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No-Fault Regulation 68

Current Regulation 68: Effective April 5, 2002

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The Current Regulation 68 was to be implemented effective as of September 1, 2001. However, due to a lawsuit filed in the New York State Supreme Court seeking a stay of enforcement of the revised regulation, the revised Regulation 68 (that included subparts one through four) became effective as of April 5, 2002. Subpart five was subsequently added and became effective November 13, 2013.

Regulation 68 is divided into five different subparts that each address a separate regulated aspect of the No-Fault reparations system as follows: Regulation 68-A - Prescribed Policy Endorsements; Regulation 68-B - Rights and Liabilities of Self Insurers; Regulation 68-C - Claims for Personal Injury Protection Benefits; Regulation 68-D - No-Fault Arbitration; and Regulation 68-E - Unauthorized Providers of Health Services.

On April 11, 2002 the Department promulgated, on an emergency basis, the First Amendment to Regulation No. 68-C (11 NYCRR 65) and the First Amendment to Regulation No. 68-D (11 NYCRR 65). These two emergency regulations amended the provisions of the Current Regulation 68 to conform it with the 25th Amendment to the old regulation, and were finally adopted on April 5, 2003.

Subsequently, the Department promulgated both the Second and Third Amendments to Regulation 68-D (11NYCRR65) to take effect on February 4, 2004.

On April 30, 2004 the Department promulgated the Second Amendment to Regulation 68-C which resulted in the repeal and re-issuance of Appendix 13 to Regulation 68, which contains a complete set of the prescribed No-Fault claim forms.

On August 31, 2006 the Department promulgated, on an emergency basis, the Third Amendment to Regulation No. 68-C (11 NYCRR 65) and the Fourth Amendment to Regulation No. 68-D (11 NYCRR 65). These two amendments to Regulation 68 were finally adopted effective March 14, 2007, requiring insurers to issue no-fault denials with specific wording so that the applicants will be aware that they can apply for special expedited arbitration to resolve the issue of which eligible insurer is designated for first party benefits, and providing the procedures for administration of the special expedited arbitration for disputes regarding the designation of the insurer for first part benefits.

On April 26, 2011 the Department promulgated the First Amendment to Regulation 68-A and the First Amendment to Regulation 68-B implementing the amendment to section 5103(b)(2) of the New York Insurance Law (effective January 26, 2011) providing limited no-fault coverage to an applicant while intoxicated.

On April 1, 2013 the Fourth Amendment to Regulation 68-C became effective and established a new 120 calendar day time frame for an applicant to respond to a verification request from a no-fault insurer, and also established a rule to prevent an applicant from receiving reimbursement in excess of the fee schedules or for services not rendered due to a late denial by the insurer.

On June 1, 2013 the Fifth Amendment to Regulation 68-C (Consensus Amendment) became effective and resulted in the repeal and re-issuance of an updated prescribed No-Fault Denial of Claim Form (NYS Form NF-10) to Appendix 13. 

On August 1, 2013 the consolidated amendment to multiple parts of 11 NYCRR took effect and resulted in the Second Amendment to Regulation 68-A, the Sixth Amendment to Regulation 68-C, the Fifth Amendment to Regulation 68-D, and the repeal and re-issuance of prescribed forms NF-1A, NF-1B, NF-4 and NF-5 of Appendix 13.  The consolidated amendment revised references that were outdated as a result of the consolidation of the New York State Insurance and Banking Departments into a new Department of Financial Services.

On November 13, 2013, the final adoption of new subpart 65-5 (Insurance Regulation 68-E) took effect. The new subpart establishes standards and procedures for investigating and suspending or removing the authorization for providers of health services to demand or request payment upon findings of certain unlawful conduct reached after investigation, notice, and a hearing pursuant to 5109 of the NYIL.

On February 4, 2015, the Sixth Amendment to Regulation 68-D took effect revising the structure of fees that are awarded to attorneys who prevail in no-fault disputes on behalf of applicants - (1) eliminates the $60 minimum attorney’s fee; (2) eliminates the $60-or-$80 attorney-fee limit that applies during the conciliation phase of the arbitration process; and (3) increases the maximum fee to be awarded to an attorney who prevails in court or at arbitration to $1,360.

On January 10, 2017, the Seventh Amendment to Regulation 68-C took effect, resulting in the repeal and re-issuance of prescribed NYS Form NF-10 (Rev 1/2017) of Appendix 13. This amendment updates the address for the Department’s Nassau County Consumer Assistance Unit office.

On October 25, 2017, the final adoption of the Third Amendment to Regulation No. 68-A (11 NYCRR 65-1), the Eighth Amendment to Regulation No. 68-C (11 NYCRR 65-3), and the Seventh Amendment to Regulation 68-D (11 NYCRR 65-4) previously promulgated on an emergency basis took effect establishing the standards and procedures for providing coverage with respect to Transportation Network Companies (Ride Sharing) pursuant to Part AAA of Chapter 59 of the Laws of 2017 effective June 29, 2017.

NOTE TO READER

In order to view Regulation 68 in totality and in its most current form, you may access it through the publicly available New York Codes, Rules and Regulations. All five subparts of the Regulation (11 NYCRR 65) can be accessed directly by clicking here. If this direct link does not work, it can be accessed through the following path:

Appendix 13 to Regulation 68 (contains all prescribed No-Fault claim forms) (PDF)

Complete Text of Regulation 68 and Amendments

If, for historical purposes, you require access to the unmodified complete text of Regulation 68 (as initially promulgated) that became effective as of April 5, 2002, or any of the subsequent amendments to the individual subparts of the Regulation, these documents can be individually accessed as follows:

Regulation 68 (as initially promulgated) (PDF format)

The above document includes all four subparts of Regulation 68 as well as Appendix 13, as initially promulgated.

NOTE that the above document does NOT reflect the subsequent issuance of amendments to Regulation 68, each of which are each individually listed below. Each document is in PDF format unless otherwise noted:

Updated 05/14/2018

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