FAQs: No-Fault Insurance Regulation 68

What are some of the more significant regulatory changes in automobile No-Fault insurance that have occurred as a result of the Department's promulgation of the revised Regulation 68 in September of 2001?
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Answer: Insurance Regulation 68, as revised effective April 5, 2002, effected numerous changes to the processing of No-Fault claims. The revised Regulation modified the timeframes in which to submit written notice of claim from 90 to 30 days and to submit medical bills from 180 to 45 days, respectively, and mandated that lost wage claims must be submitted within 90 days. The new regulation also included provisions for the electronic data transmittal of claim information, and revised rules concerning the wording and acceptance of No-Fault assignments. In addition, the revised regulation modified many of the administrative procedures in connection with No-Fault arbitration and conciliation.

 
When do the new provisions establishing time frames of 30 days for written Notice of Claim, 45 days for submission of health care bills and 90 days for submission of loss of earnings claims take effect?
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Answer: Insurers are required after April 5, 2002, to issue new prescribed endorsements with new and renewal policies containing the new requirements. These requirements can be applied only to claims that arise under policies issued which include the new endorsement.

 
Can an insurer add the new No-Fault endorsement to existing policies before the expiration of the policy?
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Answer: No, the new endorsement can only be issued with new policies or at the annual renewal of an existing policy issued after April 5, 2002.

 
Do the new time period requirements run from the date that notice or submission of claims are made to the insurer or from the date that notice or submission of claims are received by the insurer?
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Answer: The new time requirements apply as of the date that notice or submission of claims are made to the insurer. For example, if the accident occurs on January 1, notice of the claim must be mailed or submitted to the insurer no later than January 30 to comply with the notice requirement.

 
When do the new requirements of 30 days for written Notice of Claim, 45 days for submission of health care bills and 90 days for submission of loss of earnings claims take effect for self-insurers?
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Answer: Self-insurers, which do not issue endorsements, must apply the new requirements on all claims that result from accidents that occur on or after April 5, 2002.

 
What are the effective dates for the new claims practice procedures required by the revised Regulation 68?
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Answer: With some clarifications or exceptions, the new claims practice procedures contained in Regulation 68-C are in effect as of April 5, 2002. The following are the clarifications or exceptions:

  • Simple interest will be paid by insurers for overdue claims arising from accidents that occur on or after April 5, 2002;
  • The Explanation of Benefits must be provided for claims received by insurers on or after April 5, 2002.
  • Benefits for Other Necessary Expenses may no longer be assigned for claims arising from accidents that occur on or after April 5, 2002.
 
When is an insurer required to provide the NF-3 form that is contained in the First Amendment to Regulation 68-C?
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Answer: The NF-3 form contained in the First Amendment must be provided by insurers for claims arising from all accidents that occur on or after March 1, 2002.

 
When is an insurer required to provide the NF-10 Form that is contained in the First Amendment to Regulation 68-C?
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Answer: The NF-10 form contained in the First Amendment must be used for all claims denied that arose out of accidents that occur on or after March 1, 2002.

 
The revised Regulation 68 specifically provides the arbitrator with the discretion to resolve disputes involving amounts of less than $2,000 by written submissions only. When does this rule take effect?
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Answer: This rule takes effect for all arbitration requests filed on or after April 5, 2002.

 
The First Amendment to Regulation 68-D gives the arbitrator the authority to assess costs against the applicant under certain circumstances. When does this rule take effect?
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Answer: This rule takes effect for all arbitration requests filed on or after March 1, 2002.

 
There are provisions that require the payment of a minimum $80 attorney's fee if a dispute is resolved that involves a denied claim. When do these requirements take effect?
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Answer: The requirement for the payment of an $80 minimum attorney's fee for denied claims takes effect for claims received by insurers on or after April 5, 2002.

 
The revised Regulation 68 permits an insurer to make a non-binding offer during the conciliation process. If the offer is rejected by the applicant, the attorney's fee is limited if the offer equals or exceeds the award by an arbitrator. When does this rule take effect?
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Answer: This rule takes effect for all arbitration requests filed on or after April 5, 2002.

 
There are new procedures for the enforcement of unpaid arbitration awards and the payment of an attorney's fee for obtaining payment of such unpaid awards. When do these new procedures take effect?
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Answer: The new procedures for obtaining payment of an unpaid award and for the payment of an attorney's fee for enforcement of awards apply to requests for enforcement of awards that result from arbitration requests filed with the American Arbitration Association on or after April 5, 2002.

 
No-Fault provides coverage for lost wages subject to a 20% statutory offset. The lost wage payment is subject to additional statutory offsets for amounts recovered or recoverable on account of personal injury to an eligible injured person under State or Federal laws providing social security disability or workers' compensation benefits, or disability benefits under article 9 of the New York Workers' Compensation Law. Are these other statutory offsets deducted from gross wages before application of the 20% offset, or are they deducted after application of the 20% offset?
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Answer: The determination of whether the offsets for New York State Disability benefits are deducted before or after the 20% offset is dependent upon the taxability of the disability benefit. If the benefit is taxable, it is deducted prior to application of the 20% offset. If the benefit is not taxable, it is deducted after application of the 20% offset factor. No-Fault insurers should not make any assumptions as to whether or not NYS Disability benefits are taxable. The No-Fault insurer is responsible for determining the taxability of the NYS Disability benefits at the time the claim is made.