New York Codes, Rules and Regulations
Title 11 - INSURANCE
Chapter III - Policy and Certificate Provisions
Subchapter B - Property and Casualty Insurance
Part 65 - Regulations Implementing The Comprehensive Motor Vehicle Insurance Reparations Act
Subpart 65-3 - Claims For Personal Injury Protection Benefits
Section 65-3.4 - Acknowledgment of claim

Universal Citation: 11 NY Comp Codes Rules and Regs § 65-3.4

Current through Register Vol. 46, No. 39, September 25, 2024

(a) Whenever the insurer receives notice of claim by telephone, the party receiving such notice on behalf of the insurer shall be identified to the caller by name and title and shall request the name, address and telephone number of the applicant and the name of the policyholder or the policy number or both, if available, along with reasonably obtainable information regarding the time, place and circumstances of the accident which will enable the insurer to begin processing the claim.

(b) Unless the insurer will pay the claim as submitted within 30 calendar days, then, within five business days after notice is received by the insurer at the address of its proper claim processing office, either orally pursuant to subdivision (a) of this section or in any other manner, the insurer shall forward to the applicant the prescribed application for motor vehicle no-fault benefits (NYS form N-F 2) accompanied by the prescribed cover letter (NYS form N-F 1). If notice is initially received by the insurer at an address other than the proper claims processing office, the five-day period for forwarding of the prescribed forms shall commence on the day such notice is received at the proper claims processing office, but in no event shall the prescribed forms be forwarded later than 10 business days after receipt of the original notice.

(c) Attached is an appendix (Appendix 13, infra), which includes the following prescribed claim forms that must be used by all insurers, and shall not be altered unless approved by the superintendent:

(1) Cover letter (NYS form N-F 1A)--to be used with policies effective on or after September 1, 2001.

(2) Cover letter (NYS form NF-1B)--to be used with policies effective prior to September 1, 2001.

(3) Application for motor vehicle no-fault benefits (NYS form NF-2).

(4) Verification of treatment by attending physician or other provider of health service (NYS form NF-3).

(5) Verification of hospital treatment (NYS form NF-4).

(6) Hospital facility form (NYS form NF-5).

(7) Employer's wage verification report (NYS form NF-6).

(8) Verification of self-employment income (NYS form NF-7).

(9) Agreement to pursue social security disability benefits (NYS form NF-8).

(10) Agreement to pursue workers' compensation or New York State disability benefits (NYS form NF-9).

(11) Denial of claim form (NYS form NF-10).

(12) Subrogation agreement (NYS form NF-11).

(13) Lump-sum settlement agreement (NYS form NF-12).

(14) Election-optional basic economic loss (NYS form NF-13).

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