • Status: repealed
  • Authority G.S. 131E-212(b)
  • Eff. May 1, 1987
  • Amended Eff. December 1, 1994; November 1, 1994; February 1, 1993; April 1, 1991
  • Repealed Eff. September 1, 2002.
11 NCAC 15 .0109 Data Accessibility {#sec-11-ncac-15-.0109 omnilex-key=us-nc-regs-official--title-11--11 NCAC 15 .0109}

History

  • Status: repealed
  • Authority G.S. 131E-212(b)
  • Eff. May 1, 1987
  • Amended Eff. December 1, 1994; November 1, 1994; February 1, 1993; April 1, 1991
  • Repealed Eff. September 1, 2002.
11 NCAC 15 .0110 Confidentiality of Data {#sec-11-ncac-15-.0110 omnilex-key=us-nc-regs-official--title-11--11 NCAC 15 .0110}

History

  • Status: repealed
  • Authority G.S. 131E-212(b)
  • Eff. May 1, 1987
  • Amended Eff. December 1, 1994; November 1, 1994; February 1, 1993; April 1, 1991
  • Repealed Eff. September 1, 2002.
11 NCAC 15 .0111 Fees and Charges for Data {#sec-11-ncac-15-.0111 omnilex-key=us-nc-regs-official--title-11--11 NCAC 15 .0111}

History

  • Status: repealed
  • Authority G.S. 131E-211(k); 131E-212(b)(7)
  • Eff. November 1, 1993
  • Repealed Eff. September 1, 2002.
11 NCAC 15 .0112 Successor Forms {#sec-11-ncac-15-.0112 omnilex-key=us-nc-regs-official--title-11--11 NCAC 15 .0112}

History

  • Status: repealed
  • Authority G.S. 131E-212(b)
  • Temporary Adoption Eff. January 1, 1994 For a Period of 180 Days or Until the Permanent Rule Becomes Effective, Whichever is Sooner
  • Eff. April 1, 1994
  • Amended Eff. November 1, 1994
  • Repealed Eff. September 1, 2002.

Chapter 16 Actuarial Services Division

11 NCAC 16 .0101 Applicability {#sec-11-ncac-16-.0101 omnilex-key=us-nc-regs-official--title-11--11 NCAC 16 .0101}

The following Rules describe statistical data that shall be submitted to the Actuarial Services Division.

(1) 11 NCAC 16 .0103 shall apply to all companies that write North Carolina nonfleet private passenger automobile insurance and to all statistical organizations that collect data relating to that line of insurance.

(2) 11 NCAC 16 .0105 shall apply to all companies that provide professional liability insurance to more than two percent of the insured physicians and surgeons in North Carolina.

(3) 11 NCAC 16 .0106 shall apply to all companies that write North Carolina credit property insurance.

(4) 11 NCAC 16 .0107 shall apply to all companies that write North Carolina nonfiling insurance.

History

  • Authority G.S. 58-2-40(1); 58-2-190
  • Eff. December 1, 1990
  • Amended Eff. July 1, 2011
  • Readopted Eff. October 1, 2018.
11 NCAC 16 .0102 Loss Reserves {#sec-11-ncac-16-.0102 omnilex-key=us-nc-regs-official--title-11--11 NCAC 16 .0102}

History

  • Status: repealed
  • Authority G.S. 58-2-40; 58-2-190
  • Eff. December 1, 1990
  • Amended Eff. August 1, 1991
  • Repealed Eff. July 1, 2011.
11 NCAC 16 .0103 Nonfleet Private Passenger Automobile Insurance {#sec-11-ncac-16-.0103 omnilex-key=us-nc-regs-official--title-11--11 NCAC 16 .0103}

All companies writing North Carolina nonfleet private passenger automobile insurance shall collect the statistical data described in this Rule and shall report such data to their statistical agent. The statistical agents shall thereupon provide the data on a combined basis to the Actuarial Services Division.

(1) Premium, Exposure, Loss, and Claim Experience. Provide written and earned exposures, written and earned premiums, number of paid and incurred claims, and paid and incurred total limit losses biannually for each of the latest six accident or calendar half-years in the following detail:

(a) by coverage as follows: bodily injury, property damage, medical payments, uninsured motorist, underinsured motorist, comprehensive, or collision;

(b) by type of exposure as follows: voluntary, or involuntary;

(c) by territory;

(d) by class;

(e) by basic or increased limit or deductible; and

(f) by cause or type of loss for comprehensive coverage.

(2) Loss and Premium Experience by Zip Code. Provide data by zip code annually in the following detail:

(a) calendar year written premium for all coverages combined;

(b) accident year incurred losses and incurred claims valued at 15 months for bodily injury and property damage coverages;

(c) calendar year incurred losses and incurred claims for comprehensive and collision coverages;

(d) calendar year voluntary written exposures separately for bodily injury and property damage, comprehensive, and collision;

(e) calendar year involuntary written exposures for bodily injury and property damage;

(f) calendar year substandard written exposures for comprehensive and collision; and

(g) calendar year written exposures for bodily and property damage by class.

(3) Loss Trend Experience. Provide earned exposures, earned premiums, number of paid or incurred claims, paid or incurred losses, loss frequency, and loss severity for each of the latest 16 three-month and twelve-month calendar periods ending quarterly in the following detail:

(a) for bodily injury coverage:

(i) basic limits and total limits paid trends including allocated loss adjustment expense;

(ii) basic limits and total limits paid trends excluding allocated loss adjustment expense;

(iii) basic limits and total limits incurred trends including allocated loss adjustment expense; and

(iv) basic limits and total limits incurred trends excluding allocated loss adjustment expense.

(b) for property damage coverage, the same trends required for bodily injury.

(c) for medical payments coverage, total limits paid trend excluding allocated loss adjustment expense.

(d) for uninsured motorist bodily injury coverage:

(i) total limits paid trend excluding allocated loss adjustment expense; and

(ii) total limits incurred trend excluding allocated loss adjustment expense.

(e) for comprehensive coverage:

(i) paid trend excluding allocated loss adjustment expense for exposures with no deductible;

(ii) paid trend excluding allocated loss adjustment expense separately for exposures with deductibles of fifty dollars ($50.00), one hundred dollars ($100.00), two hundred dollars ($200.00), two hundred fifty dollars ($250.00), five hundred dollars ($500.00), and one thousand dollars ($1000.00); and

(iii) paid trend excluding allocated loss adjustment expense for all exposures not otherwise included.

(f) for collision coverage:

(i) paid trend excluding allocated loss adjustment expense separately for exposures with deductibles of fifty dollars ($50.00), one hundred dollars ($100.00), two hundred dollars ($200.00), two hundred fifty dollars ($250.00), five hundred dollars ($500.00), and one thousand dollars ($1000.00); and

(ii) paid trend excluding allocated loss adjustment expense for all exposures not otherwise included.

(4) Liability Loss Development Experience. Provide loss and earned exposure data for fiscal accident years ending June 30 and December 31 at annual evaluation dates from 15 to 63 months for at least ten years in the following detail:

(a) for bodily injury and property damage coverages, separately detail the coverages for voluntary business and for business ceded to the North Carolina Reinsurance Facility and also provide the total for both types of business:

(i) basic limits paid losses;

(ii) basic limits incurred losses;

(iii) total limits paid losses;

(iv) total limits incurred losses;

(v) paid claims;

(vi) incurred claims;

(vii) earned premium for the corresponding calendar year; and

(viii) earned exposures for the corresponding calendar year.

(b) for medical payments coverage, separately detail the coverages for voluntary business and for business ceded to the North Carolina Reinsurance Facility and also provide the total for both types of business:

(i) total limits paid losses;

(ii) total limits incurred losses;

(iii) paid claims;

(iv) incurred claims;

(v) earned premium for the corresponding calendar year; and

(vi) earned exposures for the corresponding calendar year.

(c) for uninsured and underinsured motorist coverage:

(i) total limits paid losses;

(ii) total limits incurred losses;

(iii) paid claims;

(iv) incurred claims;

(v) estimated (actual if available) earned premium for the corresponding calendar year; and

(vi) estimated (actual if available) earned exposures for the corresponding calendar year.

(5) Physical Damage Age and Symbol Trend Experience. Provide the average age and symbol value for each of the latest twenty half-year periods ending June 30 and December 31 for the following coverages:

(a) full coverage comprehensive;

(b) comprehensive coverage with a fifty dollar ($50.00) deductible;

(c) comprehensive coverage with a one hundred dollar ($100.00) deductible;

(d) collision coverage with a one hundred dollar ($100.00) deductible;

(e) collision coverage with a two hundred fifty dollar ($250.00) deductible; and

(f) collision coverage with a five hundred dollar ($500.00) deductible.

History

  • Authority G.S. 58-2-40; 58-2-190
  • Eff. December 1, 1990
  • Readopted Eff. October 1, 2018.
11 NCAC 16 .0104 Professional Liability Insurance {#sec-11-ncac-16-.0104 omnilex-key=us-nc-regs-official--title-11--11 NCAC 16 .0104}

History

  • Status: repealed
  • Authority G.S. 58-2-170; 58-2-190
  • Eff. December 1, 1990
  • Repealed Eff. July 1, 2011.
11 NCAC 16 .0105 Physicians and Surgeons Professional Liability Insurance {#sec-11-ncac-16-.0105 omnilex-key=us-nc-regs-official--title-11--11 NCAC 16 .0105}

Companies that insure more than two percent of the insured physicians and surgeons in North Carolina shall submit the following data upon request, evaluated as of December 31 to the Actuarial Services Division:

(1) number of insured doctors by speciality;

(2) basic limits losses and ultimate claims for the most recent ten accident or report years;

(3) class one frequency, basic limits severity, and basic limits pure premium for the most recent ten accident or report years;

(4) exposure distributions separately by class, by maturity, and by increased limits factor for the most recent ten calendar years; and

(5) percentage of claims closed with neither a loss payment nor an allocated loss adjustment payment and the percentage of claims closed with only an allocated loss adjustment payment for the most recent ten calendar and for the most recent ten accident or report years.

History

  • Authority G.S. 58-2-40(1); 58-2-190; 58-41-50(e)(14)
  • Eff. December 1, 1990
  • Readopted Eff. October 1, 2018.
11 NCAC 16 .0106 Credit Property Insurance {#sec-11-ncac-16-.0106 omnilex-key=us-nc-regs-official--title-11--11 NCAC 16 .0106}

Each writer of North Carolina credit property insurance shall submit the data described in this Rule upon request to the Actuarial Services Division.

(1) North Carolina premium, loss, and expense:

(a) written premium;

(b) earned premium;

(c) paid losses and claims;

(d) incurred losses and claims;

(e) paid loss adjustment expense;

(f) incurred loss adjustment expense;

(g) incurred commissions and brokerage expenses;

(h) incurred other acquisition costs;

(i) incurred premium taxes;

(j) other incurred expenses;

(k) incurred loss and loss adjustment expense ratio;

(l) incurred loss, loss adjustment expense, and other underwriting expense ratio;

(m) dividends paid;

(n) retrospective rate credits paid; and

(o) commissions paid.

(2) Investment income on loss, loss expense, and unearned premium reserves:

(a) loss reserve at the beginning of the year;

(b) loss reserve at the end of the year;

(c) loss expense reserve at the beginning of the year;

(d) loss expense reserve at the end of the year;

(e) unearned premium reserve at the beginning of the year;

(f) unearned premium reserve at the end of the year; and

(g) investment income earned on loss, loss expense, and unearned premium reserves.

(3) Nonrefundable fees collected.

(a) total number of transactions;

(b) transactions involving insured values less than two hundred fifty dollars ($250.00);

(c) transactions involving insured values of two hundred fifty dollars ($250.00) or more but less than five hundred dollars ($500.00); and

(d) transactions involving insured values of five hundred dollars ($500.00) or more.

(4) Insured values:

(a) insured values for single interest insurance at the beginning of the year;

(b) insured values for single interest insurance at the end of the year;

(c) insured values for dual interest insurance at the beginning of the year; and

(d) insured values for dual interest insurance at the end of the year.

(5) Supplementary information:

(a) identification of the Page 14 Annual Statement line under which the experience is reported; and

(b) explanations of any change in the amounts reported in Subparagraphs (1)(a), (1)(k) and (1)(l) of this Rule that is greater than 50 percent of the previous calendar year's value.

History

  • Authority G.S. 58-2-40; 58-57-90(b)
  • Eff. December 1, 1990
  • Amended Eff. September 1, 1991
  • Readopted Eff. March 21, 2019.
11 NCAC 16 .0107 Nonfiling Insurance {#sec-11-ncac-16-.0107 omnilex-key=us-nc-regs-official--title-11--11 NCAC 16 .0107}

Writers of North Carolina nonfiling insurance shall submit the following information upon request to the Actuarial Services Division:

(1) written premium;

(2) earned premium;

(3) earned exposures;

(4) incurred losses;

(5) number of incurred claims; and

(6) incurred expenses.

History

  • Authority G.S. 53-177; 58-2-40(1)
  • Eff. December 1, 1990
  • Readopted Eff. March 21, 2019.
11 NCAC 16 .0108 Single or Dual Interest Automobile Physical Damage Insurance {#sec-11-ncac-16-.0108 omnilex-key=us-nc-regs-official--title-11--11 NCAC 16 .0108}

Writers of North Carolina Single or Dual Interest Automobile Physical Damage Insurance shall submit the following data described in this Rule upon request to the Actuarial Services Division.

(1) North Carolina premium, loss, and expense:

(a) written premium and car year exposures;

(b) earned premium and car year exposures;

(c) paid losses and claims;

(d) incurred losses and claims;

(e) paid loss adjustment expense;

(f) incurred loss adjustment expense;

(g) incurred commissions and brokerage expenses;

(h) incurred other acquisition costs;

(i) incurred premium taxes;

(j) other incurred expenses;

(k) incurred loss and loss adjustment expense ratio;

(l) incurred loss, loss adjustment expense and other underwriting expense ratio; and

(m) policyholder dividends paid.

(2) Investment income on loss, loss expense, and unearned premium reserves:

(a) loss reserve at the beginning of the year;

(b) loss reserve at the end of the year;

(c) loss expense reserve at the beginning of the year;

(d) loss expense reserve at the end of the year;

(e) unearned premium reserve at the beginning of the year;

(f) unearned premium reserve at the end of the year; and

(g) investment unearned income earned on loss, loss expense, and unearned premium reserves.

(3) Insured values:

(a) insured values for single interest insurance at the beginning of the year;

(b) insured values for single interest insurance at the end of the year;

(c) insured values for dual interest insurance at the beginning of the year; and

(d) insured values for dual interest insurance at the end of the year.

(4) Supplementary information: identification of the Annual Statement line of business under which the experience is reported on the state page of the NAIC Annual Statement.

History

  • Authority G.S. 58-2-40; 58-57-100
  • Eff. September 1, 1991
  • Readopted Eff. October 1, 2018.
11 NCAC 16 .0201 Minimum Loss Ratio Standards {#sec-11-ncac-16-.0201 omnilex-key=us-nc-regs-official--title-11--11 NCAC 16 .0201}

(a) For individual accident and health insurance policies and riders delivered in this State, the standard minimum guideline loss ratio for conditionally renewable, guaranteed renewable, and non-cancelable medical expense, loss of income, and other type coverages, but not including long-term care insurance policies issued in this State on or after February 1, 2003, shall be as promulgated by the National Association of Insurance Commissioners (NAIC) for such coverages as of the issue date of such policies and riders.

(b) If a company fails to satisfy NAIC minimum future or lifetime loss ratio standards for a particular type of coverage, then to comply with the loss ratio standards in Paragraph (a) of this Rule, the company shall:

(1) combine the experience of such policy forms with other forms with similar type of coverage for which the pooling of experience is actuarially justified;

(2) provide premium credits or refunds;

(3) decrease premium rates for one or more subsequent rating periods; or

(4) implement an actuarially justified alternative proposal.

History

  • Authority G.S. 58-2-40; 58-3-275; 58-51-95; 58-63-15(7)b
  • Eff. March 1, 1992
  • Amended Eff. July 1, 2006
  • Readopted Eff. October 1, 2018.
11 NCAC 16 .0202 Accident and Health Insurance Renewability Definitions {#sec-11-ncac-16-.0202 omnilex-key=us-nc-regs-official--title-11--11 NCAC 16 .0202}

With respect to all individual accident and health insurance in this State, the following renewability definitions or substantively similar wording as the Commissioner approves shall be used:

(1) Conditionally Renewable - Renewal may be declined for stated reasons, except for the deterioration of health of an individual insured, provided that the declination applies to all insureds in this state insured under the same policy or rider.

(2) Guaranteed Renewable - Renewal may not be declined by an insurance company for any reason, but the insurance company may revise rates on a class basis.

(3) Non-cancelable - Renewal may not be declined nor may rates be revised by an insurance company.

History

  • Authority G.S. 58-2-40; 58-51-95; 58-63-15(7)b.
  • Eff. March 1, 1992
  • Readopted Eff. October 1, 2018.
11 NCAC 16 .0203 Conditionally Renewable Stated Reason Prohibited {#sec-11-ncac-16-.0203 omnilex-key=us-nc-regs-official--title-11--11 NCAC 16 .0203}

For policies or riders permitting the adjustment of premiums for which the insurer retains the right to nonrenew, no insurer shall exercise a right not to renew for the following reason or any synonymous reason:

"The insurer is prevented by any law, or any regulation, or any ruling of a government agency from using a table of premium rates that the insurer has certified as being reasonable in relation to the benefits provided under the policy."

History

  • Authority G.S. 58-2-40; 58-51-20
  • Eff. March 1, 1992
  • Readopted Eff. October 1, 2018.
11 NCAC 16 .0204 Optionally Renewable Prohibited {#sec-11-ncac-16-.0204 omnilex-key=us-nc-regs-official--title-11--11 NCAC 16 .0204}

No policy of accident, health, or accident and health insurance shall contain a provision that permits the insurer to refuse to renew the coverage of an individual insured based upon the deterioration of health of an individual insured or based upon the claim experience of an individual insured. As used in this Rule, "policy" shall include an endorsement, rider, or any amendment to a policy.

History

  • Authority G.S. 58-2-40; 58-51-95; 58-63-15(7)b
  • Eff. March 1, 1992
  • Readopted Eff. October 1, 2018.
11 NCAC 16 .0205 Data Requirements for Rate Revision Submission {#sec-11-ncac-16-.0205 omnilex-key=us-nc-regs-official--title-11--11 NCAC 16 .0205}

(a) With respect to any individual accident and health insurance policy governed by G.S. 58, Articles 1 through 64, for which an adjustment of premium rate is allowed by law, the insurer shall submit an actuarial memorandum describing and demonstrating the development of any requested premium rate revision. The actuarial memorandum shall contain a subsection identified as "Additional Data Requirements." The initial rate revision filing shall be submitted to the Department's Life and Health Division. An insurer shall submit all data required by this Rule within 45 days after the date that the initial rate revision filing is stamped received by the Division. Subsequent data submissions on incomplete initial rate revision filings shall be made directly to the Department's Actuarial Services Division within the 45 day period. The "Additional Data Requirements" subsection shall include:

(1) identification of the submitted data as North Carolina or countrywide and consistent use of this data identification throughout this Section;

(2) identification of all previously approved policy forms included in the rate revision submission, by North Carolina policy form number;

(3) the month, year, and percentage amount of all previous rate revisions;

(4) the month and year that the rate revision is scheduled to be implemented (hereinafter referred to as the "implementation date");

(5) the type of renewability provision contained in each policy form; such as guaranteed renewable;

(6) the type of coverage provided by each policy form; such as medical expense;

(7) identification of the type of rating methodology; such as issue age, attained age, or community rate;

(8) the National Association of Insurance Commissioners minimum guideline loss ratio and, if different, the insurer's minimum guideline loss ratio;

(9) the average annual premium for North Carolina and countrywide before and after the implementation date;

(10) the number of North Carolina and countrywide policyholders affected by the rate revision;

(11) the requested rate revision percentage attributable to experience;

(12) the requested rate revision percentage attributable to changes in benefits promulgated by Medicare, if applicable, and the calculation used to develop this percentage;

(13) identification and actuarial justification of all groupings of policy forms;

(14) the historical calendar year earned premium divided by duration and expressed on an actual and a current premium rate basis for the period of time from the earliest date that experience is recorded to the most recent date that experience is recorded;

(15) the "expected" incurred loss ratios by duration based upon original pricing assumptions for all policy durations considered in the original pricing;

(16) the "expected" lapse rates by duration based upon original pricing assumptions for all policy durations considered in the original pricing, including assumptions for voluntary lapse rates and mortality rates;

(17) the "actual" lapse rates for duration one through the duration coinciding with the calendar year for which the most recent experience is recorded;

(18) the historical calendar year incurred claims, for other than Medicare supplement insurance, covering the period of time from the earliest date that experience is recorded to the most recent date that experience is recorded;

(19) the historical calendar year incurred claims, for Medicare supplement insurance, expressed on an actual and a current benefit level basis covering the period of time from the earliest date experience is recorded to the most recent date that experience is recorded;

(20) a count of the number of incurred claims for each calendar year of data provided. The count shall be calculated by adding the total number of claims reported during the calendar year, whether paid or in the process of payment, plus the number of incurred but not reported claims at the end of the calendar year, minus the number of incurred but not reported claims at the beginning of the calendar year. For disability income insurance, only the initial claim payment for each period of disablement shall be counted. For each type of medical expense benefit, only the initial claim payment per cause shall be counted; for example, payments for continuation of a claim, such as refills on a prescription drug, shall be excluded from the incurred claim count;

(21) an estimation of the amount of policy year exposure contributed by all policyholders within each calendar year of data provided;

(22) a statement declaring whether this is an open block of business or a closed block of business;

(23) an estimation of the annual earned premium on new issues stated at the current premium rate basis for the period of time from the date that the most recent experience is last recorded to a date not exceeding the fifth year following the implementation date;

(24) the number of months that the rate will be guaranteed to an individual policyholder;

(25) the rate revision implementation method, such as the next premium due date following a given date, the next policy anniversary date, or otherwise. If otherwise, an explanation shall be included;

(26) a statement declaring the month and year of the earliest anticipated date of the next rate revision;

(27) an explanation and actuarial justification of the apportionment of the aggregate rate revision within each policy form or between policy forms that have been grouped and a demonstration that the apportionment of the aggregate rate revision yields the same premium income as if the rate revision had been applied uniformly;

(28) an explanation and actuarial justification, if applicable, for changing any factor that affects the premium;

(29) an explanation of the effect that the rate revision will have on the incurred loss ratio on those policies in force for three years or more as exhibited in the Medicare Supplement Experience Exhibit of the Annual Statement; and

(30) the name, address, and telephone number of an insurance company representative who will be available to answer questions relating to the rate revision.

(b) For the following individual accident and health policies, except Medicare supplement and long-term care, data shall not be required to be subdivided by policy year duration and the data in Subparagraphs (a)(15), (a)(16), and (a)(17) of this Rule may be omitted:

(1) short term non-renewable; e.g., airline trip, student, or accident;

(2) annual renewable term that are repriced every year; and

(3) any closed block of business for which all in force policies have exceeded the seventh year duration.

History

  • Authority G.S. 58-2-40(1); 58-51-95; 58-63-15(7)b
  • Eff. June 1, 1992
  • Amended Eff. August 1, 2005; February 1, 1994; October 1, 1993; January 1, 1993
  • Readopted Eff. October 1, 2018.
11 NCAC 16 .0206 Class Definition Restriction {#sec-11-ncac-16-.0206 omnilex-key=us-nc-regs-official--title-11--11 NCAC 16 .0206}

With respect to individual accident and health insurance policies for which the adjustment of premium rates is allowed by law, the insurer shall not establish, for rate revision purposes, a class within a policy form or group of policy forms so as to eliminate the possibility of new entrants into the class. This Rule shall not preclude actuarially justified apportionments of aggregate rate revisions on either open or closed blocks of business between classes established at the time the policy form or group of policy forms were approved by the Commissioner.

History

  • Authority G.S. 58-2-40(1); 58-51-95; 58-63-15(7)b
  • Eff. June 1, 1992
  • Readopted Eff. October 1, 2018.
11 NCAC 16 .0207 Common Block {#sec-11-ncac-16-.0207 omnilex-key=us-nc-regs-official--title-11--11 NCAC 16 .0207}

(a) As used in this Rule, "Common Block" means a grouping of similar policy form types for which the pooling of experience is actuarially justified and for which the rate revisions are based upon the common experience. A Common Block may include both open and closed policy form types.

(b) If a company establishes a Common Block for compliance with G.S. 58-51-95(h), with respect to all future rate revision filings, the company shall request a common uniform rate revision to apply to all policy forms in the Common Block and shall not request an apportionment by form. If policy forms are grouped into a Common Block, they shall remain grouped for future rate filings. Actuarially justified apportionments of the common rate increase, due to differences in benefits between forms, shall be allowed.

(c) If a company establishes a Common Block for compliance with G.S. 58-51-95(h), the Closed Block portion of policy forms that make up the Common Block shall comply with G.S. 58-3-275.

History

  • Authority G.S. 58-2-40; 58-3-275; 58-51-95; 58-63-15(7)b
  • Eff. July 1, 2006
  • Readopted Eff. October 1, 2018.
11 NCAC 16 .0208 Annual Actuarial Certifications for Long-Term Care Forms {#sec-11-ncac-16-.0208 omnilex-key=us-nc-regs-official--title-11--11 NCAC 16 .0208}

For actuarial certifications required by G.S. 58-51-95(i):

(1) The actuarial certification shall be made by an individual who is either a Fellow or an Associate of the Society of Actuaries, a Fellow or an Associate of the Casualty Actuarial Society, or a member of the American Academy of Actuaries.

(2) For a policy form which becomes closed, but for that no corrective action is currently required, or for other situations for which no corrective action is currently required, the actuary shall, in lieu of the plan of corrective action required by G.S. 58-51-95(i)(2), provide a certification that the actuary has reviewed the historical experience for the policy form and that, in the actuary's opinion, a rate revision is not currently justified.

History

  • Authority G.S. 58-2-40; 58-2-171; 58-3-275; 58-51-95; 58-63-15(7)b
  • Eff. July 1, 2006
  • Readopted Eff. October 1, 2018.
11 NCAC 16 .0301 Definitions and Scope {#sec-11-ncac-16-.0301 omnilex-key=us-nc-regs-official--title-11--11 NCAC 16 .0301}

History

  • Status: repealed
  • Filed as a Temporary Adoption Eff. January 25, 1993 for a Period of 180 Days or Until the Permanent Rule Becomes Effective, Whichever is Sooner
  • Authority G.S. 58-2-40; 58-50-130(b)
  • Eff. May 3, 1993
  • Amended Eff. January 1, 1994; October 1, 1993
  • Repealed Eff. April 1, 2001.
11 NCAC 16 .0302 Restrictions on Premium Rates {#sec-11-ncac-16-.0302 omnilex-key=us-nc-regs-official--title-11--11 NCAC 16 .0302}

History

  • Status: repealed
  • Filed as a Temporary Adoption Eff. January 25, 1993 for a Period of 180 Days or Until the Permanent Rule Becomes Effective, Whichever is Sooner
  • Authority G.S. 58-2-40; 58-50-130(b)
  • Eff. May 3, 1993
  • Amended Eff. January 1, 1994; October 1, 1993
  • Repealed Eff. April 1, 2001.
11 NCAC 16 .0303 Annual Filing {#sec-11-ncac-16-.0303 omnilex-key=us-nc-regs-official--title-11--11 NCAC 16 .0303}

History

  • Status: repealed
  • Filed as a Temporary Adoption Eff. January 25, 1993 for a Period of 180 Days or Until the Permanent Rule Becomes Effective, Whichever is Sooner
  • Authority G.S. 58-2-40; 58-50-130(b)
  • Eff. May 3, 1993
  • Amended Eff. January 1, 1994; October 1, 1993
  • Repealed Eff. April 1, 2001.
11 NCAC 16 .0401 Definitions {#sec-11-ncac-16-.0401 omnilex-key=us-nc-regs-official--title-11--11 NCAC 16 .0401}

As used in this Section:

(1) "Class of Business" means one of the following determined by the source of the business:

(a) Credit Unions;

(b) Commercial Banks and Savings and Loan Associations;

(c) Finance Companies;

(d) Motor Vehicle Dealers;

(e) Other Sales Finance; or

(f) All Others.

(2) "Account" means the aggregate credit life insurance, credit accident and health insurance, or credit unemployment insurance coverage for a single plan of insurance and for a single class of business written through a single creditor, whether coverage is written on a group or individual basis.

(3) "Case" means either a "Single Account Case" or a "Multiple Account Case" as follows:

(a) "Single Account Case" means an account that is at least 25% credible or, at the option of the insurer, any higher percentage as determined by the Credibility Formula as defined in Item (6) of this Rule; and

(b) "Multiple Account Case" means two or more accounts of the same plan of insurance and class of business having similar underwriting characteristics, excluding single account cases defined in Sub-item (3)(a) of this Rule, and that when combined, are at least as credible as the minimum level of credibility elected in Sub-item (3)(a) of this Rule.

(4) "Plan of Insurance" means:

(a) decreasing term credit life insurance on single or joint lives;

(b) level term credit life insurance on single or joint lives;

(c) credit accident and health insurance on single or joint lives, with single premiums that vary by waiting period and retroactive or nonretroactive benefits; and

(d) credit Unemployment insurance on single or joint lives.

(5) "Credibility Factor" means the degree to which the past experience of a case is expected to occur in the future.

(6) "Credibility Formula" means the following process used to calculate the credibility factor:

(a) determine the incurred claim count during the experience period;

(b) divide Sub-item (6)(a) of this Rule by 1082;

(c) take the square root of Sub-item (6)(b) of this Rule; and

(d) the credibility factor is the lesser of the number one and the results of Sub-item (6)(c) of this Rule.

(7) "Earned Premium at Current Approved Rate" means North Carolina earned premium, during the experience period, restated as though the current North Carolina approved rate had been charged.

(8) "Incurred Losses" means North Carolina incurred losses during the experience period including the increase in provision for incurred losses, whether reported or not, from the beginning to the end of the period.

(9) "Expense Ratio" means the ratio of the insurer's operating expenses for a class of business and plan of insurance to its earned premium for that class of business and plan of insurance.

(10) "Operating Expenses" means any combination of the following expenses:

(a) commissions;

(b) other acquisition;

(c) general Administration;

(d) taxes, licenses, and fees; and

(e) profit and contingency margin.

(11) "Benchmark Loss Ratio" means the percentage of premium that is expected to be used to pay losses. It is calculated by subtracting the expense loss ratio from the number one.

(12) "Rate Adjustment Factor" means the result of the calculations in 11 NCAC 16 .0403(15).

(13) "Experience Period" means the period of time for which experience is reported, but not for a period longer than the most recent three years.

(14) "Incurred Claim Count" means the number of North Carolina claims incurred for the case during the experience period. This means the total number of claims reported during the experience period, whether paid or in the process of payment, plus any claims incurred but not reported at the end of the experience period less the number of claims incurred but not reported at the beginning of the experience period. If a debtor has been issued more than one certificate for the same plan of insurance, then only one claim shall be counted. If a debtor receives credit disability or credit unemployment benefits, then only the initial claim payment for that period of disability or period of unemployment is counted.

(15) "Incurred Loss Ratio at Current Approved Rate" means the ratio of incurred losses, as defined in Item (8) of this Rule, to earned premium at current North Carolina approved rate, as defined in Item (7) of this Rule.

(16) "Class of Business Incurred Loss Ratio at Current Approved Rate" means the ratio of incurred losses, as defined in Item (8) of this Rule, to earned premium at current North Carolina approved rate, as defined in Item (7) of this Rule, for the class of business and plan of insurance associated with the case.

(17) "Qualified Actuary" means an individual who is a member of the American Academy of Actuaries, an Associate or Fellow of the Society of Actuaries, or an Associate or Fellow of the Casualty Actuarial Society.

(18) "Maximum Approved Rate" means the current North Carolina approved rate for the case multiplied by the prima facie rate adjustment factor as defined in Item (12) of this Rule.

History

  • Authority G.S. 58-2-40; 58-57-35(a); 58-57-70
  • Eff. January 1, 1994
  • Readopted Eff. October 1, 2018.
11 NCAC 16 .0402 General Submission Requirements {#sec-11-ncac-16-.0402 omnilex-key=us-nc-regs-official--title-11--11 NCAC 16 .0402}

(a) All rate deviation requests, including the data required by Rule .0403 of this Section, shall be submitted to the Life and Health Division. All rate deviation requests shall be submitted no later than March 31, of each calendar year to become effective during the calendar year of submission.

(b) All experience used in the calculation of the rate deviation shall only be North Carolina experience.

(c) All rate deviations shall be submitted, in accordance with this Rule, to the Life and Health Division each succeeding year for reevaluation.

(d) All rate deviation calculations shall be performed by or under the supervision of a qualified actuary.

(e) The following information shall be submitted in regards to the qualified actuary:

(1) the name of the qualified actuary;

(2) the professional designations of the qualified actuary, e.g. A.S.A., F.S.A., ACAS, FCAS, or M.A.A.A.;

(3) the name and address of the company or actuarial consulting firm employing the qualified actuary; and

(4) the telephone number, including extension, of the qualified actuary.

(f) The qualified actuary shall include in the credit rate deviation request a written statement certifying the following:

(1) that the qualified actuary has reviewed Rules .0401 through .0403 of this Section;

(2) that the qualified actuary certifies that all submitted calculations and data preparation are in conformity with Rules .0401 through .0403 of this Section; and

(3) that all data submitted are accurate and in conformity with Rule .0401 of this Section.

History

  • Authority G.S. 58-2-40; 58-57-35(a); 58-57-70
  • Eff. January 1, 1994
  • Readopted Eff. October 1, 2018.
11 NCAC 16 .0403 Calculation Procedure and Data Requirements for Rate Deviations {#sec-11-ncac-16-.0403 omnilex-key=us-nc-regs-official--title-11--11 NCAC 16 .0403}

An insurer requesting a rate deviation shall submit to the Department of Insurance the following information, the results of each calculation as follows, and the corresponding data required to perform each calculation in accordance with this Rule, identified for each case for which the insurer is requesting a rate deviation:

(1) identification of the class of business and plan of insurance associated with the case;

(2) identification of the single or multiple account case and, for a multiple account case, identification of each case;

(3) for the case, calculate the incurred loss ratio at the current North Carolina approved rate as defined in Rule .0401(15) of this Section;

(4) for the case, calculate the credibility factor using the credibility formula as defined in 11 NCAC 16 .0401(6);

(5) multiply Item (3) of this Rule by Item (4) of this Rule;

(6) for the class of business, calculate the class of business incurred loss ratio at current North Carolina approved rate as defined in 11 NCAC 16. 0401(16);

(7) for the class of business, calculate the credibility factor using the credibility formula as defined in 11 NCAC 16.0401(6);

(8) multiply Item (7) of this Rule by the quantity one minus Item (4) of this Rule, as in the following formula: Item (7) of this Rule x [1 - Item (4) of this Rule];

(9) multiply Item (6) of this Rule by Item (8) of this Rule;

(10) multiply the quantity one minus Item (4) of this Rule by the quantity one minus Item (7) of this Rule, as in the following formula: [1 - Item (4) of this Rule] x [1 - Item (7) of this Rule];

(11) multiply .60 by Item (10) of this Rule;

(12) add Items (5), (9) and (11) of this Rule;

(13) calculate the expense ratio as defined in 11 NCAC 16. 0401(9);

(14) calculate the benchmark loss ratio as defined in 11 NCAC 16. 0401(11);

(15) the rate adjustment factor is equal to Item (12) of this Rule divided by Item (14) of this Rule; however, if the rate adjustment factor is greater than or equal to 0.95 and less than or equal to 1.05, then the rate adjustment factor shall be set equal to the number one; and

(16) the maximum approved rate in effect for a period of 12 months is equal to the current North Carolina approved rate for the case multiplied by Item (15) of this Rule.

History

  • History Note Authority G.S. 58-2-40; 58-57-35(a); 58-57-70
  • Eff. January 1, 1994
  • Amended Eff. October 1, 2008
  • Readopted Eff. October 1, 2018.
11 NCAC 16 .0501 MINIMUM INCURRED LOSS ratio {#sec-11-ncac-16-.0501 omnilex-key=us-nc-regs-official--title-11--11 NCAC 16 .0501}

The premium rates charged for credit unemployment insurance shall be reasonable in relation to the benefits provided as indicated by a minimum annual incurred loss ratio of 60%.

History

  • Authority G.S. 58-2-40; 58-57-110(a)
  • Eff. January 1, 1994
  • Amended Eff. November 11, 2011
  • Readopted Eff. October 1, 2018.
11 NCAC 16 .0502 Definitions {#sec-11-ncac-16-.0502 omnilex-key=us-nc-regs-official--title-11--11 NCAC 16 .0502}

As used in this Section:

(1) "Earned Premium" means North Carolina credit unemployment earned premium, during the experience period, restated as though the current North Carolina credit unemployment rate had been charged.

(2) "Incurred Claims" means North Carolina credit unemployment incurred losses during the experience period.

(3) "Experience Period" means the period of time for which experience is reported, but not for a period longer than the most recent three years.

(4) "Incurred Claim Count" means the number of North Carolina credit unemployment claims incurred during the experience period. This means the total number of claims reported during the experience period, whether paid or in the process of payment, plus any claims incurred but not reported at the end of the experience period less the number of claims incurred but not reported at the beginning of the experience period. Only the initial claim payment for that period of unemployment shall be counted.

(5) "Credibility Factor" means the degree to which the past experience is expected to occur in the future.

(6) "Credibility Formula" means the following process used to calculate the credibility factor:

(a) determine the incurred claim count during the experience period;

(b) divide Sub-item (6)(a) of this Rule by 1082;

(c) take the square root of Sub-item (6)(b) of this Rule; and

(d) the credibility factor is the lesser of the number one and the results of Sub-item (6)(c) of this Rule.

(7) "Qualified Actuary" means an individual who is a member of the American Academy of Actuaries, an Associate or Fellow of the Society of Actuaries, or an Associate or Fellow of the Causality Actuarial Society.

(8) "Incurred Loss Ratio at Current Credit Unemployment Rate" means the ratio of incurred losses, as defined in Item (2) of this Rule, to earned premium, as defined in Item (1) of this Rule.

History

  • Authority G.S. 58-2-40; 58-57-70; 58-57-110(a)
  • Eff. January 1, 1994
  • Readopted Eff. October 1, 2018.
11 NCAC 16 .0503 General Submission Requirements {#sec-11-ncac-16-.0503 omnilex-key=us-nc-regs-official--title-11--11 NCAC 16 .0503}

(a) All credit unemployment minimum incurred loss ratio compliance demonstrations shall be submitted to the Life and Health Division upon request.

(b) All experience used in the demonstration of compliance shall be only North Carolina experience.

(c) All compliance demonstrations shall be submitted, in accordance with this Rule, to the Life and Health Division each succeeding year for reevaluation.

(d) The following information shall be submitted in regards to the qualified actuary:

(1) the name of the qualified actuary;

(2) the professional designations of the qualified actuary;

(3) the name and address of the company or actuarial consulting firm employing the qualified actuary; and

(4) the telephone number, including extension, of the qualified actuary.

(e) The qualified actuary shall include in the credit unemployment rate request a written statement certifying the following:

(1) that the qualified actuary has reviewed Rules .0501 through .0504 of this Section;

(2) that the qualified actuary certifies that all submitted calculations and data preparation are in conformity with Rules .0501 through .0504 of this Section; and

(3) that all data submitted are accurate and in conformity with Rule .0502 of this Section.

History

  • Authority G.S. 58-2-40; 58-57-70; 58-57-110(a)
  • Eff. January 1, 1994
  • Amended Eff. November 1, 2011
  • Readopted Eff. October 1, 2018.
11 NCAC 16 .0504 Calculation Procedure and Demonstration of Compliance {#sec-11-ncac-16-.0504 omnilex-key=us-nc-regs-official--title-11--11 NCAC 16 .0504}

Each credit unemployment insurer shall submit to the Department of Insurance the results of each calculation as follows and the corresponding data required to perform each calculation in accordance with this Rule:

(1) calculate the incurred loss ratio at current credit unemployment rate as defined in 11 NCAC 16 .0502(8);

(2) calculate the credibility factor using the credibility formula as defined in 11 NCAC 16 .0502(6);

(3) multiply Item (1) of this Rule by Item (2) of this Rule;

(4) multiply .60 by the quantity one minus Item (2) of this Rule;

(5) add Items (3) and (4) of this Rule; and

(6) divide Item (5) of this Rule by .60. Compliance with 11 NCAC 16 .0501 shall be satisfied if this quotient is equal to or greater than one. If this quotient is less than one, then in order to satisfy 11 NCAC 16 .0501 the insurer shall decrease the current credit unemployment rate until the quotient is equal to or greater than one.

History

  • Authority G.S. 58-2-40; 58-57-70; 58-57-110(a)
  • Eff. January 1, 1994
  • Readopted Eff. October 1, 2018.
11 NCAC 16 .0601 Definitions {#sec-11-ncac-16-.0601 omnilex-key=us-nc-regs-official--title-11--11 NCAC 16 .0601}

(a) The definitions contained in G.S. 58-67-5 shall apply in this Section.

(b) As used in this Section:

(1) "Adjusted community rating" means a rating method that allows an HMO to prospectively establish premium rates based upon the expected revenue requirements for individual groups and to take into account a group's historical utilization, intensity, or cost experience.

(2) "Capitated" means covered health care services are provided by an HMO, medical group, or institution based on a prepaid fixed amount per enrollee regardless of the actual value of those services.

(3) "Community rating" means a general method of establishing premiums for financing health care in which an individual's rate is based on the actual or anticipated average cost of health services used by all HMO members in a specified service area.

(4) "Community rating by class" means a modification of community rating whereby individual groups may have different rates depending on the composition by age, gender, number of family members covered, geographic area, or industry.

(5) "Contingency reserve" means the unassigned funds held over and above any known or estimated liabilities of an HMO for the protection of its enrollees against the insolvency of the HMO.

(6) "Contract type" means a classification of the members into categories, usually based on enrolled dependent status, such as subscriber only, subscriber with one dependent, and subscriber with two or more dependents.

(7) "Credibility rating" means a rating method that establishes premium rates based upon the assignment of a level of credibility to an HMO group's historical utilization, intensity, or cost experience.

(8) "Fee-for-service" means payment for health care services is made on a retrospective basis based on the actual value of those services.

(9) "Full-service HMO" means an HMO that provides a comprehensive range of medical services, including hospital and physician services.

(10) "HMO expansion request" means all materials submitted for the purpose of obtaining authority to operate an HMO in a new or expanded geographic area in this State.

(11) "HMO model type" means a classification that describes the manner in which physicians are affiliated with the HMO and the contractual and payment arrangements with hospitals, and includes types such as group, network, staff, independent practice association, and point-of-service.

(12) "HMO rate filing" means an initial HMO rate filing, an HMO expansion request, or an HMO rate revision filing.

(13) "HMO rate revision filing" means all materials submitted for the purpose of making a revision to an existing schedule of premiums.

(14) "Incurred loss ratio" means the ratio of total medical expenses, including the change in claim reserves to total earned premium revenues.

(15) "Initial HMO rate filing" means all materials submitted for the purpose of obtaining a certificate of authority to operate an HMO in this State.

(16) "Single-service HMO" means an HMO that undertakes to provide or arrange for the delivery of a single or limited type of health care service to a defined population on a prepaid basis.

History

  • Authority G.S. 58-67-50(b); 58-67-150
  • Eff. April 1, 1995
  • Readopted Eff. October 1, 2018.
11 NCAC 16 .0602 Hmo General Filing Requirements {#sec-11-ncac-16-.0602 omnilex-key=us-nc-regs-official--title-11--11 NCAC 16 .0602}

(a) All schedules of premiums for enrollee coverage for health care services and all amendments to schedules of premiums that are filed with the Department shall be submitted to and stamped received by the Life and Health Division and shall indicate whether the filing is an original or amended filing. All data requirements prescribed by this Section shall be submitted within 30 days after the date that the filing is stamped received, or the filing will be deemed to be disapproved. Subsequent data submissions for rate filings deemed to be in non-compliance with this Section shall be made directly to the Department's Actuarial Services Division within the 30 day period.

(b) All filings shall be accompanied by:

(1) A certification by a qualified actuary that the premiums applicable to an enrollee are not individually determined based on the status of their health and that such premiums are established in accordance with actuarial principles for various categories of enrollees and are not excessive, inadequate, or unfairly discriminatory.

(2) Actuarial data supporting the schedule of premiums as prescribed by 11 NCAC 16 .0603, 11 NCAC 16 .0604, 11 NCAC 16 .0605, 11 NCAC 16 .0206 and 11 NCAC 16 .0207.

(c) As used in Paragraph (b) of this Rule, "qualified actuary" means an individual who is a member of the American Academy of Actuaries, an Associate or Fellow of the Society of Actuaries, or an Associate or Fellow of the Casualty Actuarial Society, and has at least three years of substantive experience in the HMO or another managed health care field.

History

  • Authority G.S. 58-67-50(b); 58-67-150
  • Eff. April 1, 1995
  • Amended Eff. February 1, 1996
  • Readopted Eff. October 1, 2018.
11 NCAC 16 .0603 Hmo Rate Filing Data Requirements {#sec-11-ncac-16-.0603 omnilex-key=us-nc-regs-official--title-11--11 NCAC 16 .0603}

All HMO rate filings shall include the following data:

(1) identification and a brief description of the HMO model type;

(2) identification of the enrollee issue basis, whether individual or group;

(3) identification and a brief description of the type of rating methodology, such as community rating, community rating by class, adjusted community rating, credibility rating, or other;

(4) identification and listing of all rate classification factors, such as age, gender, geographic area, industry, group size, or effective date;

(5) a brief, summary description and numerical demonstration of the development of the capitated rate, including a listing of sources used;

(6) a brief, summary description and numerical demonstration of the development of any portion of the premium rate developed for fee-for-service claims, including a listing of sources used;

(7) a brief, summary description of the claim reserving methodology and the incorporation of claim reserves into the premium rate;

(8) a brief, summary description of the procedure and assumptions used to convert the total per member per month cost to the proposed premium rates, including assumptions for the distribution of community rated contracts by contract type, the ratios by tier to the single rate, and the average number of members in each contract type;

(9) the projected monthly incurred loss ratios for the period of time equal to the number of months for which the rates will be in effect, plus the number of months the rates will be guaranteed; and

(10) the percentage of the per member per month premium for administrative expenses and for surplus.

History

  • Authority G.S. 58-67-50(b); 58-67-150
  • Eff. April 1, 1995
  • Readopted Eff. October 1, 2018.
11 NCAC 16 .0604 Initial Hmo Rate Filing Data Requirements and Standards {#sec-11-ncac-16-.0604 omnilex-key=us-nc-regs-official--title-11--11 NCAC 16 .0604}

(a) All initial HMO rate filings shall include, in addition to the data required by 11 NCAC 16 .0603, the following data:

(1) a comparison of the rates to other HMO rates with the same effective date in North Carolina for similar benefit plans; and

(2) a three-year financial projection, provided by the Department's Actuarial Services Division, that details total membership, revenues, and expenses, and that includes a statement of cash flow, a balance sheet, and a statement of working capital and net worth.

(b) All initial HMO rate filings shall use in the rate development a total retention loading of:

(1) no greater than 25.0% of the total premium rate for full-service HMO products issued on a group basis;

(2) no greater than 35.0% of the total premium rate for single-service HMO products issued on a group basis;

(3) no greater than 35.0% of the total premium rate for full-service HMO products issued on an individual basis; or

(4) no greater than 45.0% of the total premium rate for single-service HMO products issued on an individual basis.

(c) If an HMO uses a total retention loading that is less than the maximum limit cited in Paragraph (b) of this Rule minus 15.0%, then the following supporting documentation shall be included in the filing:

(1) a listing of each of the specific components that make up the total retention loading expressed as a percentage of premium;

(2) a brief description of the methodology employed to obtain each of the components that make up the total retention loading;

(3) a brief explanation as to why any of the components which make up the total retention loading have changed and a statement of opinion from an officer of the HMO that these changes are permanent in nature;

(4) a brief, summary description of the impact of any special fee negotiations or contract arrangements that affect the premium rates. Identification of specific hospitals or physician groups shall not be required; and

(5) a comparison of the rates to other HMO rates with similar benefit plans.

(d) All HMO's must project a positive net income after taxes in each of the last 12 months of the three year financial projection.

History

  • Authority G.S. 58-67-10(d)(1); 58-67-50(b); 58-67-150
  • Eff. April 1, 1995
  • Readopted Eff. October 1, 2018.
11 NCAC 16 .0605 Hmo Expansion Request Data Requirements {#sec-11-ncac-16-.0605 omnilex-key=us-nc-regs-official--title-11--11 NCAC 16 .0605}

All HMO expansion requests shall include, in addition to the data required by 11 NCAC .0603, the following data:

(1) a comparison of the actual financial results, including total membership, revenues, and expenses, to the projected financial results for at least the most recent 12-month period; and

(2) a three-year financial projection, provided by the Department's Actuarial Services Division, that details total membership, revenues, and expenses, and that includes a statement of cash flow, a balance sheet, and a statement of working capital and net worth for both the existing service area and the proposed area of expansion.

History

  • Authority G.S. 58-67-10(d)(1); 58-67-50(b); 58-67-150
  • Eff. April 1, 1995
  • Readopted Eff. October 1, 2018.
11 NCAC 16 .0606 Hmo Rate Revision Filing Data Requirements {#sec-11-ncac-16-.0606 omnilex-key=us-nc-regs-official--title-11--11 NCAC 16 .0606}

All HMO rate revision filings shall include, in addition to the data required by 11 NCAC 16 .0603, the following data:

(1) a brief, summary description of the scope and reason for any rate revision, including the methodology employed to determine the revised rates;

(2) the number of months the rates will be in effect and the number of months the rates will be guaranteed;

(3) the dates and average percentage amounts of:

(a) all prior rate revisions in North Carolina during the preceding three years; and

(b) the current rate revision request;

and quarterly rate increases shall be shown in comparison to both the immediately preceding quarter and the corresponding quarter of the previous 12-month period;

(4) the North Carolina average annual per member per month premium revenue before and after the rate revision;

(5) a brief, summary explanation of all deviations in actual versus expected utilization rates or medical costs that may be used to justify a premium rate revision;

(6) identification and a brief, summary description of the derivation of all trend factors used to project medical expenses;

(7) a comparison of the actual financial results, including total membership, revenues, and expenses, to the projected financial results for at least the most recent 12-month period; and

(8) a financial projection for the period of time equal to the number of months the rates will be in effect plus the number of months the rates will be guaranteed, provided by the Department Actuarial Services Division, that details total membership, revenues, and expenses, and that includes a statement of cash flow, a balance sheet, and a statement of working capital and net worth.

History

  • Authority G.S. 58-67-50(b); 58-67-150
  • Eff. April 1, 1995
  • Readopted Eff. October 1, 2018.
11 NCAC 16 .0607 Hmo Incurred Loss Ratio Standards {#sec-11-ncac-16-.0607 omnilex-key=us-nc-regs-official--title-11--11 NCAC 16 .0607}

(a) The following shall apply to all HMO rate revision filings:

(1) The application of a requested rate increase or decrease shall result in an average incurred loss ratio projected for North Carolina over the period required in 11 NCAC 16 .0606(8) of this Section that is not less than:

(A) 75.0% for full-service HMO products issued on a group basis;

(B) 65.0% for single-service HMO products issued on a group basis;

(C) 65.0% for full-service HMO products issued on an individual basis; or

(D) 55.0% for single-service HMO products issued on an individual basis.

(2) If the average incurred loss ratio projected for North Carolina over the period required in 11 NCAC 16 .0606(8) of this Section is greater than the minimum limit cited in Subparagraph (a)(1) of this Rule plus 15.0%, then the following supporting documentation shall be included in the filing:

(A) a list of each of the specific components that make up the total retention loading expressed as a percentage of premium;

(B) a brief description of the methodology employed to obtain each of the components that make up the total retention loading;

(C) a brief explanation as to why any of the components that make up the total retention loading have changed and a statement of opinion from an officer of the HMO that these changes are permanent in nature;

(D) a brief, summary description of the impact of all special fee negotiations or contract arrangements that affect the premium rates. Identification of specific hospitals or physician groups shall not be required; and

(E) a comparison of the rates to other HMO rates with similar benefit plans.

(b) The following shall apply to all initial HMO rate filings and HMO expansion requests:

(1) The average incurred loss ratio projected for North Carolina over the last 12 months of the three year financial projection period shall be no less than:

(A) 75.0% for full-service HMO products issued on a group basis;

(B) 65.0% for single-service HMO products issued on a group basis;

(C) 65.0% for full-service HMO products issued on an individual basis; or

(D) 55.0% for single-service HMO products issued on an individual basis.

(2) If the average incurred loss ratio projected for North Carolina over the last 12 months of the three year financial projection is greater than the minimum limit cited in Subparagraph (b)(1) of this Rule plus 15.0%, then the following supporting documentation shall be included in the filing:

(A) a list of each of the specific components that make up the total retention loading expressed as a percentage of premium;

(B) a brief description of the methodology employed to obtain each of the components that make up the total retention loading;

(C) a brief explanation as to why any of the components that make up the total retention loading have changed and a statement of opinion from an officer of the HMO that these changes are permanent in nature;

(D) a brief, summary description of the impact of any special fee negotiations or contract arrangements that affect the premium rates. Identification of specific hospitals or physician groups shall not be required; and

(E) a comparison of the rates to other HMO rates with similar benefit plans.

History

  • Authority G.S. 58-67-50(b); 58-67-150
  • Eff. April 1, 1995
  • Readopted Eff. October 1, 2018.
11 NCAC 16 .0701 Definitions {#sec-11-ncac-16-.0701 omnilex-key=us-nc-regs-official--title-11--11 NCAC 16 .0701}

As used in this Section:

(1) "Claim reserves" means reserves or liabilities held for claims incurred on or before the valuation date, but unpaid as of the valuation date. Claim reserves include both reported and unreported claims. Claim reserves are established for both accrued and unaccrued benefits.

(2) "Valuation date" means the date at which reserves are estimated.

History

  • Authority G.S. 58-2-40; 58-67-135(b)
  • Eff. February 1, 1995
  • Readopted Eff. October 1, 2018.
11 NCAC 16 .0702 Claims {#sec-11-ncac-16-.0702 omnilex-key=us-nc-regs-official--title-11--11 NCAC 16 .0702}

(a) When an HMO has been informed that a claim has been incurred, if the date reported is on or before the valuation date, the claim shall be considered as a reported claim.

(b) When an HMO has not been informed, on or before the valuation date, concerning a claim that has been incurred on or before the valuation date, the claim shall be considered as an unreported claim.

(c) The date on which a claim is determined to be a liability of an HMO is the incurred date. For example: The incurred date for charges for inpatient hospital and physician visits in hospital shall be the date of admission, for outpatient hospital charges shall be the date of service, and for surgical expenses shall be the date of the surgery.

History

  • Authority G.S. 58-2-40; 58-67-135(b)
  • Eff. February 1, 1995
  • Readopted Eff. October 1, 2018.
11 NCAC 16 .0703 Claim Reserve Filing Requirements {#sec-11-ncac-16-.0703 omnilex-key=us-nc-regs-official--title-11--11 NCAC 16 .0703}

(a) A quarterly claim reserve data filing shall be made by any HMO that has been in operation for more than one full calendar year but less than three full calendar years.

(b) An annual claim reserve data filing shall be made by any HMO that satisfies either of the following conditions:

(1) for the most recent quarterly valuation the net worth less the contingency reserve is less than the statutory minimum stated in G.S. 58-67-110(c) or G.S. 58-67-110(d); or

(2) for the most recent annual valuation the sum of the following exceeds 110 percent of the estimated liability of unpaid claims on December 31 of the previous year:

(A) total of claims paid during the year and incurred in previous years; and

(B) claims unpaid at December 31 of the current year on claims incurred in previous years.

(c) A triennial claim reserve data filing shall be made by all HMOs.

(d) All annual and triennial claim reserve data filings shall be sent to the Actuarial Services Division by March 1 of the reporting year.

(e) All quarterly claim reserve data filings shall be sent to the Actuarial Services Division within 45 days after the end of each calendar quarter.

History

  • Authority G.S. 58-2-40; 58-67-135(b); 58-67-150
  • Eff. February 1, 1995
  • Amended Eff. April 1, 1997
  • Readopted Eff. October 1, 2018.
11 NCAC 16 .0704 Claim Reserve Data and Format Requirements {#sec-11-ncac-16-.0704 omnilex-key=us-nc-regs-official--title-11--11 NCAC 16 .0704}

(a) The data requirements in Paragraph (b) of this Rule shall be recorded for the following types of claims:

(1) inpatient Claims;

(2) physician Claims;

(3) referral Claims; and

(4) other.

(b) For the most recent 24-month period immediately preceding and including the valuation date, the following "monthly" historical data shall be recorded by the month in which the claim or payment was incurred and by the following:

(1) cumulative number of claims reported through the 24-month period;

(2) cumulative number of claims paid through the 24-month period;

(3) cumulative dollar amount of claims paid through the 24-month period; and

(4) cumulative dollar amount of claims incurred through the 24-month period.

(c) The following monthly historical data shall be recorded for the most recent 24-month period immediately preceding and including the valuation date:

(1) earned premiums by calendar month;

(2) total number of enrollees at the beginning and end of each month; and

(3) data on claim amounts greater than or equal to one hundred thousand dollars ($100,000).

History

  • Authority G.S. 58-2-40; 58-67-135(b); 58-67-150
  • Eff. February 1, 1995
  • Amended Eff. December 1, 1995
  • Readopted Eff. October 1, 2018.
11 NCAC 16 .0705 Claim Reserve Methodology and Actuarial Certification {#sec-11-ncac-16-.0705 omnilex-key=us-nc-regs-official--title-11--11 NCAC 16 .0705}

(a) A written description of the claim reserve methodology and a numerical verification of the claim reserves submitted in 11 NCAC 16 .0704(d) shall be included with each annual filing.

(b) Each annual filing shall contain an actuarial certification signed by an actuary stating that the actuary has examined the claim reserves listed in Schedule - H, Section II, and affirms that these claim reserves are calculated in accordance with generally accepted actuarial principles and practices and in the actuary's opinion are adequate.

History

  • Authority G.S. 58-2-40; 58-67-135(b)
  • Eff. February 1, 1995
  • Readopted Eff. October 1, 2018.
11 NCAC 16 .0801 Small Employer Group Health Insurance Actuarial Certification {#sec-11-ncac-16-.0801 omnilex-key=us-nc-regs-official--title-11--11 NCAC 16 .0801}

(a) Each small employer group carrier, as defined in G.S. 58-50-110(23), shall use the following language in its actuarial certification:

(1) The opening paragraph shall state either of the following, as applicable:

(A) For a carrier actuary, the opening paragraph shall state:

"I, (name and title of actuary), am an (officer, employee) of (name of carrier) and am a member of the American Academy of Actuaries. I am familiar with G.S. 58-50-130."

(B) For a consulting actuary, the opening paragraph shall state:

"I, (name and title of consulting actuary), am associated with (name of actuarial consulting firm) and am a member of the American Academy of Actuaries. I have been involved in the preparation of the small employer group health insurance premium rates for the (name of carrier) and am familiar with G.S. 58-50-130."

(2) A scope paragraph shall be included, which shall include the following language:

"I have examined the actuarial assumptions and methodology used by (name of carrier) in used by (name of carrier) in implementing the small employer group health benefit plan rating provisions of G.S. 58-50-130.

(3) If the actuary has examined the underlying records, the scope paragraph shall include the following language:

"I have examined the underlying records and summaries of data used by (name of carrier) in determining small employer group health benefit plan premium rates and procedures used by (name of carrier) in implementing the small employer group health benefit plan rating provisions of G.S. 58-50-130."

(4) If the actuary has not examined the underlying records, but has relied upon listings and summaries of data prepared by an officer of the company, the scope paragraph shall include the following language:

"I have not examined the underlying records used by (name of carrier) in determining small employer group health benefit plan premium rates and procedures used by (name of carrier) in implementing the small employer group health benefit plan rating provisions of G.S. 58-50-130. I have relied upon listings and summaries of data prepared by (name and title of company officer) as certified in the attached statement."

(5) The certification paragraph shall state:

"I certify that for the period from January 1, (year) to December 31, (year) the rating method(s) of (name of carrier) are actuarially sound and that:

(A) The rating factors used by (name of carrier) in its adjusted community rating (ACR) methodology are being applied consistently, are not being applied individually in the final premium rate charged to an employee, and are being applied uniformly to the premium rate charged to all eligible employee enrollees in a small employer group.

(B) Periodic adjustment factors that give recognition to medical claim or medical inflation trends are based on (name of carrier)'s entire small employer group health benefit plan business, the same in a given month for a new and a renewing small employer group with the exception of Part (J) of this Subparagraph, and the same for 12 consecutive months for a given small employer group.

(C) All small employer groups within a given medical care system have the same medical care system factor.

(D) The medical care system factors produce rates that are not excessive, are not inadequate, are not unfairly discriminatory in the medical care system areas, and are revenue neutral to the small employer group carrier for its small group business in North Carolina.

(E) The medical care system factors reflect only the relative differences in expected costs.

(F) Rate differences because of differences in health benefit plan design only reflect benefit differences.

(G) Participation and contribution requirements do not vary by policy form.

(H) Stop loss, catastrophic, or reinsurance coverage provided to small employers complies with the underwriting, rating, and other applicable standards in G.S. 58-50-100 through G.S. 58-50-156.

(I) The percentage increase in the premium rate charged to a small employer for a new rating period does not exceed the sum of the following: the percentage change in the ACR as measured from the first day of the previous rating period to the first day of the new rating period; any adjustment, not to exceed 15 percent annually, because of claim experience, health status, or duration of coverage of the employees or dependents of the small employer; and any adjustment because of change in coverage or change in case characteristics of the small employer group.

(J) Any adjustment because of duration of coverage only reflects a difference between first year and renewal coverage.

(K) (Name of carrier) uses an ACR methodology as prescribed in G.S. 58-50-130(b)(1) and the premium rates charged during a rating period to small employer groups with similar case characteristics for the same coverage do not deviate from the adjusted community rate by more than 25 percent for any reason, including differences in administrative costs and claims experience.

(L) Differences in administrative costs, defined as all non-medical care costs, within a policy form are reflected within the 25 percent deviation from the ACR.

(M) (Name of carrier) only uses the following demographic factors, as prescribed by G.S. 58-50-130(b)(2): age, gender, family size, medical care system, and industry.

(N) All small employer group health benefit plans are guaranteed issue as prescribed by G.S. 58-68-40.

(O) The industry rate factor associated with any industry classification divided by the lowest industry rate factor associated with any other industry classification shall not exceed 1.2.

(P) All small employer group health benefit plan premium rates are guaranteed for 12 months as prescribed in G.S. 58-50-130(b)(3).

(Q) All small employer group health benefit plan premium rate increases include a common premium rate increase shared by all small employer group business.

(R) The premium rates exhibit a reasonable relationship to the benefits provided by the policies and are not excessive, are not inadequate, and are not unfairly discriminatory."

(b) The certifying actuary shall include a description and a sample numerical demonstration of how the small employer group health benefit plan premium rates were tested for compliance.

(c) If the certifying actuary has not examined the underlying records or summaries, the person or persons who performed the examination of the underlying records or summaries shall provide the following certification, which shall be signed, dated, and attached to the actuarial certification:

"I, (name and title of certifying officer), am (title) of (name of insurer). I hereby affirm that the listings and summaries of data for (name of carrier) prepared for and submitted to (name of certifying actuary) were prepared under my direction and, to the best of my knowledge and belief, are accurate and complete."

(d) If the certifying actuary submits a qualified certification, the following information shall be attached to the small employer group actuarial certification:

(1) a description of the incident or incidents that resulted in the certifying actuary submitting a qualified certification; and

(2) a submission of a remedial plan to bring the incidents described in Paragraph (d)(1) of this Rule into compliance with G.S. 58-50-130(b).

History

  • Authority G.S. 58-2-40; 58-50-130
  • Eff. December 1, 2007
  • Readopted Eff. October 1, 2018.

Chapter 17 Seniors' Health Insurance Information Program

11 NCAC 17 .0101 Definitions {#sec-11-ncac-17-.0101 omnilex-key=us-nc-regs-official--title-11--11 NCAC 17 .0101}

As used in this Chapter:

(1) "Counselor" means a private citizen who has been trained by SHIIP employees and is certified by SHIIP to voluntarily provide counseling in accordance with this Chapter.

(2) "Department" means the Department of Insurance of the State of North Carolina.

(3) "SHIIP" means the Seniors' Health Insurance Information Program.

(4) "SHIIP employee" means an employee of the Department of Insurance who is acting on behalf of SHIIP.

History

  • Authority G.S. 58-2-25; 58-2-40(1); 58-54-25; 58-55-30
  • Eff. July 1, 1992
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. March 24, 2019.
11 NCAC 17 .0102 Purpose and Duties of Shiip {#sec-11-ncac-17-.0102 omnilex-key=us-nc-regs-official--title-11--11 NCAC 17 .0102}

(a) SHIIP is established within the Department as a statewide health benefits counseling program to provide Medicare beneficiaries with counseling in Medicare, private health insurance, and related health care coverage plans.

(b) In carrying out its duties under this Chapter, SHIIP:

(1) Acts as a clearinghouse for information and materials relating to Medicare and health insurance.

(2) Develops additional information and materials relating to Medicare and health insurance, as necessary.

(3) Provides minimum standards and materials for training and certifying counselors.

(4) Provides information for health insurance educational activities that are conducted by employers, senior organizations, and other interested groups.

(5) Supports, to the extent possible, additional emphasis on expansion of community educational activities that would provide for announcements on television and in other media that briefly describe the nature of Medicare, Medicare supplement insurance, and long-term care insurance, and the availability of consumer information and materials under this Chapter.

(6) Provides community education on Medicare, Medicare supplement insurance, and long-term care insurance.

(7) Recruits, trains, and coordinates counselors.

(8) Assists individuals and provides informal advocacy with respect to Medicare and health insurance benefits claims.

History

  • Authority G.S. 58-2-25; 58-2-40(1); 58-54-25; 58-55-30
  • Eff. July 1, 1992
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. March 24, 2019.
11 NCAC 17 .0103 Location, Mailing Address, and Telephone {#sec-11-ncac-17-.0103 omnilex-key=us-nc-regs-official--title-11--11 NCAC 17 .0103}

(a) The primary location of Seniors' Health Insurance Information Program or SHIIP is 3200 Beechleaf Court, Raleigh, NC 27604.

(b) The mailing address of SHIIP is 1201 Mail Service Center, Raleigh, North Carolina, 27699-1201.

(c) The telephone numbers for SHIIP are toll-free 1-855-408-1212 and 1-919-807-6900.

History

  • Authority G.S. 58-2-5; 58-2-25; 58-2-40(1); 58-54-25; 58-55-30
  • Eff. July 1, 1992
  • Amended Eff. January 1, 2018; November 1, 2011; September 1, 2002
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. March 24, 2019
  • Amended Eff. February 1, 2024.
11 NCAC 17 .0104 Counselors {#sec-11-ncac-17-.0104 omnilex-key=us-nc-regs-official--title-11--11 NCAC 17 .0104}

(a) Counselors shall not engage in the solicitation of insurance sales. Licensed insurance agents and employees of insurance companies are not eligible for training and certification as counselors by SHIIP.

(b) No counselor shall provide counseling services under this Chapter unless he or she has been trained and certified by SHIIP.

(c) Before providing any counseling services, counselors shall disclose, in writing, to recipients of counseling services pursuant to this Chapter that the counselors are acting in good faith to provide information about the Medicare program and about health insurance policies and benefits on a volunteer basis, but that the information shall not be construed to be legal advice.

(d) Counselors shall not endorse any particular insurance company or insurance agency, agent, broker, brokerage firm, or other private provider of health insurance.

(e) Counselors shall keep all consultations with recipients of counseling services confidential, except for filing of reports with SHIIP employees.

History

  • Authority G.S. 58-2-40(1); 58-54-25; 58-55-30
  • Eff. July 1, 1992
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. March 24, 2019.
11 NCAC 17 .0105 Medicare Supplement Policies {#sec-11-ncac-17-.0105 omnilex-key=us-nc-regs-official--title-11--11 NCAC 17 .0105}

All Medicare supplement insurance policy forms that have been approved by the Life and Health Division of the Department are on file in the offices of SHIIP. Copies of these policy forms are available as soon as practicable after request therefor and payment of the copying fee specified in G.S. 58-6-5(3).

History

  • Authority G.S. 58-2-40(1); 58-6-5(3); 58-54-25
  • Eff. July 1, 1992
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. March 24, 2019.
11 NCAC 17 .0106 Buyer's Guides {#sec-11-ncac-17-.0106 omnilex-key=us-nc-regs-official--title-11--11 NCAC 17 .0106}

The Guide to Health Insurance for People with Medicare, as published by the National Association of Insurance Commissioners, or any successor publications, are available from SHIIP to consumers, free of charge. Licensed insurance agents and employees of insurance companies shall obtain these publications from the insurance companies by which they are appointed or employed.

History

  • Authority G.S. 58-2-40(1); 58-54-25; 58-55-30
  • Eff. July 1, 1992
  • Amended Eff. February 1, 1996
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. March 24, 2019.

Chapter 18 Mutiple Employer Welfare Arrangements

11 NCAC 18 .0101 Purpose and Scope {#sec-11-ncac-18-.0101 omnilex-key=us-nc-regs-official--title-11--11 NCAC 18 .0101}

The purpose of this Section is to implement the provisions of Article 49 of General Statute Chapter 58 and to regulate the issuance of a license and the operation of a MEWA as provided in that Article. The definition of "multiple employer welfare arrangement" or "MEWA" contained in G.S. 58-49-30(a) is incorporated herein by reference, including any subsequent amendments or editions.

History

  • Authority G.S. 58-2-40(1); 58-49-30; 58-49-35; 58-49-40; 58-49-50; 58-49-55
  • 58-49-60; 58-49-65
  • Eff. July 1, 1992
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 16, 2014.
11 NCAC 18 .0102 General Eligibility {#sec-11-ncac-18-.0102 omnilex-key=us-nc-regs-official--title-11--11 NCAC 18 .0102}

(a) Each MEWA shall provide to the Commissioner documentation from the Internal Revenue Service confirming that the exemption under Section 501(c) of the Internal Revenue Code has been granted, or that the MEWA will operate solely for the benefit of the members of the MEWA. Any profits from the operation of the MEWA shall be invested in securities as allowed by G.S. 58-7-160 through G.S. 58-7-200, and the interest or other profits accrued or received thereon shall be contributed to surplus for the stability of rates or provide other such benefits for the members to which the trustees and the Commissioner agree; and the trust agreement required by G.S. 58-50A-70(a)(3) shall so state.

(b) Each MEWA shall be established by a trade association, industry association, professional association, or chamber association.

(c) As used in this Rule:

(1) "Industry association" means member employers who are in the same major group code, as defined by the Standard Industrial Classification Manual issued by the Executive Office of the President, Office of Management and Budget; unless restricted by Subparagraph (c)(2) or (3) of this Rule.

(2) "Professional association" means member employers who are of the same type of profession, such as physicians, dentists, accountants, lawyers, or architects; but is not limited to those professions. However, the profession must be one that is recognized by the required licensing agency.

(3) "Trade association" means member employers who are in the same type of trade, such as plumbers or electricians; and any others that are trade designations as recognized by the required licensing agency.

(4) "Chamber association" means a statewide chamber of commerce or business league that meets all of the criteria listed in G.S. 58-50A-70(a)(2)c.

(d) The feasibility study required by G.S. 58-50A-80(7) shall disclose all material assumptions.

History

  • Authority G.S. 58-2-40(1); 58-50A-70; 58-50A-80
  • Eff. August 3, 1992
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 16, 2014
  • Temporary Amendment Eff. April 7, 2025
  • Amended Eff. April 1, 2026.
11 NCAC 18 .0103 Filing Requirements {#sec-11-ncac-18-.0103 omnilex-key=us-nc-regs-official--title-11--11 NCAC 18 .0103}

(a) All communications and filings shall be made to the Deputy Commissioner, Life and Health Division, North Carolina Department of Insurance, 1201 Mail Service Center, Raleigh, North Carolina 27699-1201.

(b) To apply for licensure, an applicant shall submit the following information required by G.S. 58-49-50:

(1) A Form MEWA-1 entitled "Application for License for Multiple Employer Welfare Arrangement (MEWA)";

(2) A Form MEWA-3A entitled "Biographical Affidavit," for all officers, directors, and trustees of the MEWA that shall contain information to enable the Commissioner to determine if such persons are disqualified pursuant to G.S. 58-49-40(e);

(3) A list of all names, addresses, and telephone numbers of participating employers and the number of employees covered by the MEWA;

(4) A statement of the reasons for applying for a North Carolina MEWA license;

(5) A description of how the MEWA proposes to develop and supervise its operations in North Carolina;

(6) The name, title, and qualifications of the person who will be responsible for the MEWA's operation in North Carolina (the managing general agent if the MEWA is domiciled outside of North Carolina); and

(7) The location of and a description of the office facilities that will be provided by the MEWA in North Carolina.

(c) All forms may be obtained from the Department's website at http://www.ncdoi.com/LH/Licensing,Renewals_and_Other-_MEWA.aspx#Certificate. Every application shall contain a certification that any changes to the information required by G.S. 58-49-50 and this Rule shall be reported to the Commissioner.

(d) During the pendency of an application, the MEWA shall update the Commissioner of any changes in the required information, statements, documents, and materials.

(e) An application for a license is not complete until the MEWA has satisfied the Commissioner that the MEWA is in compliance with all of the requirements of Article 49 of General Statute Chapter 58 and this Section. The Commissioner shall not process an incomplete application.

(f) All financial information required by G.S. 58-49-50 and the rules of this Section shall be prepared in accordance with statutory accounting principles.

(g) Any change in the information required by Article 49 of General Statute Chapter 58 or by this Section shall, unless otherwise specified in that Article or in this Section, be reported to the Commissioner within two business days after such change.

History

  • Authority G.S. 58-2-40(1); 58-49-40; 58-49-50; 58-49-60
  • Eff. July 1, 1992
  • Readopted Eff. December 1, 2017.
11 NCAC 18 .0104 Financial {#sec-11-ncac-18-.0104 omnilex-key=us-nc-regs-official--title-11--11 NCAC 18 .0104}

(a) A MEWA may participate in a cash management program as long as the MEWA has direct access to its funds at all times and the depository or custodian maintains a separate accounting for each account. The depository or custodian must be a national or state bank, savings and loan association, or trust company.

(b) No surplus note(s) or the interest thereon shall be paid or repaid without the specific written approval of the Department. If there is more than one surplus note, each note shall have its own unique identification number in the upper left hand corner of each page of the document.

History

  • Authority G.S. 58-2-40(1); 58-49-40; 58-49-60
  • Eff. August 3, 1992
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 16, 2014.
11 NCAC 18 .0105 Administrative, Provider, and Management Contracts {#sec-11-ncac-18-.0105 omnilex-key=us-nc-regs-official--title-11--11 NCAC 18 .0105}

(a) As used in this Rule, "fees" means any compensation, including but not limited to, cash or other assets of a MEWA that is transferred for either contracted or noncontracted services that are rendered to the sponsoring association or the MEWA.

(b) A MEWA is prohibited from paying any fees, other than for reimbursement of specific expenses, to its sponsoring association unless the services rendered to the MEWA are available to the MEWA from persons other than the sponsoring association.

(c) The fees for such services shall not be in excess of what would be charged in an arms length transaction. Reasonable fees may also be determined by comparing those charged to other MEWAs in North Carolina.

(d) A MEWA shall give the Commissioner written notification of any proposed change to a management or administrative contract at least 45 days before the effective date of such change.

History

  • Authority G.S. 58-2-40(1); 58-49-40; 58-49-50
  • Eff. July 1, 1992
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 16, 2014.
11 NCAC 18 .0106 Annual Report {#sec-11-ncac-18-.0106 omnilex-key=us-nc-regs-official--title-11--11 NCAC 18 .0106}

A request for an extension of time to file an annual report must be made in writing and filed with the Department no later than 15 days before the due date of the annual report. Any request for extension received less than 15 days before the due date of the annual report shall be denied except in instances of death or disability of key personnel or destruction of records by fire or by another event clearly out of the MEWA's control.

History

  • Authority G.S. 58-2-40(1); 58-49-40; 58-49-60
  • Eff. July 1, 1992
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 16, 2014.
11 NCAC 18 .0107 Examination by the Department {#sec-11-ncac-18-.0107 omnilex-key=us-nc-regs-official--title-11--11 NCAC 18 .0107}

If the Department determines that the records of a MEWA are not adequate to make a determination of solvency or insolvency, the Department may take any action, administrative or otherwise, available to the Department as if the MEWA were insolvent.

History

  • Authority G.S. 58-2-40(1); 58-49-40; 58-49-55; 58-49-65
  • Eff. July 1, 1992
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 16, 2014.
11 NCAC 18 .0108 Power of Attorney {#sec-11-ncac-18-.0108 omnilex-key=us-nc-regs-official--title-11--11 NCAC 18 .0108}

A power of attorney appointing an individual to receive service of legal process must be submitted by every MEWA on Form MEWA-4 entitled "Power of Attorney". Such individual shall be a resident of North Carolina and either a corporate official of the MEWA or the MEWA's managing general agent for the State, and must be readily accessible and available for service. Both the residential and business addresses of such individual must be provided. Any change in the power of attorney after issuance of the MEWA's license must be reported to the Commissioner within two business days after the effective date of the change.

History

  • Authority G.S. 58-2-40(1); 58-16-30; 58-49-40; 58-49-50
  • Eff. July 1, 1992
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 16, 2014.
11 NCAC 18 .0109 Fidelity Bond {#sec-11-ncac-18-.0109 omnilex-key=us-nc-regs-official--title-11--11 NCAC 18 .0109}

The fidelity bond required by G.S. 58-49-50(5) shall be issued only by a surety company licensed to transact insurance in North Carolina. The bond shall be in an amount equal to no less than 10 percent of the funds or assets of the MEWA that are managed or handled annually, subject to the minimum and maximum amounts stated in G.S. 58-49-50(5). The MEWA shall notify the Commissioner of any change to the bond, including termination, change in bond amount, or change in bonded MEWA employee, within two business days after the effective date of the change.

History

  • Authority G.S. 58-2-40(1); 58-49-40; 58-49-50
  • Eff. July 1, 1992
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 16, 2014.
11 NCAC 18 .0110 Sales and Marketing {#sec-11-ncac-18-.0110 omnilex-key=us-nc-regs-official--title-11--11 NCAC 18 .0110}

Any person who solicits memberships for a MEWA shall solicit only eligible member employers of the sponsoring association, and only if that person is appointed to solicit by the Board of Trustees of the MEWA. The sponsoring association shall provide the representative with a list of eligible member employers that are not in the MEWA.

History

  • Authority G.S. 58-2-40(1); 58-49-40; 58-49-50
  • Eff. July 1, 1992
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 16, 2014.
11 NCAC 18 .0111 Disclosure {#sec-11-ncac-18-.0111 omnilex-key=us-nc-regs-official--title-11--11 NCAC 18 .0111}

Any person who advertises or solicits coverage on behalf of a MEWA or who in any manner secures, helps, or aids in the planning or administration of coverage with any MEWA shall:

(1) Prominently disclose in writing to every employer being solicited for participation the information specified in G.S. 58-49-25 and 58-49-40(b); and

(2) Provide such employer with a statement, if applicable, as to which provisions of North Carolina insurance statutes and rules, such as mandated benefits, freedom of choice of providers, continuation or conversion privileges, pre-existing conditions limitations, or premium rate revision guarantees, are not afforded by the MEWA.

History

  • Authority G.S. 58-2-40(1); 58-49-25; 58-49-40; 58-49-50
  • Eff. July 1, 1992
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 16, 2014.
11 NCAC 18 .0112 Claims Payments {#sec-11-ncac-18-.0112 omnilex-key=us-nc-regs-official--title-11--11 NCAC 18 .0112}

In order to assure that all valid claims for payments for benefits provided are paid within a reasonable time, the following standards apply:

(1) Each MEWA shall pay within 30 days of receipt by the MEWA or its administrator, if applicable, all valid claims for benefits.

(2) If the MEWA requires additional information, the MEWA shall request such additional information in writing within the 30-day period; and upon receipt of the additional information, the claim shall be paid within 30 days of receipt of the additional information.

(3) If the claim is denied, the MEWA shall provide the reason or reasons for the denial in writing to the claimant and the claimant's health care provider.

History

  • Authority G.S. 58-2-40(1); 58-49-40; 58-49-50
  • Eff. July 1, 1992
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 16, 2014.
11 NCAC 18 .0113 Dissolution {#sec-11-ncac-18-.0113 omnilex-key=us-nc-regs-official--title-11--11 NCAC 18 .0113}

Any application to dissolve a MEWA must be made on Form MEWA-5 entitled "Application for Dissolution". An application for dissolution will not be considered to have been received by the Commissioner until it has been completed to his satisfaction. Such application shall be filed with the Commissioner at the same time the MEWA files articles of dissolution with the Secretary of State of North Carolina, a copy of which articles shall accompany the application.

History

  • Authority G.S. 58-2-40(1); 58-49-40; 58-49-50
  • Eff. July 1, 1992
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 16, 2014.
11 NCAC 18 .0114 Definitions {#sec-11-ncac-18-.0114 omnilex-key=us-nc-regs-official--title-11--11 NCAC 18 .0114}

As used in this Rule and in 11 NCAC 18 .0115, 11 NCAC 18 .0116, and 11 NCAC 18 .0117, the following terms have the meanings ascribed to them:

(1) "Claims accrued" means that portion of claims incurred on or prior to the valuation date that result in liability of the MEWA for the payment of benefits for medical services that have been rendered on or prior to the valuation date, and for the payment of benefits for days of hospitalization and days of disability that have occurred on or prior to the valuation date, that the MEWA has not paid as of the valuation date, but for which it is liable, and will have to pay after the valuation date. This liability is sometimes referred to as a liability for accrued benefits.

(2) "Claims reported" means when a MEWA has been informed that a claim has been incurred, if the date reported is on or prior to the valuation date, the claim is considered as a reported claim for annual statement purposes.

(3) "Claims unaccrued" means that portion of claims incurred on or before the valuation date that result in liability of the MEWA for the payment of benefits for medical services expected to be rendered after the valuation date, and for benefits expected to be payable for days of hospitalization and days of disability occurring after the valuation date. This liability is sometimes referred to as a liability for unaccrued benefits.

(4) "Claims unreported" means when a MEWA has not been informed, on or before the valuation date, concerning a claim that has been incurred on or prior to the valuation date, the claim is considered as an unreported claim for annual statement purposes.

(5) "Claim reserves" mean reserves or liabilities held for claims incurred on or before the valuation date, but unpaid as of the valuation date. Claim reserves include both reported and unreported claims. Claim reserves are established for both accrued and unaccrued benefits.

(6) "Incurred date" means the date that a claim is determined to be a liability of the MEWA. For example, the charges for inpatient hospital and physician visits in hospitals would be assigned an incurred date equal to the date of admission; outpatient hospital charges would be assigned an incurred date equal to the date of service; surgical expenses would be assigned an incurred date equal to the date of the surgery.

(7) "Unearned premium reserves" mean reserves established for premiums received that produce insuring periods extending beyond the valuation date.

History

  • Authority G.S. 58-2-40; 58-49-40; 58-49-60
  • Eff. July 1, 1992
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 16, 2014.
11 NCAC 18 .0115 Minimum Reserve Standards {#sec-11-ncac-18-.0115 omnilex-key=us-nc-regs-official--title-11--11 NCAC 18 .0115}

(a) The following two categories of reserves shall be established by every MEWA:

(1) Claim reserves; and

(2) Premium reserves.

(b) The adequacy of a MEWA's health insurance reserves shall be determined on the basis of the two categories combined; however, the standards in this Rule and in 11 NCAC 18 .0116 and .0117 emphasize the importance of determining appropriate reserves for each category separately.

(c) When a MEWA determines that adequacy of its health insurance reserves requires reserves in excess of these minimum standards, such increased reserves shall be held and shall be considered the minimum reserves for that MEWA.

History

  • Authority G.S. 58-2-40; 58-49-40; 58-49-60
  • Eff. July 1, 1992
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 16, 2014.
11 NCAC 18 .0116 Claim Reserves {#sec-11-ncac-18-.0116 omnilex-key=us-nc-regs-official--title-11--11 NCAC 18 .0116}

(a) Minimum claim reserves are required for all incurred but unpaid claims, which include claims accrued and claims unaccrued.

(b) For the current year exposures, where historical claim information is either not available or not credible as determined by an actuary, the minimum claim reserve shall be calculated in the following manner:

(1) Calculate the total earned premium as of the end of a valuation period for each policy form, group of policy forms, master contract, or group of master contracts.

(2) Multiply the total earned premium by the expected incurred loss ratio for each policy form, group of policy forms, master contract, or group of master contracts. The sum of the results of these multiplications is referred to as the "total incurred claims".

(3) Subtract from the total incurred claims the total amount of claims paid as of the end of a valuation period. The result of this subtraction is the total "minimum" amount that shall be added to the claim reserves established at the beginning of the valuation period.

(4) The calculations in Subparagraphs (b)(1) and (2) of this Rule may give recognition to duration.

(c) For later years of exposures, where historical claim information is available and credible as determined by an actuary, the minimum reserve shall be calculated using any generally accepted or reasonable actuarial claim runoff method. Claim runoff schedules shall be developed by using appropriate incurred dates and paid dates for claims. Adequacy of the claim reserves shall be determined in the aggregate.

(d) Appropriate claim expense reserves are required with respect to the estimated expense of settlement of all incurred but unpaid claims. Claim settlement expenses shall include both allocated and unallocated expenses.

(e) All claim reserves for prior valuation periods shall be tested for adequacy and reasonableness along the lines of claim runoff schedules in accordance with the statutory financial statement including consideration of any residual unpaid liability.

(f) Each MEWA shall develop a follow-up study comparing its previous reserve estimates against subsequent claims actually paid together with the remaining estimated liability as of the valuation date. The results of this study shall be filed with the Actuarial Service Division of the Department by March 1 of each calendar year.

History

  • Authority G.S. 58-2-40; 58-49-40; 58-49-60
  • Eff. August 3, 1992
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 16, 2014.
11 NCAC 18 .0117 Premium Reserves {#sec-11-ncac-18-.0117 omnilex-key=us-nc-regs-official--title-11--11 NCAC 18 .0117}

(a) Unearned premium reserves are required for all MEWAs with respect to the period of coverage for which premiums, other than premiums paid in advance, have been paid beyond the date of valuation.

(b) If premiums due and unpaid are carried as an asset, such premiums must be treated as premiums in force, subject to unearned premium reserve determination. The value of the unpaid commissions and the cost of collection associated with due and unpaid premiums must be carried as an offsetting liability.

(c) The minimum unearned premium reserve with respect to any contract is the pro rata gross unearned modal premium that applies to the premium period beyond the valuation date.

(d) MEWAs may employ suitable approximations or estimates, including groupings, averages, and aggregate estimation, in computing premium reserves. Such approximations or estimates shall be tested periodically to determine their continuing adequacy and reliability.

History

  • Authority G.S. 58-2-40; 58-49-40; 58-49-60
  • Eff. July 1, 1992
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 16, 2014.
11 NCAC 18 .0118 Maximum Net Retention Standard {#sec-11-ncac-18-.0118 omnilex-key=us-nc-regs-official--title-11--11 NCAC 18 .0118}

(a) The specific maximum net retention limit for any MEWA, associated with the period of time that the excess insurance coverage is in force, shall be calculated in the following manner:

(1) Determine the total expected dollar value of claims;

(2) Determine the total surplus at the beginning of the period of time that the excess insurance coverage is scheduled to be in force;

(3) Multiply Subparagraph (a)(1) of this Rule by one percent and add that product to Subparagraph (a)(2) of this Rule;

(4) Multiply the result of the calculation in Subparagraph (a)(3) of this Rule times itself;

(5) Multiply Subparagraph (a)(1) of this Rule by the number 3.4; and

(6) Divide the product of the calculation in Subparagraph (a)(4) of this Rule by the product of the calculation in Subparagraph (a)(5) of this Rule.

(b) The specific maximum net retention limit shall not exceed the lesser of:

(1) The amount in Subparagraph (a)(6) of this Rule;

(2) Twenty-five thousand dollars ($25,000); or

(3) The specific maximum net retention limit determined by or for the MEWA in accordance with sound actuarial principles.

(c) The aggregate maximum net retention shall not exceed the lesser of:

(1) One hundred twenty-five percent of Subparagraph (a)(1) of this Rule; or

(2) The aggregate maximum net retention limit determined by or for the MEWA in accordance with sound actuarial principles.

(d) The Commissioner may approve a specific maximum net retention limit or an aggregate maximum net retention limit or both in excess of those calculated pursuant to this Rule, upon application to the Commissioner and the Commissioner's determination that the increase would not inhibit the ability of the MEWA to perform its present and future contractual obligations to policyholders and participants under the MEWA's plan.

History

  • History Note Authority G.S. 58-2-40; 58-49-40(c)
  • Eff. July 1, 1992
  • Amended Eff. October 1, 2008
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 16, 2014.
11 NCAC 18 .0119 "qualified Actuary"; Maximum Net Retention Filing {#sec-11-ncac-18-.0119 omnilex-key=us-nc-regs-official--title-11--11 NCAC 18 .0119}

(a) As used in this Rule and in 11 NCAC 18 .0120 and 11 NCAC 18 .0121, "qualified actuary" means an individual who is either an Associate or Fellow of the Society of Actuaries or a Member of the American Academy of Actuaries and who has at least five years of actuarial experience with MEWAs.

(b) Every year each MEWA shall calculate its maximum net retention limit in accordance with 11 NCAC 18 .0118. This calculation must be performed before the anniversary date of the MEWA's stop-loss insurance contract and shall be filed, no later than 30 days before the anniversary date of the stop-loss insurance contract, with the Actuarial Services Division of the Department. This calculation shall include the numerical results of all steps in 11 NCAC 18 .0118 and shall be performed by a qualified actuary.

History

  • Authority G.S. 58-2-40; 58-49-40(c); 58-49-50
  • Eff. July 1, 1994
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 16, 2014.
11 NCAC 18 .0120 Certification of Reserves Filing {#sec-11-ncac-18-.0120 omnilex-key=us-nc-regs-official--title-11--11 NCAC 18 .0120}

Every year each MEWA shall file the following actuarial certifications executed by a qualified actuary in the following manner:

"I (Name of Qualified Actuary) am a qualified actuary as defined by 11 NCAC 18 .0119(a) and I have reviewed:"

(1) 11 NCAC 18 .0115 titled, "Minimum Reserve Standards," and I certify that if the adequacy of the MEWA's reserves requires reserves in excess of the minimum standards described in 11 NCAC 18 .0116 and 11 NCAC 18 .0117, then such increased reserves will be held and considered the minimum reserves for (Name of MEWA).

(2) 11 NCAC 18 .0116 titled, "Claim Reserves," and I certify that the MEWA's claim reserves are being calculated in an actuarially sound manner that produces reserves at least as great as those prescribed in 11 NCAC 18 .0116.

(3) 11 NCAC 18 .0117 titled, "Premium Reserves," and I certify that the MEWA's premium reserves are being calculated in an actuarially sound manner that produces reserves at least as great as those prescribed in 11 NCAC 18 .0117.

(4) 11 NCAC 18 .0118 titled, "Maximum Net Retention Standard," and I certify that the MEWA's maximum net retention limits are being calculated in an actuarially sound manner that produces maximum net retention limits no greater than those prescribed in 11 NCAC 18 .0118, unless the Commissioner of Insurance has approved such higher limits as described in 11 NCAC 18 .0118(d).

History

  • Authority G.S. 58-2-40; 58-49-40(c)
  • Eff. July 1, 1994
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 16, 2014.
11 NCAC 18 .0121 Definitions and Certification of Rates Filing {#sec-11-ncac-18-.0121 omnilex-key=us-nc-regs-official--title-11--11 NCAC 18 .0121}

(a) As used in this Rule, the following terms have the meanings ascribed to them:

(1) "Rates are adequate" for a given block of policies or certificates means that the total payments collected now and in the future by the MEWA plus the investment earnings attributable to any net retained funds should be at least sufficient to fund the current and future benefits promised plus cover related expenses.

(2) "Block of policies" means all policies or certificates issued by the MEWA under the same schedule of rates and on the same policy form or under the same group master contract.

(3) "Rates are not excessive" for a given block of policies or certificates means that the most recent calendar year incurred loss ratio is greater than or equal to one minus the expense ratio for that given block of policies or certificates.

(4) "Expense ratio" means the ratio of the MEWA's operating expenses for a block of policies or certificates to its earned premium for that block of policies or certificates.

(5) "Operating expense" means any combination of the following expenses:

(A) Commissions;

(B) Other acquisition;

(C) General administration;

(D) Taxes, licenses, and fees; and

(E) Profit and contingency margin.

(6) Rates are not "unfairly discriminatory" if they reflect equitably differences in expected risk.

(b) Every year each MEWA shall file the following actuarial certification executed by a qualified actuary in the following manner:

"I (Name of Qualified Actuary) am a qualified actuary as defined in 11 NCAC 18 .0119(a) and I certify that the rates developed for (Name of MEWA) are calculated in an actuarially sound manner and that these rates are adequate, not excessive, and not unfairly discriminato­ry."

History

  • Authority G.S. 58-2-40; 58-49-40(c); 58-49-50
  • Eff. July 1, 1994
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 16, 2014.

Chapter 19 Market Regulation Division

11 NCAC 19 .0101 Report and Collection Procedures {#sec-11-ncac-19-.0101 omnilex-key=us-nc-regs-official--title-11--11 NCAC 19 .0101}

History

  • Status: expired
  • Authority G.S. 58-2-40(1); 58-2-50; 58-2-131; 58-2-132; 58-2-133; 58-2-134; 58-2-155; 58-6-5; 58-20-30; 58-21-40; 58-21-75; 58-22-20(6); 58-23-25; 58-24-135; 58-27-10; 58-36-85(1); 58-39-70; 58-47-100; 58-48-65; 58-49-55; 58-56-16; 58-62-66; 58-63-20; 58-64-55; 58-65-105; 58-67-100
  • Eff. March 1, 1993
  • Expired Eff. January 1, 2016 pursuant to G.S. 150B-21.3A.
11 NCAC 19 .0102 Maintenance of Records {#sec-11-ncac-19-.0102 omnilex-key=us-nc-regs-official--title-11--11 NCAC 19 .0102}

(a) Every insurer licensed to do business in this State shall maintain for at least five years all records, books, documents, and other business records that are required by this Section and by Chapter 58 of the North Carolina General Statutes.

(b) Every agency, agent, broker, or producer of record shall maintain a file for each policy sold. The file shall contain all work papers and written communications in his or her possession pertaining to that policy. These records shall be retained for at least five years after the final disposition or, for domestic companies, until the Commissioner has adopted a final report of a general examination that contains a review of these records for that calendar year, whichever is later.

History

  • Authority G.S. 58-2-40(1); 58-2-50; 58-2-131; 58-2-132; 58-2-133; 58-2-134; 58-2-185; 58-2-190; 58-2-195; 58-2-200; 58-7-50; 58-20-30; 58-21-40; 58-21-75; 58-22-20(6); 58-23-25; 58-24-135; 58-27-10; 58-36-85(1); 58-39-70; 58-41-15; 58-41-20; 58-41-25; 58-47-100; 58-48-65; 58-49-55; 58-56-16; 58-62-66; 58-63-20; 58-64-55; 58-65-105; 58-67-100
  • Eff. March 1, 1993
  • Amended Eff. January 1, 2009; August 1, 1998
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 20, 2015.
11 NCAC 19 .0103 Complaint Records {#sec-11-ncac-19-.0103 omnilex-key=us-nc-regs-official--title-11--11 NCAC 19 .0103}

Each insurer or its agents shall maintain or cause to be maintained an itemization register or log of every written complaint listing the Department's file number, the name of the insured, the nature of the complaint, the insurer's department subject to the complaint, the policy or claim number of the insured, and the final disposition of the complaint. These records shall be retained for at least five years after the final disposition of the complaint or, for domestic companies, until the Commissioner has adopted a final report of a general examination that contains a review of these records for that calendar year, whichever is later.

History

  • Authority G.S. 58-2-40(1); 58-2-50; 58-2-131; 58-2-132;58-2-133; 58-2-134; 58-2-195; 58-7-50; 58-20-30; 58-21-40; 58-36-85(1); 58-47-100; 58-21-75; 58-22-20(6); 58-23-25; 58-24-135; 58-27-10; 58-39-70; 58-48-65; 58-49-55; 58-56-16; 58-62-66; 58-63-20; 58-64-55; 58-65-105; 58-67-100
  • Eff. March 1, 1993
  • Amended Eff. January 1, 2009; August 1, 1998
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 20, 2015.
11 NCAC 19 .0104 Policy Records {#sec-11-ncac-19-.0104 omnilex-key=us-nc-regs-official--title-11--11 NCAC 19 .0104}

Each insurer or its agents shall maintain or cause to be maintained a record of each policy that specifies the policy period, basis for rating, and if terminated, documentation supporting policy termination by the insurer or policyholder, and accounting records indicating return premium amounts. These records shall be retained for at least five years after the termination of the policy or, for domestic companies until the Commissioner has adopted a final report of a general examination that contains a review of these records for that calendar year, whichever is later.

History

  • Authority G.S. 58-2-40(1); 58-2-50; 58-2-131; 58-2-132; 58-2-133; 58-2-134; 58-2-190; 58-2-195; 58-7-50; 58-20-30; 58-21-40; 58-21-75; 58-22-20(6); 58-23-25; 58-24-135; 58-27-10; 58-36-85(1); 58-39-70; 58-47-100; 58-48-65; 58-49-55; 58-56-16; 58-62-66; 58-63-20; 58-64-55; 58-65-105; 58-67-100
  • Eff. March 1, 1993
  • Amended Eff. January 1, 2009; August 1, 1998
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 20, 2015.
11 NCAC 19 .0105 Claim Records {#sec-11-ncac-19-.0105 omnilex-key=us-nc-regs-official--title-11--11 NCAC 19 .0105}

Each insurer or its agents shall maintain or cause to be maintained a record of all claim reports that specifies the inception, handling, and disposition of each claim. These records shall be retained for at least five years after the claim is settled or, for domestic companies, until the Commissioner has adopted a final report of a general examination that contains a review of these records for that calendar year, whichever is later.

History

  • Authority G.S. 58-2-40(1); 58-2-50; 58-2-131; 58-2-132; 58-2-133; 58-2-134; 58-2-190; 58-2-195; 58-20-30; 58-21-40; 58-21-75; 58-22-20(6); 58-23-25; 58-24-135; 58-27-10; 58-36-85(1); 58-39-70; 58-48-65; 58-47-100; 58-49-55; 58-56-16; 58-62-66; 58-63-20; 58-64-55; 58-65-105; 58-67-100
  • Eff. March 1, 1993
  • Amended Eff. January 1, 2009
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 20, 2015.
11 NCAC 19 .0106 Records Required for Examination {#sec-11-ncac-19-.0106 omnilex-key=us-nc-regs-official--title-11--11 NCAC 19 .0106}

(a) Market conduct examinations of property and liability insurers. Insurers being examined by the Department shall provide examiners access to information about the following areas of operation:

(1) Company overview: history and profile, company operations and management, and certificates of authority;

(2) Policyholder treatment: consumer complaints;

(3) Marketing: policy forms and filings, sales and advertising, agency management;

(4) Underwriting and rating practices: personal lines and commercial lines; all terminations (cancellations and nonrenewals) and declinations or rejections; and

(5) Claims practices: organization and procedures, closed with payment, closed without payment, total loss settlements (salvage), subrogation, and litigation.

(b) Market conduct examinations of life and health insurers. Insurers being examined by the Department shall provide examiners access to information about the following areas of operation:

(1) Company overview: history and profile, company operations and management, and certificates of authority;

(2) Policyholder treatment: consumer complaints, nonforfeiture benefits (policy loans, cash surrenders, extended term and reduced paid-up);

(3) Marketing: policy forms and filings, sales and advertising, and agency management;

(4) Underwriting and rating practices: life (individual and group), health (individual and group), annuities (individual and group); declinations (individual and group); annuity suitability questionnaires; and

(5) Claims practices: life (individual and group), health (individual and group) annuities (individual and group).

(c) Market conduct examinations of full service and single service health maintenance organizations. Health maintenance organizations being examined by the Department shall provide examiners access to information about the following areas of operation:

(1) Company overview: articles of incorporation, bylaws, history and profile, company operations and management, risk management policies, and data protection plan;

(2) Provider delivery systems: provider manual, provider contracting policies and procedures, provider directories, and availability and accessibility standards and monitoring reports related to these standards;

(3) Management agreements: management agreements, intermediary contracts, intermediary certifications, and provider agreements;

(4) Utilization management: utilization management plan, utilization management policies and procedures, annual utilization management certifications, utilization management monthly telephone reports, precertification records, and appeals of noncertification records;

(5) Quality management: quality management plan, quality management policies and procedures, quality management committee minutes, quality of care complaints, and quality management annual program evaluation;

(6) Provider credentialing: credentialing plan, credentialing policies and procedures, and credential files;

(7) Claims practices: policies and procedures, reports of processed and denied claims, claims records;

(8) Policyholder treatment: member services' policies and procedures, member services complaint logs, member complaint records, member services monthly telephone reports, late enrollment guidelines, and member materials;

(9) Marketing: agent and broker files, agent appointment and termination listings, marketing training materials, sales and advertising materials, and policy forms and filings;

(10) Underwriting and rating practices: underwriting manual, annual rate filings, overview of rate development for each filed methodology, and underwriting files; and

(11) Oversight of delegated functions: oversight committee activity, oversight monitoring tools, and audits.

(d) Market conduct examinations of managed care plans, Managed care plans being examined by the Department shall provide examiners access to information about the areas of operation referenced in Paragraphs (b) and (c) of this Rule.

(e) If the Department requests specific records relative to the areas of operations referenced in Paragraphs (a), (b), (c), and (d) of this Rule by prior written notification or in a pre-examination conference, the records shall be made available to the examinations staff when the staff arrives at the insurer's office, or shall be sent to the Department if requested.

(f) Additional records shall be made available by the insurer on the date of arrival if the Department has requested that those records be made available for the examination. Additional records, not previously requested, may be required during and after an examination. Work space that will accommodate the exam team and equipment shall be provided by the insurer to the examiners to expedite the examiners' review of the records.

(g) Information about the areas of operation referenced in Paragraphs (a), (b), (c), and (d) of this Rule shall be maintained by every insurer for at least five years.

History

  • Authority G.S. 58-2-40(1); 58-2-50; 58-2-131; 58-2-132; 58-2-133; 58-2-134; 58-2-190; 58-2-195; 58-7-50; 58-20-30; 58-21-40; 58-21-75; 58-22-20(6); 58-23-25; 58-24-135; 58-27-10; 58-36-85(1); 58-39-70; 58-47-100; 58-48-65; 58-49-55; 58-50-56; 58-50-61; 58-50-62; 58-56-16; 58-62-66; 58-63-20; 58-64-55; 58-65-105; 58-67-10; 58-67-11; 58-67-100
  • Eff. March 1, 1993
  • Amended Eff. January 1, 2009; August 1, 1998
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 20, 2015.
11 NCAC 19 .0107 Original and Duplicate Records {#sec-11-ncac-19-.0107 omnilex-key=us-nc-regs-official--title-11--11 NCAC 19 .0107}

(a) All records that are required to be maintained by this Chapter shall be either original or duplicate records, as defined in this Rule.

(b) For the purpose of this Chapter, an "original record" is the writing or recording itself or any counterpart intended to have the same effect by a person executing or issuing it. An "original" of a photograph includes the negative or any print therefrom. If data are, in the normal and ordinary course of business, stored in a computer or similar device, any printout or other output readable by sight, shown to reflect the data accurately, is an "original record".

(c) For the purpose of this Chapter, a "duplicate record" is a counterpart produced by the same impression as the original record, or from the same matrix, or by mechanical or electronic re-recording or by chemical reproduction, or by equivalent techniques, such as imaging or image processing, that accurately reproduce the original record.

(d) If only duplicate records are maintained, the following requirements must be met:

(1) The data must be easily accessible to the Department in readable form; and readable, reproduced copies must be obtainable;

(2) Before the destruction of any original records, the person in possession of the original records shall verify that the records stored consist of all information contained in the original records and that the original records can be constructed therefrom in a form acceptable to the Department; and

(3) Adequate controls must be established with respect to the transfer and maintenance of data.

(e) Disaster preparedness or disaster recovery procedures that include provisions for the maintenance or reconstruction of original or duplicate records at another location must be maintained.

(f) Every foreign insurer licensed in North Carolina shall be in substantial compliance with this Rule.

History

  • Authority G.S. 58-2-40(1); 58-2-50; 58-2-131; 58-2-132; 58-2-133; 58-2-134; 58-2-185; 58-2-190; 58-2-195; 58-20-30; 58-21-40; 58-21-75; 58-22-20(6); 58-23-25; 58-24-135; 58-27-10; 58-36-85(1); 58-39-70; 58-47-100; 58-48-65; 58-49-55; 58-56-16; 58-62-66; 58-63-20; 58-64-55; 58-65-105; 58-67-100
  • Eff. March 1, 1993
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 20, 2015.
11 NCAC 19 .0108 Definitions {#sec-11-ncac-19-.0108 omnilex-key=us-nc-regs-official--title-11--11 NCAC 19 .0108}

As used in this Chapter:

(1) Examination is defined in G.S. 58-2-131(b)(2).

(2) Examiner is defined in G.S. 58-2-131(b)(3).

(3) Health maintenance organization is defined in G.S. 58-67-5(f).

(4) Insurer includes a health maintenance organization, service corporation, and a multiple employer welfare arrangement.

(5) Managed care plan is defined in G.S. 58-50-61(a)(11).

(6) Provider is defined in G.S. 58-67-5(h).

History

  • Authority G.S. 58-2-40(1); 58-2-50; 58-2-131; 58-2-132; 58-2-133; 58-2-134; 58-2-190; 58-2-195; 58-7-50; 58-20-30; 58-21-40; 58-21-75; 58-22-20(6); 58-23-25; 58-24-135; 58-27-10; 58-36-85(1); 58-39-70; 58-47-100; 58-48-65; 58-49-55; 58-50-56, 58-50-61, 58-50-62, 58-56-16; 58-62-66; 58-63-20; 58-64-55; 58-65-105; 58-67-10; 58-67-11; 58-67-100
  • Eff. January 1, 2009
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 20, 2015.

Chapter 20 Managed Care Health Benefit Plans

11 NCAC 20 .0101 Scope and Definitions {#sec-11-ncac-20-.0101 omnilex-key=us-nc-regs-official--title-11--11 NCAC 20 .0101}

(a) Scope.

(1) Sections .0200, .0300, and .0400 of this Chapter shall apply to HMOs, licensed insurers offering PPO benefit plans, and any other entity that is a network plan carrier as defined in this Rule.

(2) Sections .0500 and .0600 of this Chapter shall apply only to HMOs.

(3) Nothing in this Chapter shall apply to service corporations offering benefit plans pursuant to G.S. 58-65-25 or G.S. 58-65-30 that do not have any differences in copayments, coinsurance, or deductibles based on the use of network versus non-network providers.

(b) Definitions. As used in this Chapter:

(1) "Carrier" means a network plan carrier.

(2) "Health care provider" means any person who is licensed, registered, or certified pursuant to Chapter 90 of the General Statutes; a health care facility as defined in G.S. 131E-176(9b); or a pharmacy.

(3) "Health maintenance organization" or "HMO" has the same meaning as in G.S. 58-67-5(f).

(4) "Intermediary" or "intermediary organization" means any entity that employs or contracts with health care providers for the provision of health care services and that also contracts with a network plan carrier or its intermediary.

(5) "Member" means an individual who is insured by a network plan carrier.

(6) "Network plan carrier" means an insurer, health maintenance organization, or any other entity acting as an insurer as defined in G.S. 58-1-5(3) that provides reimbursement or provides or arranges to provide health care services and uses increased copayments, deductibles, or other benefit reductions for services rendered by non-network providers to encourage members to use network providers.

(7) "Network provider" means any health care provider participating in a network utilized by a network plan carrier.

(8) "PPO benefit plan" means a benefit plan that is offered by a hospital or medical service corporation or network plan carrier, pursuant to G.S. 58-50-56, in which plan:

(A) either or both of the following features are present:

(i) utilization review or quality management programs are used to manage the provision of covered services; or

(ii) enrollees are given incentives via benefit differentials to limit the receipt of covered services to those furnished by participating providers; and

(B) health care services are provided by participating providers who are paid on negotiated or discounted fee-for-service bases or have agreed to accept special reimbursement or other terms for health care services under a contract with the hospital or medical service corporation or network plan carrier.

(9) "Provider" means a health care provider.

(10) "Quality management" means a program of reviews, studies, evaluations, and other activities used to monitor and enhance the quality of health care and services provided to members.

(11) "Service area" means the geographic area in North Carolina as described by the HMO pursuant to G.S. 58-67-10(c)(11) where an HMO enrolls persons who either work in the service area, reside in the service area, or work and reside in the service area, as approved by the Commissioner pursuant to G.S. 58-67-20.

(12) "Service corporation" means a medical or hospital service corporation operating pursuant to Article 65 of Chapter 58 of the General Statutes.

(13) "Single service HMO" means an HMO that undertakes to provide or arrange for the delivery of a single type or single group of health care services to a defined population on a prepaid or capitated basis, except for a member's responsibility for non-covered services, coinsurance, copayments, or deductibles.

(14) "Utilization review" has the same meaning as in G.S. 58-50-61(17).

History

  • Authority G.S. 58-2-40(1); 58-50-61; 58-65-1; 58-67-150
  • Eff. October 1, 1996
  • Amended Eff. July 1, 2006
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 16, 2014
  • Temporary Amendment Eff. September 24, 2018
  • Amended Eff. February 1, 2019.
11 NCAC 20 .0201 Written Contracts {#sec-11-ncac-20-.0201 omnilex-key=us-nc-regs-official--title-11--11 NCAC 20 .0201}

(a) All contracts between network plan carriers and health care providers and between network plan carriers and intermediary organizations offering networks of health care providers to be used by network plan carriers for the provision of care on a preferred or in-network basis shall be in writing and shall comply with 11 NCAC 20 .0202 as a condition of such health care providers' and networks' being listed in the carrier's provider directory.

(b) The form of every contract under Paragraph (a) of this Rule shall be filed with the Division for approval according to these Rules before it is used.

(c) As used in this Section and in Section .0600 of this Chapter, "Division" means the Life and Health Division of the Department of Insurance.

History

  • Authority G.S. 58-2-40(1); 58-50-50; 58-50-55; 58-65-25; 58-65-140; 58-67-10; 58-67-20; 58-67-35; 58-67-65; 58-67-140; 58-67-150
  • Eff. October 1, 1996
  • Amended Eff. July 1, 2006
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 16, 2014.
11 NCAC 20 .0202 Contract Provisions {#sec-11-ncac-20-.0202 omnilex-key=us-nc-regs-official--title-11--11 NCAC 20 .0202}

All contract forms shall contain provisions addressing the following:

(1) Whether the contract and any attached or incorporated amendments, exhibits, or appendices constitute the entire contract between the parties.

(2) Definitions of technical insurance or managed care terms used in the contract, and whether those definitions reference other documents distributed to providers and are consistent with definitions included in the evidence of coverage issued in conjunction with the network plan.

(3) Term of the contract.

(4) Any requirements for written notice of termination and each party's grounds for termination.

(5) The provider's continuing obligations after termination of the provider contract or in the case of the carrier or intermediary's insolvency. The obligations shall address:

(a) Transition of administrative duties and records.

(b) Continuation of care, when inpatient care is on-going. If the carrier provides or arranges for the delivery of health care services on a prepaid basis, inpatient care shall be continued until the patient is ready for discharge.

(6) The provider's obligation to maintain licensure, accreditation, and credentials that meet the carrier's credential verification program requirements and to notify the carrier of subsequent changes in status of any information relating to the provider's professional credentials.

(7) The provider's obligation to maintain professional liability insurance coverage in an amount acceptable to the carrier and notify the carrier of subsequent changes in status of professional liability insurance.

(8) With respect to member billing:

(a) If the carrier provides or arranges for the delivery of health care services on a prepaid basis under G.S. 58, the provider shall not bill any network plan member for covered services, except for specified coinsurance, copayments, and applicable deductibles. This provision shall not prohibit a provider and member from agreeing to continue non-covered services at the member's own expense, as long as the provider has notified the member in advance that the carrier may not cover or continue to cover specific services and the member chooses to receive the service.

(b) Any provider's responsibility to collect applicable member deductibles, copayments, coinsurance, and fees for noncovered services shall be specified.

(9) Any provider's obligation to arrange for call coverage or other back-up to provide service in accordance with the carrier's standards for provider accessibility.

(10) The carrier's obligation to provide a mechanism that allows providers to verify member eligibility, based on current information held by the carrier, before rendering health care services. Mutually agreeable provision may be made for cases where incorrect or retroactive information was submitted by employer groups.

(11) Provider requirements regarding patients' records. The provider shall:

(a) Maintain confidentiality of enrollee medical records and personal information as required by G.S. 58, Article 39 and other health records as required by law.

(b) Maintain medical and other health records according to standards established by the carrier and as required by law.

(c) Make copies of such records available to the carrier and Department in conjunction with its regulation of the carrier.

(12) The provider's obligation to cooperate with members in member grievance procedures.

(13) A provision that the provider shall not discriminate against members on the basis of race, color, national origin, gender, age, religion, marital status, health status, or health insurance coverage.

(14) Provider payment that describes the methodology to be used as a basis for payment to the provider. For example, Medicare DRG reimbursement, discounted fee for service, withhold arrangement, HMO provider capitation, or capitation with bonus.

(15) The carrier's obligations to provide data and information to the provider, such as:

(a) Performance feedback reports or information to the provider, if compensation is related to efficiency criteria.

(b) Information on:

(i) benefit exclusions;

(ii) administrative and utilization management requirements;

(iii) credential verification programs;

(iv) quality assessment programs; and

(v) provider sanction policies.

Notification of changes in these requirements shall also be provided by the carrier, allowing providers time to comply with such changes.

(16) The provider's obligations to comply with the carrier's utilization management programs, credential verification programs, quality management programs, and provider sanctions programs with the stipulation that none of these shall override the professional or ethical responsibility of the provider or interfere with the provider's ability to provide information or assistance to their patients.

(17) The provider's authorization and the carrier's obligation to include the name of the provider or the provider group in the provider directory distributed to its members.

(18) Any process to be followed to resolve contractual differences between the carrier and the provider.

(19) Provisions on assignment of the contract shall contain:

(a) The provider's duties and obligations under the contract shall not be assigned, delegated, or transferred without the prior written consent of the carrier.

(b) The carrier shall notify the provider, in writing, of any duties or obligations that are to be delegated or transferred, before the delegation or transfer.

History

  • Authority G.S. 58-2-40(1); 58-2-131; 58-39-45; 58-39-75; 58-65-25; 58-65-105; 58-67-10; 58-67-20; 58-67-35; 58-67-65; 58-67-100; 58-67-115; 58-67-140; 58-67-150
  • Eff. October 1, 1996
  • Readopted Eff. August 1, 2018.
11 NCAC 20 .0203 Changes Requiring Approval {#sec-11-ncac-20-.0203 omnilex-key=us-nc-regs-official--title-11--11 NCAC 20 .0203}

All material changes to an approved contract form shall be filed with the Division for approval before use. For the purpose of this Rule, a "material change" includes a change in:

(1) the means of calculating payment to the provider; for example, change from fee for service to capitation;

(2) the distribution of risk between parties; or

(3) the delegation of clinical and administrative responsibilities.

History

  • Authority G.S. 58-2-40(1); 58-65-25; 58-67-10; 58-67-20; 58-67-35; 58-67-115; 58-67-120; 58-67-150
  • Eff. October 1, 1996
  • Readopted Eff. December 1, 2017.
11 NCAC 20 .0204 Carrier and Intermediary Contracts {#sec-11-ncac-20-.0204 omnilex-key=us-nc-regs-official--title-11--11 NCAC 20 .0204}

(a) If a carrier contracts with an intermediary for the provision of a network to deliver health care services, the carrier shall file with the Division for prior approval its form contract with the intermediary. The filing shall be accompanied by a certification from the carrier that the intermediary will, by the terms of the contract, be required to comply with all statutory and regulatory requirements that apply to the functions delegated. The certification shall also state that the carrier shall monitor such compliance.

(b) A carrier's contract form with the intermediary shall state that:

(1) All provider contracts used by the intermediary shall comply with the provisions of Rule .0202 of this Section.

(2) The network carrier retains its legal responsibility to monitor and oversee the offering of services to its members and financial responsibility to its members.

(3) The intermediary may not subcontract for its services without the carrier's written permission.

(4) The carrier may approve or disapprove participation of individual providers contracting with the intermediary for inclusion in or removal from the carrier's own network plan.

(5) The carrier shall retain copies or the intermediary shall make available for review by the Department all provider contracts and subcontracts held by the intermediary.

(6) If the intermediary organization assumes risk from the carrier or pays its providers on a risk basis or is responsible for claims payment to its providers:

(A) The carrier shall receive documentation of utilization and claims payment and maintain accounting systems and records.

(B) The carrier shall arrange for financial protection of itself and its members through such approaches as member hold harmless language, retention of signatory control of the funds to be disbursed, or financial reporting requirements.

(C) To the extent provided by law, the Department shall have access to the books, records, and financial information to examine activities performed by the intermediary on behalf of the carrier. Such books and records shall be maintained in North Carolina.

(7) The intermediary shall comply with all statutory and regulatory requirements that apply to the functions delegated by the carrier and assumed by the intermediary.

(c) If a carrier contracts with an intermediary to provide health care services and pays that intermediary directly for the services provided, the carrier shall either monitor the financial condition of the intermediary to ensure that providers are paid for services, or maintain member hold harmless agreements with providers.

History

  • Authority G.S. 58-2-40(1); 58-2-131; 58-34-10; 58-34-15; 58-65-1; 58-65-25; 58-65-105; 58-65-140; 58-67-10; 58-67-20; 58-67-30; 58-67-35; 58-67-65; 58-67-100; 58-67-115; 58-67-150
  • Eff. October 1, 1996
  • Readopted Eff. August 1, 2018.
11 NCAC 20 .0205 Filing Requirements {#sec-11-ncac-20-.0205 omnilex-key=us-nc-regs-official--title-11--11 NCAC 20 .0205}

All contract form filings shall be submitted to the Department in the following manner:

(1) New managed care contract forms shall be submitted in either paper or an electronic format in accordance with 11 NCAC 12 .0329.

(2) Amendments to contract forms shall include both a red-line formatted copy and a clean copy of the contract.

(3) Each contract form shall be designated by a unique form number assigned by the carrier for identification purposes that shall not exceed the length of 70 character spaces.

(4) Contract form filings shall be held open for a 60-day period beginning on the date that the Division receives the submission. If the submission is not brought into compliance within that period, the file shall be formally disapproved and closed.

History

  • Authority G.S. 58-2-40(1); 58-50-50; 58-50-55; 58-65-25; 58-65-140; 58-67-10; 58-67-20; 58-67-35; 58-67-150
  • Eff. October 1, 1996
  • Amended Eff. July 1, 2006
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 16, 2014.
11 NCAC 20 .0301 Provider Availability Standards {#sec-11-ncac-20-.0301 omnilex-key=us-nc-regs-official--title-11--11 NCAC 20 .0301}

Each network plan carrier shall develop a methodology to determine the size and adequacy of the provider network necessary to serve the members. The methodology shall provide for the development of performance targets that shall address the following:

(1) The number and type of primary care physicians, specialty care providers, hospitals, and other provider facilities, as defined by the carrier.

(2) A method to determine when the addition of providers to the network will be necessary based on increases in the membership of the network plan carrier.

(3) A method for arranging or providing health care services outside of the service area when providers are not available in the area.

History

  • Authority G.S. 58-2-40(1); 58-65-1; 58-65-25; 58-67-10; 58-67-20; 58-67-35; 58-67-65; 58-67-140; 58-67-150
  • Eff. October 1, 1996
  • Readopted Eff. June 1, 2018.
11 NCAC 20 .0302 Provider Accessibility Standards {#sec-11-ncac-20-.0302 omnilex-key=us-nc-regs-official--title-11--11 NCAC 20 .0302}

Each carrier shall establish performance targets for member accessibility to primary and specialty care physician services and hospital-based services. Carriers shall also establish similar performance targets for health care services provided by providers who are not physicians. Carriers shall establish written policies and performance targets that address the following:

(1) The proximity of network providers, as measured by such means as driving distance or time a member must travel to obtain primary care, specialty care, and hospital services, taking into account local variations in the supply of providers, and geographic considerations.

(2) The availability to provide emergency services on a 24-hour, 7 day per week basis.

(3) Emergency provisions within and outside of the service area.

(4) The average or expected waiting time for urgent, routine, and specialist appointments.

History

  • Authority G.S. 58-2-40(1); 58-65-1; 58-65-25; 58-67-10; 58-67-20; 58-67-35; 58-67-65; 58-67-140; 58-67-150
  • Eff. October 1, 1996
  • Readopted Eff. June 1, 2018.
11 NCAC 20 .0303 Provider Network Safeguards {#sec-11-ncac-20-.0303 omnilex-key=us-nc-regs-official--title-11--11 NCAC 20 .0303}

History

  • Status: expired
  • Authority G.S. 58-2-40(1); 58-50-55(b); 58-65-1; 58-65-25; 58-65-140; 58-67-10; 58-67-20
  • 58-67-35; 58-67-65; 58-67-140; 58-67-150
  • Eff. October 1, 1996
  • Pursuant to G.S. 150B-21.3A, rule Expired January 1, 2015.
11 NCAC 20 .0304 Monitoring Activities {#sec-11-ncac-20-.0304 omnilex-key=us-nc-regs-official--title-11--11 NCAC 20 .0304}

Each carrier shall, by means of site visits or review of information gathered by the carrier, monitor compliance with this Section and evaluate provider availability and accessibility at least annually to ensure that the needs of its members are met. The documentation of these activities shall be maintained by domestic carriers for a period of five years or until the completion of the next quintennial examination conducted by the Department, whichever is later. Foreign carriers shall maintain the documentation of these activities for a period of at least five years.

History

  • Authority G.S. 58-2-40(1); 58-2-131; 58-50-55(b); 58-65-1; 58-65-25; 58-65-105; 58-65-140
  • 58-67-10; 58-67-20; 58-67-35; 58-67-65; 58-67-100; 58-67-140; 58-67-150
  • Eff. October 1, 1996
  • Amended Eff. January 1, 2009
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 16, 2014.
11 NCAC 20 .0401 Credential Verification Program {#sec-11-ncac-20-.0401 omnilex-key=us-nc-regs-official--title-11--11 NCAC 20 .0401}

In order to assure accessibility and availability of services, each carrier shall establish a program in accordance with this Section that verifies that its network providers are credentialed before the carrier lists those providers in the carrier's provider directory, handbooks, or other marketing or member materials.

History

  • Authority G.S. 58-2-40(1); 58-50-55(b); 58-65-1; 58-65-25; 58-65-140; 58-67-5; 58-67-10
  • 58-67-20; 58-67-35; 58-67-65; 58-67-140; 58-67-150
  • Eff. October 1, 1996
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 16, 2014.
11 NCAC 20 .0402 Organization Structure {#sec-11-ncac-20-.0402 omnilex-key=us-nc-regs-official--title-11--11 NCAC 20 .0402}

The program established under Rule .0401 of this Section shall provide for an identifiable person or persons to be responsible for all credential verification activities, which person or persons shall be capable of carrying out that responsibility.

History

  • Authority G.S. 58-2-40(1); 58-50-55(b); 58-65-1; 58-65-25; 58-65-140; 58-67-5; 58-67-10
  • 58-67-20; 58-67-35; 58-67-65; 58-67-140; 58-67-150
  • Eff. October 1, 1996
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 16, 2014.
11 NCAC 20 .0403 Written Credential Verification Plan {#sec-11-ncac-20-.0403 omnilex-key=us-nc-regs-official--title-11--11 NCAC 20 .0403}

Each carrier shall develop and adopt a written credentialing plan that contains policies and procedures to support the credential verification program. The plan shall include:

(1) The purpose, goals, and objectives of the credential verification program.

(2) The roles of those persons responsible for the credential verification program.

History

  • Authority G.S. 58-2-40(1); 58-50-55(b); 58-65-1; 58-65-25; 58-65-105; 58-65-140; 58-67-5; 58-67-10; 58-67-20; 58-67-35; 58-67-65; 58-67-140; 58-67-150
  • Eff. October 1, 1996
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 16, 2014.
11 NCAC 20 .0404 Application {#sec-11-ncac-20-.0404 omnilex-key=us-nc-regs-official--title-11--11 NCAC 20 .0404}

For all providers who submit applications to be added to a carrier's network:

(1) The definitions in G.S. 58-3-167 are incorporated into this Rule by reference. Each carrier that is an insurer that issues a health benefit plan shall obtain and retain on file each provider's signed and dated application on the form approved by the Commissioner under G.S. 58-3-230. All required information shall be current upon final approval of the provider by the carrier. The application shall include, when applicable:

(a) The provider's name, address, and telephone number.

(b) Practice information, including call coverage.

(c) Education, training, and work history.

(d) The current provider license, registration, or certification, and the names of other states where the applicant is or has been licensed, registered, or certified.

(e) Drug Enforcement Agency (DEA) registration number and prescribing restrictions.

(f) Specialty board or other certification.

(g) Professional and hospital affiliation.

(h) The amount of professional liability coverage and any malpractice history.

(i) Any disciplinary actions by medical organizations and regulatory agencies.

(j) Any felony or misdemeanor convictions.

(k) The type of affiliation requested, for example, primary care, consulting specialists, ambulatory care.

(l) A signed and dated statement by the provider attesting that the information provided is true, accurate, and complete, and authorizing the release of information and materials related to the provider's qualifications and competence.

(m) Letters of reference or recommendation or letters of oversight from supervisors, or both, that attest to the qualifications or competence of the provider or otherwise recommend approval of the provider's application.

(2) The carrier shall obtain and retain on file the following information regarding facility provider credentials, when applicable:

(a) The Joint Commission's certification or certification from other accrediting agencies.

(b) State licensure.

(c) Medicare and Medicaid certification.

(d) Evidence of active malpractice insurance.

(3) No credential item listed in Items (1) or (2) of this Rule shall be construed as a substantive threshold or criterion or as a standard for credentials that must be held by any provider in order to be a network provider.

History

  • Authority G.S. 58-2-40(1); 58-2-131; 58-3-167; 58-3-230; 58-65-1; 58-65-25; 58-65-105; 58-67-10; 58-67-20; 58-67-35; 58-67-65; 58-67-100; 58-67-140; 58-67-150
  • Eff. October 1, 1996
  • Temporary Amendment Eff. October 1, 2001
  • Amended Eff. May 1, 2008; August 1, 2002
  • Readopted Eff. December 1, 2017.
11 NCAC 20 .0405 Verification of Credentials {#sec-11-ncac-20-.0405 omnilex-key=us-nc-regs-official--title-11--11 NCAC 20 .0405}

(a) Each carrier's process for verifying credentials shall take into account and make allowance for the time required to request and obtain primary source verifications and other information that must be obtained from third parties in order to authenticate the applicant's credentials, and shall make allowance for the scheduling of a final decision by a credentialing committee, if the carrier's credentialing program requires such review.

(b) Within 60 days after receipt of a completed application and all supporting documents, the carrier shall assess and verify the applicant's qualifications and notify the applicant of its decision. If, by the 60th day after receipt of the application, the carrier has not received all of the information or verifications it requires from third parties, or date-sensitive information has expired, the carrier shall issue a written notification to the applicant either closing the application and detailing the carrier's attempts to obtain the information or verification, or pending the application and detailing the carrier's attempts to obtain the information or verifications. If the application is held, the carrier shall inform the applicant of the length of time the application will be pending. The notification shall include the name, address and phone number of a credentialing staff person who will serve as a contact person for the applicant.

(c) Within 15 days after receipt of an incomplete application, the carrier shall notify the applicant in writing of all missing or incomplete information or supporting documents, in accordance with the following procedures:

(1) The notice to the applicant shall include a complete and detailed description of all of the missing or incomplete information or documents that must be submitted in order for review of the application to continue. The notification shall include the name, address, and telephone number of a credentialing staff person who will serve as a contact person for the applicant.

(2) Within 60 days after receipt of all of the missing or incomplete information or documents, the carrier shall assess and verify the applicant's qualifications and notify the applicant of its decision, in accordance with paragraph (b) of this rule.

(3) If the missing information or documents have not been received within 60 days after initial receipt of the application or if date-sensitive information has expired, the carrier shall close the application or delay final review, pending receipt of the necessary information. The carrier shall provide written notification to the applicant of the closed or pending status of the application and where applicable, the length of time the application will be pending. The notification shall include the name, address, and telephone number of a credentialing staff person who will serve as a contact person to the applicant.

(d) If a carrier elects not to include an applicant in its network, for reasons that do not require review of the application, the carrier shall provide written notice to the applicant of that determination within 30 days after receipt of the application.

(e) Nothing in this rule shall require a carrier to include a health care provider in its network or prevent a carrier from conducting a complete review and verification of an applicant's credentials, including an assessment of the applicant's office, before agreeing to include the applicant in its network.

History

  • Authority G.S. 58-2-40(1); 58-3-230; 58-65-1; 58-65-25; 58-65-105; 58-67-5; 58-67-10; 58-67-20; 58-67-35; 58-67-65; 58-67-140; 58-67-150
  • Eff. October 1, 1996
  • Temporary Amendment Eff. October 1, 2001
  • Eff. July 1, 2002
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 16, 2014.
11 NCAC 20 .0406 Provider Files {#sec-11-ncac-20-.0406 omnilex-key=us-nc-regs-official--title-11--11 NCAC 20 .0406}

Each carrier shall maintain centralized files, either paper or electronic, on each individual provider making application to affiliate with the carrier. Each file shall include documentation of compliance with Rules .0404 and .0405 of this Section.

History

  • Authority G.S. 58-2-40(1); 58-2-131; 58-50-55(b); 58-65-1; 58-65-25; 58-65-105; 58-65-140; 58-67-5; 58-67-10; 58-67-20; 58-67-35; 58-67-65; 58-67-100; 58-67-140; 58-67-150
  • Eff. October 1, 1996
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 16, 2014.
11 NCAC 20 .0407 Reverification of Provider Credentials {#sec-11-ncac-20-.0407 omnilex-key=us-nc-regs-official--title-11--11 NCAC 20 .0407}

Each carrier shall reverify the credentials of all network providers at least every three years. On or after October 1, 2001, carriers shall use the form approved by the Commissioner under G.S. 58-3-230. Carriers may require completion of all or only selected sections of the form for reverification of credentials.

History

  • Authority G.S. 58-2-40(1); 58-3-230; 58-65-1; 58-65-25; 58-65-105; 58-67-5; 58-67-10; 58-67-20; 58-67-35; 58-67-65; 58-67-140; 58-67-150
  • Eff. October 1, 1996
  • Temporary Amendment Eff. October 1, 2001
  • Amended Eff. August 1, 2002
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 16, 2014.
11 NCAC 20 .0408 Confidentiality {#sec-11-ncac-20-.0408 omnilex-key=us-nc-regs-official--title-11--11 NCAC 20 .0408}

Each carrier shall develop written policies and procedures to protect the confidentiality of patient health or medical record information and personal information, as provided by law.

History

  • Authority G.S. 58-2-40(1); 58-2-131; 58-39-45; 58-39-75; 58-50-55(b); 58-65-1; 58-65-25; 58-65-105; 58-67-5; 58-67-10; 58-67-20; 58-67-35; 58-67-65; 58-67-100; 58-67-140; 58-67-180
  • Eff. October 1, 1996
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 16, 2014.
11 NCAC 20 .0409 Records and Examinations {#sec-11-ncac-20-.0409 omnilex-key=us-nc-regs-official--title-11--11 NCAC 20 .0409}

History

  • Status: expired
  • Authority G.S. 58-2-40(1); 58-2-131; 58-50-55(b); 58-65-1; 58-65-25; 58-65-105; 58-65-140
  • 58-67-5; 58-67-10; 58-67-20; 58-67-35; 58-67-65; 58-67-100; 58-67-140; 58-67-150
  • Eff. October 1, 1996
  • Amended Eff. January 1, 2009
  • Pursuant to G.S. 150B-21.3A, rule Expired January 1, 2015.
11 NCAC 20 .0410 Delegation of Credential Verification Activities {#sec-11-ncac-20-.0410 omnilex-key=us-nc-regs-official--title-11--11 NCAC 20 .0410}

Whenever any carrier delegates credential verification activities to a contracting entity, whether an intermediary or subcontractor, the carrier shall review the contracting entity's credential verification program before contracting to ensure that the entity complies with all applicable requirements in this Section. The carrier shall monitor the contracting entity's credential verification activities. The carrier shall implement oversight mechanisms, including:

(1) Reviewing the contracting entity's credential verification plans, policies, procedures, forms, and adherence to verification procedures.

(2) Requiring the contract entity to submit an updated list of providers quarterly.

(3) Conducting an evaluation of the contracting entity's credential verification program every three years.

History

  • Authority G.S. 58-2-40(1); 58-65-1; 58-65-25; 58-67-10; 58-67-20; 58-67-35; 58-67-65; 58-67-140; 58-67-150
  • Eff. October 1, 1996
  • Readopted Eff. December 1, 2017.
11 NCAC 20 .0411 Suspension or Termination of Network Providers {#sec-11-ncac-20-.0411 omnilex-key=us-nc-regs-official--title-11--11 NCAC 20 .0411}

Each carrier shall have a mechanism in place to reduce, suspend, or terminate the participation of any network provider.

History

  • Authority G.S. 58-2-40(1); 58-50-55(b); 58-65-1; 58-65-25; 58-65-105; 58-65-140; 58-67-5
  • 58-67-10; 58-67-20; 58-67-35; 58-67-65; 58-67-140; 58-67-150
  • Eff. October 1, 1996
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 16, 2014.
11 NCAC 20 .0501 Program {#sec-11-ncac-20-.0501 omnilex-key=us-nc-regs-official--title-11--11 NCAC 20 .0501}

(a) Each HMO shall have a program designed to monitor, evaluate, improve, and promote:

(1) The quality of health care and quality of services provided through its network of providers; and

(2) Its policies, procedures, and performance.

(b) The program shall identify those areas and aspects of health care covered by the HMO's benefit plan or plans that are included in its quality management program.

History

  • Authority G.S. 58-2-40(1); 58-67-5; 58-67-10; 58-67-20; 58-67-35; 58-67-65; 58-67-140; 58-67-150
  • Eff. October 1, 1996
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 16, 2014.
11 NCAC 20 .0502 Structure {#sec-11-ncac-20-.0502 omnilex-key=us-nc-regs-official--title-11--11 NCAC 20 .0502}

Each HMO shall develop and maintain an organizational structure to conduct quality management. The structure shall provide for an identifiable person or persons to be responsible for all quality management, which person or persons shall be capable of carrying out that responsibility.

History

  • Authority G.S. 58-2-40(1); 58-67-5; 58-67-10; 58-67-20; 58-67-35; 58-67-65; 58-67-100; 58-67-140
  • 58-67-150
  • Eff. October 1, 1996
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 16, 2014.
11 NCAC 20 .0503 Plan {#sec-11-ncac-20-.0503 omnilex-key=us-nc-regs-official--title-11--11 NCAC 20 .0503}

Each HMO shall develop and adopt a written quality management plan that contains policies and procedures to support the quality management program. This plan shall include the following:

(1) The purpose, goals, and objectives of the quality management program.

(2) The role of those responsible for all quality management programs.

(3) The specific services to be monitored in accordance with 11 NCAC 20 .0501.

History

  • Authority G.S. 58-2-40(1); 58-67-5; 58-67-10; 58-67-20; 58-67-35; 58-67-65; 58-67-100; 58-67-140; 58-67-150
  • Eff. October 1, 1996
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 16, 2014.
11 NCAC 20 .0504 Activities {#sec-11-ncac-20-.0504 omnilex-key=us-nc-regs-official--title-11--11 NCAC 20 .0504}

(a) Each HMO shall develop quality of care and quality of service standards and establish a mechanism to determine if the standards are being met.

(b) Each HMO shall employ a variety of quality management tools that assess and monitor:

(1) The quality of health care and quality of service and that takes into account treatment settings for all types of medical care that have been provided through its network of providers; and

(2) Administrative and utilization management decisions of the carrier.

History

  • Authority G.S. 58-2-40(1); 58-67-5; 58-67-10; 58-67-20; 58-67-35; 58-67-65; 58-67-140; 58-67-150
  • Eff. October 1, 1996
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 16, 2014.
11 NCAC 20 .0505 Quality of Care Complaints {#sec-11-ncac-20-.0505 omnilex-key=us-nc-regs-official--title-11--11 NCAC 20 .0505}

Each HMO shall maintain policies and procedures to record, investigate, and take corrective action in response to patient complaints about the quality of care delivered by network providers and decisions made by the HMO. The policies and procedures shall provide for the following:

(1) Complaints about quality of care issues shall be forwarded to and investigated by individuals who are capable of performing that function.

(2) A method of aggregating, categorizing, and analyzing quality of care complaints relating to provider performance or HMO policies or procedures.

History

  • Authority G.S. 58-2-40(1); 58-67-5; 58-67-10; 58-67-20; 58-67-35; 58-67-65; 58-67-100; 58-67-140; 58-67-150
  • Eff. October 1, 1996
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 16, 2014.
11 NCAC 20 .0506 Delegation of Activities {#sec-11-ncac-20-.0506 omnilex-key=us-nc-regs-official--title-11--11 NCAC 20 .0506}

Whenever any HMO delegates quality management activities to another entity, the HMO shall review and approve the entity's quality management program before contracting with the entity and shall monitor the entity's quality management activities. The HMO shall implement oversight mechanisms, including:

(1) Reviewing the contracting entity's quality management plans, policies, procedures, activities, and provider contracting forms; and verifying that they meet the HMO's standards.

(2) Requiring the contracting entity to submit, at least annually, reports of its quality management activities and operations.

(3) Conducting audits of the contracting entity's quality assurance activities and operations.

History

  • Authority G.S. 58-2-40(1); 58-67-5; 58-67-10; 58-67-20; 58-67-35; 58-67-65; 58-67-140; 58-67-150
  • Eff. October 1, 1996
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 16, 2014.
11 NCAC 20 .0507 Corrective Action {#sec-11-ncac-20-.0507 omnilex-key=us-nc-regs-official--title-11--11 NCAC 20 .0507}

Each HMO shall have procedures for identifying and taking corrective action on quality of care and quality of service problems related to network providers or the carrier, whether a specific individual or system-wide.

History

  • Authority G.S. 58-2-40(1); 58-67-5; 58-67-10; 58-67-20; 58-67-35; 58-67-65; 58-67-140; 58-67-150
  • Eff. October 1, 1996
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 16, 2014.
11 NCAC 20 .0508 Conflicts of Interest {#sec-11-ncac-20-.0508 omnilex-key=us-nc-regs-official--title-11--11 NCAC 20 .0508}

Each HMO shall develop written policies and procedures about conflicts of interest. No person shall conduct utilization review of health care provided by any facility or entity in which that person or any member of his or her family has, directly or indirectly, a financial interest. That person shall recuse himself or herself from such review.

History

  • Authority G.S. 58-2-40(1); 58-67-5; 58-67-10; 58-67-20; 58-67-35; 58-67-65; 58-67-140; 58-67-150
  • Eff. October 1, 1996
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 16, 2014.
11 NCAC 20 .0509 Confidentiality {#sec-11-ncac-20-.0509 omnilex-key=us-nc-regs-official--title-11--11 NCAC 20 .0509}

Each HMO shall develop written policies and procedures to protect the confidentiality of medical record information and personal information relating to covered individuals, as those terms are defined in G.S. 58-39-15.

History

  • Authority G.S. 58-2-40(1); 58-39-45; 58-39-75; 58-67-5; 58-67-10; 58-67-20; 58-67-35; 58-67-65
  • 58-67-140; 58-67-150; 58-67-180
  • Eff. October 1, 1996
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 16, 2014.
11 NCAC 20 .0510 Records and Examinations {#sec-11-ncac-20-.0510 omnilex-key=us-nc-regs-official--title-11--11 NCAC 20 .0510}

History

  • Status: expired
  • Authority G.S. 58-2-40(1); 58-67-5; 58-67-10; 58-67-20; 58-67-35; 58-67-65; 58-67-100; 58-67-140; 58-67-150
  • Eff. October 1, 1996
  • Amended Eff. January 1, 2009
  • Pursuant to G.S. 150B-21.3A, rule Expired January 1, 2015.
11 NCAC 20 .0511 Internal Audit {#sec-11-ncac-20-.0511 omnilex-key=us-nc-regs-official--title-11--11 NCAC 20 .0511}

Each HMO shall at least annually evaluate its quality management program to assure that it complies with this Section and the HMO's internal standards, policies, and procedures. The effectiveness and efficiency of the program shall also be evaluated. The results of the evaluation shall be used in continuous improvement efforts.

History

  • Authority G.S. 58-2-40(1); 58-67-5; 58-67-10; 58-67-20; 58-67-35; 58-67-65; 58-67-140; 58-67-150
  • Eff. October 1, 1996
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 16, 2014.
11 NCAC 20 .0601 Applications for Modifications to Service Areas or Product Lines {#sec-11-ncac-20-.0601 omnilex-key=us-nc-regs-official--title-11--11 NCAC 20 .0601}

(a) All requests to expand an HMO's service area shall be submitted in electronic format as an application to the Division for review and approval. The application shall include the following information:

(1) a description of operational changes that will result from the expansion;

(2) financial and actuarial information as required by 11 NCAC 11C .0311 and 11 NCAC 16 .0605;

(3) a description of provider interest and network development in the service area requested and information as to the HMO's existing provider network; and

(4) copies of any form contracts to be made as a result of the expansion, including providers and subcontractors.

(b) Material changes in the product lines offered by an HMO shall be submitted in electronic format as an application to the Division for review and approval. For the purposes of this Section, "material changes" include the addition of a point of service product, or the addition of or changes to the HMO's existing health care delivery model, such as the addition of an IPA product or group model product or the addition of a gatekeeper product. The application shall include the following information:

(1) a description of operational changes that will result from the expansion;

(2) financial and actuarial information as required by 11 NCAC 11C .0311 and 11 NCAC 16 .0605;

(3) a description of provider interest and network development in the service area requested and information as to the HMO's existing provider network; and

(4) copies of form contracts to be made as a result of the expansion, including providers and subcontractors.

(c) Notice of the addition of an intermediary shall be submitted by an HMO in writing to the Division within 30 days after the execution of the contract for the intermediary's services.

(d) Notice of the deletion of an intermediary shall be submitted by the HMO in writing within 30 days after termination of the contract, unless termination is immediate, along with a plan to select another intermediary or for the HMO to perform the formerly delegated functions in-house.

(e) All changes to provider and intermediary contract forms shall be submitted to the Division for review and approval in accordance with Rule .0203 of this Chapter prior to the use of the amended form.

(f) Each HMO shall submit written notice to the Division of its intent to engage in any arrangement through which the HMO owns, controls, or manages any operations of another HMO in any other state, before entering into the arrangement.

History

  • Authority G.S. 58-2-40; 58-67-10; 58-67-150
  • Eff. October 1, 1996
  • Readopted Eff. December 1, 2017.
11 NCAC 20 .0602 Written Notice {#sec-11-ncac-20-.0602 omnilex-key=us-nc-regs-official--title-11--11 NCAC 20 .0602}

In addition to those modifications set out in G.S. 58-67-10(d)(1), an HMO shall submit written notice to the Division of the following:

(1) Changes to the members of the HMO's Board of Directors, Trustees, Officers, or any entity maintaining at least 10 percent ownership in the HMO, within 15 days after the change.

(2) Reductions in the number of providers that exceed 10 percent of the total number of providers in a particular service area within 15 days after the change.

(3) Any application made in any other state for licensure as an HMO, insurance company or any other type of managed care organization, within 15 days after making the application.

(4) Any application made in North Carolina or any other state to engage in business arrangements involving Medicare, Medicaid, CHAMPUS or Workers Compensation, within 15 days after making the application.

History

  • Authority G.S. 58-2-40; 58-67-10; 58-67-150
  • Eff. October 1, 1996
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 16, 2014.

Chapter 21 Third Party Administrators

11 NCAC 21 .0101 Definitions: License Applications {#sec-11-ncac-21-.0101 omnilex-key=us-nc-regs-official--title-11--11 NCAC 21 .0101}

(a) The definitions in G.S. 58-56-2 are incorporated into this Chapter by reference.

(b) In addition to those items listed in G.S. 58-56-51, the following items shall be filed in order to constitute a complete application for initial or renewal TPA licensure:

(1) Transmittal form;

(2) An application for administrator's license;

(3) Biographical form(s) completed by principal officers;

(4) A narrative description specifying the TPA's services performed in North Carolina;

(5) A power of attorney duly executed by the TPA, if not domiciled in North Carolina, appointing the Commissioner as attorney for the TPA in and for this State, upon whom process in any legal action or proceeding against the TPA on a cause of action arising in this State may be served;

(6) Internal controls narrative; and

(7) Administrator's questionnaire.

(c) Copies of all forms may be obtained from the Department.

History

  • Authority G.S. 58-2-40; 58-16-30; 58-56-2; 58-56-51
  • Eff. June 1, 1996
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 16, 2014.
11 NCAC 21 .0102 Financial Statements {#sec-11-ncac-21-.0102 omnilex-key=us-nc-regs-official--title-11--11 NCAC 21 .0102}

The financial statements required by G.S. 58-56-51(b)(4) shall include a balance sheet, a statement of operations, and a statement of cash flows for the TPA's two most recent fiscal years. Financial statements shall be prepared by an independent certified public accountant. Financial statements of a TPA's parent company are acceptable if those statements contain consolidating schedules that include a breakout of the finances of the TPA, and if the certified public accountant's opinion letter does not disclaim association with the consolidating schedules.

History

  • Authority G.S. 58-2-40; 58-2-205; 58-56-51
  • Eff. June 1, 1996
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 16, 2014.
11 NCAC 21 .0103 Determination of Financial Responsibility {#sec-11-ncac-21-.0103 omnilex-key=us-nc-regs-official--title-11--11 NCAC 21 .0103}

In determining the financial responsibility of an applicant for a TPA license, the Department shall require that an applicant be solvent. In addition, the Department shall consider:

(1) Liquidity;

(2) Any internal controls the applicant may have in place to afford protection for benefit plans, which may include the manner in which benefit plan fund accounts are established; and

(3) Segregation of duties.

History

  • Authority G.S. 58-2-40; 58-56-51
  • Eff. June 1, 1996
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 16, 2014.
11 NCAC 21 .0104 Service Contracts {#sec-11-ncac-21-.0104 omnilex-key=us-nc-regs-official--title-11--11 NCAC 21 .0104}

No TPA shall enter into an agreement to administer insurance with an insurance company or health maintenance organization unless the company or HMO is licensed to operate in North Carolina.

History

  • Authority G.S. 58-2-40; 58-56-6; 58-56-51
  • Eff. June 1, 1996
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 16, 2014.
11 NCAC 21 .0105 CLAIM ADJUSTING BY TPAs {#sec-11-ncac-21-.0105 omnilex-key=us-nc-regs-official--title-11--11 NCAC 21 .0105}

A TPA or an employee of a TPA does not have to have a license to adjust insurance claims for an insurer with which the TPA has a written agreement under G.S. 58-56-6.

History

  • Authority G.S. 58-2-40; 58-56-2(5); 58-56-51
  • Eff. June 1, 1996
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 16, 2014.
11 NCAC 21 .0106 Payment of Claims {#sec-11-ncac-21-.0106 omnilex-key=us-nc-regs-official--title-11--11 NCAC 21 .0106}

If claims filed with a TPA or insurer are not paid within 30 days after receipt of the initial claim by the TPA or the insurer, the TPA or the insurer shall at that time mail a claim status report to the claimant.

History

  • Authority G.S. 58-2-40; 58-3-100; 58-56-31
  • Eff. June 1, 1996
  • Readopted Eff. December 1, 2017.
11 NCAC 21 .0107 General Administration {#sec-11-ncac-21-.0107 omnilex-key=us-nc-regs-official--title-11--11 NCAC 21 .0107}

Every TPA shall:

(1) Establish a governing body that is authorized to set policy for the organization.

(2) Maintain complete corporate records in a secure and accessible location.

(3) Employ a management information system that is able to provide information on all areas of the TPA operations.

(4) Set internal policies and procedures for contract management.

History

  • Authority G.S. 58-2-40; 58-56-6; 58-56-16; 58-56-51
  • Eff. June 1, 1996
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 16, 2014.
11 NCAC 21 .0108 Claims Administration {#sec-11-ncac-21-.0108 omnilex-key=us-nc-regs-official--title-11--11 NCAC 21 .0108}

(a) Each TPA's claims administration service shall be supported by a set of written policies, procedures, and performance standards related to timeliness in payment of claims and its financial operations.

(b) Each TPA shall develop and implement a claims administration internal audit and a quality assurance program to monitor and improve claims processing services.

History

  • Authority G.S. 58-2-40; 58-56-26; 58-56-31; 58-56-51
  • Eff. June 1, 1996
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 16, 2014.
11 NCAC 21 .0109 Marketing and Sales {#sec-11-ncac-21-.0109 omnilex-key=us-nc-regs-official--title-11--11 NCAC 21 .0109}

(a) Each TPA shall ensure that all direct sales staff and brokers are licensed by the State of North Carolina to sell insurance and meet all continuing education requirements.

(b) Each TPA that markets or sells insurance products shall quote only premium rates that have been filed with, and if applicable, approved by the Commissioner for those products. Where premium rates accompany a policy form filing and the rates are not subject to approval but the policy form filing is subject to approval, the TPA shall not quote those premium rates until the related forms have been approved by the Commissioner.

History

  • Authority G.S. 58-2-40; 58-56-31; 58-56-51; 58-63-15; 58-63-65
  • Eff. June 1, 1996
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 16, 2014.
11 NCAC 21 .0110 Services to Insureds {#sec-11-ncac-21-.0110 omnilex-key=us-nc-regs-official--title-11--11 NCAC 21 .0110}

(a) Each TPA shall make available to insureds and insurers a written description of its premium collection and claims payment policies and procedures.

(b) Each TPA shall be accessible to insureds and insurers by telephone to respond to inquiries about premium collections and claims payments.

History

  • Authority G.S. 58-2-40; 58-56-41; 58-56-51
  • Eff. June 1, 1996
  • Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 16, 2014.

Chapter 22 PEO Trusts

11 NCAC 22 .0101 Scope {#sec-11-ncac-22-.0101 omnilex-key=us-nc-regs-official--title-11--11 NCAC 22 .0101}

History

  • Status: expired
  • Authority G.S. 58-2-40; 58-89A-15; 58-89A-105; 58-89A-106
  • Eff. April 1, 2010
  • Pursuant to G.S. 150B-21.3A, rules Expired January 1, 2015.
11 NCAC 22 .0102 Definitions {#sec-11-ncac-22-.0102 omnilex-key=us-nc-regs-official--title-11--11 NCAC 22 .0102}

History

  • Status: expired
  • Authority G.S. 58-2-40; 58-89A-15; 58-89A-105; 58-89A-106
  • Eff. April 1, 2010
  • Pursuant to G.S. 150B-21.3A, rules Expired January 1, 2015.
11 NCAC 22 .0103 General Eligibility {#sec-11-ncac-22-.0103 omnilex-key=us-nc-regs-official--title-11--11 NCAC 22 .0103}

History

  • Status: expired
  • Authority G.S. 58-2-40; 58-89A-15; 58-89A-105; 58-89A-106
  • Eff. April 1, 2010
  • Pursuant to G.S. 150B-21.3A, rules Expired January 1, 2015.
11 NCAC 22 .0104 Filing Requirements {#sec-11-ncac-22-.0104 omnilex-key=us-nc-regs-official--title-11--11 NCAC 22 .0104}

History

  • Status: expired
  • Authority G.S. 58-2-40; 58-89A-15; 58-89A-105; 58-89A-106
  • Eff. April 1, 2010
  • Pursuant to G.S. 150B-21.3A, rules Expired January 1, 2015.
11 NCAC 22 .0105 Financial Requirements {#sec-11-ncac-22-.0105 omnilex-key=us-nc-regs-official--title-11--11 NCAC 22 .0105}

History

  • Status: expired
  • Authority G.S. 58-2-40; 58-89A-15; 58-89A-105; 58-89A-106
  • Eff. April 1, 2010
  • Pursuant to G.S. 150B-21.3A, rules Expired January 1, 2015.
11 NCAC 22 .0106 Administrative, Provider, and Management Contracts {#sec-11-ncac-22-.0106 omnilex-key=us-nc-regs-official--title-11--11 NCAC 22 .0106}

History

  • Status: expired
  • Authority G.S. 58-2-40; 58-89A-15; 58-89A-105; 58-89A-106
  • Eff. April 1, 2010
  • Pursuant to G.S. 150B-21.3A, rules Expired January 1, 2015.
11 NCAC 22 .0107 trust Submittal AND Plan of Operation {#sec-11-ncac-22-.0107 omnilex-key=us-nc-regs-official--title-11--11 NCAC 22 .0107}

History

  • Status: expired
  • Authority G.S. 58-2-40; 58-89A-15; 58-89A-105; 58-89A-106
  • Eff. April 1, 2010
  • Pursuant to G.S. 150B-21.3A, rules Expired January 1, 2015.
11 NCAC 22 .0108 Claims Payments {#sec-11-ncac-22-.0108 omnilex-key=us-nc-regs-official--title-11--11 NCAC 22 .0108}

History

  • Status: expired
  • Authority G.S. 58-2-40; 58-89A-15; 58-89A-105; 58-89A-106
  • Eff. April 1, 2010
  • Pursuant to G.S. 150B-21.3A, rules Expired January 1, 2015.
11 NCAC 22 .0109 Dissolution {#sec-11-ncac-22-.0109 omnilex-key=us-nc-regs-official--title-11--11 NCAC 22 .0109}

History

  • Status: expired
  • Authority G.S. 58-2-40; 58-89A-15; 58-89A-105; 58-89A-106
  • Eff. April 1, 2010
  • Pursuant to G.S. 150B-21.3A, rules Expired January 1, 2015.
11 NCAC 22 .0110 Minimum Reserve Standards {#sec-11-ncac-22-.0110 omnilex-key=us-nc-regs-official--title-11--11 NCAC 22 .0110}

History

  • Status: expired
  • Authority G.S. 58-2-40; 58-89A-15; 58-89A-105; 58-89A-106
  • Eff. April 1, 2010
  • Pursuant to G.S. 150B-21.3A, rules Expired January 1, 2015.
11 NCAC 22 .0111 Claim Reserves {#sec-11-ncac-22-.0111 omnilex-key=us-nc-regs-official--title-11--11 NCAC 22 .0111}

History

  • Status: expired
  • Authority G.S. 58-2-40; 58-89A-15; 58-89A-105; 58-89A-106
  • Eff. April 1, 2010
  • Pursuant to G.S. 150B-21.3A, rules Expired January 1, 2015.
11 NCAC 22 .0112 Premium Reserves {#sec-11-ncac-22-.0112 omnilex-key=us-nc-regs-official--title-11--11 NCAC 22 .0112}

History

  • Status: expired
  • Authority G.S. 58-2-40; 58-89A-15; 58-89A-105; 58-89A-106
  • Eff. April 1, 2010
  • Pursuant to G.S. 150B-21.3A, rules Expired January 1, 2015.
11 NCAC 22 .0113 Maximum Net Retention Standard {#sec-11-ncac-22-.0113 omnilex-key=us-nc-regs-official--title-11--11 NCAC 22 .0113}

History

  • Status: expired
  • Authority G.S. 58-2-40; 58-89A-15; 58-89A-105; 58-89A-106
  • Eff. April 1, 2010
  • Pursuant to G.S. 150B-21.3A, rules Expired January 1, 2015.
11 NCAC 22 .0114 "qualified Actuary"; Maximum Net Retention Filing {#sec-11-ncac-22-.0114 omnilex-key=us-nc-regs-official--title-11--11 NCAC 22 .0114}

History

  • Status: expired
  • Authority G.S. 58-2-40; 58-89A-15; 58-89A-105; 58-89A-106
  • Eff. April 1, 2010
  • Pursuant to G.S. 150B-21.3A, rules Expired January 1, 2015.
11 NCAC 22 .0115 Certification of Reserves Filing {#sec-11-ncac-22-.0115 omnilex-key=us-nc-regs-official--title-11--11 NCAC 22 .0115}

History

  • Status: expired
  • Authority G.S. 58-2-40; 58-89A-15; 58-89A-105; 58-89A-106
  • Eff. April 1, 2010
  • Pursuant to G.S. 150B-21.3A, rules Expired January 1, 2015.
11 NCAC 22 .0116 Definitions and Certification of Rates Filing {#sec-11-ncac-22-.0116 omnilex-key=us-nc-regs-official--title-11--11 NCAC 22 .0116}

History

  • Status: expired
  • Authority G.S. 58-2-40; 58-89A-15; 58-89A-105; 58-89A-106
  • Eff. April 1, 2010
  • Pursuant to G.S. 150B-21.3A, rules Expired January 1, 2015.

Chapter 23 Industrial Commission

Subchapter A

11 NCAC 23A .0101 Location of MAIN OFFICE and Hours of Business {#sec-11-ncac-23a-.0101 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23A .0101}

The main office of the North Carolina Industrial Commission is located in the Dobbs Building, 430 North Salisbury Street, Raleigh, North Carolina. Documents that may be filed via hand-delivery in accordance with Rule .0108 of this Section may be filed at the main office between the hours of 8:00 a.m. and 5:00 p.m. only. Documents permitted to be filed electronically may be filed until 11:59 p.m. on the required filing date.

History

  • Authority G.S. 97-80(a)
  • Eff. January 1, 1990
  • Amended Eff. January 1, 2016; November 1, 2014; January 1, 2011; June 1, 2000
  • Recodified from 04 NCAC 10A .0101 Eff. June 1, 2018
  • Amended Eff. December 1, 2018.
11 NCAC 23A .0102 Official Forms {#sec-11-ncac-23a-.0102 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23A .0102}

(a) Copies of the Commission's rules and forms may be obtained by:

(1) contacting the Commission in person at the address in Rule .0101 of this Section, by written request mailed to North Carolina Industrial Commission, 1236 Mail Service Center, Raleigh, NC 27699-1236, Attn.: Office of the Clerk, or

(2) accessing or downloading the rules or forms from the Commission's website at http://www.ic.nc.gov/abtrules.html and http://www.ic.nc.gov/forms.html.

(b) Insurance carriers, self-insured employers, attorneys, and other parties may reproduce current Commission forms for their own use, provided:

(1) no statement, question, or information blank contained on the Commission form is omitted from the substituted form; and

(2) the substituted form is identical in size and format to the Commission form.

History

  • Authority G.S. 97-80(a); 97-81(a)
  • Eff. January 1, 1990
  • Amended Eff. November 1, 2014; June 1, 2000
  • Recodified from 04 NCAC 10A .0102 Eff. June 1, 2018
  • Amended Eff. December 1, 2018.
11 NCAC 23A .0103 Notice of Accident and Claim of Injury or Occupational Disease {#sec-11-ncac-23a-.0103 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23A .0103}

To give notice of an accident or occupational disease and to make a workers' compensation claim, an employee may complete a Form 18 Notice of Accident to Employer and Claim of Employee, Representative, or Dependent and file it in accordance with Rule .0108 of this Section.

History

  • Authority G.S. 97-22; 97-24; 97-58; 97-80(a); 97-81
  • Eff. January 1, 1990
  • Amended Eff. November 1, 2014
  • Recodified from 04 NCAC 10A .0103 Eff. June 1, 2018
  • Amended Eff. December 1, 2018.
11 NCAC 23A .0104 Employer's Requirement to File FIRST REPORT OF INJURY {#sec-11-ncac-23a-.0104 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23A .0104}

(a) The form required to be provided by G.S. 97-92(a) is the Form 19 Employer's Report of Employee's Injury or Occupational Disease to the Industrial Commission. The Form 19 shall be used when the injury causes the employee to be absent from work for more than one day or when the charges for medical compensation exceed four thousand dollars ($4,000). The Form 19 shall be filed with the Commission in accordance with Rule .0108(d) of this Section.

(b) The employer, carrier, or administrator shall provide the employee with a copy of the completed Form 19 Employer's Report of Employee's Injury or Occupational Disease to the Industrial Commission, along with a blank Form 18 Notice of Accident to Employer and Claim of Employee, Representative, or Dependent for use by the employee in making a claim.

History

  • Authority G.S. 97-80(a); 97-92
  • Eff. March 15, 1995
  • Amended Eff. November 1, 2014; January 1, 2011; August 1, 2006; March 1, 2001; June 1, 2000
  • Recodified from 04 NCAC 10A .0104 Eff. June 1, 2018
  • Amended Eff. December 1, 2020.
11 NCAC 23A .0105 Electronic Payment of Costs {#sec-11-ncac-23a-.0105 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23A .0105}

History

  • Status: expired
  • Authority G.S. 97-80(a)
  • Eff. January 1, 2011
  • Rule Expired July 18, 2013 (see S.L. 2013-294, s. 1)
  • Recodified from 04 NCAC 10A .0105 Eff. June 1, 2018.
11 NCAC 23A .0106 Filing of Annual Report Requirement {#sec-11-ncac-23a-.0106 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23A .0106}

Every carrier, individual self-insurer, group self-insurer, and member self-insurer as defined by G.S. 97-130 shall submit on a yearly basis a Form 51 Annual Consolidated Fiscal Report of "Medical Only" and "Lost Time" Cases.

History

  • Authority G.S. 97-80(a); 97-92; 97-93; 97-130
  • Eff. November 1, 2014
  • Recodified from 04 NCAC 10A .0106 Eff. June 1, 2018.
11 NCAC 23A .0107 Computation of Time AND NOTICE BY THE COMMISSION {#sec-11-ncac-23a-.0107 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23A .0107}

(a) Except as otherwise provided by statute or rule, in computing any period of time prescribed or allowed by the Commission Rules, order of the Commission, or any applicable statute, the day of the act, event, or default after which the designated period of time begins to run shall not be included. The last day of the period so computed shall be included, unless it is a Saturday, a Sunday, or a holiday established by the State Human Resources Commission pursuant to 25 NCAC 01E .0901 and any subsequent amendments thereto, in which event the period runs until the end of the next State business day. When the period of time prescribed or allowed is less than seven days, intermediate Saturdays, Sundays, and holidays shall be excluded in the computation. Whenever a party has the right to do some act or take some proceedings within a prescribed period after the service of any document by mail, three days shall be added to the prescribed period.

(b) If service is provided by electronic mail, notice pursuant to G.S. 97-86 is complete one hour after it is sent by the Commission, provided that:

(1) notice sent after 5:00 p.m. shall be complete at 8:00 a.m. the following State business day; and

(2) notice sent by electronic mail that is not readable by the recipient is not complete. Within five State business days of receipt of an unreadable document, the receiving party shall notify the Commission of the unreadability of the document.

(c) If service is provided by U.S. Mail, notice pursuant to G.S. 97-86 shall be complete upon the Commission's placing the item to be served, enclosed in a wrapper addressed to the party to be served, in the custody of the Mail Service Center or an official depository of the United States Postal Service.

History

  • Authority G.S. 97-80; 97-81; 97-86
  • Eff. November 1, 2014
  • Amended Eff. May 1, 2018
  • Recodified from 04 NCAC 10A .0107 Eff. June 1, 2018.
11 NCAC 23A .0108 Electronic Filings with the Commission; How to File {#sec-11-ncac-23a-.0108 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23A .0108}

(a) All documents filed with the Commission in workers' compensation cases shall be submitted electronically in accordance with this Rule. Any document transmitted to the Commission in a manner not in accordance with this Rule shall not be accepted for filing. Any document filed with the Commission that requires contemporaneous payment of a processing fee pursuant to Rule 11 NCAC 23E .0203 shall not be deemed filed until the fee has been paid in full. The electronic filing requirements of this Rule shall not apply to employees or non-insured employers without legal representation. Employees and non-insured employers without legal representation may file all documents with the Commission via the Commission's Electronic Document Filing Portal ("EDFP") or by sending the documents to the Clerk of the Industrial Commission via electronic mail (dockets@ic.nc.gov), facsimile, U.S. Mail, private courier service, or hand delivery.

(b) Except as set forth in Paragraphs (d) and (e) of this Rule, all documents required to be submitted electronically to the Commission shall be filed via EDFP. Information regarding how to use EDFP is available at http://www.ic.nc.gov/training.html. In the event EDFP is inoperable, all documents required to be filed via EDFP shall be transmitted to the Commission via electronic mail to edfp@ic.nc.gov. Documents required to be filed via EDFP that are sent to the Commission via electronic mail when EDFP is operable shall not be accepted for filing.

(c) Transcripts of depositions shall be filed with the Commission pursuant to this Rule by the court reporting service. Transcripts filed with the Commission shall have only one page of text per page and shall include all exhibits. The parties shall provide the Commission's court reporting service with the information necessary to effectuate filing of the deposition transcripts and attached exhibits via EDFP. If an exhibit to a deposition is in a form that makes submission of an electronic copy impracticable, counsel for the party offering the exhibit shall make arrangements with the Commission to facilitate the submission of the exhibit. Condensed transcripts and paper copies of deposition transcripts shall not be accepted for filing.

(d) A Form 19 shall be filed as the first report of injury (FROI) via electronic data interchange (EDI), except in claims involving non-insured employers, in claims for lung disease, in claims with multiple employers or multiple carriers, or in claims with six-character IC file numbers, in which case the Form 19 shall be filed electronically via EDFP or as otherwise permitted pursuant to Paragraph (a) of this Rule. Information regarding how to register for and use EDI is available at www.ncicedi.info.

(e) Documents to be filed with the Criminal Investigations & Employee Classification Division regarding fraud complaints shall be submitted electronically to fraudcomplaints@ic.nc.gov. Documents to be filed with the Criminal Investigations & Employee Classification Division regarding employee misclassification shall be submitted electronically to emp.classification@ic.nc.gov. Safety rules to be filed with the Commission under 11 NCAC 23A .0411 shall be submitted electronically to safety@ic.nc.gov.

(f) A self-insured employer, carrier or guaranty association, third-party administrator, court reporting service, medical provider, or law firm may apply to the Commission for an emergency temporary waiver of the electronic filing requirement set forth in Paragraph (a) of this Rule when it is unable to comply because of temporary technical problems or lack of electronic mail or internet access. The request for an emergency temporary waiver shall be included with any filing submitted via facsimile, U.S. Mail, or hand delivery due to such temporary technical or access issues.

(g) A Notice of Appeal to the North Carolina Court of Appeals shall be accepted for filing by the Commission via EDFP, U.S. Mail, hand delivery, or any other means allowed by the Rules of Appellate Procedure or applicable statutes governing appeals from the General Courts of Justice. Notwithstanding the foregoing, employees and non-insured employers without legal representation may file all documents with the Commission as provided in Paragraph (a) of this Rule.

History

  • Authority G.S. 97-80; 97-81; 97-86
  • Eff. February 1, 2016
  • Amended Eff. February 1, 2017
  • Recodified from 04 NCAC 10A .0108 Eff. June 1, 2018
  • Amended Eff. March 1, 2021; December 1, 2018.
11 NCAC 23A .0109 Contact information {#sec-11-ncac-23a-.0109 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23A .0109}

(a) "Contact information" for purposes of this Rule shall include telephone number, facsimile number, email address, and mailing address.

(b) All attorneys of record with matters before the Commission shall provide and maintain current contact information via the Commission's Electronic Document Filing Portal ("EDFP").

(c) All unrepresented persons or entities with matters before the Commission shall inform the Commission upon any change to their contact information in the following manner:

(1) All employees who are not represented by counsel shall inform the Commission of any change in contact information by filing a written notice via EDFP, email to contactinfo@ic.nc.gov, facsimile to (919) 715-0282, U.S. mail sent to Office of the Clerk, 1236 Mail Service Center, Raleigh North Carolina 27699-1236, private courier service in accordance with Rule .0101 of this Section, or hand delivery in accordance with Rule .0101 of this Section.

(2) All non-insured employers that are not represented by counsel shall inform the Commission of any change in contact information by filing a written notice via EDFP, email to contactinfo@ic.nc.gov, facsimile to (919) 715-0282, U.S. mail sent to Office of the Clerk, 1236 Mail Service Center, Raleigh North Carolina 27699-1236, private courier service in accordance with Rule .0101 of this Section, or hand delivery in accordance with Rule .0101 of this Section.

(d) All carriers, third party administrators, and self-insured employers shall provide the Commission, by sending an email to contactinfo@ic.nc.gov, with an email address for service of claim-related documents in cases where the Commission does not have email contact information for a specific representative assigned to the claim.

(e) Instructions on how to provide and update contact information via EDFP are available at https://www.ic.nc.gov/docfiling.html.

History

  • Authority G.S. 97-80
  • Eff. January 1, 2019
  • Amended Eff. March 1, 2021.
11 NCAC 23A .0201 Posting Requirement for Employers {#sec-11-ncac-23a-.0201 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23A .0201}

(a) The form required to be posted by G.S. 97-93(e) is the Form 17 Workers' Compensation Notice to Injured Workers and Employers, that includes the following:

(1) name of insurer;

(2) policy number; and

(3) dates of coverage.

(b) If there is a change in coverage, the Form 17 Workers' Compensation Notice to Injured Workers and Employers shall be amended within five working days.

History

  • Authority G.S. 97-80(a); 97-93
  • Eff. January 1, 1990
  • Amended Eff. November 1, 2014; March 15, 1995
  • Recodified from 04 NCAC 10A .0201 Eff. June 1, 2018.
11 NCAC 23A .0301 Proof of Insurance Coverage {#sec-11-ncac-23a-.0301 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23A .0301}

(a) Every employer, either personally or through its carrier or third party administrator, subject to the provisions of the Workers' Compensation Act shall file with the Commission proof that it has obtained workers' compensation insurance, and shall post notice of proof of insurance to employees consistent with Rule .0201 of this Subchapter.

(b) Upon actual notice of a workers' compensation claim or upon reporting a workers' compensation claim to a carrier, third party administrator, servicing agent, professional employer organization as defined in G.S. 58-89A-5(14), or the Commission, all employers shall provide the injured worker with the name of their insurance carrier and policy number or shall inform the injured worker of their self-insured status, membership in a self-insurance group or relationship with a professional employer organization that provides the insurance coverage.

(c) Every carrier, third party administrator, servicing agent, or other entity filing a Form 19 Employer's Report of Employee's Injury or Occupational Disease to the Industrial Commission shall identify by name and address any professional employer organization and the name of the client company employing the employee who is the subject of the Form 19 Employer's Report of Employee's Injury or Occupational Disease to the Industrial Commission.

(d) A professional employer organization shall, within 30 days of initiation or termination of the professional employer organization's relationship with any client company, notify the Commission of either the initiation or termination of the relationship and the status of the client company's workers' compensation coverage.

(e) Upon notice from the Commission that an employer is non-insured, coverage has lapsed or been canceled, or coverage or self-insured status cannot be verified, an employer shall show proof of coverage to the Commission by:

(1) a certificate of insurance issued by the insurance agent who procured workers' compensation insurance on behalf of the employer;

(2) submitting a copy of the letter of approval, license or amended license with subsidiary information, if applicable, from the North Carolina Department of Insurance notifying or indicating the employer has qualified as a self-insured employer for workers' compensation purposes;

(3) submitting a copy of the Form 18WC Application for Membership indicating the employer is a member of a self-insurance group or fund;

(4) submitting a copy of a declaration of coverage page from an insurance policy procured in another state that indicates North Carolina is a covered jurisdiction under the workers' compensation policy;

(5) submitting the names of the general contractor, subcontractor, professional employer organization or other entity that has provided workers' compensation coverage for the employer; provided however, that coverage shall be verified by the Commission in order to be removed from the non-insured docket; or

(6) submitting other documentation or information relevant to the workers' compensation claim upon request of the Commission.

(f) A principal contractor, intermediate contractor or subcontractor may satisfy the requirements of G.S. 97-19 by obtaining a certificate of insurance issued by the insurance agent who procured insurance on behalf of the subcontractor or a certificate of compliance issued by the Department of Insurance to a self-insured subcontractor. If the subcontractor has notice that the policy of insurance has lapsed, is cancelled, is not renewed, or the subcontractor ceases to qualify as a self-insured employer, the subcontractor shall, within 24 hours, notify any contractor to whom it has provided a certificate of insurance that the certificate or certificate of compliance is no longer valid.

History

  • Authority G.S. 97-19; 97-80(a); 97-93
  • Eff. January 1, 1990
  • Amended Eff. January 1, 2013; June 1, 2000
  • Recodified from 04 NCAC 10A .0301 Eff. June 1, 2018.
11 NCAC 23A .0302 Required Contact Information from Carriers {#sec-11-ncac-23a-.0302 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23A .0302}

All insurance carriers, third party administrators, and self-insured employers shall designate a primary contact person for workers' compensation issues in North Carolina and shall maintain and provide annually on July 1 to the Director of Claims Administration of the Commission via the Commission's Electronic Document Filing Portal ("EDFP") the primary contact person's current contact information, including direct telephone and facsimile numbers, mailing addresses, and email addresses. Contact information shall be updated within 30 days of any change.

History

  • Authority G.S. 97-80(a); 97-94
  • Eff. January 1, 2011
  • Amended Eff. November 1, 2014
  • Recodified from 04 NCAC 10A .0302 Eff. June 1, 2018
  • Amended Eff. December 1, 2018
  • Amended Eff. March 1, 2021.
11 NCAC 23A .0401 Calculating the Seven-Day Waiting Period {#sec-11-ncac-23a-.0401 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23A .0401}

(a) When the injured employee is not paid wages for the entire day on which the injury occurred, the seven-day waiting period prescribed by the Workers' Compensation Act shall include the day of injury regardless of the hour of the injury.

(b) When the injured employee is paid wages for the entire day on which the injury occurred and fails to return to work on his next regular workday because of the injury, the seven-day waiting period shall begin with the first calendar day following the injury, even though this may or may not be a regularly scheduled workday.

(c) All days, or parts of days, when the injured employee is unable to earn a full day's wages, or is not paid a full day's wages due to injury, shall be counted in computing the waiting period even though the days may not be consecutive, or regularly scheduled workdays.

(d) There is no seven-day waiting period when the permanent partial disability period added to the temporary disability period, exceeds 21 days.

History

  • Authority G.S. 97-28; 97-80(a)
  • Eff. January 1, 1990
  • Amended Eff. November 1, 2014
  • Recodified from 04 NCAC 10A .0401 Eff. June 1, 2018.
11 NCAC 23A .0402 Submission of Earnings Statement Required {#sec-11-ncac-23a-.0402 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23A .0402}

(a) Within 30 days of a request by the employee or the Commission, the employer shall submit a verified statement of the specific days worked and the earnings of the employee during the 52-week period immediately preceding the injury to the Commission and the employee's attorney of record or the employee, if not represented.

(b) In all cases involving a fractional part of a week, the average weekly wage shall be computed based upon the applicable fractional portion of the week worked.

History

  • Authority G.S. 97-2(5); 97-18(b); 97-80(a); 97-81
  • Eff. January 1, 1990
  • Amended Eff. November 1, 2014
  • Recodified from 04 NCAC 10A .0402 Eff. June 1, 2018.
11 NCAC 23A .0403 Manner of Payment of Compensation {#sec-11-ncac-23a-.0403 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23A .0403}

(a) All payments of compensation shall be made directly to the employee, dependent, guardian or personal representative. Payment of compensation shall be mailed by first class mail, postage pre-paid, to an address specified by the employee, unless another method is specified by and agreed upon by the parties.

(b) All payments of compensation shall be made in accordance with the award issued by the Commission.

History

  • Authority G.S. 97-18; 97-80(a)
  • Eff. January 1, 1990
  • Amended Eff. November 1, 2014; June 1, 2000
  • Recodified from 04 NCAC 10A .0403 Eff. June 1, 2018.
11 NCAC 23A .0404 Termination and Suspension of Compensation {#sec-11-ncac-23a-.0404 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23A .0404}

(a) No application to terminate or suspend compensation shall be approved by the Commission without a formal hearing if the effect of the approval is to set aside the provisions of an award of the Commission.

(b) When an employer, carrier, or administrator seeks to terminate or suspend temporary total disability compensation being paid pursuant to G.S. 97-29 for a reason other than those specified in G.S. 97-18(d) (payment without prejudice), G.S. 97-18.1(b) (trial return to work), or G.S. 97-29(b) (expiration of 500-week limit on disability compensation (only for claims arising on or after June 24, 2011)), the employer, carrier, or administrator shall notify the employee's attorney of record or the employee, if not represented, on Form 24, Application to Terminate or Suspend Payment of Compensation. This form requests:

(1) the date of injury or accident and date the disability began;

(2) the nature and extent of injury;

(3) the number of weeks of compensation paid and the date range(s) during which such compensation was paid;

(4) the total amount of indemnity compensation paid to date;

(5) whether one of the following events has occurred:

(A) an agreement was approved by the Commission and the date;

(B) an employer admitted employee's right to compensation pursuant to G.S. 97-18(b);

(C) an employer paid compensation to the employee without contesting the claim within the statutory period provided under G.S. 97-18(d); or

(D) any other event related to the termination or suspension of compensation;

(6) whether the application is made to terminate or suspend compensation and the grounds; and

(7) whether the employee is in managed care.

(c) The employer, carrier, or administrator shall specify the grounds and the alleged facts supporting the application and shall complete the blank space in the "Important Notice to Employee" portion of Form 24 Application to Terminate or Suspend Payment of Compensation by inserting a date 17 days from the date the employer, carrier, or administrator serves the completed Form 24 Application to Terminate or Suspend Payment of Compensation on the employee's attorney of record by e-mail or facsimile, or the employee, if not represented, by first class mail. The Form 24 Application to Terminate or Suspend Payment of Compensation and attached documents shall be sent to the Commission via upload to the Electronic Document Filing Portal in accordance with Rule .0108 of this Subchapter, and shall be contemporaneously served on employee's counsel by e-mail or facsimile, or on the employee, if unrepresented, by first class mail.

(d) The Form 24 Application to Terminate or Suspend Payment of Compensation shall specify the number of pages of documents attached which are to be considered by the Commission. If the employee or the employee's attorney of record objects by the date inserted on the employer's Form 24 Application to Terminate or Suspend Payment of Compensation, the Commission shall set the case for an informal hearing, unless waived by the parties in favor of a formal hearing. The objection shall be filed in accordance with Rule .0108 and shall be accompanied by all currently available supporting documentation. A copy of any objection shall be contemporaneously served on the employer, carrier, or administrator. The Form 24 Application to Terminate or Suspend Payment of Compensation or objection may be supplemented with any additional relevant documentation received after the initial filing. The term "carrier" or "administrator" also includes any successor in interest in the pending claim.

(e) If an employee does not object within the allowed time, the Commission shall review the Form 24 Application to Terminate or Suspend Payment of Compensation and any attached documentation, and an Administrative Decision and Order shall be rendered without an informal hearing as to whether there is a sufficient basis under the Workers' Compensation Act to terminate or suspend compensation, except as provided in Paragraph (g) of this Rule. Either party may seek review of the Administrative Decision and Order as provided by Rule .0702 of this Subchapter.

(f) If the employee timely objects to the Form 24 Application to Terminate or Suspend Payment of Compensation, the Commission shall conduct an informal hearing within 25 days of the receipt by the Commission of the Form 24 Application to Terminate or Suspend Payment of Compensation, unless the time is extended for good cause shown. The informal hearing may be by telephone conference between the Commission and the parties or their attorneys of record. The informal hearing may be conducted with the parties or their attorneys of record personally present with the Commission. The Commission shall make arrangements for the informal hearing with a view towards conducting the hearing in the most expeditious manner. The informal hearing shall be no more than 30 minutes, with each side given 10 minutes to present its case and five minutes for rebuttal. Notwithstanding the above, the employer, carrier, or administrator may waive the right to an informal hearing and proceed to a formal hearing by filing a request for hearing on a Form 33 Request that Claim be Assigned for Hearing.

(g) Either party may appeal the Administrative Decision and Order of the Commission as provided by Rule .0702 of this Subchapter. A Deputy Commissioner shall conduct a hearing which shall be a hearing de novo. The hearing shall be peremptorily set and shall not require a Form 33 Request that Claim be Assigned for Hearing. The employer has the burden of producing evidence on the issue of the employer's application for termination or suspension of compensation. If the Deputy Commissioner reverses an order previously granting a Form 24 Application to Terminate or Suspend Payment of Compensation motion, the employer, carrier, or administrator shall promptly resume compensation or otherwise comply with the Deputy Commissioners decision, notwithstanding any appeal or application for review to the Full Commission pursuant to G.S. 97-85.

(h) If the Commission is unable to reach a decision after an informal hearing, the Industrial Commission shall issue an Administrative Decision and Order to that effect that shall be in lieu of a Form 33 Request that Claim be Assigned for Hearing, and the case shall be placed on the formal hearing docket. If additional issues are to be addressed, the employer, carrier, or administrator shall within 30 days of the date of the Administrative Decision and Order file a Form 33 Request that Claim be Assigned for Hearing or notify the Commission that a formal hearing is not currently necessary. The effect of placing the case on the docket shall be the same as if the Form 24 Application to Terminate or Suspend Payment of Compensation were denied, and compensation shall continue until such time as the case is decided by a Commissioner or a Deputy Commissioner following a formal hearing.

(i) The Commission shall send a copy of the Administrative Decision and Order to a non-prevailing party who is without legal representation by certified mail.

(j) No order issued as a result of an informal Form 24 Application to Terminate or Suspend Payment of Compensation hearing shall terminate or suspend compensation retroactively to a date preceding the filing date of the Form 24 Application to Terminate or Suspend Payment of Compensation. Compensation may be terminated retroactively to a date preceding the filing date of the Form 24 Application to Terminate or Suspend Payment of Compensation without a formal hearing where there is agreement by the parties, where allowed by statute, or where the employee is incarcerated. Otherwise, retroactive termination or suspension of compensation to a date preceding the filing of a Form 24 Application to Terminate or Suspend Payment of Compensation may be ordered as a result of a formal hearing. Additionally, nothing shall impair an employer's right to seek a credit pursuant to G.S. 97-42.

(k) Any Administrative Decision and Order or other Commission decision allowing the suspension of compensation on the grounds of noncompliance with medical treatment pursuant to G.S. 97-25 or G.S. 97-27, noncompliance with vocational rehabilitation pursuant to G.S. 97-25 or G.S. 97-32.2, or unjustified refusal to return to work pursuant to G.S. 97-32 must specify what action the employee must take to end the suspension and reinstate the compensation.

History

  • Authority G.S. 97-18.1(c); 97-18.1(d); 97-32.2(g); 97-80(a)
  • Eff. January 1, 1990
  • Amended Eff. February 1, 2016; November 1, 2014; June 1, 2000; March 15, 1995
  • Recodified from 04 NCAC 10A .0404 Eff. June 1, 2018.
11 NCAC 23A .0404a Trial Return to Work {#sec-11-ncac-23a-.0404a omnilex-key=us-nc-regs-official--title-11--11 NCAC 23A .0404a}

(a) Except as provided in Paragraph (g) of this Rule, when compensation for total disability being paid pursuant to G.S. 97-29is terminated because the employee has returned to work for the same or a different employer, the termination is subject to the provisions of G.S. 97-32.1 (trial return to work). When compensation is terminated under these circumstances, the employer, carrier, or administrator shall, within 16 days of the termination of compensation, file a Form 28T Notice of Termination of Compensation by Reason of Trial Return to Work with the Commission and provide a copy of it to the employee's attorney of record or the employee, if unrepresented.

(b) If during the trial return to work period, the employee must stop working due to the injury for which compensation had been paid, the employee may complete and file with the Commission a Form 28U Employee's Request that Compensation be Reinstated after Unsuccessful Trial Return to Work, without regard to whether the employer, carrier or administrator has filed a Form 28T Notice of Termination of Compensation by Reason of Trial Return to Work as required by Paragraph (a) of this Rule, and provide a copy of the completed form to the employer and carrier or administrator. A Form 28U Employee's Request that Compensation be Reinstated after Unsuccessful Trial Return to Work contains a section that shall be completed by the physician who imposed the restrictions or one of the employee's authorized treating physicians, certifying that the employee's injury for which compensation had been paid prevents the employee from continuing the trial return to work. If the employee returned to work with an employer other than the employer at the time of injury, the employee may complete the "Employee's Release of Employment Information" section of a Form 28U Employee's Request that Compensation be Reinstated after Unsuccessful Trial Return to Work. An employee's failure to provide a Form 28U Employee's Request that Compensation be Reinstated after Unsuccessful Trial Return to Work does not preclude a subsequent finding by the Commission that the trial return to work was unsuccessful.

(c) Upon receipt of a completed Form 28U Employee's Request that Compensation be Reinstated after Unsuccessful Trial Return to Work, the employer, carrier, or administrator shall resume payment of compensation for total disability. If the employee fails to provide the required certification of an authorized treating physician as specified in Paragraph (b) of this Rule, or if the employee fails to execute the "Employees Release and Request" section of a Form 28U Employee's Request that Compensation be Reinstated after Unsuccessful Trial Return to Work, if required pursuant to Paragraph (b) of this Rule, the employer, carrier, or administrator is not required to resume payment of compensation. Instead, the employer, carrier, or administrator shall return a Form 28U Employee's Request that Compensation be Reinstated after Unsuccessful Trial Return to Work to the employees attorney of or the employee, if unrepresented, along with a statement explaining the reason the Form 28U Employee's Request that Compensation be Reinstated after Unsuccessful Trial Return to Work is being returned and the reason compensation is not being reinstated.

(d) The reinstated compensation shall be due and payable and subject to the provisions of G.S. 97-18(g) on the date and for the period commencing on the date the employer, carrier, or administrator receives a completed Form 28U Employee's Request that Compensation be Reinstated after Unsuccessful Trial Return to Work certifying an unsuccessful return to work. Such resumption of compensation does not preclude the employee's right to seek, nor the employer's, carrier's, or administrator's right to contest, the payment of compensation for the period prior or subsequent to the reinstatement. If it is thereafter determined by the Commission that any temporary total or temporary partial compensation, including the reinstated compensation, was not due and payable, a credit shall be given against any other compensation determined to be owed.

(e) When the employer, carrier, or administrator has received a completed Form 28U Employee's Request that Compensation be Reinstated after Unsuccessful Trial Return to Work and contests the employee's right to reinstatement of total disability compensation, the employer, carrier, or administrator may suspend or terminate compensation only as provided in G.S. 97-18.1, G.S. 97-83 or G.S. 97-84.

(f) Upon resumption of payment of compensation for total disability, the employer, carrier, or administrator shall complete and file a Form 62 Notice of Reinstatement or Modification of Compensation or such other forms as may be required by the Workers' Compensation Act or by Commission rule. A copy of the Form 62 Notice of Reinstatement or Modification of Compensation shall be sent to the employee's attorney of record or the employee, if unrepresented.

(g) The trial return to work provisions do not apply to the following:

(1) cases in which the employee is not absent from work for more than one day or in which medical expenses are less than two thousand dollars ($2,000);

(2) cases in which the employee has missed fewer than eight days from work;

(3) cases in which the employee has been released to return to work by an authorized treating physician as specified in Paragraph (b) of this Rule without restriction or limitation except that if the physician, within 45 days of the employee's return to work date, determines that the employee is not able to perform the job duties assigned, then the employer, carrier, or administrator shall resume benefits. If within the same time period, the physician determines that the employee may work only with restrictions, then the employee is entitled to a resumption of benefits commencing as of the date of the report, unless the employer is able to offer employment consistent with the restrictions, in which case a trial return to work period shall be deemed to have commenced at the time of the employee's initial return to work;

(4) cases in which the employee has accepted or agreed to accept compensation for permanent partial disability pursuant to G.S. 97-31, unless the trial return to work follows reinstatement of compensation for total disability under G.S. 97-29; and

(5) claims pending on or filed after 1 January 1995, when the employer, carrier, or administrator contests a claim pursuant to G.S. 97-18(d) within the time allowed thereunder.

(h) This Rule applies to any employee who leaves work on or after February 15, 1995 due to a compensable injury.

History

  • Authority G.S. 97-18(h); 97-29; 97-32.1; 97-80(a)
  • Eff. February 15, 1995
  • Amended Eff. November 1, 2014; August 1, 2006; June 1, 2000
  • Recodified from 04 NCAC 10A .0404A Eff. June 1, 2018.
11 NCAC 23A .0405 Reinstatement of Compensation {#sec-11-ncac-23a-.0405 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23A .0405}

(a) In a claim in which the employer, carrier, or administrator has admitted liability, when an employee seeks reinstatement of compensation pursuant to G.S. 97-18(k), the employee may notify the employer, carrier, or administrator and the employer's, carrier's, or administrator's attorney of record on a Form 23 Application to Reinstate Payment of Disability Compensation or by the filing of a Form 33 Request that Claim be Assigned for Hearing.

(b) When reinstatement is sought by the filing of a Form 23 Application to Reinstate Payment of Disability Compensation, the original Form 23 Application to Reinstate Payment of Disability Compensation and the attached documents shall be filed with the Commission in accordance with Rule .0108 of this Subchapter, and a copy of the Form 23 and attached documents shall contemporaneously be sent to the employer, carrier, or administrator and the employer's, carrier's, or administrator's attorney of record. The employee shall specify the grounds and the alleged facts supporting the application and shall complete the blank space in the "Important Notice to Employer" portion of Form 23 Application to Reinstate Payment of Disability Compensation by inserting a date 17 days from the date the employee serves the completed Form 23 Application to Reinstate Payment of Disability Compensation on the employer, carrier, or administrator and the attorney of record, if any. The Form 23 Application to Reinstate Payment of Disability Compensation shall specify the number of pages of documents attached that are to be considered by the Commission. Within 17 days from the date the employee serves the completed Form 23 Application to Reinstate Payment of Disability Compensation on the employer, carrier, or administrator and the attorney of record, if any, the employer, carrier, or administrator shall complete Section B of the Form 23 Application to Reinstate Payment of Disability Compensation and file it with the Commission in accordance with Rule .0108 of this Subchapter and send a copy contemporaneously to the employee or the employee's attorney of record.

(c) If the employer, carrier, or administrator does not object within the time allowed, the Commission shall review the Form 23 Application to Reinstate Payment of Disability Compensation and the attached documentation and, without an informal hearing, issue an Administrative Decision and Order as to whether there is sufficient basis under the Workers' Compensation Act to reinstate compensation. This Administrative Decision and Order shall be issued within five days of the expiration of the time within which the employer, carrier, or administrator could have filed a response to the Form 23 Application to Reinstate Payment of Disability Compensation. Either party may seek review of the Administrative Decision and Order as provided by Rule .0702 of this Subchapter.

(d) If the employer, carrier, or administrator timely objects to the Form 23 Application to Reinstate Payment of Disability Compensation, the Commission shall conduct an informal hearing within 25 days of the receipt by the Commission of the Form 23 Application to Reinstate Payment of Disability Compensation unless the time is extended for good cause shown. The informal hearing may be conducted with the parties or their attorneys of record personally present with the Commission. The Commission shall make arrangements for the informal hearing with a view toward conducting the hearing in the most expeditious manner. The informal hearing shall be no more than 30 minutes, with each side being given 10 minutes to present its case and five minutes for rebuttal. Notwithstanding the foregoing, the employee may waive the right to an informal hearing and proceed to a formal hearing by filing a request for hearing on a Form 33 Request that Claim be Assigned for Hearing. Either party may appeal the Administrative Decision and Order of the Commission as provided by Rule .0702 of this Subchapter. A Deputy Commissioner shall conduct a hearing which shall be a hearing de novo. The hearing shall be peremptorily set and shall not require a Form 33 Request that Claim be Assigned for Hearing. The employee has the burden of producing evidence on the issue of the employee's application to reinstate compensation. If the Deputy Commissioner reverses an order previously granting a Form 23 Application to Reinstate Payment of Disability Compensation motion, the employer shall promptly terminate compensation or otherwise comply with the Deputy Commissioner's decision, notwithstanding any appeal or application for review to the Full Commission under G.S. 97-85.

(e) If the Commission is unable to render a decision after the informal hearing, the Commission shall issue an order to that effect, which shall be in lieu of a Form 33 Request that Claim be Assigned for Hearing, and the case shall be placed on the formal hearing docket. If additional issues are to be addressed, the employee, employer, carrier, or administrator shall file a Form 33 Request that Claim be Assigned for Hearing or notify the Commission that a formal hearing is not currently necessary within 30 days of the date of the Administrative Decision or Order. The effect of placing the case on the docket shall be the same as if the Form 23 Application to Reinstate Payment of Disability Compensation was denied, and compensation shall not be reinstated until such time as the case is decided by a Commissioner or a Deputy Commissioner following a formal hearing.

History

  • Authority G.S. 97-18(k); 97-80(a)
  • Eff. January 1, 1990
  • Amended Eff. February 1, 2016; November 1, 2014
  • Recodified from 04 NCAC 10A .0405 Eff. June 1, 2018.
11 NCAC 23A .0406 Discount Rate to Be Used in Determining Commuted Values {#sec-11-ncac-23a-.0406 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23A .0406}

To compute the present value of unaccrued compensation payments, the parties shall utilize the Internal Revenue Service's Applicable Federal Rate or the discount rate that is:

(1) used to determine the present value of an annuity, an interest for life or a term of years, or a remainder or reversionary interest,

(2) set monthly by the Internal Revenue Service for Section 7520 interest rates, and

(3) found in the Index of Applicable Federal Rate (AFR) Rulings. The Index of AFR Rulings is hereby incorporated by reference and includes subsequent amendments and editions. A copy may be obtained at no charge from the Internal Revenue Service's website, https://apps.irs.gov/app/picklist/list/federalRates.html or upon request, at the offices of the Commission, located in the Dobbs Building, 430 North Salisbury Street, Raleigh, North Carolina, between the hours of 8:00 a.m. and 5:00 p.m.

History

  • Authority G.S. 97-40; 97-44; 97-80(a)
  • Eff. January 1, 1990
  • Amended Eff. November 1, 2014
  • Recodified from 04 NCAC 10A .0406 Eff. June 1, 2018
  • Amended Eff. October 1, 2019.
11 NCAC 23A .0407 Fees for Medical Compensation {#sec-11-ncac-23a-.0407 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23A .0407}

History

  • Status: repealed
  • Authority G.S. 97-18(i); 97-25.6; 97-26; 97-80(a); 138-6
  • Eff. January 1, 1990
  • Amended Eff. June 1, 2000; March 15, 1995
  • Repealed Eff. November 1, 2014
  • Recodified from 04 NCAC 10A .0407 Eff. June 1, 2018.
11 NCAC 23A .0408 Application for or Stipulation to Additional Medical Compensation {#sec-11-ncac-23a-.0408 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23A .0408}

(a) An employee may file an application for additional medical compensation with the Office of the Executive Secretary for an order for payment of additional medical compensation within two years of the date of the last payment of medical or indemnity compensation, whichever occurs last. An application may be made on a Form 18M Employee's Application for Additional Medical Compensation or by written request. In the alternative, an employee may file an application for additional medical compensation by filing a Form 33 Request that Claim be Assigned for Hearing with the Commission pursuant to Rule .0602 of this Subchapter.

(b) Upon receipt of a Form 18M Employee's Application for Additional Medical Compensation or a written request, the Commission shall notify the employer, carrier, or administrator that the claim has been received by providing a copy of the Form 18M Employee's Application for Additional Medical Compensation or the written request. Within 30 days, the employer, carrier, or administrator may send to the Commission and the employee's attorney of record or the employee, if unrepresented, a written statement as to whether the request is accepted or denied. If the request is denied, the employer, carrier, or administrator may state in writing the grounds for the denial and shall attach any supporting documentation to the statement of denial.

(c) The parties may, by agreement or stipulation consistent with the Workers' Compensation Act, provide for additional medical compensation.

(d) This Rule applies to injuries occurring on or after July 5, 1994.

History

  • Authority G.S. 97-25.1; 97-80(a)
  • Eff. March 15, 1995
  • Amended Eff. November 1, 2014; June 1, 2000
  • Recodified from 04 NCAC 10A .0408 Eff. June 1, 2018
  • Amended Eff. December 1, 2020.
11 NCAC 23A .0409 Claims for Death Benefits {#sec-11-ncac-23a-.0409 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23A .0409}

(a) An employer shall notify the Commission of the occurrence of a death resulting from an injury or occupational disease allegedly arising out of and in the course of employment by filing a Form 19 Employer's Report of Employee's Injury or Occupational Disease to the Industrial Commission within five days of knowledge of the death.

(b) An employer, carrier, or administrator shall conduct an investigation to determine the names and addresses of decedent's potential beneficiaries under G.S. 97-38 and identify them on the Form 29 Supplemental Report for Fatal Accidents. The Form 29 Supplemental Report for Fatal Accidents shall be filed with the Commission within 45 days of notification of a death or allegation of death resulting from an injury or occupational disease arising out of and in the course of employment.

(c) If the employer, carrier, or administrator disputes that an employee's death is compensable or denies it has liability for the claim, the employer, carrier, or administrator shall notify the Commission on a Form 61 Denial of Workers' Compensation Claim. When the employer, carrier, or administrator denies liability for a claim involving an employee's death, the employer, carrier, or administrator shall send the form to all known potential beneficiaries, their attorneys of record, if any, all health care providers that have submitted bills to the employer, carrier, or administrator, and the Commission.

(d) If the employer, carrier, or administrator accepts liability for a claim involving an employee's death and there are no issues necessitating a hearing for determination of beneficiaries or their respective rights, the parties shall submit either a Form 30 Agreement for Compensation for Death as set forth in Rule .0501 of this Subchapter or a proposed Opinion and Award.

(e) If the parties submit a Form 30 Agreement for Compensation for Death, the agreement shall be filed in accordance with Rule .0108 of this Subchapter with the following:

(1) a stipulation as to average weekly wage;

(2) any affidavits regarding dependents;

(3) the employee's death certificate;

(4) a Form 29 Supplemental Report for Fatal Accidents;

(5) a Form 42 Application for Appointment of Guardian ad Litem, if any beneficiary is a minor or incompetent;

(6) proof of beneficiary status, such as marriage license, birth certificate, or divorce decree;

(7) a funeral bill or stipulation as to payment of the funeral benefit;

(8) a Form 30D Award Approving Agreement for Compensation for Death; and

(9) an affidavit or itemized statement in support of an award of attorney's fees if an attorney is seeking fees for representation of one or more beneficiaries.

(f) If the parties seek a written Opinion and Award from the Commission regarding the payment of death benefits in lieu of submitting a Form 30 Agreement for Compensation for Death, the parties shall file, in accordance with Rule .0108 of this Subchapter, a proposed Opinion and Award with the following:

(1) a stipulation regarding all jurisdictional matters;

(2) the decedent's name, social security number, employer, insurance carrier or servicing agent, and the date of the injury giving rise to this claim;

(3) a stipulation as to average weekly wage;

(4) any affidavits regarding dependents;

(5) the employee's death certificate;

(6) a Form 29 Supplemental Report for Fatal Accidents;

(7) a Form 42 Application for Appointment of Guardian ad Litem, if any beneficiary is a minor or incompetent;

(8) proof of beneficiary status, such as marriage license, birth certificate, or divorce decree;

(9) medical records, if any;

(10) a statement of payment of medical expenses incurred, if any;

(11) a funeral bill or stipulation as to payment of the funeral benefit; and

(12) an affidavit or itemized statement in support of an award of attorney's fees if an attorney is seeking fees for representation of one or more beneficiaries.

(g) If an issue exists as to whether a person is a beneficiary pursuant to G.S. 97-38 or if any other disputed issue exists in an accepted claim, the employer, carrier, administrator, potential beneficiary, or any person asserting a claim for benefits may request a hearing by filing a Form 33 Request that Claim be Assigned for Hearing in accordance with Rule .0602 of this Subchapter.

(h) Upon approval by the Commission of a Form 30 Agreement for Compensation for Death or upon the issuance of a final order of the Commission directing payment of death benefits pursuant to G.S. 97-38, payment shall be made by the employer, carrier, or administrator directly to the beneficiaries, with the following exceptions:

(1) any applicable award of attorney's fees shall be paid directly to the attorney; and

(2) benefits due to a minor or incompetent.

(i) In all cases involving minors and incompetent persons who are potential beneficiaries, a guardian ad litem shall be appointed pursuant to Rule .0604 of this Subchapter.

(j) Any benefits due to a minor pursuant to G.S. 97-38 shall be paid directly to the minor's parent, legal guardian, or legal custodian, if the minor remains in the physical custody of such person, or another person if ordered by the Commission for good cause shown. The benefits shall be for the exclusive use and benefit of the minor. When a beneficiary reaches the age of 18, any remaining benefits shall be paid directly to the beneficiary.

(k) The Commission shall order that the benefits for an incompetent beneficiary shall be paid to the person or entity authorized to receive funds on behalf of the beneficiary pursuant to a federal or state court order, or to the Clerk of Court in the county in which the beneficiary resides, for the beneficiary's exclusive use and benefit.

(l) Upon a change in circumstances, any interested party may request that the Commission amend the terms of any award with respect to a minor or incompetent person to direct payment to another party on behalf of the minor or incompetent person.

(m) In the case of benefits commuted to present value, only those sums that have not accrued at the time of the approval of a Form 30 Agreement for Compensation for Death or entry of a final order of the Commission directing payment of death benefits pursuant to G.S. 97-38 are subject to commutation pursuant to Rule .0406 of this Subchapter.

History

  • Authority G.S. 97-38; 97-39; 97-80(a)
  • Eff. June 1, 2000
  • Amended Eff. November 1, 2014; January 2, 2011
  • Recodified from 04 NCAC 10A .0409 Eff. June 1, 2018
  • Amended Eff. December 1, 2020.
11 NCAC 23A .0410 Communication for Medical Information {#sec-11-ncac-23a-.0410 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23A .0410}

(a) When an employer seeks to communicate pursuant to G.S. 97-25.6(c)(2) with an employee's authorized health care provider in writing, without the express authorization of the employee, to obtain relevant medical information not available in the employee's medical records under G.S. 97-25.6(c)(1), the employer may use the Commission's Medical Status Questionnaire.

(b) When an employee seeks a protective order under G.S. 97-25.6(d)(4) or G.S. 97-25.6(f), the employee shall provide the following to the Commission:

(1) the proposed written communication and any proposed additional information from which the employee seeks a protective order;

(2) description of any attempt to resolve the issue cooperatively;

(3) grounds for the protective order; and

(4) any alternative methods to discover the information.

(c) When responding to an employee's request under G.S. 97-25.6(d)(4) or G.S. 97-25.6(f), for a protective order, the employer shall provide the following to the Commission:

(1) the statutory provision on which the proposed communication is based;

(2) description of any attempts which have been made to resolve the issue cooperatively;

(3) description of any other attempts which have been made to obtain the relevant medical information; and

(4) justification for the communication.

(d) When an employer seeks the Commission's authorization for other forms of communication pursuant to G.S. 97-25.6(g), the employer shall follow the procedures for motions in Rule .0609 of this Subchapter.

History

  • Authority G.S. 97-25.6; 97-80(a)
  • Eff. November 1, 2014
  • Recodified from 04 NCAC 10A .0410 Eff. June 1, 2018.
11 NCAC 23A .0411 safety rules {#sec-11-ncac-23a-.0411 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23A .0411}

The process for the Commission to approve safety rules or regulations adopted by an employer as set forth in G.S. 97-12 is as follows:

(1) The rules shall comply with the general provisions of the safety rules outlined by the American National Standards Institute and the Occupational Safety and Health Act. These standards can be purchased at http://ansi.org/ and accessed free of charge at https://www.osha.gov/law-regs.html, respectively.

(2) The rules shall be filed by the employer in writing with the Commission in accordance with Rule .0108 of this Subchapter.

(3) The rules shall be reviewed by the Commission or the Commission's designee and approved if they are found to be in compliance with Item (1) of this Rule. The Commission shall return to the employer a copy of the rules bearing a certificate of approval from the Commission indicating that the rules have been approved by the Commission pursuant to G.S. 97-12. An employer may revise and resubmit the rules if not approved by the Commission.

History

  • Authority G.S. 97-12; 97-80(a)
  • Eff. November 1, 2014
  • Recodified from 04 NCAC 10A .0411 Eff. June 1, 2018
  • Amended Eff. December 1, 2018.
11 NCAC 23A .0501 Agreements for Prompt Payment of Compensation {#sec-11-ncac-23a-.0501 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23A .0501}

(a) To facilitate the payment of compensation within the time prescribed in G.S. 97-18, the Commission shall accept memoranda of agreement on Commission forms. These forms include the Form 21 Agreement for Compensation for Disability, Form 26 Supplemental Agreement as to Payment of Compensation, Form 26A Employer's Admission of Employee's Right to Permanent Partial Disability, Form 26D Agreement for Payment of Unpaid Compensation in Unrelated Death Cases, and Form 30 Agreement for Compensation for Death.

(b) No agreement for permanent disability shall be approved until the relevant medical and vocational records, including a job description if the employee has permanent work restrictions and has returned to work for the employer of injury, known to exist in the case have been filed with the Commission. When requested by the Commission, the parties shall file any additional documentation necessary to determine whether the employee is receiving the disability compensation to which he or she is entitled and that an employee qualifying for disability compensation under G.S. 97-29 or G.S. 97-30, and G.S. 97-31 has the benefit of the more favorable remedy.

(c) After the employer, carrier, or administrator has received a memorandum of agreement that has been signed by the employee and the employee's attorney of record, if any, the employer, carrier, or administrator shall submit the memorandum of agreement within 20 days to the Commission for review and approval. Agreements conforming to the provisions of the Workers' Compensation Act shall be approved by the Commission and a copy returned to the employer, carrier, or administrator, and a copy sent to the employee.

(d) Upon submission to the Commission of the executed agreement, the employer, carrier, administrator, or the attorney of record, if any, shall provide the employee, beneficiary, or attorney of record, if any, with a copy of the executed agreement that was submitted to the Commission.

(e) All memoranda of agreement for cases that are calendared for hearing before a Commissioner or Deputy Commissioner shall be addressed to that Commissioner or Deputy Commissioner, and filed in accordance with Rule .0108 of this Subchapter. Before a case is calendared, or once a case has been continued or removed, or after the filing of an Opinion and Award, all memoranda of agreement shall be addressed to the Claims Section of the Commission, and filed in accordance with Rule .0108 of this Subchapter.

History

  • Authority G.S. 97-18; 97-80(a); 97-82
  • Eff. January 1, 1990
  • Amended Eff. November 1, 2014; August 1, 2006
  • Recodified from 04 NCAC 10A .0501 Eff. June 1, 2018
  • Amended Eff. December 1, 2020.
11 NCAC 23A .0502 Compromise Settlement Agreements {#sec-11-ncac-23a-.0502 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23A .0502}

(a) The Commission shall not approve a compromise settlement agreement unless it contains the following:

(1) The employee knowingly and intentionally waives the right to further benefits under the Workers' Compensation Act for the injury that is the subject of this agreement.

(2) The parties' agreement, if any, as to the payment of the costs due to the Commission pursuant to 11 NCAC 23E .0203, and any mediation costs pursuant to 11 NCAC 23G .0107. If there is no agreement as to the payment of some or all of these costs, the compromise settlement agreement shall include the credits, including the amounts, to be applied by the employer or carrier against the settlement proceeds.

(3) An affirmative statement that no rights other than those arising under the provisions of the Workers' Compensation Act are compromised or released by this agreement.

(4) Whether the employee has, or has not, returned to work.

(5) If the employee has returned to work, whether the employee is earning the same or greater average weekly wage.

(6) If the employee has returned to work at a lower average weekly wage, a description of the specific job or position, the name of the employer, and the average weekly wage earned. This Subparagraph does not apply if the employee is represented by counsel or if the employee certifies that partial wage loss due to an injury or occupational disease is not being claimed.

(7) If the employee has not returned to work, a summary of the employee's age, educational level, past vocational training, past work experience, and any emotional, mental, or physical impairment that predates the current injury or occupational disease. This Subparagraph does not apply if:

(A) it places an unreasonable burden upon the parties;

(B) the employee is represented by counsel; or

(C) the employee certifies that total wage loss due to an injury or occupational disease is not being claimed.

(b) No compromise settlement agreement shall be considered by the Commission unless the following requirements are met:

(1) The relevant medical, vocational, and rehabilitation reports known to exist, including those pertinent to the employee's future earning capacity, are submitted with the agreement to the Commission by the employer, carrier, administrator, or the attorney for the employer.

(2) The employee, the employee's attorney of record, if any, and an attorney of record or other representative who has been given the authority to sign for the employer, carrier and administrator, have signed the agreement.

(3) In a claim where liability is admitted or otherwise has been established, the employer, carrier, or administrator has undertaken to pay all medical expenses for the compensable injury to the date of the settlement agreement.

(4) In a claim in which the employer, carrier, or administrator has not agreed to pay all medical expenses of the employee related to the injury up to the date of the settlement agreement, the settlement agreement contains a list of all known medical expenses of the employee related to the injury to the date of the settlement agreement. This list of known medical expenses shall include:

(A) All expenses that have been paid by the employer, carrier, or administrator;

(B) All expenses that the employer, carrier, or administrator disputes;

(C) All expenses that have been paid by the employee;

(D) All expenses that have been paid by a health benefit plan;

(E) All unpaid expenses that will be paid by the employer, carrier, or administrator; and

(F) All unpaid expenses that will be paid by the employee.

(5) The settlement agreement provides that a party who has agreed to pay a disputed unpaid medical expense will notify the unpaid health care provider in writing of the party's responsibility to pay the unpaid medical expense. Other unpaid health care providers will be notified in writing of the completion of the settlement by the party specified in the settlement agreement:

(A) when the employee or the employee's attorney has notified the unpaid health care provider in writing under G.S. 97-90(e) not to pursue a private claim against the employee for the costs of medical treatment; or

(B) when the unpaid health care provider has notified the employee or the employee's attorney in writing of its claim for payment for the costs of medical treatment and has requested notice of a settlement.

(6) Any obligation of any party to pay an unpaid disputed medical expense pursuant to a settlement agreement does not require payment of any medical expense in excess of the maximum allowed under G.S. 97-26.

(7) The settlement agreement contains a finding that the positions of the parties to the agreement are reasonable as to the payment of medical expenses.

(c) When a settlement has been reached, the written agreement shall be submitted to the Commission upon execution in accordance with Rule .0108 of this Subchapter. All compromise settlement agreements shall be distributed for review in accordance with Paragraphs (a) through (c) of Rule .0609 of this Subchapter. Any changes or addenda to the agreement submitted to the Commission shall be served upon the opposing party contemporaneously with submission to the Commission.

(d) The employer, carrier, or administrator shall furnish an executed copy of the agreement to the employee's attorney of record or the employee, if unrepresented.

(e) An employee's attorney who seeks fees in connection with a compromise settlement agreement shall submit a copy of the fee agreement with the employee. Further, if the employee's attorney is aware of a fee being claimed by a prior attorney for the employee, the employee's attorney shall advise the Commission at the time of the submission of a compromise settlement agreement whether an agreement has been reached with the prior attorney regarding a division of the fee and, if so, the division proposed.

History

  • Authority G.S. 97-17; 97-80(a); 97-82
  • Eff. January 1, 1990
  • Amended Eff. February 1, 2016; November 1, 2014; August 1, 2006; June 1, 2000; March 15, 1995
  • Recodified from 04 NCAC 10A .0502 Eff. June 1, 2018
  • Amended Eff. January 1, 2019.
11 NCAC 23A .0503 Notice of Last Payment Filing Requirement {#sec-11-ncac-23a-.0503 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23A .0503}

The form(s) required to be provided by G.S. 97-18(h) include the following:

(1) Form 28B Report of Employer or Carrier/Administrator of Compensation and Medical Compensation Paid and Notice of Right to Additional Medical Compensation; and

(2) Form 28C Report of Employer or Carrier/Administrator of Compensation and Medical Compensation Paid Pursuant to a Compromise Settlement Agreement.

History

  • Authority G.S. 97-18(h); 97-80(a)
  • Eff. January 1, 1990
  • Amended Eff. November 1, 2014
  • Recodified from 04 NCAC 10A .0503 Eff. June 1, 2018
  • Amended Eff. December 1, 2018.
11 NCAC 23A .0601 EMPLOYER'S OBLIGATIONS UPON NOTICE; DENIAL OF LIABILiTY; and Sanctions {#sec-11-ncac-23a-.0601 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23A .0601}

(a) Upon the employee's filing of a claim for compensation with the Commission, the Commission may order sanctions pursuant to G.S. 97-18(j) against the employer or its insurance carrier if it does not, within 30 days following notice from the Commission of the filing of the claim, or 90 days when a disease is alleged to be from exposure to chemicals, fumes, or other materials or substances in the workplace, do one of the following:

(1) File a Form 60 Employer's Admission of Employee's Right to Compensation to notify the Commission and the employee in writing that the employer is admitting the employee's right to compensation and, if applicable, satisfy the requirements for payment of compensation under G.S. 97-18(b);

(2) File a Form 61 Denial of Workers' Compensation Claim to notify the Commission and the employee that the employer denies the employee's right to compensation consistent with G.S. 97-18(c);

(3) File a Form 63 Notice to Employee of Payment of Compensation Without Prejudice consistent with G.S. 97-18(d).

For purposes of this Rule, sanctions ordered pursuant to G.S. 97-18(j) shall not prohibit the employer or its insurance carrier from contesting the compensability of and its liability for the claim.

Requests for extensions of time to comply with G.S. 97-18(j) shall be addressed to the Claims Administration Section.

(b) When liability in any case is denied, the employer or insurance carrier shall provide a detailed statement of the basis of denial that shall be set forth in a letter of denial or Form 61 Denial of Workers' Compensation Claim, and that shall be sent to the employee's attorney of record or the employee, if unrepresented, all known health care providers who have submitted bills and provided medical records to the employer or carrier, and the Commission.

History

  • Authority G.S. 97-18; 97-80(a); 97-81(a)
  • Eff. January 1, 1990
  • Amended Eff. November 1, 2014; August 1, 2006; June 1, 2000
  • Recodified from 04 NCAC 10A .0601 Eff. June 1, 2018.
11 NCAC 23A .0602 Request for Hearing {#sec-11-ncac-23a-.0602 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23A .0602}

(a) Contested claims shall be set on the hearing docket only upon the written request of one of the parties for a hearing or rehearing of the case in dispute. Any request for hearing shall contain the following:

(1) the basis of the disagreement between the parties, including a statement of the issues raised by the requesting party;

(2) the date of injury;

(3) the part of the body injured;

(4) the city and county where the injury occurred;

(5) the names and addresses of all doctors and other expert witnesses whose testimony is needed by the requesting party;

(6) the names of all lay witnesses to be called to testify for the requesting party;

(7) an estimate of the time required for the hearing of the case; and

(8) the telephone number(s), email address(es), and mailing address(es) of the party(ies) requesting the hearing and their legal counsel.

(b) A Form 33 Request that Claim be Assigned for Hearing, completed in full, shall constitute compliance with this Rule. The request for a hearing shall be filed with the Office of the Clerk in accordance with Rule .0108 of this Subchapter. A copy of the Form 33 Request that Claim be Assigned for Hearing shall be forwarded to the attorneys for all opposing parties, or to the opposing parties themselves, if unrepresented.

History

  • Authority G.S. 97-80(a); 97-83
  • Eff. January 1, 1990
  • Amended Eff. November 1, 2014; June 1, 2000
  • Recodified from 04 NCAC 10A .0602 Eff. June 1, 2018
  • Amended Eff. December 1, 2018.
11 NCAC 23A .0603 Responding to a Party's Request for Hearing {#sec-11-ncac-23a-.0603 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23A .0603}

(a) No later than 45 days from receipt of a request for hearing from a party, the opposing party or parties shall file with the Commission a response to the request for hearing.

(b) The response shall contain the following:

(1) the basis of the disagreement between the parties, including a statement of the issues raised by the moving party that are conceded and the issues raised by the moving party that are denied;

(2) the date of the injury, if it is contended to be different than that alleged by the moving party;

(3) the part of the body injured, if it is contended to be different than that alleged by the moving party;

(4) the city and county where the injury occurred, if they are contended to be different than that alleged by the moving party;

(5) an estimate of the time required for the hearing of the case; and

(6) the telephone number(s), email address(es), and mailing address(es) of the party or parties responding to the request for hearing and their legal counsel.

(c) A Form 33R Response to Request that Claim be Assigned for Hearing, completed in full and filed with the Office of the Clerk in accordance with Rule .0108 of this Subchapter, shall constitute compliance with this Rule. A copy of the Form 33R Response to Request that Claim be Assigned for Hearing shall be forwarded to the attorneys for all opposing parties or the opposing parties themselves, if unrepresented.

History

  • Authority G.S. 97-80(a); 97-83
  • Eff. January 1, 1990
  • Amended Eff. November 1, 2014; June 1, 2000
  • Recodified from 04 NCAC 10A .0603 Eff. June 1, 2018
  • Amended Eff. December 1, 2018.
11 NCAC 23A .0604 Appointment of Guardian Ad Litem {#sec-11-ncac-23a-.0604 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23A .0604}

(a) Minors or incompetent individuals may bring an action only through their guardian ad litem. Upon the written application on a Form 42 Application for Appointment of Guardian Ad Litem, the Commission shall appoint the person as guardian ad litem, if the Commission determines it to be in the best interest of the minor or incompetent individual. The Commission shall appoint the guardian ad litem only after due inquiry as to the fitness of the person to be appointed.

(b) No compensation due or owed to an incompetent individual shall be paid directly to the guardian ad litem, unless the guardian ad litem has authority to receive the money pursuant to a federal or state court order. No compensation due or owed to a minor shall be paid directly to the guardian ad litem, except that a parent, legal guardian, or legal custodian may receive compensation on behalf of a minor in his or her capacity as parent, legal guardian, or legal custodian.

(c) The Commission may assess a fee to be paid by the employer or the insurance carrier to an attorney who serves as a guardian ad litem for services rendered upon receipt of an affidavit of time spent in representation of the minor or incompetent individual as part of the costs.

History

  • Authority G.S. 97-50; 97-79(e); 97-80(a); 97-91
  • Eff. January 1, 1990
  • Amended Eff. November 1, 2014; January 1, 2011; June 1, 2000; March 15, 1995
  • Recodified from 04 NCAC 10A .0604 Eff. June 1, 2018
  • Amended Eff. January 1, 2019.
11 NCAC 23A .0605 Discovery {#sec-11-ncac-23a-.0605 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23A .0605}

In addition to depositions provided for in G.S. 97-80, parties may obtain discovery by the use of interrogatories and requests for production of documents as follows:

(1) Any party may serve upon any other parties written interrogatories, up to 30 in number, including subparts thereof, to be answered by the party served or, if the party served is a public or private corporation or a partnership or association or governmental agency, by any officer or agent, who shall furnish such information as is available from the party interrogated.

(2) Interrogatories may, without leave of the Commission, be served upon any party after the filing of a Form 18 Notice of Accident to Employer and Claim of Employee, Representative, or Dependent, Form 18B Claim by Employee, Representative, or Dependent for Benefits for Lung Disease, or Form 33 Request that Claim be Assigned for Hearing, or after the acceptance of liability for a claim by the employer.

(3) Each interrogatory shall be answered separately and in writing under oath, unless it is objected to, in which event the reasons for objection shall be stated in lieu of an answer. The answers shall be signed by the person making them and the objections shall be signed by the party making them. The party on whom the interrogatories have been served shall serve a copy of the answers and objections, if any, within 30 days after service of the interrogatories. The parties may stipulate to an extension of time to respond to the interrogatories. A motion to extend the time to respond shall state that an attempt to reach agreement with the opposing party to informally extend the time for response has been unsuccessful and the opposing party's position or that there has been an attempt to contact the opposing party to ascertain its position.

(4) If there is an objection to or other failure to answer an interrogatory, the party submitting the interrogatories may move the Commission for an order compelling answer.

(5) Interrogatories and requests for production of documents shall relate to matters that are not privileged, that are relevant to an issue in dispute, or that the requesting party reasonably believes may later be disputed. The signature of a party or attorney serving interrogatories or requests for production of documents constitutes a certificate by such person that he or she has personally read each of the interrogatories and requests for production of documents, that no such interrogatory or request for production of documents will oppress a party or cause any unnecessary expense or delay, that the information requested is not known or equally available to the requesting party, and that the interrogatory or requested document relates to an issue presently in dispute or that the requesting party reasonably believes may later be in dispute. A party may serve an interrogatory, however, to obtain verification of facts relevant to an issue presently in dispute. Answers to interrogatories may be used to the extent permitted by Chapter 8C of the North Carolina General Statutes.

(6) The parties may serve requests for production of documents without leave of the Commission until 35 days prior to the date of hearing.

(7) Additional methods of discovery as provided by the North Carolina Rules of Civil Procedure may be used only upon motion and approval by the Commission or by agreement of the parties. The Commission may approve the motion if it is shown to be in the interests of justice or to promote judicial economy.

(8) Discovery requests and responses, including interrogatories and requests for production of documents, shall not be filed with the Commission, except for the following:

(a) notices of depositions;

(b) discovery requests and responses deemed by filing party to be pertinent to a pending motion;

(c) responses to discovery following a motion or order to compel; and

(d) post-hearing discovery requests and responses.

The above-listed documents shall be filed with the Commission, as well as served on the opposing party.

(9) Sanctions shall be imposed under this Rule for failure to comply with a Commission order compelling discovery unless the Commission excuses the failure based on an inability to comply with the order. A motion by a party or its attorney to compel discovery under this Rule and Rule .0607 of this Subchapter shall represent that informal means of resolving the discovery dispute have been attempted in good faith and state the opposing party's position or that there has been a reasonable attempt to contact the opposing party and ascertain its position.

History

  • Authority G.S. 97-80(a); 97-80(f); S.L. 2014-77
  • Eff. January 1, 1990
  • Amended Eff. November 1, 2014; January 1, 2011; June 1, 2000
  • Recodified from 04 NCAC 10A .0605 Eff. June 1, 2018.
11 NCAC 23A .0606 Discovery - Post Hearing {#sec-11-ncac-23a-.0606 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23A .0606}

Discovery may not be conducted after the initial hearing on the merits of a case unless allowed by order of a Commissioner or Deputy Commissioner. In determining whether to allow further discovery, the Commissioner or Deputy Commissioner shall consider whether further discovery is in the interests of justice or to promote judicial economy.

History

  • Authority G.S. 97-80(a); 97-80(f)
  • Eff. January 1, 1990
  • Amended Eff. November 1, 2014
  • Recodified from 04 NCAC 10A .0606 Eff. June 1, 2018.
11 NCAC 23A .0607 Discovery of Records and Reports {#sec-11-ncac-23a-.0607 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23A .0607}

(a) Upon written request, any party shall provide to the requesting party without cost, a copy of all medical, vocational and rehabilitation reports, employment records, Commission forms, and written communications with health care providers in its possession, within 30 days of the request, unless objection is made within that time period. The duty to respond exists whether or not a request for hearing has been filed and is a continuing one, and any such reports and records that come into the possession of a party after receipt of a request pursuant to this Rule shall be provided to the requesting party within 15 days from the party's receipt of these reports and records.

(b) Upon receipt of a request, a carrier or administrator for an employer's workers' compensation program shall inquire of the employer concerning the existence of records encompassed by the request.

History

  • Authority G.S. 97-80(a); 97-80(b); 97-80(f)
  • Eff. January 1, 1990
  • Amended Eff. November 1, 2014; June 1, 2000; March 15, 1995
  • Recodified from 04 NCAC 10A .0607 Eff. June 1, 2018.
11 NCAC 23A .0608 Statement of Incident Leading to Claim {#sec-11-ncac-23a-.0608 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23A .0608}

(a) Upon the request of the employer or the employer's agent to take a written or a recorded statement, the employer or the employer's agent shall advise the employee that the statement may be used to determine whether the claim will be paid or denied. Any employee who gives his or her employer, the employer's carrier, or any agent of the employer either a written or recorded statement of the facts and circumstances surrounding his or her injury shall be furnished a copy of the statement within 45 days after a request by the employee. Further, any employee who gives a written or recorded statement of the facts and circumstances surrounding his or her injury shall, without request, be furnished a copy of the statement within 45 days after the filing of a Form 33 Request that Claim be Assigned for Hearing. The copy shall be furnished at the expense of the person, firm, or corporation at whose direction the statement was taken.

(b) If any person, firm, or corporation fails to comply with this Rule, then a Commissioner or Deputy Commissioner may, if it is in the interest of justice, enter an order prohibiting that person, firm, or corporation, or its representative, from introducing the statement into evidence or using any part of the statement.

History

  • Authority G.S. 97-80(a)
  • Eff. January 1, 1990
  • Amended Eff. November 1, 2014; June 1, 2000
  • Recodified from 04 NCAC 10A .0608 Eff. June 1, 2018
  • Amended Eff. December 1, 2018.
11 NCAC 23A .0609 Motions Practice {#sec-11-ncac-23a-.0609 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23A .0609}

(a) Motions and responses before a Deputy Commissioner:

(1) in cases that are currently calendared for hearing before a Deputy Commissioner shall be filed in accordance with Rule .0108 of this Subchapter.

(2) to reconsider or amend an Opinion and Award, made prior to giving notice of appeal to the Full Commission, shall be addressed to the Deputy Commissioner who authored the Opinion and Award and filed in accordance with Rule .0108 of this Subchapter.

(b) Motions and responses shall be filed with the Office of the Executive Secretary in accordance with Rule .0108 of this Subchapter:

(1) when a case is not calendared before a Deputy Commissioner;

(2) once a case has been continued or removed from a Deputy Commissioner's calendar; or

(3) after the filing of an Opinion and Award when the time for taking appeal has run.

(c) Motions and responses before the Full Commission:

(1) in cases calendared for hearing before the Full Commission shall be addressed to the Chair of the Full Commission panel and filed in accordance with Rule .0108 of this Subchapter.

(2) filed after notice of appeal to the Full Commission has been given but prior to the calendaring of the case shall be addressed to the Chair of the Commission and filed in accordance with Rule .0108 of this Subchapter.

(3) in cases continued from the Full Commission hearing docket, shall be addressed to the Chair of the panel of Commissioners who ordered the continuance and filed in accordance with Rule .0108 of this Subchapter.

(4) filed after the filing of an Opinion and Award by the Full Commission but prior to giving notice of appeal to the Court of Appeals or the expiration of the period allowed to give notice of appeal to the Court of Appeals shall be addressed to the Commissioner who authored the Opinion and Award and filed in accordance with Rule .0108 of this Subchapter.

(d) Motions requesting an award of attorney's fees from ongoing compensation pursuant to G.S. 97-90 that are not required to be filed with a Deputy Commissioner or the Full Commission pursuant to Paragraphs (a) and (c) of this Rule shall be filed with the Commission's Claims Administration Section in accordance with Rule .0108 of this Subchapter.

(e) All motions and responses thereto, including requests for extensions of time and requests to withdraw motions, shall include a caption containing the Industrial Commission file number(s), party names, and a title identifying the nature of the motion or response. Motions and responses set forth in the body of electronic mail correspondence or contained in a brief will not be accepted for filing by the Commission. This Paragraph does not apply to parties without legal representation.

(f) A motion shall state with particularity the grounds on which it is based, the relief sought, and the opposing party's position, if known, and any effort made by the moving party to resolve the issue in dispute before filing of the motion. Service shall be made on all opposing attorneys of record, or on all opposing parties if not represented.

(g) Motions to continue or remove a case from the hearing calendar on which the case is set shall be made as far in advance as possible of the scheduled hearing and may be made in written or oral form. In all cases, the moving party shall provide the basis for the motion and state that the other parties have been advised of the motion and relate the position of the other parties regarding the motion, or that there has been a reasonable attempt to contact the opposing party and ascertain its position regarding the motion.

(h) Oral motions shall be followed with a written motion from the moving party, if requested by a hearing officer considering the interests of justice.

(i) The responding party to a motion shall have 10 days after a motion is served during which to file and serve copies of a response in opposition to the motion. The Commission may shorten or extend the time for responding to any motion in the interests of justice or to promote judicial economy. Parties in agreement may submit a written stipulation to a single extension of time for responding to any motion, except for medical motions pursuant to Rule .0609A of this Section. The parties submitting a stipulation shall agree to an extension of a reasonable time, not to exceed 30 days.

(j) Motions shall be ruled upon without oral argument unless the Commission determines that oral argument is necessary for a complete understanding of the issues.

(k) All written motions and responses thereto shall include a proposed Order in Microsoft Word format to be considered by the Commission. The proposed Order shall include:

(1) the Industrial Commission file number(s);

(2) the case caption;

(3) the subject of the proposed Order;

(4) the procedural posture; and

(5) the party appearances or contact information. If a party is represented by counsel, then the appearance shall include the attorney and firm name, email address, telephone number, and fax number. If a party is unrepresented, then the proposed Order shall include the party's email address, telephone number, and fax number, if available.

History

  • Authority G.S. 97-79(b); 97-80(a); 97-84; 97-91
  • Eff. January 1, 1990
  • Amended Eff. February 1, 2016; November 1, 2014; June 1, 2000; March 15, 1995
  • Recodified from 04 NCAC 10A .0609 Eff. June 1, 2018
  • Amended Eff. January 1, 2019.
11 NCAC 23A .0609A Medical Motions and Emergency Medical Motions {#sec-11-ncac-23a-.0609a omnilex-key=us-nc-regs-official--title-11--11 NCAC 23A .0609A}

(a) Medical motions brought pursuant to G.S. 97-25 and responses thereto shall be brought before either the Office of the Chief Deputy Commissioner or the Executive Secretary and shall be submitted in accordance with Rule .0108 of this Subchapter. For parties to whom the electronic filing requirements of Rule .0108(b) of this Subchapter apply, motions, responses, and notices of appeal shall be submitted under the EDFP category "Medical Motions and Responses." The submitting party shall contemporaneously serve a copy of the filing to the opposing party or opposing party's counsel, if represented.

(b) In addition to any notice of representation contained in a medical motion or response, an attorney who is retained by a party to prosecute or defend a medical motion or appeal before the Commission shall file a notice of representation in accordance with Rule .0108 of this Subchapter and send a copy of the notice to all other counsel and all unrepresented parties involved in the proceeding.

(c) Motions submitted pursuant to G.S. 97-25 and requesting medical relief other than emergency relief shall contain the following:

(1) a designation as a "Medical Motion" brought pursuant to G.S. 97-25 and a statement directly underneath the case caption clearly indicating the request is for either an administrative ruling by the Executive Secretary or an expedited full evidentiary hearing before a Deputy Commissioner;

(2) a statement of the treatment or relief requested;

(3) a statement of the medical diagnosis of the employee and the name of any health care provider having made a diagnosis or treatment recommendation that is the basis for the motion;

(4) a statement as to whether the claim has been admitted on a Form 60, Employer's Admission of Employee's Right to Compensation, Form 63, Notice to Employee of Payment of Compensation without Prejudice (G.S. 97-18(d)) or Payment of Medical Benefits Only without Prejudice (G.S. 97-2(19) & 97-25), Form 21, Agreement for Compensation for Disability, or is subject to a prior Commission Opinion and Award or Order finding compensability, with supporting documentation attached;

(5) a statement of the time-sensitive nature of the request, if any;

(6) an explanation of opinions known and in the possession of the movant by any relevant experts, independent medical examiners, and second opinion examiners;

(7) if the motion requests a second opinion examination pursuant to G.S. 97-25, the motion shall specify whether the employee has made a prior written request to the defendants for the examination, as well as the date of the request and the date of the denial, if any;

(8) a representation that informal means of resolving the issue have been attempted in good faith, and a statement of the opposing party's position or that there has been a reasonable attempt to contact the opposing party and ascertain its position; and

(9) a proposed Order in Microsoft Word format, in accordance with Rule .0609 of this Section.

(d) Motions submitted pursuant to G.S. 97-25 and requesting emergency medical relief shall contain the following:

(1) a boldface or otherwise emphasized designation as "Emergency Medical Motion";

(2) if the employee is unrepresented, the employee's telephone number and, if available, the employee's email address and fax number;

(3) the adjuster's name, email address, telephone number, and fax number if counsel for the employer/carrier has not been retained;

(4) an explanation of the medical diagnosis and treatment recommendation of the health care provider that requires emergency attention;

(5) a statement of the need for a shortened time period for review, including relevant dates and the potential for adverse consequences if the recommended relief is not provided emergently;

(6) an explanation of opinions known and in the possession of the movant by any relevant experts, independent medical examiner, and second opinion examiners;

(7) a representation that informal means of resolving the issue have been attempted in good faith, and a statement of the opposing party's position or that there has been a reasonable attempt to contact the opposing party and ascertain its position;

(8) documents known and in the possession of the movant relevant to the request, including relevant medical records; and

(9) a proposed Order in Microsoft Word format, in accordance with Rule .0609 of this Section.

(e) Upon receipt of an emergency medical motion, the non-moving party(ies) shall be advised by the Commission of any time allowed for response and whether informal telephonic oral argument is necessary. The Commission shall consider the interests of justice or judicial economy when determining the time allowed for response and whether informal telephonic oral argument is necessary.

(f) A party may appeal an Order of the Executive Secretary on a motion brought pursuant to G.S. 97-25(f)(1) or receipt of a ruling on a motion to reconsider filed pursuant to Rule .0702(b) of this Subchapter by filing notice of appeal in accordance with Rule .0108 of this Subchapter within 15 calendar days of receipt of the Order. Notices of appeal shall be submitted via EDFP under the category "Medical Motions and Responses." A letter or motion expressing an intent to appeal a decision of the Executive Secretary shall be considered a request for an expedited hearing pursuant to G.S. 97-25 and G.S. 97-84. The letter or motion shall specifically identify the Order from which the appeal is taken and shall indicate that the appeal is from an administrative Order by the Executive Secretary entered pursuant to G.S. 97-25(f)(1). After receipt of a notice of appeal, the appeal shall be assigned to a Deputy Commissioner and an Order under the name of the Deputy Commissioner to which the appeal is assigned shall be issued within five days of receipt of the notice of appeal.

(g) Depositions, if requested by the parties or ordered by the Deputy Commissioner, shall be taken in accordance with Rule .0612 of this Section and on the Deputy Commissioner's order pursuant to G.S. 97-25. In full evidentiary hearings conducted by a Deputy Commissioner pursuant to G.S. 97-25(f)(1) and (f)(2), depositions shall be completed and all transcripts, briefs, and proposed Opinion and Awards filed with the Deputy Commissioner in accordance with Rule .0108 of this Subchapter within 60 days of the filing of the motion or appeal. The Deputy Commissioner may reduce or enlarge the timeframe contained in this Paragraph for good cause shown or upon agreement of the parties.

(h) A party may appeal the decision of a Deputy Commissioner filed pursuant to G.S. 97-25(f)(2) by filing notice of appeal to the Full Commission within 15 calendar days of receipt of the decision in accordance with Rule .0108 of this Subchapter. A letter expressing an intent to appeal a Deputy Commissioner's decision filed pursuant to G.S. 97-25 shall be considered notice of appeal to the Full Commission, provided that the letter specifically identifies the decision from which appeal is taken and indicates that the appeal is taken from a decision by a Deputy Commissioner pursuant to G.S. 97-25(f)(2). After receipt of notice of appeal, the appeal shall be acknowledged by the Commission within three days by sending an Order under the name of the Chair of the Panel to which the appeal is assigned. The Order shall set the schedule for filing briefs. A Full Commission hearing on an appeal of a medical motion filed pursuant to G.S. 97-25 shall be held telephonically and shall not be recorded unless unusual circumstances arise and the Commission so orders. All correspondence, briefs, and motions related to the appeal shall be addressed to the Chair of the Panel and shall be filed in accordance with Rule .0108 of this Subchapter.

(i) A party may appeal the administrative decision of the Chief Deputy Commissioner or the Chief Deputy Commissioner's designee filed pursuant to G.S. 97-25(f)(3) by filing notice of appeal electronically in accordance with Rule .0108 of this Subchapter within 15 calendar days of receipt of the Order. A letter or motion expressing an intent to appeal the Chief Deputy Commissioner's or the Chief Deputy Commissioner's designee's Order filed pursuant to G.S. 97-25(f)(3) shall be considered a notice of appeal, provided that the letter specifically identifies the Order from which appeal is taken and indicates that the appeal is from an Order of a Deputy Commissioner entered pursuant to G.S. 97-25(f)(3). After receipt of notice of appeal, the appeal shall be acknowledged within five days by sending an Order under the name of the Deputy Commissioner to whom the appeal is assigned. The appeal of the administrative decision of the Chief Deputy Commissioner or the Chief Deputy Commissioner's designee shall be subject to G.S. 97-25(f)(2) and G.S 97-84.

History

  • Authority G.S. 97-25; 97-78(f)(2); 97-78(g)(2); 97-80(a); S.L. 2014-77
  • Eff. January 1, 2011
  • Amended Eff. February 1, 2016; November 1, 2014
  • Recodified from 04 NCAC 10A .0609A Eff. June 1, 2018
  • Amended Eff. December 1, 2018.
11 NCAC 23A .0610 Pre-Trial Agreement {#sec-11-ncac-23a-.0610 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23A .0610}

(a) A Pre-Trial Agreement shall be signed by the attorneys and filed with the Commission in accordance with Rule .0108 of this Subchapter 10 days before the hearing, unless a shorter time period is ordered upon agreement of the parties.

(b) The Pre-Trial Agreement shall be prepared in a form that conforms to the Order on Final Pre-Trial Conference adopted in the North Carolina Rules of Practice for the Superior and District Courts. Should the parties fail to comply with a Pre-Trial Order, the Commissioner or Deputy Commissioner shall remove the case from the hearing docket if required in the interests of justice or to promote judicial economy. Should the parties comply with the Pre-Trial Order after the removal of the case, the Pre-Trial Agreement shall be directed to the Commissioner or Deputy Commissioner who removed the case from the docket and filed in accordance with Rule .0108 of this Subchapter. The Commissioner or Deputy Commissioner shall order the case returned to the hearing docket as if a Request for Hearing had been filed on the date of the Order to return the case to the hearing docket. No new Form 33 Request that Claim be Assigned for Hearing is required.

(c) If the parties need a conference, a Commissioner or Deputy Commissioner shall order the parties to participate in a pre-trial conference. This conference shall be conducted at such place and by such method as the Commissioner or Deputy Commissioner deems appropriate in the interests of justice or judicial economy, including conference telephone calls.

(d) Any party may request a pre-trial conference to aid in settling the case or resolving contested issues prior to trial. Requests for such pre-trial conferences shall be directed to the Commissioner or Deputy Commissioner before whom the claim has been calendared.

History

  • Authority G.S. 97-80(a); 97-80(b); 97-83
  • Eff. January 1, 1990
  • Amended Eff. February 1, 2016; November 1, 2014; January 1, 2011; June 1, 2000; March 15, 1995
  • Recodified from 04 NCAC 10A .0610 Eff. June 1, 2018
  • Amended Eff. December 1, 2018.
11 NCAC 23A .0611 Hearings Before the Commission {#sec-11-ncac-23a-.0611 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23A .0611}

(a) The Commission may, on its own motion, order a hearing or rehearing of any case in dispute. The Commission shall set a contested case for hearing in a location deemed convenient to witnesses and the Commission.

(b) In setting contested cases for hearing, cases in which the payment of workers' compensation benefits is at issue take precedence.

(c) The Commission shall give notice of hearings in every case. Postponement or continuance of a duly scheduled hearing shall be allowed only in the discretion of a Commissioner or Deputy Commissioner before whom the case is set if required in the interests of justice or to promote judicial economy. When a party has not notified the Commission of the attorney representing the party prior to the mailing of calendars for hearing, notice to that party constitutes notice to the party's attorney.

(d) In a contested case, the record includes all prior Opinion and Awards, filed Commission forms, form agreements, awards, and orders of the Commission. Any other documents that the parties wish to have included in the record shall be introduced and received into evidence.

(e) In the event of inclement weather or natural disaster, hearings set by the Commission shall be cancelled or delayed and rescheduled if the proceedings before the General Court of Justice in that county are cancelled or delayed.

History

  • Authority G.S. 97-79; 97-80(a); 97-84; 97-91
  • Eff. January 1, 1990
  • Amended Eff. November 1, 2014; June 1, 2000
  • Recodified from 04 NCAC 10A .0611 Eff. June 1, 2018
  • Amended Eff. December 1, 2018.
11 NCAC 23A .0612 Depositions {#sec-11-ncac-23a-.0612 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23A .0612}

(a) Prior to a hearing before a Deputy Commissioner, the parties shall confer to determine the methods by which medical evidence will be submitted. The parties shall stipulate in a Pre-Trial Agreement to the admission of all relevant medical records, reports, and forms, as well as opinion letters from the employee's health care providers with the goal of minimizing the use of post-hearing depositions. The parties shall state all experts to be deposed post-hearing. The parties shall certify that the parties have conferred to determine the methods by which medical evidence will be submitted. If there is a disagreement about the stipulation of medical evidence, the parties shall state the nature and basis of the disagreement.

(b) When medical or other expert testimony is requested by the parties for the disposition of a case, a Deputy Commissioner or Commissioner may order expert depositions to be taken on or before a day certain not to exceed 60 days from the date of the hearing; provided, however, the time allowed may be enlarged or shortened in the interests of justice or to promote judicial economy, or where required by the Act.

(c) The employer shall pay for the costs of up to two post-hearing depositions requested by the employee of health care providers who evaluated or treated the employee. The employer shall also bear the costs of a deposition of a second opinion doctor selected jointly by the parties or ordered by the Commission pursuant to G.S. 97-25.

(d) The parties may notice depositions of additional experts, and the costs thereof shall be borne by the party noticing the depositions; provided, however, if a ruling favorable to the employee is rendered and is not timely appealed by the employer, or the employer's appeal is dismissed or withdrawn, then the employer shall reimburse the employee the costs of such additional expert depositions.

(e) In claims pursuant to G.S. 97-29(d) or cases involving exceptional, unique, or complex injuries or diseases, the Commission may allow additional depositions of experts to be taken at the employer's expense, when requested by the employee and when necessary to address the issues in dispute, in which case the employee shall state, and the Commission shall consider when determining whether or not the employer shall bear the costs of such depositions such factors as:

(1) the name and profession of the proposed deponent;

(2) if the proposed deponent is a health care provider, whether the health care provider evaluated, diagnosed or treated the employee;

(3) the issue to which the testimony is material, relevant and necessary;

(4) the availability of alternate methods for submitting the evidence and the efforts made to utilize alternate methods;

(5) the severity or complexity of the employee's condition;

(6) the number and complexity of the issues in dispute;

(7) whether the testimony is likely to be duplicative of other evidence; and

(8) the opposing party's position on the request.

(f) The term "costs" as used in this Rule shall mean the expert's fee as approved by the Commission for the deposition, including the expert's time preparing for the deposition, if applicable. The term shall include fees associated with the production and delivery of a transcript of the deposition to the Commission, including the court reporter's appearance fee. The term shall not include costs for a party to obtain his or her own copy of the deposition transcript, or attorney's fees associated with the deposition, unless so ordered by the Commission pursuant to G.S. 97-88.1.

(g) Notwithstanding Paragraphs (c) and (d) of this Rule, the parties may come to a separate agreement regarding reimbursement of deposition costs, which shall be submitted to the Commission for approval.

(h) If the claimant is unrepresented at the time of a full evidentiary hearing before a Deputy Commissioner, the Commission shall confer with the parties and determine the best method for presenting medical evidence, if necessary, and the party responsible for bearing associated costs.

(i) If a party refuses to stipulate to relevant medical evidence, and as a result, the case is reset or depositions are ordered for testimony of medical or expert witnesses, a Deputy Commissioner or Commissioner may assess the costs of such hearing or depositions, including reasonable attorney fees, against the party who refused the stipulation, pursuant to G.S. 97-88.1.

(j) All evidence and witnesses other than those tendered as an expert witness shall be offered at the hearing before the Deputy Commissioner. Non-expert evidence may be offered after the hearing before the Deputy Commissioner by order of a Deputy Commissioner or Commissioner. The costs of obtaining non-expert testimony by deposition shall be borne by the party making the request unless otherwise ordered by the Commission in the interests of justice or to promote judicial economy.

History

  • Authority G.S. 97-26.1; 97-80(a); 97-88; 97-88.1
  • Eff. June 1, 1990
  • Amended Eff. November 1, 2014; June 1, 2000
  • Recodified from 04 NCAC 10A .0612 Eff. June 1, 2018.
11 NCAC 23A .0613 Expert Witnesses and Fees {#sec-11-ncac-23a-.0613 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23A .0613}

(a) The parties shall file with the Deputy Commissioner or Commissioner in accordance with Rule .0108 of this Subchapter within 15 days following the hearing, a list identifying all expert witnesses to be deposed and the deposition dates unless otherwise extended by the Commission in the interests of justice and judicial economy.

(b) After the deposition of each expert, the party that noticed the deposition shall, within 10 days after receiving the expert's fee invoice, file with the Deputy Commissioner or Commissioner in accordance with Rule .0108 of this Subchapter a request to approve the costs related to the expert deposition. In these requests, the party shall provide, in a cover letter along with the invoice (if available), the following:

(1) the name of the expert and the expert's practice;

(2) the expert's fax number;

(3) the expert's area of specialty and board certifications, if any;

(4) the length of the deposition;

(5) the length of time the expert spent preparing for the deposition, excluding any time meeting with parties' counsel;

(6) whether the Commission determined that the claim was filed pursuant to G.S. 97-29(d) or involved an exceptional, unique, or complex injury or disease;

(7) whether the deponent was selected by the employee in the Pre-Trial Agreement as an expert to be deposed at employer's expense; and

(8) the party initially responsible for payment of the deposition fee pursuant to Rule .0612 of this Section.

At the time the request is made, the requesting party shall submit a proposed Order that shows the expert's name, practice name and fax number under the "Appearances" section. The proposed Order shall also reflect the party initially responsible for payment of the deposition fee pursuant to Rule .0612 of this Section.

(c) The Commission shall issue an order setting the deposition costs of the expert. The term "costs" as used in this Rule shall mean the expert's fee as approved by the Commission for the deposition, including the expert's time preparing for the deposition, if applicable.

(d) Failure to make payment to an expert witness within 30 days following the entry of a fee order shall result in an amount equal to 10 percent being added to the fee granted in the Order.

(e) A proposed fee for cancellation of a deposition within five days of a scheduled deposition may be filed with the Deputy Commissioner in accordance with Rule .0108 of this Subchapter for consideration and approval if in the interest of justice and judicial economy.

(f) This Rule applies to all expert fees for depositions; provided, however, either party may elect to reimburse a retained expert that did not treat or examine the employee the difference between the fee awarded by the Commission and the contractual fee of the expert.

History

  • Authority G.S. 97-26.1; 97-80(a); 97-80(d)
  • Eff. January 1, 1990
  • Amended Eff. February 1, 2016; November 1, 2014; January 1, 2011; June 1, 2000
  • Recodified from 04 NCAC 10A .0613 Eff. June 1, 2018.
11 NCAC 23A .0614 Health Care Provider Fee Dispute Procedure {#sec-11-ncac-23a-.0614 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23A .0614}

(a) Health care providers seeking to resolve a dispute regarding payment of charges for medical compensation shall make an inquiry directly to the employer or employer's workers compensation insurance carrier responsible for the payment of medical fees by using an Industrial Commission Form 26I Medical Provider Dispute Resolution Questionnaire.

(b) The Commission shall assist a health care provider who has been unsuccessful in obtaining carrier contact information. No information regarding a specific claim shall be provided by the Commission to the health care provider.

(c) When an employer or carrier does not respond to a health care provider's Form 26I Medical Provider Dispute Resolution Questionnaire inquiry regarding a medical fee dispute within 20 days, or denies liability as a Form 26I Medical Provider Dispute Resolution Questionnaire response, the health care provider may file a written request seeking assistance from the Commission regarding the fee dispute.

(d) The Commission shall conduct a conference between the health care provider and the employer or carrier in an effort to resolve the dispute.

(e) When the health care provider, with assistance from the Commission is unable to resolve the dispute, the health care provider may request limited intervention in the workers' compensation claim for the sole purpose of resolving the fee dispute.

(f) A health care provider seeking limited intervention in a workers' compensation claim shall file a motion to intervene with the Commission. The Motion to Intervene must include the following:

(1) the Commission file number, if known;

(2) the employee's name, address, and last four digits of his or her social security number;

(3) the date of injury and a description of the workplace injury, including the body parts known to be affected;

(4) an itemized list of the medical fees in dispute, including CPT codes relating specific charges to the Workers' Compensation Medical Fee Schedule, and explanations directly relating each charge to the employee's workplace injury;

(5) a copy of the Form 26I Medical Provider Dispute Resolution Questionnaire submitted by the health care provider, including all accompanying materials, and any response received back by the health care provider from the employer or carrier contacted;

(6) a copy of the written request for assistance submitted to the Medical Fees Section of the Commission;

(7) a copy of the written summary by the Medical Fees Section of the informal resolution process and outcome;

(8) a sworn affidavit by the health care provider that states:

(A) the health care provider has treated the employee;

(B) the medical fees itemized by the health care provider are current and unpaid; and

(C) the health care provider reasonably believes that the employer or carrier named on the Form 26I Medical Provider Dispute Resolution Questionnaire is obligated to pay the fees under the Workers' Compensation Act; and

(9) a certification of service upon both the employee and the employer or carrier named on the Form 26I Medical Provider Dispute Resolution Questionnaire.

(g) A health care provider who has been denied intervention may request a review by the Commission by filing a written request with the Docket Section of the Industrial Commission within 10 days of receipt of the order denying intervention.

(h) The request for review by the Commission shall be served on all parties to the workers' compensation claim and include:

(1) a statement of facts necessary to an understanding of the issue(s);

(2) a statement of the relief sought;

(3) a copy of the motion to intervene, including all attachments required by Paragraph (f) of this Rule; and

(4) a copy of the order denying intervention.

(i) Within 10 days after service of a request for review by the Commission, any party to the workers' compensation claim may file a response, including supporting affidavits or documentation not previously filed with the Commission.

(j) The Commission's determination shall be made on the basis of the request for review and any response(s), including supporting documentation. No briefs or oral argument are allowed by the Commission.

(k) In accordance with the G.S. 97-90.1, when a health care provider is allowed to intervene by the Commission, the intervention is limited to the medical fee dispute.

(l) Following intervention, a health care provider may request and obtain information from the Commission related to the medical fee. The request for information must be in writing, include a copy of the order allowing the health care provider to intervene, and be directed to the Claims Section of the Commission.

(m) Discovery by a health care provider shall be allowed following a Commission order allowing intervention but is limited to matters related to the medical fee dispute.

(n) A health care provider who has intervened in a workers' compensation claim may obtain a hearing before the Commission on a medical fee dispute by filing an Industrial Commission Form 33I Intervenor's Request that Claim be Assigned for Hearing and paying a filing fee.

(o) Upon resolution of a medical fee dispute, costs shall be determined and assessed by the Commission and the health care provider shall be dismissed from the claim. The health care provider shall retain standing to request review of an order from the Commission.

History

  • Authority G.S. 97-26(i); 97-80(a)
  • Eff. January 1, 1990
  • Amended Eff. November 1, 2014; January 1, 2011; June 1, 2000; March 15, 1995
  • Recodified from 04 NCAC 10A .0614 Eff. June 1, 2018.
11 NCAC 23A .0615 Cases Removed from a Hearing Calendar {#sec-11-ncac-23a-.0615 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23A .0615}

(a) A claim may be removed from a hearing calendar by motion of the party requesting the hearing or by the Commission upon its own motion in the interests of justice or to promote judicial economy.

(b) Upon settlement of a case or approval of a form agreement, the parties shall submit a request to remove a case from a hearing calendar and a proposed Order.

(c) After a case has been removed from a hearing calendar, the case may be reset on a hearing calendar by Order of the Commission or filing of a Form 33 Request that Claim be Assigned for Hearing by the party requesting a hearing.

History

  • Authority G.S. 97-80(a); 97-84; 97-91
  • Eff. January 1, 1990
  • Amended Eff. November 1, 2014; June 1, 2000
  • Recodified from 04 NCAC 10A .0615 Eff. June 1, 2018.
11 NCAC 23A .0616 Dismissals {#sec-11-ncac-23a-.0616 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23A .0616}

(a) No claim filed under the Workers' Compensation Act shall be dismissed without prejudice, except upon order of the Commission in the interest of justice. No voluntary dismissal shall be granted after the record in a case is closed. Unless otherwise ordered by the Commission in the interests of justice, a plaintiff shall have one year from the date of the Order of Voluntary Dismissal Without Prejudice to refile his claim.

(b) Upon notice and opportunity to be heard, any claim may be dismissed with or without prejudice by the Commission on its own motion or by motion of any party if the Commission finds that the party failed to prosecute or to comply with the rules in this Subchapter or any Order of the Commission.

(c) In a denied claim, if a plaintiff has not requested a hearing within two years of the filing of the Order removing the case from a hearing calendar and has not pursued the claim, upon notice and opportunity to be heard, any claim shall be dismissed with prejudice by the Commission, on its own motion or by motion of any party.

History

  • Authority G.S. 97-80(a); 97-84; 97-91
  • Eff. June 1, 2000
  • Amended Eff. November 1, 2014; January 1, 2011
  • Recodified from 04 NCAC 10A .0616 Eff. June 1, 2018.
11 NCAC 23A .0617 Attorneys Retained for Proceedings {#sec-11-ncac-23a-.0617 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23A .0617}

(a) Any attorney who is retained by a party in a proceeding before the Commission shall comply with the applicable rules of the North Carolina State Bar. A copy of a notice of representation shall be served upon all other counsel and all unrepresented parties, and submitted to the Commission in accordance with Rule .0108 of this Subchapter. Thereafter, all notices required to be served on a party shall be served upon the attorney. No direct contact or communication concerning contested matters may be made with a represented party by the opposing party or any person on his or her behalf, without the attorney's permission except as permitted by G.S. 97-32 or other applicable law.

(b) Any attorney who wishes to withdraw from representation in a proceeding before the Commission shall file with the Commission, in writing, a Motion to Withdraw that contains a statement of reasons for the request and that the request has been served on the client. The attorney shall make reasonable efforts to ascertain the last known contact information as defined in Rule .0109 of this Subchapter of the client and shall include this information in the motion. A Motion to Withdraw before an award is made shall state whether the withdrawing attorney requests an attorney's fee from the represented party once an award of compensation is made or approved.

(c) An attorney may withdraw from representation only by written order of the Commission. The issuance of an award of the Commission does not release an attorney as the attorney of record.

(d) An attorney withdrawing from representation whose client wishes to appeal an Order, Decision, or Award to the Full Commission shall timely file a notice of appeal, as set out by this Subchapter, on behalf of his or her client either before or with his or her Motion to Withdraw.

(e) Motions to Withdraw shall be submitted in accordance with Rule .0108 of this Subchapter. The Motion to Withdraw shall include a proposed Order in Microsoft Word format that includes, in the appearances, the last known address of any pro se party or the contact information as defined in Rule .0109 of this Subchapter of new counsel if such counsel has been retained. The proposed Order shall include fax numbers for all parties, if known.

History

  • Authority G.S. 97-80(a); 97-90; 97-91
  • Eff. January 1, 2011
  • Amended Eff. February 1, 2016; November 1, 2014
  • Recodified from 04 NCAC 10A .0617 Eff. June 1, 2018
  • Amended Eff. January 1, 2019.
11 NCAC 23A .0618 Disqualification of a Commissioner or Deputy Commissioner {#sec-11-ncac-23a-.0618 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23A .0618}

History

  • Status: repealed
  • Authority G.S. 97-79(b); 97-80(a)
  • Eff. November 1, 2014
  • Recodified from 04 NCAC 10A .0618 Eff. June 1, 2018
  • Repealed Eff. December 1, 2018.
11 NCAC 23A .0619 Foreign Language and sign language Interpreters {#sec-11-ncac-23a-.0619 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23A .0619}

(a) When a person who does not speak or understand the English language or who is speech or hearing impaired is either called to testify in a hearing, other than in an informal hearing conducted pursuant to G.S. 97-18.1, or appears unrepresented before the Full Commission for an oral argument, the person, whether a party or a witness, shall be assisted by a qualified interpreter upon request. For purposes of this Rule, "language" means foreign language or sign language.

(b) To qualify as a foreign language interpreter, a person shall possess sufficient experience and education, or a combination of experience and education, speaking and understanding English and the foreign language to be interpreted, to qualify as an expert witness pursuant to G.S. 8C-1, Rule 702. For Spanish language interpretation, the interpreter must be "Level A" certified by the North Carolina Administrative Office of the Courts. A person qualified as an interpreter under this Rule shall not be interested in the claim and shall make a declaration under oath or affirmation to interpret accurately and truthfully, meaning without any additions or deletions, all questions propounded to the witness and all responses thereto.

(c) To qualify as a sign language interpreter, a person shall possess a license from the North Carolina Interpreter and Transliterator Licensing Board, under Chapter 90D of the North Carolina General Statutes.

(d) Any party who is unable to speak or understand English, or who is speech or hearing impaired, or who intends to call as a witness a person who is unable to speak or understand English or who is speech or hearing impaired, shall so notify the Commission and the opposing party, in writing, not less than 21 days prior to the date of the hearing. The notice shall state the language(s) that shall be interpreted for the Commission.

(e) Upon receiving or giving the notice required in Paragraph (d) of this Rule, the employer or insurer shall retain an interpreter who possesses the qualifications listed in Paragraph (b) or (c) of this Rule to appear at the hearing and interpret the testimony or oral argument of all persons for whom the notice in Paragraph (d) of this Rule has been given or received.

(f) The interpreter's fee shall constitute a cost as set forth in G.S. 97-80. A qualified interpreter who interprets testimony or oral argument for the Commission is entitled to payment of the fee agreed upon by the interpreter and employer or insurer that retained the interpreter. Except in cases where a claim for compensation has been prosecuted without reasonable ground, the fee agreed upon by the interpreter and employer or insurer shall be paid by the employer or insurer. When the Commission ultimately determines that the request for an interpreter was unfounded, attendant costs shall be assessed against the movant.

(g) Foreign language interpreters shall abide by the Code of Ethics and Professional Conduct for Court Interpreters, contained in Section 11 of Standards for Language Access Services, North Carolina Judicial Branch and promulgated by the North Carolina Administrative Office of the Courts, and shall interpret, as word for word as is practicable, without editing, commenting, or summarizing, testimony or other communications. The Code of Ethics and Professional Conduct for Court Interpreters is hereby incorporated by reference and includes subsequent amendments and editions. A copy may be obtained at no charge from the North Carolina Administrative Office of the Court's website, https://www.nccourts.gov/assets/inline-files/02_2_NC_Standards_for_Language_Access_0.pdf?NhuszCAEVfS8KkdLetH97b9I4NRBcd.f, or upon request, at the offices of the Commission, located in the Dobbs Building, 430 North Salisbury Street, Raleigh, North Carolina, 27603, between the hours of 8:00 a.m. and 5:00 p.m.

(h) Sign language interpreters shall interpret, as word for word as is practicable, without editing, commenting, or summarizing, testimony or other communications. Sign language interpreters shall abide by the ethical standards communicated in the training required by G.S. 90D-8.

History

  • Authority G.S. 97-79(b); 97-80(a)
  • Eff. November 1, 2014
  • Recodified from 04 NCAC 10A .0619 Eff. June 1, 2018
  • Amended Eff. April 1, 2020; January 1, 2019.
11 NCAC 23A .0620 written Communications with the commission {#sec-11-ncac-23a-.0620 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23A .0620}

(a) This Rule shall apply to written communications related to a case before the Commission that are not governed by statute or another rule in this Subchapter.

(b) Written communications sent to the Commission shall be contemporaneously sent by the same method of transmission, where possible, to the opposing party or, if represented, to opposing counsel.

(c) Written communications, whether addressed directly to the Commission or copied to the Commission, shall not be used as an opportunity to introduce new evidence or to argue the merits of the case.

History

  • Authority G.S. 97-80(a)
  • Eff. January 1, 2019.
11 NCAC 23A .0701 Review by the Full Commission {#sec-11-ncac-23a-.0701 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23A .0701}

(a) Notice of Appeal. Application for review shall be made to the Commission within 15 days from the date when notice of the Deputy Commissioner's Opinion and Award was given. A letter requesting review shall be considered an application for review to the Full Commission within the meaning of G.S. 97-85, provided that the letter specifies the Order or Opinion and Award from which appeal is taken.

(b) Motions to Reconsider to the Deputy Commissioner. A motion to reconsider or to amend the decision of a Deputy Commissioner shall be filed with the Deputy Commissioner within 15 days of receipt of notice of the award. The time for filing a request for review from the decision of a Deputy Commissioner under the rules in this Subchapter shall be tolled until a motion to reconsider or to amend the decision has been ruled upon by the Deputy Commissioner. However, if either party files a letter requesting review of the decision as set forth in Paragraph (a) of this Rule after a motion to reconsider or to amend has been filed with the Deputy Commissioner, jurisdiction shall be transferred to the Full Commission. Any party who had a pending motion to reconsider or amend the decision of the Deputy Commissioner may file a motion with the Chair of the Commission requesting remand to the Deputy Commissioner with whom the motion was pending. Upon remand, jurisdiction shall be transferred to the Deputy Commissioner. Following the Deputy Commissioner's ruling on the motion to reconsider or amend the decision, a party requesting review of the initial decision of the Deputy Commissioner or the ruling on the motion to reconsider or amend the decision shall file a letter requesting review as set forth in Paragraph (a) of this Rule to transfer jurisdiction of the matter back to the Full Commission.

(c) Acknowledging Receipt; Form 44; Joint Certification. The Commission shall acknowledge the request for review by letter. The Commission shall prepare the official transcript and exhibits, if any, and provide them along with a Form 44 Application for Review to the parties involved in the appeal at no charge within 30 days of the acknowledgement letter.

(1) The official transcript and exhibits and a Form 44 Application for Review shall be provided electronically to parties represented by counsel. In such cases, the Commission shall send an email to the parties with directions on how to obtain an electronic copy of the official transcript and exhibits. The e-mail shall also provide instructions for the submission of the parties' acknowledgement of receipt of the Form 44 Application for Review and the official transcript and exhibits to the Commission. Parties represented by counsel shall sign a joint certification acknowledging receipt of the Form 44 Application for Review and the official transcript and exhibits and submit the certification within 10 days of receipt of the Form 44 Application for Review and the official transcript and exhibits. The certification shall stipulate the date the Form 44 Application for Review and the official transcript and exhibits were received by the parties and shall note the date the appellant's brief is due. The Commission shall save a copy of the parties' acknowledgements in the file for the claim to serve as record of the parties' electronic receipt of the Form 44 Application for Review and the official transcript and exhibits.

(2) In cases where it is not possible to provide a party with the official transcript and exhibits electronically, the Commission shall serve the official transcript and exhibits and a Form 44 Application for Review via any class of U.S. Mail that is fully prepaid.

(d) Appellant's Form 44. The appellant shall submit a Form 44 Application for Review stating with particularity all assignments of error and grounds for review, including, where applicable, the pages in the transcript or the record on which the alleged errors shall be recorded. Grounds for review and assignments of error not set forth in the Form 44 Application for Review are deemed abandoned, and argument thereon shall not be heard before the Full Commission.

(e) Timing Requirements. The appellant shall file the Form 44 Application for Review and brief in support of the grounds for review with the Commission with a certificate of service on the appellee within 25 days after receipt of the transcript or receipt of notice that there will be no transcript. The appellee shall have 25 days from service of the Form 44 Application for Review and appellant's brief to file a responsive brief with the Commission. The appellee's brief shall include a certificate of service on the appellant. When an appellant fails to file a brief, an appellee shall file its brief within 25 days after the appellant's time for filing the Form 44 Application for Review and appellant's brief has expired. A party who fails to file a brief shall not participate in oral argument before the Full Commission. If multiple parties request review, each party shall file an appellant's brief and appellee's brief on the schedule set forth in this Paragraph. If the matter has not been calendared for hearing, a party may obtain a single extension of time not to exceed 15 days by filing a written stipulation pursuant to Rule .0108 of this Subchapter.

(f) Brief Requirements. Briefs to the Full Commission shall not exceed 35 pages, excluding attachments. In no event shall attachments be used to circumvent the 35-page limit or as a means to submit documents into evidence. No page limit applies to the length of attachments. Briefs shall be prepared using a 12 point proportional font and serif typeface, shall be double spaced, and shall be prepared with non-justified right margins. Each page of the brief shall be numbered at the bottom of the page. When a party quotes or paraphrases testimony or other evidence from the appellate record in the party's brief, the party shall include, at the end of the sentence in the brief that quotes or paraphrases the testimony or other evidence, a parenthetic entry that designates the source of the quoted or paraphrased material and the page number within the applicable source. The party shall use "T" to refer to the transcript of hearing testimony and "Ex" for exhibit. For example, if a party quotes or paraphrases material located in the hearing transcript on page 11, the party shall use the following format "(T 11)," and if a party quotes or paraphrases material located in an exhibit on page 12, the party shall use the following format "(Ex 12)." When a party quotes or paraphrases testimony in the transcript of a deposition in the party's brief, the party shall include the last name of the deponent and the page on which such testimony is located. For example, if a party quotes or paraphrases the testimony of John Smith, located on page 11 of such deposition, the party shall use the following format "(Smith 11)." Parties shall not discuss matters outside the record, assert personal opinions or relate personal experiences, or attribute wrongful acts or motives to opposing counsel or members of the Commission.

(g) Reply Briefs. Within 10 days of service of the appellee's brief, a party may request by motion to file a reply brief. The motion shall not contain a reply brief. A reply brief may only be filed if ordered by the Full Commission. Reply briefs shall not exceed 15 pages, excluding attachments. Reply briefs shall be prepared in accordance with the requirements of Paragraph (f) of this Rule. Any reply brief filed shall be limited to a concise rebuttal of arguments set out in the appellee's brief, and shall not reiterate arguments set forth in the appellant's principal brief.

(h) Citations. Case citations shall be to the North Carolina Reports, the North Carolina Court of Appeals Reports, or the North Carolina Reporter, and when possible, to the South Eastern Reporter. An unpublished appellate decision does not constitute controlling legal authority. If a party believes that an unpublished opinion has precedential or persuasive value to a material issue in the case and that there is no published opinion that would serve as well, the party may cite the unpublished opinion. When citing an unpublished opinion, a party shall indicate the opinion's unpublished status. If no reporter citation is available at the time a brief is filed, the party citing to the case shall attach a copy of the case to its brief.

(i) Motions. After a request for review has been submitted to the Full Commission, any motions related to the issues for review shall be filed with the Full Commission, with service on the other parties. Motions related to the issues for review including motions for new trial, to supplement the record, including documents from offers of proof, or to take additional evidence, filed during the pendency of a request for review to the Full Commission, shall be considered by the Full Commission at the time of review of the appeal, except motions related to the official transcript and exhibits. The Full Commission, for good cause shown, may rule on such motions prior to oral argument.

(j) Oral Argument.

(1) Each appellant shall have 20 minutes to present oral argument and may reserve any amount of the twenty-minute total allotment for rebuttal, unless otherwise specified by Order of the Commission. Each appellee shall also have 20 minutes to present oral argument, unless otherwise specified by Order of the Commission. The appellee(s) may not reserve rebuttal time. In the case of cross-appeals, each appealing party may reserve rebuttal time.

(2) Any party may request additional time to present oral argument in excess of the 20-minute allowance. Such requests shall be made in writing and submitted to the Full Commission no less than 10 days prior to the scheduled hearing date. The written request for additional time shall state with particularity the reason(s) for the request of additional time and the amount of additional time requested.

(3) An employee appealing the amount of a disfigurement award shall personally appear before the Full Commission to permit the Full Commission to view the disfigurement.

(4) A party may waive oral argument or appearance before the Commission at any time with approval of the Commission. Upon the request of a party or on its own initiative, the Commission may review the case and file an Order or Award without oral argument or appearance before the Commission.

(5) If any party fails to appear before the Full Commission upon the call of the case, the Commission may, in the interests of justice or judicial economy, disallow the party's right to present oral argument. If neither party appears upon the call of the case, the Full Commission may decide the case upon the record and briefs on appeal, unless otherwise ordered.

(6) Parties shall not discuss matters outside the record, assert personal opinions, relate personal experiences, or attribute wrongful acts or motives to opposing counsel or members of the Commission.

History

  • Authority G.S. 97-80(a); 97-85
  • Eff. January 1, 1990
  • Amended Eff. November 1, 2014; January 1, 2011; August 1, 2006; June 1, 2000
  • Recodified from 04 NCAC 10A .0701 Eff. June 1, 2018
  • Amended Eff. January 1, 2019.
11 NCAC 23A .0702 Review of Administrative Decisions {#sec-11-ncac-23a-.0702 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23A .0702}

(a) Administrative decisions include orders, decisions, and awards made in a summary manner, without findings of fact, including decisions on the following:

(1) applications to approve agreements to pay compensation and medical bills;

(2) applications to approve the termination or suspension or the reinstatement of compensation;

(3) applications to change the interval of payments; and

(4) applications for lump sum payments of compensation.

(b) Administrative decisions made in cases not set for hearing before a Commissioner or Deputy Commissioner or before the Full Commission for review shall be reviewed upon the filing of a Motion for Reconsideration, upon a request for hearing on the administrative decision, or upon request for hearing on the ruling on a Motion for Reconsideration. A Motion for Reconsideration shall be filed within 15 days of receipt of the administrative decision and addressed to the Administrative Officer who made the decision. A request for hearing shall be filed within 15 days of the administrative decision or a ruling on a Motion for Reconsideration. Notwithstanding the provisions above, issues addressed by an administrative decision may be raised and determined at a subsequent hearing.

(c) Motions for Reconsideration shall not stay the effect of the order, decision, or award; provided that Administrative Officer making the decision or a Commissioner may enter an order staying its effect pending the ruling on the Motion for Reconsideration or pending a decision by a Commissioner or Deputy Commissioner following a formal hearing. In determining whether or not to grant a stay, the Commissioner or Administrative Officer shall consider whether granting the stay will frustrate the purposes of the order, decision, or award. Motions to Stay shall not be filed with both the Administrative Officer and a Commissioner.

(d) Any request for a hearing to review an administrative decision pursuant to Paragraph (b) shall be filed with the Office of the Clerk. The Commission shall designate a Commissioner or Deputy Commissioner to hear the review. The Commissioner or Deputy Commissioner hearing the matter shall consider all issues de novo, and no issue shall be considered moot solely because the order has been fully executed during the pendency of the hearing.

(e) Any request for review by the Full Commission of an administrative decision by a Commissioner or Deputy Commissioner made during the pendency of a case assigned to them pursuant to G.S. 97-84 shall be filed with the Office of the Clerk. If the administrative decision made by the authoring Commissioner or Deputy Commissioner is a final judgment as to one or more issues or parties and the administrative decision contains a certification that there is no just reason for delay, the request for review shall be referred directly to a panel of the Full Commission. If the administrative decision contains no certification, requests for review will be referred to the Chair of the Commission for a determination regarding the right to immediate review, and the parties shall address the grounds upon which immediate review shall be allowed.

(f) Orders filed by a single Commissioner in matters before the Full Commission for review pursuant to G.S. 97-85, including orders dismissing reviews to the Full Commission or denying a request for immediate review to the Full Commission, are administrative orders and are not final determinations of the Commission. As such, an order filed by a single Commissioner is not appealable to the North Carolina Court of Appeals. A one-signature order filed by a single Commissioner may be reviewed by:

(1) filing a Motion for Reconsideration addressed to the Commissioner who filed the order; or

(2) requesting a review to a Full Commission panel by requesting a hearing within 15 days of receipt of the order or receipt of the ruling on a Motion for Reconsideration.

(g) This Rule shall not apply to medical motions filed pursuant to G.S. 97-25; provided, however, that a party may request reconsideration of an administrative ruling on a medical motion, or may request a stay, or may request an evidentiary hearing de novo, all as set forth in G.S. 97-25.

History

  • Authority G.S. 97-79(g); 97-80(a); 97-85; S.L. 2014-77
  • Eff. January 1, 1990
  • Amended Eff. November 1, 2014; January 1, 2011; June 1, 2000
  • Recodified from 04 NCAC 10A .0702 Eff. June 1, 2018
  • Amended Eff. January 1, 2019.
11 NCAC 23A .0702A reMAND FROM THE APPELLATE COURTS {#sec-11-ncac-23a-.0702a omnilex-key=us-nc-regs-official--title-11--11 NCAC 23A .0702A}

History

  • Status: repealed
  • Authority G.S. 97-80(a)
  • Eff. August 1, 2006
  • Repealed Eff. November 1, 2014
  • Recodified from 04 NCAC 10A .0702A Eff. June 1, 2018.
11 NCAC 23A .0703 Appeal to the Court of Appeals {#sec-11-ncac-23a-.0703 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23A .0703}

(a) The time to file a notice of appeal, and bonds therefrom, including in forma pauperis affidavits, to the North Carolina Court of Appeals from the Full Commission is governed by the provisions of G.S. 97-86.

(b) A motion to reconsider or to amend an award of the Full Commission shall be filed within 15 days of receipt of notice of the award. An award of the Full Commission is not final until the disposition is filed by the Commission on the pending motion to reconsider or to amend an award.

History

  • Authority G.S. 97-80(a); 97-86
  • Eff. March 15, 1995
  • Amended Eff. November 1, 2014; January 1, 2011; June 1, 2000
  • Recodified from 04 NCAC 10A .0703 Eff. June 1, 2018.
11 NCAC 23A .0704 Remand from the Appellate Courts {#sec-11-ncac-23a-.0704 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23A .0704}

When a case is remanded to the Commission from the appellate courts, each party may file a statement, with or without a brief, to the Full Commission setting forth its position on the actions or proceedings, including evidentiary hearings or depositions, required to comply with the court's decision. This statement shall be filed within 30 days of the issuance of the court's mandate and shall be filed with the Commissioner who authored the Full Commission decision or the Commissioner designated by the Chairman of the Commission if the Commissioner who authored the decision is no longer a member of the Industrial Commission. The deadline to submit the statement to the Commission shall be stayed automatically upon a party filing a petition for discretionary review or rehearing to the appellate courts. The stay shall be automatically lifted if the petition for discretionary review or rehearing is denied by the appellate courts.

History

  • Authority G.S. 97-80(a); 97-86
  • Eff. November 1, 2014
  • Recodified from 04 NCAC 10A .0704 Eff. June 1, 2018.
11 NCAC 23A .0801 WAIVER of Rules {#sec-11-ncac-23a-.0801 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23A .0801}

In the interests of justice or to promote judicial economy, the Commission may, except as otherwise provided by the rules in this Subchapter, waive or vary the requirements or provisions of any of the rules in this Subchapter in a case pending before the Commission upon request of a party or upon its own initiative only if the employee is not represented by counsel. Notwithstanding oral requests made during a hearing before the Commission, all requests shall be submitted in writing and served upon all opposing parties contemporaneously. By order of the Commission, oral requests shall be submitted in writing within five days of the request. Responses to requests considered pursuant to this Rule may be submitted in accordance with Rule .0609 of this Subchapter within five days of service of the original request. Citation to this Rule or use of the term "waiver" is not required for requests considered pursuant to this Rule. Factors the Commission shall use in determining whether to grant the waiver are:

(1) the necessity of a waiver;

(2) the party's responsibility for the conditions creating the need for a waiver;

(3) the party's prior requests for a waiver;

(4) the precedential value of such a waiver;

(5) notice to and opposition by the opposing parties; and

(6) the harm to the party if the waiver is not granted.

History

  • Authority G.S. 97-80(a)
  • Eff. January 1, 1990
  • Amended Eff. November 1, 2014
  • Recodified from 04 NCAC 10A .0801 Eff. June 1, 2018
  • Amended Eff. January 1, 2019.
11 NCAC 23A .0802 Sanctions {#sec-11-ncac-23a-.0802 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23A .0802}

History

  • Status: repealed
  • Authority G.S. 1A-1, Rule 37; 97-18; 97-80(a); 97-88.1
  • Eff. January 1, 1990
  • Amended Eff. June 1, 2000
  • Repealed Eff. November 1, 2014
  • Recodified from 04 NCAC 10A .0802 Eff. June 1, 2018.
11 NCAC 23A .0803 Rulemaking {#sec-11-ncac-23a-.0803 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23A .0803}

History

  • Status: repealed
  • Authority G.S. 97-80(a)
  • Eff. January 1, 1990
  • Repealed Eff. November 1, 2014
  • Recodified from 04 NCAC 10A .0803 Eff. June 1, 2018.
11 NCAC 23A .0901 Check Endorsement {#sec-11-ncac-23a-.0901 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23A .0901}

If a self-insured employer, carrier or third party administrator places "check endorsement" language on the back of an employee's check, the following language (or language approved by the Commission as equivalent) shall be used:

By endorsing this check, I certify that I have not worked for or earned wages from any business or individual during the period covered by this check, or that I have reported any earnings to the employer or carrier paying me workers' compensation benefits. I understand that making a false statement by endorsing this benefit check may result in civil and criminal penalties.

History

  • Authority G.S. 97-80(a); 97-88.2
  • Eff. June 1, 2000
  • Amended Eff. November 1, 2014
  • Recodified from 04 NCAC 10A .0901 Eff. June 1, 2018.
11 NCAC 23A .0902 Notice {#sec-11-ncac-23a-.0902 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23A .0902}

A self-insured employer, carrier or third party administrator shall not use check endorsement language on the back of an employee's workers' compensation benefit check unless the employee has been provided the following Notice sent by certified mail return receipt requested:

NOTICE TO EMPLOYEE RECEIVING WORKERS' COMPENSATION BENEFITS

This NOTICE is intended to advise you of important information you must know if you are receiving workers' compensation benefits.

Please TAKE NOTICE of the following:

(a) When you are receiving weekly workers' compensation benefits, you must report any earnings you receive to the insurance company (or employer if the employer is self-insured) that is paying you the benefits. "Earnings" include any cash, wages or salary received from self-employment or from any employment other than the employment where you were injured. Earnings also include commissions, bonuses, and the cash value for all payments received in any form other than cash (e.g., a building custodian receiving a rent-free apartment). Incentives, commissions, bonuses, or other compensation earned before disability but received during the time you are also receiving workers' compensation benefits do not constitute earnings that must be reported.

(b) You must report any work in any business, even if the business lost money or if profits or income were reinvested or paid to others.

(c) Your endorsement on a benefit check or deposit of the check into an account is your certification that you have not worked for or earned wages from any business or individual during the period covered by the check, or that you have reported any earnings to the employer or carrier paying you workers' compensation benefits and that you are entitled to receive workers' compensation benefits. Your signature on a benefit check is further certification that you have made no material false statement or concealed any material fact regarding your right to receive the benefit check.

(d) Making false statements for the purpose of obtaining workers' compensation benefits may result in civil and criminal penalties.

History

  • Authority G.S. 97-80(a); 97-88.2
  • Eff. June 1, 2000
  • Amended Eff. November 1, 2014
  • Recodified from 04 NCAC 10A .0902 Eff. June 1, 2018.
11 NCAC 23A .0903 Employee's Obligation to Report Earnings {#sec-11-ncac-23a-.0903 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23A .0903}

(a) A self-insured employer, carrier, or third-party administrator may require the employee who has filed a claim and is receiving wage loss benefits under G.S. 97-29 or G.S. 97-30 to complete a Form 90 Report of Earnings when reasonably necessary but not more than once every six months.

(b) The Form 90 Report of Earnings shall be sent to the employee by certified mail, return receipt requested, and shall include a self-addressed stamped envelope for the return of the form. When the employee is represented by an attorney, the Form 90 Report of Earnings shall be sent only to the attorney for the employee and shall be sent by any method of transmission that provides proof of receipt, including electronic mail, facsimile, or certified mail, return receipt requested.

(c) The employee shall complete and return the Form 90 Report of Earnings within 15 days after receipt of a Form 90 Report of Earnings. If the employee fails to complete and return the Form 90 Report of Earnings within 30 days of receipt of the form, the self-insured employer, carrier, or third-party administrator may seek to suspend compensation being paid pursuant to G.S. 97-29 by filing a Form 24 Application to Terminate or Suspend Payment of Compensation, as allowed by G.S. 97-18.1 and Rule .0404 of this Subchapter.

(d) If compensation is suspended pursuant to Paragraph (c) of this Rule and the employee subsequently completes and returns the Form 90 Report of Earnings, the self-insured employer, carrier, or third-party administrator shall reinstate payment of compensation to the employee with back payment. However, if the Form 90 Report of Earnings does not indicate continuing eligibility for disability compensation, the self-insured employer, carrier, or third-party administrator is not required to reinstate payment of compensation. If the Form 90 Report of Earnings indicates continuing eligibility for temporary partial disability compensation, the self-insured employer, carrier, or third-party administrator shall make payment of compensation pursuant to G.S. 97-30 with back payment within 14 days of receipt of documentation establishing the amount of compensation due. If payment of compensation is not reinstated following submission of the completed Form 90 Report of Earnings and the employee claims entitlement to ongoing disability compensation, the employee may seek reinstatement by filing a Form 23 Application to Reinstate Payment of Disability Compensation or Form 33 Request that Claim be Assigned for Hearing.

History

  • Authority G.S. 97-80(a)
  • Eff. June 1, 2000
  • Amended Eff. November 1, 2014; August 1, 2006
  • Recodified from 04 NCAC 10A .0903 Eff. June 1, 2018
  • Amended Eff. December 1, 2020.
11 NCAC 23A .1001 Preauthorization for Surgery and Inpatient Treatment {#sec-11-ncac-23a-.1001 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23A .1001}

(a) An insurer that requires preauthorization must establish a preauthorization review policy that describes the process for requesting preauthorization review. The policy must be publicly available on the insurer's website.

(b) As used in this Section:

(1) "insurer" means an insurance carrier, self-insured administrator, managed care organization, employer, or any other entity that conducts preauthorization review;

(2) "preauthorization" means the determination by an insurer that proposed surgical or inpatient treatment is medically necessary; and

(3) "preauthorization review" means a prospective review process conducted by an insurer to determine whether a proposed surgical or inpatient treatment is medically necessary.

(c) Insurers shall, on an annual basis, electronically submit an electronic copy or link for any medical practice guidelines the insurer utilizes in the preauthorization review process to the Commission at the following email address, execsec@ic.nc.gov, by July 1 of each year.

(d) The insurer shall list each surgical procedure and each inpatient service for which preauthorization review is required. These procedures and services shall be publicly available on the insurer's website.

(e) The preauthorization review policy shall include:

(1) procedures for requesting preauthorization, responding to and approving requests for preauthorization, and appealing a denial of preauthorization;

(2) procedures via telephone, fax and email for communicating with the preauthorization agent with decision making powers on a pending request for preauthorization (including Peer Review Physicians) on a continuous basis on every business day (which excludes weekends and holidays) between the hours of 8:00 a.m. and 8:00 p.m. eastern standard time;

(3) methods by which the insurer shall respond to requests for preauthorization and methods by which a health care provider, claimant, person, or entity requesting preauthorization may respond to inquiries or determinations by the insurer;

(4) a statement that the insurer will provide a statement with supporting documentation of the substantive clinical justification for a denial of preauthorization, including the relevant clinical criteria upon which the denial is based. Denials based upon lack of information shall specify what information is needed to make a determination;

(5) an outline of the appeal rights and procedures with instructions on how to submit appeals by mail, email or fax;

(6) a statement that advises the appealing party of the right to seek authorization for any denied treatment from the Commission; and

(7) the name, title, address, telephone number, fax number, email address and other contact information for the person with authority over all decision-making for preauthorization determinations (in addition to the claims adjuster), and the normal business hours and time zone of this contact person.

(f) Delivery of a request for preauthorization to the claims adjuster or other designated Preauthorization Agent at the place (email address, fax number, telephone number) provided by the insurer shall constitute receipt of the preauthorization request by the claims adjuster.

(g) Preauthorization agents shall acknowledge receipt of all communications within two business days of the request, and the acknowledgment shall satisfy G.S. 97-25.3(a)(2).

(h) Upon receipt of a request for preauthorization, the insurer shall provide to the health care provider or person making the request the name, telephone number, fax number and email address of the Preauthorization Agent. The Preauthorization Agent must be available on a continuous basis, every business day (which excludes weekends and holidays) from 8:00 a.m. to 8:00 p.m. Eastern Standard Time to facilitate responses to insurer communications or determinations.

(i) Insurers that utilize a Peer Review Physician in making preauthorization decisions shall indicate in their preauthorization review policy the name, licensure, and specialty area of that Peer Review Physician and shall provide a profile ("Peer Review Physician Profile") of that Peer Review Physician. The Peer Review Physician shall be licensed in either North Carolina, South Carolina, Georgia, Virginia, or Tennessee and shall hold professional qualifications, certifications, and fellowship training in a like specialty that is at least equal to that of the treating provider who is requesting preauthorization of surgery or inpatient treatment.

(j) Insurers shall, on an annual basis, electronically submit their Peer Review Physician Profiles to the Commission at the following email address, execsec@ic.nc.gov, by July 1 of each year.

(k) All requests for preauthorization by health care providers, claimant's attorneys, or unrepresented claimants, and all preauthorization determinations made by insurers on the preauthorization requests shall be submitted on Industrial Commission Form 25PR. The Preauthorization Agent is responsible for providing the preauthorization review (PR) claim number and for forwarding medical records, communications, and preauthorization review determinations to the proper entities upon receipt, unless the insurer's Preauthorization Plan designates and identifies another person to perform this requirement.

(l) The failure of an insurer to make a determination on a request for preauthorization within seven business days as specified in G.S. 97-25.3 shall result in an automatic waiver of the insurer's right to contest the requested treatment, unless:

(1) an extension of time, not to exceed seven business days, is agreed upon by the insurer and the medical provider requesting preauthorization (or the claimant's attorney or unrepresented claimant, if no medical provider has requested preauthorization); or

(2) an additional extension of time is granted by the Commission pursuant to G.S. 97-25.3(a)(3).

(m) Requests made to the Commission for an extension of time shall be directed to the Office of the Executive Secretary, and shall be simultaneously copied to the requesting health care provider, if any, and to the claimant's attorney or to the claimant, if unrepresented.

(n) In accordance with G.S. 97-18(i), insurers are obligated to pay for any surgery or inpatient treatment provided under G.S. 97-25.3, for which preauthorization was requested for an admitted condition after the right to contest the preauthorization request is waived.

History

  • Authority G.S. 97-25.3; 97-80(a)
  • Eff. November 1, 2014
  • Recodified from 04 NCAC 10A .1001 Eff. June 1, 2018
  • Amended Eff. January 1, 2026.

Subchapter B

11 NCAC 23B .0101 LOCATION OF Main Office AND HOURS OF BUSINESS {#sec-11-ncac-23b-.0101 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23B .0101}

The main office of the North Carolina Industrial Commission is located in the Dobbs Building, 430 North Salisbury Street, Raleigh, North Carolina. Documents that are not being filed electronically may be filed at the main office between the hours of 8:00 a.m. and 5:00 p.m. only. Documents permitted to be filed electronically may be so filed until 11:59 p.m. on the required filing date.

History

  • Authority G.S. 143-291; 143-300
  • Eff. January 1, 1989
  • Amended Eff. July 1, 2014; May 1, 2000
  • Recodified from 04 NCAC 10B .0101 Eff. June 1, 2018
  • Amended Eff. March 1, 2019.
11 NCAC 23B .0102 Official Forms {#sec-11-ncac-23b-.0102 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23B .0102}

(a) Copies of the Commission's rules and forms regarding tort claims may be obtained by contacting the Commission in person at the address in Rule .0101 of this Section; by written request mailed to 1236 Mail Service Center, Raleigh, NC 27699-1236, Attn.: Office of the Clerk; or from the Commission's website at http://www.ic.nc.gov/abtrules.html and http://www.ic.nc.gov/forms.html.

(b) The use of any printed forms other than those provided by the Commission is prohibited, except that parties may reproduce current Commission forms for their own use, provided:

(1) no statement, question, or information blank contained on the Commission form is omitted from the substituted form; and

(2) the substituted form is identical in size and format to the Commission form.

History

  • Authority G.S. 143-300
  • Eff. January 1, 1989
  • Amended Eff. July 1, 2014; May 1, 2000
  • Recodified from 04 NCAC 10B .0102 Eff. June 1, 2018
  • Amended Eff. March 1, 2019.
11 NCAC 23B .0103 Filing Fees {#sec-11-ncac-23b-.0103 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23B .0103}

(a) No tort claim shall be accepted for filing with the Commission unless the claim is accompanied by an attorney's check, certified check, money order, or electronic transfer of funds in payment of a filing fee in an amount equal to the filing fee required for the filing of a civil action in the Superior Court division of the General Court of Justice.

(b) The provisions of Paragraph (a) of this Rule notwithstanding, a tort claim that is accompanied by a Petition to Sue as an Indigent shall be accepted for filing upon the date of its receipt.

(c) A Petition to Sue as an Indigent shall consist of an affidavit sufficient to satisfy the provisions of G.S. 1-110, stating that plaintiff is unable to comply with Paragraph (a) of this Rule.

(d) If the Commission determines the plaintiff is able to pay the fee assessed under this Rule, an Order shall be issued directing payment of that fee, and the plaintiff shall, within 30 days from receipt of the Order, forward to the Commission an attorney's check, certified check, money order, or electronic transfer of funds for the full amount required to be paid. Failure to submit the required amount of the filing fee within this time shall result in the tort claim being dismissed without prejudice.

(e) Upon consideration of a prison inmate's Petition to Sue as an Indigent, the Commission shall determine whether the inmate's tort claim is frivolous and whether to dismiss the claim, pursuant to G.S. 1-110. Appeals from the dismissal of a frivolous tort claim pursuant to G.S. 1-110 shall proceed directly to the Full Commission and shall be decided without oral argument.

History

  • Authority G.S. 143-291.2; 143-300
  • Eff. January 1, 1989
  • Amended Eff. July 1, 2014; May 1, 2000
  • Recodified from 04 NCAC 10B .0103 Eff. June 1, 2018
  • Amended Eff. March 1, 2019.
11 NCAC 23B .0104 Electronic Filings with the Commission; How to File {#sec-11-ncac-23b-.0104 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23B .0104}

(a) All filings to the Commission in tort claims shall be submitted electronically in accordance with this Rule. Any document transmitted to the Commission in a manner not in accordance with this Rule shall not be accepted for filing. Plaintiffs without legal representation may file all documents with the Office of the Clerk of the Commission via the Commission's Electronic Document Filing Portal ("EDFP") or by sending the documents to the Clerk of the Industrial Commission via electronic mail (dockets@ic.nc.gov), facsimile, U.S. Mail, private courier service, or hand delivery.

(b) Information regarding how to use EDFP is available at http://www.ic.nc.gov/training.html. In the event EDFP is inoperable, all documents required to be filed via EDFP shall be transmitted to the Commission via electronic mail to edfp@ic.nc.gov. Documents required to be filed via EDFP that are sent to the Commission via electronic mail when EDFP is operable shall not be accepted for filing.

(c) Any party may apply to the Commission for an emergency temporary waiver of the electronic filing requirement set forth in Paragraph (a) of this Rule if it is unable to comply because of temporary technical problems or lack of electronic mail or internet access. The request for an emergency temporary waiver shall be included with any filing submitted via facsimile, U.S. Mail, or hand delivery due to such temporary technical or access issues.

(d) A Notice of Appeal to the North Carolina Court of Appeals shall be accepted for filing by the Commission via EDFP, U.S. Mail, hand delivery, or any other means allowed by the Rules of Appellate Procedure or applicable statutes governing appeals from the General Courts of Justice. Notwithstanding the foregoing, plaintiffs without legal representation may file all documents with the Commission as provided in Paragraph (a) of this Rule.

History

  • Authority G.S. 143-291; 143-293; 143-297; 143-300
  • Eff. May 1, 2000
  • Amended Eff. July 1, 2014
  • Recodified from 04 NCAC 10B .0104 Eff. June 1, 2018
  • Amended Eff. March 1, 2021; March 1, 2019.
11 NCAC 23B .0105 Contact information {#sec-11-ncac-23b-.0105 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23B .0105}

(a) "Contact information" for purposes of this Rule shall include telephone number, facsimile number, email address, and mailing address.

(b) All persons or entities without legal representation who have matters pending before the Commission shall inform the Commission of any change in contact information by filing a written notice via the Commission's Electronic Document Filing Portal ("EDFP"), email to contactinfo@ic.nc.gov, facsimile to (919) 715-0282, U.S. mail sent to Office of the Clerk, 1236 Mail Service Center, Raleigh North Carolina 27699-1236, private courier service in accordance with Rule .0101 of this Section, or hand delivery in accordance with Rule .0101 of this Section.

(c) A plaintiff without legal representation who was an inmate in the North Carolina Division of Adult Corrections at the time of filing his or her tort claim, shall, within 30 days of release, provide the Commission with written notice of his or her post-release contact information in any manner authorized in Paragraph (b) of this Rule. Following the initial written notice of post-release contact information, the previously incarcerated plaintiff shall continue to inform the Commission of all changes in contact information in accordance with Paragraph (b) of this Rule.

(d) All attorneys of record with matters before the Commission shall provide and maintain current contact information for the Commission's records via EDFP.

(e) Instructions on how to provide and update contact information via EDFP are available at https://www.ic.nc.gov/docfiling.html.

History

  • Authority G.S. 143-291; 143-300
  • Eff. March 1, 2019
  • Amended Eff. March 1, 2021.
11 NCAC 23B .0106 Notice by the commission {#sec-11-ncac-23b-.0106 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23B .0106}

(a) If service is provided by electronic mail, "receipt of such notice" pursuant to G.S. 143-292 and "receipt of the decision and order" of the Full Commission pursuant to G.S. 143-293 is complete one hour after it is sent by the Commission, provided that:

(1) notice sent after 5:00 p.m. shall be complete at 8:00 a.m. the following State business day; and

(2) notice sent by electronic mail that is not readable by the recipient is not complete. Within five State business days of receipt of an unreadable document, the receiving party shall notify the Commission of the unreadability of the document.

(b) If service is provided by electronic mail, notice of orders or other documents issued pursuant to G.S. 143-296 is complete in accordance with the same provisions set forth in Paragraph (a) of this Rule.

History

  • Authority G.S. 143-300
  • Eff. December 1, 2020.
11 NCAC 23B .0201 Rules of Civil Procedure {#sec-11-ncac-23b-.0201 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23B .0201}

History

  • Status: repealed
  • Authority G.S. 143-300
  • Eff. January 1, 1989
  • Amended Eff. January 1, 2011; May 1, 2000
  • Repealed Eff. July 1, 2014
  • Recodified from 04 NCAC 10B .0201 Eff. June 1, 2018.
11 NCAC 23B .0202 Medical Malpractice Claims by Unrepresented Prison Inmates {#sec-11-ncac-23b-.0202 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23B .0202}

In any tort claim filed by an unrepresented prison inmate in which the Commission determines that the plaintiff is alleging that a health care provider, as defined in G.S. 90-21.11, failed to comply with the applicable standard of care set forth in G.S. 90-21.12, or the defendant has moved to dismiss the claim for failure to comply with Rule 9(j) of the North Rules of Civil Procedure, all discovery shall be stayed until a recorded non-evidentiary hearing before the Commission is held for the purpose of determining whether a claim for medical malpractice has been stated and, if so, whether:

(1) the plaintiff must meet the requirements of Rule 9(j)(1) or (2) of the North Carolina Rules of Civil Procedure to proceed with the claim; or

(2) the plaintiff has alleged facts establishing negligence under the existing common-law doctrine of res ipsa loquitur.

If the Commission determines that a claim for medical malpractice has been stated and plaintiff must meet the requirements of Rule 9(j)(1) or (2) of the North Carolina Rules of Civil Procedure, the defendant shall produce medical records to the plaintiff within the time period ordered by the Commission. The plaintiff shall have one hundred and twenty (120) days following receipt of the medical records to comply with Rule 9(j) of the North Carolina Rules of Civil Procedure.

History

  • Authority G.S. 143-300
  • Eff. January 1, 1989
  • Recodified from 04 NCAC 10B .0206 Eff. April 17, 2000
  • Amended Eff. July 1, 2014; May 1, 2000
  • Recodified from 04 NCAC 10B .0202 Eff. June 1, 2018
  • Amended Eff. March 1, 2019.
11 NCAC 23B .0203 Infants and Incompetents {#sec-11-ncac-23b-.0203 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23B .0203}

(a) Persons seeking to appear on behalf of an infant or incompetent in accordance with G.S. 1A-1, Rule 17 shall apply on a Form T-42 Application for Appointment of Guardian ad Litem. The Commission shall appoint a guardian ad litem if it is in the best interest of the minor or incompetent. The Commission shall appoint the guardian ad litem only after due inquiry as to the fitness of the person to be appointed.

(b) The Commission may assess a fee to be paid to an attorney who serves as a guardian ad litem for actual services rendered upon receipt of an affidavit of actual time spent in representation of the minor or incompetent as part of the costs assessed pursuant to G.S. 143-291.2(a) or Rule 17(b)(2) of the North Carolina Rules of Civil Procedure.

History

  • Authority G.S. 143-291; 143-295; 143-300
  • Eff. January 1, 1989
  • Recodified from 04 NCAC 10B .0307 Eff. April 17, 2000
  • Amended Eff. July 1, 2014; May 1, 2000
  • Recodified from 04 NCAC 10B .0203 Eff. June 1, 2018
  • Amended Eff. March 1, 2019.
11 NCAC 23B .0204 Motions {#sec-11-ncac-23b-.0204 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23B .0204}

(a) All motions regarding tort claims shall be filed pursuant to Rule .0104 of this Subchapter.

(b) A motion shall state the grounds on which it is based with particularity, the relief sought, and the opposing party's position, or that the opposing party's position could not be ascertained after a good faith effort.

(c) At the same time a motion is filed, the party filing the motion shall provide a copy of the motion to all opposing attorneys of record or on all opposing parties if not represented.

(d) All motions and responses thereto filed electronically shall include a proposed Order in Microsoft Word format.

(e) By motion of the parties or on its own motion, the Commission may enlarge the time for an act required or allowed to be done under the Rules in this Subchapter in the interests of justice or to promote judicial economy. An enlargement of time may be granted either before or after the relevant time requirement has elapsed.

(f) Motions to continue or remove a case from the hearing docket shall be made as much in advance of the scheduled hearing as possible and shall be made in writing. The moving party shall state that the other parties have been advised of the motion and shall state the position of the other parties regarding the motion. Oral motions shall be permitted in emergency situations.

(g) The responding party to a motion, with the exception of motions to continue or to remove a case from a hearing docket, has 10 days after a motion is served during which to file and serve copies of a response in opposition to the motion.

(h) Notwithstanding Paragraph (g) of this Rule, a motion may be acted upon at any time by the Commission, despite the absence of notice to all parties and without awaiting a response. Motions shall be determined without oral argument, unless the Commission orders otherwise in the interests of justice.

(i) Motions to dismiss or for summary judgment filed by the defendant on the ground that plaintiff has failed to name the individual officer, agent, employee, or involuntary servant whose alleged negligence gave rise to the claim, or has failed to properly name the department or agency of the State with whom such person was employed, shall be ruled upon following the completion of discovery.

(j) Motions to reconsider or amend an Order or Decision and Order, made prior to giving notice of appeal to the Full Commission, shall be addressed to the Deputy Commissioner who authored the Order or Decision and Order.

History

  • Authority G.S. 143-296; 143-300
  • Eff. January 1, 1989
  • Recodified from 04 NCAC 10B .0203 Eff. April 17, 2000
  • Amended Eff. July 1, 2014; May 1, 2000
  • Recodified from 04 NCAC 10B .0204 Eff. June 1, 2018
  • Amended Eff. March 1, 2019.
11 NCAC 23B .0205 Mediation {#sec-11-ncac-23b-.0205 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23B .0205}

(a) Any party participating in mediation shall be bound by the Rules for Mediated Settlement and Neutral Evaluation Conferences of the Commission, found in 11 NCAC 23G, except to the extent these Rules conflict with the Tort Claims Act or the other rules in this Subchapter, in which case the Tort Claims Act and the other rules in this Subchapter shall apply.

(b) An employee or agent of the named governmental entity or agency shall either physically attend or be available via telecommunication. Mediation shall not be delayed due to the absence or unavailability of the employee or agent of the named governmental entity or agency.

History

  • Authority G.S. 143-295; 143-296; 143-300
  • Eff. January 1, 1989
  • Amended Eff. July 1, 2014; January 1, 2011; May 1, 2000
  • Recodified from 04 NCAC 10B .0205 Eff. June 1, 2018
  • Amended Eff. March 1, 2019.
11 NCAC 23B .0206 Hearings {#sec-11-ncac-23b-.0206 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23B .0206}

(a) The Commission may, on its own motion, order a hearing, rehearing, or pre-trial conference of any tort claim in dispute. The Commission shall set the date, time, and location of the hearing, and provide notice of the hearing to the parties. Any pre-trial conference, as well as hearings of claims in which the plaintiff is incarcerated at the time of the hearing, may be conducted via videoconference or telephone conference in lieu of an in-person hearing. Where a party has not notified the Commission of the attorney representing the party prior to the mailing of calendars for hearing, notice to that party constitutes notice to the party's attorney. Any scheduled hearings shall proceed to completion unless recessed, continued, or removed by Order of the Commission, and shall not be limited by the business hours of the Commission as set forth in Rule .0101 of this Subchapter.

(b) When an attorney is notified to appear for a pre-trial conference, motion hearing, hearing, or any other appearance the attorney shall, consistent with the North Carolina Rules of Professional Conduct, appear or have a partner, associate, or other attorney appear. Counsel for each party or any party without legal representation shall remain in the hearing room throughout the course of the hearing, unless excused by the Commission.

(c) A motion for a continuance shall be allowed by the Commissioner or Deputy Commissioner before whom the case is set in the interests of justice or to promote judicial economy.

(d) In cases involving property damage of less than five hundred dollars ($500.00), the Commission may, upon its own motion or upon the motion of either party, order a videoconference or telephone conference hearing on the matter.

(e) Unless otherwise ordered by the Commission, in the event of inclement weather or natural disaster, hearings set by the Commission shall be cancelled or delayed and rescheduled when the proceedings before the General Courts of Justice in that county are cancelled or delayed.

(f) Unless otherwise ordered or waived by the Commission, applications for issuance of a writ of habeas corpus ad testificandum requesting the appearance of witnesses incarcerated by the North Carolina Division of Adult Corrections, shall be filed with the Commission with a copy to the opposing party or counsel, for review by the Commission in accordance with G.S. 143-296.

History

  • Authority G.S. 143-296; 143-300
  • Eff. January 1, 1989
  • Recodified from 04 NCAC 10B .0202 Eff. April 17, 2000
  • Amended Eff. July 1, 2014; January 1, 2011; May 1, 2000
  • Recodified from 04 NCAC 10B .0206 Eff. June 1, 2018
  • Amended Eff. March 21, 2019.
11 NCAC 23B .0207 Hearings of Claims by Prison Inmates {#sec-11-ncac-23b-.0207 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23B .0207}

History

  • Status: repealed
  • Authority G.S. 97-101.1; 143-296; 143-300
  • Eff. January 1, 1989
  • Recodified from 04 NCAC 10B .0204 Eff. April 17, 2000
  • Amended Eff. July 1, 2014; May 1, 2000
  • Recodified from 04 NCAC 10B .0207 Eff. June 1, 2018
  • Repealed Eff. March 21, 2019.
11 NCAC 23B .0208 Hearing Costs {#sec-11-ncac-23b-.0208 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23B .0208}

Costs assessed pursuant to Rule 11 NCAC 23E .0202 in tort claims shall be due upon receipt of a bill or statement from the Commission.

History

  • Authority G.S. 7A-305; 143-291.1; 143-291.2; 143-300
  • Eff. July 1, 2014
  • Recodified from 04 NCAC 10B .0208 Eff. June 1, 2018
  • Amended Eff. March 1, 2019.
11 NCAC 23B .0301 Scope {#sec-11-ncac-23b-.0301 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23B .0301}

The rules in this Section are the applicable Rules for appeals of cases brought pursuant to Article 31 of Chapter 143 of the General Statutes to the Full Commission.

History

  • Authority G.S. 143-292; 143-300
  • Eff. January 1, 1989
  • Amended Eff. July 1, 2014; May 1, 2000
  • Recodified from 04 NCAC 10B .0301 Eff. June 1, 2018.
11 NCAC 23B .0302 Appeals TO THE FULL COMMISSION {#sec-11-ncac-23b-.0302 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23B .0302}

(a) Notice of appeal shall be made to the Commission within 15 days from the date when notice of the Deputy Commissioner's Order or Decision and Order has been received by the appellant. The notice of appeal shall specify, by tort claim number and filing date, the Order or Decision and Order from which appeal is taken. The notice of appeal shall include a written statement confirming that a copy of the notice of appeal has been sent to the opposing party or parties.

(b) After receipt of the notice of appeal, the Commission shall acknowledge the notice of appeal in writing. Within 30 days of the acknowledgement, the Commission shall prepare and provide, at no charge to the parties, electronic copies of any official transcript, any exhibits, and a Form T-44 Application for Review. In cases where it is not possible to provide a party with the official transcript and exhibits electronically, the Commission shall provide the official transcript, all exhibits, and a Form T-44 Application for Review via any class of U.S. mail that is fully prepaid.

(c) Within 25 days of receipt of the official transcript and exhibits or receipt of notice that there will be no official transcript and exhibits, the appellant shall submit a Form T-44 Application for Review or written statement stating with particularity all assignments of error and grounds for review, including, where applicable, the pages in the transcript or the record on which the alleged errors are recorded. The Form T-44 Application for Review or the written statement shall be accompanied by confirmation that a copy of the document has been sent to the opposing party or parties. Failure to state the proposed issues on appeal, either by Form T-44 Application for Review or by written statement, shall be grounds for dismissal of the appeal either upon the motion of the non-appealing party or upon the Full Commission's own motion.

(d) An appellant may file a brief in support of the grounds for appeal with the Commission, with a written statement confirming that a copy of the brief has been sent to the opposing party or parties, within 25 days after receipt of the official transcript and exhibits or receipt of notice that there will be no official transcript and exhibits. The appellee shall have 25 days from service of the appellant's brief to file a reply brief with the Commission with a written statement confirming that a copy of the brief has been sent to the opposing party or parties. If the appellant fails to file a brief, the appellee shall file a brief within 25 days after the appellant's time for filing a brief has expired. If multiple parties appeal, each party may file an appellant's brief and appellee's brief on the schedule set forth in this Rule. If the matter has not been calendared for hearing, any party may file a written stipulation to a single extension of time not to exceed 15 days with the Office of the Clerk. The cumulative extensions of time shall not exceed 30 days. A party who fails to file a brief shall not be allowed oral argument before the Full Commission.

(e) Briefs to the Full Commission shall not exceed 35 pages, excluding attachments. No page limit applies to the length of attachments. Typed briefs shall be prepared using 12-point proportional type, shall be double spaced, and shall be prepared with non-justified right margins. Each page of the brief shall be numbered at the bottom right of the page. If a party quotes or paraphrases testimony or evidence from the official transcript or exhibits in a brief, the party shall include, at the end of the sentence, a parenthetic entry that designates the source and page number of the quoted or paraphrased material. The party shall use "T" for transcript and "Ex" for exhibit. For example, (1) if a party quotes or paraphrases material located in the transcript on page 11, the party shall use the following format "(T 11)," and (2) if a party quotes or paraphrases material located in an exhibit on page 12, the party shall use the following format "(Ex 12)". If a party quotes or paraphrases testimony or other evidence in the transcript of a deposition, the party shall include, at the end of the sentence, a parenthetic entry that contains the name of the person deposed and the page number in the transcript of the deposition. For example, if a party quotes or paraphrases the testimony of John Smith located on page 11 of the transcript of the deposition, the party shall use the following format "(Smith 11)". Cases shall be cited to the North Carolina Reports, the North Carolina Court of Appeals Reports, or the North Carolina Reporter and, if possible, to the South Eastern Reporter. Briefs shall be based upon the record in the matter, pursuant to G.S. 143-292.

(g) A request for review by the Full Commission of an order by a Commissioner or Deputy Commissioner made during the pendency of a case assigned to them shall be filed with the Office of the Clerk. If the order made by the authoring Commissioner or Deputy Commissioner is a final judgment as to one or more issues or parties and the order contains a certification that there is no just reason for delay, the request for review shall be referred directly to a panel of the Full Commission. If the order contains no certification, requests for review shall be referred to the Chair of the Commission for a determination regarding the right to immediate review, and the parties shall address the grounds upon which immediate review shall be allowed.

History

  • Authority G.S. 143-292; 143-300
  • Eff. January 1, 1989
  • Amended Eff. July 1, 2014; May 1, 2000
  • Recodified from 04 NCAC 10B .0302 Eff. June 1, 2018
  • Amended Eff. March 1, 2019.
11 NCAC 23B .0303 Proposed Issues on Appeal {#sec-11-ncac-23b-.0303 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23B .0303}

History

  • Status: repealed
  • Authority G.S. 143-292; 143-300; 362 N.C. 191 (2008)
  • Eff. January 1, 1989
  • Amended Eff. July 1, 2014; January 1, 2011; May 1, 2000
  • Recodified from 04 NCAC 10B .0303 Eff. June 1, 2018
  • Repealed Eff. March 1, 2019.
11 NCAC 23B .0304 Dismissals of Appeals {#sec-11-ncac-23b-.0304 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23B .0304}

History

  • Status: repealed
  • Authority G.S. 143-300
  • Eff. January 1, 1989
  • Recodified from 04 NCAC 10B .0305 Eff. April 17, 2000
  • Amended Eff. May 1, 2000
  • Repealed Eff. July 1, 2014
  • Recodified from 04 NCAC 10B .0304 Eff. June 1, 2018.
11 NCAC 23B .0305 Briefs to the Full Commission {#sec-11-ncac-23b-.0305 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23B .0305}

History

  • Status: repealed
  • Authority G.S. 143-296; 143-300
  • Eff. January 1, 1989
  • Recodified from 04 NCAC 10B .0306 Eff. April 17, 2000
  • Amended Eff. July 1, 2014; May 1, 2000
  • Recodified from 04 NCAC 10B .0305 Eff. June 1, 2018
  • Repealed Eff. March 1, 2019.
11 NCAC 23B .0306 Motion for New Hearing {#sec-11-ncac-23b-.0306 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23B .0306}

History

  • Status: repealed
  • Authority G.S. 143-292; 143-296; 143-300
  • Eff. January 1, 1989
  • Recodified from 04 NCAC 10B .0310 Eff. April 17, 2000
  • Amended Eff. May 1, 2000
  • Repealed Eff. July 1, 2014
  • Recodified from 04 NCAC 10B .0306 Eff. June 1, 2018.
11 NCAC 23B .0307 Motions Before the Full Commission {#sec-11-ncac-23b-.0307 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23B .0307}

(a) After notice of appeal has been given to the Full Commission, all motions related to the claim before the Full Commission shall be in writing and filed with the Full Commission with a statement confirming that copies have been provided to the other parties. A Motion for a New Hearing shall be supported by an Affidavit.

(b) Motions related to the issues on appeal, including motions for new trial, to amend the record, or to take additional evidence, filed during the pendency of an appeal to the Full Commission shall be argued before the Full Commission at the time of the hearing of the appeal.

History

  • Authority G.S. 143-296; 143-300
  • Eff. January 1, 1989
  • Recodified from 04 NCAC 10B .0308 effective April 17, 2000
  • Amended Eff. July 1, 2014; May 1, 2000
  • Recodified from 04 NCAC 10B .0307 Eff. June 1, 2018
  • Amended Eff. March 1, 2019.
11 NCAC 23B .0308 Stays {#sec-11-ncac-23b-.0308 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23B .0308}

If a case is appealed to the Full Commission, all Orders or Decision and Orders of a Deputy Commissioner shall be stayed pending appeal.

History

  • Authority G.S. 143-292; 143-296; 143-300
  • Eff. May 1, 2000
  • Amended Eff. July 1, 2014
  • Recodified from 04 NCAC 10B .0308 Eff. June 1, 2018
  • Amended Eff. March 1, 2019.
11 NCAC 23B .0309 New Evidence {#sec-11-ncac-23b-.0309 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23B .0309}

History

  • Status: repealed
  • Authority G.S. 143-300
  • Eff. January 1, 1989
  • Amended Eff. May 1, 2000
  • Repealed Eff. July 1, 2014
  • Recodified from 04 NCAC 10B .0309 Eff. June 1, 2018.
11 NCAC 23B .0310 Oral Argument {#sec-11-ncac-23b-.0310 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23B .0310}

(a) A party may waive oral argument at any time with approval of the Commission. Upon the request of a party or on its own initiative, the Commission may review the case and file an Order or Decision and Order without oral argument.

(b) When presenting oral argument, each appellant shall have 20 minutes to present oral argument and may reserve any amount of the 20-minute total allotment for rebuttal, unless otherwise specified by Order of the Commission. Each appellee shall also have 20 minutes to present oral argument, unless otherwise specified by Order of the Commission; however, the appellees shall not reserve rebuttal time. In cross-appeals, each appealing party may reserve rebuttal time.

(c) A party may request additional time to present oral argument in excess of the standard 20-minute allowance. Such requests shall be made in writing and submitted to the Full Commission no less than 10 days prior to the scheduled hearing date. The written request for additional time shall state with specificity the reasons for the request of additional time and the amount of additional time requested.

(d) If a party fails to appear before the Full Commission upon the call of the case, the Commission may, upon consideration of the interests of justice and judicial economy, disallow the party's right to present oral argument. If neither party appears upon the call of the case, the Full Commission may, upon consideration of the interests of justice and judicial economy, decide the case upon the record and briefs on appeal, unless otherwise ordered.

(e) Oral arguments shall be based upon the record in the matter, pursuant to G.S. 143-292.

History

  • Authority G.S. 143-292; 143-296; 143-300
  • Eff. January 1, 1989
  • Recodified from 04 NCAC 10B .0311 Eff. April 17, 2000
  • Amended Eff. July 1, 2014; May 1, 2000
  • Recodified from 04 NCAC 10B .0310 Eff. June 1, 2018
  • Amended Eff. March 1, 2019.
11 NCAC 23B .0401 Scope {#sec-11-ncac-23b-.0401 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23B .0401}

The rules in this Section are the applicable Rules for appeals to the Court of Appeals pursuant to Article 31 of Chapter 143 of the General Statutes.

History

  • Authority G.S. 143-293; 143-300
  • Eff. January 1, 1989
  • Amended Eff. July 1, 2014
  • Recodified from 04 NCAC 10B .0401 Eff. June 1, 2018.
11 NCAC 23B .0402 Stays {#sec-11-ncac-23b-.0402 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23B .0402}

If a case is appealed to the Court of Appeals, all Orders or Decision and Orders of the Full Commission shall be stayed pending appeal.

History

  • Authority G.S. 143-292; 143-294; 143-296; 143-300
  • Eff. January 1, 1989
  • Amended Eff. July 1, 2014; May 1, 2000
  • Recodified from 04 NCAC 10B .0402 Eff. June 1, 2018
  • Amended Eff. March 1, 2019.
11 NCAC 23B .0403 Motions for Court of Appeals Cases {#sec-11-ncac-23b-.0403 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23B .0403}

(a) Prior to the docketing of the record on appeal in the Court of Appeals, all motions filed by the parties regarding an appeal to the Court of Appeals shall be addressed to and ruled upon by the Chair of the Commission, or the Chair's designee.

(b) A motion to reconsider or to amend an award of the Full Commission shall be filed within 15 days of receipt of notice of the award. An award of the Full Commission is not final until the disposition is filed by the Commission on the pending motion to reconsider or to amend an award.

History

  • Authority G.S. 143-293; 143-300
  • Eff. January 1, 1989
  • Amended Eff. July 1, 2014; May 1, 2000
  • Recodified from 04 NCAC 10B .0403 Eff. June 1, 2018.
11 NCAC 23B .0404 Remand from Appellate Courts {#sec-11-ncac-23b-.0404 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23B .0404}

When a case is remanded to the Commission from the appellate courts, each party may file a statement, with or without a brief to the Full Commission, setting forth its position on the actions or proceedings, including evidentiary hearings or depositions, required to comply with the court's decision. This statement shall be filed within 30 days of the issuance of the court's mandate and shall be filed with the Commissioner who authored the Full Commission decision or the Commissioner designated by the Chairman of the Commission if the Commissioner who authored the decision is no longer a member of the Commission.

History

  • Authority G.S. 143-292; 143-296; 143-300
  • Eff. January 1, 1989
  • Amended Eff. July 1, 2014; May 1, 2000
  • Recodified from 04 NCAC 10B .0404 Eff. June 1, 2018.
11 NCAC 23B .0501 WAIVER of Rules {#sec-11-ncac-23b-.0501 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23B .0501}

In the interests of justice or to promote judicial economy, the Commission may, except as otherwise provided by the rules in this Subchapter, waive or vary the requirements or provisions of any of the rules in this Subchapter in a case pending before the Commission upon request of a party or upon its own initiative only if the plaintiff is not represented by counsel. Factors the Commission shall use in determining whether to grant the waiver are:

(1) the necessity of a waiver;

(2) the party's responsibility for the conditions creating the need for a waiver;

(3) the party's prior requests for a waiver;

(4) the precedential value of such a waiver;

(5) notice to and opposition by the opposing parties; and

(6) the harm to the party if the waiver is not granted.

History

  • Authority G.S. 143-291; 143-300
  • Eff. January 1, 1989
  • Amended Eff. July 1, 2014; May 1, 2000
  • Recodified from 04 NCAC 10B .0501 Eff. June 1, 2018
  • Amended Eff. March 1, 2019.
11 NCAC 23B .0502 Rulemaking {#sec-11-ncac-23b-.0502 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23B .0502}

History

  • Status: repealed
  • Authority G.S. 143-300
  • Eff. January 1, 1989
  • Repealed Eff. July 1, 2014
  • Recodified from 04 NCAC 10B .0502 Eff. June 1, 2018.
11 NCAC 23B .0503 Sanctions {#sec-11-ncac-23b-.0503 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23B .0503}

The Commission may, on its own initiative or motion of a party, impose a sanction against a party, or attorney, or both, when the Commission determines that such party, or attorney, or both failed to comply with the Rules in this Subchapter, an Order of the Commission, the North Carolina Rules of Civil Procedure, and North Carolina Rules of Professional Conduct, or other applicable law.

History

  • Authority G.S. 1A-1, Rule 11 and Rule 37; 143-291; 143-296; 143-300
  • Eff. January 1, 2011
  • Amended Eff. July 1, 2014
  • Recodified from 04 NCAC 10B .0503 Eff. June 1, 2018
  • Amended Eff. March 21, 2019.

Subchapter C

11 NCAC 23C .0101 Applicabilty of the Rules {#sec-11-ncac-23c-.0101 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23C .0101}

(a) The rules in this Subchapter apply to:

(1) cases in which the employer is obligated to provide medical compensation, and the injured worker is obligated to accept medical compensation under the Workers' Compensation Act, or in which such compensation is provided by agreement, and during any period when the employer is paying temporary total disability benefits without prejudice in accordance with G.S. 97-18(d); and

(2) any rehabilitation professional as defined in Item (1) of Rule .0103 of this Subchapter, who is assigned under the Workers' Compensation Act and approved by the Commission pursuant to Rule .0105 of this Subchapter.

(b) Any rehabilitation professional who is not assigned under the Workers' Compensation Act and approved by the Commission pursuant to Rule .0105 of this Subchapter must disclose his or her role to the health care provider at the time of the initial contact and any other person from whom the non-approved rehabilitation professional seeks information about the case.

History

  • Authority G.S. 97-18(d); 97-25.4; 97-25.5; 97-32.2; 97-80
  • Eff. January 1, 1996
  • Recodified from 04 NCAC 10C .0103, Eff. April 17, 2000
  • Amended Eff. November 1, 2014; June 1, 2000
  • Recodified from 04 NCAC 10C .0101 Eff. June 1, 2018.
11 NCAC 23C .0102 Purpose of the Rules {#sec-11-ncac-23c-.0102 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23C .0102}

History

  • Status: repealed
  • Authority G.S. 97-25.4
  • Eff. January 1, 1996
  • Repealed Eff. November 1, 2014
  • Recodified from 04 NCAC 10C .0102 Eff. June 1, 2018.
11 NCAC 23C .0103 Definitions {#sec-11-ncac-23c-.0103 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23C .0103}

As used in this Subchapter:

(1) "Rehabilitation professional" means a medical case manager, a coordinator of medical rehabilitation services, or a vocational rehabilitation professional providing vocational rehabilitation services, including state, private, or carrier based, whether on site, telephonic, or in or out of state. Physical therapists, occupational therapists, speech therapists, and other direct care providers are not rehabilitation professionals under the Rules in this Subchapter.

(2) "Medical rehabilitation" means the planning and coordination of health care services by a medical case manager or coordinator, with the goal of assisting an injured worker to be restored as nearly as possible to the worker's pre-injury level of physical function. Medical case management includes:

(a) case assessment;

(b) development, implementation and coordination of a care plan with health care providers, the worker, and his or her family;

(c) evaluation of treatment results;

(d) planning for community re-entry and return to work; and

(e) referral for further vocational rehabilitation services.

(3) "Vocational rehabilitation" means the delivery and coordination of services under an individualized written plan, with the goal of assisting the injured worker to return to suitable employment or participate in education or retraining, as defined by Item (5) of this Rule or applicable statute.

(4) "Return to work" means placement of the injured worker into suitable employment, as defined by Item (5) of this Rule or applicable statute.

(5) For claims arising before June 24, 2011, "suitable employment" means employment in the labor market or self-employment that is reasonably attainable and that offers an opportunity to restore the worker as soon as possible and as nearly as practicable to pre-injury wage, while giving due consideration to the worker's qualifications (age, education, work experience, physical and mental capacities), impairment, vocational interests, and aptitudes. No one factor shall be considered solely in determining suitable employment. For claims arising on or after June 24, 2011, the statutory definition of "suitable employment," G.S. 97-2(22), applies.

(6) "Conditional rehabilitation professional" means a rehabilitation professional who has not met the requirements for qualified rehabilitation professionals under of Rule .0105(d) of this Subchapter and who desires to provide services as a rehabilitation professional in cases subject to the rules in this Subchapter.

History

  • Authority G.S. 97-2(22); 97-25.4; 97-25.5; 97-32.2; 97-80
  • Eff. January 1, 1996
  • Recodified from 04 NCAC 10C .0101 Eff. April 17, 2000
  • Amended Eff. November 1, 2014; June 1, 2000
  • Recodified from 04 NCAC 10C .0103 Eff. June 1, 2018.
11 NCAC 23C .0104 Goals of Rehabilitation {#sec-11-ncac-23c-.0104 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23C .0104}

History

  • Status: repealed
  • Authority G.S. 97-25.4
  • Eff. January 1, 1996
  • Repealed Eff. June 1, 2000
  • Recodified from 04 NCAC 10C .0104 Eff. June 1, 2018.
11 NCAC 23C .0105 Qualifications Required {#sec-11-ncac-23c-.0105 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23C .0105}

(a) Rehabilitation professionals in cases subject to the rules in this Subchapter shall follow the Code of Ethics specific to their certification as well as any statutes specific to their occupation.

(b) Rehabilitation professionals who are Registered Nurses providing medical rehabilitation services in North Carolina must have a North Carolina license to practice and are subject to the requirements of the North Carolina Nursing Practice Act. Rehabilitation professionals who are Registered Nurses providing medical rehabilitation services outside North Carolina must have a license to practice in the state in which the medical care is provided.

(c) To provide medical rehabilitation services and vocational rehabilitation services in cases subject to the Rules in this Subchapter, rehabilitation professionals must either be a qualified rehabilitation professional or a conditional rehabilitation professional as set forth in this Rule.

(d) To qualify as a qualified rehabilitation professional, a rehabilitation professional must:

(1) possess one of the following certifications:

(A) Certified Rehabilitation Counselor (CRC), as certified by the Commission on Rehabilitation Counselor Certification;

(B) Certified Registered Rehabilitation Nurse (CRRN), as certified by the Rehabilitation Nursing Certification Board;

(C) Certified Disability Management Specialist (CDMS), as certified by the Certification of Disability Management Specialists Commission;

(D) Certified Vocational Evaluator (CVE), as certified by the Commission on Rehabilitation Counselor Certification;

(E) Certified Occupational Health Nurse-Specialist (COHN-S), as certified by the American Board of Occupational Health Nurses;

(F) Certified Occupational Health Nurse (COHN), as certified by the American Board of Occupational Health Nurses;

(G) Orthopaedic Nurse Certified (ONC), as certified by the Orthopaedic Nurses Certification Board; or

(H) Certified Case Manager (CCM), as certified by the Commission for Case Manager Certification; or

(2) have prior employment within the North Carolina Department of Health and Human Services as a vocational rehabilitation provider.

(e) A qualified rehabilitation professional must also:

(1) possess two years of full-time work experience, or its equivalent, in workers' compensation case management, where at least 30 percent of the rehabilitation professional's time was spent managing medical or vocational rehabilitation services to persons with disabling conditions or diseases within the past 15 years; and

(2) complete the comprehensive course entitled, "Workers' Compensation Case Management in NC: A Basic Primer for Medical and Vocational Case Managers," provided by the Commission or the International Association of Rehabilitation Professionals of the Carolinas.

(f) To maintain "qualified" status, a rehabilitation professional shall attend a two-hour refresher course every five years, beginning with the date of the original course completion. Rehabilitation professionals who completed the course in its pilot phase prior to March 17, 2011 have until July 1, 2016 to meet the refresher program mandate.

(g) Effective July 1, 2013, any rehabilitation professional on the Commission's Registry of Workers' Compensation Rehabilitation Professionals who does not hold a certificate of completion for the mandated course shall lose "qualified" rehabilitation professional status and may work as a conditional rehabilitation professional under supervision of a qualified rehabilitation professional for no longer than six months before completing the required course.

(h) After July 1, 2013, any rehabilitation professional who begins providing rehabilitation services in cases subject to the Rules in this Subchapter shall have six months to obtain a certificate of completion of the mandated course.

(i) The Commission shall oversee the implementation and ongoing administration of the mandated course and training.

(j) Conditional rehabilitation professionals permitted to provide services in cases subject to the rules in this Subchapter include:

(1) individuals who possess one of the certifications for qualified rehabilitation professionals listed in Subparagraph (d) and (e) of this Rule, but who do not possess the workers' compensation case management experience required by the rules in this Subchapter;

(2) individuals with a post-baccalaureate degree in a health-related field from an institution accredited by an agency recognized by the United States Department of Education and one year of experience providing rehabilitation services to persons with disabling conditions or diseases;

(3) individuals with a baccalaureate degree in a health-related field from an institution accredited by an agency recognized by the United States Department of Education and two years of experience providing rehabilitation services to individuals with disabling conditions or diseases; and

(4) individuals with current North Carolina licensure as a registered nurse and three years of experience in clinical nursing providing care for adults with disabling conditions and diseases.

(k) To provide services as a rehabilitation professional in cases subject to the rules in this Subchapter, a conditional rehabilitation professional must work under the direct supervision of a qualified rehabilitation professional, who shall ensure that the conditional rehabilitation professional's work meets the requirements of the rules in this Subchapter and any applicable statute, and whose name, address and telephone number shall be on all documents identifying the conditional rehabilitation professional.

(l) As used in this Rule, direct supervision includes regular case review between the conditional rehabilitation professional and the qualified rehabilitation professional supervisor, review by the qualified rehabilitation professional supervisor of all reports, and periodic meetings that occur at least on a quarterly basis.

(m) A rehabilitation professional may maintain conditional rehabilitation professional status for a period of two years only. To continue providing services as a rehabilitation professional in cases subject to the rules in this Subchapter beyond the two year period, the conditional rehabilitation professional must obtain the qualifications for a qualified rehabilitation professional listed under Paragraph (d) of this Rule.

(n) Rehabilitation professionals shall, upon request, provide a resume of their qualifications and credentials during initial meetings with parties and health care providers.

History

  • Authority G.S. 97-25.4; 97-32.2; 97-25.5; 97-80
  • Eff. January 1, 1996
  • Amended Eff. November 1, 2014; June 1, 2000
  • Recodified from 04 NCAC 10C .0105 Eff. June 1, 2018.
11 NCAC 23C .0106 Professional Responsibility of the Rehabilitation Professional in Workers' Compensation Claims {#sec-11-ncac-23c-.0106 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23C .0106}

(a) A rehabilitation professional shall exercise independent professional judgment in making and documenting recommendations for medical and vocational rehabilitation for an injured worker, including any alternatives for medical treatment and cost-effective return-to-work options. It is not the role of the rehabilitation professional to direct medical care.

(b) A rehabilitation professional shall inform the parties of his or her assignment and role in the case. Upon assignment, a rehabilitation professional shall disclose to health care providers and the parties any possible conflict of interest, including any compensation and the carrier's or employer's ownership of or affiliation with the rehabilitation professional.

(c) Subject to the provisions for medical care and treatment set forth in the Workers' Compensation Act, the medical rehabilitation professional may explain medical information to the worker and shall discuss with the worker all treatment options appropriate to the worker's conditions, but shall not advocate any one source for treatment or change in treatment.

(d) As case consultants or expert witnesses, rehabilitation professionals shall provide unbiased, objective opinions. The limits of their relationships shall be defined through written or oral means in accordance with the following, applicable professional codes of ethics or professional conduct, which are hereby incorporated by reference, including subsequent amendments and editions:

(1) for Certified Rehabilitation Counselors and Certified Vocational Evaluators, the Commission on Rehabilitation Counselor Certification Code of Professional Ethics;

(2) for Certified Registered Rehabilitation Nurses and Orthopaedic Nurse Certifieds, the Code of Ethics for Nurses;

(3) for Certified Disability Management Specialists, the Certification of Disability Management Specialists Commission Code of Professional Conduct;

(4) for Certified Occupational Health Nurses and Certified Occupational Health Nurse-Specialists, the American Association of Occupational Health Nurses, Inc. Code of Ethics; and

(5) for Certified Case Managers, the Code of Professional Conduct for Case Managers.

(e) Copies of the codes of ethics or professional conduct listed in Subparagraphs (d)(1) through (d)(5) of this Rule may be obtained at no cost, either upon request at the offices of the Commission, located in the Dobbs Building, 430 North Salisbury Street, Raleigh, North Carolina, between the hours of 8:00 a.m. and 5:00 p.m., or at one of the following applicable websites:

(1) for Certified Rehabilitation Counselors and Certified Vocational Evaluators, the Commission on Rehabilitation Counselor Certification Code of Professional Ethics), http://www.crccertification.com/filebin/pdf/CRCCodeOfEthics.pdf;

(2) for Certified Registered Rehabilitation Nurses and Orthopaedic Nurse Certifieds, the Code of Ethics for Nurses,

http://www.nursingworld.org/MainMenuCategories/EthicsStandards/CodeofEthicsforNurses/Code-of-Ethics.pdf;

(3) for Certified Disability Management Specialists, the Certification of Disability Management Specialists Commission Code of Professional Conduct, http://new.cdms.org/docs/CDMS%20Code%20of%20Professional%20Conduct%2008012011.pdf;

(4) for Certified Occupational Health Nurses and Certified Occupational Health Nurse-Specialists, the American Association of Occupational Health Nurses, Inc. Code of Ethics,https://www.aaohn.org/dmdocuments/Code_of_Ethics_2009.pdf; and

(5) for Certified Case Managers, the Code of Professional Conduct for Case Managers http://www.ccmcertification.org/sites/default/files/downloads/2012/CCMC_Code_of_Conduct%202-22-12.pdf.

(f) Rehabilitation professionals shall practice only within the boundaries of their competence, based on their education, training, professional experience, and other professional credentials.

(g) A rehabilitation professional shall not conduct or assist any party in claims negotiation or investigative activities.

(h) A rehabilitation professional shall not advise the worker as to any legal matter including claims settlement options or procedures, monetary evaluation of claims, or the applicability to the worker of benefits of any kind under the Workers' Compensation Act during his or her assignment in the case. The rehabilitation professional shall advise the non-represented worker to direct such questions to the Information Specialists at the Commission, and the represented worker to direct questions to his or her attorney.

(i) Rehabilitation professionals shall not accept any compensation or reward from any source as a result of settlement.

History

  • Authority G.S. 97-25.4; 97-25.5; 97-32.2; 97-80
  • Eff. January 1, 1996
  • Amended Eff. November 1, 2014; June 1, 2000
  • Recodified from 04 NCAC 10C .0106 Eff. June 1, 2018.
11 NCAC 23C .0107 Communication {#sec-11-ncac-23c-.0107 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23C .0107}

(a) The insurance carrier shall notify the Commission and all parties on a Form 25N Notice to the Commission of Assignment of Rehabilitation Professional when a rehabilitation professional is assigned to a case and identify the purpose of the rehabilitation involvement.

(b) At the initial meeting, the rehabilitation professional shall provide the injured worker with a copy of the Rules in this Subchapter, and shall inform the injured worker that the rehabilitation professional is required to share relevant medical and vocational rehabilitation information with the employer and insurance carrier and that the rehabilitation professional may be compelled to testify regarding any information obtained.

(c) The rehabilitation professional shall timely inform injured workers that the Rehabilitation Professional will share relevant and material information with the employer and insurance carrier and that the Rehabilitation Professional may be compelled to testify regarding any information obtained.

(d) In cases where the employer is paying medical compensation to a provider rendering treatment under the Workers' Compensation Act, the injured worker, if requested by a rehabilitation professional, shall sign a Form 25C Authorization for Rehabilitation Professional to Obtain Medical Records of Current Treatment authorizing the rehabilitation professional to obtain records of the current treatment.

(e) The rehabilitation professional shall provide copies of all correspondence and reports contemporaneously to all parties by the same mode of transmission.

(f) In preparing written and oral reports, the rehabilitation professional shall present only information relevant and material to the worker's medical rehabilitation and vocational rehabilitation and shall make every effort to avoid invasion of the worker's privacy.

(g) The rehabilitation professional shall make periodic written reports documenting accurately and completely the substance of all activity in the case, including rehabilitation activity. The rehabilitation professional shall furnish a worker who is unrepresented by counsel with a copy of each periodic report, or, in the alternative, the rehabilitation professional shall advise the worker either orally or in writing (at least as often as reports are produced) as to the plan for and progress of the case, and that the worker has the right to request a copy of the reports under 11 NCAC 23A .0607.

(h) Frequency and timing of periodic reports shall be determined at the time of referral and shall depend on the type of service provided. Communication of activity to all parties by telephone, facsimile, electronic media, or letter must occur when information relevant to the rehabilitation process is obtained, changes or revisions are recommended or occur in medical or vocational treatment plans, or on any other occasion when the worker's understanding and cooperation is critical to the implementation of the rehabilitation plan.

(i) If requested by the injured worker or his or her attorney, the initial meeting of the injured worker and rehabilitation professional shall take place at the office of the worker's attorney and shall occur within 20 days of the request.

(j) The rehabilitation professional may coordinate activities with the injured worker's attorney, and, at the employer or carrier's discretion, with the defense attorney.

(k) If the rehabilitation professional believes the injured worker is not complying with the provision of rehabilitation services, the rehabilitation professional shall detail in writing the actions that the rehabilitation professional believes the injured worker is required to take to return to compliance. In determining whether the injured worker is in compliance with the provision of rehabilitation services, the rehabilitation professional shall rely on his or her independent professional judgment and training and shall focus on the overall effect that the worker's actions or inactions are having on the rehabilitation goals.

History

  • Authority G.S. 97-25.4; 97-25.5; 97-32.2; 97-2(19); 97-80
  • Eff. January 1, 1996
  • Amended Eff. November 1, 2014; June 1, 2000
  • Recodified from 04 NCAC 10C .0107 Eff. June 1, 2018
  • Amended Eff. November 1, 2022.
11 NCAC 23C .0108 Interaction with Physicians {#sec-11-ncac-23c-.0108 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23C .0108}

(a) At the initial visit with a physician the rehabilitation professional shall provide identification in the form of a company identification or business card and explain the rehabilitation professional's role in the case.

(b) In all cases, the rehabilitation professional shall advise the worker that the worker has the right to a private examination by the health care provider outside of the presence of the rehabilitation professional. If the worker prefers, he or she may request that the rehabilitation professional accompany him or her during the examination. However, if the worker or the worker's attorney notifies the rehabilitation professional in writing that the worker desires a private examination, no subsequent waiver of that right shall be effective unless the waiver is made in writing by the worker or, if represented, by the worker's attorney.

(c) If the rehabilitation professional needs to have an in-person conference with the physician following an examination, the rehabilitation professional shall reserve with the physician sufficient appointment time for the conference. The worker shall be offered the opportunity to attend the conference with the physician. If the worker or the physician does not consent to a joint conference, or if in the physician's opinion it is medically contraindicated for the worker to participate in the conference, the rehabilitation professional shall note this in his or her report, may communicate directly with the physician, and shall report the substance of the communication.

(d) When the rehabilitation professional determines that it is necessary to communicate with a physician other than at a joint meeting, the rehabilitation professional shall first notify the injured worker, or his or her attorney if represented, of the rehabilitation professional's intent to communicate and the reasons therefore. The rehabilitation professional is not required to obtain the injured worker's or his or her attorney's prior consent if:

(1) The communication is limited to scheduling issues or requests for time-sensitive medical records;

(2) A medical emergency is involved;

(3) The injured worker's health or medical treatment would either be adversely affected by a delay or benefited by immediate action;

(4) The communication is limited to advising the physician of the employer or carrier approval for recommended testing or treatment;

(5) The injured worker or attorney has consented to the communications;

(6) The communication is initiated by the physician; or

(7) The injured worker failed to show up for a scheduled appointment or arrived at a time other than the scheduled appointment time.

When a rehabilitation professional communicates with a physician without the prior consent or presence of the injured worker, the rehabilitation professional must document the reasons for and the substance of the communication and report the reasons and substance to the injured worker or his or her attorney, if represented, pursuant to Rule .0106 of this Subchapter.

(e) The following requirements apply to interactions regarding impairment ratings, independent medical examinations, second opinions or consults:

(1) When a party or health care provider requests a consult, second opinion, or independent medical examination that is authorized or ordered, the rehabilitation professional may, if requested, assemble and forward medical records and information, schedule and coordinate an appointment, and, if the worker consents, have a joint meeting with the health care provider and the worker after a private exam.

(2) When any such exam is requested by the carrier, the worker shall receive at least 10 calendar days' notice of the appointment unless the parties agree otherwise or unless otherwise required by statute.

(f) The rehabilitation professional shall simultaneously send to the parties copies of all written communications with health care providers and shall accurately and completely record and report all oral communications.

History

  • Authority G.S. 97-25.4; 97-25.5; 97-32.2; 97-80
  • Eff. January 1, 1996
  • Amended Eff. November 1, 2014; June 1, 2000
  • Recodified from 04 NCAC 10C .0108 Eff. June 1, 2018.
11 NCAC 23C .0109 Vocational Rehabilitation Services and Return to Work {#sec-11-ncac-23c-.0109 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23C .0109}

(a) When performing the vocational assessment and formulating and drafting the individualized written rehabilitation plan for the employee required by G.S. 97-32.2(c), the vocational rehabilitation professional shall follow G.S. 97-32.2.

(b) Job placement activities may not be commenced until after a vocational assessment and an individualized written rehabilitation plan for vocational rehabilitation services specifying the goals and the priority for return-to-work options have been completed in the case in accordance with G.S. 97-32.2. Job placement activities shall be directed as defined by Rule .0103(5) of this Subchapter or by applicable statute.

(c) Return-to-work options should be considered in the following order of priority:

(1) current job, current employer;

(2) new job, current employer;

(3) on-the-job training, current employer;

(4) new job, new employer;

(5) on-the-job training, new employer;

(6) formal education or vocational training to prepare the worker for a job with current or new employer; and

(7) self-employment, only when its feasibility is documented with reference to the employee's aptitudes and training, adequate capitalization, and market conditions.

(d) When an employee requests retraining or education as permitted in G.S. 97-32.2(a), the vocational rehabilitation professional shall provide a written assessment of the employee's request that includes an evaluation of:

(1) the retraining or education requested;

(2) the availability, location, cost, and identity of providers of the requested retraining or education;

(3) the likely duration until completion of the requested retraining or education, the number of credits needed to complete the retraining or education, the course names and schedules for the retraining or education, and identification of which courses are available on-line versus in person;

(4) the current or projected availability of employment upon completion of the requested retraining or education; and

(5) the anticipated pay range for employment upon completion of the requested retraining or education.

(e) The rehabilitation professional shall obtain a list of work restrictions from the health care provider that addresses the demands of any proposed employment. If ordered by a physician, the rehabilitation professional shall schedule an appointment with a third party provider to evaluate an injured employee's functional capacity, physical capacity, or impairments to work.

(f) The rehabilitation professional shall refer the worker only to opportunities for suitable employment, as defined by Rule .0103(5) of this Subchapter or by applicable statute.

(g) If the rehabilitation professional intends to utilize written or videotaped job descriptions in the return-to-work process, the rehabilitation professional shall provide a copy of the description to all parties for review before the job description is provided to the doctor. The employee or the employee's attorney shall have seven business days from the mailing of the job description to notify the rehabilitation professional, all parties, and the physician of any objections or amendments thereto. The job description and the objections or amendments, if any, shall be submitted to the physician simultaneously. This process shall be expedited when job availability is critical. This waiting period does not apply if the employee or the employee's attorney has given prior approval to the job description.

(h) In preparing written job descriptions, the rehabilitation professional shall utilize standards including, but not limited to, the Dictionary of Occupational Titles and the Handbook for Analyzing Jobs published by the United States Department of Labor. These standards can be accessed at no cost at https://www.dol.gov/agencies/oalj/topics/libraries/LIBDOT and https://skilltran.com/index.php/support-area/documentation/1991rhaj, respectively. The Handbook for Analyzing Jobs may also be purchased from major online booksellers for approximately eighty-five dollars ($85.00).

(i) The rehabilitation professional may conduct follow-up after job placement to verify the appropriateness of the job placement.

(j) The rehabilitation professional shall not initiate or continue placement activities that do not appear reasonably likely to result in placement of the injured worker in suitable employment. The rehabilitation professional shall report to the parties when efforts to initiate or continue placement activities do not appear reasonably likely to result in placement of the injured worker in suitable employment.

History

  • Authority G.S. 97-2(22); 97-25.5; 97-32.2; S.L. 2014-77, s. 6(4)
  • Eff. January 1, 1996
  • Amended Eff. November 1, 2014; June 1, 2000
  • Recodified from 04 NCAC 10C .0109 Eff. June 1, 2018
  • Amended Eff. April 1, 2023.
11 NCAC 23C .0110 Change of Rehabilitation Professional {#sec-11-ncac-23c-.0110 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23C .0110}

(a) By agreement or stipulation of the parties, the rehabilitation professional may be changed.

(b) A rehabilitation professional may be removed from a case upon motion by either party or by the Commission for good cause. The motion shall be filed with the Executive Secretary's Office and served upon all parties and the rehabilitation professional. Any party or the rehabilitation professional may file a response to the motion within 10 days.

(c) A party or the rehabilitation professional may request reconsideration of a ruling or appeal from an order as provided in 11 NCAC 23A .0702 or pursuant to G.S. 97-83 and G.S. 97-84.

History

  • Authority G.S. 97-25.4; 97-25.5; 97-32.2; 97-80; 97-83; 97-84
  • Eff. January 1, 1996
  • Amended Eff. November 1, 2014; June 1, 2000
  • Recodified from 04 NCAC 10C .0110 Eff. June 1, 2018.
11 NCAC 23C .0201 WAIVER of Rules {#sec-11-ncac-23c-.0201 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23C .0201}

In the interests of justice or to promote judicial economy the Commission may, except as otherwise provided by the rules in this Subchapter, waive or vary the requirements or provisions of any of the rules in this Subchapter in a case pending before the Commission upon written application of a party or upon its own initiative only if the employee is not represented by counsel. Factors the Commission shall use in determining whether to grant the waiver are:

(1) the necessity of a waiver;

(2) the party's responsibility for the conditions creating the need for a waiver;

(3) the party's prior requests for a waiver;

(4) the precedential value of such a waiver;

(5) notice to and opposition by the opposing parties; and

(6) the harm to the party if the waiver is not granted.

History

  • Authority G.S. 97-25.4; 97-80
  • Eff. November 1, 2014
  • Recodified from 04 NCAC 10C .0201 Eff. June 1, 2018.

Subchapter D

11 NCAC 23D .0101 Purpose {#sec-11-ncac-23d-.0101 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23D .0101}

The rules in this Subchapter are intended to facilitate the timely and cost-effective delivery of appropriate medical compensation services to fulfill the employer's duty to provide such services as are reasonably necessary to effect a cure, give relief, or shorten the period of disability resulting from compensable injuries through the use of Managed Care Organizations (MCOs). The rules in this Subchapter do not affect informal lists or "employer networks" of providers assembled by employers or insurers for their own referrals.

History

  • Authority G.S. 97-2(19); 97-2(20); 97-2(21); 97-25; 97-25.2; 97-25.3(e); 97-25.4(a); 97-26(b); 97-26(c)
  • Eff. January 1, 1996
  • Amended Eff. July 1, 2014
  • Recodified from 04 NCAC 10D .0101 Eff. June 1, 2018.
11 NCAC 23D .0102 Definitions {#sec-11-ncac-23d-.0102 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23D .0102}

As used in this Subchapter:

(1) "Employer" means an employer as defined by G.S. 97-2(3) who is obligated by the Workers' Compensation Act to pay or provide indemnity or medical compensation, including any insurance carrier, self-insurance fund, third party administrator or other person, firm or corporation undertaking to pay or adjust claims on behalf of the employer's employees.

(2) "Act" means the North Carolina Workers' Compensation Act, Chapter 97, Article 1 (G.S. 97-1 through G.S. 97-101.1).

(3) "Employer network" means any group of providers assembled by or for an entity liable for medical compensation that agrees to accept the referrals of that entity's workers' compensation patients, and from among whom an adjuster, officer, employee, or insured patient of the entity chooses the initial provider; provided, the entity has no right to sell the services of the providers to a third party.

History

  • Authority G.S. 58-50-50; 97-2(3); 97-2(20); 97-2(21); 97-25; 97-25.2; 97-26(b); 97-26(c); 97-77; 97-79
  • Eff. January 1, 1996
  • Amended Eff. July 1, 2014
  • Recodified from 04 NCAC 10D .0102 Eff. June 1, 2018.
11 NCAC 23D .0103 Qualification by Department of Insurance {#sec-11-ncac-23d-.0103 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23D .0103}

History

  • Status: repealed
  • Authority G.S. 97-2(21); 97-25
  • Eff. January 1, 1996
  • Repealed Eff. July 1, 2014
  • Recodified from 04 NCAC 10D .0103 Eff. June 1, 2018.
11 NCAC 23D .0104 Qualification and Revocation {#sec-11-ncac-23d-.0104 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23D .0104}

For ineffective delivery of medical services, failure to comply with applicable laws, rules or regulations, and failure to respond to lawful orders of the Commission or other regulatory authorities, the Commission shall change the provider of medical compensation in accordance with the Workers' Compensation Act.

History

  • Authority G.S. 97-25; 97-25.2
  • Eff. January 1, 1996
  • Amended Eff. July 1, 2014
  • Recodified from 04 NCAC 10D .0104 Eff. June 1, 2018.
11 NCAC 23D .0105 Notice to Commission {#sec-11-ncac-23d-.0105 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23D .0105}

(a) Upon contracting with an employer to provide medical compensation services, an MCO shall provide to the Commission the following:

(1) a copy of that portion of the contract containing the provisions specified in Rule .0106 of this Subchapter and the method for determining payment to the MCO, excluding those of its terms kept confidential by the North Carolina Department of Insurance, initialed by the employer;

(2) a copy of its current certificate(s) issued annually by the North Carolina Department of Insurance pursuant to G.S. Chapter 58; and

(3) the name and address of all owners or shareholders, or related groups of owners or shareholders, holding more than 10 percent interest in the MCO, and whether they are or have any relationship with a provider.

(b) Persons or firms are related, for the purpose of this Rule, if either has the following:

(1) a financial interest in the other;

(2) shares officers, agents, or employees; or,

(3) if natural persons, are first cousins or closer in kinship.

(c) An MCO subject to the Rules in this Subchapter shall report its medical compensation expenditures annually on I.C. Form 51.

History

  • Authority G.S. 97-25.2
  • Eff. January 1, 1996
  • Amended Eff. July 1, 2014
  • Recodified from 04 NCAC 10D .0105 Eff. June 1, 2018.
11 NCAC 23D .0106 Contract Provisions {#sec-11-ncac-23d-.0106 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23D .0106}

An MCO's contract with an employer subject to the Rules in this Subchapter shall include:

(1) the principal place(s) of employment of the covered employees, including address(es) and phone number(s) of the workplace(s);

(2) the name, title, mailing address, phone number, fax number, and email address, if any, of an officer or responsible employee of the MCO empowered to assent to the treatment or referral of covered employees, capable of obtaining and providing complete business, administrative and medical records generated pursuant to the contract, and empowered to resolve routine disputes with employees, employers and providers under the Commission's jurisdiction;

(3) the name, title, mailing address, phone number, fax number, and email address, if any, of an adjuster, officer, agent or employee of the employer empowered to negotiate the resolution of routine medical compensation disputes, and receive orders of the Commission on behalf of the employer;

(4) an acknowledgment that the MCO is bound by applicable requirements of Chapters 58 and 97 of the North Carolina General Statutes and the rules in this Subchapter, and is subject to orders of the Commission to the same extent as the employer;

(5) the agreement of the employer that it will cooperate and assist in furnishing its employees and supervisors with a phone number and instructions for obtaining emergency treatment and contacting the MCO upon injury to any employee during the workday or on the employer's premises requiring physician attention;

(6) a dispute resolution plan in accordance with G.S. 97-25.2, including provisions for notice of decision in appeals within 30 days, or within 72 hours of appeal when the regular appeals process would cause a delay in the rendering of health care that would be detrimental to the health of the employee;

(7) a description of physician panels, including specialties represented, and the employee's right to select his or her attending physician from the appropriate panel, and to subsequently change attending physicians once within the members of the panel; and

(8) whether the MCO or employer will be responsible for securing the services of "out of network" providers when needed.

History

  • Authority G.S. 97-25.2
  • Eff. January 1, 1996
  • Amended Eff. July 1, 2014
  • Recodified from 04 NCAC 10D .0106 Eff. June 1, 2018.
11 NCAC 23D .0107 Information for Employee {#sec-11-ncac-23d-.0107 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23D .0107}

(a) Following the onset of an injury, the employer or MCO shall provide to the employee a printed explanation of the system being utilized for his care, suitable for sharing with emergency, "out-of-network", and referral physicians, that shall be filed with any Form 19 submitted to the Commission; provided, that electronic filers may otherwise notify the Commission of the identity of the MCO. This statement shall include the following information:

(1) the offices to contact concerning medical treatment for the injury, including a telephone number;

(2) if known at that time, the employee's chosen treating physician, including a phone number for seeking medical assistance outside normal business hours if the injury might cause such a need;

(3) the applicable methods for choosing and changing treating physicians and resolving disputes concerning physicians or treatment pursuant to G.S. 97-25.2;

(4) that the MCO can provide access to licensed physicians of all specialties;

(5) the employer's obligation to pay for treatment for which the employee is referred to the MCO, whether or not the employer admits liability for the injury per G.S. 97-90(e);

(6) the employee's duty to cooperate in treatment, and right to secure treatment at his or her own expense that does not interfere with the treating physician's treatment; and

(7) the Commission's File Number, if known when filed.

(b) Providers may include identifying billing information on the statement.

History

  • Authority G.S. 97-25.2
  • Eff. January 1, 1996
  • Amended Eff. July 1, 2014
  • Recodified from 04 NCAC 10D .0107 Eff. June 1, 2018.
11 NCAC 23D .0108 Inclusive Provider Panels {#sec-11-ncac-23d-.0108 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23D .0108}

Following the onset of an injury, and upon an employee's first request to change attending physician, the MCO shall provide the employee with a list of reasonably accessible and available panel physicians qualified to treat or manage the primary condition for which the employer has accepted liability or authorized treatment from which the employee may select the attending physician. The employer and MCO shall provide for access to all medical compensation services, and include in its panels, or otherwise make available for the employee's choice, one or more licensed physicians representing all specialties available in the community to provide necessary treatment for the employee's primary compensable condition.

History

  • Authority G.S. 97-2(19); 97-2(20); 97-25; 97-25.2
  • Eff. January 1, 1996
  • Amended Eff. July 1, 2014
  • Recodified from 04 NCAC 10D .0108 Eff. June 1, 2018.
11 NCAC 23D .0109 Quality Assurance and Utilization Review {#sec-11-ncac-23d-.0109 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23D .0109}

An MCO subject to the Rules in this Subchapter shall comply with the requirements of the North Carolina Department of Insurance for quality assurance and utilization review plans, and upon request, provide the Commission with copies of records generated by, or utilized in, the operation of those programs, and copies of plans or amendments to plans not yet filed with the Department of Insurance.

History

  • Authority G.S. 97-25.2
  • Eff. January 1, 1996
  • Amended Eff. July 1, 2014
  • Recodified from 04 NCAC 10D .0109 Eff. June 1, 2018.
11 NCAC 23D .0110 Waiver of Rules {#sec-11-ncac-23d-.0110 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23D .0110}

In the interests of justice or to promote judicial economy, the Commission may, except as otherwise provided by the rules in this Subchapter, waive or vary the requirements or provisions of any of the rules in this Subchapter in a case pending before the Commission upon written application of a party or upon its own initiative only if the employee is not represented by counsel. Factors the Commission shall use in determining whether to grant the waiver are:

(1) the necessity of a waiver;

(2) the party's responsibility for the conditions creating the need for a waiver;

(3) the party's prior requests for a waiver;

(4) the precedential value of such a waiver;

(5) notice to and opposition by the opposing parties; and

(6) the harm to the party if the waiver is not granted.

History

  • Authority G.S. 97-25.2; 97-80(a)
  • Eff. January 1, 1996
  • Amended Eff. July 1, 2014
  • Recodified from 04 NCAC 10D .0110 Eff. June 1, 2018.

Subchapter E

11 NCAC 23E .0101 Instructions for Filing a Petition for Rule-Making {#sec-11-ncac-23e-.0101 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23E .0101}

(a) Any person may petition the Commission to adopt a new rule, or amend or repeal an existing rule by submitting a rule-making petition to the Commission at 1240 Mail Service Center, Raleigh, NC 27699-1240. The petition must be titled "Petition for Rule-making" and must include the following information:

(1) the name and address of the person submitting the petition;

(2) a citation to any rule for which an amendment or repeal is requested;

(3) a draft of any proposed rule or amended rule;

(4) an explanation of why the new rule or amendment or repeal of an existing rule is requested and the effect of the new rule, amendment, or repeal on the procedures of the Commission; and

(5) any other information the person submitting the petition considers relevant.

(b) The Commission must decide whether to grant or deny a petition for rule-making within 120 days of receiving the petition. In making the decision, the Commission shall consider the information submitted with the petition and any other relevant information.

(c) When the Commission denies a petition for rule-making, a written notice of the denial must be sent to the person who submitted the request. The notice must state the reason for the denial. When the Commission grants a rule-making petition, the Commission must initiate rule-making proceedings and send written notice of the proceedings to the person who submitted the request.

History

  • Authority G.S. 97-73; 150B-20
  • Eff. January 1, 1996
  • Amended Eff. July 1, 2014
  • Recodified from 04 NCAC 10E .0101 Eff. June 1, 2018
  • Amended Eff. April 1, 2020.
11 NCAC 23E .0102 Mailing List {#sec-11-ncac-23e-.0102 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23E .0102}

(a) Any person or agency desiring to be placed on the mailing list for the Commission's rule-making notices issued pursuant to G.S. 150B-21.2 may file a request in writing to the Chairperson of the Commission at 1240 Mail Service Center Raleigh, NC 27699-1240.

(b) The request shall:

(1) include the person's name and address;

(2) specify the subject areas within the authority of the Commission for which notice is requested; and

(3) state the calendar year(s) for which the notice is desired.

History

  • Authority G.S. 97-73; 97-80(a); 150B-21.2(d)
  • Eff. July 1, 2014
  • Recodified from 04 NCAC 10E .0102 Eff. June 1, 2018
  • Amended Eff. April 1, 2020.
11 NCAC 23E .0103 Admission of Out-of-State Attorneys to Appear Before the Commission {#sec-11-ncac-23e-.0103 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23E .0103}

(a) Attorneys residing in and licensed to practice law in another state who seek to be admitted to practice before the Commission to represent a client in a claim pursuant to G.S. 84-4.1 shall file a motion with the Commission that complies with the requirements of G.S. 84-4.1. The North Carolina attorney with whom the out-of-state attorney associates pursuant to G.S. 84-4.1(5) may file the motion instead as long as it complies with the requirements of G.S. 84-4.1.

(b) The motion shall be filed with the Executive Secretary of the Commission except under the following circumstances:

(1) If the motion is filed in a claim that is set for hearing before or pending decision by a Deputy Commissioner or the Full Commission, the motion shall be filed with the Deputy Commissioner or chair of the Full Commission panel, respectively.

(2) If the motion is filed in a claim involving a form application regarding a death claim, the motion shall be filed with the Director of Claims Administration.

(3) If the motion is filed in a claim involving a stipulated Opinion and Award regarding a death claim, the motion shall be filed with the Chief Deputy Commissioner.

(c) A proposed Order granting pro hac vice admission that includes the facsimile numbers for all counsel of record shall be provided with the motion.

(d) Following review of the motion, the Commission shall issue an Order granting or denying the motion. The Commission has the discretionary authority to deny such motions even if they comply with the requirements of G.S. 84-4.1.

(e) Upon receipt of an Order granting a motion for pro hac vice admission, the admitted attorney or the associated North Carolina attorney shall pay the fees to the North Carolina State Bar and General Court of Justice required by G.S. 84-4.1 and file a statement with the Executive Secretary documenting payment of said fees and the submission of any pro hac vice admission registration statement required by the North Carolina State Bar.

History

  • Authority G.S. 84-4.1; 97-80(a)
  • Eff. July 1, 2014
  • Recodified from 04 NCAC 10E .0103 Eff. June 1, 2018.
11 NCAC 23E .0104 Secure Leave Periods for Attorneys {#sec-11-ncac-23e-.0104 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23E .0104}

(a) Any attorney may request one or more secure leave periods each year as provided in this Rule.

(b) For the purpose of this Paragraph only, a "secure leave period" is defined as a partial calendar week or a complete calendar week. Within a calendar year, an attorney is entitled to obtain secure leave periods totaling up to 15 business days for any purpose.

(c) For the purpose of this Paragraph only, a "secure leave period" is defined as a complete calendar week. Within a 24-week period surrounding the birth or adoption of an attorney's child, that attorney is entitled to have the benefit of up to 12 additional secure leave periods.

(d) To request a secure leave period, an attorney shall file a written request, by letter or motion, containing the information required by Paragraph (e) of this Rule with the Office of the Chair within the time period provided in Paragraph (f) of this Rule. Upon such filing, the Chair shall review the request. If the request is made pursuant to Paragraph (b) or Paragraph (c) of this Rule and the request complies with Paragraphs (e) and (f) of this Rule, the Chair shall issue a letter allowing the requested secure leave period. The attorney shall not be required to appear at any trial, hearing, deposition, or other proceeding before the Commission during a secure leave period that is allowed.

(e) The request shall contain the following information:

(1) the attorney's name, mailing address, telephone number, email address, and state bar number;

(2) the date(s) for which secure leave is being requested;

(3) the dates of all other secure leave periods during the current calendar year that have previously been designated by the attorney pursuant to this Rule;

(4) a statement that the secure leave period is not being designated for the purpose of delaying, hindering, or interfering with the disposition of any matter in any pending action or proceeding;

(5) a statement that no action or proceeding in which the attorney has entered an appearance has been scheduled, tentatively set, or noticed for trial, hearing, deposition, or other proceeding during the designated secure leave period; and

(6) for secure leave requests that arise under Paragraph (c) of this Rule, the expected birth date or adoption date of the child.

(f) The request shall be filed:

(1) no later than 90 days before the beginning of the secure leave period; and

(2) before any trial, hearing, deposition, or other matter has been scheduled, peremptorily set, or noticed for a time during the designated secure leave period.

(g) The Chair may, as set forth in Rule .0301 of this Subchapter, make exception to the 15-day aggregate limit set forth in Paragraph (b) of this Rule, the requirement set forth in Subparagraph (e)(5) of this Rule, and the limitations set forth in Paragraph (f) of this Rule. An attorney requesting that the Chair make an exception under this Paragraph shall inform the Chair of all known actions or proceedings involving that attorney that are scheduled, tentatively set, or noticed for trial, hearing, deposition, or other proceeding during the requested secure leave period. The attorney also shall provide notice to all opposing parties or, if represented, opposing counsel of record in all cases subject to the jurisdiction of the Industrial Commission of the beginning and ending dates of the requested secure leave period and of all known actions or proceedings involving that attorney that are scheduled, tentatively set, or noticed for trial, hearing, deposition, or other proceeding during the requested secure leave period.

(h) After a secure leave period has been allowed pursuant to this Rule, if any trial, hearing, or other proceeding is scheduled or tentatively set for a time during the secure leave period, the attorney shall file with the Deputy Commissioner or Chair of the Full Commission panel before which the matter was calendared or set, and serve on all parties, a copy of the letter allowing the secure leave period with a certificate of service attached. Upon receipt, the proceeding shall be rescheduled for a time that is not within the attorney's secure leave period.

(i) After a secure leave period has been allowed pursuant to this Rule, if any deposition is noticed for a time during the secure leave period, the attorney shall serve on the party that noticed the deposition a copy of the letter allowing the secure leave period with a certificate of service attached, and that party shall reschedule the deposition for a time that is not within the attorney's secure leave period.

History

  • Authority G.S. 97-80(a)
  • Eff. July 1, 2014
  • Recodified from 04 NCAC 10E .0104 Eff. June 1, 2018
  • Amended Eff. December 1, 2020.
11 NCAC 23E .0201 Document and Record Fees {#sec-11-ncac-23e-.0201 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23E .0201}

(a) The fees in this Rule apply to all subject areas within the authority of the Commission.

(b) Upon written request, to the extent permitted by Article 1 of Chapter 97, Article 31 of Chapter 143, and Chapter 132 of the North Carolina General Statutes, transcripts of Commission proceedings, copies of recordings of Commission proceedings, copies of exhibits from Commission proceedings, and copies of all other public documents are available at the "actual cost" as defined by G.S. 132-6.2(b). The Commission shall provide the "actual cost" on the Commission's website.

(c) Certified copies are available upon request at a cost of one dollar ($1.00) per certification in addition to any other applicable cost for the document. Electronic copy certification is not available.

(d) Documents shall be sent via certified mail upon request at the actual cost established by the United States Postal Service.

(e) North Carolina sales tax shall be added if applicable.

History

  • Authority G.S. 7A-305; 97-73; 97-79; 97-80; 132-6.2; 143-291.1; 143-291.2; 143-300
  • Eff. November 1, 2014
  • Recodified from 04 NCAC 10E .0201 Eff. June 1, 2018.
11 NCAC 23E .0202 Hearing Costs or Fees {#sec-11-ncac-23e-.0202 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23E .0202}

(a) (Effective until July 1, 2015) The following hearing costs or fees apply to all subject areas within the authority of the Commission:

(1) one hundred twenty dollars ($120.00) for a hearing before a Deputy Commissioner to be charged after the hearing has been held;

(2) one hundred twenty dollars ($120.00) if a case is continued after the case is calendared for a specific hearing date, to be paid by the requesting party or parties;

(3) one hundred twenty dollars ($120.00) if a case is withdrawn, removed, or dismissed after the case is calendared for a specific hearing date;

(4) two hundred twenty dollars ($220.00) for a hearing before the Full Commission to be charged after the hearing has been held; and

(5) one hundred twenty dollars ($120.00) if one of the following occurs after an appeal or request for review is scheduled for a specific hearing date before the Full Commission:

(A) the appeal or request for review is withdrawn; or

(B) the appeal or request for review is dismissed for failure to prosecute or perfect the appeal or request for review.

In workers' compensation cases, these fees shall be paid by the employer unless the Commission orders otherwise, except as specified in Subparagraph (a)(2) above.

(a) (Effective July 1, 2015) The following hearing costs or fees apply to all subject areas within the authority of the Commission other than workers' compensation cases:

(1) one hundred twenty dollars ($120.00) for a hearing before a Deputy Commissioner to be charged after the hearing has been held;

(2) one hundred twenty dollars ($120.00) if a case is continued after the case is calendared for a specific hearing date, to be paid by the requesting party or parties;

(3) one hundred twenty dollars ($120.00) if a case is withdrawn, removed, or dismissed after the case is calendared for a specific hearing date;

(4) two hundred twenty dollars ($220.00) for a hearing before the Full Commission to be charged after the hearing has been held; and

(5) one hundred twenty dollars ($120.00) if one of the following occurs after an appeal or request for review is scheduled for a specific hearing date before the Full Commission:

(A) the appeal or request for review is withdrawn; or

(B) the appeal or request for review is dismissed for failure to prosecute or perfect the appeal or request for review.

(b) The Commission may waive fees set forth in Paragraph (a) of this Rule, or assess such fees against a party or parties pursuant to G.S. 97-88.1 if the Commission determines that the hearing has been brought, prosecuted, or defended without reasonable ground.

History

  • Authority G.S. 97-73; 97-80; 97-88.1; 143-291.1; 143-291.2; 143-300; S.L. 2014-77
  • Eff. November 1, 2014
  • Recodified from 04 NCAC 10E .0202 Eff. June 1, 2018.
11 NCAC 23E .0203 Fees Set by the Commission {#sec-11-ncac-23e-.0203 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23E .0203}

(a) In workers' compensation cases, the Commission sets the following fees:

(1) four hundred dollars ($400.00) for the processing of a compromise settlement agreement to be paid 50 percent by the employee and 50 percent by the employer(s) or the employer's carrier(s). The employer(s) or the employer's carrier(s) shall pay such fee in full when submitting the agreement to the Commission and, unless the parties agree otherwise, shall be entitled to a credit for the employee's 50 percent share of such fee against settlement proceeds;

(2) two hundred dollars ($200.00) for the processing of a I.C. Form MSC5, Report of Mediator, to be paid 50 percent by the employee and 50 percent by the employer(s) or the employer's carrier(s). The employer(s) or the employer's carrier(s) shall pay such fee in full upon receipt of an invoice from the Commission and, unless the parties agree otherwise, shall be reimbursed for the employee's share of such fees when the case is concluded from any compensation that may be determined to be due to the employee. The employer(s) or the employer's carrier(s) may withhold funds from any award for this purpose; and

(3) a fee equal to the filing fee required to file of a civil action in the Superior Court division of the General Court of Justice for the processing of a Form 33I Intervenor's Request that Claim be Assigned for Hearing, to be paid by the intervenor.

(b) In tort claims cases, the filing fee is an amount equal to the filing fee required to file a civil action in the Superior Court division of the General Court of Justice.

History

  • Authority G.S. 7A-305; 97-17; 97-26(i); 97-73; 97-80; 143-291.2; 143-300; S.L 2014-77
  • Eff. November 1, 2014
  • Amended Eff. July 1, 2015
  • Recodified from 04 NCAC 10E .0203 Eff. June 1, 2018.
11 NCAC 23E .0204 Accident Prevention and Safety Educational Program Fees {#sec-11-ncac-23e-.0204 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23E .0204}

(a) The following fees shall be assessed for accident prevention and safety educational programs:

(1) one hundred twenty-five dollars ($125.00) per person for an Accident Prevention Awareness (APCAP) Workshop;

(2) seventy-five dollars ($75.00) per person for an Advanced APCAP Workshop;

(3) thirty dollars ($30.00) per person for a Safety and Health Workshop;

(4) twenty dollars ($20.00) per person for a First Aid, CPR, and AED Course, plus fifteen dollars ($15.00) per person for materials;

(5) fifteen dollars per person ($15.00) for a First Aid Course, plus twelve dollars ($12.00) per person for materials;

(6) fifteen dollars per person ($15.00) for a CPR and AED Course, plus twelve dollars ($12.00) per person for materials;

(7) twenty dollars ($20.00) per person for a Defensive Driving Course, plus four dollars ($4.00) per person for materials;

(8) fifty dollars ($50.00) per person for a Hazardous Waste Operations and Emergency Response (HAZWOPER) Course or Refresher Course;

(9) thirty dollars ($30.00) per person for a HAZWOPER Awareness Course;

(10) twenty-five dollars ($25.00) per person for a Work Zone Flagger Course, plus five dollars ($5.00) for materials;

(11) thirty dollars ($30.00) per person for a Trenching Competent Person Course;

(12) thirty-five dollars ($35.00) per person for a Competent Person Scaffolding Course;

(13) forty-five dollars ($45.00) per person for an eight-hour National Fire Protection Association (NFPA) E Arc Flash Course;

(14) thirty dollars ($30.00) per person for a four-hour NFPA E Arc Flash Course;

(15) fifty dollars ($50.00) per person for a Safety for Supervisors Course;

(16) one hundred fifty dollars ($150.00) per person for a Safety Leadership Course;

(17) a two hundred dollar ($200.00) flat fee for a (five to eight-hour) Workplace Training;

(18) a one hundred-fifty dollar ($150.00) flat fee for a (three to four-hour)Workplace Training (3-4 hours); and

(19) a one hundred dollar ($100.00) flat fee for a (one to two-hour) Workplace Training.

(b) In addition to the fees listed in Paragraph (a), each individual or group registering for a class must pay a four dollar and ninety-five cent ($4.95) registration processing fee to the Commission's third party vendor upon registering for an educational program listed in Paragraph (a).

History

  • Authority G.S. 97-73; 97-80
  • Eff. July 1, 2014
  • Recodified from 04 NCAC 10E .0204 Eff. June 1, 2018.
11 NCAC 23E .0301 WAIVER of Rules {#sec-11-ncac-23e-.0301 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23E .0301}

In the interests of justice or to promote judicial economy, the Commission may, except as otherwise provided by the rules in this Subchapter, waive or vary the requirements or provisions of any of the rules in this Subchapter in a case pending before the Commission upon written application of a party or upon its own initiative only if the employee is not represented by counsel. Factors the Commission shall use in determining whether to grant the waiver are:

(1) the necessity of a waiver;

(2) the party's responsibility for the conditions creating the need for a waiver;

(3) the party's prior requests for a waiver;

(4) the precedential value of such a waiver;

(5) notice to and opposition by the opposing parties; and

(6) the harm to the party if the waiver is not granted.

History

  • Authority G.S. 97-25.2; 97-25.4; 97-73; 97-80; 130A-425(d); 143-166.4; 143-296; 143-300
  • Eff. July 1, 2014
  • Recodified from 04 NCAC 10E .0301 Eff. June 1, 2018.
11 NCAC 23E .0302 emergency orders and directives of the chief justice of the north carolina supreme court {#sec-11-ncac-23e-.0302 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23E .0302}

(a) This Rule applies to all matters within the authority and jurisdiction of the Commission and to all Subchapters of the Commission's rules.

(b) In the interests of justice or to protect the public health or safety, the Commission may waive or modify any portion of its rules in order to bring them in conformity with an emergency Order or directive of the Chief Justice of the North Carolina Supreme Court that is in effect. The Commission shall consider the following factors in determining whether to grant the waiver or modification:

(1) the necessity of waiving or modifying the rule; and

(2) the impact of waiving or modifying the rule on the regulated parties and on the Commission.

If the Commission waives or modifies a rule to bring it into conformity with any emergency Order or directive of the Chief Justice of the North Carolina Supreme Court, the Commission shall post a notice of the waiver or modification of the rule on its website unless the waiver or modification is case-specific and not generally applicable to the regulated public. For a waiver or modification that is case-specific and not generally applicable to the regulated public, the Commission shall notify the parties in the case of the waiver or modification via an order of the Commission.

(c) During any period that an emergency Order or directive of the Chief Justice of the North Carolina Supreme Court authorizes the taking of oaths and verifications outside the presence of a notary public, the Commission shall accept any pleading, motion, petition, supporting affidavit, or other document with an affirmation or representation not attested to before a notary public so long as the subscriber affirms the truth of the matter to be verified by an affirmation or representation in substantially the same language as that allowed by the emergency Order or directive of the Chief Justice of the North Carolina Supreme Court.

(d) Any waiver or modification made pursuant to this Rule shall only remain in effect during the duration of any emergency Order or directive of the Chief Justice of the North Carolina Supreme Court upon which that waiver or modification is based.

History

  • Authority G.S. 97-80; 130A-425(d); 143-166.4; 143-296; 143-300
  • Emergency Adoption Eff. November 6, 2020
  • Temporary Adoption Eff. January 29, 2021
  • Eff. August 1, 2021.

Subchapter F

11 NCAC 23F .0101 Electronic Medical Billing and Payment Requirement {#sec-11-ncac-23f-.0101 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23F .0101}

Carriers and licensed health care providers shall utilize electronic billing and payment in workers' compensation claims. Carriers and health care providers shall develop and implement electronic billing and payment processes consistent with 45 CFR 162. Carriers and health care providers shall comply with this Rule on or before March 1, 2014. 45 CFR 162 is hereby incorporated by reference and includes subsequent amendments and editions. A copy may be obtained at no charge from the National Archives and Records Administration's website, http://ecfr.gpoaccess.gov/cgi/t/text/text-idx?c=ecfr&tpl=/ecfrbrowse/Title45/45cfr162_main_02.tpl, or upon request, at the offices of the Commission, located in the Dobbs Building, 430 North Salisbury Street, Raleigh, North Carolina, between the hours of 8:00 a.m. and 5:00 p.m.

History

  • Authority G.S. 97-26(g1); 97-80
  • Eff. July 1, 2014
  • Recodified from 04 NCAC 10F .0101 Eff. June 1, 2018.
11 NCAC 23F .0102 Definitions {#sec-11-ncac-23f-.0102 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23F .0102}

As used in this Subchapter:

(1) "Clearinghouse" means a public or private entity, including a billing service, repricing company, community health management information system or community health information system, and "value-added" networks and switches, that is an agent of either the payer or the provider and that may perform the following functions:

(a) Processes or facilitates the processing of medical billing information received from a client in a nonstandard format or containing nonstandard data content into standard data elements or a standard transaction for further processing of a bill related transaction; or

(b) Receives a standard transaction from another entity and processes or facilitates the processing of medical billing information into nonstandard format or nonstandard data content for a client entity.

(2) "Complete electronic bill" submission means a medical bill that meets all of the criteria enumerated in this Subchapter.

(3) "Electronic" refers to a communication between computerized data exchange systems that complies with the standards enumerated in this Subchapter.

(3) "Health Care Provider" is as set forth in G.S. 97-2(20).

(4) "Health Care Provider Agent" is a person or entity that contracts with a health care provider establishing an agency relationship to process bills for services provided by the health care provider under the terms and conditions of a contract between the agent and health care provider. Such contracts may permit the agent to submit bills, request reconsideration, receive reimbursement, and seek medical dispute resolution for the health care provider services.

(5) "Implementation guide" is a published document for national electronic standard formats as defined in this Subchapter that specifies data requirements and data transaction sets.

(6) "National Provider Identification Number" or "NPI" means the unique identifier assigned to a health care provider or health care facility by the Secretary of the United States Department of Health and Human Services.

(7) "Payer" means the insurance carrier, third-party administrator, managed care organization, or employer responsible for paying the workers' compensation medical bills.

(8) "Payer agent" means any person or entity that performs medical bill related processes for the payer responsible for the bill. These processes include reporting to government agencies, electronic transmission, forwarding or receipt of documents, review of reports, adjudication of bill, and final payment.

History

  • Authority G.S. 97-26; 97-26(g1); 97-80
  • Eff. January 1, 1996
  • Recodified from 04 NCAC 10F .0101 Eff. July 1, 2014
  • Amended Eff. July 1, 2014
  • Recodified from 04 NCAC 10F .0102 Eff. June 1, 2018.
11 NCAC 23F .0103 Formats for Electronic Medical Bill Processing {#sec-11-ncac-23f-.0103 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23F .0103}

(a) Beginning March 1, 2014, electronic medical billing transactions shall be conducted using the electronic formats adopted under the Code of Federal Regulations, Title 45, part 162, subparts K, N, and P. Whenever a standard format is replaced with a newer standard, the most recent standard shall be used. The requirement to use a new version shall commence on the effective date of the new version as published in the Code of Federal Regulations.

(b) Nothing in this Subchapter shall prohibit payers and health care providers from using a direct data entry methodology for complying with these requirements, provided the methodology complies with the data content requirements of the adopted formats and these Rules.

History

  • Authority G.S. 97-26; 97-26(g1); 97-80
  • Eff. January 1, 1996
  • Recodified from 04 NCAC 10F .0102 Eff. July 1, 2014
  • Amended Eff. July 1, 2014
  • Recodified from 04 NCAC 10F .0103 Eff. June 1, 2018.
11 NCAC 23F .0104 Billing Code Sets {#sec-11-ncac-23f-.0104 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23F .0104}

Billing codes and modifier systems identified below are valid codes for the specified workers' compensation transactions, in addition to any code sets defined by the standards adopted in 11 NCAC 23F .0103:

(1) "CDT-4 Codes" that refers to the codes and nomenclature prescribed by the American Dental Association.

(2) "CPT-4 Codes" that refers to the procedural terminology and codes contained in the "Current Procedural Terminology, Fourth Edition," as published by the American Medical Association.

(3) "Diagnosis Related Group (DRG)" that refers to the inpatient classification scheme used by CMS for hospital inpatient reimbursement.

(4) "Healthcare Common Procedure Coding System" (HCPCS) that refers to a coding system which describes products, supplies, procedures, and health professional services and that includes CPT-4 codes, alphanumeric codes, and related modifiers.

(5) "ICD-9-CM Codes" that refers to diagnosis and procedure codes in the International Classification of Diseases, Ninth Revision, Clinical Modification published by the United States Department of Health and Human Services.

(6) "ICD-10-CM/PCS" that refers to diagnosis and procedure codes in the International Classification of Diseases, Tenth Edition, Clinical Modification/Procedure Coding System.

(7) National Drug Codes (NDC) of the United States Food and Drug Administration.

(8) "Revenue Codes" that refers to the 4-digit coding system developed and maintained by the National Uniform Billing Committee for billing inpatient and outpatient hospital services, home health services, and hospice services.

(9) "National Uniform Billing Committee Codes" that refers to the code structure and instructions established for use by the National Uniform Billing Committee (NUBC).

History

  • Authority G.S. 97-26(g1); 97-80
  • Eff. July 1, 2014
  • Recodified from 04 NCAC 10F .0104 Eff. June 1, 2018.
11 NCAC 23F .0105 Electronic Medical Billing, Reimbursement, and Documentation {#sec-11-ncac-23f-.0105 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23F .0105}

(a) Payers and payer agents shall:

(1) accept electronic medical bills submitted in accordance with the standards adopted in this Subchapter;

(2) transmit acknowledgments and remittance advice in compliance with the standards adopted in this Subchapter in response to electronically submitted medical bills; and

(3) utilize methods to receive electronic documentation required for the adjudication of a bill.

(b) A health care provider shall:

(1) exchange medical bill data in accordance with the standards adopted in this Subchapter;

(2) submit medical bills as defined by this Rule to any payers who have established connectivity with the health care provider system or clearinghouse;

(3) submit required documentation in accordance with Paragraph (d) of this Rule; and

(4) receive and act upon any acceptance or rejection acknowledgment from the payer.

(c) To be considered a complete electronic medical bill, the bill or supporting transmissions shall:

(1) be submitted in the correct billing format, with the correct billing code sets as presented in this Rule;

(2) be transmitted in compliance with the format requirements described in this Rule;

(3) include in legible text all medical reports and records, including evaluation reports, narrative reports, assessment reports, progress reports and notes, clinical notes, hospital records and diagnostic test results that are necessary for adjudication;

(4) identify the:

(A) injured employee;

(B) employer;

(C) insurance carrier, third party administrator, managed care organization or its agent;

(D) health care provider; and

(E) medical service or product;

(5) comply with any other requirements as presented in a companion guide published by the Commission; and

(6) use current and valid codes and values as defined in the applicable formats defined in this Subchapter.

(d) Electronic Acknowledgment:

(1) Interchange Acknowledgment (TA1) notifies the sender of the receipt of, and structural defects associated with, an incoming transaction.

(2) As used in this Paragraph, Implementation Acknowledgment (ASC X12 999) transaction is an electronic notification to the sender of the file that it has been received and has been:

(A) accepted as a complete and structurally correct file; or

(B) rejected with a valid rejection code.

(3) As used in this Paragraph, Health Care Claim Status Response (ASC X12 277) or Acknowledgment transaction (detail acknowledgment) is an electronic notification to the sender of an electronic transaction (individual electronic bill) that the transaction has been received and has been:

(A) accepted as a complete, correct submission; or

(B) rejected with a valid rejection code.

(4) A payer shall acknowledge receipt of an electronic medical bill by returning an Implementation Acknowledgment (ASC X12 999) within one business day of receipt of the electronic submission.

(5) Notification of a rejected bill shall be transmitted when an electronic medical bill does not meet the definition of a complete electronic medical bill as described in this Rule or does not meet the edits defined in the applicable implementation guide or guides.

(6) A health care provider or its agent may not submit a duplicate electronic medical bill earlier than 60 days from the date originally submitted if a payer has acknowledged acceptance of the original complete electronic medical bill. A health care provider or its agent may submit a corrected medical bill electronically to the payer after receiving notification of a rejection. The corrected medical bill shall be submitted as a new, original bill.

(7) A payer shall acknowledge receipt of an electronic medical bill by returning a Health Care Claim Status Response or Acknowledgment (ASC X12 277) transaction (detail acknowledgment) within two business days of receipt of the electronic submission.

(8) Notification of a rejected bill shall be transmitted in an ASC X12 277 response or acknowledgment when an electronic medical bill does not meet the definition of a complete electronic medical bill or does not meet the edits defined in the applicable implementation guide or guides.

(9) A health care provider or its agent may not submit a duplicate electronic medical bill earlier than 60 days from the date originally submitted if a payer has acknowledged acceptance of the original complete electronic medical bill. A health care provider or its agent may submit a corrected medical bill electronically to the payer after receiving notification of a rejection. The corrected medical bill shall be submitted as a new, original bill.

(10) Acceptance of a complete medical bill is not an admission of liability by the payer. A payer may subsequently reject an accepted electronic medical bill if the employer or other responsible party named on the medical bill is not legally liable for its payment.

(11) The subsequent rejection shall occur no later than seven days from the date of receipt of the complete electronic medical bill.

(12) The rejection transaction shall indicate that the reason for the rejection is due to denial of liability.

(13) Acceptance of an incomplete medical bill does not satisfy the written notice of injury requirement from an employee or payer as required in G.S. 97-22.

(14) Acceptance of a complete or incomplete medical bill by a payer does not begin the time period by which a payer shall accept or deny liability for any alleged claim related to such medical treatment pursuant to G.S. 97-18 and 11 NCAC 23A .0601.

(15) Transmission of an Implementation Acknowledgment under Subparagraph (d)(2)of this Rule and acceptance of a complete, structurally correct file serves as proof of the received date for an electronic medical bill in this Rule.

(e) Electronic Documentation

(1) Electronic documentation, including medical reports and records submitted electronically that support an electronic medical bill, may be required by the payer before payment may be remitted to the health care provider. Electronic documentation may be submitted simultaneously with the electronic medical bill.

(2) Electronic transmittal by electronic mail shall contain the following information:

(A) the name of the injured employee;

(B) identification of the worker's employer, the employer's insurance carrier, or the third party administrator or its agent handling the workers' compensation claim;

(C) identification of the health care provider billing for services to the employee, and where applicable, its agent;

(D) the date(s) of service; and

(E) the workers' compensation claim number assigned by the payer, if known.

(f) Electronic remittance notification

(1) As used in the Paragraph, an electronic remittance notification is an explanation of benefits (EOB) or explanation of review (EOR), submitted electronically regarding payment or denial of a medical bill, recoupment request, or receipt of a refund.

(2) A payer shall provide an electronic remittance notification in accordance with G.S. 97-18.

(3) The electronic remittance notification shall contain the appropriate Group Claim Adjustment Reason Codes, Claim Adjustment Reason Codes (CARC) and associated Remittance Advice Remark Codes (RARC) or, for pharmacy charges, the National Council for Prescription Drugs Program (NCPDP) Reject Codes, denoting the reason for payment, adjustment, or denial.

(4) The remittance notification shall be sent within two days of:

(A) the expected date of receipt by the health care provider of payment from the payer; or

(B) the date the bill was rejected by the payer. If a recoupment of funds is being requested, the notification shall contain the proper code described in Subparagraph (e)(3) of this Rule and an explanation for the amount and basis of the refund.

(g) A health care provider or its agent may not submit a duplicate paper medical bill earlier than 30 days from the date originally submitted unless the payer has returned the medical bill as incomplete in accordance with this Subchapter. A health care provider or its clearinghouse or agent may submit a corrected paper medical bill to the payer after receiving notification of the return of an incomplete medical bill. The corrected medical bill shall be submitted as a new, original bill.

(h) A payer shall establish connectivity with any clearinghouse that requests the exchange of data in accordance with this Subchapter. A payer or its agent may not reject a standard transaction on the basis that it contains data elements not needed or used by the payer or its agent.

(j) A health care provider that does not send standard transactions shall use an internet-based direct data entry system offered by a payer if the payer does not charge a transaction fee. A health care provider using an Internet-based direct data entry system offered by a payer or other entity shall use the appropriate data content and data condition requirements of the standard transactions.

History

  • Authority G.S. 97-26(g1); 97-80
  • Eff. July 1, 2014
  • Recodified from 04 NCAC 10F .0105 Eff. June 1, 2018.
11 NCAC 23F .0106 Employer, Insurance Carrier, Managed Care Organization, or Agents' Receipt of Medical Bills from Health Care Providers {#sec-11-ncac-23f-.0106 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23F .0106}

(a) Upon receipt of medical bills submitted in accordance with the rules in this Subchapter, a payer shall evaluate each bill's conformance with the criteria of a complete medical bill. A payer shall not return to the health care provider medical bills that are complete, unless the bill is a duplicate bill. Within 21 days of receipt of an incomplete medical bill, a payer or its agent shall either:

(1) Complete the bill by adding missing health care provider identification or demographic information already known to the payer; or

(2) Return the bill to the sender, in accordance with this Paragraph.

(b) The received date of an electronic medical bill is the date all of the contents of a complete electronic bill are successfully received by the claims payer.

(c) The payer may contact the health care provider to obtain the information necessary to make the bill complete. Any request by the payer or its agent for additional documentation to pay a medical bill shall:

(1) be made by telephone or electronic transmission unless the information cannot be sent by those media, in which case the sender shall send the information by mail or personal delivery;

(2) be specific to the bill or the bill's related episode of care;

(3) describe with specificity the clinical and other information to be included in the response;

(4) be relevant and necessary for the resolution of the bill;

(5) be for information that is contained in or is in the process of being incorporated into the injured employee's medical or billing record maintained by the health care provider; and

(6) indicate the reason for which the insurance carrier is requesting the information.

If the payer or its agent obtains the missing information and completes the bill to the point it can be adjudicated for payment, the payer shall document the name and telephone number of the person who supplied the information. Health care providers and payers, or their agents, shall maintain, in a reproducible format, documentation of communications related to medical bill processing.

(d) A payer shall not return a medical bill except as provided in this Rule. When returning an electronic medical bill, the payer shall identify the reason(s) for returning the bill by utilizing the appropriate Reason and Rejection Code identified in the standards identified in this Subchapter.

(e) The proper return of an incomplete medical bill in accordance with this section fulfills the obligation of the payer to provide to the health care provider or its agent information related to the incompleteness of the bill.

(f) Payers shall timely reject bills or request additional information needed to reasonably determine the amount payable as follows:

(1) For bills submitted electronically, the rejection of all or part of the bill shall be sent to the submitter within two days of receipt.

(2) If bills are submitted in a batch transmission, only the specific bills failing edits shall be rejected.

(g) If a payer has reason to challenge the coverage or amount of a specific line item on a bill, but has no reasonable basis for objections to the remainder of the bill, the uncontested portion shall be paid timely, as required in this Rule.

(i) Payment of all uncontested portions of a complete medical bill shall be made within 30 days of receipt of the original bill, or receipt of additional information requested by the payer allowed under the law. After 60 days an amount equal to 10 percent shall be added to an unpaid bill.

(j) A payer shall not return a medical bill except as provided in this Rule. When returning a medical bill, the payer shall also communicate the reason(s) for returning the bill.

History

  • Authority G.S. 97-18(a); 97-26(g1); 97-80
  • Eff. July 1, 2014
  • Recodified from 04 NCAC 10F .0106 Eff. June 1, 2018.
11 NCAC 23F .0107 Communication Between Health Care Providers and Payers {#sec-11-ncac-23f-.0107 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23F .0107}

(a) Any communication between the health care provider and the payer related to medical bill processing shall be of sufficient detail to allow the responder to easily identify the information required to resolve the issue or question related to the medical bill. Generic statements that simply state a conclusion such as "payer improperly reduced the bill" or "health care provider did not document" or other similar phrases with no further description of the factual basis for the sender's position do not satisfy the requirements of this Rule.

(b) When communicating with the health care provider, agent, or assignee, the payer may utilize the ASC X12 Reason Codes, or the NCPDP Reject Codes, to communicate with the health care provider, agent, or assignee.

(c) Communication between the health care provider and payer related to medical bill processing shall be made by telephone or electronic transmission unless the information cannot be sent by those media, in which case the sender shall send the information by mail or personal delivery.

History

  • Authority G.S. 97-26(g1); 97-80(a)
  • Eff. July 1, 2014
  • Recodified from 04 NCAC 10F .0107 Eff. June 1, 2018.
11 NCAC 23F .0108 Effective Date {#sec-11-ncac-23f-.0108 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23F .0108}

This Chapter applies to all medical services and products provided on or after March 1, 2014. For medical services and products provided prior to March 1, 2014, medical billing and processing shall be in accordance with the rules in effect at the time the health care was provided.

History

  • Authority G.S. 97-26(g1); 97-80
  • Eff. July 1, 2014
  • Recodified from 04 NCAC 10F .0108 Eff. June 1, 2018.

Subchapter G

11 NCAC 23G .0101 Order for Mediated Settlement Conference {#sec-11-ncac-23g-.0101 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23G .0101}

(a) Mediation Upon Agreement of the Parties. If the parties to a workers' compensation claim or state tort claim agree to mediate the claim, the parties may schedule and proceed with mediation on their own, or the parties may submit a request for a mediation order pursuant to Paragraph (d) of this Rule. No order from the Commission is necessary if the parties mutually agree to mediate the claim, but the mediator shall file a report of mediation with the Commission as required by Paragraph (g) of Rule .0106 of this Subchapter. If the parties proceed with mediation in the absence of an order from the Commission and the Commission thereafter enters a mediation order, the parties shall notify the Commission that the parties have agreed upon the selection of a mediator or, if the mediated settlement conference has been completed, that the parties request to be excused from any further mediation obligations pursuant to Paragraph (f) of this Rule.

(b) Referral Upon Receipt of a Form 33 Request that Claim be Assigned for Hearing. In any case in which the Commission receives a Form 33 Request that Claim be Assigned for Hearing, the Commission shall order the case to a mediated settlement conference unless doing so would be contrary to the interests of justice.

(c) By Order of the Commission. Commissioners, Deputy Commissioners, the Commission's Dispute Resolution Coordinator, and such other employees as the Commission Chair designates may, by written order, require the parties and their representatives to attend a mediated settlement conference concerning a dispute within the workers' compensation and state tort claim jurisdiction of the Commission. Requests to dispense with or defer a mediated settlement conference shall be addressed to the Dispute Resolution Coordinator. Unless the context otherwise requires, references to the "Commission" in the rules in this Subchapter shall mean the Dispute Resolution Coordinator.

(d) Mediation Upon Request of a Party. If a case is not otherwise ordered to a mediated settlement conference, a party may move the Commission to order a conference. The motion shall be served on non-moving parties and shall state the reasons why the order should be entered. Responses may be filed in writing with the Commission within 10 days after the date of the service of the motion. Any motion for a mediation order shall be submitted on a form provided by the Commission.

(e) Timing of the Order. The order requiring mediation may be issued whenever it appears that the parties have a dispute arising under the Workers' Compensation Act or the Tort Claims Act.

(f) Motion to Dispense with or Defer Mediated Settlement Conference. Mediation may be dispensed with by the Commission in the interests of justice or judicial economy. As used in this Rule, the term "dispensed with" means setting aside or rescinding the mediation order(s) entered in the case, or excusing the parties from their obligations under the applicable order(s) or the Rules in this Subchapter. Mediation may not be dispensed with by the parties or the mediator unless the parties have agreed, subject to Commission approval, on a full and complete resolution of all disputed issues set forth in the request for hearing filed in the case, and the parties have given notice of the settlement to the Dispute Resolution Coordinator. Within 55 days of the filing of a Form 33 Request that Claim be Assigned for Hearing, or otherwise within the deadline set forth in the Commission's order entered pursuant to Paragraph (c) or Paragraph (d) of this Rule, a party may move to dispense with or defer the mediated settlement conference. The motion shall state the reasons the relief is sought and must be received by the Dispute Resolution Coordinator within the applicable deadline.

(g) Exemption from Mediated Settlement Conference. The State shall not be compelled to participate in a mediation or neutral evaluation procedure with a prison inmate.

(h) Motion to Authorize the Use of Neutral Evaluation Procedures. The parties may move the Commission to authorize the use of a neutral evaluation procedure contained in Rule .0109 of this Subchapter in lieu of a mediated settlement conference. The motion shall be filed on a form provided by the Commission within 55 days of the filing of a Form 33 Request that Claim be Assigned for Hearing, or otherwise within the deadline set forth in the Commission's order entered pursuant to Paragraph (c) or Paragraph (d) of this Rule, and shall state:

(1) that all parties consent to the motion;

(2) that the neutral evaluator and the parties have agreed upon the selection and all terms of compensation of the neutral selected; and

(3) the name, address, and telephone number of the neutral evaluator selected by the parties.

(i) If the parties are unable to agree to the matters listed in Paragraph (h), the Commission shall deny the motion for authorization to use a neutral evaluation procedure, and the parties shall attend the mediated settlement conference as originally ordered by the Commission. If the parties are able to agree on the matters listed in Paragraph (h), the Commission shall order the use of a neutral evaluation proceeding; provided, however, that the Commission shall not order the use of a neutral evaluation proceeding in any case in which the plaintiff is not represented by counsel.

(j) Cases Involving Plaintiffs Not Represented by Counsel. Unless an unrepresented plaintiff requests that the plaintiff's case be mediated, the Commission shall enter an order dispensing with mediation.

History

  • Authority G.S. 97-80(a),(c); 143-296; 143-300; Rule 1 of Rules for Mediated Settlement Conferences and Other Settlement Procedures in Superior Court Civil Actions
  • Eff. January 16, 1996
  • Amended Eff. October 1, 1998
  • Recodified from 04 NCAC 10A .0616
  • Amended Eff. July 1, 2014; January 1, 2011; June 1, 2000
  • Recodified from 04 NCAC 10G .0101 Eff. June 1, 2018.
11 NCAC 23G .0102 Selection of Mediator {#sec-11-ncac-23g-.0102 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23G .0102}

(a) By Agreement of Parties. The parties in a workers' compensation case or a state tort claims case may, by agreement, select a mediator certified by the North Carolina Dispute Resolution Commission within 55 days of the filing of a Form 33 Request that Claim be Assigned for Hearing, or otherwise within the deadline set forth in the Commission's order entered pursuant to Paragraph (c) or Paragraph (d) of Rule .0101 of this Subchapter, subject to the Commission's authority to remove the mediator selected by the parties due to a conflict of interest. The stipulation may be transmitted by either party, shall be dated as of the date it is transmitted to the Commission, and must be received by the Dispute Resolution Coordinator within 55 days of the filing of a Form 33 Request that Claim be Assigned for Hearing, or otherwise within the deadline set forth in the Commission's order entered pursuant to Paragraph (c) or Paragraph (d) of Rule .0101 of this Subchapter. The scheduled date of the mediated settlement conference shall be within 120 days of the mediation order. The stipulation shall include the date of the scheduled mediation, the name, address and telephone number of the mediator selected by agreement, and shall confirm that the mediator is certified by the Dispute Resolution Commission. The applicable deadline shall be extended by the Dispute Resolution Coordinator upon request of the parties. Any party may waive the applicable deadline for the selection and suggestion of mediators and request that the Commission appoint a mediator.

(b) Appointment by Commission. If the parties fail to notify the Commission of the parties' selection of a mediator within 55 days of the filing of a Form 33 Request that Claim be Assigned for Hearing, or otherwise within the deadline set forth in the Commission's order entered pursuant to Paragraph (c) or Paragraph (d) of Rule .0101 of this Subchapter, the Commission shall appoint a mediator to hold a mediated settlement conference in the case. The Commission shall appoint a mediator who meets the requirements in Paragraph (b) of Rule .0108 of this Subchapter. In the absence of any suggestions by the parties with regard to the appointment of mediators, the Commission shall select the mediator for the case by random order, unless the Commission determines that, because of unusual circumstances, a particular mediator should be appointed in a particular case.

(c) Disqualification of Mediator. Any party may move the Commission for an order disqualifying a mediator. For good cause, such order shall be entered. If the mediator is disqualified, an order shall be entered for the selection of a replacement mediator pursuant to this Rule. Nothing in this Paragraph shall preclude mediators from disqualifying themselves.

History

  • Authority G.S. 97-80(a),(c); 143-296; 143-300; Rule 2 of Rules for Mediated Settlement Conferences and Other Settlement Procedures in Superior Court Civil Actions
  • Eff. January 16, 1996
  • Amended Eff. October 1, 1998
  • Recodified from 04 NCAC 10A .0616
  • Amended Eff. July 1, 2014; January 1, 2011; June 1, 2000
  • Eff. January 16, 1996
  • Amended Eff. October 1, 1998
  • Recodified from 04 NCAC 10A .0616
  • Amended Eff. July 1, 2014; January 1, 2011; June 1, 2000
  • Recodified from 04 NCAC 10G .0102 Eff. June 1, 2018.
11 NCAC 23G .0103 The Mediated Settlement Conference {#sec-11-ncac-23g-.0103 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23G .0103}

(a) Where Conference Is to Be Held. Unless all parties in a workers' compensation case or a state tort claims case and the mediator otherwise agree, the mediated settlement conference shall be held in the county where the case is pending. The mediator shall reserve a place and make arrangements for the conference and give notice to all attorneys and unrepresented parties of the time and location of the conference.

(b) When Conference Is to Be Held. The conference shall be held at the time agreed to by the parties and the mediator, or if the parties do not agree, at the time specified by the mediator.

(c) Request to Extend Date of Completion. In the interests of justice, the Commission may extend the deadline for completion of the conference upon the Commission's own motion, a motion or stipulation of the parties or the suggestion of the mediator.

(d) Recesses. The mediator may recess the conference at any time and may set times for reconvening. If the time for reconvening is set before the conference is recessed, no further notification is required for persons present at the recessed conference.

(e) The Mediated Settlement Conference Is Not to Delay Other Proceedings. A mediated settlement conference is not cause for delay of other proceedings in the case, including the completion of discovery and the filing or hearing of motions, unless ordered by the Commission in the interests of justice. No depositions shall be taken following a Commission order requiring mediation until mediation is concluded, except by agreement of the parties or order of the Commission in the interest of justice.

(f) Inadmissibility of Negotiations by Parties and Attorneys. Evidence of statements made and conduct occurring in a mediated settlement conference or other settlement proceeding conducted pursuant to the Rules in this Subchapter, whether attributable to a party, the mediator, other neutral, or a neutral observer present at the settlement conference or proceeding, are not subject to discovery and shall be inadmissible in any proceeding in the action or other actions on the same claim, except:

(1) proceedings for sanctions for violations of the attendance or payment of mediation fee provisions contained in Rule .0104 and Rule.0107 of this Subchapter;

(2) proceedings to enforce or rescind a settlement of the action;

(3) disciplinary proceedings before the North Carolina State Bar or any agency enforcing standards of conduct for mediators or other neutrals, including the Commission; or

(4) proceedings to enforce laws concerning juvenile or elder abuse.

(g) No settlement agreement to resolve any or all issues reached at the settlement conference or proceeding conducted under this Subchapter or reached during a recess in the conference or proceeding shall be enforceable unless the settlement agreement has been reduced to writing and signed by the parties. No evidence otherwise discoverable shall be inadmissible solely because the evidence is presented or discussed in a mediated settlement conference or other settlement proceeding.

(h) Inadmissibility of Mediator Testimony. No mediator, other neutral, or neutral observer present at a settlement proceeding shall be compelled to testify or produce evidence concerning statements made and conduct occurring in anticipation of, during, or as a follow-up to a mediated settlement conference or other settlement proceeding conducted pursuant to the Rules in this Subchapter in any Commission case or civil proceeding for any purpose, including proceedings to enforce or rescind a settlement of the action, except:

(1) to attest to the signing of any settlement agreements;

(2) proceedings for sanctions for violations of the attendance or payment of mediation fee provisions contained in Rule .0104 and Rule .0107 of this Subchapter;

(3) disciplinary proceedings before the North Carolina State Bar or any agency enforcing standards of conduct for mediators or other neutrals, including the Commission; and

(4) proceedings to enforce laws concerning juvenile or elder abuse.

(i) As used in this Subchapter, the term "neutral observer" includes persons seeking mediator certification, persons studying dispute resolution processes, and persons acting as interpreters.

History

  • Authority G.S. 97-80(a),(c); 143-296; 143-300; Rule 3 of Rules for Mediated Settlement Conferences and Other Settlement Procedures in Superior Court Civil Actions
  • Eff. January 16, 1996
  • Amended Eff. October 1, 1998
  • Recodified from 04 NCAC 10A .0616
  • Amended Eff. July 1, 2014; January 1, 2011; June 1, 2000
  • Eff. January 16, 1996
  • Amended Eff. October 1, 1998
  • Recodified from 04 NCAC 10A .0616
  • Amended Eff. July 1, 2014; January 1, 2011; June 1, 2000
  • Recodified from 04 NCAC 10G .0103 Eff. June 1, 2018.
11 NCAC 23G .0104 Duties of Parties, Representatives, and Attorneys {#sec-11-ncac-23g-.0104 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23G .0104}

(a) Attendance. The following persons shall attend the mediated settlement conference:

(1) all individual parties;

(2) in a workers' compensation case, a representative of the employer at the time of injury if:

(A) the employer, instead of or in addition to the insurance company or administrator, has decision-making authority with respect to settlement;

(B) the employer is offering the claimant employment and the suitability of that employment is at issue; or

(C) the employer and the claimant have agreed to simultaneously mediate non-compensation issues arising from the injury.

(3) an officer, employee, or agent of any party, that is not a natural person or a governmental entity, who is not the party's outside counsel and who has the authority to decide on behalf of the party whether and on what terms to settle the action;

(4) in a workers' compensation case, an employee or agent of any party that is a governmental entity who is not the party's outside counsel or Attorney General's counsel responsible for the case and who has the authority to decide on behalf of the party whether and on what terms to settle the action;

(5) when the governing law prescribes that the terms of a proposed settlement may be approved only by a board, an employee or agent who is not the party's outside counsel or Attorney General's counsel responsible for the case and who has the authority to negotiate on behalf of and to make a recommendation to the board. In claims with settlements subject to the review and approval by the Industrial Commission under G.S. 143-295, an employee or agent of the named governmental entity or agency is not required to attend the mediated settlement conference. The Attorney General shall attempt to make an employee or agent of the named governmental entity or agency in a State tort claim available via telecommunication, and mediation shall not be delayed due to the absence or unavailability of the employee or agent of the named governmental entity or agency;

(6) the counsels of record. Appearance by counsel does not dispense with or waive the required attendance of the parties listed in Subparagraphs (1) through (5);

(7) a representative of each defendant's primary workers' compensation or liability insurance carrier or self-insured that may be obligated to pay all or part of any claim presented in the action. Each carrier or self-insured shall be represented at the conference by an officer, employee, or agent who is not the party's outside counsel and who has the authority to decide on behalf of the carrier or self-insured whether and on what terms to settle the action, or who has been authorized to negotiate on behalf of the carrier or self-insured and can communicate during the conference with persons who have the decision making authority.

(8) any employer or carrier who may be obligated to pay all or part of any claim presented in the action and who is not required to attend the mediated settlement conference pursuant to Subparagraphs (1) through (7) of this Paragraph may attend the conference if the employer or carrier elects to attend. If, during the conference, the mediator determines that the attendance of one or more additional persons is necessary to resolve the matters in dispute in the subject action, the mediator may recess the conference and reconvene the conference at a later date and time to allow the additional person or persons to attend.

(b) Any party or person required to attend a mediated settlement conference shall attend the conference until an agreement is reduced to writing and signed as provided in Paragraph (e) of this Rule, or until an impasse has been declared. The attendance method for Industrial Commission mediations shall be the same as the attendance method set forth in Rule 4 of the Rules for Mediated Settlement Conferences and Other Settlement Procedures in Superior Court Civil Actions, which is hereby incorporated by reference and includes subsequent amendments and editions. A copy of the Rules for Mediated Settlement Conferences and Other Settlement Procedures in Superior Court Civil Actions may be obtained at no charge from the North Carolina Judicial Branch website, at https://www.nccourts.gov/courts/supreme-court/court-rules/rules-for-mediated-settlement-conferences-and-other-settlement-procedures-in-superior-court-civil-actions, or upon request at the main office of the Industrial Commission, located on the 6th floor of the Dobbs Building, 430 North Salisbury Street, Raleigh, North Carolina 27603, between the hours of 8:00 a.m. and 5:00 p.m. Monday through Friday, excluding holidays established by the State Human Resources Commission. All parties and persons required to attend the conference, including the mediator, shall comply with all public health and safety requirements set forth in the mediation rules approved by the North Carolina Supreme Court for use in the Superior Court division that are in effect at the time of the mediation.

(c) In appropriate cases, the Commission or the mediator, with the consent of the parties, may allow a party or insurance carrier representative who is required to attend a mediated settlement conference in person under this Rule to attend the conference by telephone, conference call, speaker telephone, or videoconferencing. The attending party or representative shall bear all costs of the telephone calls or videoconferencing. In addition, the mediator may communicate directly with the insurance representative with regard to matters discussed in mediation, and the mediator may set a subsequent mediated settlement conference at which all parties and representatives shall attend the mediated settlement conference in person, subject to Paragraph (b) of this Rule. The failure to appear by telephone or videoconferencing in accordance with this Paragraph shall subject the responsible party or representative to sanctions pursuant to Rule .0105 of this Subchapter.

(d) Notice of Mediation Order. Within seven days after the receipt of an order for a mediated settlement conference, the carrier or self-insured named in the order shall provide a copy of the order to the employer and all other carriers who may be obligated to pay all or part of any claim presented in the workers' compensation case or any related third-party tortfeasor claims, and shall provide the mediator and the other parties in the action with the name, address, and telephone number of all such carriers.

(e) Finalizing Agreement. If an agreement is reached in the mediated settlement conference, the parties shall reduce the agreement to writing, specifying all terms of the agreement that bear on the resolution of the dispute before the Commission, and shall sign the agreement along with their counsel. The parties may use IC Form MSC8, Mediated Settlement Agreement, or MSC9, Mediated Settlement Agreement – Alternative Form, for this purpose. Execution by counsel of a mediated settlement agreement for an employer or carrier who does not physically attend the mediated settlement conference shall be deemed to be in compliance with this Rule and 11 NCAC 23A .0502. By stipulation of the parties and at the parties' expense, the agreement may be electronically or stenographically recorded. All agreements for payment of compensation shall be submitted for Commission approval in accordance with 11 NCAC 23A .0501 and .0502.

(f) Payment of Mediator's Fee. The mediator's fee shall be paid at the conclusion of the mediated settlement conference, unless otherwise provided by Rule .0107 of this Subchapter, or by agreement with the mediator.

(g) Related Cases. Upon application by any party or any person as defined in G.S. 97-2(4), and upon notice to all parties, the Commission may, in the interests of justice, order an attorney of record, party, or representative of an insurance carrier who may be liable for all or any part of a claim pending in a Commission case to attend a mediated settlement conference convened in another related pending case, regardless of the forum in which the other case may be pending, provided that all parties in the other pending case consent to the attendance ordered pursuant to this Paragraph. Any disputed issues concerning such an order shall be addressed to the Commission's Dispute Resolution Coordinator. Unless otherwise ordered, any attorney, party, or carrier representative who attends a mediated settlement conference pursuant to this Paragraph shall not be required to pay any of the mediation fees or costs related to that conference. Requests that a party, attorney of record, or insurance carrier representative in a related case attend a mediated settlement conference in a Commission case shall be addressed to the court or agency where the related case is pending, provided that all parties in the Commission case consent to the requested attendance.

History

  • Authority G.S. 97-80; 143-296; 143-300
  • Eff. January 16, 1996
  • Amended Eff. October 1, 1998
  • Recodified from 04 NCAC 10A .0616
  • Amended Eff. July 1, 2014; January 1, 2011; June 1, 2000
  • Recodified from 04 NCAC 10G .0104 Eff. June 1, 2018
  • Emergency Amendment Eff. June 16, 2020
  • Amended Eff. August 1, 2020
  • Temporary Amendment Eff. August 28, 2020
  • Amended Eff. February 1, 2023; March 1, 2021.
11 NCAC 23G .0104A Foreign Language Interpreters {#sec-11-ncac-23g-.0104a omnilex-key=us-nc-regs-official--title-11--11 NCAC 23G .0104A}

(a) Any party who is unable to speak or understand English shall so notify the Commission, the mediator, and the opposing party or parties in writing, not less than 21 days prior to the date of the mediated settlement conference. The notice shall contain the party's primary language and how the party plans to communicate in English during the mediation.

(b) The party requesting the assistance of a qualified foreign language interpreter shall bear the costs.

(c) If the certified mediator, in his or her discretion, notifies the parties of the need for a qualified foreign language interpreter, the parties shall retain a disinterested interpreter who possesses the qualifications listed in Paragraph (d) of this Rule to assist at the mediated settlement conference. The fee of the foreign language interpreter and any postponement fees necessitated by the need for a qualified foreign language interpreter shall be shared by the parties unless the parties agree otherwise.

(d) A qualified foreign language interpreter shall possess sufficient experience and education, or a combination of experience and education, in speaking and understanding English and the foreign language to be interpreted, to qualify as an expert witness pursuant to G.S. 8C-1, Rule 702.

(e) Qualified foreign language interpreters shall abide by the Code of Conduct and Ethics of Foreign Language Interpreters and Translators, contained in Part 4 of Policies and Best Practices for the Use of Foreign Language Interpreting and Translating Services in the North Carolina Court System and promulgated by the North Carolina Administrative Office of the Courts, and shall interpret, as word for word as is practicable, without editing, commenting, or summarizing, testimony or other communications. The Code of Conduct and Ethics of Foreign Language Interpreters and Translators is hereby incorporated by reference and includes subsequent amendments and editions. A copy may be obtained at no charge from the North Carolina Administrative Office of the Court's website, http://www.nccourts.org/Citizens/CPrograms/Foreign/Documents/guidelines.pdf, or upon request, at the offices of the Commission, as set forth in Rule 11 NCAC 23A .0101.

History

  • Authority G.S. 97-80(a); 97-80(c); 143-296; 143-300
  • Eff. January 1, 2011
  • Amended Eff. July 1, 2014
  • Recodified from 04 NCAC 10G .0104A Eff. June 1, 2018.
11 NCAC 23G .0105 SANCTIONS (effective july 1, 2014) {#sec-11-ncac-23g-.0105 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23G .0105}

If a person or party whose attendance at a mediated settlement conference is required by Rule.0104 of this Subchapter fails to attend or cancels, without Commission approval in accordance with Paragraph (f) of Rule .0101 of this Subchapter, a duly ordered mediated settlement conference without good cause, the Commission may impose upon the party any lawful sanction, including holding the party in contempt or requiring the party to pay fines, attorneys' fees, mediator fees and expenses and loss of earning incurred by persons attending the conference. Any sanctions that are assessed against a party consistent with the Workers' Comp Act, the Tort Claims Act and the Rules in this Subchapter, including mediated settlement conference postponement fees and sanctions for the unauthorized cancellation or failure to appear at the conference, may be assessed against the party depending on whose conduct necessitated the assessment of sanctions.

History

  • Authority G.S. 97-80(a),(c); 143-296; 143-300; Rule 5 of Rules for Mediated Settlement Conferences and Other Settlement Procedures in Superior Court Civil Actions
  • Eff. January 16, 1996
  • Amended Eff. October 1, 1998
  • Recodified from 04 NCAC 10A .0616
  • Amended Eff. July 1, 2014; June 1, 2000
  • Recodified from 04 NCAC 10G .0105 Eff. June 1, 2018.
11 NCAC 23G .0106 Authority and Duties of Mediators {#sec-11-ncac-23g-.0106 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23G .0106}

(a) Control of Conference. The mediator shall at all times be in control of the mediated settlement conference and the procedures to be followed. Except as otherwise set forth in the Rules in this Subchapter with regard to the finalization of the parties' agreement, there shall be no audio, video, electronic or stenographic recording of the mediation process by any participant.

(b) Private Consultation. The mediator may meet and consult privately with any participant prior to or during the conference. The fact that private communications have occurred with a participant shall be disclosed to all other participants at the beginning of the conference.

(c) Scheduling the Conference. The mediator shall make a good faith effort to schedule the conference at a time that is convenient with the parties, attorneys and mediator. In the absence of agreement, the mediator shall select the date for the conference.

(d) Information to the Parties. The mediator shall define and describe the following to the parties at the beginning of the mediated settlement conference:

(1) the process of mediation;

(2) the differences between mediation and other forms of conflict resolution;

(3) the costs of the conference;

(4) the facts that the conference is not a trial or hearing, the mediator is not acting in the capacity of a Commissioner or Deputy Commissioner and shall not act in such capacity in the subject case at any time in the future, and the parties retain their right to a hearing if the parties do not reach a settlement;

(5) the circumstances under which the mediator may meet alone with any of the parties or with any other person;

(6) whether and under what conditions, communications with the mediator will be held in confidence during the conference;

(7) the inadmissibility of conduct and statements as provided by G.S. 8C-1, Rule 408 and Paragraph (f) of Rule. 0103 of this Subchapter;

(8) the duties and responsibilities of the mediator and the parties; and

(9) the fact that any agreement reached will be reached by mutual consent of the parties.

(e) Disclosure. The mediator shall be impartial and advise all parties of any circumstances bearing on possible bias, prejudice or partiality.

(f) Declaring Impasse. The mediator shall determine when mediation is not viable, that an impasse exists, or that mediation should end.

(g) Reporting Results of Conference. In all cases within the Commission's jurisdiction, whether mediated voluntarily or pursuant to an order of the Commission, the mediator shall report the results of the mediated settlement conference on a form provided by the Commission. If an agreement was reached, the report shall state whether the issue or matter under mediation will be resolved by Commission form agreement, compromise settlement agreement, other settlement agreement, voluntary dismissal or removal from the hearing docket, and shall identify the persons designated to file or submit for approval the agreement, or dismissal. The mediator shall not attach a copy of the parties' memorandum of agreement to the mediator's report transmitted to the Commission and, except as permitted under the Rules in this Subchapter, or unless deemed necessary in the interests of justice by the Commission, the mediator shall not disclose the terms of settlement in the mediator's report. The Commission shall require the mediator to provide statistical data for evaluation of the mediated settlement conference program on forms provided by the Commission.

(h) Scheduling and Holding the Conference. The mediator shall schedule the mediated settlement conference in consultation with the parties and conduct the conference prior to the completion deadline set out in the Commission's order. Deadlines for completion of the conference shall be observed by the mediator unless the time limits are changed by the Commission.

(i) Standards of Conduct. All mediators conducting mediated settlement conferences pursuant to the Rules in this Subchapter shall adhere to the Standards of Professional Conduct for Mediators adopted by the Supreme Court of North Carolina and enforced by the North Carolina Dispute Resolution Commission. The Standards of Professional Conduct for Mediators is hereby incorporated by reference and includes subsequent amendments and editions. A copy may be obtained at no charge from the North Carolina Administrative Office of the Court's website, https://www.nccourts.gov/courts/supreme-court/court-rules/standards-of-professional-conduct-for-mediators, or upon request, at the offices of the Commission, located in the Dobbs Building, 430 North Salisbury Street, Raleigh, North Carolina, between the hours of 8:00 a.m. and 5:00 p.m.

History

  • Authority G.S. 97-80(a),(c); 143-296; 143-300; Rule 6 of Rules for Mediated Settlement Conferences and Other Settlement Procedures in Superior Court Civil Actions
  • Eff. January 16, 1996
  • Amended Eff. October 1, 1998
  • Recodified from 04 NCAC 10A .0616
  • Amended Eff. July 1, 2014; June 1, 2000
  • Eff. January 16, 1996
  • Amended Eff. October 1, 1998
  • Recodified from 04 NCAC 10A .0616
  • Amended Eff. July 1, 2014; June 1, 2000
  • Recodified from 04 NCAC 10G .0106 Eff. June 1, 2018
  • Amended Eff. October 1, 2024.
11 NCAC 23G .0107 Compensation of the Mediator {#sec-11-ncac-23g-.0107 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23G .0107}

(a) By Agreement. When the mediator is stipulated to by the parties, compensation shall be as agreed upon between the parties and the mediator.

(b) By Commission Order. When the mediator is appointed by the Commission, the mediator's compensation shall be as follows:

(1) Conference Fees. The mediator shall be paid by the parties at the rate of one hundred fifty dollars ($150.00) per hour for mediation services provided at the mediated settlement conference.

(2) Administrative Fees. The parties shall pay to the mediator a one time, per case administrative fee of one hundred fifty dollars ($150.00). The mediator's administrative fee shall be paid in full unless, within 10 days after the mediator has been appointed, written notice is given to the mediator and to the Dispute Resolution Coordinator that the issues for which a request for hearing was filed have been fully resolved or that the hearing request has been withdrawn.

(3) Postponement Fees. As used in this Subchapter, the term "postpone" means to reschedule or otherwise not proceed with a scheduled mediated settlement conference after the conference has been scheduled to convene on a specific date. After a conference is scheduled to convene on a specific date, the conference may not be postponed unless the requesting party notifies all other parties of the grounds for the requested postponement and obtains the consent and approval of the mediator or the Dispute Resolution Coordinator. If the conference is postponed without good cause, the mediator shall be paid a postponement fee. The postponement fee shall be three hundred dollars ($300.00) if the conference is postponed within seven calendar days of the scheduled date, and one hundred fifty dollars ($150.00) if the conference is postponed more than seven calendar days prior to the scheduled date. Unless otherwise ordered by the Commission in the interests of justice, postponement fees shall be allocated in equal shares to the party or parties requesting the postponement. As used in this Rule, "good cause" shall mean that the reason for the postponement involves a situation over which the party seeking the postponement has no control, including a party or attorney's illness, a death in a party or attorney's family, a demand by a judge that a party or attorney for a party appear in court, or inclement weather such that travel is prohibitive.

(4) The settlement of a case prior to the scheduled date of the mediated settlement conference shall be good cause to cancel the mediation without the approval of the mediator or the Dispute Resolution Coordinator. The parties shall notify the mediator of any cancellation due to settlement. The mediator may charge a cancellation fee of one hundred fifty dollars ($150.00) if notified of the cancellation within 14 days of the scheduled date, or three hundred dollars ($300.00) if notified within seven days of the scheduled date.

(c) Payment by Parties. Payment is due upon completion of the mediated settlement conference; provided, that the State shall be billed at the conference and shall pay within 30 days of receipt of the bill, and insurance companies or carriers whose written procedures do not provide for payment of the mediator at the conference shall pay within 15 days of the conference. Unless otherwise agreed to by the parties or ordered by the Dispute Resolution Coordinator due to a party or parties violating a rule in this Subchapter, the costs of the conference shall be allocated to the parties, as follows:

(1) one share by plaintiff(s);

(2) one share by the workers' compensation defendant-employer or its insurer, or if more than one employer or carrier is involved, or if there is a dispute between employer(s) or carrier(s), one share by each separately represented entity;

(3) one share by participating third-party tort defendants or their carrier, or if there are conflicting interests among them, one share from each defendant or group of defendants having shared interests; and

(4) if applicable, one share by the defendant State agency in a Tort Claims Act case.

Parties obligated to pay a share of the costs are responsible for equal shares; provided, however, that in workers' compensation claims the defendant shall pay the plaintiff's share of mediation, postponement, and substitution fees, as well as defendant's own share. If plaintiff requests postponement of the mediated settlement conference, defendants shall be entitled to a credit for the postponement fee.

(d) Unless the Dispute Resolution Coordinator enters an order allocating such fees to a particular party due to the party violating a Rule in this Subchapter, the fees may be taxed as other costs by the Commission in an Order or Opinion and Award. After the case is concluded, the defendant shall be reimbursed for the plaintiff's share of such fees from any compensation determined to be due to the plaintiff, and the defendant may withhold funds from any award for this purpose.

History

  • Authority G.S. 97-80(a); 97-80(c); 143-296; 143-300; Rule 7 of Rules for Mediated Settlement Conference and Other Settlement Procedures in Superior Court Civil Actions
  • Eff. January 16, 1996
  • Amended Eff. October 1, 1998
  • Recodified from 04 NCAC 10A .0616
  • Amended Eff. July 1, 2014; January 1, 2011; June 1, 2000
  • Recodified from 04 NCAC 10G .0107 Eff. June 1, 2018.
11 NCAC 23G .0108 Mediator Certification and Decertification {#sec-11-ncac-23g-.0108 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23G .0108}

(a) Party Selection. The parties may, by mutual consent, select any North Carolina Dispute Resolution Commission-certified mediator, with or without the qualifications in Paragraph (b) of this Rule, as the parties' mediator.

(b) Appointment of Mediators. If the parties have agreed or been ordered to mediate, and cannot agree on the selection of a mediator, the Commission shall appoint a mediator, who holds current certification from the North Carolina Dispute Resolution Commission that he or she is qualified to carry out mandatory mediations in the Superior Courts of the State of North Carolina and who has filed a declaration with the Commission, on forms provided by the Commission, stating that the declarant agrees to accept and perform mediations of disputes before the Commission with reasonable frequency when called upon for the fees and at the rates of payment specified by the Commission. A mediator making this declaration shall notify the Commission when any of the facts declared are no longer accurate.

(c) Failure of Mediator to Appear at Conference. If a mediator fails to appear at a scheduled mediated settlement conference, the mediator is not entitled to the administrative fee for the case.

History

  • Authority G.S. 97-80(a),(c); 143-296; 143-300; Rule 8 of Rules for Mediated Settlement Conferences and Other Settlement Procedures in Superior Court Civil Actions
  • Eff. January 16, 1996
  • Amended Eff. October 1, 1998
  • Recodified from 04 NCAC 10A .0616
  • Amended Eff. July 1, 2014; January 1, 2011; June 1, 2000
  • Recodified from 04 NCAC 10G .0108 Eff. June 1, 2018.
11 NCAC 23G .0109 Neutral Evaluation {#sec-11-ncac-23g-.0109 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23G .0109}

(a) Nature of Neutral Evaluation. As used in this Subchapter, neutral evaluation is an abbreviated presentation of facts and issues by the parties to a neutral evaluator at an early stage of the case. The neutral evaluator is responsible for evaluating the strengths and weaknesses of the case, and for providing a candid assessment of liability, settlement value, and a dollar value or range of potential awards if the case proceeds to a hearing. The neutral evaluator is also responsible for identifying areas of agreement and disagreement and suggesting necessary and appropriate discovery.

(b) When Conference Is to Be Held. The provisions applicable to the scheduling of mediated settlement conferences set forth in Rule .0103 of this Subchapter also apply to neutral evaluation proceedings.

(c) Pre-conference Submissions. No later than 20 days prior to the date established for the neutral evaluation conference to begin, each party may, but is not required to, furnish the evaluator with written information about the case, and shall at the same time certify to the evaluator that the party has served a copy of such summary on all other parties in the case. The information provided to the neutral evaluator and the other parties under this Rule shall be a summary of the facts and issues in the case, shall not be more than 10 pages in length, and shall include as attachments copies of any documents supporting the party's summary. Information provided to the neutral evaluator and to the other parties pursuant to this Paragraph shall not be filed with the Commission.

(d) Replies to Pre-conference Submissions. No later than five days prior to the date established for the neutral evaluation conference to begin, any party may, but is not required to, send additional written information to the neutral evaluator responding to the submission of an opposing party. The party's response shall not exceed five pages in length, and the party sending the response shall certify to the neutral evaluator that the party has served a copy of the response on all other parties in the case. The response shall not be filed with the Commission.

(e) Conference Procedure. Prior to a neutral evaluation conference, the neutral evaluator may, if he or she deems it necessary, request additional written information from any party. At the conference, the neutral evaluator may address questions to the parties and give the parties an opportunity to complete their summaries with a brief oral statement.

(f) Modification of Procedure. Subject to the approval of the neutral evaluator, the parties may agree to modify the procedures for neutral evaluation required by the Rules in this Subchapter, or the procedures may be modified by order of the Commission in the interests of justice. The modified procedures may include the presentation of submissions in writing or by telephone in lieu of physical appearance at a neutral evaluation conference, and may also include revisions to the time periods and page limitations concerning the parties' submissions.

(g) Evaluator's Opening Statement. At the beginning of the neutral evaluation conference, the neutral evaluator shall define and describe the following points to the parties:

(1) the facts that:

(A) the conference is not a hearing,

(B) the neutral evaluator is not acting in the capacity of a Commissioner or Deputy Commissioner and shall not act in such capacity in the subject case at any time in the future,

(C) the neutral evaluator's opinions are not binding on any party, and

(D) the parties retain their right to a hearing if the parties do not reach a settlement;

(2) the fact that any settlement reached will be only by mutual consent of the parties;

(3) the process of the proceeding;

(4) the differences between the proceeding and other forms of conflict resolution;

(5) the costs of the proceeding;

(6) the inadmissibility of conduct and statements as provided by G.S. 8C-1, Rule 408 and Paragraph (f) of Rule .0103 in this Subchapter; and

(7) the duties and responsibilities of the neutral evaluator and the participants.

(h) Oral Report to Parties by Evaluator. In addition to the written report to the Commission required under the Rules in this Subchapter, at the conclusion of the neutral evaluation conference, the neutral evaluator shall issue an oral report to the parties advising the parties of the neutral evaluator's opinion of the case. The opinion shall include a candid assessment of liability, estimated settlement values and options, and the strengths and weaknesses of the parties' claims and defenses if the case proceeds to a hearing. The oral report shall also contain a suggested settlement or disposition of the case and the reasons therefor. The neutral evaluator shall not reduce his or her oral report to writing and shall not inform the Commission thereof.

(i) Report of Evaluator to Commission. Within 10 days after the completion of the neutral evaluation conference, the neutral evaluator:

(1) shall submit to the Dispute Resolution Coordinator a written report using a form prepared and distributed by the Commission, stating:

(A) when and where the conference was held,

(B) the names of those persons who attended the conference,

(C) whether or not an agreement was reached by the parties, and

(D) whether the issue or matter will be resolved by Commission form agreement, compromise settlement agreement, other settlement agreement, voluntary dismissal or removal from the hearing docket;

(2) shall identify the persons designated to file or submit for approval such agreement, or dismissal; and

(3) shall provide statistical data for evaluation of the settlement conference programs on forms provided by the Commission.

(j) Evaluator's Authority to Assist Negotiations. If all parties at the neutral evaluation conference request and agree, the neutral evaluator may assist the parties in settlement discussions. If the parties do not reach a settlement during the discussions, the neutral evaluator shall complete the neutral evaluation conference and make his or her written report to the Commission as if the settlement discussions had not occurred.

(k) Finalizing Agreement. If the parties are able to reach an agreement before the conclusion of the neutral evaluation conference and before the evaluator provides his report to the Commission, the parties shall reduce the agreement to writing, specifying all the terms of the parties' agreement that bear on the resolution of the dispute before the Commission, and shall sign the agreement along with the parties' respective counsel. By stipulation of the parties and at their expense, the agreement may be electronically or stenographically recorded. All agreements for payment of compensation shall be submitted for Commission approval and shall be filed with the Commission within 20 days of the conclusion of the conference.

(l) Applicability of Mediation Rules and Duties. All provisions and duties applicable to mediated settlement conferences set forth in Rule .0103 through Rule .0107 of this Subchapter, that are not in conflict with the provisions and duties of Rule .0109 of this Subchapter, apply to neutral evaluation conferences conducted under the Rules in this Subchapter.

(m) Ex Parte Communications Prohibited. Unless all parties agree otherwise, there shall be no ex parte communication prior to the conclusion of the proceeding between the neutral evaluator and any counsel or party on any matter related to the proceeding except with regard to administrative matters.

(n) Adherence to Standards of Conduct for Neutrals. All neutral evaluators conducting neutral evaluation conferences pursuant to the Rules in the Subchapter shall adhere to any applicable standards of conduct that are adopted by the North Carolina Dispute Resolution Commission and are hereby incorporated by reference and include subsequent amendments and editions. A copy may be obtained at no charge from The North Carolina Court System's website, http://www.nccourts.org/Courts/CRS/Councils/DRC/Default.asp, or upon request, at the offices of the Commission, located in the Dobbs Building, 430 North Salisbury Street, Raleigh, North Carolina, between the hours of 8:00 a.m. and 5:00 p.m.

History

  • Authority G.S. 97-80(a),(c); 143-296; 143-300; Rule 11 of Rules for Mediated Settlement Conferences and Other Settlement Procedures in Superior Court Civil Actions
  • Eff. January 16, 1996
  • Amended Eff. October 1, 1998
  • Recodified from 04 NCAC 10A .0616
  • Amended Eff. July 1, 2014; January 1, 2011; June 1, 2000
  • Recodified from 04 NCAC 10G .0109 Eff. June 1, 2018.
11 NCAC 23G .0110 Waiver of Rules {#sec-11-ncac-23g-.0110 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23G .0110}

In the interests of justice or to promote judicial economy, the Commission may, except as otherwise provided by the rules in this Subchapter, waive or vary the requirements or provisions of any of the rules in this Subchapter in a case pending before the Commission upon written application of a party or upon its own initiative only if the employee is not represented by counsel. Factors the Commission shall use in determining whether to grant the waiver are:

(1) the necessity of a waiver;

(2) the party's responsibility for the conditions creating the need for a waiver;

(3) the party's prior requests for a waiver;

(4) the precedential value of such a waiver;

(5) notice to and opposition by the opposing parties; and

(6) the harm to the party if the waiver is not granted.

History

  • Authority G.S. 97-80(a); 97-80(c); 143-296; 143-300
  • Eff. January 16, 1996
  • Amended Eff. October 1, 1998
  • Recodified from 04 NCAC 10A .0616
  • Amended Eff. July 1, 2014; June 1, 2000
  • Recodified from 04 NCAC 10G .0110 Eff. June 1, 2018.
11 NCAC 23G .0111 Motions {#sec-11-ncac-23g-.0111 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23G .0111}

Unless otherwise indicated by the Rules in this Subchapter or an applicable order by the Commission in the interests of justice or judicial economy, motions pursuant to the Rules in this Subchapter shall be addressed to the Commission's Dispute Resolution Coordinator and served on all parties to the claim and the settlement procedure. Responses may be filed with the Commission within 10 days after the date of receipt of the motion. Notwithstanding the above, the Commission may, in the interests of justice, act upon oral motions, or act upon motions prior to the expiration of the 10-day response period. Motions shall be decided without oral argument unless otherwise ordered in the interests of justice. Any appeals from orders issued pursuant to a motion under the Rules in this Subchapter shall be addressed to the attention of the Commission Chair or the Chair's designee for appropriate action.

History

  • Authority G.S. 97-80(a),(c); 143-296; 143-300
  • Eff. January 16, 1996
  • Amended Eff. October 1, 1998
  • Recodified from 04 NCAC 10A .0616
  • Amended Eff. July 1, 2014; January 1, 2011; June 1, 2000
  • Recodified from 04 NCAC 10G .0111 Eff. June 1, 2018.
11 NCAC 23G .0112 Miscellaneous {#sec-11-ncac-23g-.0112 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23G .0112}

Throughout the Rules in this Subchapter any reference to the number of days within which any act may be performed shall mean and refer to calendar days, and shall include Saturdays, Sundays and holidays established by the State Personnel Commission. Provided, however, that if the last day (a) to file a motion, (b) to give notice of the selection of a mediator, or (c) for a pro se plaintiff to give notice that the plaintiff requests mediation is a Saturday, Sunday or holiday established by the State Personnel Commission, the motion or notice may be filed or given on the next day that is not a Saturday, Sunday or holiday established by the State Personnel Commission.

History

  • Authority G.S. 97-80(a),(c); 143-296; 143-300
  • Eff. January 16, 1996
  • Amended Eff. October 1, 1998
  • Recodified from 04 NCAC 10A .0616
  • Amended Eff. July 1, 2014; June 1, 2000
  • Recodified from 04 NCAC 10G .0112 Eff. June 1, 2018.

Subchapter H

11 NCAC 23H .0101 Location of Offices and Hours of Business {#sec-11-ncac-23h-.0101 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23H .0101}

For purposes of this Subsection, the offices of the North Carolina Industrial Commission are located in the Dobbs Building, 430 North Salisbury Street, Raleigh, North Carolina. Documents that are not being filed electronically may be filed between the hours of 8:00 a.m. and 5:00 p.m. only. Documents permitted to be filed electronically may be filed until 11:59 p.m. on the required filing date.

History

  • Authority G.S. 143-166.4
  • Eff. November 1, 1977
  • Amended Eff. July 1, 2014
  • Recodified from 04 NCAC 10H .0101 Eff. June 1, 2018.
11 NCAC 23H .0201 Determination of Claims by the Commission {#sec-11-ncac-23h-.0201 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23H .0201}

(a) Upon application for an award under the provisions of the Public Safety Employees' Death Benefits Act, the Commission shall determine whether sufficient evidence is contained in the Commission's workers' compensation or other files upon which to base an order for the payment of benefits. If the Commission is satisfied that such an order should be issued, it shall, without conducting a hearing, file an award directing the payment of benefits.

(b) If the Commission is of the opinion that the Commission's workers' compensation or other files have insufficient evidence upon which to base an award for the payment of benefits, the Commission shall place the case upon the Commission's hearing docket. The Commission shall set a contested case for hearing in a location deemed convenient to witnesses and the Commission.

History

  • Authority G.S. 143-166.4
  • Eff. August 1, 1979
  • Amended Eff. July 1, 2014
  • Recodified from 04 NCAC 10H .0201 Eff. June 1, 2018
  • Amended Eff. January 1, 2019.
11 NCAC 23H .0202 Hearings Before the Commission {#sec-11-ncac-23h-.0202 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23H .0202}

(a) The Commissioner or Deputy Commissioner before whom a case regarding the Public Safety Employees' Death Benefits Act is set for hearing, shall order the parties to participate in a pre-trial conference. This conference shall be conducted at such place and by such method as the Commissioner or Deputy Commissioner deems appropriate in consideration of the interests of justice and judicial economy, including conference telephone calls.

(b) The Commission shall give notice of hearing in every case. Postponement or continuance of a scheduled hearing shall be granted in the interests of justice or to promote judicial economy.

(c) Notice of the hearing shall be given to the Attorney General of the State of North Carolina, who may appear as amicus curiae.

History

  • Authority G.S. 143-166.4
  • Eff. August 1, 1979
  • Amended Eff. July 1, 2014
  • Recodified from 04 NCAC 10H .0202 Eff. June 1, 2018
  • Amended Eff. January 1, 2019.
11 NCAC 23H .0203 Appointment of Guardian Ad Litem {#sec-11-ncac-23h-.0203 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23H .0203}

(a) Infants or incompetents may bring an action under this Subchapter only through their guardian ad litem. The Commission shall appoint a person as guardian ad litem if the Commission determines it to be in the best interest of the infant or incompetent. The Commission shall appoint a guardian ad litem only after due inquiry as to the fitness of the person to be appointed.

(b) No compensation due or owed to the infant or incompetent shall be paid directly to the guardian ad litem.

(c) The Commission may assess a fee to be paid to an attorney who serves as a guardian ad litem for actual services rendered upon receipt of an affidavit of actual time spent in representation of the infant or incompetent.

History

  • Authority G.S. 143-166.4
  • Eff. August 1, 1979
  • Amended Eff. July 1, 2014
  • Recodified from 04 NCAC 10H .0203 Eff. June 1, 2018.
11 NCAC 23H .0204 Written or Recorded Statement {#sec-11-ncac-23h-.0204 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23H .0204}

(a) Upon the request of the employer or his agent to take a written or a recorded statement in an action pursuant to Article 12A of Chapter 143 of the General Statutes, the employer or his agent shall advise any person eligible for payments that the statement may be used to determine whether the claim will be paid or denied. Any person eligible for payments who gives the employer, its carrier, or any agent either a written or recorded statement of the facts and circumstances surrounding the decedent's injury shall be furnished a copy of such statement within 45 days after request. Any person eligible for payments shall immediately be furnished with a copy of the written or recorded statement following a denial of the claim. A copy shall be furnished at the expense of the party to whom the statement was given.

(b) If any party fails to comply with this Rule, a Commissioner or Deputy Commissioner shall enter an order prohibiting that party from introducing the statement into evidence or using any part of the statement.

History

  • Authority G.S. 143-166.4
  • Eff. August 1, 1979
  • Amended Eff. July 1, 2014
  • Recodified from 04 NCAC 10H .0204 Eff. June 1, 2018.
11 NCAC 23H .0205 Review by the Full Commission {#sec-11-ncac-23h-.0205 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23H .0205}

(a) A party may request a review of an award filed by a Deputy Commissioner in an action pursuant to Article 12A of Chapter 143 of the General Statutes by filing a letter expressing a request for review to the Full Commission within 15 days of receipt of the award. The award is binding on the parties if not appealed.

(b) After receipt of notice of review, the Commission shall supply to the appellant and to the appellee a transcript of the record upon which the award is based and from which a review is being taken to the Full Commission. The appellant shall, within ten days of receipt of transcript of the record, file with the Commission a written statement of the particular grounds for the appeal, with service on all opposing parties.

(c) Grounds for review not set forth are deemed to be abandoned and argument thereon shall not be heard before the Full Commission.

(d) When a review is made to the Full Commission, the appellant's brief, if any, in support of his ground for appeal shall be filed with the Commission, with service on all opposing parties no less than 15 days prior to the hearing on review. The appellee shall have five days in which to file a reply brief, if deemed necessary, with the Commission, with service on all opposing parties.

(e) Any motions by either party shall be filed with the Full Commission, with service on all opposing parties.

(f) Upon the request of a party, or its own motion, the Commission may waive oral arguments in the interests of justice or to promote judicial economy. In the event of such waiver, the Full Commission shall file an award based on the record and briefs.

History

  • Authority G.S. 143-166.4
  • Eff. August 1, 1979
  • Amended Eff. July 1, 2014
  • Recodified from 04 NCAC 10H .0205 Eff. June 1, 2018.
11 NCAC 23H .0206 WaIVER of Rules {#sec-11-ncac-23h-.0206 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23H .0206}

In the interests of justice or to promote judicial economy the Commission may, except as otherwise provided by the rules in this Subchapter, waive or vary the requirements or provisions of any of the rules in this Subchapter in a case pending before the Commission upon written application of a party or upon its own initiative only if the employee is not represented by counsel. Factors the Commission shall use in determining whether to grant the waiver are:

(1) the necessity of a waiver;

(2) the party's responsibility for the conditions creating the need for a waiver;

(3) the party's prior requests for a waiver;

(4) the precedential value of such a waiver;

(5) notice to and opposition by the opposing parties; and

(6) the harm to the party if the waiver is not granted.

History

  • Authority G.S. 97-80(a); 143-166.4
  • Eff. July 1, 2014
  • Recodified from 04 NCAC 10H .0206 Eff. June 1, 2018.

Subchapter I

11 NCAC 23I .0101 Locations of Offices and Hours of BUSINESS {#sec-11-ncac-23i-.0101 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23I .0101}

For purposes of this Subsection, the offices of the North Carolina Industrial Commission are located in the Dobbs Building, 430 North Salisbury Street, Raleigh, North Carolina. Documents pertaining to the Childhood Vaccine-Related Injury claims that are not being filed electronically may be filed between the hours of 8:00 a.m. and 5:00 p.m. only. Documents permitted to be filed electronically may be filed until 11:59 p.m. on the required filing date.

History

  • Authority G.S. 130A-424; 130A-425(d)
  • Eff. January 20, 1995
  • Amended Eff. July 1, 2014
  • Recodified from 04 NCAC 10I .0101 Eff. June 1, 2018.
11 NCAC 23I .0102 Official Forms {#sec-11-ncac-23i-.0102 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23I .0102}

The use of any printed forms related to Childhood Vaccine-Related Injury claims, other than those provided by the Commission is prohibited, except that insurance carriers, self-insurers, attorneys and other parties may reproduce forms for their own use, provided:

(1) no statement, question, or information blank contained on the Commission form is omitted from the substituted form; and

(2) the substituted form is identical in size and format with the Commission form.

History

  • Authority G.S. 130A-424; 130A-425(d)
  • Eff. January 20, 1995
  • Amended Eff. July 1, 2014
  • Recodified from 04 NCAC 10I .0102 Eff. June 1, 2018.
11 NCAC 23I .0201 Procedure {#sec-11-ncac-23i-.0201 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23I .0201}

When a claim is filed in accordance with G.S. 130A-425(b), the respondent shall determine and report its position to the claimant and the Commission on the issues listed in G.S. 130A-426(a) within 90 days. If the respondent agrees that the claimant has established damages which entitle claimant to money compensation meeting or exceeding the maximum amount set forth in G.S. 130A-427(b), the Commission shall so notify the claimant and respondent, and further notify them of the services the Department of Human Resources proposes to provide pursuant to G.S. 130A-427(a)(5). The Commission shall allow the parties an opportunity to settle the matter before proceeding to hearing.

History

  • Authority G.S. 130A-423; 130A-424; 130A-425; 130A-427
  • Eff. January 20, 1995
  • Amended Eff. July 1, 2014
  • Recodified from 04 NCAC 10I .0201 Eff. June 1, 2018.
11 NCAC 23I .0202 Attorneys' Fees {#sec-11-ncac-23i-.0202 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23I .0202}

An attorney seeking fees pursuant to G.S. 130A-427(a)(4) shall submit to the Commission a copy of the fee agreement, a request for payment of fee, and an affidavit or itemized statement in support of an award of attorneys' fees.

History

  • Authority G.S. 130A-425(d); 130A-427(a)(4)
  • Eff. January 20, 1995
  • Amended Eff. July 1, 2014
  • Recodified from 04 NCAC 10I .0202 Eff. June 1, 2018.
11 NCAC 23I .0203 WAIVER of Rules {#sec-11-ncac-23i-.0203 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23I .0203}

In the interests of justice or to promote judicial economy the Commission may, except as otherwise provided by the rules in this Subchapter, waive or vary the requirements or provisions of any of the rules in this Subchapter in a case pending before the Commission upon written application of a party or upon its own initiative only if the employee is not represented by counsel. Factors the Commission shall use in determining whether to grant the waiver are:

(1) the necessity of a waiver;

(2) the party's responsibility for the conditions creating the need for a waiver;

(3) the party's prior requests for a waiver;

(4) the precedential value of such a waiver;

(5) notice to and opposition by the opposing parties; and

(6) the harm to the party if the waiver is not granted.

History

  • Authority G.S. 97-80(a); 130A-425(d)
  • Eff. July 1, 2014
  • Recodified from 04 NCAC 10I .0203 Eff. June 1, 2018.
11 NCAC 23I .0204 Sanctions {#sec-11-ncac-23i-.0204 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23I .0204}

(a) The Commission may, on its own initiative or motion of a party, impose a sanction against a party or attorney or both when the Commission determines that such party, or attorney, or both failed to comply with the Rules in this Subchapter. The Commission may impose sanctions of the type and in the manner prescribed by Rule 37 of the North Carolina Rules of Civil Procedure.

(b) Failure to timely file forms as required by either the Rules in this Subchapter or pursuant to the Childhood Vaccine-Related Injury Compensation Program may result in sanctions.

History

  • Authority G.S. 130A-425(d)
  • Eff. July 1, 2014
  • Recodified from 04 NCAC 10I .0204 Eff. June 1, 2018.

Subchapter J

11 NCAC 23J .0101 General Provisions {#sec-11-ncac-23j-.0101 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23J .0101}

(a) Pursuant to G.S. 97-26, the Commission adopts a Medical Fee Schedule composed of maximum amounts, reimbursement rates, and payment guidelines, as set out in the rules of this Subchapter. The amounts and reimbursement rates prescribed in the applicable published Medical Fee Schedule shall govern and apply according to G.S. 97-26(c).

(b) The Medical Fee Schedule is available on the Commission's website at http://www.ic.nc.gov/ncic/pages/feesched.asp and in hardcopy at the offices of the Commission as set forth in 11 NCAC 23A .0101.

(c) Insurers and managed care organizations, or administrators on their behalf, may review and reimburse charges for all medical compensation, including medical, hospital, and dental fees, without submitting the charges to the Commission for review and approval.

(d) A provider of medical compensation shall submit its bill for services within 75 days of the rendition of the service, or if treatment is longer, within 30 days after the end of the month during which multiple treatments were provided. However, in cases where liability is initially denied but subsequently admitted or determined by the Commission, the time for submission of medical bills shall run from the time the health care provider received notice of the admission or determination of liability. Within 30 days of receipt of the bill, the employer, carrier, or managed care organization or administrator on its behalf, shall pay the bill or send the provider written objections to the bill. If an employer, carrier, administrator, or managed care organization disputes a portion of the provider's bill, the employer, carrier, administrator, or managed care organization, shall pay the uncontested portion of the bill and shall resolve disputes regarding the balance of the charges through its contractual arrangement or through the Commission.

(e) When the 10 percent addition to the bill pursuant to G.S. 97-18(i) is uncontested, payment shall be made to the provider without notifying or seeking approval from the Commission. When the 10 percent addition to the bill is contested, any party may request a hearing by the Commission pursuant to G.S. 97-83 and G.S. 97-84.

(f) When the responsible party seeks an audit of hospital charges, and has paid the hospital charges in full, the payee hospital, upon request, shall provide access to and copies of appropriate records, without charge or fee, to the person(s) chosen by the payor to review and audit the records.

(g) The responsible employer, carrier, managed care organization, or administrator shall pay the bills of medical compensation providers to whom the employee has been referred by the treating physician authorized by the insurance carrier for the compensable injury or body part, unless it has requested that the physician obtain authorization for referrals or tests. Compliance with the request shall not unreasonably delay the treatment or service to be rendered to the employee.

(h) Employees are entitled to reimbursement for travel expenses when the travel is medically necessary and the mileage is 20 or more miles, round trip, at the business standard mileage rate set by the Internal Revenue Service per mile of travel and the actual cost of any tolls paid. Employees are entitled to lodging and meal expenses, at the rate established for state employees by the North Carolina Director of Budget, when it is medically necessary that the employee stay overnight at a location away from the employee's usual place of residence. Employees are entitled to reimbursement for the costs of parking or a vehicle for hire, when the costs are medically necessary, at the actual costs of the expenses. The current reimbursement rates referenced in this Paragraph are contained in the Form 25T, Itemized Statement of Charges for Travel, which shall be used to claim travel expenses.

(i) Any employer, carrier, or administrator denying a claim in which medical care has previously been authorized is responsible for all costs incurred prior to the date that notice of denial is provided to each health care provider to whom authorization has been previously given.

History

  • Authority G.S. 97-18(i); 97-25; 97-25.6; 97-26; 97-80(a); 138-6; S.L. 2013-410
  • Eff. January 1, 1990
  • Amended Eff. April 1, 2015; July 1, 2014; January 1, 2013; June 1, 2000
  • Recodified from 04 NCAC 10J .0101 Eff. June 1, 2018.
11 NCAC 23J .0102 Fees for Professional Services {#sec-11-ncac-23j-.0102 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23J .0102}

(a) Except as otherwise provided in this Rule, maximum allowable amounts payable to health care providers for professional services shall be based on the current year's Medicare Part B Fee Schedule for North Carolina ("the Medicare base amount"), as published by the Centers for Medicare & Medicaid Services ("CMS") or its administrative contractor, including subsequent versions and editions. The Medicare Part B Fee Schedule for North Carolina can be found at http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/index.html.

(b) The schedule of maximum reimbursement rates for professional services is as follows:

(1) evaluation & management services are 140 percent of the Medicare base amount;

(2) physical medicine services are 140 percent of the Medicare base amount;

(3) emergency medicine services are 169 percent of the Medicare base amount;

(4) neurology services are 153 percent of the Medicare base amount;

(5) pain management services are 163 percent of the Medicare base amount;

(6) radiology services are 195 percent of the Medicare base amount;

(7) major surgery services are 195 percent of the Medicare base amount; and

(8) all other professional services are 150 percent of the Medicare base amount.

(c) The schedule of maximum reimbursement rates for anesthesia services is as follows:

(1) when provided by an anesthesiologist, the allowable amount is three dollars and eighty-eight cents ($3.88) per minute up to and including 60 minutes, and two dollars and five cents ($2.05) per minute beyond 60 minutes; and

(2) when provided by a certified registered nurse anesthetist, the allowable amount is two dollars and fifty-five cents ($2.55) per minute up to and including 60 minutes, and one dollar and fifty-five cents ($1.55) per minute beyond 60 minutes.

(d) The maximum allowable amount for an assistant at surgery is 20 percent of the amount payable for the surgical procedure.

(e) Using the Medicare base amounts and maximum reimbursement rates in Paragraphs (a) through (d) of this Rule the Commission shall publish annually an official Professional Fee Schedule Table listing allowable amounts for individual professional services in accordance with this fee schedule. The allowable amounts contained in the Professional Fee Schedule Table shall take effect January 1 of each year. The Professional Fee Schedule Table is available as set forth in Rule .0101(b) of this Section and in hardcopy at the offices of the Commission as set forth in Rule 11 NCAC 23A .0101.

(f) Maximum allowable amounts for durable medical equipment and supplies ("DME") provided in the context of professional services are 100 percent of those rates established for North Carolina in the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies ("DMEPOS") Fee Schedule published by CMS. The DMEPOS can be found at http://cms.gov/Medicare/Medicare-Fee-for-Service-Payment/DMEPOSFeeSched/DMEPOS-Fee-Schedule.html. The Commission will publish annually on its website an official DME Fee Schedule Table listing allowable amounts for individual items and services in accordance with this fee schedule. The allowable amounts contained in the DME Fee Schedule Table will take effect January 1 of each year. The DME Fee Schedule Table is available as set forth in Rule .0101(b) of this Section and in hardcopy at the offices of the Commission as set forth in Rule 11 NCAC 23A .0101.

(g) Maximum allowable amounts for clinical laboratory services are 150 percent of those rates established for North Carolina in the Clinical Diagnostic Laboratory Fee Schedule published by CMS. The CMS Clinical Laboratory Fee Schedule can be found at http://cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ClinicalLabFeeSched/clinlab.html. The Commission will publish annually on its website an official Clinical Laboratory Fee Schedule Table listing allowable amounts for individual items and services in accordance with this fee schedule. The allowable amounts contained in the Clinical Laboratory Fee Schedule Table will take effect January 1 of each year. The Clinical Laboratory Fee Schedule Table is available as set forth in Rule .0101(b) of this Section and in hardcopy at the offices of the Commission as set forth in Rule 11 NCAC 23A .0101.

(h) The following licensed health care providers may provide professional services in workers' compensation cases subject to physician supervision and other scope of practice requirements and limitations under North Carolina law:

(1) certified registered nurse anesthetists;

(2) anesthesiologist assistants;

(3) nurse practitioners;

(4) physician assistants;

(5) certified nurse midwives; and

(6) clinical nurse specialists.

Services rendered by these providers are subject to the schedule of maximum fees for professional services as provided in this Rule.

History

  • Authority G.S. 97-25; 97-26; 97-80(a); S.L. 2013-410
  • Eff. April 1, 2015
  • Amended Eff. July 1, 2015
  • Recodified from 04 NCAC 10J .0102 Eff. June 1, 2018.
11 NCAC 23J .0103 Fees for INSTITUTIONAL SERVICES [Effective April 1, 2015] {#sec-11-ncac-23j-.0103 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23J .0103}

(a) Except where otherwise provided, maximum allowable amounts for inpatient and outpatient institutional services shall be based on the current federal fiscal year's facility-specific Medicare rate established for each institutional facility by the Centers for Medicare & Medicaid Services ("CMS"). "Facility-specific" rate means the all-inclusive amount eligible for payment by Medicare for a claim, excluding pass-through payments.

(b) The schedule of maximum reimbursement rates for hospital inpatient institutional services is as follows:

(1) Beginning April 1, 2015, 190 percent of the hospital's Medicare facility-specific amount.

(2) Beginning January 1, 2016, 180 percent of the hospital's Medicare facility-specific amount.

(3) Beginning January 1, 2017, 160 percent of the hospital's Medicare facility-specific amount.

(c) The schedule of maximum reimbursement rates for hospital outpatient institutional services is as follows:

(1) Beginning April 1, 2015, 220 percent of the hospital's Medicare facility-specific amount.

(2) Beginning January 1, 2016, 210 percent of the hospital's Medicare facility-specific amount.

(3) Beginning January 1, 2017, 200 percent of the hospital's Medicare facility-specific amount.

(d) Notwithstanding the Paragraphs (a) through (c) of this Rule, maximum allowable amounts for institutional services provided by critical access hospitals ("CAH"), as certified by CMS, are based on the Medicare inpatient per diem rates and outpatient claims payment amounts allowed by CMS for each CAH facility.

(e) The schedule of maximum reimbursement rates for inpatient institutional services provided by CAHs is as follows:

(1) Beginning April 1, 2015, 200 percent of the hospital's Medicare CAH per diem amount.

(2) Beginning January 1, 2016, 190 percent of the hospital's Medicare CAH per diem amount.

(3) Beginning January 1, 2017, 170 percent of the hospital's Medicare CAH per diem amount.

(f) The schedule of maximum reimbursement rates for outpatient institutional services provided by CAHs is as follows:

(1) Beginning April 1, 2015, 230 percent of the hospital's Medicare CAH claims payment amount.

(2) Beginning January 1, 2016, 220 percent of the hospital's Medicare CAH claims payment amount.

(3) Beginning January 1, 2017, 210 percent of the hospital's Medicare CAH claims payment amount.

(g) Notwithstanding Paragraphs (a) through (f) of this Rule, the maximum allowable amounts for institutional services provided by ambulatory surgical centers ("ASC") shall be based on the Medicare ASC reimbursement amount determined by applying the most recently adopted and effective Medicare Payment System Policies for Services Furnished in Ambulatory Surgical Centers and Outpatient Prospective Payment System reimbursement formula and factors as published annually in the Federal Register ("the Medicare ASC facility-specific amount"). Reimbursement shall be based on the fully implemented payment amount in Addendum AA, Final ASC Covered Surgical Procedures for CY 2015, and Addendum BB, Final ASC Covered Ancillary Services Integral to Covered Surgical Procedures for 2015, as published in the Federal Register, or their successors.

(h) The schedule of maximum reimbursement rates for institutional services provided by ambulatory surgical centers is as follows:

(1) Beginning April 1, 2015, 220 percent of the Medicare ASC facility-specific amount.

(2) Beginning January 1, 2016, 210 percent of the Medicare ASC facility-specific amount.

(3) Beginning January 1, 2017, 200 percent of the Medicare ASC facility-specific amount.

(i) If the facility-specific Medicare payment includes an outlier payment, the sum of the facility-specific reimbursement amount and the applicable outlier payment amount shall be multiplied by the applicable percentages set out in Paragraphs (b), (c), (e), (f), and (h) of this Rule.

(j) Charges for professional services provided at an institutional facility shall be paid pursuant to the applicable fee schedules in Rule .0102 of this Section.

(k) If the billed charges are less than the maximum allowable amount for a Diagnostic Related Grouping ("DRG") payment pursuant to the fee schedule provisions of this Rule, the insurer or managed care organization shall pay no more than the billed charges.

(l) For specialty facilities paid outside Medicare's inpatient and outpatient Prospective Payment System, the payment shall be determined using Medicare's payment methodology for those specialized facilities multiplied by the inpatient institutional acute care percentages set out in Paragraphs (b) and (c) of this Rule.

History

  • Authority G.S. 97-25; 97-26; 97-80(a); S.L. 2013-410
  • Eff. April 1, 2015
  • Recodified from 04 NCAC 10J .0103 Eff. June 1, 2018.
11 NCAC 23J .0103 FEES FOR INSTITUTIONAL SERVICES [EffEctive June 1, 2018]] {#sec-11-ncac-23j-.0103 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23J .0103}

(a) Except where otherwise provided, maximum allowable amounts for inpatient and outpatient institutional services shall be based on the current federal fiscal year's facility-specific Medicare rate established for each institutional facility by the Centers for Medicare & Medicaid Services ("CMS"). "Facility-specific" rate means the all-inclusive amount eligible for payment by Medicare for a claim, excluding pass-through payments. An institutional facility may only be reimbursed for hospital outpatient institutional services pursuant to this Paragraph and Paragraphs (c), (d), and (f) of this Rule if it qualifies for payment by CMS as an outpatient hospital.

(b) The schedule of maximum reimbursement rates for hospital inpatient institutional services is as follows:

(1) Beginning April 1, 2015, 190 percent of the hospital's Medicare facility-specific amount.

(2) Beginning January 1, 2016, 180 percent of the hospital's Medicare facility-specific amount.

(3) Beginning January 1, 2017, 160 percent of the hospital's Medicare facility-specific amount.

(c) The schedule of maximum reimbursement rates for hospital outpatient institutional services is as follows:

(1) Beginning April 1, 2015, 220 percent of the hospital's Medicare facility-specific amount.

(2) Beginning January 1, 2016, 210 percent of the hospital's Medicare facility-specific amount.

(3) Beginning January 1, 2017, 200 percent of the hospital's Medicare facility-specific amount.

(d) Notwithstanding the Paragraphs (a) through (c) of this Rule, maximum allowable amounts for institutional services provided by critical access hospitals ("CAH"), as certified by CMS, are based on the Medicare inpatient per diem rates and outpatient claims payment amounts allowed by CMS for each CAH facility.

(e) The schedule of maximum reimbursement rates for inpatient institutional services provided by CAHs is as follows:

(1) Beginning April 1, 2015, 200 percent of the hospital's Medicare CAH per diem amount.

(2) Beginning January 1, 2016, 190 percent of the hospital's Medicare CAH per diem amount.

(3) Beginning January 1, 2017, 170 percent of the hospital's Medicare CAH per diem amount.

(f) The schedule of maximum reimbursement rates for outpatient institutional services provided by CAHs is as follows:

(1) Beginning April 1, 2015, 230 percent of the hospital's Medicare CAH claims payment amount.

(2) Beginning January 1, 2016, 220 percent of the hospital's Medicare CAH claims payment amount.

(3) Beginning January 1, 2017, 210 percent of the hospital's Medicare CAH claims payment amount.

(g) Notwithstanding Paragraphs (a) through (f) of this Rule, the maximum allowable amounts for institutional services provided by ambulatory surgical centers ("ASC") shall be based on the most recently adopted and effective Medicare Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems reimbursement formula and factors, including all Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems Addenda, as published annually in the Federal Register and on the CMS website at https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/index.html ("the OPPS/ASC Medicare rule"). An ASC's specific Medicare wage index value as set out in the OPPS/ASC Medicare rule shall be applied in the calculation of the maximum allowable amount for any institutional service it provides.

(h) The schedule of maximum reimbursement rates for institutional services provided by ambulatory surgical centers is as follows:

(1) A maximum reimbursement rate of 200 percent shall apply to institutional services that are eligible for payment by CMS when performed at an ASC.

(2) A maximum reimbursement rate of 135 percent shall apply to institutional services performed at an ASC that are eligible for payment by CMS if performed at an outpatient hospital facility, but would not be eligible for payment by CMS if performed at an ASC.

(i) If the facility-specific Medicare payment includes an outlier payment, the sum of the facility-specific reimbursement amount and the applicable outlier payment amount shall be multiplied by the applicable percentages set out in Paragraphs (b), (c), (e), (f), and (h) of this Rule.

(j) Charges for professional services provided at an institutional facility shall be paid pursuant to the applicable fee schedules in Rule .0102 of this Section.

(k) If the billed charges are less than the maximum allowable amount for a Diagnostic Related Grouping ("DRG") payment pursuant to the fee schedule provisions of this Rule, the insurer or managed care organization shall pay no more than the billed charges.

(l) For specialty facilities paid outside Medicare's inpatient and outpatient Prospective Payment System, the payment shall be determined using Medicare's payment methodology for those specialized facilities multiplied by the inpatient institutional acute care percentages set out in Paragraphs (b) and (c) of this Rule.

History

  • Authority G.S. 97-25; 97-26; 97-80(a); S.L. 2013-410
  • Eff. April 1, 2015
  • Temporary Amendment Eff. January 1, 2017
  • Temporary Rule invalidated by Order of Judge G. Bryan Collins, Jr. in North Carolina Ambulatory Center Association, et al. v. North Carolina Industrial Commission, No. 17-CVS-00144 (Wake County Superior Court)
  • Recodified from 04 NCAC 10J .0103 Eff. June 1, 2018
  • Amended Eff. June 1, 2018.

Subchapter K

11 NCAC 23K .0101 Location of Offices and Hours of Business {#sec-11-ncac-23k-.0101 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23K .0101}

History

  • Status: expired
  • Authority G.S. 143B-426.50; 143B-426.52(b),(d)
  • Temporary Adoption Eff. December 3, 2013 and shall expire on the earlier of the date all claims made under this section are finally adjudicated or June 30, 2018 pursuant to G.S. 143B-426.52(d)
  • Recodified from 04 NCAC 10K .0101-.0103 Eff. June 1, 2018
  • Temporary Adoption Expired Eff. June 30, 2018.
11 NCAC 23K .0102 Official Forms {#sec-11-ncac-23k-.0102 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23K .0102}

History

  • Status: expired
  • Authority G.S. 143B-426.50; 143B-426.52(b),(d)
  • Temporary Adoption Eff. December 3, 2013 and shall expire on the earlier of the date all claims made under this section are finally adjudicated or June 30, 2018 pursuant to G.S. 143B-426.52(d)
  • Recodified from 04 NCAC 10K .0101-.0103 Eff. June 1, 2018
  • Temporary Adoption Expired Eff. June 30, 2018.
11 NCAC 23K .0103 Authority to file on behalf of third party {#sec-11-ncac-23k-.0103 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23K .0103}

History

  • Status: expired
  • Authority G.S. 143B-426.50; 143B-426.52(b),(d)
  • Temporary Adoption Eff. December 3, 2013 and shall expire on the earlier of the date all claims made under this section are finally adjudicated or June 30, 2018 pursuant to G.S. 143B-426.52(d)
  • Recodified from 04 NCAC 10K .0101-.0103 Eff. June 1, 2018
  • Temporary Adoption Expired Eff. June 30, 2018.
11 NCAC 23K .0201 Initial DETERMINATION OF CLAIMS BY THE COMMISSION {#sec-11-ncac-23k-.0201 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23K .0201}

History

  • Status: expired
  • Authority G.S. 143B-426.52; 143B-426.52(d); 143B-426.53(a),(d)
  • Temporary Adoption Eff. December 3, 2013 and shall expire on the earlier of the date all claims made under this section are finally adjudicated or June 30, 2018 pursuant to G.S. 143B-426.52(d)
  • Recodified from 04 NCAC 10K .0201-.0203 Eff. June 1, 2018
  • Temporary Adoption Expired Eff. June 30, 2018.
11 NCAC 23K .0202 Requests for additional review by the Deputy Commissioner {#sec-11-ncac-23k-.0202 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23K .0202}

History

  • Status: expired
  • Authority G.S. 143B-426.52; 143B-426.52(d); 143B-426.53(a),(d)
  • Temporary Adoption Eff. December 3, 2013 and shall expire on the earlier of the date all claims made under this section are finally adjudicated or June 30, 2018 pursuant to G.S. 143B-426.52(d)
  • Recodified from 04 NCAC 10K .0201-.0203 Eff. June 1, 2018
  • Temporary Adoption Expired Eff. June 30, 2018.
11 NCAC 23K .0203 HEARINGS BEFORE A Deputy Commissioner {#sec-11-ncac-23k-.0203 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23K .0203}

History

  • Status: expired
  • Authority G.S. 143B-426.52; 143B-426.52(d); 143B-426.53(a),(d)
  • Temporary Adoption Eff. December 3, 2013 and shall expire on the earlier of the date all claims made under this section are finally adjudicated or June 30, 2018 pursuant to G.S. 143B-426.52(d)
  • Recodified from 04 NCAC 10K .0201-.0203 Eff. June 1, 2018
  • Temporary Adoption Expired Eff. June 30, 2018.
11 NCAC 23K .0301 Appeal TO THE FULL COMMISSION {#sec-11-ncac-23k-.0301 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23K .0301}

History

  • Status: expired
  • Authority G.S. 143B-426.52(d); 143B-426.53(e)
  • Temporary Adoption Eff. December 3, 2013 and shall expire on the earlier of the date all claims made under this section are finally adjudicated or June 30, 2018 pursuant to G.S. 143B-426.52(d)
  • Recodified from 04 NCAC 10K .0301-.0302 Eff. June 1, 2018
  • Temporary Adoption Expired Eff. June 30, 2018.
11 NCAC 23K .0302 MOTIONS for reconsideraTion by the Full commission {#sec-11-ncac-23k-.0302 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23K .0302}

History

  • Status: expired
  • Authority G.S. 143B-426.52(d); 143B-426.53(e)
  • Temporary Adoption Eff. December 3, 2013 and shall expire on the earlier of the date all claims made under this section are finally adjudicated or June 30, 2018 pursuant to G.S. 143B-426.52(d)
  • Recodified from 04 NCAC 10K .0301-.0302 Eff. June 1, 2018
  • Temporary Adoption Expired Eff. June 30, 2018.
11 NCAC 23K .0401 Stays {#sec-11-ncac-23k-.0401 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23K .0401}

History

  • Status: expired
  • Authority G.S. 143-293; 143-294; 143B-426.50; 143B-426.52(d); 143B-426.53(f)
  • Temporary Adoption Eff. December 3, 2013 and shall expire on the earlier of the date all claims made under this section are finally adjudicated or June 30, 2018 pursuant to G.S. 143B-426.52(d).
  • Recodified from 04 NCAC 10K .0401-.0403 Eff. June 1, 2018
  • Temporary Adoption Expired Eff. June 30, 2018.
11 NCAC 23K .0402 Motions for Court of Appeals Cases {#sec-11-ncac-23k-.0402 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23K .0402}

History

  • Status: expired
  • Authority G.S. 143-293; 143-294; 143B-426.50; 143B-426.52(d); 143B-426.53(f)
  • Temporary Adoption Eff. December 3, 2013 and shall expire on the earlier of the date all claims made under this section are finally adjudicated or June 30, 2018 pursuant to G.S. 143B-426.52(d).
  • Recodified from 04 NCAC 10K .0401-.0403 Eff. June 1, 2018
  • Temporary Adoption Expired Eff. June 30, 2018.
11 NCAC 23K .0403 Remand from Appellate Courts {#sec-11-ncac-23k-.0403 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23K .0403}

History

  • Status: expired
  • Authority G.S. 143-293; 143-294; 143B-426.50; 143B-426.52(d); 143B-426.53(f)
  • Temporary Adoption Eff. December 3, 2013 and shall expire on the earlier of the date all claims made under this section are finally adjudicated or June 30, 2018 pursuant to G.S. 143B-426.52(d).
  • Recodified from 04 NCAC 10K .0401-.0403 Eff. June 1, 2018
  • Temporary Adoption Expired Eff. June 30, 2018.
11 NCAC 23K .0501 WAIVER of Rules {#sec-11-ncac-23k-.0501 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23K .0501}

History

  • Status: expired
  • Authority G.S. 143-293; 143B-426.50; 143B-426.52(d)
  • Temporary Adoption Eff. December 3, 2013 and shall expire on the earlier of the date all claims made under this section are finally adjudicated or June 30, 2018 pursuant to G.S. 143B-426.52(d)
  • Recodified from 04 NCAC 10K .0501 Eff. June 1, 2018
  • Temporary Adoption Expired Eff. June 30, 2018.

Subchapter L

11 NCAC 23L .0101 Form 21 – Agreement for Compensation for Disability {#sec-11-ncac-23l-.0101 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23L .0101}

(a) The parties to a workers' compensation claim shall use the following Form 21, Agreement for Compensation for Disability, for agreements regarding disability and payment of compensation therefor pursuant to G.S. 97-29 and 97-30. Additional issues agreed upon by the parties such as payment of compensation for permanent partial disability may also be included on the form. This form is necessary to comply with Rule 11 NCAC 23A .0501, where applicable. The Form 21, Agreement for Compensation for Disability, shall read as follows:

North Carolina Industrial Commission

Agreement for Compensation for Disability

(G.S. 97-82)

IC File # __________

Emp. Code # __________

Carrier Code # __________

Carrier File # __________

The Use Of This Form Is Required Under The Provisions of The Workers' Compensation Act

Employee's Name

Address

City State Zip

Home Telephone Work Telephone

Last 4 digits of Social Security Number: _______ Sex: o M o F Date of Birth: _______

Employer's Name Telephone Number

Employer's Address City State Zip

Insurance Carrier

Carrier's Address City State Zip

Carrier's Telephone Number Carrier's Fax Number

We, The Undersigned, Do Hereby Agree And Stipulate As Follows:

  1. All parties hereto are subject to and bound by the provisions of the Workers' Compensation Act and __________ is the carrier/administrator for the employer.

  2. The employee sustained an injury by accident or the employee contracted an occupational disease arising out of and in the course of employment on or by __________.

  3. The injury by accident or occupational disease resulted in the following injuries: __________

________________________________________________________________________________.

  1. The employee o was/ o was not paid for the entire day when the injury occurred.

  2. The average weekly wage of the employee at the time of the injury, including overtime and all allowances, was $________, subject to verification unless otherwise agreed upon in Item 9 below.

  3. Disability resulting from the injury or occupational disease began on ________.

  4. The employer and carrier/administrator hereby undertake to pay compensation to the employee at the rate of $________ per week beginning ________, and continuing for ________ weeks.

  5. The employee o has / o has not returned to work for ________________________________

on ________________ , at an average weekly wage of $________.

  1. State any further matters agreed upon, including disfigurement, permanent partial, or temporary partial disability: ________________________________________________________________.

  2. If applicable, the Second Injury Fund Assessment is $________. Check o is o is not attached.

  3. The date of this agreement is ________. Date of first payment: ________ Amount: ________.

Name Of Employer Signature Title

Name Of Carrier / Administrator Signature Title

By signing I enter into this agreement and certify that I have read the “Important Notices to Employee” printed on Page 2 of this form.

Signature of Employee Address

Signature of Employee's Attorney Address

North Carolina Industrial Commission

The Foregoing Agreement Is Hereby Approved:

Claims Examiner Date

Attorney's Fee Approved

o Check Box If No Attorney Retained.

o Check Box If Employee Is In Managed Care.

IMPORTANT NOTICE TO EMPLOYEE CLAIMING ADDITIONAL WEEKLY CHECKS OR LUMP SUM PAYMENTS

Once your compensation checks have been stopped, if you claim further compensation, you must notify the Industrial Commission in writing within two years from the date of receipt of your last compensation check or your rights to these benefits may be lost.

IMPORTANT NOTICE TO EMPLOYEE INJURED BEFORE JULY 5, 1994 CLAIMING ADDITIONAL MEDICAL BENEFITS

If your injury occurred before July 5, 1994, you are entitled to medical compensation as long as it is reasonably necessary, related to your workers' compensation case, and authorized by the carrier or the Industrial Commission.

IMPORTANT NOTICE TO EMPLOYEE INJURED ON OR AFTER JULY 5, 1994 CLAIMING ADDITIONAL MEDICAL BENEFITS

If your injury occurred on or after July 5, 1994, your right to future medical compensation will depend on several factors. Your right to payment of future medical compensation will terminate two years after your employer or carrier/administrator last pays any medical compensation or other compensation, whichever occurs last. If you think you will need future medical compensation, you must file an application for additional medical compensation pursuant to G.S. 97-25.1 within two years, or your right to these benefits may be lost. An application for additional medical compensation may be made on a Form 18M Employee’s Application for Additional Medical Compensation or by written request. In the alternative, an employee may file an application for additional medical compensation by filing a Form 33 Request that Claim be Assigned for Hearing pursuant to 11 NCAC 23A .0602. All Industrial Commission forms are available at https://www.ic.nc.gov/forms.html.

IMPORTANT NOTICE TO EMPLOYER

The employee must be provided a copy of the form when the agreement is signed by the employee. Pursuant to Rule 11 NCAC 23A .0501, within 20 days after receipt of the agreement executed by the employee, the employer or carrier/administrator must submit the agreement to the Industrial Commission. The employer or carrier/administrator shall file a Form 28B, Report of Compensation and Medical Compensation Paid, within 16 days after the last payment made pursuant to this agreement or be subject to a penalty.

NEED ASSISTANCE?

If you have questions or need help and you do not have an attorney, you may contact the Industrial Commission at (800) 688-8349.

Form 21

3/2021

Self-Insured Employer or Carrier, File via Electronic Document Filing Portal ("EDFP"):

https://www.ic.nc.gov/docfiling.html

Contact Information:

NCIC- Claims Administration

Telephone: (919) 807-2502

Helpline: (800) 688-8349

Website: https://www.ic.nc.gov

(b) The copy of the form described in Paragraph (a) of this Rule can be accessed at https://www.ic.nc.gov/forms/form21.pdf. The form may be reproduced only in the format available at https://www.ic.nc.gov/forms/form21.pdf and may not be altered or amended in any way.

History

  • Authority G.S. 97-73; 97-80(a); 97-81(a); 97-82; S.L. 2014-77
  • Eff. November 1, 2014
  • Recodified from 04 NCAC 10L .0101 Eff. June 1, 2018
  • Amended Eff. March 1, 2021.
11 NCAC 23L .0102 Form 26 – Supplemental Agreement as to Payment of Compensation {#sec-11-ncac-23l-.0102 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23L .0102}

(a) If the parties to a workers' compensation claim have previously entered into an approved agreement on a Form 21, Agreement for Compensation for Disability, or a Form 26A, Employer's Admission of Employee's Right to Permanent Partial Disability, they shall use the following Form 26, Supplemental Agreement as to Payment of Compensation, for agreements regarding subsequent additional disability and payment of compensation pursuant to G.S. 97-29 and 97-30. Additional issues agreed upon by the parties such as payment of compensation for permanent partial disability may also be included on the form. This form is necessary to comply with Rule 11 NCAC 23A .0501, where applicable. The Form 26, Supplemental Agreement as to Payment of Compensation, shall read as follows:

North Carolina Industrial Commission

Supplemental Agreement as to Payment

of Compensation (G.S. §97-82)

IC File # __________

Emp. Code # __________

Carrier Code # __________

Carrier File # __________

The Use Of This Form Is Required Under The Provisions of The Workers' Compensation Act

Employee's Name

Address

City State Zip

Home Telephone Work Telephone

Last 4 digits of Social Security Number: _______ Sex: o M o F Date of Birth: _______

Employer's Name Telephone Number

Employer's Address City State Zip

Insurance Carrier

Carrier's Address City State Zip

Carrier's Telephone Number Carrier's Fax Number

We, The Undersigned, Do Hereby Agree and Stipulate As Follows:

  1. Date of injury: __________.

  2. The employee o returned to work / o was rated on __________ (date), at a weekly wage of $__________.

  3. The employee became totally disabled on __________.

  4. Employee's average weekly wage o was reduced / o was increased on , from $ per week to $__________ per week.

  5. The employer and carrier/administrator hereby undertake to pay compensation to the employee at the rate of $__________ per week.

Beginning , and continuing for weeks. The type of disability compensation is

________________________________________________________________________________.

  1. State any further matters agreed upon, including disfigurement or temporary partial disability:

________________________________________________________________________________.

  1. The date of this agreement is __________.

Name Of Employer Signature Title

Name Of Carrier/Administrator Signature Title

By signing I enter into this agreement and certify that I have read the "Important Notices to Employee" printed on Page 2 of this form.

Signature of Employee Address

Signature of Employee's Attorney Address

o Check box if no attorney retained.

North Carolina Industrial Commission

The Foregoing Agreement Is Hereby Approved:

Claims Examiner Date

Attorney's fee approved

IMPORTANT NOTICE TO EMPLOYEE CLAIMING ADDITIONAL WEEKLY CHECKS OR LUMP SUM PAYMENTS

Once your compensation checks have been stopped, if you claim further compensation, you must notify the Industrial Commission in writing within two years from the date of receipt of your last compensation check or your rights to these benefits may be lost.

IMPORTANT NOTICE TO EMPLOYEE INJURED BEFORE JULY 5, 1994 CLAIMING ADDITIONAL MEDICAL BENEFITS

If your injury occurred before July 5, 1994, you are entitled to medical compensation as long as it is reasonably necessary, related to your workers’ compensation case, and authorized by the carrier or the Industrial Commission.

IMPORTANT NOTICE TO EMPLOYEE INJURED ON OR AFTER JULY 5, 1994 CLAIMING ADDITIONAL MEDICAL BENEFITS

If your injury occurred on or after July 5, 1994, your right to future medical compensation will depend on several factors. Your right to payment of future medical compensation will terminate two years after your employer or carrier/administrator last pays any medical compensation or other compensation, whichever occurs last. If you think you will need future medical compensation, you must file an application for additional medical compensation pursuant to G.S. 97-25.1 within two years, or your right to these benefits may be lost. An application for additional medical compensation may be made on a Form 18M Employee’s Application for Additional Medical Compensation or by written request. In the alternative, an employee may file an application for additional medical compensation by filing a Form 33 Request that Claim be Assigned for Hearing pursuant to 11 NCAC 23A .0602. All Industrial Commission forms are available at https://www.ic.nc.gov/forms.html.

IMPORTANT NOTICE TO EMPLOYER

This form shall be used only to supplement Form 21, Agreement for Compensation for Disability (G.S. 97-82), or an award in cases in which subsequent conditions require a modification of a former agreement or award. The employee must be provided a copy of the form when the agreement is signed by the employee. Pursuant to Rule 11 NCAC 23A .0501, within 20 days after receipt of the agreement executed by the employee, the employer or carrier/administrator must submit the agreement to the Industrial Commission. The employer or carrier/administrator shall file a Form 28B, Report of Compensation and Medical Compensation Paid, within 16 days after the last payment made pursuant to this agreement or be subject to a penalty.

NEED ASSISTANCE?

If you have questions or need help and you do not have an attorney, you may contact the Industrial Commission at (800) 688-8349.

Form 26

3/2021

Self-Insured Employer or Carrier, File via Electronic Document Filing Portal ("EDFP"):

https://www.ic.nc.gov/docfiling.html

Contact Information:

NCIC- Claims Administration

Telephone: (919) 807-2502

Helpline: (800) 688-8349

Website: https://www.ic.nc.gov

(b) The copy of the form described in Paragraph (a) of this Rule can be accessed at https://www.ic.nc.gov/forms/form26.pdf. The form may be reproduced only in the format available at https://www.ic.nc.gov/forms/form26.pdf and may not be altered or amended in any way.

History

  • Authority G.S. 97-73; 97-80(a); 97-81(a); 97-82; S.L. 2014-77
  • Eff. November 1, 2014
  • Recodified from 04 NCAC 10L .0102 Eff. June 1, 2018
  • Amended Eff. March 1, 2021.
11 NCAC 23L .0103 Form 26a – Employer's Admission of Employee's Right to Permanent Partial Disability (effective December 1, 2020) {#sec-11-ncac-23l-.0103 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23L .0103}

(a) The parties to a workers' compensation claim shall use the following Form 26A, Employer's Admission of Employee's Right to Permanent Partial Disability, for agreements regarding the employee's entitlement to and the employer's payment of compensation for permanent partial disability pursuant to G.S. 97-31. Additional issues agreed upon by the parties, such as election of payment of temporary partial disability pursuant to G.S. 97-30, may also be included on the form. This form is necessary to comply with Rule 11 NCAC 23A .0501, where applicable. The Form 26A, Employer's Admission of Employee's Right to Permanent Partial Disability, shall read as follows:

North Carolina Industrial Commission

Employer's Admission of Employee's Right to Permanent Partial Disability

(G.S. 97-31)

IC File # __________

Emp. Code # __________

Carrier Code # __________

Carrier File # __________

Employer FEIN __________

The Use Of This Form Is Required Under The Provisions of The Workers' Compensation Act

Employee's Name

Address

City State Zip

Home Telephone Work Telephone

Social Security Number: _______ Sex: ‘ M ‘ F Date of Birth: _______

Employer's Name Telephone Number

Employer's Address City State Zip

Insurance Carrier

Carrier's Address City State Zip

Carrier's Telephone Number Carrier's Fax Number

WE, THE UNDERSIGNED, DO HEREBY AGREE AND STIPULATE AS FOLLOWS:

  1. All the parties hereto are subject to and bound by the provisions of the Workers' Compensation Act and ______________________ is the Carrier/Administrator for the Employer.

  2. The employee sustained an injury by accident or the employee contracted an occupational disease arising out of and in the course of employment on _____________________.

  3. The injury by accident or occupational disease resulted in the following injuries: ______________________________________.

  4. The employee ‘ was ‘ was not paid for the 7 day waiting period.

If not, was salary continued? ‘ yes ‘ no. Was employee paid for the date of injury? ‘ yes ‘ no

  1. The average weekly wage of the employee at the time of the injury, including overtime and all allowances, was $___________. This results in a weekly compensation rate of $__________.

  2. The employee ‘ has ‘ has not returned full time to work for _________________________

on ______, at an average weekly wage of $.

  1. Claimant was released ‘ with permanent restrictions ‘ without permanent restrictions. If claimant was released with permanent restrictions and has returned to work for the employer of injury, attach a job description if known to exist.

  2. Permanent partial disability compensation will be paid to the injured worker as follows:

____ weeks of compensation at rate of $________ per week for ____% rating to ___________ (body part)

____ weeks of compensation at rate of $________ per week for ____% rating to ___________ (body part)

____ weeks of compensation at rate of $________ per week for ____% rating to ___________ (body part)

Total amount of permanent partial disability compensation is $. Date of first payment:___.

  1. State any further matters agreed upon, including disfigurement, loss of teeth, election of temporary partial disability, waiting period or other: ___________________________________________________________________________________.

  2. An overpayment is claimed in the amount of $. Overpayment was calculated as follows:__________________________________________.

If overpayment claimed, a Form 28B, Report of Compensation and Medical Compensation Paid, is attached. ‘ yes ‘ no

  1. If applicable, the Second Injury Fund Assessment is $ ___________________. A check ‘ is ‘ is not included.

The undersigned hereby certify that the material medical and vocational records related to the injury, including any job description known to exist if the employee has permanent restrictions and has returned to work for the employer of injury, have been provided to the employee or the employee's attorney and have been filed with the Industrial Commission for consideration pursuant to G.S. 97-82(a) and Rule 11 NCAC 23A .0501.

Name Of Employer Signature Title Date

Name Of Carrier/Administrator Signature Direct Phone Number Email Address Title Date

By signing I enter into this agreement and certify that I have read the "Important Notices to Employee"

printed on Page 3 of this form.

Signature of Employee Address Email Address Date

Signature of Employee's Attorney Address Email Address Date

‘ Check box if no attorney retained.

North Carolina Industrial Commission

The Foregoing Agreement Is Hereby Approved:

Claims Examiner Date

Attorney's fee approved

IMPORTANT NOTICE TO EMPLOYEE CLAIMING ADDITIONAL WEEKLY CHECKS OR LUMP SUM PAYMENTS

Once your compensation checks have been stopped, if you claim further compensation, you must notify the Industrial Commission in writing within two years from the date of receipt of your last compensation check or your rights to these benefits may be lost.

IMPORTANT NOTICE TO EMPLOYEE INJURED BEFORE JULY 5, 1994 CLAIMING ADDITIONAL MEDICAL BENEFITS

If your injury occurred before July 5, 1994, you are entitled to medical compensation as long as it is reasonably necessary, related to your workers' compensation case, and authorized by the carrier or the Industrial Commission.

IMPORTANT NOTICE TO EMPLOYEE INJURED ON OR AFTER JULY 5, 1994 CLAIMING ADDITIONAL MEDICAL BENEFITS

If your injury occurred on or after July 5, 1994, your right to future medical compensation will depend on several factors. Your right to payment of future medical compensation will terminate two years after your employer or carrier/administrator last pays any medical compensation or other compensation, whichever occurs last. If you think you will need future medical compensation, you must apply to the Industrial Commission in writing within two years, or your right to these benefits may be lost. To apply you may also use Industrial Commission 18M, Employee's Application for Additional Medical Compensation (G.S. 97-25.1), available at http://www.ic.nc.gov/forms.html.

IMPORTANT NOTICE TO EMPLOYER

The employee must be provided a copy when the agreement is signed by the employee. Pursuant to Rule 11 NCAC 23A .0501, within 20 days after receipt of the agreement executed by the employee, the employer or carrier/administrator must submit the agreement to the Industrial Commission, or show cause for not submitting the agreement. The employer or carrier/administrator shall file a Form 28B, Report of Compensation and Medical Compensation Paid, within 16 days after the last payment made pursuant to this agreement or be subject to a penalty.

NEED ASSISTANCE?

If you have questions or need help and you do not have an attorney, you may contact the Industrial Commission at (800) 688-8349.

Form 26A

12/2020

Self-Insured Employer or Carrier Mail to:

NCIC - Claims Administration

4335 Mail Service Center

Raleigh, North Carolina 27699-4335

Main Telephone: (919) 807-2500

Helpline: (800) 688-8349

Website: http://www.ic.nc.gov/

(b) A copy of the form described in Paragraph (a) of this Rule can be accessed at http://www.ic.nc.gov/forms/form26a.pdf. The form may be reproduced only in the format available at http://www.ic.nc.gov/forms/form26a.pdf and may not be altered or amended in any way.

History

  • Authority G.S. 97-30; 97-31; 97-73; 97-80(a); 97-81(a); 97-82; S.L. 2014-77
  • Eff. November 1, 2014
  • Recodified from 04 NCAC 10L .0103 Eff. June 1, 2018
  • Amended Eff. December 1, 2020.
11 NCAC 23L .0103 FORM 26A – EMPLOYER'S ADMISSION OF EMPLOYEE'S RIGHT TO PERMANENT PARTIAL DISABILITY (eFFECTIVE MARCH 1, 2021) {#sec-11-ncac-23l-.0103 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23L .0103}

(a) The parties to a workers' compensation claim shall use the following Form 26A, Employer's Admission of Employee's Right to Permanent Partial Disability, for agreements regarding the employee's entitlement to and the employer's payment of compensation for permanent partial disability pursuant to G.S. 97-31. Additional issues agreed upon by the parties, such as election of payment of temporary partial disability pursuant to G.S. 97-30, may also be included on the form. This form is necessary to comply with Rule 11 NCAC 23A .0501, where applicable. The Form 26A, Employer's Admission of Employee's Right to Permanent Partial Disability, shall read as follows:

North Carolina Industrial Commission

Employer's Admission of Employee's Right to Permanent Partial Disability

(G.S. 97-31)

IC File # __________

Emp. Code # __________

Carrier Code # __________

Carrier File # __________

The Use Of This Form Is Required Under The Provisions of The Workers' Compensation Act

Employee's Name

Address

City State Zip

Home Telephone Work Telephone

Last 4 digits of Social Security Number: _______ Sex: o M o F Date of Birth: _______

Employer's Name Telephone Number

Employer's Address City State Zip

Insurance Carrier

Carrier's Address City State Zip

Carrier's Telephone Number Carrier's Fax Number

WE, THE UNDERSIGNED, DO HEREBY AGREE AND STIPULATE AS FOLLOWS:

  1. All the parties hereto are subject to and bound by the provisions of the Workers' Compensation Act and ______________________ is the Carrier/Administrator for the Employer.

  2. The employee sustained an injury by accident or the employee contracted an occupational disease arising out of and in the course of employment on _____________________.

  3. The injury by accident or occupational disease resulted in the following injuries: ______________________________________________________________________________.

  4. The employee o was o was not paid for the 7 day waiting period.

If not, was salary continued? o yes o no. Was employee paid for the date of injury? o yes o no

  1. The average weekly wage of the employee at the time of the injury, including overtime and all allowances, was $___________. This results in a weekly compensation rate of $__________.

  2. The employee o has o has not returned full time to work for _________________________

on ______, at an average weekly wage of $.

  1. Claimant was released o with permanent restrictions o without permanent restrictions. If claimant was released with permanent restrictions and has returned to work for the employer of injury, attach a job description if known to exist.

  2. Permanent partial disability compensation will be paid to the injured worker as follows:

____ weeks of compensation at rate of $________ per week for ____% rating to ___________ (body part)

____ weeks of compensation at rate of $________ per week for ____% rating to ___________ (body part)

____ weeks of compensation at rate of $________ per week for ____% rating to ___________ (body part)

Total amount of permanent partial disability compensation is $. Date of first payment:___.

  1. State any further matters agreed upon, including disfigurement, loss of teeth, election of temporary partial disability, waiting period or other: ___________________________________________________________________________________.

  2. An overpayment is claimed in the amount of $___________. Overpayment was calculated as follows:___________________________________________________________________.

If overpayment claimed, a Form 28B, Report of Compensation and Medical Compensation Paid, is attached. o yes o no

  1. If applicable, the Second Injury Fund Assessment is $ ___________________. A check o is o is not included.

The undersigned hereby certify that the material medical and vocational records related to the injury, including any job description known to exist if the employee has permanent restrictions and has returned to work for the employer of injury, have been provided to the employee or the employee's attorney and have been filed with the Industrial Commission for consideration pursuant to G.S. 97-82(a) and Rule 11 NCAC 23A .0501.

Name Of Employer Signature Title Date

Name Of Carrier/Administrator Signature Direct Phone Number Email Address Title Date

By signing I enter into this agreement and certify that I have read the "Important Notices to Employee"

printed on Page 3 of this form.

Signature of Employee Address Email Address Date

Signature of Employee's Attorney Address Email Address Date

o Check box if no attorney retained.

North Carolina Industrial Commission

The Foregoing Agreement Is Hereby Approved:

Claims Examiner Date

Attorney's fee approved

IMPORTANT NOTICE TO EMPLOYEE CLAIMING ADDITIONAL WEEKLY CHECKS OR LUMP SUM PAYMENTS

Once your compensation checks have been stopped, if you claim further compensation, you must notify the Industrial Commission in writing within two years from the date of receipt of your last compensation check or your rights to these benefits may be lost.

IMPORTANT NOTICE TO EMPLOYEE INJURED BEFORE JULY 5, 1994 CLAIMING ADDITIONAL MEDICAL BENEFITS

If your injury occurred before July 5, 1994, you are entitled to medical compensation as long as it is reasonably necessary, related to your workers' compensation case, and authorized by the carrier or the Industrial Commission.

IMPORTANT NOTICE TO EMPLOYEE INJURED ON OR AFTER JULY 5, 1994 CLAIMING ADDITIONAL MEDICAL BENEFITS

If your injury occurred on or after July 5, 1994, your right to future medical compensation will depend on several factors. Your right to payment of future medical compensation will terminate two years after your employer or carrier/administrator last pays any medical compensation or other compensation, whichever occurs last. If you think you will need future medical compensation, you must file an application for additional medical compensation pursuant to G.S. 97-25.1 within two years, or your right to these benefits may be lost. An application for additional medical compensation may be made on a Form 18M Employee's Application for Additional Medical Compensation or by written request. In the alternative, an employee may file an application for additional medical compensation by filing a Form 33 Request that Claim be Assigned for Hearing pursuant to 11 NCAC 23A .0602. All Industrial Commission forms are available at https://www.ic.nc.gov/forms.html.

IMPORTANT NOTICE TO EMPLOYER

The employee must be provided a copy of the form when the agreement is signed by the employee. Pursuant to Rule 11 NCAC 23A .0501, within 20 days after receipt of the agreement executed by the employee, the employer or carrier/administrator must submit the agreement to the Industrial Commission. The employer or carrier/administrator shall file a Form 28B, Report of Compensation and Medical Compensation Paid, within 16 days after the last payment made pursuant to this agreement or be subject to a penalty.

NEED ASSISTANCE?

If you have questions or need help and you do not have an attorney, you may contact the Industrial Commission at (800) 688-8349.

Form 26A

3/2021

Self-Insured Employer or Carrier, File via Electronic Document Filing Portal ("EDFP"):

https://www.ic.nc.gov/docfiling.html

Contact Information:

NCIC- Claims Administration

Telephone: (919) 807-2502

Helpline: (800) 688-8349

Website: https://www.ic.nc.gov

(b) A copy of the form described in Paragraph (a) of this Rule can be accessed at https://www.ic.nc.gov/forms/form26a.pdf. The form may be reproduced only in the format available at https://www.ic.nc.gov/forms/form26a.pdf and may not be altered or amended in any way.

History

  • Authority G.S. 97-30; 97-31; 97-73; 97-80(a); 97-81(a); 97-82; S.L. 2014-77
  • Eff. November 1, 2014
  • Recodified from 04 NCAC 10L .0103 Eff. June 1, 2018
  • Amended Eff. December 1, 2020
  • Amended Eff. March 1, 2021.
11 NCAC 23L .0104 Form 36 – Subpoena {#sec-11-ncac-23l-.0104 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23L .0104}

(a) The parties to a claim shall use the following Form 36, Subpoena, to subpoena a person(s) to appear and testify and/or produce documents for inspection before the Commission. The Form 36, Subpoena, shall read as follows:

STATE OF NORTH CAROLINA File No. _____________

________________ County North Carolina Industrial Commission

VERSUS

SUBPOENA

G.S. 1A-1, Rule 45; G.S. 8-59; G.S. 97-80(e)

Party Requesting Subpoena

___ NCIC/State/Plaintiff ___ Defendant

NOTE TO PARTIES NOT REPRESENTED BY COUNSEL: Subpoenas may be produced at your request, but must be signed and issued by a Commissioner, Deputy Commissioner, or the Executive Secretary.

TO: Name and Address of Person Subpoenaed _______________________________________________

Alternate Address ______________________________________________________________________

Telephone No. _________________________________________________________________________

Alternate Telephone No. _________________________________________________________________

YOU ARE COMMANDED TO: (check all that apply):

___ appear and testify, in the above entitled action, before the Industrial Commission at the place, date and time indicated below.

___ appear and testify, in the above entitled action, at a deposition at the place, date and time indicated below.

___ produce and permit inspection and copying of the following items, at the place, date and time indicated below. (A party shall not issue a subpoena duces tecum less than 30 days prior to the hearing date except upon prior approval of the Commission. G.S. 97-80(e).)

___ See attached list. (List here if space sufficient)

Location of Hearing/Place of Deposition/Place to Produce ________________________________________

Date to Appear/Produce _____________________

Time to Appear/Produce : __ AM __ PM

Name and Address of Applicant or Applicant's Attorney ________________________________________

Date ____________________

Signature of Official or Attorney _________________________________________

___ Deputy Commissioner ___ Commissioner ___ Executive Secretary ___ Attorney

Telephone No. of Applicant or Applicant's Attorney____________________________________________

RETURN OF SERVICE

I certify this subpoena was received and served on the person subpoenaed as follows:

By

___ personal delivery.

___ registered or certified mail, receipt requested and attached.

___ service by Sheriff.

___ I was unable to serve this subpoena. Reason unable to serve: ________________________________

Service Fee $ ___________

___ Paid

___ Due

Date Served ________

Name of Authorized Server (Type Or Print) __________________________

Signature of Authorized Server ____________________________________

Title ______________________

NOTE TO PERSON REQUESTING SUBPOENA: A copy of this subpoena must be delivered, mailed or faxed to the attorney for each party in this case. If a party is not represented by an attorney, the copy must be mailed or delivered to the party.

NOTE: Rule 45, North Carolina Rules of Civil Procedure, Subsections (c) and (d). (With respect to the provisions of Rule 45 cited below as they apply to this subpoena, the North Carolina Industrial Commission is the "court" and the "court in the county." All motions regarding this subpoena shall be filed with the North Carolina Industrial Commission pursuant to 11 NCAC 23A .0609.)

(c) Protection of Persons Subject to Subpoena

(1) Avoid undue burden or expense. - A party or an attorney responsible for the issuance and service of a subpoena shall take reasonable steps to avoid imposing an undue burden or expense on a person subject to the subpoena. The court shall enforce this subdivision and impose upon the party or attorney in violation of this requirement an appropriate sanction that may include compensating the person unduly burdened for lost earnings and for reasonable attorney's fees.

(2) For production of public records or hospital medical records. - Where the subpoena commands any custodian of public records or any custodian of hospital medical records, as defined in G.S. 8-44.1, to appear for the sole purpose of producing certain records in the custodian's custody, the custodian subpoenaed may, in lieu of personal appearance, tender to the court in which the action is pending by registered or certified mail or by personal delivery, on or before the time specified in the subpoena, certified copies of the records requested together with a copy of the subpoena and an affidavit by the custodian testifying that the copies are true and correct copies and that the records were made and kept in the regular course of business, or if no such records are in the custodian's custody, an affidavit to that effect. When the copies of records are personally delivered under this subdivision, a receipt shall be obtained from the person receiving the records. Any original or certified copy of records or an affidavit delivered according to the provisions of this subdivision, unless otherwise objectionable, shall be admissible in any action or proceeding without further certification or authentication. Copies of hospital medical records tendered under this subdivision shall not be open to inspection or copied by any person, except to the parties to the case or proceedings and their attorneys in depositions, until ordered published by the judge at the time of the hearing or trial. Nothing contained herein shall be construed to waive the physician-patient privilege or to require any privileged communication under law to be disclosed.

(3) Written objection to subpoena. - Subject to subsection (d) of this rule, a person commanded to appear at a deposition or to produce and permit the inspection and copying of records, books, papers, documents, electronically stored information, or tangible things may, within 10 days after service of the subpoena or before the time specified for compliance if the time is less than 10 days after service, serve upon the party or the attorney designated in the subpoena written objection to the subpoena, setting forth the specific grounds for the objection. The written objection shall comply with the requirements of Rule 11 of the North Carolina Rules of Civil Procedure. Each of the following grounds may be sufficient for objecting to a subpoena:

a. The subpoena fails to allow reasonable time for compliance.

b. The subpoena requires disclosure of privileged or other protected matter and no exception or waiver applies to the privilege or protection.

c. The subpoena subjects a person to an undue burden or expense.

d. The subpoena is otherwise unreasonable or oppressive.

e. The subpoena is procedurally defective.

(4) Order of court required to override objection. - If objection is made under subdivision (3) of this subsection, the party serving the subpoena shall not be entitled to compel the subpoenaed person's appearance at a deposition or to inspect and copy materials to which an objection has been made except pursuant to an order of the court. If objection is made, the party serving the subpoena may, upon notice to the subpoenaed person, move at any time for an order to compel the subpoenaed person's appearance at the deposition or the production of the materials designated in the subpoena. The motion shall be filed in the court in the county in which the deposition or production of materials is to occur.

(5) Motion to quash or modify subpoena. - A person commanded to appear at a trial, hearing, deposition, or to produce and permit the inspection and copying of records, books, papers, documents, electronically stored information, or other tangible things, within 10 days after service of the subpoena or before the time specified for compliance if the time is less than 10 days after service, may file a motion to quash or modify the subpoena. The court shall quash or modify the subpoena if the subpoenaed person demonstrates the existence of any of the reasons set forth in subdivision (3) of this subsection. The motion shall be filed in the court in the county in which the trial, hearing, deposition, or production of materials is to occur.

(6) Order to compel; expenses to comply with subpoena. - When a court enters an order compelling a deposition or the production of records, books, papers, documents, electronically stored information, or other tangible things, the order shall protect any person who is not a party or an agent of a party from significant expense resulting from complying with the subpoena. The court may order that the person to whom the subpoena is addressed will be reasonably compensated for the cost of producing the records, books, papers, documents, electronically stored information, or tangible things specified in the subpoena.

(7) Trade secrets; confidential information. - When a subpoena requires disclosure of a trade secret or other confidential research, development, or commercial information, a court may, to protect a person subject to or affected by the subpoena, quash or modify the subpoena, or when the party on whose behalf the subpoena is issued shows a substantial need for the testimony or material that cannot otherwise be met without undue hardship, the court may order a person to make an appearance or produce the materials only on specified conditions stated in the order.

(8) Order to quash; expenses. - When a court enters an order quashing or modifying the subpoena, the court may order the party on whose behalf the subpoena is issued to pay all or part of the subpoenaed person's reasonable expenses including attorney's fees.

(d) Duties in Responding to Subpoena

(1) Form of response. - A person responding to a subpoena to produce records, books, documents, electronically stored information, or tangible things shall produce them as they are kept in the usual course of business or shall organize and label them to correspond with the categories in the request.

(2) Form of producing electronically stored information not specified. - If a subpoena does not specify a form for producing electronically stored information, the person responding must produce it in a form or forms in which it ordinarily is maintained or in a reasonably useable form or forms.

(3) Electronically stored information in only one form. - The person responding need not produce the same electronically stored information in more than one form.

(4) Inaccessible electronically stored information. - The person responding need not provide discovery of electronically stored information from sources that the person identifies as not reasonably accessible because of undue burden or cost. On motion to compel discovery or for a protective order, the person responding must show that the information is not reasonably accessible because of undue burden or cost. If that showing is made, the court may nonetheless order discovery from such sources if the requesting party shows good cause, after considering the limitations of Rule 26(b)(1a) of the North Carolina Rules of Civil Procedure. The court may specify conditions for discovery, including requiring the party that seeks discovery from a nonparty to bear the costs of locating, preserving, collecting, and producing the electronically stored information involved.

(5) Specificity of objection. - When information subject to a subpoena is withheld on the objection that it is subject to protection as trial preparation materials, or that it is otherwise privileged, the objection shall be made with specificity and shall be supported by a description of the nature of the communications, records, books, papers, documents, electronically stored information, or other tangible things not produced, sufficient for the requesting party to contest the objection.

INFORMATION FOR WITNESS

NOTE: If you have any questions about being subpoenaed as a witness, you should contact the person named on Page One of this Subpoena in the box labeled "Name And Address Of Applicant Or Applicant's Attorney."

DUTIES OF A WITNESS

· Unless otherwise directed by the presiding Deputy Commissioner or Commissioner, you must answer all questions asked when you are on the stand giving testimony.

· In answering questions, speak clearly and loudly enough to be heard.

· Your answers to questions must be truthful.

· If you are commanded to produce any items, you must bring them with you to court or to the deposition.

· You must continue to attend court until released by the court. You must continue to attend a deposition until the deposition is completed.

BRIBING OR THREATENING A WITNESS

It is a violation of State law for anyone to attempt to bribe, threaten, harass, or intimidate a witness. If anyone attempts to do any of these things concerning your involvement as a witness in a case, you should promptly report that to the presiding Deputy Commissioner or Commissioner.

Form 36 (Rev. 4/14)

(b) The copy of the form described in Paragraph (a) of this Rule can be accessed at http://www.ic.nc.gov/forms/form36.pdf. The form may be reproduced only in the format available at http://www.ic.nc.gov/forms/form36.pdf and may not be altered or amended in any way.

History

  • Authority G.S. 1A-1, Rule 45; 8-59; 97-80(a); 97-80(e); 97-81(a); S.L. 2013-294, s. 8.(12)
  • Eff. July 1, 2014
  • Recodified from 04 NCAC 10L .0104 Eff. June 1, 2018.
11 NCAC 23L .0105 Form T-42 – Application for Appointment of Guardian Ad Litem {#sec-11-ncac-23l-.0105 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23L .0105}

(a) Persons seeking to appear on behalf of an infant or incompetent shall apply on a Form T-42, Application for Appointment of Guardian Ad Litem, in accordance with Rule 11 NCAC 23B .0203. The Form T-42, Application for Appointment of Guardian Ad Litem, shall read as follows:

North Carolina Industrial Commission

IC File # TA- __________

Application for Appointment of Guardian Ad Litem

The use of this Form is required under Rule 11 NCAC 23B .0203

___________ Plaintiff(s) v. _________Defendant(s)

To the North Carolina Industrial Commission:

The undersigned __________ respectfully shows unto the North Carolina Industrial Commission that __________ is an __ infant or __ incompetent without general or testamentary guardian in this State, and that by reason thereof can bring an action only by a guardian ad litem; that the infant or incompetent has a cause of action against the defendants on account of the following matter and things:

The undersigned is a reputable person closely connected with the infant or incompetent having the relationship with the infant or incompetent as follows: _______________________________________________________________

Wherefore, the undersigned prays the Commission that a fit and proper person be appointed Guardian Ad Litem for the infant or incompetent for the purpose of bringing on his or her behalf an action as above set out.

Signature of Applicant __________________________________________________ Date____________________

(Please complete page 2 of form)

Order Appointing Guardian Ad Litem

It appearing to the North Carolina Industrial Commission from the above application that ____________________ is an __ infant or __ incompetent having no general or testamentary guardian within this State and that said infant or incompetent appears to have a good cause of action against the defendant(s); and it further appearing to the Commission after due inquiry that ____________________ is a fit and proper person to be appointed guardian ad litem for the infant or incompetent for the purpose of bringing this action on his or her behalf;

It is therefore ordered that ____________________ be and is hereby appointed guardian ad litem of ____________________ to bring action on his or her behalf.

This __________ day of ____________________.

Commissioner, Deputy Commissioner, or Executive Secretary ______________________________________________________________________

Please type or print:

Full name and address of minor or incompetent:

Birth date of minor: ____________________

Full name and address of proposed guardian ad litem:

Important Information for Parties

Parties should take notice of the provisions set forth in Rule 11 NCAC 23B .0203.

11 NCAC 23B .0203 Infants and Incompetents

(a) Persons seeking to appear on behalf of an infant or incompetent, in accordance with G.S. 1A-1, Rule 17, shall apply on a Form T-42 Application for Appointment of Guardian ad Litem. The Commission shall appoint a fit and proper person as guardian ad litem, if the Commission determines it to be in the best interest of the minor or incompetent. The Commission shall appoint the guardian ad litem only after due inquiry as to the fitness of the person to be appointed.

(b) The Commission may assess a fee to be paid to an attorney who serves as a guardian ad litem for actual services rendered upon receipt of an affidavit of actual time spent in representation of the minor or incompetent as part of the costs.

ATTORNEYS: File via Electronic Document Filing Portal (“EDFP”)

https://www.ic.nc.gov/docfiling.html

UNREPRESENTED PLAINTIFFS: File via EDFP, https://www.ic.nc.gov/docfiling.html OR

Mail to: Industrial Commission Clerk’s Office, 1236 Mail Service Center, Raleigh NC 27699-1236 OR

File via hand delivery: Business days from 8 a.m. – 5 p.m., Dobbs Building, 6th floor, 430 N. Salisbury Street,

Raleigh NC 27603 OR Fax to (919) 715-0282 OR Email to dockets@ic.nc.gov.

FORM T-42

(b) A copy of the form described in Paragraph (a) of this Rule can be accessed at https://www.ic.nc.gov/forms/formt-42.pdf. The form shall be reproduced only in the format available at https://www.ic.nc.gov/forms/formt-42.pdf and shall not be altered or amended in any way.

History

  • Authority G.S. 143-291; 143-295; 143-300
  • Eff. March 1, 2019
  • Amended Eff. March 1, 2021.

Subchapter M

11 NCAC 23M .0101 Purpose and Applicability of the Rules {#sec-11-ncac-23m-.0101 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23M .0101}

(a) The rules in this Subchapter address the utilization of opioids, related prescriptions, and pain management treatment in all claims arising under the provisions of the Workers' Compensation Act. However, Section .0200 of this Subchapter shall not apply to claims in which the employee received treatment with a targeted controlled substance for more than 12 consecutive weeks immediately preceding the effective date of the rules.

(b) The rules in this Subchapter apply to the prescription of targeted controlled substances as defined in Rule .0102 of this Section and the prescription of other modalities of pain management treatment for the outpatient treatment of non-cancer pain in claims in which the employer is providing medical compensation pursuant to the Workers' Compensation Act. The rules in this Subchapter do not apply to prescriptions for medications to be administered in a health care setting.

(c) The rules do not constitute medical advice or a standard of medical care. Disputes regarding the treatment addressed by these Rules shall be governed by G.S. 97-25 and Rule 11 NCAC 23A .0609A.

History

  • Authority G.S. 97-25; 97-25.4; 97-80(a); S.L. 2017-203, s. 4
  • Eff. May 1, 2018
  • Recodified from 04 NCAC 10M .0101 Eff. June 1, 2018.
11 NCAC 23M .0102 Definitions {#sec-11-ncac-23m-.0102 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23M .0102}

As used in this Subchapter:

(1) "Acute phase" means 12 weeks of treatment for pain following an injury by accident, occupational disease, surgery for an injury by accident or occupational disease, or subsequent aggravation of an injury by accident or occupational disease. There may be more than one acute phase during treatment for an injury or occupational disease.

(2) "Chronic phase" means continued treatment for pain immediately following a 12-week period of treatment for pain using a targeted controlled substance.

(3) "Confirmatory urine drug test" means a definitive urine drug test that verifies the results of a presumptive urine drug test. A confirmatory urine drug test identifies individual drugs and drug metabolites. Health care providers shall use a confirmatory drug test for the lowest number of drug classes necessary based on the results of the presumptive urine drug test, not to exceed 21 drug classes.

(4) "CSRS" means the Controlled Substances Reporting System as established by the North Carolina Controlled Substances Reporting System Act, Article 5E of Chapter 90 of the North Carolina General Statutes.

(5) "Long-acting opioid" or "extended-release opioid" means any targeted controlled substance that is formulated to release the drug gradually into the bloodstream or to have a long half-life for prolonged activity with an analgesic effect of 8 to 72 hours or longer.

(6) "Lowest effective dosage" means the lowest dose necessary to achieve the clinical goal.

(7) "Morphine equivalent dose" means conversion of various opioids to an equivalent morphine dose by using the most current conversion guidelines provided by the Centers for Disease Control and Prevention ("CDC"). The CDC Opioid Prescribing Guideline Mobile App and the CDC's guidelines for Calculating Total Daily Dose of Opioids for Safer Dosage are hereby incorporated by reference, including any subsequent amendments or editions. These materials are available online at no cost at https://www.cdc.gov/drugoverdose/pdf/calculating_total_daily_dose-a.pdf and

https://www.cdc.gov/drugoverdose/pdf/App_Opioid_Prescribing_Guideline-a.pdf.

(8) "Opioid antagonist" means the term as defined in G.S. 90-12.7(a).

(9) "Pain" means pain resulting from an injury by accident or occupational disease.

(10) "Presumptive urine drug test" means an initial urine drug test that identifies negative specimens and presumptive positive specimens, and is interpreted through visual examination. Examples include dipstick tests and drug test cups. A health care provider who is providing pain management treatment in the chronic phase to an employee may administer a presumptive urine drug test that is qualitative and interpreted or analyzed with instrumental or chemical assistance if the health care provider believes, in his or her medical opinion, that a more sensitive presumptive urine drug test is appropriate and is likely to reduce the need for a confirmatory urine drug test.

(11) "Short-acting opioid" means any targeted controlled substance with a quick onset of action and short duration of analgesic activity that is formulated for dosing at intervals of two to six hours.

(12) "Targeted controlled substance" means any controlled substance included in G.S. 90-90(1) or (2) or G.S. 90-91(d).

History

  • Authority G.S. 97-25.4; 97-80(a); S.L. 2017-203, s. 4
  • Eff. May 1, 2018
  • Recodified from 04 NCAC 10M .0102 Eff. June 1, 2018.
11 NCAC 23M .0103 Waiver of Rules {#sec-11-ncac-23m-.0103 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23M .0103}

In the interests of justice or to promote judicial economy, the Commission may, except as otherwise provided by the rules in this Subchapter, waive or vary the requirements or provisions of any of the rules in this Subchapter in a case pending before the Commission upon written application of a party or upon its own initiative. Factors the Commission shall use in determining whether to grant the waiver are:

(1) the necessity of a waiver;

(2) the party's responsibility for the conditions creating the need for a waiver;

(3) the party's prior requests for a waiver;

(4) the precedential value of such a waiver;

(5) notice to and opposition by the opposing parties; and

(6) the harm to the party if the waiver is not granted.

History

  • Authority G.S. 97-25; 97-25.4; 97-80(a); S.L. 2017-203, s. 4
  • Eff. May 1, 2018
  • Recodified from 04 NCAC 10M .0103 Eff. June 1, 2018.
11 NCAC 23M .0201 FIRST PRESCRIPTION OF MEDICATION FOR PAIN in AN acute phase {#sec-11-ncac-23m-.0201 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23M .0201}

(a) This Rule applies to the first prescription of any medication to an employee for pain in an acute phase.

(b) Before prescribing a targeted controlled substance, a health care provider shall document his or her medical opinion in the medical record that non-pharmacological and non-opioid therapies are insufficient to treat the employee's pain.

(c) A health care provider shall not prescribe more than one targeted controlled substance at the time of the first prescription. A health care provider shall not provide at the time of the first prescription any additional prescription for a targeted controlled substance to be dispensed at a later time.

(d) A health care provider shall prescribe the lowest number of days' supply of a targeted controlled substance necessary in his or her medical opinion to treat an employee's pain, not to exceed a five-day supply. However, the first prescription of any targeted controlled substance for post-operative pain immediately following a surgical procedure may exceed five days but shall not exceed a seven-day supply.

(e) A health care provider shall prescribe the lowest effective dosage of a targeted controlled substance, not to exceed a 50 mg morphine equivalent dose per day, using only short-acting opioids. However, a health care provider may prescribe more than a 50 mg morphine equivalent dose per day, if the employee was being prescribed a targeted controlled substance immediately prior to the first prescription. The dosage limits in this Paragraph apply only to an opioid prescription being prescribed pursuant to this Rule.

(f) A health care provider shall not prescribe transcutaneous, transdermal, transmucosal, or buccal opioid preparations without documentation in the medical record that oral opioid dosing is medically contraindicated for the employee.

(g) A health care provider shall not prescribe fentanyl for pain in an acute phase.

(h) A health care provider shall not prescribe benzodiazepines for pain or as muscle relaxers in an acute phase.

(i) A health care provider shall not prescribe carisoprodol and a targeted controlled substance in an acute phase.

(j) If an employee is taking benzodiazepines or carisoprodol prescribed by another health care provider, the health care provider shall not prescribe a targeted controlled substance to the employee without advising the employee of the potential risks of combining a targeted controlled substance and benzodiazepines or carisoprodol. The health care provider shall also communicate with the health care provider prescribing the benzodiazepines or carisoprodol to inform that health care provider of the prescription of a targeted controlled substance.

(k) A health care provider shall review the information in the CSRS pertaining to the employee for the 12-month period preceding the first prescription. The health care provider shall document in the medical record the review and any potential contraindications to prescribing a targeted controlled substance found in the CSRS. The effective date of this Paragraph is November 1, 2018, or shall coincide with the date of application in S.L. 2017-74, s. 15.(e), and any amendments thereto, whichever is earlier.

History

  • Authority G.S. 90-106(a3); 90-113.74C(a); 97-25; 97-25.4; 97-80(a); S.L. 2017-203, s. 4
  • Eff. May 1, 2018
  • Recodified from 04 NCAC 10M .0201 Eff. June 1, 2018.
11 NCAC 23M .0202 PRESCRIPTION OF MEDICATION FOR PAIN IN AN ACUTE PHASE following the first prescription {#sec-11-ncac-23m-.0202 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23M .0202}

(a) This Rule applies to prescriptions for medication to an employee for pain during an acute phase that are written after a first prescription as described in Rule .0201 of this Section.

(b) Before prescribing a targeted controlled substance, a health care provider shall document his or her medical opinion in the medical record that non-pharmacological and non-opioid therapies are insufficient to treat the employee's pain.

(c) A health care provider shall not prescribe more than one targeted controlled substance at a time in an acute phase.

(d) A health care provider shall prescribe the lowest number of days' supply of a targeted controlled substance necessary in his or her medical opinion to treat an employee's pain.

(e) A health care provider shall prescribe the lowest effective dosage of a targeted controlled substance, not to exceed 50 mg morphine equivalent dose per day, using only short-acting opioids. However, the health care provider may prescribe a morphine equivalent dose higher than 50 mg per day, but not higher than 90 mg per day, after documenting the medical justification for the prescription, including a comparison of the expected benefits to the employee versus any potential risks of increasing the employee's dosage. If the health care provider prescribes a morphine equivalent dose higher than 50 mg per day in an acute phase, the health care provider shall review at all subsequent evaluations whether the employee experienced the expected benefits and consider whether to continue the higher dosage and document the medical record accordingly. The dosage limits in this Paragraph apply only to an opioid prescription being prescribed pursuant to this Rule.

(f) A health care provider shall not prescribe transcutaneous, transdermal, transmucosal, or buccal opioid preparations without documentation in the medical record that oral opioid dosing is medically contraindicated for the employee.

(g) A health care provider shall not prescribe fentanyl for pain in an acute phase.

(h) A health care provider shall not prescribe benzodiazepines for pain or as muscle relaxers in an acute phase.

(i) A health care provider shall not prescribe carisoprodol and a targeted controlled substance in an acute phase.

(j) If an employee is taking benzodiazepines or carisoprodol prescribed by another health care provider, the health care provider shall not prescribe a targeted controlled substance to the employee without advising the employee of the potential risks of combining a targeted controlled substance and benzodiazepines or carisoprodol. The health care provider shall also communicate with the health care provider prescribing the benzodiazepines or carisoprodol to inform that health care provider of the prescription of a targeted controlled substance.

(k) A health care provider shall review the information in the CSRS pertaining to the employee for the preceding 12-month period every time the health care provider prescribes a targeted controlled substance in an acute phase. The health care provider shall document in the medical record the review and any potential contraindications to prescribing a targeted controlled substance found in the CSRS. The effective date of this Paragraph is November 1, 2018, or shall coincide with the date of application in S.L. 2017-74, s. 15.(e), and any amendments thereto, whichever is earlier.

(l) After an employee has received the first prescription of a targeted controlled substance as described in Rule .0201 of this Section and an additional 30 days of treatment with a targeted controlled substance, the health care provider may only continue treatment with a targeted controlled substance after fulfilling the following requirements:

(1) The health care provider shall administer and document in the medical record the results of a presumptive urine drug test as defined in Rule .0102 of this Subchapter. The health care provider may meet this requirement by requiring that the employee take a random, unannounced urine drug test. If the test results are positive for non-disclosed drugs or negative for prescribed controlled substances, the health care provider shall obtain confirmatory urine drug testing as defined in Rule .0102 of this Section. Nothing herein prevents a health care provider from ordering confirmatory urine drug testing for a medical reason other than the presumptive urine drug test results if the medical reason is documented in the medical record. The health care provider may obtain the confirmatory urine drug test results before prescribing a targeted controlled substance. Alternatively, the health care provider may order a limited supply of a targeted controlled substance pending the results of the confirmatory urine drug test. The results of any confirmatory urine drug test shall be documented in the medical record.

(2) The health care provider shall administer and document in the medical record the results of a tool for screening and assessing opioid risk that has been validated by clinical studies. Examples of these tools include the following:

(A) NIDA Quick Screen V1.0 and NIDA-Modified ASSIST V2.0 (National Institute on Drug Abuse), available at

https://www.drugabuse.gov/sites/default/files/files/QuickScreen_Updated_2013(1).pdf;

(B) Screener and Opioid Assessment for Patients with Pain (SOAPP)® Version 1.0 (Inflexxion, Inc.), available at http://nhms.org/sites/default/files/Pdfs/SOAPP-14.pdf;

(C) SOAPP-Revised (Inflexxion, Inc.), available at https://www.painedu.org; and

(D) Opioid Risk Tool (ORT) (Lynn Webster, MD), available at http://agencymeddirectors.wa.gov/Files/opioidrisktool.pdf.

(3) The health care provider shall review and document in the medical record whether the information obtained by complying with Paragraph (k) of this Rule or Subparagraphs (1) or (2) of this Paragraph, or any other aspects of the employee's medical records or examination, indicate an increased risk for opioid-related harm. If the health care provider continues the prescription of a targeted controlled substance despite any increased risks identified, the health care provider shall document in the medical record the reasons justifying the continued prescription.

History

  • Authority 97-25; 97-25.4; 97-80(a); S.L. 2017-203, s. 4
  • Eff. May 1, 2018
  • Recodified from 04 NCAC 10M .0202 Eff. June 1, 2018.
11 NCAC 23M .0203 Prescription of Medication for Pain in a Chronic Phase {#sec-11-ncac-23m-.0203 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23M .0203}

(a) This Rule applies to prescriptions for medication to an employee for pain during a chronic phase.

(b) Before prescribing a targeted controlled substance, a health care provider shall document his or her medical opinion in the medical record that non-pharmacological and non-opioid therapies are insufficient to treat the employee's pain.

(c) A health care provider shall not prescribe more than one targeted controlled substance at a time in a chronic phase without documentation of justification in the medical record. A health care provider shall not prescribe more than two targeted controlled substances at a time in a chronic phase, to include no more than one short-acting opioid and one long-acting or extended-release opioid.

(d) A health care provider shall prescribe the lowest number of days' supply of a targeted controlled substance necessary in his or her medical opinion to treat an employee's pain.

(e) A health care provider shall prescribe the lowest effective dosage of a targeted controlled substance, not to exceed 50 mg morphine equivalent dose per day.

(1) However, the health care provider may prescribe a morphine equivalent dose higher than 50 mg per day, but not higher than 90 mg per day, after documenting the medical justification for the prescription, including a comparison of the expected benefits to the employee versus any potential risks of increasing the employee's dosage. If the health care provider prescribes a morphine equivalent dose higher than 50 mg per day in the chronic phase, the health care provider shall review at all subsequent evaluations whether the employee experienced the expected benefits and consider whether to continue the higher dosage and document the medical record accordingly.

(2) If a health care provider considers it necessary to prescribe a morphine equivalent dose higher than 90 mg per day to treat an employee's pain, the health care provider shall seek preauthorization from the employer or carrier. If the employer or carrier authorizes, or the Commission orders, authorization of a prescription of a morphine equivalent dose higher than 90 mg per day, the health care provider shall review at all subsequent evaluations whether the employee experienced the expected benefits of the increased dosage and consider whether to continue the higher dosage and document the medical record accordingly.

The dosage limits in this Paragraph apply only to an opioid prescription being prescribed pursuant to this Rule.

(f) A health care provider shall not prescribe transcutaneous, transdermal, transmucosal, or buccal opioid preparations included in G.S. 90-90(1) or (2) without documentation in the medical record that oral opioid dosing is medically contraindicated for the employee.

(g) A health care provider shall seek preauthorization from the employer or carrier before prescribing transdermal fentanyl. A health care provider shall seek preauthorization from the employer or carrier before prescribing methadone for pain in a chronic phase.

(h) A health care provider shall not prescribe benzodiazepines for pain or as muscle relaxers in a chronic phase.

(i) A health care provider shall seek preauthorization from the employer or carrier before prescribing carisoprodol and a targeted controlled substance in a chronic phase. A health care provider shall advise the employee of the potential risks of combining a targeted controlled substance and carisoprodol if both medications are prescribed.

(j) If an employee is taking benzodiazepines or carisoprodol prescribed by another health care provider, the health care provider shall not prescribe a targeted controlled substance to the employee without advising the employee of the potential risks of combining a targeted controlled substance and benzodiazepines or carisoprodol. The health care provider shall also communicate with the health care provider prescribing the benzodiazepines or carisoprodol to inform that health care provider of the prescription of a targeted controlled substance.

(k) A health care provider shall review the information in the CSRS pertaining to the employee for the preceding 12-month period at every appointment with the employee at which a targeted controlled substance is prescribed or every three months, whichever is more frequent. The health care provider shall document in the medical record the review and any potential contraindications to prescribing a targeted controlled substance found in the CSRS. The effective date of this Paragraph is November 1, 2018, or shall coincide with the date of application in S.L. 2017-74, s. 15.(e), and any amendments thereto, whichever is earlier.

(l) Before first prescribing a targeted controlled substance in a chronic phase, a health care provider shall administer and document in the medical record the results of a presumptive urine drug test as defined in Rule .0102 of this Subchapter.

(m) Following compliance with Paragraph (l) of this Rule, a health care provider shall administer a presumptive urine drug test as defined in Rule .0102 of this Subchapter and document the results in the medical record a minimum of two times per year and a maximum of four times per year during a chronic phase, unless additional urine drug tests are authorized by the employer or carrier at the request of the health care provider. The limitation on the number of urine drug tests to be conducted per year without authorization by the employer or carrier for additional urine drug tests shall not apply in those cases where a patient is being prescribed targeted controlled substances for the purpose of substance use disorder treatment in addition to pain management.

(n) The health care provider may meet the requirements of Paragraphs (l) and (m) by requiring that the employee take random, unannounced urine drug tests.

(o) If the result of a presumptive urine drug test administered pursuant to this Rule is positive for non-disclosed drugs or negative for prescribed medications, the health care provider shall obtain confirmatory urine drug testing as defined in Rule .0102 of this Subchapter. The health care provider may obtain the confirmatory urine drug test results before prescribing a targeted controlled substance. Alternatively, the health care provider may order a limited supply of a targeted controlled substance pending the results of the confirmatory urine drug test. The results of any confirmatory urine drug test shall be documented in the medical record. Nothing herein prevents a health care provider from ordering a confirmatory urine drug test for a medical reason other than the presumptive urine drug test results if the medical reason is documented in the medical record.

(p) If an employee's medical treatment involving the prescription of targeted controlled substances is transferred to a health care provider in a different health care practice from the one that administered the opioid risk screening and assessment tool required by Rule .0202(l)(2) of this Section, the new health care provider shall administer and document in the medical record the results of a tool for screening and assessing opioid risk that has been validated by clinical studies, including those in Rule .0202(l)(1)(A) through (D) of this Section.

(q) A health care provider shall document in the medical record whether the information obtained by complying with Paragraphs (k), (l), (m), (o) or (p) of this Rule indicates an increased risk for opioid-related harm. If the health care provider continues the prescription of a targeted controlled substance despite any increased risks identified, the health care provider shall document in the medical record the reasons justifying the continued prescription.

History

  • Authority 97-25; 97-25.4; 97-80(a); S.L. 2017-203, s. 4
  • Eff. May 1, 2018
  • Recodified from 04 NCAC 10M .0203 Eff. June 1, 2018.
11 NCAC 23M .0301 Co-Prescription of Opioid Antagonist {#sec-11-ncac-23m-.0301 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23M .0301}

(a) A health care provider prescribing a targeted controlled substance shall consider co-prescribing an opioid antagonist to the following:

(1) employees taking benzodiazepines and a targeted controlled substance;

(2) employees whose dosage exceeds a 50 mg morphine equivalent dose per day;

(3) employees with a history of drug overdose;

(4) employees with a history of substance use disorder;

(5) employees with a history of an underlying mental health condition that places them at an increased risk for overdose;

(6) employees with a medical condition such as respiratory disease, sleep apnea, or other comorbidities that places them at an increased risk for opioid toxicity, respiratory distress, or opioid overdose.

(b) If a health care provider prescribes an opioid antagonist pursuant to one or more of the conditions listed in Paragraph (a) of this Rule, the health care provider shall write the prescription to allow for product selection by the employer or carrier, including an intranasal formulation approved by the United States Food and Drug Administration.

History

  • Authority 97-25; 97-25.4; 97-80(a); S.L. 2017-203, s. 4
  • Eff. May 1, 2018
  • Recodified from 04 NCAC 10M .0301 Eff. June 1, 2018.
11 NCAC 23M .0401 Non-Pharmacological Treatment for Pain {#sec-11-ncac-23m-.0401 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23M .0401}

(a) A health care provider shall consider and may prescribe non-pharmacological treatments for pain. Examples of these treatments include the following: physical therapy, chiropractic services, acupuncture, massage, cognitive behavioral therapy, biofeedback, and functional restoration programs.

(b) The employer or carrier may request additional information from the health care provider regarding the prescribed treatment by any method allowed pursuant to the Workers' Compensation Act.

History

  • Authority 97-25.4; 97-80(a); S.L. 2017-203, s. 4
  • Eff. May 1, 2018
  • Recodified from 04 NCAC 10M .0401 Eff. June 1, 2018.
11 NCAC 23M .0501 treatment FOR SUBSTANCE USE DISORDER INVOLVING a targeted controlled substance {#sec-11-ncac-23m-.0501 omnilex-key=us-nc-regs-official--title-11--11 NCAC 23M .0501}

(a) If a health care provider believes, in his or her medical opinion, that an employee may benefit from an evaluation for discontinuation or tapering of a targeted controlled substance or for treatment for substance use disorder involving a targeted controlled substance, the health care provider may refer the employee to a health care provider specializing in such treatment for evaluation. The employer or carrier may request additional information from the health care provider regarding the referral by any method allowed pursuant to the Workers' Compensation Act.

(b) If treatment is recommended following the evaluation referenced in Paragraph (a) of this Rule, the employer or carrier may request additional information from the recommending health care provider regarding the treatment by any method allowed pursuant to the Workers' Compensation Act.

History

  • Authority 97-25.4; 97-80(a); S.L. 2017-203, s. 4
  • Eff. May 1, 2018
  • Recodified from 04 NCAC 10M .0501 Eff. June 1, 2018.

Chapter 24 Pharmacy Benefits Management

11 NCAC 24 .0101 Definitions: License Applications {#sec-11-ncac-24-.0101 omnilex-key=us-nc-regs-official--title-11--11 NCAC 24 .0101}

(a) The definitions contained in G.S. 58-56A-1, including subsequent amendments, are incorporated into this Chapter by reference.

(b) The following definitions apply in this Chapter:

(1) "Control" means the term as defined in G.S. 58-19-5(2).

(2) "Insurance" means any coverage offered or provided by an insurer.

(3) "Material modification" means any material change in a Pharmacy Benefits Manager (PBM)'s ownership, control, or other fact or circumstance affecting the PBM's qualification for a license in this State.

(c) The following items shall be filed in order to constitute a complete application submission for initial or renewal PBM licensure:

(1) Transmittal form;

(2) A completed pharmacy benefits application form as set forth in G.S. 58-56A-2(b);

(3) Biographical form(s) completed by principal officers;

(4) All organizational documents of the PBM, including any articles of incorporation, articles of association, partnership agreement, trade name certificate, or trust agreement, any other applicable documents, and all amendments to these documents;

(5) The bylaws, rules, regulations, or similar documents regulating the internal affairs of the PBM;

(6) Annual financial statements or reports for the two most recent years that prove that the applicant is solvent and any other information the Commissioner may require in order to review the current financial condition of the applicant;

(7) A general description of the business operations, including information on staffing levels and activities proposed in this State and nationwide. The description must provide details setting forth the PBM's capability for providing a sufficient number of experienced and qualified personnel in the areas of claims processing and record keeping;

(8) A power of attorney duly executed by the PBM, if not domiciled in North Carolina, appointing the Commissioner as attorney for the PBM in and for this State, upon whom process in any legal action or proceeding against the PBM on a cause of action arising in this State may be served; and

(9) Evidence of maintenance of a fidelity bond, errors and omissions liability insurance or other security.

(d) Each applicant shall make available for inspection by the Commissioner copies of all contracts with insurers or other persons using the services of the PBM.

(e) An applicant or PBM shall notify the Commissioner of any material modification within 30 business days after the change.

(f) Copies of all forms may be obtained from the Department.

History

  • Authority G.S. 58-2-40; 58-16-30; 58-19-5; 58-56A-2
  • Eff. September 1, 2025.
11 NCAC 24 .0102 Fees {#sec-11-ncac-24-.0102 omnilex-key=us-nc-regs-official--title-11--11 NCAC 24 .0102}

(a) The initial application fee for a PBM license shall be two thousand dollars ($2,000).

(b) The annual renewal fee for a PBM license shall be one thousand five hundred dollars ($1,500).

History

  • Authority G.S. 58-2-40; 58-56A-2
  • Eff. September 1, 2025.
11 NCAC 24 .0103 Financial Statements {#sec-11-ncac-24-.0103 omnilex-key=us-nc-regs-official--title-11--11 NCAC 24 .0103}

The financial statements required by 11 NCAC 24 .0101(c)(6) shall include a balance sheet, a statement of operations, and a statement of cash flows for the PBM's two most recent fiscal years. Financial statements shall be prepared by an independent certified public accountant. Financial statements of a PBM's parent company are acceptable if those statements contain consolidating schedules that include a breakout of the finances of the PBM, and if the certified public accountant's opinion letter does not disclaim association with the consolidating schedules.

History

  • Authority G.S. 58-2-40; 58-2-205; 58-56A-2
  • Eff. September 1, 2025.
11 NCAC 24 .0104 Determination of Financial Responsibility {#sec-11-ncac-24-.0104 omnilex-key=us-nc-regs-official--title-11--11 NCAC 24 .0104}

In determining the financial responsibility of an applicant for a PBM license, the Department shall require that an applicant be solvent. In addition, the Department shall consider:

(1) Liquidity;

(2) Any internal controls the applicant may have in place to afford protection for benefit plans, which may include the manner in which benefit plan fund accounts are established; and

(3) Segregation of duties.

History

  • Authority G.S. 58-2-40; 58-56A-2
  • Eff. September 1, 2025.
11 NCAC 24 .0105 Claim Processing by Pbms {#sec-11-ncac-24-.0105 omnilex-key=us-nc-regs-official--title-11--11 NCAC 24 .0105}

A PBM or an employee of a PBM does not have to have a license to adjust insurance claims for an insurer with which the PBM has a written agreement to provide claims processing services.

History

  • Authority G.S. 58-2-40; 58-56A-1(4); 58-56A-2
  • Eff. September 1, 2025.
11 NCAC 24 .0106 Payment of Claims {#sec-11-ncac-24-.0106 omnilex-key=us-nc-regs-official--title-11--11 NCAC 24 .0106}

If claims filed with a PBM or insurer are not paid within 30 days after receipt of the initial claim by the PBM or the insurer, the PBM or the insurer shall at that time mail a claim status report to the claimant.

History

  • Authority G.S. 58-2-40; 58-3-225; 58-56A-2
  • Eff. September 1, 2025.
11 NCAC 24 .0107 General Administration {#sec-11-ncac-24-.0107 omnilex-key=us-nc-regs-official--title-11--11 NCAC 24 .0107}

Every PBM shall:

(1) Establish a governing body that is authorized to set policy for the organization.

(2) Maintain complete corporate records in a secure and accessible location.

(3) Employ a management information system that is able to provide information on all areas of the PBM operations.

(4) Set internal policies and procedures for contract management.

History

  • Authority G.S. 58-2-40; 58-56A-2
  • Eff. September 1, 2025.
11 NCAC 24 .0108 Claims Processing {#sec-11-ncac-24-.0108 omnilex-key=us-nc-regs-official--title-11--11 NCAC 24 .0108}

(a) Each PBM's claims processing service shall be supported by a set of written policies, procedures, and performance standards related to timeliness in payment of claims and its financial operations.

(b) Each PBM shall develop and implement a claims processing internal audit and a quality assurance program to monitor and improve claims processing services.

(c) Each PBM shall be accessible to insureds, insurers, and pharmacists by telephone to respond to inquiries about claims payments.

History

  • Authority G.S. 58-2-40;58-56A-1(4); 58-56A-2
  • Eff. September 1, 2025.

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