§ 26.1-38.1-05 — Powers and duties of the association

North Dakota § 26.1-38.1-05

• Jurisdiction: North Dakota
• Title 26.1: Insurance
• Ch. 26.1-38.1: Life and Health Insurance Guaranty Association

Text

1. If a member insurer is an impaired insurer, the association may, in its discretion, and
subject to any conditions imposed by the association that do not impair the contractual
obligations of the impaired insurer, and that are approved by the commissioner:
a. Guarantee, assume, reissue, or reinsure, or cause to be guaranteed, assumed,
reissued, or reinsured, any or all of the policies or contracts of the impaired
insurer; or
b. Provide such moneys, pledges, loans, notes, guarantees, or other means as are
proper to effectuate subdivision a and assure payment of the contractual
obligations of the impaired insurer pending action under subdivision a.
2. If a member insurer is an insolvent insurer, the association, in its discretion, shall:
a. Guarantee, assume, reissue, or reinsure, or cause to be guaranteed, assumed,
reissued, or reinsured, the policies or contracts of the insolvent insurer;
b. Assure payment of the contractual obligations of the insolvent insurer;
c. Provide moneys, pledges, loans, notes, guarantees, or other means reasonably
necessary to discharge the association's duties; or
d. Provide benefits and coverage in accordance with the following provisions:
(1) With respect to policies and contracts, assure payment of benefits that
would have been payable under the policies or contracts of the insolvent
insurer, for claims incurred:
(a) With respect to group policies and contracts, not later than the earlier
of the next renewal date under those policies or contracts or forty-five
days, but in no event less than thirty days, after the date on which the

association becomes obligated with respect to the policies and
contracts.
(b) With respect to nongroup policies, contracts, and annuities, not later
than the earlier of the next renewal date, if any, under such policies or
contracts or one year, but in no event less than thirty days, from the
date on which the association becomes obligated with respect to the
policies or contracts.
(2) Make diligent efforts to provide all known insureds, enrollees, or annuitants
for nongroup policies and contracts, or group policy or contract owners with
respect to group policies and contracts, thirty days' notice of the termination
pursuant to paragraph 1 of the benefits provided.
(3) With respect to nongroup policies and contracts covered by the association,
make available to each known insured, enrollee, or annuitant, or owner if
other than the insured or annuitant, and with respect to an individual
formerly an insured, enrollee, or annuitant under a group policy or contract
who is not eligible for replacement group coverage, make available
substitute coverage on an individual basis in accordance with the provisions
of paragraph 4, if the insureds, enrollees, or annuitants had a right under
law or the terminated policy, contract, or annuity to convert coverage to
individual coverage or to continue an individual policy, contract, or annuity in
force until a specified age or for a specified time, during which the insurer or
health maintenance organization had no right unilaterally to make changes
in any provision of the policy, contract, or annuity or had a right only to make
changes in premium by class.
(a) In providing the substitute coverage required under this paragraph, the
association may offer either to reissue the terminated coverage or to
issue an alternative policy or contract at actuarially justified rates,
subject to the prior approval of the commissioner.
(b) Alternative or reissued policies or contracts shall be offered without
requiring evidence of insurability, and shall not provide for any waiting
period or exclusion that would not have applied under the terminated
policy or contract.
(c) The association may reinsure any alternative or reissued policy or
contract.
(4) Alternative policies or contracts adopted by the association shall be subject
to the approval of the commissioner. The association may adopt alternative
policies or contracts of various types for future issuance without regard to
any particular impairment or insolvency.
(5) Alternative policies or contracts must contain at least the minimum statutory
provisions required in this state and provide benefits that are not
unreasonable in relation to the premium charged. The association shall set
the premium in accordance with a table of rates which it shall adopt. The
premium must reflect the amount of insurance to be provided and the age
and class of risk of each insured, but may not reflect any changes in the
health of the insured after the original policy or contract was last
underwritten.
(6) Any alternative policy or contract issued by the association shall provide
coverage of a type similar to that of the policy or contract issued by the
impaired or insolvent insurer, as determined by the association.
(7) If the association elects to reissue terminated coverage at a premium rate
different from that charged under the terminated policy or contract, the
premium must be actuarially justified and set by the association in
accordance with the amount of insurance or coverage provided and the age
and class of risk, subject to prior approval of the commissioner.
(8) The association's obligations with respect to coverage under any policy or
contract of the impaired or insolvent insurer or under any reissued or

alternative policy or contract shall cease on the date the coverage or policy
or contract is replaced by another similar policy or contract by the policy or
contract owner, the insured, the enrollee, or the association.
3. When proceeding under subsection 2 with respect to any policy or contract carrying
guaranteed minimum interest rates, the association shall assure the payment or
crediting of a rate of interest consistent with subdivision c of subsection 3 of section
26.1-38.1-01.
4. Nonpayment of premiums within thirty-one days after the date required under the
terms of any guaranteed, assumed, alternative, or reissued policy or contract or
substitute coverage terminates the association's obligations under the policy, contract,
or coverage under this chapter with respect to the policy, contract, or coverage, except
with respect to any claims incurred or any net cash surrender value which may be due
in accordance with the provisions of this chapter.
5. Premiums due for coverage after entry of an order of liquidation of an insolvent insurer
belong to and are payable at the direction of the association. If the liquidator of an
insolvent insurer requests, the association shall provide a report to the liquidator
regarding the premium collected by the association. The association is liable for
unearned premiums due to policy or contract owners arising after the entry of the
order.
6. The protection provided by this chapter does not apply when any guaranty protection
is provided to residents of this state by the laws of the domiciliary state or jurisdiction
of the impaired or insolvent insurer other than this state.
7. In carrying out its duties under subsection 2, the association may:
a. Subject to approval by a court in this state, impose permanent policy or contract
liens in connection with any guarantee assumption or reinsurance agreement, if
the association finds that the amounts which can be assessed under this chapter
are less than the amounts needed to assure full and prompt performance of the
association's duties under this chapter, or that the economic or financial
conditions as they affect member insurers are sufficiently adverse to render the
imposition of such permanent policy or contract liens, to be in the public interest.
b. Subject to approval by a court in this state, impose temporary moratoriums or
liens on payments of cash values and policy loans, or any other right to withdraw
funds held in conjunction with policies or contracts, in addition to any contractual
provisions for deferral or cash or policy loan value. In addition, in the event of a
temporary moratorium or moratorium charge imposed by the receivership court
on payment of cash values or policy loans, or on any other right to withdraw funds
held in conjunction with policies or contracts, out of the assets of the impaired or
insolvent insurer, the association may defer the payment of cash values, policy
loans, or other rights by the association for the period of the moratorium or
moratorium charge imposed by the receivership court, except for claims covered
by the association to be paid in accordance with a hardship procedure
established by the liquidator or rehabilitator and approved by the receivership
court.
8. A deposit in this state, held according to law or as required by the commissioner for
the benefits of creditors, including policy or contract owners, not turned over to the
domiciliary liquidator upon the entry of a final order of liquidation or order approving a
rehabilitation plan of a member insurer domiciled in this state or in a reciprocal state,
under section 26.1-06.1-50, must be paid promptly to the association. The association
may retain a portion of any amount received equal to the percentage determined by
dividing the aggregate amount of policy or contract owners' claims related to that
insolvency for which the association has provided statutory benefits by the aggregate
amount of all policy or contract owners' claims in this state related to that insolvency
and shall remit to the domiciliary receiver the amount so paid to the association, less
the amount retained pursuant to this subsection. Any amount paid to the association
and retained by it is treated as a distribution of estate assets pursuant to section

26.1-06.1-43 or similar provision of the state of domicile of the impaired or insolvent
insurer.
9. If the association fails to act within a reasonable period of time with respect to an
insolvent insurer, as provided in subsection 2, the commissioner shall have the powers
and duties of the association under this chapter with respect to insolvent insurers.
10. The association may render assistance and advice to the commissioner, upon request,
concerning rehabilitation, payment of claims, continuance of coverage, or the
performance of other contractual obligations of any impaired or insolvent insurer.
11. The association shall have standing to appear or intervene before any court or agency
in this state with jurisdiction over an impaired or insolvent insurer concerning which the
association is or may become obligated under this chapter or with jurisdiction over any
person or property against which the association may have rights through subrogation
or otherwise. Such standing extends to all matters germane to the powers and duties
of the association, including proposals for reinsuring, reissuing, modifying, or
guaranteeing the policies or contracts of the impaired or insolvent insurer and the
determination of the policies or contracts and contractual obligations. The association
shall also have the right to appear or intervene before a court or agency in another
state with jurisdiction over an impaired or insolvent insurer for which the association is
or may become obligated or with jurisdiction over any person or property against
whom the association may have rights through subrogation or otherwise.
12. Any person receiving benefits under this chapter must be deemed to have assigned
the rights under, and any causes of action against any person for losses arising under,
resulting from, or otherwise relating to, the covered policy or contract to the
association to the extent of the benefits received because of this chapter, whether the
benefits are payments of or on account of contractual obligations, continuation of
coverage, or provision of substitute or alternative policies, contracts, or coverages. The
association may require an assignment to it of such rights and causes of action by any
enrollee, payee, policy or contract owner, beneficiary, insured, or annuitant as a
condition precedent to the receipt of any right or benefits conferred by this chapter
upon such person.
13. The subrogation rights of the association under this section have the same priority
against the assets of the impaired or insolvent insurer as that possessed by the person
entitled to receive benefits under this chapter.
14. In addition to subsections 12 and 13, the association shall have all common-law rights
of subrogation and other equitable or legal remedy that would have been available to
the impaired or insolvent insurer or owner, beneficiary, enrollee, or payee of a policy or
contract with respect to such policy or contract, including, in the case of a structured
settlement annuity, any rights of the owner, beneficiary, or payee of the annuity, to the
extent of benefits received under this chapter, against a person originally or by
succession responsible for the losses arising from the personal injury relating to the
annuity or payment for the personal injury, except any such person responsible solely
by reason of serving as an assignee in respect of a qualified assignment under section
130 of the Internal Revenue Code.
15. If subsections 12, 13, and 14 are invalid or ineffective with respect to any person or
claim for any reason, the amount payable by the association with respect to the related
covered obligations must be reduced by the amount realized by any other person with
respect to the person or claim that is attributable to the policies or contracts or portion
of the policies or contracts covered by the association. If the association has provided
benefits with respect to a covered obligation and a person recovers amounts as to
which the association has rights as described in the preceding paragraphs of this
subsection, the person shall pay to the association the portion of the recovery
attributable to the policies or contracts or portion of the policies or contracts covered
by the association.
16. In addition to any other rights and powers under this chapter, the association may:
a. Enter into such contracts as are necessary or proper to carry out the provisions
and purposes of this chapter;

b. Sue or be sued, including taking any legal actions necessary or proper to recover
any unpaid assessments under section 26.1-38.1-06 and to settle claims or
potential claims against it;
c. Borrow money to effect the purposes of this chapter and any notes or other
evidences of indebtedness of the association not in default shall be legal
investments for domestic member insurers and may be carried as admitted
assets;
d. Employ or retain such persons as are necessary or appropriate to handle the
financial transactions of the association, and to perform such other functions as
become necessary or proper under this chapter;
e. Take such legal action as may be necessary or appropriate to avoid or recover
payment of improper claims;
f. Exercise, for the purposes of this chapter and to the extent approved by the
commissioner, the powers of a domestic life insurer, health insurer, or health
maintenance organization, but in no case may the association issue policies or
contracts other than those issued to perform its obligations under this chapter;
g. Organize itself as a corporation or in other legal form permitted by the laws of this
state;
h. Request information from a person seeking coverage from the association in
order to aid the association in determining its obligations under this chapter with
respect to the person, and the person promptly shall comply with the request;
i. Unless prohibited by law, in accordance with the terms and conditions of the
policy or contract, file for actuarially justified rate or premium increases for any
policy or contract for which the association provides coverage under this chapter;
and
j. Take other necessary or appropriate action to discharge its duties and obligations
under this chapter or to exercise its powers under this chapter.
17. The association may join an organization of one or more state associations of similar
purposes, to further the purposes and administer the powers and duties of the
association.
18. At any time within one year after the date on which the association becomes
responsible for the obligations of a member insurer, the association may elect to
succeed to the rights and obligations of the member insurer which accrue on or after
this coverage date and which relate to contracts covered in whole or in part by the
association under any indemnity reinsurance agreement entered by the member
insurer as a ceding insurer and selected by the association. However, the association
may not exercise an election with respect to a reinsurance agreement if the receiver,
rehabilitator, or liquidator of the member insurer previously and expressly has
disaffirmed the reinsurance agreement. The election is effected by a notice to the
receiver, rehabilitator, or liquidator and to the affected reinsurers. If the association
makes an election, subdivisions a through d apply with respect to the agreements
selected by the association.
a. The association is responsible for all unpaid premiums due under the
agreements, for periods both before and after the coverage date, and is
responsible for the performance of all other obligations to be performed after the
coverage date, in each case which relate to contracts covered, in whole or in part,
by the association. The association may charge contracts covered in part by the
association, through reasonable allocation methods, the costs for reinsurance in
excess of the obligations of the association.
b. The association is entitled to any amounts payable by the reinsurer under the
agreements with respect to losses or events that occur in periods after the
coverage date and that relate to contracts covered by the association, in whole or
in part, provided that, upon receipt of any of these amounts, the association is
obliged to pay to the beneficiary under the policy or contract on account of which
the amounts were paid a portion of the amount equal to the excess of the amount
received by the association, over the benefits paid by the association on account

of the policy or contract less the retention of the impaired or insolvent member
insurer applicable to the loss or event.
c. Within thirty days following the association's election, the association and each
indemnity reinsurer shall calculate the net balance due to or from the association
under each reinsurance agreement as of the date of the association's election,
giving full credit to every item paid by the member insurer or its receiver,
rehabilitator, or liquidator, or the indemnity reinsurer during the period between
the coverage date and the date of the association's election. The association or
indemnity reinsurer shall pay the net balance due the other within five days of the
completion of the aforementioned calculation. If the receiver, rehabilitator, or
liquidator received any amounts due the association pursuant to subdivision b,
the receiver, rehabilitator, or liquidator shall remit the amounts to the association
as promptly as practicable.
d. If the association, within sixty days of the election, pays the premiums due for
periods both before and after the coverage date that relate to contracts covered
by the association, in whole or in part, the reinsurer may not terminate the
reinsurance agreements, to the extent the agreements relate to contracts covered
by the association, in whole or in part, and may not set off any unpaid premium
due for periods before the coverage date against amounts due the association.
19. If the association transfers its obligations to another insurer, and if the association and
the other insurer agree, the other insurer shall succeed to the rights and obligations of
the association under subsection 18 effective as of the date agreed by the association
and the other insurer and regardless of whether the association made the election,
provided that:
a. The indemnity reinsurance agreements automatically terminate for new
reinsurance unless the indemnity reinsurer and the other insurer agree to the
contrary;
b. The obligations described in the proviso to subdivision b of subsection 18 no
longer apply on and after the date the indemnity reinsurance agreement is
transferred to the third-party insurer; and
c. This subsection does not apply if the association previously expressly determined
in writing that it will not exercise the election referred to in subsection 18.
20. Subsections 18 and 19 supersede the provisions of any law of this state or of any
affected reinsurance contract that provides for or requires any payment of reinsurance
proceeds, on account of losses or events that occur in periods after the coverage date,
to the receiver, rehabilitator, or liquidator, of the insolvent member insurer. The
receiver, rehabilitator, or liquidator remains entitled to any amounts payable by the
reinsurer under the reinsurance agreement with respect to losses or events that occur
in periods before the coverage date, subject to applicable setoff provisions.
21. Except as otherwise expressly provided in this section, this section does not alter or
modify the terms and conditions of the indemnity reinsurance agreements of the
insolvent member insurer. This section does not abrogate or limit any rights of any
reinsurer to claim that it is entitled to rescind a reinsurance agreement. This section
does not give a policy owner, contract owner, enrollee, certificate holder, or beneficiary
an independent claim for relief against an indemnity reinsurer which is not otherwise
set forth in the indemnity reinsurance agreement.
22. The board of directors of the association has discretion and may exercise reasonable
business judgment to determine the means by which the association is to provide the
benefits of this chapter in an economical and efficient manner.
23. If the association arranged or offered to provide the benefits of this chapter to a
covered person under a plan or arrangement that fulfills the association's obligations
under this chapter, the person is not entitled to benefits from the association in addition
to or other than those provided under the plan or arrangement.
24. Burleigh County is the venue in a course of action against the association arising
under this chapter. The association is not required to give an appeal bond in an appeal
that relates to a cause of action arising under this chapter.

25. The association, in carrying out association duties in connection with guaranteeing,
assuming, reissuing, or reinsuring policies or contracts under subsections 1 and 2,
may issue substitute coverage for a policy or contract that provides a rate of interest,
crediting of a rate of interest, or similar factor determined by using an index or other
external reference stated in the policy or contract which is employed in calculating
returns or changes in value by issuing an alternative policy or contract if:
a. Instead of the index or other external reference provided for in the original policy
or contract, the alternative policy or contract provides for a fixed interest rate,
payment of dividends with minimum guarantees, or different method for
calculating interest or changes in value;
b. There is no requirement for evidence of insurability, a waiting period, or other
exclusion that would not have applied under the replaced policy or contract; and
c. The alternative policy or contract is substantially similar to the replaced policy or
contract in all other material terms.