2012 New York Consolidated Laws
ISC - Insurance
Article 55 - (5501 - 5517-A) MEDICAL MALPRACTICE INSURANCE ASSOCIATION
5504 - Policies.

 
    §  5504. Policies. (a) No policy form shall be used by the association
  unless it has been filed with  the  superintendent  and  either  he  has
  approved  it,  or thirty days have elapsed and he has not disapproved it
  as misleading or violative of public policy.
    (b) (1) Except as provided in paragraph two  of  this  subsection,  no
  cancellation  notice  or nonrenewal notice shall be effective unless the
  association at least forty-five days prior to the effective date of such
  cancellation or the end of the policy period, as the case may be,  mails
  or  delivers  such  notice  to  the  insured at the address shown on the
  policy and to such insured's licensed representative.
    (2) Where the cancellation is for nonpayment of  premium  or  loss  of
  license  to  practice  or,  if  the  insured is a hospital, it no longer
  possesses a  valid  operating  certificate  under  section  twenty-eight
  hundred one-a of the public health law, such cancellation notice must be
  mailed or delivered at least fifteen days prior to the effective date of
  the cancellation.
    (3)  Upon  written  request  by  an insured or such insured's licensed
  representative, the association shall mail or deliver  loss  information
  as  provided  in  subsection  (g) of section three thousand four hundred
  twenty-six of this chapter to such insured or  such  insured's  licensed
  representative within ten business days of such request.
    (4)  All  cancellation  notices  or nonrenewal notices shall state the
  grounds upon which the policy is cancelled or nonrenewed and that,  upon
  written request of an insured or such insured's licensed representative,
  the  association  will  furnish  the  facts on which the cancellation or
  nonrenewal is based. Grounds for nonrenewal shall be limited to the same
  grounds as for cancellation.  All  cancellation  notices  or  nonrenewal
  notices shall also provide or be accompanied by a statement advising the
  insured  of  the  availability  of  the  loss  information  specified in
  subsection (g) of section three thousand four hundred twenty-six of this
  chapter.
    (c) A policy of insurance issued by the association may be  terminated
  other than for non-payment of premiums if the insured:
    (1)  Is not complying substantially with any term or condition of such
  contract.
    (2) Has knowingly made, or caused to be made, any false  statement  or
  misrepresentation of a material fact for use in applying for insurance.
    (3)  Has  failed  to  pay to the association all stabilization reserve
  fund charges.
    (d) Any termination shall apply to care or services provided after the
  effective date  of  termination,  except  that  insurance  coverage  may
  continue for up to thirty days after termination with respect to care or
  services to patients which are a continuation of a treatment begun prior
  to the effective date of termination.
    (e)  Policies issued by the association shall provide at the insured's
  option for deductibles and for co-insurance. An  applicant  electing  an
  option  for  a  deductible  or  for co-insurance shall have the right to
  purchase an option under which the  association  shall  not  settle  any
  claim  under  the  policy without the consent of the insured. Any policy
  issued by the association without a  deductible  or  co-insurance  shall
  provide that the association shall have the sole authority to settle any
  claim up to policy limits without the consent of the insured.
    (f)  (1)  The  association  shall  issue  or renew policies of medical
  malpractice insurance for physicians  on  a  claims-made  or  occurrence
  basis, as prescribed by the superintendent by regulation.
    (2) A claims-made policy shall contain the following provisions:
    (A) if the insured has purchased a claims-made policy from an admitted
  insurer  or  the  association  for  a period of five or more consecutive

  years and the insured, after attaining the age of sixty-five  or  older,
  retires  permanently and totally from the practice of medicine or if the
  insured has purchased a claims-made policy for a period of ten  or  more
  consecutive years and the insured, after attaining the age of fifty-five
  or older, retires permanently and totally from the practice of medicine,
  the  association  shall, without charging an additional premium therefor
  at the time of, or  subsequent  to,  such  retirement,  also  cover  all
  occurrences  between  the  inception  date of the first such consecutive
  policy from such association and such retirement date which,  subsequent
  to  the  termination date, are reported in accordance with statutory and
  policy requirements;
    (B) if the insured dies or becomes permanently disabled and unable  to
  practice  medicine  while  covered by such policy the association shall,
  without charging an additional premium  therefor  at  the  time  of,  or
  subsequent  to,  such  event,  also  cover  all  occurrences between the
  inception  date  of  the  first  such  consecutive  policy   from   such
  association and the death or disability of the insured, and
    (C)  the association shall make available and shall advise the insured
  of the availability and cost of coverage  for  occurrences  between  the
  inception   date   of  the  first  such  consecutive  policy  from  such
  association and the termination of such policy which, subsequent to  the
  termination  date,  are reported in accordance with statutory and policy
  requirements, pursuant to such terms and conditions as may be  specified
  by  the  superintendent by regulation. The insured shall have the option
  of purchasing such coverage either in  a  single  payment  or  in  three
  annual installments with an additional finance charge.
    (3)  Such  regulation  shall  also  provide that if the coverage of an
  insured who continues to practice in this state is transferred  from  an
  admitted  insurer  or the association to another admitted insurer or the
  association without any gap in coverage, the  former  entity  shall  pay
  over  to  the  successor  an  actuarially  appropriate  dollar amount to
  provide for the requirements of paragraph two of  this  subsection,  and
  the  insured  shall  be entitled to the benefits of this provision as if
  such insured had been  continuously  covered  by  the  successor  entity
  during the entire period of consecutive years of coverage.
    (4)  Such  regulation  shall  also  provide that if the coverage of an
  insured is transferred from the association, if the  association  is  in
  liquidation,  to  an admitted insurer not in liquidation without any gap
  in coverage, then the successor entity shall accept the amounts  payable
  from  the  property-casualty  insurance  security  fund  as  provided in
  subparagraph (G) of paragraph one of subsection  (a)  of  section  seven
  thousand  six  hundred  three  of  this  chapter,  to  provide  for  the
  requirements of paragraphs two and three of  this  subsection,  and  the
  insured  shall be entitled to the benefits of such paragraphs as if such
  insured had been continuously covered by the successor entity during the
  entire period of consecutive years of coverage.
    (5) The association may issue a claims-made policy with  more  liberal
  policy  provisions  than are required in this subsection, subject to the
  approval of the  superintendent.  Such  liberal  policy  provisions  may
  include  but  shall  not be limited to a provision which, for all of the
  policyholders of the association, grants  credits  toward  the  cost  of
  coverage  provided  in paragraph two of this subsection in proportion to
  the number of years the insured has purchased a claims-made policy.