Section 2339. Charging or receiving of rates; deviations  


Latest version.
  • (a) This section
      shall apply only to kinds of insurance the rates for which  are  subject
      to  prior  approval  pursuant  to subsection (b) of section two thousand
      three hundred five of this article.
        (b) No member of or subscriber to a rate service organization, and  no
      insurer which makes and files its own rates, shall charge or receive any
      rate  which  deviates  from  the  rates,  rating plans, classifications,
      schedules, rules and standards made  and  filed  by  such  rate  service
      organization,  or  by  such  insurer,  as  the  case  may  be, which are
      applicable to any kind or type  of  business  done  by  such  member  or
      subscriber, or by such insurer, except as provided in this article.
        (c)  Any  insurer which is a member of or subscriber to a rate service
      organization may make written  application  to  the  superintendent  for
      permission  to  deviate from the rates, schedules, rating plans or rules
      filed on its behalf by the rate service  organization.  The  application
      shall  specify  the  basis for the modification and a copy shall also be
      sent simultaneously to such rate service  organization.  In  considering
      the  application  to deviate the superintendent shall give consideration
      to the available statistics  and  the  principles  for  rate  making  as
      provided  in section two thousand three hundred four of this article. If
      the superintendent finds the deviation to be justified, he shall approve
      it to be effective for a period to be fixed by him, but in no event  for
      a  period  of  less  than  one  year,  unless  sooner  terminated by the
      applicant with the permission of the  superintendent  or  unless  sooner
      withdrawn  or  appropriately  adjusted by an order of the superintendent
      made in  accordance  with  the  provisions  of  this  article  generally
      applicable  to  rate  filings.  If  the  superintendent  finds  that the
      deviation applied for does not meet the requirements of this article, he
      shall  send  to  the  applicant  written  notice  of  his   disapproval,
      specifying  in  what respects he finds it fails to meet the requirements
      of this article.  The  superintendent  shall  inform  the  rate  service
      organization of his action upon the deviation application.
        (d) (1) Notwithstanding any other provision of law, except as provided
      in  paragraph  three  of this subsection, the state insurance fund shall
      not charge an insured any rate, or receive from an insured any  rate  in
      excess  of  the  total  of  (i) the applicable loss cost approved by the
      superintendent, (ii) the  applicable  expense  component  of  the  state
      insurance fund and (iii) a fair and reasonable differential charge which
      takes  into  consideration  the  nature  and  hazards  of  the insured's
      business  or  operations,  the  insured's  prior  loss  experience,  the
      insured's  prior  and presently existing safety practices, the insured's
      prior premium payment history, the number of persons the insured employs
      in such business or operations  and  the  specific  type  of  work  they
      perform,  the  insured's  prior  and current compliance with obligations
      imposed upon the insured by the workers' compensation law and other laws
      which require premium or other payments by the insured on the  basis  of
      earnings  and  other  remuneration  earned  by  persons  engaged  in the
      furtherance of the insured's enterprise or enterprises,  the  promptness
      and  completeness  of such reports as the insured has filed on accidents
      and claims, and such other factors as may be relevant to  the  appraisal
      of the insured or proposed insured as a risk in whole.
        (2)  A  differential  charge  applied by the state insurance fund to a
      workers' compensation and employer's liability insurance policy  may  be
      challenged  by  the  insured by an appeal to the superintendent after an
      exhaustion by the insured of all internal review procedures of the state
      insurance fund as established by rules adopted by the  commissioners  of
      the state insurance fund and filed with the secretary of state; provided
      that a writing setting forth the grounds upon which such appeal is based
    
      is  served  and  filed with the superintendent and with the secretary to
      the board of commissioners of the state  insurance  fund  within  thirty
      days after a final determination by the state insurance fund. Appeals to
      the  superintendent  shall  be determined upon papers and documents that
      were before the state insurance fund in  connection  with  the  internal
      review  procedures,  the  writing  setting  forth  the  grounds  of  the
      insured's appeal and any answer to  such  appeal  served  by  the  state
      insurance fund upon the insured and filed with the superintendent within
      thirty days after the service of the insured's notice.
        (3) The provisions of this section shall not apply to a policy sold by
      the  state  insurance fund under article six-G of the executive law. The
      rate which the state insurance fund may charge under such article  shall
      be governed only by such regulations or guidelines as the superintendent
      may issue.