PDF CLAIMS HANDLING FOR NEW YORK Property & Casualty Insurance
CLAIMS HANDLING FOR NEW YORK Property & Casualty Insurance
ACT TO BE PERFORMED
COMPLIANCE
REFERENCE
TIMEFRAME
Acknowledge in writing receipt of claim to
Within 15 business days after N.Y. Comp. Codes R.
first-party claimant or third-party claimant receipt
& Regs. tit. 11 ?
216.4(a)
Reply to all pertinent communications
Within 15 business days
N.Y. Comp. Codes R.
& Regs. tit. 11 ?
216.4(b)
Reply to any inquiry from the Insurance
Within 10 business days from N.Y. Comp. Codes
Department
any inquiry
R. & Regs. tit. 11 ?
216.4(d)
Provide to first-party claimant or third-party Within 15 business days of
N.Y. Comp. Codes R.
claimant notification of all items, statements receipt of notice of the claim & Regs. tit. 11 ?
and forms required of the claimant
216.5(a)
Commence investigation of any claim
Within 15 business days of
N.Y. Comp. Codes
receipt of notice of the claim R. & Regs. tit. 11 ?
216.5(a)
Advise the first-party claimant or third-party Within 15 days after receipt of N.Y. Comp. Codes R.
claimant of acceptance or denial of the claim proofs of loss or requested
& Regs. tit. 11 ?
information
216.6(c)
When insurer suspects claim involves arson
Within 30 days after receipt of N.Y. Comp. Codes R.
advise first-party claimant or third-party
proofs of loss or requested
& Regs. tit. 11 ?
claimant of acceptance or denial of claim
information
216.6(c)
Notify the claimant in writing stating the
Within 15 days after receipt of N.Y. Comp. Codes R.
reasons additional time is needed for
proofs of loss or requested
& Regs. tit. 11 ?
investigation
information and every 90 days 216.6(c)
thereafter
Notify claimant citing specific reasons that no As soon as it is determined. N.Y. Comp. Codes R.
policy was in force or that insurer is
& Regs. tit. 11 ?
disclaiming liability because of a breach of
216.6(d)
policy provisions by policyholder
Pay amount finally agreed upon in settlement of Within 5 business days from N.Y. Comp. Codes R.
all or part of any claim
the receipt of agreement by
& Regs. tit. 11 ?
insurer or date of performance 216.6(f)
of conditions in agreement by
claimant
(Current as of May 2012) ? This chart is not to be used as a substitute for reviewing the actual statutes and regulations.
* The links provided are to the entire New York Codes, Rules and Regulations. In order to find the specific section, you will need to click on Title 11 Insurance Department, then click the plus symbol next to Chapter IX Unfair Trade Practices, then click the plus symbol next to Part 216 Unfair Claims Settlement Practices and Claim Cost Control Measures, and finally click on the specified section.
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