New York State Seal
STATE OF NEW YORK
INSURANCE DEPARTMENT
25 BEAVER STREET
NEW YORK, NEW YORK 10004

George E. Pataki
Governor

Gregory V. Serio
Superintendent

The Office of General Counsel issued the following informal opinion on February 10, 2004, representing the position of the New York State Insurance Department.

Re: Signatures on Unfair Claims Letters

Question Presented

Must a status letter required pursuant to 11 NYCRR 216.7(g)(5), (Regulation 64) be signed by the insurer’s representative?

Conclusion

No. The insurer may satisfy 11 NYCRR 216.7(g)(5), (Regulation 64) by indicating that the letter was sent by the subrogation department, and providing the telephone number of the subrogation department where the insured could obtain additional information concerning the 11 NYCRR 216.7(g)(5), (Regulation 64) status letter if the insured were to have questions, and this will not conflict with 11 NYCRR 216.7(d)(3), (Regulation 64).

Facts

The inquirer works in the subrogation department of an insurer that would like to automate its status letters that must be sent to insureds pursuant to 11 NYCRR 216.7(g)(5), (Regulation 64). The inquirer wants to know if such letters must contain the name and signature of the employee who wrote the letter, or if it would be sufficient that such letter indicate that the letter was sent by the subrogation department, and provide the telephone number for such department.

Analysis

11 NYCRR Part 216.7(g)(5), Regulation 64 states:

If an insurer has paid a physical damage claim that is subject to a deductible and it is pursuing its subrogation claim, the insurer shall notify its insured in writing of the status of its claim 120 calendar days after the date of the claim payment to its insured. An updated status letter shall be sent every 120 calendar days thereafter until the claim is either honored or rejected.

11 NYCRR 216.7(d)(3), (Regulation 64) states in relevant part: "[a]ny letter of explanation or rejection of any element of a claim shall contain the identity and claims processing address of the insurer, the insured’s policy number, the claim number. . . . "

The insurer can satisfy 11 NYCRR 216.7(g)(5), (Regulation 64) by indicating that the letter was sent by the subrogation department, and providing the telephone number of the subrogation department where the insured could obtain additional information concerning the 11 NYCRR 216.7(g)(5), (Regulation 64) status letter if the insured were to have questions, and this will not conflict with 11 NYCRR 216.7(d)(3), (Regulation 64).

For further information one may contact Senior Attorney Susan A. Dess at the New York City Office.