New Mexico Register / Volume XXX, Issue 12 / June 25, 2019
TITLE 13 INSURANCE
CHAPTER 1 INSURANCE
GENERAL PROVISIONS
PART 6 INFORMAL
ADMINISTRATIVE HEARINGS
13.1.6.1 ISSUING
AGENCY: New
Mexico Office of Superintendent of Insurance.
[13.1.6.1 NMAC - N, 7/1/2019]
13.1.6.2 SCOPE: The rules in this part
govern every informal proceeding conducted pursuant to a notice of hearing
issued by the Superintendent of Insurance pursuant to Section 59A-4-18 NMSA
1978.
[13.1.6.2
NMAC - N, 7/1/2019]
13.1.6.3 STATUTORY AUTHORITY: Sections 59A-2-9 and 59A-4-18 NMSA 1978.
[13.1.6.2
NMAC - N, 7/1/2019]
13.1.6.4 DURATION: Permanent.
[13.1.6.4
NMAC - N, 7/1/2019]
13.1.6.5 EFFECTIVE DATE: July 1, 2019 unless a later date is specified
at the end of a section.
[13.1.6.5
NMAC - N, 7/1/2019]
13.1.6.6 OBJECTIVE: The purpose of this part is to provide rules
of procedure to govern informal hearings before the superintendent.
[13.1.6.6
NMAC - N, 7/1/2019]
13.1.6.7 DEFINITIONS: These rules incorporate the definitions found
in 13.1.5.7 NMAC.
[13.1.6.7
NMAC - N, 7/1/2019]
13.1.6.8 REQUESTING A HEARING:
A. Written request required. Any person seeking an informal hearing
before the superintendent shall file a written request using the form available
on the OSI website or as otherwise directed by the superintendent. The request shall include the language “Request for Informal Hearing” and the
following:
(1) all
of the items listed in Paragraphs (1) through (6) of Subsection A of 13.1.5.9
NMAC; and
(2) one
of the following:
(a) a
written protest or request for hearing challenging that action or inaction; or
(b) a
request for the superintendent to issue an order declaring the rights or
obligations of the requestor under a specific statute, rule or bulletin within
the jurisdiction of the superintendent, and concrete facts showing the
requestor’s interest in the declaration.
B. Request rejected. The superintendent shall reject any
request for an informal hearing if the request relates to a matter that requires
the superintendent to act in fewer than 91 days after the request is made, or
for any of the reasons listed in Subsection B of 13.1.5.9 NMAC.
(1) If
a request for hearing is rejected, the superintendent will notify the requestor
in writing with a brief explanation of the rejection.
(2) If the request for hearing is
deficient for any reason, the requestor may correct any deficiency and resubmit
the request for hearing.
(3) If
the superintendent otherwise determines that it would be more appropriate for
the matter to proceed as a formal hearing under rule 13.1.5 NMAC, the
superintendent may convert the request for informal hearing to a request for formal
hearing upon written notice to the requestor.
C. Designation of hearing officer and docket. The superintendent shall proceed as set
forth in Subsection C of 13.1.5.9 NMAC.
D. Waiver
of right. A request for an informal
hearing constitutes a waiver of any right the requestor may have to a hearing
under any other provision of the Insurance Code, or its implementing rules,
unless the superintendent, sua sponte,
or for good cause shown, orders the hearing to proceed pursuant to 13.1.5 NMAC.
E. Intervenors. Request to intervene shall be handled as
set forth in Subsection D of 13.1.5.9 NMAC.
F. Characterization of
request. A hearing request that does not include the language “Request
for Informal Hearing” will be treated as a request for a formal hearing
governed by 13.1.5 NMAC.
[13.1.6.8
NMAC – N, 7/1/2019]
13.1.6.9 INFORMAL HEARING PROCESS AND
DECISION: Any matter or question that is the subject of a notice of an
informal hearing shall be determined based solely on the exhibits and pleadings
submitted to the superintendent pursuant to these rules. The superintendent shall have 45 days to
determine the matter or question following the date set for closing the
record. The date set for closing the
record shall not be more than 45 days or less than 30 days after issuance of
the notice of an informal hearing.
[13.1.6.9
NMAC - N, 7/1/2019]
13.1.6.10 REPRESENTATION AT HEARING, FORMAL ENTRY OF
APPEARANCE, SUBSTITUTION OF COUNSEL, AND WITHDRAWAL FROM REPRESENTATION: Rules pertaining to legal representation
at hearing are as set forth in 13.1.5.10 NMAC.
[13.1.6.10
NMAC - N, 7/1/2019]
13.1.6.11 FILING OF PLEADINGS: Rules pertaining to filing for pleadings
are as set forth in 13.1.5.11 NMAC.
[13.1.6.11
NMAC - N, 7/1/2019]
13.1.6.12 CONTINUANCES: Rules
pertaining to handling of continuances are as set forth in 13.1.5.15 NMAC.
[13.1.6.12
NMAC - N, 7/1/2019]
13.1.6.13 BURDEN OF PROOF, PRESENTATION OF
CASE, EVIDENCE: Rules pertaining to burden of proof, conduct of the case and use
of evidence are as set forth in 13.1.5.17 NMAC, with the following
modifications:
A. A
party may submit written arguments any time before the record closes, or as
otherwise ordered by the hearing officer.
B. If
OSI staff has not already entered an appearance, the hearing officer may
request briefing from OSI staff, subject to the right of any party to object or
respond to the submission.
[13.1.6.13
NMAC - N, 7/1/2019]
13.1.6.14 HEARING OFFICER POWERS AND
RESPONSIBILITIES:
A. General authority. The superintendent may preside over OSI’s
hearings or may designate a hearing officer to preside instead.
B. Duties of the hearing officer. The hearing officer shall have the duty to
conduct fair and impartial hearings, to take all necessary action to avoid
delay in the proceedings and to maintain order. The hearing officer shall have the powers
necessary to carry out these duties as set forth in Paragraphs (1) through (15)
of Subsection B of 13.1.5.19 NMAC, to the extent applicable for informal
hearings.
C. Independence of the hearing officer. In the performance of these functions, the
hearing officer shall not be responsible to or subject to the direction of any
other officer, employee or agent of OSI, except that a hearing officer
appointed by the superintendent shall be subject to the direction of the
superintendent.
D. Ex-parte
communication. The rules pertaining
to ex-parte communication for an informal hearing are as set forth in 13.1.5.19
NMAC.
E. Final
order. After
a thorough review of the record and any recommendation prepared by a designated
hearing officer, the superintendent shall issue a final order. No party or member of OSI staff shall engage
in any ex parte communication with
the superintendent in an attempt to influence his final decision.
[13.1.6.14
NMAC - N, 7/1/2019]
13.1.6.15 CLOSED OR PUBLIC HEARING, SEALED
RECORDS, AND DELIBERATIVE NOTES OF HEARING OFFICER: The
rules pertaining to public access to hearings and related records are as set
forth in 13.1.5.20 NMAC.
[13.1.6.15
NMAC - N, 7/1/2019]
13.1.6.16 RECONSIDERATION: Rules pertaining to
requests of reconsideration are as set forth in 13.1.5.24 NMAC.
[13.1.6.16 NMAC - N, 7/1/2019]
13.1.6.17 APPEALS FOLLOWING HEARING: Rules pertaining to
appeals following hearing are as set forth in 13.1.5.25 NMAC.
[13.1.6.17
NMAC - N, 7/1/2019]
13.1.6.18 REQUESTING COPIES OF EXHIBITS,
AUDIO, OR THE ADMINISTRATIVE RECORD: Rules pertaining to requests for copies of hearing-related
matters following hearing are as set forth in Section 13.1.5.26 NMAC.
[13.1.6.18
NMAC - N, 7/1/2019]
History of 13.1.6
NMAC: [RESERVED]