New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter III - Policy and Certificate Provisions › Subchapter B - Property and Casualty Insurance › Part 65 - Regulations Implementing The Comprehensive Motor Vehicle Insurance Reparations Act › Subpart 65-2 - Rights And Liabilities Of Self-insurers › Section 65-2.4 - Conditions

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Action against
					 self-insurer. No action shall lie against the self-insurer unless, as a
					 condition precedent thereto, there shall have been full compliance with the
					 terms of this section.
(b) Notice.
					 In the event of an accident, written notice setting forth details sufficient to
					 identify the eligible injured person, along with reasonably obtainable
					 information regarding the time, place and circumstances of the accident, shall
					 be given by or on behalf of each eligible injured person to the self-insurer or
					 any of the self-insurer's authorized agents, as soon as reasonably practicable,
					 but in no event more than 30 days after the date of the accident, unless the
					 eligible injured person submits written proof providing clear and reasonable
					 justification for the failure to comply with such time limitation. If an
					 eligible injured person or that person's legal representative institutes a
					 proceeding to recover damages for personal injury under section 5104(b) of the
					 New York Insurance Law, a copy of the summons and complaint or other process
					 served in connection with such action shall be forwarded as soon as practicable
					 to the self-insurer or any of the self-insurer's authorized agents by such
					 eligible injured person or that person's legal representative.
(c) Proof of claim; medical, work loss, and
					 other necessary expenses. In the case of a claim for health service expenses,
					 the eligible injured person or that person's assignee or legal representative
					 shall submit written proof of claim to the self-insurer, including full
					 particulars of the nature and extent of the injuries and treatment received and
					 contemplated, as soon as reasonably practicable but, in no event later than 45
					 days after the date services are rendered. The eligible injured person or that
					 person's legal representative shall submit written proof of claim for work loss
					 benefits and for other necessary expenses to the self-insurer as soon as
					 reasonably practicable but, in no event, later than 90 days after the work loss
					 is incurred or the other necessary services are rendered. The foregoing time
					 limitations for the submission of proof of claim shall apply unless the
					 eligible injured person submits written proof providing clear and reasonable
					 justification for the failure to comply with such time limitation. Upon request
					 by the self-insurer, the eligible injured person or that person's assignee or
					 representative shall:
(1) execute a written
					 proof of claim under oath;
(2) as
					 may reasonably be required submit to examinations under oath by any person
					 named by the self-insurer and subscribe the same;
(3) provide authorization that will enable
					 the self-insurer to obtain medical records; and
(4) provide any other pertinent information
					 that may assist the self-insurer in determining the amount due and payable.
The eligible injured person shall submit to medical
						examination by physicians selected by, or acceptable to, the self-insurer,
						when, and as often as, the self-insurer may reasonably require.