2023 New York Laws › ISC - Insurance › Article 26 - Unfair Claim Settlement Practices; Other Misconduct; Discrimination › 2618 - Standards for Prompt Investigation and Settlement of Claims.

§  2618.  Standards for prompt investigation and settlement of claims.
(a) (1) For the purpose of this section, "natural  disaster"  means  the
occurrence  of widespread catastrophic or severe damage, injury, or loss
of life or property resulting from any natural  cause,  including  fire,
flood,  earthquake, hurricane, tornado, high water, landslide, mudslide,
wind, storm, wave action, and ice storm.
(2) This section shall apply to every insurer who writes policies that
cover loss of or damage to real property,  personal  property  or  other
liabilities  for  loss  of,  damage to, or injury to persons or property
when:
(A) a local  state  of  emergency  is  declared  pursuant  to  section
twenty-four  of the executive law, when the governor declares a disaster
emergency pursuant to section twenty-eight of the executive law, or when
the President issues a major disaster or emergency declaration  pursuant
to  the  Robert T. Stafford Disaster Relief and Emergency Assistance Act
(P.L. 93-288);
(B) the disaster is a natural disaster or a disaster caused by an  act
of terrorism; and
(C) the claims are a result of such disaster.
(3)  An insurer shall acknowledge the receipt of all claims in writing
to  the  claimant  or  the  claimant's  authorized   representative   in
accordance with regulations promulgated by the superintendent;
(4)  If  the insurer wishes its investigation to include an inspection
of damaged or destroyed property, the inspection, whether  performed  by
the  insurer,  an  independent  adjuster, or other representative of the
insurer, shall occur in accordance with regulations promulgated  by  the
superintendent.  Furthermore,  where  necessary  to  protect  health and
safety, immediate repairs to windows, exterior  walls,  exterior  doors,
roofs, heating systems, water systems and electrical systems may be made
and  alternative  proof  of  loss such as photographs, video recordings,
inventories and all receipts for repairs or replacement  property  shall
satisfy policy requirements;
(5)  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, the
agent notifies the person  filing  the  claim  that  the  agent  is  not
authorized to receive notices of claim; and
(6)  An  insurer  shall  furnish  to  such claimant, or the 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  in  order  to  investigate  such claim in accordance with
regulations promulgated by the superintendent.
(b)(1) An insurer shall, within fifteen business days of receipt of  a
properly executed proof of loss and receipt of all items, statements and
forms  requested under this section from the claimant, or the claimant's
authorized representative, advise the claimant in  writing  whether  the
insurer  has  accepted  or  rejected  the non-commercial claim. When the
insurer suspects that  the  non-commercial  claim  involves  arson,  the
foregoing fifteen business days shall be read as thirty business days.
(2)  An  insurer  shall  be  granted  a  one-time extension of fifteen
business days to determine whether  a  non-commercial  claim  should  be
accepted  or  rejected. If the insurer elects to utilize this extension,
it  shall  so  notify  the  claimant,  or  the   claimant's   authorized
representative,  in writing. Such notification shall include the reasons
additional time is needed for the investigation.
(3) (i) If the insurer  needs  more  time  to  determine  whether  the
non-commercial  claim should be accepted or rejected because the insurer
is prohibited from accessing the property to investigate the claim,  the
insurer  shall  be  granted one additional extension of fifteen business

days. If the insurer elects to  utilize  this  extension,  it  shall  so
notify  the  claimant,  or  the claimant's authorized representative, in
writing, setting forth the reasons additional time  is  needed  for  the
investigation.
(ii)  If  the  insurer needs more time to be able to physically access
the property because the insurer is prohibited from  accessing  it,  the
insurer  shall  so  notify  the  claimant,  or the claimant's authorized
representative, every fifteen business days, in writing,  setting  forth
the  reasons  additional  time is needed for the investigation. When the
insurer is no longer prohibited from accessing  the  property,  and  the
property  can  be  accessed, the insurer shall have no more than fifteen
days to adjudicate the claim.
(c) (1) An insurer shall, within fifteen business days of receipt of a
properly executed proof of loss and receipt of all items, statements and
forms requested under this section from the claimant, or the  claimant's
authorized  representative,  advise  the claimant in writing whether the
insurer has accepted or rejected the commercial claim.
(2) An insurer  shall  be  granted  a  one-time  extension  of  thirty
business days to determine whether a commercial claim should be accepted
or  rejected.  If the insurer elects to utilize this extension, it shall
so notify the claimant, or the claimant's authorized representative,  in
writing,  setting  forth  the  reasons additional time is needed for the
investigation.
(3) If succeeding the one-time extension of thirty business  days  the
insurer needs more time to determine whether the commercial claim should
be  accepted  or  rejected, the insurer shall so notify the claimant, or
the claimant's authorized representative, every thirty business days, in
writing, setting forth the reasons additional time  is  needed  for  the
investigation.
(4)  Once  the  claim  is  accepted  by the insurer, the insurer shall
advise the claimant, or the  claimant's  authorized  representative,  in
writing  of  the amount the insurer is offering to settle the claim. The
insurer shall also provide to the claimant, or the claimant's authorized
representative,  in  writing,  of  all  applicable   policy   provisions
regarding  the  claimant's  right  to  reject  the  offer and request an
appraisal.
(5) In any case where the  claim  is  rejected  by  the  insurer,  the
insurer   shall  notify  the  claimant,  or  the  claimant's  authorized
representative, in writing, of  all  applicable  policy  provisions  and
deadlines  by which a claimant may sue the insurer. Any notice rejecting
any element of a  claim  involving  personal  property  insurance  shall
contain  the  identity and the claims processing address of the insurer,
the insured's policy number, the claim number, and information regarding
how  to  file  a  complaint  with  the  department  in  accordance  with
regulations promulgated by the superintendent.
(d)  Every  insurer  shall  pay  any  amount  finally  agreed  upon in
settlement of all or part of any claim not later than four business days
from the receipt of such agreement by the insurer, or from the  date  of
the  performance by the claimant of any condition set by such agreement,
whichever  is  later,  except  as  provided  in  section  three  hundred
thirty-one  of  this  chapter  with respect to liens by tax districts on
fire insurance proceeds.
(e)  The  superintendent  may  promulgate  any  rules  or  regulations
necessary to implement the provisions of this section.