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The Office of General Counsel issued the following opinion on February 11, 2003, representing the position of the New York State Insurance Department.

Time requirement to submit medical proof of claim to insurer

Question Presented

What is the time frame within which a health care provider must submit bills to an insurer for medical services rendered to a No-Fault patient?


N. Y. Comp. Codes R. & Regs. tit. 11, § 65-1.1(d) (Regulation 68) (2002) provides for no longer than a 45 day period after the date services were rendered for submission of a claim for medical expenses rendered by a health care provider to a No-Fault insurer.


None were provided.


Pursuant to N. Y. Comp. Codes R. & Regs. tit. 11, § 65-1.1(d), which contains the prescribed Personal Injury Protection Endorsement for No-Fault coverage in New York required for all new and renewal policies issued on or after April 5, 2002, the Proof of Claim Condition provision requires

[i]n the case of a claim for health service expenses, the eligible injured person or that person’s assignee or representative shall submit written proof of claim to the Company, including full particulars of the nature and extent of the injuries and treatment received and contemplated, as soon as reasonably practicable but, in no event later than 45 days after the date services are rendered.

For further information you may contact Associate Attorney Jeffrey A. Stonehill at the New York City Office.


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