2023 New York Laws › ISC - Insurance › Article 51 - Comprehensive Motor Vehicle Insurance Reparations › 5106 - Fair Claims Settlement.

§  5106.  Fair claims settlement. (a) Payments of first party benefits
and additional first party  benefits  shall  be  made  as  the  loss  is
incurred.    Such  benefits  are  overdue if not paid within thirty days
after the claimant supplies  proof  of  the  fact  and  amount  of  loss
sustained.  If  proof is not supplied as to the entire claim, the amount
which is supported by proof is overdue if not paid  within  thirty  days
after  such  proof is supplied. All overdue payments shall bear interest
at the rate of two percent per month. If a valid claim  or  portion  was
overdue,  the  claimant shall also be entitled to recover his attorney's
reasonable fee, for services necessarily performed  in  connection  with
securing   payment   of   the  overdue  claim,  subject  to  limitations
promulgated by the superintendent in regulations.
(b) Every  insurer  shall  provide  a  claimant  with  the  option  of
submitting  any  dispute  involving the insurer's liability to pay first
party benefits, or additional first party benefits, the  amount  thereof
or  any  other matter which may arise pursuant to subsection (a) of this
section  to  arbitration  pursuant  to  simplified  procedures   to   be
promulgated   or   approved   by  the  superintendent.  Such  simplified
procedures shall include an expedited eligibility hearing  option,  when
required,  to designate the insurer for first party benefits pursuant to
subsection (d) of this section. The expedited eligibility hearing option
shall be a forum for eligibility disputes only, and  shall  not  include
the submission of any particular bill, payment or claim for any specific
benefit  for  adjudication,  nor  shall it consider any other defense to
payment.
(c) An award by an arbitrator shall be binding except where vacated or
modified by a master arbitrator in accordance with simplified procedures
to be promulgated or approved by the  superintendent.  The  grounds  for
vacating or modifying an arbitrator's award by a master arbitrator shall
not  be  limited  to  those  grounds  for  review  set  forth in article
seventy-five of the civil practice law and rules. The award of a  master
arbitrator  shall be binding except for the grounds for review set forth
in article seventy-five  of  the  civil  practice  law  and  rules,  and
provided further that where the amount of such master arbitrator's award
is   five  thousand  dollars  or  greater,  exclusive  of  interest  and
attorney's fees, the insurer or  the  claimant  may  institute  a  court
action to adjudicate the dispute de novo.
(d)  (1) Except as provided in paragraph two of this subsection, where
there is reasonable belief more than one insurer would be the source  of
first  party benefits, the insurers may agree among themselves, if there
is a valid basis therefor, that one of them  will  accept  and  pay  the
claim  initially.  If there is no such agreement, then the first insurer
to whom notice of claim is given shall be responsible for  payment.  Any
such  dispute  shall  be  resolved  in  accordance  with the arbitration
procedures established pursuant to section  five  thousand  one  hundred
five   of   this   article   and   regulations  as  promulgated  by  the
superintendent, and any insurer paying  first-party  benefits  shall  be
reimbursed  by other insurers for their proportionate share of the costs
of the claim and the allocated expenses  of  processing  the  claim,  in
accordance  with  the  provisions entitled "other coverage" contained in
regulation and the provisions entitled  "other  sources  of  first-party
benefits"  contained  in regulation. If there is no such insurer and the
motor vehicle accident occurs in this state, then an applicant who is  a
qualified  person  as defined in article fifty-two of this chapter shall
institute the claim against the motor vehicle  accident  indemnification
corporation.
(2)  A  group  policy  issued  pursuant to section three thousand four
hundred fifty-five or three thousand four hundred  fifty-eight  of  this

chapter  shall  provide first party benefits when a dispute exists as to
whether a driver was using or operating a motor  vehicle  in  connection
with  a  transportation  network  company  or  peer-to-peer  car sharing
program  when  loss,  damage,  injury, or death occurs. A transportation
network company or peer-to-peer car sharing program administrator  shall
notify the insurer that issued the owner's policy of liability insurance
of  the  dispute  within  ten  business  days of becoming aware that the
dispute exists. When there is a dispute, the group  insurer  liable  for
the  payment of first party benefits under a group policy shall have the
right to recover the amount paid from the driver's  insurer  or  in  the
case  of  a peer-to-peer car sharing program, the shared vehicle owner's
insurer to the extent that the driver would  have  been  liable  to  pay
damages in an action at law.
(e)  With respect to an action for serious personal injury permissible
under section five thousand one hundred four of this article,  an  award
or  decision  of  an  arbitrator  or  master arbitrator or that is court
rendered pursuant to subsection (c) of  this  section  seeking  no-fault
reimbursement by or for medical providers, shall not be given collateral
estoppel  effect  in  any  action  or proceeding arising out of the same
occurrence and shall not be admissible in any action  or  proceeding  in
actions  seeking  damages  for  bodily injuries, pain suffering, medical
care and loss of wages as evidence of any facts.