N.Y. Comp. Codes R. & Regs. tit. 11 § 73.1

Current through Register Vol. 46, No. 45, November 2, 2024

Section 73.1 - Definitions

For purposes of this Part, the following definitions shall apply:

(a) Claims-made policy means an insurance policy that covers liability for injury or damage that the insured is legally obligated to pay (including injury or damage occurring prior to the effective date of the policy, but subsequent to the retroactive date, if any), arising out of incidents, acts or omissions, as long as the claim is first made during the policy period or any extended reporting period.

(b) Retroactive date means a date concurrent with the effective date of the policy or a particular date prior to the effective date of the policy upon which the insurer and insured agree in the policy that policy coverage will be applicable.

(c) Prior acts coverage, nose or nose coverage means coverage under the policy for injury or damage that occurs on or after the retroactive date and prior to the effective date of the policy.

(d) Extended reporting period coverage, tail or tail coverage means coverage for that period of time specified in the policy wherein claims first made after termination of coverage under the policy, for injury or damage that occurs during the policy term, or that occurs on or after the retroactive date, if any, will be considered made during the policy term.

(e) Medical malpractice insurance means insurance as defined in section 5501 (b) of the Insurance Law.

(f) Public entity insurance means insurance as defined in section 107 (a)(50) of the Insurance Law.

(g) Large commercial insured means a commercial risk policy insured that:

(1) has a net worth of at least $7,500,000, as determined by an independent certified public accountant, as of the insured's fiscal year end immediately preceding the policy's effective date;

(2) has gross assets exceeding $25,000,000 and a net worth of at least $1,500,000, as determined by an independent certified public accountant, as of the insured's fiscal year end immediately preceding the policy's effective date;

(3) is a for-profit business entity that generates annual gross revenues exceeding $25,000,000, and has a net worth of at least $1,500,000, as determined by an independent certified public accountant, as of the insured's fiscal year end immediately preceding the policy's effective date;

(4) is a for-profit business entity that has gross assets exceeding $25,000,000 and generates annual gross revenues exceeding $25,000,000, as determined by an independent certified public accountant, as of the insured's fiscal year end immediately preceding the policy's effective date; or

(5) is a not-for-profit organization or public entity with an annual budget exceeding $25,000,000 for each of its three fiscal years immediately preceding the policy's effective date.

(h) Excess liability policy means any commercial liability policy, other than an excess motor vehicle liability policy, written over one or more underlying liability policies that in the aggregate provide primary coverage of at least $1,000,000.

(i) Commercial umbrella policy means any such policy as provided for in Part 150 of this Title (Regulation 51).

(j) Occurrence policy means an insurance policy that covers liability for injury or damage that the insured is legally obligated to pay arising out of incidents, acts or omissions that occurred during the policy period, and where a claim may be made during or subsequent to the policy period.

(k) Insurer shall include the Medical Malpractice Insurance Association (MMIA) and the New York Property Insurance Underwriting Association.

(l) Circumstance or incident means any accident, happening or event, including continuous or repeated exposure to the same general harmful conditions (and shall include any intentional act by or at the discretion of the insured which results in personal injury or property damage if such injury or damage arises solely from the use of reasonable force for the purpose of protecting persons or property), which although it has not yet resulted in a claim or claims being made, in writing, against the insured for personal injury or property damage, it is likely to result in a claim or claims being made against the insured at some future date.

(m) Notice of circumstance, circumstance reporting, notice of incident or incident reporting means whenever the insured has information relating to a circumstance or incident and gives notice of such circumstance or incident, in writing, during the period of the policy, or within 60 days (90 days in the case of public entity liability insurance) following expiration of the policy, to the insurer, then any claim, as respects such circumstance or incident, which is made, in writing, against the insured shall be deemed to have been first made on the date upon which the notice of such circumstance or incident was first sent to the insurer.

(n) Termination of coverage means, whether made by the insurer or the insured at any time:

(1) cancellation or nonrenewal of a policy; or

(2) decrease in limits, reduction of coverage, increased deductible or self-insured retention, new exclusion, or any other change in coverage less favorable to the insured.

(o) Professional liability insurance means insurance as defined in section 107 (a)(49) of the Insurance Law.

(p) Claims-made relationship means that period of time between the effective date of the first claims-made policy between the insurer and the insured and the cancellation or nonrenewal of the last consecutive claims-made policy between such parties, where there has been no gap in coverage, but does not include any period covered by extended reporting period coverage.

(q) Physician claims-made relationship means that period of time between the effective date of the first claims-made policy between any insurer and the insured and the cancellation or nonrenewal of the last consecutive claims-made policy between such insurer, or another insurer, and the insured, where there has been no gap in coverage, but does not include any period covered by extended reporting period coverage.

(r) Issue shall include issue for delivery.

(s) Not-for-profit organization means a corporation, association, organization or trust described in section 501(c)(3) of the United States Internal Revenue Code.

N.Y. Comp. Codes R. & Regs. Tit. 11 § 73.1