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