Mich. Admin. Code R. 257.533 - Application; form; completeness; signature; effective date; accompanying documents

Current through Vol. 22-05, April 1, 2022

Rule 3.

(1) A person who seeks to qualify as a self-insurer or renew his or her certificate of self-insurance shall submit an application for a certificate of self-insurance to the director on a form prescribed by the director and available on the department of insurance and financial services website.
(2) The application for a certificate of self-insurance must contain complete answers to all questions and must be signed by the person who makes the application or by the applicant's duly authorized representative.
(3) An application must be submitted to the director not less than 45 days before the desired effective date of the certificate.
(4) An application must be accompanied by all of the following documents:
(a) A statement of financial condition that has been prepared in accordance with generally accepted accounting practices and principles, that has been certified by a certified public accountant, and that covers at least a 1-year period ending not more than 12 months before the date of application. The director may request more recent unaudited financial statements be filed with the application.
(b) A copy of the declaration sheet of any policy of excess insurance.
(c) Either of the following:
(i) A written estimate of loss reserve that is prepared by a qualified actuary.
(ii) A written estimate of loss reserve that is prepared by a qualified employee of a casualty insurance company.
(d) A copy of a written authorization that designates a specified employee of the applicant, or another authorized person, to receive and process claims that are submitted to the applicant.
(e) A copy of a claim form that is used by a person who submits a claim to the applicant for benefits due to suffering accidental bodily injury or property damage arising out of the ownership, operation, maintenance, or use of a motor vehicle that is registered or owned by the applicant.
(f) A list of all motor vehicles that are registered in this state in the name of the applicant at the time of application or that are to be self-insured under a certificate of self-insurance issued to the applicant as determined at the time of application. The vehicles must be identified by all of the following:
(i) Make.
(ii) Model.
(iii) Year.
(iv) Vehicle identification number (VIN).
(v) Registration number.
(g) A written policy and procedure or detailed description on how claims will be processed and paid in a timely manner.
(5) A claim form that accompanies an application must include all of the following information:
(a) A statement of a claimant's right to personal protection insurance benefits, property protection insurance benefits, and residual liability insurance benefits under the no-fault law.
(b) A statement of a self-insurer's responsibility to pay claims in a timely manner.
(c) An instruction that directs claimants to contact the director concerning a self-insurer's failure to fulfill its responsibilities under the no-fault law.


Mich. Admin. Code R. 257.533
1993 AACS; 2018 MR 5, Eff. 3/15/2018

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