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N.Y. Ins. Law § 5106

Fair claims settlement

Showing this section's text as in effect on January 1, 2015 (in force January 1, 2015 – January 1, 2018). View current text →

§ 5106. Fair claims settlement. (a) Payments of first party benefits\nand additional first party benefits shall be made as the loss is\nincurred. Such benefits are overdue if not paid within thirty days\nafter the claimant supplies proof of the fact and amount of loss\nsustained. If proof is not supplied as to the entire claim, the amount\nwhich is supported by proof is overdue if not paid within thirty days\nafter such proof is supplied. All overdue payments shall bear interest\nat the rate of two percent per month. If a valid claim or portion was\noverdue, the claimant shall also be entitled to recover his attorney's\nreasonable fee, for services necessarily performed in connection with\nsecuring payment of the overdue claim, subject to limitations\npromulgated by the superintendent in regulations.\n (b) Every insurer shall provide a claimant with the option of\nsubmitting any dispute involving the insurer's liability to pay first\nparty benefits, or additional first party benefits, the amount thereof\nor any other matter which may arise pursuant to subsection (a) of this\nsection to arbitration pursuant to simplified procedures to be\npromulgated or approved by the superintendent. Such simplified\nprocedures shall include an expedited eligibility hearing option, when\nrequired, to designate the insurer for first party benefits pursuant to\nsubsection (d) of this section. The expedited eligibility hearing option\nshall be a forum for eligibility disputes only, and shall not include\nthe submission of any particular bill, payment or claim for any specific\nbenefit for adjudication, nor shall it consider any other defense to\npayment.\n (c) An award by an arbitrator shall be binding except where vacated or\nmodified by a master arbitrator in accordance with simplified procedures\nto be promulgated or approved by the superintendent. The grounds for\nvacating or modifying an arbitrator's award by a master arbitrator shall\nnot be limited to those grounds for review set forth in article\nseventy-five of the civil practice law and rules. The award of a master\narbitrator shall be binding except for the grounds for review set forth\nin article seventy-five of the civil practice law and rules, and\nprovided further that where the amount of such master arbitrator's award\nis five thousand dollars or greater, exclusive of interest and\nattorney's fees, the insurer or the claimant may institute a court\naction to adjudicate the dispute de novo.\n (d) Where there is reasonable belief more than one insurer would be\nthe source of first party benefits, the insurers may agree among\nthemselves, if there is a valid basis therefor, that one of them will\naccept and pay the claim initially. If there is no such agreement, then\nthe first insurer to whom notice of claim is given shall be responsible\nfor payment. Any such dispute shall be resolved in accordance with the\narbitration procedures established pursuant to section five thousand one\nhundred five of this article and regulation as promulgated by the\nsuperintendent, and any insurer paying first-party benefits shall be\nreimbursed by other insurers for their proportionate share of the costs\nof the claim and the allocated expenses of processing the claim, in\naccordance with the provisions entitled "other coverage" contained in\nregulation and the provisions entitled "other sources of first-party\nbenefits" contained in regulation. If there is no such insurer and the\nmotor vehicle accident occurs in this state, then an applicant who is a\nqualified person as defined in article fifty-two of this chapter shall\ninstitute the claim against motor vehicle accident indemnification\ncorporation.\n

Official source: NYS Open Legislation (New York State Senate). Reproduced from public-domain New York statutes; confirm against the official source for the current text. Not legal advice.