NMSA 1978, § 59A-17-1 Short title
59A-17-1. Short title
Chapter 59A, Article 17 NMSA 1978 may be cited as the "Insurance Rate Regulation Law".
Laws 1984, ch. 127, § 299; 2007, ch. 367, § 1.
Insurance Rates and Rating
NMSA 1978 ch. 59A, art. 17
in effectNMSA 1978, § 59A-17-2 Scope of article; exemptions
59A-17-2. Scope of article; exemptions
A. The Insurance Rate Regulation Law applies to all kinds and lines of direct insurance written on risks or operations in this state by any authorized insurer, except:
(1) wet marine and transportation insurance, as defined in Section 59A-7-5 NMSA 1978 [repealed];
(2) life insurance;
(3) variable and fixed annuities; and
(4) health insurance.
B. For purposes of the Insurance Rate Regulation Law, "workers' compensation" insurance includes employer's liability insurance.
C. The superintendent may by order exempt any person or class of persons or any market segment from any or all of the provisions of the Insurance Rate Regulation Law to the extent that the superintendent finds the provision or provisions unnecessary to achieve the purposes of that law.
Laws 1984, ch. 127, § 297; 2007, ch. 367, § 2.
NMSA 1978, § 59A-17-3 Purposes of article
59A-17-3. Purposes of article
A. The purposes of this article are:
(1) to promote the public welfare by regulating insurance rates to the end that they shall not be excessive, inadequate or unfairly discriminatory, and to protect policyholders and the public against the adverse effects of excessive, inadequate or unfairly discriminatory rates;
(2) in general to permit and encourage, as an effective way to produce rates that conform to the foregoing, independent action by and reasonable price competition among insurers;
(3) to provide formal regulatory controls for use where independent actions and price competition fail;
(4) to authorize cooperative action among insurers in the rate-making process, and to regulate such cooperation in order to prevent practices tending to create monopoly or to lessen or destroy competition;
(5) to encourage efficient and economic marketing practices; and
(6) to regulate that part of the insurance business which is subject to this article, in a manner to preclude application of federal antitrust laws.
B. The provisions of this article shall be liberally interpreted to effectuate the above purposes.
Laws 1984, ch. 127, § 298.
NMSA 1978, § 59A-17-4 Definitions
59A-17-4. Definitions
As used in the Insurance Rate Regulation Law:
A. "advisory organization" means an entity, including its affiliates or subsidiaries, that either has two or more member insurers or is controlled either directly or indirectly by two or more insurers, and that assists insurers in the promulgation of policy forms; in ratemaking activities, such as the collection, compilation and furnishing of loss or expense statistics; or in the recommendation, making or filing of rates, prospective loss costs, supplementary rate information, policy forms or endorsements. Two or more insurers having a common ownership or operating in New Mexico under common management or control constitute a single insurer for purposes of this definition;
B. "commercial insurance" means any line or kind of property or casualty insurance not for personal, family or household needs;
C. "market" means any line or kind of insurance or any subdivision thereof or any class of risks or combination of classes;
D. "residual market mechanism" means an arrangement, either voluntary or mandated by law, involving participation by insurers in the equitable apportionment among them of insurance that may be afforded applicants who are unable to obtain insurance through ordinary methods;
E. "reverse competition" means a marketplace situation where the placement of a line, kind or class of insurance with insurers is determined primarily or exclusively by parties other than the policyholders;
F. "supplementary rate information" includes any manual or plan of rates, classification, rating schedule, minimum premium, policy fee, rating rule, underwriting rule and any other information needed to determine the applicable rate in effect or to be in effect; and
G. "supporting information" means:
(1) the experience and judgment of the filer and the experience or data of other insurers or advisory organizations relied upon by the filer;
(2) the interpretation of any other data relied upon by the filer;
(3) descriptions of methods used in making the rates; and
(4) any other information required by the superintendent to be filed.
Laws 1984, ch. 127, § 300; 2007, ch. 367, § 3.
NMSA 1978, § 59A-17-5 Administration of insurance rate regulatory law
59A-17-5. Administration of insurance rate regulatory law
The provisions of Chapter 59A, Article 17 NMSA 1978 shall be administered by the superintendent.
Laws 1984, ch. 127, § 301; 1999, ch. 289, § 23.
NMSA 1978, § 59A-17-5.1 Underwriting guidelines
59A-17-5.1. Underwriting guidelines
A. The superintendent may direct an insurer writing homeowners insurance, private passenger non-fleet automobile insurance or other lines, kinds or classes of noncommercial insurance in New Mexico to file with the superintendent underwriting guidelines that determine the acceptance of applicants and tiering guidelines that determine the placement of applicants and insureds into rating tiers, regardless of whether such tiers exist within the insurer or within a group of insurers under common ownership or management.
B. The superintendent, after notice and hearing, may order an insurer to cease using underwriting or tiering guidelines that are unfairly discriminatory or that fail to place applicants and insureds into tiers in a clear, objective, risk-based and mutually exclusive manner.
C. Filings made pursuant to this section shall be considered confidential trade secrets under the Uniform Trade Secrets Act [57-3A-1 to 57-3A-7 NMSA 1978].
Laws 2007, ch. 367, § 7.
NMSA 1978, § 59A-17-6 Rate standards
59A-17-6. Rate standards
A. Rates shall not be excessive, inadequate or unfairly discriminatory, nor shall an insurer charge any rate that, if continued, will have or tend to have the effect of destroying competition or creating a monopoly.
B. In a competitive market, rates are presumed not to be excessive.
C. In a noncompetitive market, rates are excessive if they are likely to produce a profit that is unreasonably high in relation to the riskiness of the line, kind or class of business, or if expenses are unreasonably high in relation to the services rendered.
D. Rates are inadequate if they are clearly insufficient, together with the investment income attributable to them, to sustain projected losses and expenses in the line, kind or class of business to which they apply.
E. There is unfair discrimination if one rate is unfairly discriminatory in relation to another in the same line, kind or class if it clearly fails to reflect equitably the differences in expected losses and expenses. Rates are not unfairly discriminatory because different premiums result for policyholders with like loss exposures but different expense factors, or like expense factors but different loss exposures, so long as the rates reflect the differences with reasonable accuracy. Rates are not unfairly discriminatory if they are averaged broadly among persons insured under a group, franchise or blanket policy or a mass marketing plan.
Laws 1984, ch. 127, § 302; 2007, ch. 367, § 8.
NMSA 1978, § 59A-17-6.1 Competitive market
59A-17-6.1. Competitive market
A competitive market is presumed to exist unless the superintendent, after notice and hearing, determines that a reasonable degree of competition does not exist within a market and issues a ruling to that effect. The ruling shall expire three years after issue unless rescinded earlier by the superintendent or unless the superintendent renews the ruling after a hearing and a finding as to the continued lack of a reasonable degree of competition. Any ruling that finds that competition does not exist shall identify the factors that cause the market not to be competitive and may also include a plan for enhancing competition. The superintendent shall monitor the degree and continued existence of competition in New Mexico on an ongoing basis. An interested party may petition the superintendent to initiate a hearing to examine whether a particular market is competitive or whether a particular market is no longer noncompetitive.
2007, ch. 367, § 4.
NMSA 1978, § 59A-17-6.2 Reverse competitive market
59A-17-6.2. Reverse competitive market
A reverse competitive market for a line, kind or class of insurance is presumed to exist wherever the placement of a line, kind or class of insurance with insurers is determined primarily or exclusively by parties other than the policyholders. The superintendent may, by notice and hearing, establish rules for determining the specific lines, kinds or classes of insurance that, for the purposes of the Insurance Rate Regulation Law, are reversely competitive.
Laws 2007, ch. 367, § 5.
NMSA 1978, § 59A-17-7 Rating methods
59A-17-7. Rating methods
In determining whether rates comply with the rate standards, the following criteria shall be applied:
A. due consideration shall be given to past and prospective loss and expense experience within and without this state, to catastrophic hazards and contingencies, to trends within and without this state, to loadings for leveling premium rates over time or for dividends or savings to be allowed or returned by insurers to their policyholders, members or subscribers and to all other relevant factors, including the judgment of technical personnel;
B. risks may be classified in any reasonable way for the establishment of rates and minimum premiums, except that classifications may not be based on race, color, creed or national origin;
C. the expense provisions included in the rates to be used by an insurer may reflect the operating methods of the insurer and, so far as it is credible, its own expense experience; and
D. the rates may contain an allowance permitting a profit that is not unreasonable in relation to the riskiness of the line, kind or class of business. Profit shall include investment income attributable to such rates.
Laws 1984, ch. 127, § 303; 2007, ch. 367, § 9.
NMSA 1978, § 59A-17-7.1 Motor vehicle liability; not-at-fault accidents
59A-17-7.1. Motor vehicle liability; not-at-fault accidents
A. The rates of a motor vehicle liability insurer shall not provide for an increase in the premium if based upon an accident in which the insured is not at fault in any manner as determined by either the accident report or the insurer. If the insurer determines that its insured is at fault contrary to the specific finding of an accident report that the insured is not at fault, the insurer shall reach its conclusion only after an investigation.
B. A motor vehicle liability insurer shall not cancel, or use as a basis for nonrenewal, an insurance policy if such cancellation or nonrenewal is based upon an accident in which the insured is not at fault in any manner as determined by either the accident report or the insurer. If the insurer determines that its insured is at fault contrary to the specific finding of an accident report that the insured is not at fault, the insurer shall reach its conclusion only after an investigation.
C. As used in this section, "motor vehicle liability insurer" means an insurer authorized to transact in this state the business of automobile and motor vehicle bodily injury, property damage liability and physical damage insurance.
D. This section shall not apply if other factors exist, exclusive of the accident in which the insured is not at fault, that allow for a premium increase, cancellation or nonrenewal of an insurance policy under the Insurance Code or rules pursuant to the Insurance Code.
1978 Comp., § 59A-17-7.1, enacted by Laws 1987, ch. 80, § 1; 2007, ch. 367, § 10.
NMSA 1978, § 59A-17-8 Making of rates; workers' compensation; rate calculations; rate classifications
59A-17-8. Making of rates; workers' compensation; rate calculations; rate classifications
A. A workers' compensation insurer shall adhere to a uniform classification system and uniform experience rating system filed with the superintendent by an advisory organization designated by the superintendent.
B. A workers' compensation insurer shall report its experience in accordance with the statistical plans and other reporting requirements in use by the advisory organization designated by the superintendent.
C. Workers' compensation premium rates shall be equalized and calculated on a basis that does not discriminate against or penalize employers who pay higher wages than other employers to workers in the same job classification. The legislature finds that calculating workers' compensation premium rates strictly on the basis of an employer's wages paid discriminates against and penalizes higher-paying employers. The legislature accordingly directs that the superintendent shall:
(1) investigate alternatives to the current method of computing workers' compensation premiums, including but not limited to:
(a) split classification;
(b) payroll cap;
(c) hours worked; and
(d) premium credits;
(2) immediately conduct hearings on the issue, including consideration of other alternatives; and
(3) adopt regulations, to become effective no later than April 1, 1991, to equalize the workers' compensation premium rates employers must pay for workers who perform the same job.
Nothing in this subsection shall be construed to prohibit the use of experience rating or scheduled credits.
D. A workers' compensation insurer may develop subclassifications of the uniform classification system upon which rates may be made. Such subclassifications and their filing shall be subject to all applicable provisions of the Insurance Rate Regulation Law. Data produced from such subclassifications shall be reported in accordance with the statistical plans, uniform classification system and experience rating system in use by the advisory organization designated by the superintendent.
E. Classification assignments may be changed within sixty days of the effective date or renewal date of the policy, provided the employer is given reasonable prior notice of the proposed change in order to object and provided further that the change is based upon an appropriate audit or investigation. The same provisions apply to initial classification assignments for new operations added by the employer so that they may be changed within sixty days of the date the classification assignments are initially established. No subsequent changes shall be made unless the insurer proves, after conducting an audit or investigation, that:
(1) there has been a substantial change in the nature of the work performed; or
(2) the initial assignment was in error due to withheld or inaccurate material information provided by the employer.
F. A workers' compensation insurer may develop rating plans that identify loss experience as a factor to be used. The rating plans and their filing shall be subject to all applicable provisions of the Insurance Rate Regulation Law.
G. The superintendent shall disapprove subclassifications, rating plans or other variations from supplementary rate information filed by a workers' compensation insurer if the insurer fails to demonstrate that the data produced can be reported consistent with the uniform classification system and experience rating system and in such a fashion so as to allow for the application of experience rating filed by the advisory organization designated by the superintendent.
Laws 1984, ch. 127, § 304; 1987, ch. 244, § 1; 1990 (2nd S.S.), ch. 2, § 92; 2007, ch. 367, § 11.
NMSA 1978, § 59A-17-9 Filing of rates
59A-17-9. Filing of rates
A. In regard to filings in competitive markets:
(1) for purposes of this section, reverse competitive markets and residual markets are not competitive markets;
(2) for filings by insurers:
(a) an insurer shall file with the superintendent rates and supplementary rate information prior to their use in New Mexico;
(b) rates to be used in a competitive market for commercial insurance other than workers' compensation and medical professional liability need not be filed; and
(c) insurers that wish to use workers' compensation subclassifications, rating plans, loss costs or other supplementary rate information that differs from items filed by the advisory organization designated by the superintendent shall file with the superintendent relevant subclassifications, rating plans, rates, loss costs, other supplementary rate information and supporting information in accordance with the requirements and provisions of Subsection B of this section; and
(3) for filings by advisory organizations:
(a) with the exception of workers' compensation filings, an advisory organization shall file with the superintendent rates, supplementary rate information and supporting information prior to their use in New Mexico; and
(b) regarding workers' compensation filings, the advisory organization designated by the superintendent shall file with the superintendent rates, supplementary rate information and supporting information in accordance with the requirements and provisions of Subsection B of this section.
B. In regard to filings in noncompetitive, reverse competitive and residual markets:
(1) an insurer or advisory organization shall file with the superintendent rates, supplementary rate information and supporting information for noncompetitive, reverse competitive and residual markets at least thirty days before the proposed effective date;
(2) the superintendent may give written or electronic notice, within thirty days of receipt of the filing, that the superintendent needs additional time, not to exceed thirty days from the date of such notice, to consider the filing;
(3) upon written or electronic application of the insurer or advisory organization, the superintendent may authorize rates to be effective before the expiration of the waiting period or an extension of the waiting period;
(4) a filing shall be deemed to meet the requirements of this section and to become effective unless disapproved pursuant to Section 59A-17-13 NMSA 1978 by the superintendent before the expiration of the waiting period or an extension of the waiting period;
(5) the operation of the deemer provision shall be suspended during a period of not more than sixty days upon written or electronic notice to the insurer or advisory organization that made the filing that additional information is needed to complete the review of the filing. The suspension of the deemer provision may occur only once for a filing. Failure of the insurer or advisory organization to provide the requested information within sixty days shall be deemed a request to withdraw the filing from further consideration. The superintendent shall either approve or disapprove the filing within thirty days of receipt of the requested additional information. Failure of the superintendent to act within the thirty-day period shall result in the filing being deemed to meet the requirements of the Insurance Rate Regulation Law. Neither the insurer nor the superintendent may waive the timeliness requirements of the deemer provisions of this section; and
(6) residual market mechanisms or advisory organizations may file residual market rates.
C. In regard to reference filings, an insurer may file its rates either by filing its final rates or by filing a multiplier and, if applicable, an expense constant adjustment to be applied to prospective loss costs that have been filed by an advisory organization on behalf of the insurer as permitted by Section 59A-17-17 NMSA 1978. Such reference filings shall be made prior to their use or by other methods the superintendent may allow by rule. An insurer that chooses to adopt the prospective loss costs or rates that have been filed by an advisory organization on its behalf for a competitive commercial line other than workers' compensation or medical professional liability need not file.
D. All filings submitted pursuant to this section shall be filed electronically. The superintendent may designate an entity to receive the electronic filings submitted pursuant to this section.
Laws 1984, ch. 127, § 305; 1987, ch. 244, § 2; 2003, ch. 202, § 9; 2007, ch. 367, § 12; 2009, ch. 182, § 1.
NMSA 1978, § 59A-17-10.1 Workers' compensation insurance; policy and rate required for employers not domiciled in state
59A-17-10.1. Workers' compensation insurance; policy and rate required for employers not domiciled in state
No insurer insuring a workers' compensation risk arising from the employment of a worker performing work for an employer in New Mexico, when that employer is not domiciled in New Mexico, shall issue any workers' compensation insurance contract or endorsement of a workers' compensation insurance contract to cover the described risk except in accordance with filings and rates which are lawfully in effect for the insurer as provided in Sections 59A-17-10 and 59A-18-12 NMSA 1978.
Laws 1978 Comp., § 59A-17-10.1, enacted by Laws 1988, ch. 119, § 2.
NMSA 1978, § 59A-17-11 Filings open to inspection
59A-17-11. Filings open to inspection
A filing and supporting information filed under Sections 59A-17-9 and 59A-17-10 NMSA 1978 shall, as soon as filed, be open to public inspection at a reasonable time. A copy of a filing and supporting information may be obtained by a person on request to the superintendent and payment of a reasonable charge. If the insurer or advisory organization believes that information contained in the filing contains material that it considers to be a trade secret, it shall include that information in a separate section of the filing and include a request for the superintendent to consider whether that information should be kept confidential.
Laws 1984, ch. 127, § 307; 1987, ch. 244, § 4; 2007, ch. 367, § 13.
NMSA 1978, § 59A-17-11.1 Consumer information
59A-17-11.1. Consumer information
A. The superintendent shall use, develop or cause to be developed a consumer information system that will provide and disseminate price and other relevant information on a readily available basis to purchasers of homeowners, private passenger non-fleet automobile or property insurance for personal, family or household needs as well as for title insurance, including escrow, closing and settlement charges for one to four family residential property transactions, and for any other types of personal or commercial insurance designated by the superintendent. To the extent deemed necessary and appropriate by the superintendent, insurers, advisory organizations and other persons or organizations involved in conducting the business of insurance in New Mexico, to which this section applies, shall cooperate in the development and utilization of a consumer information system.
B. An insurer writing homeowners insurance or private passenger non-fleet automobile insurance in New Mexico shall, upon renewal or upon the transfer of a policy to another insurer under the same ownership or management as the transferring insurer, provide its policyholders with written notification of their right to obtain from the insurer a detailed written explanation of the reasons why their policy premium has changed or is about to change.
Laws 2007, ch. 367, § 6; 2009, ch. 80, § 2.
NMSA 1978, § 59A-17-12 Insurer must adhere to rates; consent to rate
59A-17-12. Insurer must adhere to rates; consent to rate
A. No insurer shall make or issue a contract or policy of insurance except in accordance with filings or rates that are lawfully in effect for the insurer as provided in the Insurance Rate Regulation Law.
B. Upon written application of the insured stating the underlying reasons that is filed with and approved by the superintendent, a rate in excess of or below that otherwise applicable may be used as to a specific risk.
Laws 1984, ch. 127, § 308; 2007, ch. 367, § 14.
NMSA 1978, § 59A-17-13 Grounds and procedures for disapproval of rates
59A-17-13. Grounds and procedures for disapproval of rates
A. The superintendent shall disapprove a rate for use in a competitive market if the superintendent finds that the rate is inadequate or unfairly discriminatory under the rate standards set forth in Section 59A-17-6 NMSA 1978. The superintendent shall disapprove a rate for use in a noncompetitive, reverse competitive or residual market if the superintendent finds that the rate is excessive, inadequate or unfairly discriminatory under the rate standards set forth in Section 59A-17-6 NMSA 1978.
B. The superintendent may at any time disapprove a filing submitted under the "file and use" provisions of Subsection A of Section 59A-17-9 NMSA 1978 after giving notice of hearing pursuant to the provisions of Subsection A of Section 59A-4-16 NMSA 1978 to every insurer and advisory organization that adopted the rate.
C. The superintendent may disapprove a filing submitted under the "prior approval" provisions of Subsection B of Section 59A-17-9 NMSA 1978:
(1) without a hearing prior to the expiration of the waiting period or an extension of the waiting period. An insurer or advisory organization whose rates are disapproved under this subsection may request a hearing before the superintendent by filing a written request within thirty days of the date of the disapproval notice; or
(2) at any time after the expiration of the waiting period or an extension of the waiting period, after giving notice of hearing pursuant to the provisions of Subsection A of Section 59A-4-16 NMSA 1978 to every insurer and advisory organization that adopted the rate.
D. The superintendent's notice or order of disapproval shall specify the respects in which the rate fails to meet the standards set forth in Section 59A-17-6 NMSA 1978. The notice or order shall state an effective date no sooner than thirty business days after the date of the notice or order when the insurer shall discontinue the use of the rate. The notice or order shall not affect any policy made before the effective date of the notice or order.
Laws 1984, ch. 127, § 309; 1987, ch. 244, § 5; 2007, ch. 367, § 15.
NMSA 1978, § 59A-17-13.1 Discounts on homeowners' policies for burglary protections
59A-17-13.1. Discounts on homeowners' policies for burglary protections
Any insurer licensed to write homeowner's insurance, as defined by the superintendent, within the state shall provide a minimum premium discount of ten percent for houses with electronic alarm systems designed to prevent unauthorized entry into the house. The insurer shall also provide a minimum premium discount of five percent for houses with wrought iron bars covering all the doors and windows of the house. These discounts shall apply to comprehensive coverage and shall be part of the insurer's rate filing. Some or all of the premium discounts required by this section may be omitted upon demonstration to the superintendent in an insurer's rate filing that the discounts are duplicative of other discounts provided by the insurer.
Laws 1993, ch. 103, § 1; 2007, ch. 367, § 17.
NMSA 1978, § 59A-17-13.2 Large commercial policyholders
59A-17-13.2. Large commercial policyholders
A. The superintendent may, by rule, establish a class of large commercial policyholders, to be known as exempt commercial policyholders, that shall be exempt from the rate and form requirements of Chapter 59A, Articles 17 and 18 NMSA 1978, except for form provisions relating to workers' compensation mandatory coverage provisions.
B. In the promulgation of this rule, the superintendent shall consider the following factors in establishing an exempt commercial policyholder class:
(1) the characteristics of insureds that are likely to study and understand the details of their business risks, insurance coverages and exclusions;
(2) the characteristics of insureds that are likely to avail themselves of regular price comparisons between competing insurers and are likely to study and understand the differences and details of pricing proposals that they receive;
(3) the characteristics of insureds that are likely to require individually written policies, as contrasted to insureds that can customarily have their coverage needs met through a compilation of forms with applicability to other insureds as well;
(4) the characteristics of insureds for which filed rates and rating plans are less likely to provide the lowest premiums otherwise consistent with the provisions of the Insurance Rate Regulation Law;
(5) the favorable or adverse experiences with exemptions from regulatory requirements, especially the experience in New Mexico;
(6) the extent to which commercial insureds primarily located in another jurisdiction are subject to similar exemptions or waivers in that jurisdiction; and
(7) any other relevant factors.
C. The superintendent may, by rule, waive some or all of the diligent search requirements related to placement of risks in the approved surplus lines market for some or all of the exempt commercial policyholders.
Laws 2007, ch. 367, § 16.
NMSA 1978, § 59A-17-16 Requirement for supporting information
59A-17-16. Requirement for supporting information
A. By rule, the superintendent may require the filing of supporting data as to any or all kinds or lines of insurance or subdivisions thereof or classes of risks or combinations thereof as the superintendent deems necessary for the proper functioning of the rate monitoring and regulating process. The supporting data shall include:
(1) the experience and judgment of the filer and, to the extent it wishes or the superintendent requires, of other insurers or advisory organizations;
(2) its interpretation of any statistical data relied upon;
(3) descriptions of the actuarial and statistical methods employed in setting the rates; and
(4) any other relevant matters required by the superintendent.
B. Whenever a filing is not accompanied by the information as the superintendent has required under Subsection A of this section, the superintendent may inform the insurer and the filing shall be deemed to be made when the information is furnished.
Laws 1984, ch. 127, § 312; 1987, ch. 244, § 7; 2007, ch. 367, § 18.
NMSA 1978, § 59A-17-17 Use of advisory organization filings
59A-17-17. Use of advisory organization filings
A. An insurer may itself establish rates and supplementary rate information for a market segment based on the factors set forth in Section 59A-17-7 NMSA 1978 or it may in its rate filing incorporate by reference loss costs and other supplementary rate information prepared by an advisory organization, with modification for its own loss experience as the credibility of that experience allows.
B. Nothing in the Insurance Rate Regulation Law shall be construed as requiring an insurer to become a member of or subscriber to any advisory organization.
C. The superintendent may adopt rules establishing standards and administrative procedures to carry out the provisions of this section.
Laws 1984, ch. 127, § 313; 1987, ch. 244, § 8; 1990 (2nd S.S.), ch. 2, § 93; 2003, ch. 202, § 10; 2007, ch. 367, § 19.
NMSA 1978, § 59A-17-17.1 Experience modification factor; workers' compensation claims; New Mexico Works Act
59A-17-17.1. Experience modification factor; workers' compensation claims; New Mexico Works Act
A. Workers' compensation claims by participants as defined in the New Mexico Works Act [Chapter 27, Article 2B NMSA 1978] shall be separately recorded and maintained in the calculation of the experience modification factor used to calculate premiums for the participating employer so that the experience modification factor attributable to claims by participants can be separated from the remainder of the employer's experience modification factor.
B. The separately calculated experience modification factor for the first year of employment of each participant shall not be considered as part of the experience modification factor of any employer. The superintendent of insurance shall promulgate rules to implement this section.
C. For the purpose of this section, "participants" means participants as defined in the New Mexico Works Act.
Laws 1999, ch. 181, § 1.
NMSA 1978, § 59A-17-18 Advisory organizations; license required; obligation to provide service
59A-17-18. Advisory organizations; license required; obligation to provide service
A. No advisory organization shall provide a service relating to the statistical collection or the rates of an insurance subject to the Insurance Rate Regulation Law, and no insurer shall use the services of the organization for such purposes, unless the organization has obtained a license as required by Section 59A-17-19 NMSA 1978.
B. No advisory organization shall refuse to supply a service for which it is licensed in this state to an authorized insurer offering to pay the fair and usual compensation for the services.
Laws 1984, ch. 127, § 314; 2007, ch. 367, § 20.
NMSA 1978, § 59A-17-19 Advisory organizations; licensing
59A-17-19. Advisory organizations; licensing
A. A person, whether domiciled within or outside this state, may apply to the superintendent for license as an advisory organization for the kinds of insurance or subdivisions thereof as are specified in its application. The application shall include:
(1) a copy of its constitution, charter, articles of organization, agreement, association or incorporation and a copy of its bylaws, plan of operation and other rules governing conduct of its business;
(2) a list of its members and subscribers;
(3) the name and address of one or more residents of this state upon whom notices, process affecting it or orders of the superintendent may be served;
(4) a statement showing its technical qualifications for acting in the capacity for which it seeks a license;
(5) payment of the license application fee in an amount specified in Section 59A-6-1 NMSA 1978; and
(6) any other relevant information and documents that the superintendent may require.
B. Every advisory organization that has applied for a license shall promptly notify the superintendent in writing of every material change in the facts or in the documents on which its application was based, or of change in name, address of its process agent under Paragraph (3) of Subsection A of this section. No amendment to a document referred to in Paragraph (1) of Subsection A of this section shall be effective until not less than thirty days after the amendment is filed with the superintendent.
C. If the superintendent finds that the applicant and the individuals through whom it acts are competent, trustworthy and technically qualified to provide the services proposed, and that all requirements of law are met, the superintendent shall within sixty days after completion of the application issue a license to the applicant specifying the authorized activity; otherwise, the superintendent shall refuse to issue the license and shall promptly notify the applicant, specifying the grounds for refusal. The superintendent shall not issue a license if the proposed activity would tend to create a monopoly or lessen or destroy price competition.
D. Licenses issued pursuant to this section shall remain in effect until the licensee withdraws from the state or until the license is suspended or revoked, subject to annual continuation on May 1 of each year by payment of the continuation fee specified in Section 59A-6-1 NMSA 1978.
Laws 1984, ch. 127, § 315; 2007, ch. 367, § 21.
NMSA 1978, § 59A-17-20 Suspension, revocation of license
59A-17-20. Suspension, revocation of license
The superintendent shall promptly revoke the license of an advisory organization if it ceases business or withdraws from this state, and the superintendent may suspend or revoke the license if the superintendent finds after a hearing that:
A. the organization no longer meets the qualifications for licensing; or
B. the organization has failed to file amended documents as required under Section 59A-17-19 NMSA 1978, or has violated or failed to comply with any other material requirement of the Insurance Rate Regulation Law or any other law.
Laws 1984, ch. 127, § 316; 2007, ch. 367, § 22.
NMSA 1978, § 59A-17-21 Conduct of advisory organization
59A-17-21. Conduct of advisory organization
A. An advisory organization shall furnish its services without discrimination to its members and subscribers.
B. An advisory organization shall not adopt any rule, the effect of which would be to prohibit or regulate payment of dividends, savings or unabsorbed premium deposits allowed or returned by insurers to their policyholders, members or subscribers.
Laws 1984, ch. 127, § 317; 2007, ch. 367, § 23.
NMSA 1978, § 59A-17-23 Advisory organizations; appeal by minority
59A-17-23. Advisory organizations; appeal by minority
A member of or subscriber to an advisory organization may appeal to the superintendent from the action or decision of the advisory organization in approving or rejecting a proposed change in or addition to the filings of the advisory organization and the superintendent shall, after a hearing, issue an order approving the action or decision of the advisory organization or directing it to give further consideration to the proposal; or, if the appeal is from the action or decision of the advisory organization in rejecting a proposed addition to its filings, the superintendent may, in the event the superintendent finds that the action or decision was unreasonable, issue an order directing the advisory organization to make an addition to its filings, on behalf of its members and subscribers, in a manner consistent with the superintendent's findings, within a reasonable time after the issuance of the order.
Laws 1984, ch. 127, § 319; 2007, ch. 367, § 24.
NMSA 1978, § 59A-17-25 Joint underwriting, joint reinsurance pool and residual market mechanisms
59A-17-25. Joint underwriting, joint reinsurance pool and residual market mechanisms
A. A group, association or other organization of insurers that engages in joint underwriting, joint reinsurance pools or residual market mechanisms through the group, association or organization or by standing agreement among the members, shall file with the superintendent:
(1) a copy of its constitution, its articles of incorporation, agreement or association and its bylaws and rules governing its activities, all duly certified by the custodian of the originals;
(2) a list of its members; and
(3) the name and address of a resident of this state upon whom notices or orders of the superintendent or process affecting the group, association or organization may be served.
B. Every such group, association or other organization shall notify the superintendent promptly in writing of changes in its constitution, its articles of incorporation, agreement or association, its bylaws and rules governing conduct of its business, its list of members or the name and address of its process agent referred to in Paragraph (3) of Subsection A of this section.
C. Every such group, association or organization shall be subject to regulation as herein provided, subject, however, as to joint underwriting to applicable provisions of the Insurance Rate Regulation Law, and as to joint reinsurance to Sections 59A-17-13, 59A-17-32, 59A-17-34 and 59A-17-35 NMSA 1978.
D. No group, association or organization shall engage in an unfair or unreasonable practice with respect to its activities. If, after a hearing, the superintendent finds that an activity or practice of a group, association or organization is unfair or unreasonable or otherwise inconsistent with the provisions of the Insurance Rate Regulation Law, the superintendent may issue an order specifying the respects in which the activity or practice is unfair or unreasonable or otherwise inconsistent with the provisions of the Insurance Rate Regulation Law and requiring discontinuance of the activity or practice.
Laws 1984, ch. 127, § 320; 1999, ch. 289, § 24; 2007, ch. 367, § 25.
NMSA 1978, § 59A-17-26 Binding agreements by insurers
59A-17-26. Binding agreements by insurers
No insurer shall assume an obligation to a person other than a policyholder or other insurers that with it are under common control or management or are members of a joint underwriting organization subject to the provisions of Section 59A-17-25 NMSA 1978, to use or adhere to certain rates or rules, and no other person shall impose a penalty or other adverse consequence for failure of an insurer to adhere to certain rates or rules except as to action by the superintendent in enforcement of Section 59A-17-12 NMSA 1978.
Laws 1984, ch. 127, § 321; 2007, ch. 367, § 26.
NMSA 1978, § 59A-17-27 Cooperative activities authorized
59A-17-27. Cooperative activities authorized
Cooperation among advisory organizations or among organizations and insurers in rate making or in other matters within the scope of the Insurance Rate Regulation Law is hereby authorized, provided the filings resulting from the cooperation are subject to provisions of the Insurance Rate Regulation Law applicable to filings generally. The superintendent may review the cooperative activities and practices and if, after a hearing, the superintendent finds that the activity or practice is unfair or unreasonable or otherwise inconsistent with the Insurance Rate Regulation Law, the superintendent may issue an order specifying the respects in which the activity or practice is unreasonable or otherwise inconsistent with the Insurance Rate Regulation Law and requiring discontinuance of the activity or practice.
Laws 1984, ch. 127, § 322; 2007, ch. 367, § 27.
NMSA 1978, § 59A-17-28 Recording, reporting of experience
59A-17-28. Recording, reporting of experience
The superintendent shall promulgate or approve reasonable rules, including rules providing statistical plans, for use by all insurers in the recording and reporting of loss and expense experience, so that the experience of an insurer may be made available to the superintendent at least annually in such form and detail as may be necessary to aid the superintendent in determining whether rating systems comply with applicable rate standards and requirements. In promulgating the rules and plans the superintendent shall give due consideration to the rating systems on file with the superintendent and, so that the rules and plans may be as uniform as practicable among the several states, to the rules and form of plans used for rating systems in other states. No insurer shall be required to record or report its experience on a classification basis inconsistent with its own rating system. The superintendent may designate one or more advisory organizations to assist the superintendent in gathering that experience and making compilations of that experience, which shall be made available to insurers, advisory organizations and the public.
Laws 1984, ch. 127, § 323; 2007, ch. 367, § 28.
NMSA 1978, § 59A-17-29 Exchange of data, consultation authorized
59A-17-29. Exchange of data, consultation authorized
A. The superintendent may promulgate reasonable rules and plans for interchange among insurers, advisory organizations and others, of data necessary for application of rating plans.
B. For furtherance of uniformity in administration of rate regulatory laws, the superintendent and every insurer and advisory organization may exchange information and experience data with insurance regulatory officials, insurers and advisory organizations in this and other states and may consult with them as to rate making and the application of rating systems.
Laws 1984, ch. 127, § 324; 2007, ch. 367, § 29.
NMSA 1978, § 59A-17-30 Information to be furnished insureds; hearings and appeals of insureds
59A-17-30. Information to be furnished insureds; hearings and appeals of insureds
A. Every advisory organization and every insurer that makes its own rates shall, within time frames promulgated by the superintendent or, in the absence of time frames, within a reasonable time after receiving written request, furnish to an insured affected by a rate made by it, or to the authorized representative of the insured, all pertinent information as to the rate.
B. Every advisory organization and every insurer that makes its own rates shall provide within this state reasonable means whereby a person aggrieved by the application of its rating system may be heard, in person or by the person's authorized representative, on the person's written request to review the manner in which the rating system has been applied in connection with the insurance afforded the person. If the advisory organization or insurer fails to grant or reject the request within thirty days after it is made, the applicant may proceed in the same manner as if the application had been rejected. A party affected by the action of the rate service organization or the insurer on the request may, within thirty days after written notice of the action, appeal to the superintendent, who, after a hearing, may affirm or reverse the action. If, after the hearing, it is determined that the rates charged by an insurer are in excess of the otherwise appropriate rate, the overcharge shall be refunded to the insured.
Laws 1984, ch. 127, § 325; 2007, ch. 367, § 30.
NMSA 1978, § 59A-17-31 False or misleading information
59A-17-31. False or misleading information
No person shall willfully withhold information from, or knowingly give false or misleading information to, the superintendent or statistical agency designated by the superintendent or advisory organization or insurer that will affect rates or rating plans under the Insurance Rate Regulation Law. Violation of this section shall be subject to the penalties provided under Section 59A-1-18 NMSA 1978.
Laws 1984, ch. 127, § 326; 2007, ch. 367, § 31.
NMSA 1978, § 59A-17-32 Examination of advisory and joint underwriting organizations, joint reinsurance pools and residual market mechanisms
59A-17-32. Examination of advisory and joint underwriting organizations, joint reinsurance pools and residual market mechanisms
A. To be informed about any matter related to enforcement of provisions of the Insurance Code [Chapter 59A NMSA 1978], the superintendent may examine the affairs and condition of any advisory or joint underwriting organization, joint reinsurance pool or residual market mechanism. The superintendent shall examine every advisory organization and conduct the examinations at intervals established by rules promulgated by the superintendent.
B. In lieu of all or part of an examination, or in addition to an examination, the superintendent may order an independent audit by certified public accountants or actuarial evaluation by actuaries approved by the superintendent, or may accept the report of an audit already made by certified public accountants or actuarial evaluation by actuaries approved by the superintendent, or the report of an examination made by the insurance supervisory official of another state.
C. Conduct of the examination, examiners and other personnel used by the superintendent in making the examinations, payment of costs of the examination by the examinee, examination report and review and adoption and the examination in general shall be subject to the applicable provisions of Chapter 59A, Article 4 NMSA 1978.
Laws 1984, ch. 127, § 327; 2007, ch. 367, § 32.
NMSA 1978, § 59A-17-33 Enforcement; cease and desist, injunctions; penalties
59A-17-33. Enforcement; cease and desist, injunctions; penalties
A. The superintendent shall enforce compliance with the provisions of the Insurance Rate Regulation Law. Whenever the superintendent believes that there is a violation of the Insurance Rate Regulation Law and that such violation is continuing, the superintendent shall serve upon the advisory, joint underwriting, joint reinsurance pool, residual market mechanism or insurer or other person violating, as the case may be, notice of a hearing before the superintendent to be held not less than twenty days after service of the notice, and requiring the organization or person to show cause why the superintendent should not order the organization or person to cease and desist from the violation.
B. The superintendent, through the attorney general, may maintain an action to enjoin a continuing violation of the Insurance Rate Regulation Law.
C. After hearing, the superintendent may suspend the license of an advisory organization or insurer that fails to comply with the superintendent's order within the time limited by the order or an extension of time that the superintendent may grant. The suspension shall not become effective until the time prescribed for an appeal has expired, or if an appeal has been taken, until the order has been affirmed; otherwise, the superintendent may determine when the suspension shall become effective, and the suspension shall remain in effect for the period fixed unless the superintendent modifies or rescinds the suspension, or until the order on which suspension is based is modified, rescinded or reversed.
D. If the superintendent finds that a person has violated any provision of the Insurance Rate Regulation Law, the superintendent may impose a penalty of not more than ten thousand dollars ($10,000) for each violation; but if the superintendent finds the violation to be willful, the superintendent may impose a penalty of not more than twenty-five thousand dollars ($25,000) for each violation. Such penalties may be in addition to any other penalty provided by law, and, if not paid voluntarily by the violator, may be collected through civil action in the district court of Santa Fe county in the name of the state of New Mexico on the relation of the insurance board.
E. For the purposes of this section, an insurer using a rate for which the insurer has failed to file the rate, supplementary rate information or supporting information, if Section 59A-17-9 NMSA 1978 requires the materials to be filed, shall have committed a separate violation for each day the failure continues.
Laws 1984, ch. 127, § 328; 2007, ch. 367, § 33.
NMSA 1978, § 59A-17-34 Hearings
59A-17-34. Hearings
A. Any person aggrieved by any action, threatened action or failure to act of the superintendent or otherwise under Chapter 59A, Article 17 NMSA 1978 shall have the same right to a hearing before the superintendent with respect thereto as provided for in general under Section 59A-4-15 NMSA 1978. Notice of hearing shall be given, the hearing conducted, rights and powers exercised and the superintendent's order on hearing made and given as provided as to hearings in general under the applicable provisions of Chapter 59A, Article 4 NMSA 1978.
B. Any person aggrieved by the superintendent's order issued pursuant to this section or by the superintendent's refusal to hold the hearing may appeal the order or refusal to the court of appeals.
Laws 1984, ch. 127, § 329; 1990, ch. 110, § 1; 1999, ch. 289, § 25; 2011, ch. 127, § 13; 2013, ch. 74, § 20.
NMSA 1978, § 59A-17-35 Appeals from superintendent
59A-17-35. Appeals from superintendent
Any order made by the superintendent pursuant to Section 59A-17-34 NMSA 1978, or by the superintendent's refusal to hold a hearing, shall be subject to review by appeal to the court of appeals. The decision of the superintendent shall be set aside only if it is shown that the decision is arbitrary or capricious or reflects an abuse of discretion; is not supported by substantial evidence; or is otherwise not in accordance with the law. Upon institution of the appeal and for good cause shown upon motion and hearing, the court may, in the following cases, stay operation of the superintendent's order:
A. where, pursuant to the Insurance Rate Regulation Law, an advisory organization has been refused a license or an insurer has been refused a certificate of authority or had its license or certificate of authority suspended, it may, with leave of court, be allowed to continue to engage in business, subject to the provisions of the Insurance Rate Regulation Law, pending final disposition of its application for review; or
B. where any order of the superintendent shall provide for a change in a rate or rating system that results in an increase or decrease in rates, an insurer affected may, with leave of court pending final disposition of the proceedings in the court of appeals, continue to charge rates that existed prior to the order, on condition that the difference in the rates be deposited in a special escrow or trust account with a reputable financial institution by the insurer affected, to be held in trust by the insurer and to be retained by the insurer or paid to the holders of policies issued after the order of the court, as the court may determine.
Laws 1984, ch. 127, § 330; 1990, ch. 110, § 2; 1998, ch. 55, § 63; 1999, ch. 265, § 67; 1999, ch. 289, § 26; 2007, ch. 367, § 34; 2013, ch. 74, § 21.
NMSA 1978, § 59A-17-36 Rate filing; failure to submit data; penalty
59A-17-36. Rate filing; failure to submit data; penalty
A. An insurer or advisory organization that makes a rate filing under the Insurance Rate Regulation Law and fails, without reasonable cause, to provide the data requested by the superintendent within thirty working days from the date of the request shall be subject to an administrative penalty as provided in Section 59A-1-18 NMSA 1978.
B. The superintendent may, for good cause shown, grant an extension of the thirty-day time period provided for in Subsection A of this section.
C. The insurer or advisory organization may, within ten days after entry of the order, request a hearing before the superintendent as provided in Section 59A-17-34 NMSA 1978.
1978 Comp., § 59A-17-36, enacted by Laws 1989, ch. 145, § 2; 2007, ch. 367, § 35.
Source: New Mexico Compilation Commission (nmonesource.com)URL: https://nmonesource.com/nmos/nmsa-unanno/en/item/18562/index.doFetched: 10/20/2026