New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter IX - Unfair Trade Practices › Part 216 - Unfair Claims Settlement Practices And Claim Cost Control Measures › Section 216.10 - Standards for prompt, fair and equitable settlement of third-party property damage claims arising under motor vehicle liability insurance contracts

Current through Register Vol. 46, No. 28, July 10, 2024
This section is applicable to claims arising under motor
				  vehicle liability insurance contracts affording coverage for claims of property
				  damage by third parties caused by the alleged negligence of the insured. The
				  following provisions of this Part shall also be applicable to these claims:
				  sections
				  216.0(a), (b), (d),
				  (e);
				  216.1;
				  216.2(preamble);
				  216.3;
				  216.4(b),
				  (c), (d), (e);
				  216.5;
				  216.6(a),
				  (b), (e)-(g);
				  216.7(a),
				  (b)(4)-(6), (11)-(13), (c)(1), (3), (4); and
				  216.11.
(a) Within 15 business days of receipt of
				notice of claim, the insurer shall send either written acknowledgment of the
				receipt of notice of claim, or payment, to the claimant or the claimant's
				representative.
(1) When notice of a claim is
				received from a claimant or the claimant's representative, and the insurer is
				of the opinion that it is not liable for any payment, then its sole obligation
				shall be to advise the claimant in writing that it is the insurer and furnish
				the claimant with its policy number and deny the claim, setting forth the
				reasons therefor.
(2) If the
				insurer is unable to verify coverage of the insured, its written acknowledgment
				shall indicate such fact and request any additional information as may be
				needed to ascertain the existence or absence of coverage. Upon verification of
				coverage, the insurer shall provide the notification pursuant to paragraph (3)
				of this subdivision.
(3)
(i) In all other claims, the written
				acknowledgment by the insurer shall inform the claimant that the insured has a
				policy which, to the extent of the insured's negligence, provides coverage for
				property damage, including the loss of use of damaged property and any other
				out-of-pocket expenses reasonably attributable to the accident. The
				acknowledgment shall also state that in no event will the recovery against the
				insurer exceed the maximum amount of the policy. The acknowledgment shall
				contain an explanation of the comparative negligence rules in New York, to the
				effect that, should the insurer's investigation determine that its insured is
				only partially liable, coverage of the property damage, loss of use and other
				expenses will only be partially reimbursed in accordance with the percentage
				that the insured is found to be at fault in the accident.
(ii) Concurrent with the acknowledgment, the
				insurer shall send a claim form or shall request by telephone or personal
				contact any pertinent additional information necessary for the insurer to reach
				a final evaluation of the claim. Within 10 business days of acknowledgment of
				the claim or the receipt of the information requested when acknowledging the
				claim, the insurer must request any additional information required to process
				the claim. If, during the investigation, additional information will be
				required, the insurer must initiate a request for such information within 10
				business days after the need for the information is established. If the insurer
				is advised by the claimant that the claimant is pursuing recovery under another
				policy, the insurer may suspend action on the claim.
(4)
(i)
				Limitations for adjustment of rental vehicle claims for vehicles rented in New
				York State. With respect to the rights of authorized drivers and insurers to
				inspect rental vehicles, notwithstanding any other provisions of this Part,
				insurers are also subject to the provisions of section 396-z (5)(c)  of the
				General Business Law, effective February 24, 2003, which provides as follows:
"Within seventy-two hours of return of the vehicle, the
				  authorized driver or his or her insurer must notify the rental vehicle company
				  that he or she wishes to inspect the damaged vehicle. The inspection must be
				  completed within seven days of the return date of the vehicle. If the
				  authorized driver or his or her insurer does not request this inspection within
				  the seventh-two-hour period, the authorized driver or his or her insurer will
				  be deemed to have waived this right. If the rental vehicle company determines
				  the damaged vehicle to be a total loss and subject to salvage, such
				  seventy-two-hour period for notification or waiver of the wish to inspect the
				  damaged vehicle shall not apply, and the authorized driver or his or her
				  insurer shall have 10 business days from the authorized driver's receipt of
				  notification from the rental vehicle company pursuant to paragraph (a) of this
				  subdivision [section 396- z(5)(a)] to inspect the damaged vehicle, unless the
				  rental vehicle company agrees to provide access to such damaged vehicle beyond
				  the 10 business days provided herein."
(ii) Section 396-z (5)(c)  of the
				General Business Law further provides:
"Within the limits provided in this paragraph, the rental
				  vehicle company shall identify the repairer of, and provide access to, the
				  damaged vehicle, in order to verify the nature and extent of damages, repairs
				  and repair costs, and/or repair estimates."