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General Guidelines for Rate, Form, Territory, Classification and Rule Filings

(PROPERTY BUREAU)

Section V. Other General Instructions, Guidelines, Specifications and Prohibitions

The following is a summary of subjects that either must or must not be contained in your filings, and the required treatment of these subjects in New York. While these may not be "filing or submission requirements", the failure to address them in accordance with the instructions below will result in the rejection of your filing.

NOTE: The following is not an exhaustive subject list. There may be other areas of concern that you may need to address upon completion of this Department’s review of the filing.

Examples of Prohibited Coverages:
Crime Reward,
Punitive Damages and
Corporal Punishment Coverages are not permitted in NY.
The absolute pollution exclusion is not permitted for personal lines policies.

Commercial Policies:
Pursuant to Section 3426 (g)(2) of the New York Insurance Law, loss information must be provided by the insurer, at the insured's request, covering a period of years specified by the Superintendent by regulation or the period of time coverage has been provided by the insurer, whichever is less. NOTE: Since the Superintendent has not specified a period of time by Regulation, the company must provide the insured with loss information covering the period of time the insured has been with the insurer.

Computer Simulation Models:
Pursuant to Circular Letter No. 7 (April 30, 1998), the inclusion of computer simulation modeling results in the ratemaking process is not permitted.

Workers Compensation Drug Free Workplace Premium Credit:
The guidelines listed below must be followed when submitting a filing to the Department requesting a drug-free workplace credit.  Note that  requirements for an insured to qualify as a "drug-free workplace" are shown in item 9 below.

  1. In general, the maximum amount allowed for a drug-free rate credit is 5%. A request for a credit greater than 5% will be reviewed carefully by our actuaries and must contain specific statistical or judgmental support.
  2. Any approved rate modification will be effective for only four years. After four years, the actual experience will be reflected in the experience rating modification.
  3. The drug-free rate credit can only be applied to non-retrospectively rated policies.
  4. The discount should be applied on a multiplicative basis, after the experience modification and before premium discounts and expense constants.
  5. The insurer must verify from the employer the existence of a drug-free environment and explain in its filing how such verification will occur.
  6. The filing should include a copy of the format of the certification of a drug-free workplace that will be sent to all employers. The completed certification by the employer must be filed with the company for each year the modification is permitted under the program. If it is subsequently determined that the insured misrepresented its compliance with the drug-free workplace rules, the insured’s policy will be subject to an additional premium equal to the amount of credit previously granted.
  7. Policy language should include the cancellation and non-renewal guidelines in the New York Workers’ Compensation and Employers Liability Manual.
  8. The insurer must report annually to the New York Compensation Insurance Rating Board the total amount of the drug-free workplace rate modification for all policies, the standard earned premium and the net earned premium.
  9. The following constitute the minimum requirements the Department considers essential in for an insured to qualify as a drug-free workplace environment. These requirements should be included in the filing made to the Department as part of the insurer’s definition of a drug-free workplace.
    • Employers should give all employees a written policy statement notifying them of details of the program, including the consequences of testing positive for controlled substances.
    • An employer that requires an employee or job applicant to submit to a drug test must document the reasonable suspicions that warrant the testing and must provide a copy of the document to the employee upon request.
    • All employees working in safety sensitive positions, as legally allowed by the State, are subject to random urinalysis drug testing. An employee that is involved in an on- the- job accident that requires outside medical attention should submit to a drug test within a reasonable period of time.
    • In addition, the employer must ensure the integrity of the testing system as follows:
      • Specimens must be collected and documented in a manner that safeguards the privacy of the individual and in a manner that prevents substitution or contamination of the specimens.
      • A licensed and approved laboratory must conduct each initial and confirmation test (excluding the taking or collection of a specimen to be tested). If the drug test result is positive, an employee or job applicant may request that a portion of the specimen be re-tested at another certified laboratory.
      • The employee or job applicant must be informed of the test results and may submit information to the designated Medical Review Officer (MRO) explaining or contesting the test results.
      • Insurers, employers, laboratories, employee assistance programs, drug and alcohol rehabilitation programs and their agents must keep all information concerning drug test results confidential.

Duty to Defend:
Payment by the insurer of the policy limit, in the absence of final judgment or settlement, does not discharge the responsibility to defend against an action.

"Other Insurance" Provisions:
In the event that other valid and collectible insurance is applicable to a claim covered under the company's policy, the company may state that its POLICY will either contribute with or be excess over such other insurance in order to avoid duplication of payment on claims. However, the company may not exclude coverage under its policy in the event the insured has other valid and collectible insurance.

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