375.775. Association, powers and duties.
Association, powers and duties.
375.775. 1. The association shall be obligated to the extent of thecovered claims existing prior to the date of a final order of liquidationor a judicial determination by a court of competent jurisdiction in theinsurer's domiciliary state that an insolvent insurer exists and arisingwithin thirty days from the date or at the time of the first such order ordetermination, or before the policy expiration date if less than thirtydays after such date, or before or at the time the insured replaces thepolicy or causes its cancellation, if he does so within thirty days of suchdate. Such obligation shall be satisfied by paying to the claimant anamount as follows:
(1) The full amount of a covered claim for benefits under workers'compensation insurance coverage;
(2) An amount not exceeding twenty-five thousand dollars per policyfor a covered claim for the return of unearned premium;
(3) An amount not exceeding three hundred thousand dollars per claimfor all other covered claims.
2. In no event shall the association be obligated to an insured orclaimant in an amount in excess of the face amount or the limits of thepolicy from which a claim arises or be obligated for the payment ofunearned premium in excess of the amount of twenty-five thousand dollars,or to an insured or claimant on any covered claim until it receivesconfirmation from the receiver or liquidator of an insolvent insurer thatthe claim is within the coverage of an applicable policy of the insolventinsurer, except that within the sole discretion of the association, if theassociation deems it has sufficient evidence from other sources, includingany claim forms which may be propounded by the association, that the claimis within the coverage of an applicable policy of the insolvent insurer, itshall proceed to process the claim, pursuant to its statutory obligations,without such confirmation by the receiver or liquidator:
(1) All covered claims shall be filed with the association on theclaim information form required by this subdivision* no later than thefinal date first set by the court for the filing of claims against theliquidator or receiver of an insolvent insurer, except that if the timefirst set by the court for filing claims is one year or less from the dateof insolvency, and an extension of the time to file claims is granted bythe court, claims may be filed with the association no later than the newdate set by the court or within one year of the date of insolvency,whichever first occurs. In no event shall the association be obligated ona claim filed after such date or on one not filed on the required form. Aclaim information form shall consist of a statement verified under oath bythe claimant which includes all of the following:
(a) The particulars of the claim;
(b) A statement that the sum claimed is justly owing and that thereis no setoff, counterclaim, or defense to said claim;
(c) The name and address of the claimant and the attorney whorepresents the claimant, if any; and
(d) If the claimant is an insured, that the insured's net worth didnot exceed twenty-five million dollars on the date the insurer became aninsolvent insurer.
The association may require that a prescribed form be used and may requirethat other information and documents be included. A covered claim shallnot include any claim not described in a timely filed claim informationform even though the existence of the claim was not known to the claimantat the time a claim information form was filed;
(2) In the case of claims arising from a member insurer subject to afinal order of liquidation issued on or after September 1, 2000, theprovisions of subdivision (1) of subsection 2 of this section shall notapply and in lieu thereof, such claims shall be governed by thissubdivision. All covered claims shall be filed with the association,liquidator or receiver. Notwithstanding any other provisions of sections375.771 to 375.779, a covered claim shall not include a claim filed afterthe earlier of eighteen months after the date of the order of liquidation,or the final date set by the court for the filing of claims against theliquidator or receiver of an insolvent insurer. The association mayrequire that other information and documents be included in confirming theexistence of a covered claim or in determining eligibility of any claimant.Such information may include, but is not limited to:
(a) The particulars of the claim;
(b) A statement that the sum claimed is justly owing and that thereis no setoff, counterclaim, or defense to said claim;
(c) The name and address of the claimant and the attorney whorepresents the claimant, if any; and
(d) A verification under oath of such requested information.
In no event shall the association be obligated on a claim filed with theassociation, liquidator or receiver for protection afforded under theinsured's policy for incurred but not reported losses. A covered claimshall not include any claim that is not filed prior to the final date forfiling claims, even though the existence of the claims was not known to theclaimant prior to such final date.
3. In the case of claims arising from bodily injury, sickness ordisease, the amount of any such award shall not exceed the claimant'sreasonable expenses incurred for necessary medical, surgical, X-ray, dentalservices and comparable services for individuals who, in the exercise oftheir constitutional rights, rely on spiritual means alone for healing inaccordance with the tenets and practices of a recognized church orreligious denomination by a duly accredited practitioner thereof, includingprosthetic devices and necessary ambulance, hospital, professional nursing,and any amounts lost or to be lost by reason of claimant's inability towork and earn wages or salary or their equivalent, except that theassociation shall pay the full amount of any covered claim arising out of aworkers' compensation policy. Such award may also include payments in factmade to others, not members of claimant's household, which were reasonablyincurred to obtain from such other persons ordinary and necessary servicesfor the production of income in lieu of those services the claimant wouldhave performed for himself had he not been injured. Verdicts as respectonly those civil actions as may be brought to recover damages as providedin this section shall specifically set out the sums applicable to each itemin this section for which an award may be made.
4. In the case of claims arising from a member insurer subject to afinal order of liquidation dated on or after August 31, 2004, theprovisions of subsection 3 of this section shall not apply.
5. Notwithstanding any other provision of sections 375.771 to375.779, except in the case of a claim for benefits under workers'compensation coverage, any obligation of the association to or on behalf ofthe insured and its affiliates on covered claims shall cease when tenmillion dollars has been paid in the aggregate by the association and anyone or more associations similar to the association in any other state orstates to or on behalf of such insured, its affiliates, and additionalinsureds on covered claims or allowed claims arising under the policy orpolicies of any one insolvent insurer.
6. If the association determines that there may be more than oneclaimant having a covered claim or allowed claim against the association,or any associations similar to the association in other states, under thepolicy or policies of any one solvent insurer, the association mayestablish a plan to allocate amounts payable by the association in suchmanner as the association in its discretion deems equitable.
7. The association shall be deemed the insurer only to the extent ofits obligations on the covered claims and to such extent, subject to thelimitations provided in sections 375.771 to 375.779, shall have all rights,duties, and obligations of the insolvent insurer as if the insurer had notbecome insolvent, including but not limited to the right to pursue andretain salvage and subrogation recoverable on paid covered claimobligations. The association shall not be deemed the insolvent insurer forany purpose relating to the issue of whether the association is amenable tothe personal jurisdiction of the courts of any states. However, anyobligation to defend an insured shall cease upon:
(1) The association's payment by settlement releasing the insured oron a judgment of an amount equal to the lesser of the association's coveredclaim obligation limit or the applicable policy limit; or
(2) The association's tender of such amount.
8. The association shall allocate claims paid and expenses incurredamong the four accounts separately, and assess member insurers separatelyfor each account amounts necessary to pay the obligations of theassociation under subsection 1 of this section to an insolvency, theexpenses of handling covered claims subsequent to an insolvency, the costof examinations under subdivision (3) of subsection 9 of this section, andother expenses authorized by sections 375.771 to 375.779. The assessmentsof each member insurer shall be in the proportion that the net directwritten premiums of the member insurer for the preceding calendar year onthe kinds of insurance in the account bears to the net direct writtenpremiums of all member insurers for the preceding calendar year of thekinds of insurance in the account. Each member insurer's assessment may berounded to the nearest ten dollars. Each member insurer shall be notifiedof the assessment not later than thirty days before it is due. No memberinsurer may be assessed in any year on any account an amount greater thanone percent of that member insurer's net direct written premiums for thepreceding calendar year on the kinds of insurance in the account. If themaximum assessment, together with the other assets of the association inany account, does not provide in any one year in any account an amountsufficient to make all necessary payments from that account, the fundsavailable shall be prorated and the unpaid portion shall be paid as soonthereafter as funds become available. The association may defer, in wholeor in part, the assessment of any member insurer, if the assessment wouldcause the member insurer's financial statement to reflect amounts ofcapital or surplus less than the minimum amounts required for a certificateof authority by any jurisdiction in which the member insurer is authorizedto transact insurance. Deferred assessments shall be paid when suchpayment will not reduce capital or surplus below required minimums. Suchpayments shall be refunded to those companies receiving larger assessmentsby virtue of such deferment, or, in the discretion of any such company,credited against future assessments. No dividends shall be paidstockholders or policyholders of a member insurer so long as all or part ofany assessment against such insurer remains deferred. Each member insurermay set off against any assessment, authorized payments made on coveredclaims and expenses incurred in the payment of such claims by the memberinsurer if they are chargeable to the account for which the assessment ismade. Assessments made under sections 375.771 to 375.779 and section375.916 shall not be subject to subsection 1 of section 375.916;
9. The association shall:
(1) Handle claims through its employees or through one or moreinsurers or other persons designated as servicing facilities. Designationof a servicing facility is subject to the approval of the director, butsuch designation may be declined by a member insurer;
(2) Reimburse each servicing facility for obligations of theassociation paid by the facility and for actual expenses incurred by thefacility while handling claims on behalf of the association and shall paythe other expenses of the association authorized by this section;
(3) Be subject to examination and regulation by the director. Theboard of directors shall submit, not later than March thirtieth of eachyear, a financial report for the preceding calendar year in a form approvedby the director; and
(4) Proceed to investigate, settle, and determine covered claims.
10. The association may:
(1) Appear in, defend and appeal any action on a claim broughtagainst the association;
(2) Employ or retain such persons as are necessary to handle claimsand perform other duties of the association;
(3) Act as a servicing facility for other similar entities created bysimilar laws in this state or other states;
(4) Borrow funds necessary to effect the purposes of sections 375.771to 375.779 in accord with the plan of operation;
(5) Sue or be sued. Such power to sue includes the power and rightto intervene as a party before any court that has jurisdiction over aninsolvent insurer as defined in section 375.772;
(6) Negotiate and become a party to such contracts as are necessaryto carry out the purpose of sections 375.771 to 375.779;
(7) Perform such other acts as are necessary or proper to effectuatethe purpose of sections 375.771 to 375.779;
(8) Refund to the member insurers in proportion to the contributionof each member insurer to that account that amount by which the assets ofthe account exceed the liabilities, if, at the end of any calendar year,the board of directors finds that the assets of the association in anyaccount exceed the liabilities of that account as estimated by the board ofdirectors for the coming year; and
(9) Become a member of the National Conference on Insurance GuarantyFunds.
(L. 1989 S.B. 333, A.L. 1991 H.B. 385, et al., A.L. 2002 H.B. 1468, A.L. 2004 S.B. 1299)*Word "paragraph" appears in original rolls.