N.Y. Comp. Codes R. & Regs. tit. 11 § 216.5

Current through Register Vol. 46, No. 50, December 11, 2024

Section 216.5 - Standards for prompt investigation of claims

(a) Every insurer shall establish procedures to commence an investigation of any claim filed by a claimant, or by a claimant's authorized representative, within 15 business days of notice of claim. An insurer shall furnish to every claimant, or claimant's authorized representative, a notification of all items, statements and forms, if any, which the insurer reasonably believes will be required of the claimant, within 15 business days of receiving notice of the claim. A claim filed with an agent of an insurer shall be deemed to have been filed with the insurer unless, consistent with law or contract, such agent notifies the person filing the claim that the agent is not authorized to receive notices of claim.

(b) Where there is a reasonable basis, supported by specific information available for review by Department of Financial Services examiners, that the claimant has fraudulently caused or contributed to the loss, the insurer is relieved from the requirements of this Part. The provisions of this Part are suspended for the period required to investigate the alleged fraudulent aspects of the claim. The insurer must submit the report required by Part 86 (Criminal Investigations Unit) of this Title when an insurer determines that a loss is suspect.

N.Y. Comp. Codes R. & Regs. Tit. 11 § 216.5