A guaranty fund is a non-profit, state based statutorily created entity that pays certain outstanding claims of insolvent insurance companies providing a level of protection for policyholders and claimants.

The Association administers the claims of the New Jersey Property-Liability Insurance Guaranty Association (“NJPLIGA”), the New Jersey Surplus Lines Insurance Guaranty Fund (“NJSLIGF”) and the Workers' Compensation Security Fund (“WCSF”).

An insolvency proceeding describes the process, similar to bankruptcy, of concluding the affairs and liquidating an insurance company that is no longer able to meet its financial obligations to claimants and policyholders.

An insurance company is declared insolvent and ordered into liquidation by a court of competent jurisdiction in this State or the state in which the property-casualty insurer was located. The court then appoints a Liquidator (often referred to as the Receiver) to liquidate the company, settle its affairs and manage the estate. The Liquidator is usually the Commissioner of Banking and Insurance or his or her designee. The Liquidator stops payments to all creditors of the insolvent company and marshals the assets of the insolvent company for ultimate distribution to creditors pursuant to the State’s liquidation statute.

Once the company is ordered into liquidation, the Association is authorized, by statute, to administer the covered claims of policyholders and claimants. Those claims that do not qualify as covered claims can be filed directly as creditor claims against the estate of the insolvent insurance company.

Notice of the liquidation is usually mailed to policyholders. A public notice is also published in New Jersey newspapers of general circulation when a property-casualty insurer is involved.

The Liquidator will forward all unpaid New Jersey claims to the Association for coverage determination and potential handling pursuant to applicable statutes. The Association will administer covered claims to conclusion which may include defense or settlement. The timetable to conclude a claim will vary depending upon the nature and procedural status of each claim.

Claimants and general creditors must file a Proof of Claim (“POC”) with the Liquidator. POCs should be filed even though claims may have been reported to the insurance company prior to insolvency and must be done before the “bar date”, which is a final date for filing claims, established by the court. Notifying the Association of a claim is not a substitute for filing a claim directly with the Liquidator of the insolvent insurance company.

Generally, the unearned premiums due on a property-casualty insurance policy canceled upon liquidation may be refunded to claimants provided all statutory requirements are satisfied.

The unearned, return or audit premium due on a workers’ compensation policy canceled upon liquidation is not refundable and must be filed directly with the insolvent estate.

There are limits on guaranty association coverage which vary from fund to fund as determined by the State Legislature and can be found in each fund’s governing statute.

The Association is generally not responsible for outstanding service provider or vendor invoices as these liabilities were incurred pre-insolvency. Providers/Vendors are not without recourse. The Liquidator should be contacted for additional instructions. Services should not be provided after the date of liquidation with the expectation of payment by the Association without authorization of the Association.

The Unsatisfied Claim and Judgment Fund (“UCJF”) administers bodily injury, personal injury protection and property damage claims for eligible uninsured motorists and eligible uninsured pedestrians struck by private passenger automobiles.

A qualified person injured in an automobile accident involving an uninsured automobile may be entitled to statutory benefits if no other coverage is available. The claims’ process begins with the filing of a “Notice of Intention to Make a Claim” (“NOI”) within 180 days as required by N.J.S.A. 39:6-65. All statutory requirements of the Unsatisfied Claim and Judgment Fund Law, N.J.S.A. 39:6-61 et seq., must also be satisfied. An NOI form can be downloaded here.

Pedestrians injured in an accident with a private passenger automobile, with no other available coverage, may be entitled to statutory benefits from the UCJF. Notice of the claim must be given within two years of the injury. An NOI form can be downloaded here. Separate notice must be filed for each claimant.

A Notice of Intention to Make a Claim (“NOI”) must be submitted in order to file a claim with the UCJF. An NOI form can be downloaded here. In addition to the NOI, the Association requires the following forms which can be downloaded from the Forms library on the Association’s website:

• PIP APPLICATION - Form made in support of a claim. Must be fully completed and submitted to the Association.
• AFFIDAVIT IN SUPPORT OF UCJF ELIGIBILITY - Sworn statement made in support of a claim. Must be fully completed, notarized and submitted to the Association.
• CERTIFICATE OF MEDICARE ELIGIBILITY – Sworn statement made in support of a claimant’s Medicare beneficiary status. Must be fully completed and submitted to the Association.
• HIPAA PRIVACY AUTHORIZATION - Authorization for use or disclosure of protected health information pursuant to the Health Insurance Portability and Accountability Act.

Once the required forms are received, a claim file will be established and assigned to a claims adjuster who will review the claim and advise if the claimant is eligible for statutory benefits from the UCJF.

The primary reason a social security number is required is that, by law, we have a duty to verify medicare beneficiary status in relation to claims. In addition, social security numbers are needed in order to obtain and verify information essential to determining eligibility for benefits from the UCJF.

The payment of excess medical benefits above $75,000 to insurance carriers on certain personal injury protection (“PIP”) claims. Excess medical benefits were originally administered by the UCJF in an effort to control medical expenses by providing a level of reinsurance for automobile policies. EMB payments ceased for automobile policies issued or renewed on or after January 1, 2004 and the responsibility for the run-off of EMB claims was transferred to the Association.

The following documents need to be submitted by the carrier depending upon the status of the EMB claim:

• FIRST NOTICE: Pursuant to N.J.A.C. 11:3-28.3, the EMB first notice form must be completed by the insurer whenever medical expense benefits in the amount of $50,000 have been paid on account of personal injury to any one person in any one accident and the insurer’s potential exposure exceeds $75.000.
• REIMBURSEMENT AND RESERVING: The Association requires that carriers submit the Reimbursement and Reserve ("RR") form to request reimbursement and provide estimation as to the reserve requirements on individual claims. The RR form must be accompanied by the EMB Payment Record below.
• EMB PAYMENT RECORD: The Association requires this form to be submitted in conjunction with the RR form. This form must be completed in order to provide the Association with an accounting of medical benefits incurred and paid. Bills for providers in excess of $10,000 must be accompanied by an audit report and bills for facilities in excess of $50,000 must be accompanied by an on-site audit report or they are subject to a 20% penalty.
• RECOVERY CERTIFICATION: The Association requires that this form be completed and submitted with the First Notice or RR form. The signature on the form confirms that all potential recovery sources, including subrogation against culpable third parties, have been appropriately investigated and pursued.
• PIP COVERAGE SELECTION: The Association requires that this form be completed and submitted with the First Notice. The signature on the form confirms that the injured party is afforded PIP benefits under the insurance policy. There may be concurrent PIP coverage with other carriers that must be investigated.

• New Jersey Property-Liability Insurance Guaranty Association: NJPLIGA has two primary sources of funds to fulfill its statutory obligations. First, the Association receives distributions from insolvent estates as reimbursement for payments made on behalf of those estates. Second, the Association can assess member companies which may then be authorized by the Department of Banking and Insurance to recover their assessments through surcharges on the policies issued to New Jersey residents.
• New Jersey Surplus Lines Insurance Guaranty Fund: The Fund receives distributions from insolvent estates as reimbursement for payments made on behalf of those estates. The Fund is authorized to place a surcharge on surplus policy premiums. The surcharge has been inactive since 1993 but is subject to potential reenactment.
• Workers' Compensation Security Fund: Pursuant to statute, the WCSF is funded through assessments of workers’ compensation carriers authorized to transact the business of workers’ compensation insurance in this State and distributions from insolvent estates as reimbursement for payments made on behalf of those estates.
• Unsatisfied Claim and Judgment Fund: The UCJF is funded through assessments of member companies writing automobile insurance in New Jersey.

The Association assesses member insurance companies (not insureds) on an annual basis. Member companies are permitted, by statute, to recoup the NJPLIGA assessment by placing a surcharge on the insurance policies issued to their policyholders provided that those policies are subject to the NJPLIGA Act. NJPLIGA has no role in the insurance carrier’s recoupment process. Questions regarding an insurer’s ability to surcharge policyholders should be addressed directly to the insurance company.

The surcharge imposed by the insurance carrier is a fee, not a tax. Accordingly, the insured’s tax exempt status is irrelevant. Questions regarding an insurer’s ability to surcharge policyholders should be addressed directly to the insurance company.

The Association is obligated to assess all premiums for policies subject to the NJPLIGA Act which includes all kinds of direct insurance except life insurance, accident and health insurance, workers’ compensation insurance, title insurance, annuities, surety bonds, credit insurance, mortgage guaranty insurance, municipal bond coverage, fidelity insurance, investment return assurance, ocean marine insurance and pet health insurance. The Association is also obligated to assess all premiums reported on line 34 of the Annual Statement of Reported Premiums that are not specifically exempted from assessment. The “Assessment/Recoupment” section of this website contains the Association’s Bulletins which describe the process for requesting an exemption from assessment.

The “Communications” section of this website contains the Association’s annual report.

To protect the privacy of Claimants, all requests for medical bill status, must be submitted on provider letterhead via fax to 908-382-7154 or emailed to Billinfo@NJGuaranty.org. Please be prepared to provide information about the medical service(s) including the invoice number, claim number, name of the provider(s)/physician(s), name of the patient, date(s) of service, procedure(s) performed, diagnosis/procedure, bill amount and any other relevant information.

Regarding PIP medical billing, payments are processed according to New Jersey’s No-Fault Law and are paid, delayed or denied within 60 days of receipt of the invoice. Please do not request the status of invoices submitted within the 60-day period as we will not respond to such requests.

Please contact the Association at (908) 382-7100 (press 0 when prompted) for the status of any disputed medical bill. Please be prepared to provide information about the disputed medical bill including the invoice number, claim number, name of anyone at the Association you have already spoken to regarding the disputed invoice and any other relevant information.

Pre-Service Appeals can be found here and may be sent by facsimile to (866)327-9318 https://www.genexservices.com/nj-dpr, the following e-mail address: NJDPRPlus@reviewstat.com, or the following mailing address:

Genex NJDPR+Department
PO Box 4379
Westlake Village, CA 91359

Pre-Service Appeals sent to any other destination will not be considered.

Post-Service Appeal Forms must be sent by facsimile to (908) 382-7158. Post-Service Appeals sent by any other means or to any other facsimile number will not be considered. Post Service Appeal Forms MUST be used and can be found here.

The Association’s DPR Plan and all applicable forms related to the Association’s DPR Plan can be obtained on the DPR Plans’ page on this website.

Information regarding the Association’s Voluntary Utilization Network (“VUN”) can be obtained from this website.

Please send all invoices to:
Fax: (908) 382-7139

or Mail to:
New Jersey Property-Liability
Insurance Guaranty Association
233 Mt. Airy Road
Basking Ridge, NJ 07920

Effective September 1, 2019 for automobile medical billing and November 1, 2019 for workers’ compensation medical billing, the Association began accepting electronic medical bills for payment on standardized forms in accordance with the laws and guidelines established by the State of New Jersey. More information can be found here.

A Taxpayer Identification Certificate (IRS form W-9) must be submitted to the Association in order to process invoice(s) for payment. Invoice(s) will not be processed until the required IRS form W-9 is received by the Association.

Please send all W-9s to:
Fax: (908) 382-7139

or Mail to:
New Jersey Property-Liability
Insurance Guaranty Association
233 Mt. Airy Road
Basking Ridge, NJ 07920

In order to avoid a delay or denial in payment, the information on file with the IRS must accurately correspond to the “Billing Provider Information” on any submitted invoice. The Association will issue payment only to the individual or entity on record with the IRS as being associated with the TIN/EIN on the invoice(s) submitted to the Association. If the remittance address is different than the way your company is listed with the IRS, please provide the Association with the remittance information on company letterhead, along with the completed, signed IRS form W-9. If you have any questions, please contact the Association at (908) 382-7100 (press 0 when prompted).

Automobile medical claims: medical precertification should be submitted in accordance with the requirements outlined in the Association’s Decision Point Review (“DPR”) Plan for the procedures identified in the Association’s DPR Plan.

Precertification requests MUST be submitted to:

Genex NJDPR+Department
PO Box 4379
Westlake Village, CA 91359
Fax: (866)327-9318
NJDPRPlus@reviewstat.com
Website: www.genexservices.com/nj-dpr

Requests sent to any other destination will not be processed.

Workers’ compensation claims: Requests or authorization for medical treatment for a work related injury should be directed to the adjuster assigned to the claim. If you do not know who is assigned to the claim, please contact the Association at (908) 382-7100. Please be prepared to provide information you have regarding including the claimant’s name, date of loss, claim number and the name of anyone at the Association you have already spoken to regarding this claim.