Supplement No. 1 to Insurance Circular Letter No. 16 (2005): Claims for No-fault Benefits – Resolution Methods for Disputes Between Insurers Revisions to the Emergency Third Amendment to Regulation No. 68-C

Supplement No. 1 to
Circular Letter No. 16 (2005)

September 6, 2006

TO:

All insurers authorized to write motor vehicle insurance in New York State, motor vehicle self-insurers, and the Motor Vehicle Accident Indemnification Corporation

RE:

Claims for No-fault Benefits - Resolution Methods for Disputes Between Insurers

Revisions to the Emergency Third Amendment to Regulation No. 68-C

STATUTORY REFERENCE: NYIL Section 5106, Sections 65-3.12 and 65-3.13 of the Emergency Third Amendment to Regulation No. 68-C (11 NYCRR 65-3)

Circular Letter No. 16 (2005) issued October 5, 2005 provided guidance to insurers about recent legislation and amendments to Regulation No. 68-C and Regulation No. 68-D with regard to processing certain first party No-fault claims.

The purpose of this supplement is to advise insurers about a revision to the required denial language that must be utilized by an insurer when the insurer concludes that it was not the first insurer contacted to provide first party benefits and denies coverage for the claim. The Emergency Third Amendment to Regulation No. 68-C effective September 1, 2006 contains the revised denial language that must be used when denying a priority of payment dispute. The following is the revised denial language an insurer must use on its denial of claim form (NF-10) in box 33:

If after contacting the insurer that we advised you has primary responsibility for the payment of first party benefits, that insurer denies coverage for your claim, you have the option to submit this dispute for expedited arbitration by providing a copy of the denial form and a written request along with a $40.00 filing fee to the organization listed under option two on the back of this form. Your $40.00 filing fee will be refunded to you by the insurer determined to be responsible for processing your claim. This arbitration is limited solely to determining the insurer to process your claim, and it will not resolve issues regarding pending bills or consider any other defense to payment. You do not need to submit bills for this arbitration.

The revised denial language must replace the language that was required in the prior Emergency Third Amendment to Regulation No. 68-C.

Please direct any comments or questions regarding the contents of this Supplement to Isaac Zamdas, Principal Insurance Examiner, Property Bureau, at the following address:

New York State Insurance Department
25 Beaver Street
New York, New York 10004

Mr. Zamdas can also be contacted by telephone at 212-480-5586 or via e-mail at Isaac Zamdas.

Very truly yours,

________________________________
Mark Presser
Assistant Deputy Superintendent &
Chief Examiner
Property Bureau