reglab/statecodes huggingface dataset:
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter IX - Unfair Trade Practices › Part 215 - Advertisements Of Accident And Health Insurance › Section 215.7 - Necessity for disclosing policy provisions relating to renewability, cancellability and termination

Current through Register Vol. 46, No. 28, July 10, 2024
When an advertisement refers to either a dollar amount or a
				  period of time for which any benefit is payable, or the cost of the policy, or
				  specific policy benefit, or the loss for which such benefit is payable, it
				  shall disclose the provisions relating to renewability, cancellability and
				  termination and any modification of benefits, losses covered or premiums
				  because of age or for other reasons, in a manner which shall not minimize or
				  render obscure the qualifying conditions.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter IX - Unfair Trade Practices › Part 215 - Advertisements Of Accident And Health Insurance › Section 215.8 - Testimonials or endorsements by third parties

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Testimonials used in advertisements must
				be genuine, represent the current opinion of the author, be applicable to the
				policy advertised and be accurately reproduced. The insurer, in using a
				testimonial, makes as its own all of the statements contained therein, and the
				advertisement, including such statements, is subject to all of the provisions
				of this Part.
(b) If the person
				making a testimonial, an endorsement or an appraisal has a financial interest
				in the insurer or a related entity as a stockholder, director, officer,
				employee, or otherwise, such fact shall be disclosed in the advertisement. If a
				person is compensated for making a testimonial, endorsement or appraisal, such
				fact shall be disclosed in the advertisement by language substantially as
				follows: "Paid endorsement". This rule does not require disclosure of union
				"scale" wages required by union rules if the payment is actually for such
				"scale" for TV or radio performances. The payment of substantial amounts,
				directly or indirectly, for "travel and entertainment" for filming or recording
				of TV or radio advertisements remove the filming or recording from the category
				of an unsolicited testimonial and require disclosure of such
				compensation.
(c) An advertisement
				shall not state or imply that an insurer or a policy has been approved or
				endorsed by any individual group of individuals, society, association or other
				organizations, unless such is the fact, and unless any proprietary relationship
				between an organization and the insurer is disclosed. If the entity making the
				endorsement or testimonial has been formed by the insurer or is owned or
				controlled by the insurer or the person or persons who own or control the
				insurer, such fact shall be disclosed in the advertisement.
(d) When a testimonial refers to benefits
				received under a policy, the specific claim data, including claim number, date
				of loss, and other pertinent information shall be retained by the insurer for
				inspection for a period of four years or until the filing of the next regular
				report on examination of the insurer, whichever is the longer period of
				time.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter IX - Unfair Trade Practices › Part 215 - Advertisements Of Accident And Health Insurance › Section 215.9 - Use of statistics

Current through Register Vol. 46, No. 28, July 10, 2024
(a) An
				advertisement relating to the dollar amounts of claims paid, the number of
				persons insured, or similar statistical information relating to any insurer or
				policy shall not use irrelevant facts, and shall not be used unless it
				accurately reflects all of the relevant facts. Such an advertisement shall not
				imply that such statistics are derived from the policy advertised unless such
				is the fact, and when applicable to other policies or plans shall specifically
				so state.
(b) An advertisement
				shall not represent or imply that claim settlements by the insurer are
				"liberal" or "generous," or use words of similar import, or that claim
				settlements are or will be beyond the actual terms of the contract. An unusual
				amount paid for a unique claim for the policy advertised is misleading and
				shall not be used.
(c) The source
				of any statistics used in an advertisement shall be identified in such
				advertisement.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter IX - Unfair Trade Practices › Part 215 - Advertisements Of Accident And Health Insurance › Section 215.10 - Identification of plan or number of policies

Current through Register Vol. 46, No. 28, July 10, 2024
(a) When a choice of the amount of benefits
				is referred to, an advertisement shall disclose that the amount of benefits
				provided depends upon the plan selected and that the premium will vary with the
				amount of the benefits selected.
(b) When an advertisement refers to various
				benefits which may be contained in two or more policies, other than group or
				blanket policies, the advertisement shall disclose that such benefits are
				provided only through a combination of such policies.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter IX - Unfair Trade Practices › Part 215 - Advertisements Of Accident And Health Insurance › Section 215.11 - Disparaging comparisons and statements

Current through Register Vol. 46, No. 28, July 10, 2024
An advertisement shall not directly or indirectly make unfair
				  or incomplete comparisons of policies or benefits or comparisons of
				  non-comparable policies of other insurers, and shall not disparage competitors,
				  their policies, services or business methods, and shall not disparage or
				  unfairly minimize competing methods of marketing insurance.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter IX - Unfair Trade Practices › Part 215 - Advertisements Of Accident And Health Insurance › Section 215.12 - Jurisdictional licensing and status of insurer

Current through Register Vol. 46, No. 28, July 10, 2024
(a) An advertisement which is intended to be
				seen or heard beyond the limits of the jurisdiction in which the insurer is
				licensed shall not imply licensing beyond those limits.
(b) An advertisement shall not create the
				impression directly or indirectly that the insurer, its financial condition or
				status, or the payment of its claims, or the merits, desirability, or
				advisability of its policy forms or kinds or plans of insurance are approved,
				endorsed, or accredited by any division or agency of this State or the United
				States government.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter IX - Unfair Trade Practices › Part 215 - Advertisements Of Accident And Health Insurance › Section 215.13 - Identity of insurer

Current through Register Vol. 46, No. 28, July 10, 2024
(a) The name of
				the actual insurer and the form number or numbers advertised shall be
				identified and made clear in all of its advertisements. An advertisement shall
				not use a trade name, any insurance group designation, name of the parent
				company of the insurer, name of a particular division of the insurer, service
				mark, slogan, symbol or other device which without disclosing the name of the
				actual insurer would have the capacity and tendency to mislead or deceive as to
				the true identity of the insurer.
(b) No advertisement shall use any
				combination of words, symbols, or physical materials which by their content,
				phraseology, shape, color or other characteristics are so similar to any
				combination of words, symbols, or physical materials used by agencies of the
				Federal government or of this State, or otherwise appear to be of such a nature
				that it tends to confuse or mislead prospective insureds into believing that
				the solicitation is in some manner connected with an agency of the municipal,
				State, or Federal government.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter IX - Unfair Trade Practices › Part 215 - Advertisements Of Accident And Health Insurance › Section 215.14 - Group or quasi-group implications

Current through Register Vol. 46, No. 28, July 10, 2024
An advertisement of a particular policy shall not state or
				  imply that prospective insureds become group or quasi-group members covered
				  under a group policy and as such enjoy special rates or underwriting
				  privileges, unless such is the fact.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter IX - Unfair Trade Practices › Part 215 - Advertisements Of Accident And Health Insurance › Section 215.15 - Introductory, initial or special offers

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
(1) An
				advertisement of an individual policy shall not directly or by implication
				represent that a contract or combination of contracts is an introductory,
				initial or special offer, or that applicants will receive substantial
				advantages not available at a later date, or that the offer is available only
				to a specified group of individuals, unless such is the fact. An advertisement
				shall not describe an enrollment period as "special", or "limited", or use
				similar words or phrases when the insurer uses enrollment periods as the usual
				method of advertising accident and sickness insurance.
(2) An enrollment period during which a
				particular insurance product may be purchased on an individual basis shall not
				be offered within the same marketing area unless there has been a lapse of not
				less than six months between the close of the immediately preceding enrollment
				period for the same product and the opening of the new enrollment period. The
				advertisement shall indicate the date by which the applicant must mail the
				application which shall be not less than 10 days and not more than 40 days from
				the date that such enrollment period is advertised for the first time. This
				rule applies to all advertising media, i.e., mail, newspapers, radio,
				television, magazines and periodicals, by any one insurer. It is inapplicable
				to solicitations of employees or members of a particular group or association
				which otherwise would be eligible under specific provisions of the New York
				Insurance Law for group, blanket or franchise insurance. The phrase "any one
				insurer" includes all the affiliated companies of a group of insurance
				companies under common management or control.
(3) This rule prohibits any statement or
				implication to the effect that only a specific number of policies will be sold,
				or that a time is fixed for the discontinuance of the sale of the particular
				policy advertised because of special advantages available in the policy, unless
				such is the fact.
(4) The phrase "a
				particular insurance product" in paragraph (2) of this subdivision means an
				insurance policy which provides substantially different benefits than those
				contained in any other policy. Different terms of renewability; an increase or
				decrease in the dollar amounts of benefits; an increase or decrease in any
				elimination period or waiting period from those available during an enrollment
				period for another policy shall not be sufficient to constitute the product
				being offered as a different product eligible for concurrent or overlapping
				enrollment periods.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter IX - Unfair Trade Practices › Part 215 - Advertisements Of Accident And Health Insurance › Section 215.16 - Statements about an insurer

Current through Register Vol. 46, No. 28, July 10, 2024
An advertisement shall not contain statements which are
				  untrue in fact, or by implication misleading, with respect to the assets,
				  corporate structure, financial standing, age or relative position of the
				  insurer in the insurance business. An advertisement shall not contain a
				  recommendation by any commercial rating system unless it clearly indicates the
				  purpose of the recommendation and the limitations of the scope and extent of
				  the recommendation.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter IX - Unfair Trade Practices › Part 215 - Advertisements Of Accident And Health Insurance › Section 215.17 - Enforcement procedures

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
				Advertising file. Each insurer shall maintain at its home or principal office a
				complete file containing every printed, published or prepared advertisement of
				its individual policies and typical printed, published or prepared
				advertisements of its blanket, franchise and group policies hereafter
				disseminated in this or any other State whether or not licensed in such other
				State, with a notation attachhed to each such advertisement which shall
				indicate the manner and extent of distribution and the form number of any
				policy advertised. Such file shall be subject to regular and periodical
				inspection by the department. All such advertisements shall be maintained in
				said file for a period of either four years or until the filing of the next
				regular report on examination of the insurer, whichever is the longer period of
				time.
(b) Certificate of
				compliance. Each insurer required to file an annual statement which is now or
				which hereafter becomes subject to the provisions of this Part must file with
				this department with its annual statement a certificate of compliance executed
				by an authorized officer of the insurer wherein it is stated that to the best
				of his knowledge, information and belief the advertisements which were
				disseminated by the insurer during the preceding statement year complied or
				were made to comply in all respects with the provisions of this Part and the
				Insurance Laws of this State as implemented and interpreted by this
				Part.
(c) Corrective advertising.
				If the superintendent finds, after notice and opportunity to be heard, that any
				advertisement is in violation of the provisions of this Part, and that the
				violation was such as to substantially deceive or to mislead the public, he
				may, in addition to any other remedy or monetary penalties he may otherwise
				impose, order the insurer responsible for the dissemination of such
				advertisement to publish at its own expense a corrective advertisement in a
				form and manner to be approved by the superintendent. Should any insurer fail
				to publish a corrective advertisement as required by the superintendent, the
				superintendent may publish such an advertisement and the insurer shall, in
				addition to any monetary penalty imposed, reimburse the department for the
				expenses incurred in connection with the publication of such
				advertisement.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter IX - Unfair Trade Practices › Part 215 - Advertisements Of Accident And Health Insurance › Section 215.18 - Severability provision

Current through Register Vol. 46, No. 28, July 10, 2024
If any section or portion of a section of this Part, or the
				  applicability thereof to any person or circumstance is held invalid by a court,
				  the remainder of this Part, or the applicability of such provision to other
				  persons or circumstances, shall not be affected thereby.
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 216.0 - Preamble

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Section 2601  of the Insurance Law prohibits
				insurers doing business in this State from engaging in unfair claims settlement
				practices and provides that, if any insurer performs any of the acts or
				practices proscribed by that section without just cause and with such frequency
				as to indicate a general business practice, then those acts shall constitute
				unfair claims settlement practices. This Part contains claim practice rules
				which insurers must apply to the processing of all first- and third-party
				claims arising under policies subject to this Part. In addition, specific rules
				are provided for the processing of first-party motor vehicle physical damage
				claims and third-party property damage claims arising under motor vehicle
				liability insurance contracts.
(b)
				This Part is issued for the purpose of defining certain minimum standards
				which, if violated without just cause and with such frequency as to indicate a
				general business practice, would constitute unfair claims settlement practices.
				This Part is not exclusive, and other acts, not herein specified, may also be
				found to constitute such practices.
(c) Section 3411 (i)  of the Insurance
				Law has been implemented by section
				216.7 
				of this Part.
(d) Section 3412  of the Insurance Law has been
				implemented by section
				216.8 
				of this Part.
(e) Claim practice
				principles to be followed by all insurers.
(1) Have as your basic goal the prompt and
				fair settlement of all claims.
(2)
				Assist the claimant in the processing of a claim.
(3) Do not demand verification of facts
				unless there are good reasons to do so. When verification of facts is
				necessary, it should be done as expeditiously as possible.
(4) Clearly inform the claimant of the
				insurer's position regarding any disputed matter.
(5) Respond promptly, when response is
				indicated, to all communications from insureds, claimants, attorneys and any
				other interested persons.
(6) Every
				insurer shall distribute copies of this regulation to every person directly
				responsible for the supervision, handling and settlement of claims subject to
				this regulation, and every insurer shall satisfy itself that all such personnel
				are thoroughly conversant with, and are complying with, this
				regulation.
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 216.1 - Definitions

Current through Register Vol. 46, No. 28, July 10, 2024
The definitions set forth in this section shall govern the
				  construction of the terms used in this Part.
(a) Agent shall mean any person, firm,
				association or corporation authorized to act as the representative of an
				insurer and licensed pursuant to the provisions of article 21 of the Insurance
				Law. With respect to group life and group accident and health policies, the
				group policyholder shall be the agent of the insurer to the extent such
				policyholder has been authorized to act on behalf of such insurer.
(b) Claimant shall mean any person who
				attempts to obtain a benefit from an insurer.
(c) Investigation shall mean any procedure
				adopted by an insurer to determine whether to accept or reject a
				claim.
(d) Business day shall mean
				a day other than Saturday, Sunday or a New York State legal holiday.
(e) Notice of claim shall mean any
				notification, whether in writing or otherwise, to an insurer or its agent, by
				any claimant who reasonably apprises the insurer of the facts pertinent to a
				claim.
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 216.2 - Applicability

Current through Register Vol. 46, No. 28, July 10, 2024
This Part shall apply to all insurers licensed to do business
				  in this State.
(a) It shall not be
				applicable to policies of workers' compensation insurance issued pursuant to
				the provisions of section 1113 (a)(15)  of the
				Insurance Law; credit insurance issued pursuant to the provisions of section
				1113(a)(17); title insurance issued pursuant to the provisions of section
				1113(a)(18); inland marine insurance issued pursuant to the provisions of
				section 1113(a)(20); unless such insurance is subject to the provisions of
				section 3425  of the
				Insurance Law; and ocean marine insurance issued pursuant to the provisions of
				section 1113(a)(20) and (21).
(b)
				Subdivisions (a) and (b) of section
				216.6  of this Part shall not be
				applicable to policies of life insurance written pursuant to the provisions of
				section 1113 (a)(1)  of the
				Insurance Law. Subdivision (b) of section
				216.6  of this Part shall not be
				applicable to accident and health policies written pursuant to the provisions
				of section 1113(a)(3) and the provisions of article 43 of the Insurance
				Law.
(c) Sections
				216.4 and
				216.5  and subdivision (c) of
				section 216.6  of this Part shall not be
				applicable to policies of accident and health insurance written pursuant to the
				provisions of section 1113(a)(3) and the provisions of article 43 of the
				Insurance Law, where the claimant is neither a policyholder, a certificate
				holder under a policy of group insurance, nor a relative or member of the
				household of such policy or certificate holder.
(d) Subdivision (b) of section
				216.3, subdivision (b) of section
				216.4  and subdivision (a) of
				section 216.5  of this Part shall not be
				applicable to policies of insurance where the claimant is represented by a
				public adjuster or a person acting in the capacity of a public adjuster
				pursuant to the provisions of article 21 of the Insurance Law.
(e) This Part shall also apply to an
				unauthorized insurer with respect to a group policy issued pursuant to section 3455 or 3458  of the Insurance Law.
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 216.3 - Misrepresentation of policy provisions

Current through Register Vol. 46, No. 28, July 10, 2024
(a) No insurer shall knowingly misrepresent
				to a claimant the terms, benefits or advantages of the insurance policy
				pertinent to the claim.
(b) No
				insurer shall deny any element of a claim on the grounds of a specific policy
				provision, condition or exclusion unless reference to such provision, condition
				or exclusion is made in writing.
(c) Any payment, settlement or offer of
				settlement which, without explanation, does not include all amounts which
				should be included according to the claim filed by the claimant and
				investigated by the insurer shall, provided it is within the policy limits, be
				deemed to be a communication which misrepresents a pertinent policy
				provision.
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 216.4 - Failure to acknowledge pertinent communications

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Every insurer, upon notification of a
				claim, shall, within 15 business days, acknowledge the receipt of such notice.
				Such acknowledgment may be in writing. If an acknowledgment is made by other
				means, an appropriate notation shall be made in the claim file of the insurer.
				Notification given to an agent of an insurer shall be notification to the
				insurer. If notification is given to an agent of an insurer, such agent may
				acknowledge receipt of such notice. Unless otherwise provided by law or
				contract, notice to an agent of an insurer shall not be notice to the insurer
				if such agent notifies the claimant that the agent is not authorized to receive
				notices of claims.
(b) An
				appropriate reply shall be made within 15 business days on all other pertinent
				communications.
(c) Every insurer
				shall establish an internal department specifically designated to investigate
				and resolve complaints filed with the Department of Financial Services and to
				take action necessitated as a result of its complaint investigation findings.
				Such internal department is to operate in a staff capacity to the entire
				company with authority to question and change the position taken in individual
				instances or company practices generally. Responsibility for such department is
				to be vested in a corporate officer who is also to be entrusted with the duty
				of executing the Department of Financial Services' directives. If the
				Department of Financial Services requests the appearance of an insurer
				representative to discuss a pending matter, the individual whom the company
				sends shall be authorized to make any determination warranted after all the
				facts are elicited at such conference. Each insurer must furnish the
				superintendent with the name and title of the corporate officer responsible for
				its internal consumer services department.
(d) Every insurer, upon receipt of any
				inquiry from the Department of Financial Services respecting a claim, shall,
				within 10 business days, furnish the department with the available information
				requested respecting the claim.
(e)
				As part of its complaint handling function, an insurer's consumer services
				department shall maintain an ongoing central log to register and monitor all
				complaint activity.
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 216.5 - Standards for prompt investigation of claims

Current through Register Vol. 46, No. 28, July 10, 2024
(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.
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 216.6 - Standards for prompt, fair and equitable settlements

Current through Register Vol. 46, No. 28, July 10, 2024
(a) In any case where there is no dispute as
				to coverage, it shall be the duty of every insurer to offer claimants, or their
				authorized representatives, amounts which are fair and reasonable as shown by
				its investigation of the claim, providing the amounts so offered are within
				policy limits and in accordance with the policy provisions.
(b) Actual cash value, unless otherwise
				specifically defined by law or policy, means the lesser of the amounts for
				which the claimant can reasonably be expected to:
(1) repair the property to its condition
				immediately prior to the loss; or
(2) replace it with an item substantially
				identical to the item damaged. Such amount shall include all monies paid or
				payable as sales taxes on the item repaired or replaced. This shall not be
				construed to prevent an insurer from issuing a policy insuring against physical
				damage to property, where the amount of damages to be paid in the event of a
				total loss to the property is a specified dollar amount.
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 216.9 - Written notice to claimants of payment of claim in third-party settlements

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Upon payment of
				$5,000 or more in settlement of any third-party liability claim, where the
				claimant is a natural person, the insurer shall cause written notice to be
				mailed to the claimant at the same time payment is made, by the insurer or its
				representative (including the insurer's attorney), to the claimant's attorney
				or other representative of the claimant by draft, check or otherwise.
(b) Nothing in subdivision (a) of this
				section shall create, or be construed to create, a cause of action for any
				person or entity, other than the Department of Financial Services, against the
				insurer or its representative based upon a failure to serve such notice, or the
				defective service of such notice. Nothing in subdivision (a) of this section
				shall establish, or be construed to establish, a defense for any party to any
				cause of action based upon a failure by the insurer or its representative to
				serve such notice, or the defective service of such notice.
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 216.11 - Examinations

Current through Register Vol. 46, No. 28, July 10, 2024
To verify compliance with this Part and related statutes,
				  Department of Financial Services examiners will investigate the market
				  performance of insurers. To enable department personnel to reconstruct an
				  insurer's activities, all insurers subject to the provisions of this Part must
				  maintain within each claim file all communications, transactions, notes and
				  work papers relating to the claim. All communications and transactions, whether
				  written or oral, emanating from or received by the insurer shall be dated by
				  the insurer. Claim files must be so maintained that all events relating to a
				  claim can be reconstructed by the Department of Financial Services examiners.
				  Insurers shall either make a notation in the file or retain a copy of all forms
				  mailed to claimants.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter IX - Unfair Trade Practices › Part 217 - Processing Of Health Insurance Claims › Subpart 217-1 - Prompt Payment Of Health Insurance Claims › Section 217-1.1 - Definitions and applicability

Current through Register Vol. 46, No. 28, July 10, 2024
(a) For the purposes of this Subpart:
(1) payer shall mean an insurer authorized to
				  write accident and health insurance or that is licensed pursuant to article 43
				  of the New York Insurance Law, or an entity certified pursuant to article 44 of
				  the Public Health Law; and
(2)
				  submitted on paper shall include claims submitted on paper or by
				  facsimile.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter IX - Unfair Trade Practices › Part 217 - Processing Of Health Insurance Claims › Subpart 217-2 - Coordination Of Benefit Claims › Section 217-2.1 - Definitions and applicability

Current through Register Vol. 46, No. 28, July 10, 2024
(a) For purposes of this Subpart:
(1) Coordination of benefits or COB means a
				  procedure that is intended to avoid claims payment delays and duplication of
				  benefits when a person is covered by two or more health insurers providing
				  benefits or services for medical, dental or other care or treatment by:
				  establishing an order in which plans pay their claims, providing the authority
				  for the orderly transfer of information needed to pay claims properly and
				  permitting a reduction of the benefits of a health insurer when, by the rules
				  established by section
				  52.23  of
				  this Title (Regulation No. 62), it does not have to pay its benefits
				  first.
(2) Health care claim means
				  a request for payment for services rendered to an insured pursuant to the
				  benefits provided in a health insurance policy.
(3) Health care provider means an entity
				  licensed or certified pursuant to article 28, 36 or 40 of the Public Health
				  Law; a facility licensed pursuant to article 19, 23 or 31 of the Mental Hygiene
				  Law; a health care professional licensed, registered or certified pursuant to
				  title 8 of the Education Law; or a health care provider comparably licensed,
				  registered or certified by another state; or a dispenser or provider of
				  pharmaceutical products, services or durable medical equipment.
(4) Health insurance policy means a contract
				  that provides benefits or services for medical, dental or other health care or
				  treatment.
(5) Health insurer means
				  an insurer that issues a health insurance policy.
(6) Remittance advice means a form on which a
				  health insurer indicates to a health care provider the details of the health
				  insurer's processing of a particular claim.
(7) Primary health insurer means a health
				  insurer whose benefits for a person's health care coverage must be determined
				  without taking the existence of coverage issued by any other health insurer
				  into consideration, pursuant to the COB rules in section
				  52.23  of
				  this Title and the provisions of the health insurer's policy or
				  contract.
(8) Secondary health
				  insurer means a health insurer that is not a primary health insurer that may
				  take into consideration the benefits of the primary health insurer or insurers
				  and the benefits of any other accident and health coverage.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter IX - Unfair Trade Practices › Part 217 - Processing Of Health Insurance Claims › Subpart 217-2 - Coordination Of Benefit Claims › Section 217-2.3 - Effective date

Current through Register Vol. 46, No. 28, July 10, 2024
This Subpart shall become effective July 15, 2009, and
					 shall apply to all claims initially submitted on or after that
					 date.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter IX - Unfair Trade Practices › Part 218 - Prohibition Against Geographical Redlining And Discriminating In Certain Property/casualty Policies › Section 218.1 - Preamble

Current through Register Vol. 46, No. 28, July 10, 2024
The purpose of this Part is to make fire or fire and extended
				  coverage insurance, private passenger automobile insurance, and homeowners
				  insurance readily available in the voluntary market by implementing statutory
				  prohibitions against companies engaging in redlining practices through refusing
				  to issue or renew or cancelling fire or fire and extended coverage insurance,
				  and private passenger automobile insurance policies based solely on the
				  geographic location of the risk; or by terminating or cancelling contracts or
				  accounts of agents or brokers with respect to such policies based solely on
				  their geographic location or the geographic location of the risks or properties
				  for which coverage is being provided by such producers; or through refusing to
				  issue or renew or canceling homeowners insurance and fire or fire and extended
				  coverage insurance policies based solely on the applicant for insurance or
				  insured residing in an area serviced by a volunteer fire
				  department.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter IX - Unfair Trade Practices › Part 218 - Prohibition Against Geographical Redlining And Discriminating In Certain Property/casualty Policies › Section 218.2 - Applicability

Current through Register Vol. 46, No. 28, July 10, 2024
This Part shall be applicable only to:
(a) applicants for, and policies of, fire or
				fire and extended coverage insurance covering properties located in this
				State;
(b) applicants for, and
				policies of, automobile insurance covering risks in this State which are
				subject to section 3425  of the Insurance Law;
(c) applicants for, and policies of,
				homeowners insurance, as such term is defined in section 2351 (a)  of the Insurance
				Law, to the extent that an insurance company refused to issue, refused to renew
				or cancelled insurance coverage because a person lives in an area serviced by a
				volunteer fire department, except for section
				218.7 
				of this Part; and
(d) contracts and
				accounts of agents and brokers writing insurance subject to this
				Part.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter IX - Unfair Trade Practices › Part 218 - Prohibition Against Geographical Redlining And Discriminating In Certain Property/casualty Policies › Section 218.3 - Notices to insureds or applicants

Current through Register Vol. 46, No. 28, July 10, 2024
(a) An insurer or its agent, consistent with
				its method of marketing, shall furnish an application for insurance, upon
				request of the applicant or the applicant' s representative, or upon request of
				a broker that has an account with the insurer or its agent. An agent or broker
				shall transmit an application for insurance to the appropriate office of the
				insurer within five working days after the application is received by such
				agent or broker from the applicant or the applicant's representative.
(b)
(1) All
				notices by an insurer, to new applicants for insurance or to insureds, of
				refusal to issue, or to nonrenew or to cancel coverage, shall state the
				specific reason or reasons for such action. A specific reason shall not be an
				unsupported general statement such as "underwriting judgment".
(2) All notices by an insurer, to new
				applicants for insurance, which state reasons for refusal to issue, shall be
				mailed or delivered to the applicant not more than 30 days after the
				application is received by the agent or broker.
(3) All notices to insureds of reasons for
				nonrenewal of insurance shall be mailed or delivered in compliance with section 3425 (d)(1) and section 3426 (e)  of the Insurance
				Law.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter IX - Unfair Trade Practices › Part 218 - Prohibition Against Geographical Redlining And Discriminating In Certain Property/casualty Policies › Section 218.4 - Notices to agents or brokers

Current through Register Vol. 46, No. 28, July 10, 2024
(a) All notices to agents or brokers that
				their contract or account is to be terminated, in whole or in part, shall state
				the specific reason or reasons for such termination. A specific reason shall
				not be an unsupported general statement, such as "insufficient volume" or "poor
				loss ratio".
(b) All such notices
				shall be mailed or delivered to the affected agent or broker at least 30 days
				prior to the effective date of such termination or such greater period as may
				be provided for in the contract or account, except that a lesser period is
				permitted where the insurer alleges that the agent or broker has acted in an
				untrustworthy manner.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter IX - Unfair Trade Practices › Part 218 - Prohibition Against Geographical Redlining And Discriminating In Certain Property/casualty Policies › Section 218.5 - Complaints

Current through Register Vol. 46, No. 28, July 10, 2024
(a) The following
				notice shall be clearly and prominently set out in bold face type on the front
				(except that the company name, company representative, company address and
				company phone number may be stamped, or typed in the appropriate place in the
				notice), so that it draws the reader's attention on all notices of refusal to
				issue, cancellation or nonrenewal, except where the cancellation is for
				nonpayment of premium; and on all notices of termination of agents' and
				brokers' contracts or accounts, which are subject to this Part:
If you have any questions regarding this termination, please
				  contact this company's representative at (company phone number, name of company
				  representative, company address).
The New York Insurance Law prohibits insurers from engaging
				  in redlining practices based upon geographic location of the risk or the
				  producer. If you have any reason to believe that we have acted in violation of
				  such law, you may file a complaint with the department either on its website at
www.dfs.ny.gov/consumer/fileacomplaint.htm
or by writing to the New York State Department of Financial Services, Consumer
				  Assistance Unit, at either One State Street, New York, NY 10004 or One Commerce
				  Plaza, Albany, NY 12257.
(b)
				Insureds, applicants, agents and/or brokers may file geographical redlining
				complaints with the superintendent when action taken by an insurer or its
				representative is believed to be in violation of provisions of section 3429, 3429-a, or
				3433  of the Insurance Law.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter IX - Unfair Trade Practices › Part 218 - Prohibition Against Geographical Redlining And Discriminating In Certain Property/casualty Policies › Section 218.6 - Action by superintendent

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
				The superintendent shall investigate each geographical redlining complaint and
				shall notify the complainant of the determination thereon.
(b) The superintendent's statutory authority
				to investigate and hold hearings on possible violation of provisions of the
				Insurance Law is hereby incorporated in this Part.
(c) Any insurer found by the superintendent
				to be in violation of section 3429, 3429-a, 3431 (a), or
				3433  of the Insurance Law shall be
				considered to be engaged in unfair methods of competition and unfair or
				deceptive acts or practices, and shall be subject to the provisions of article
				24 of the Insurance Law.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter IX - Unfair Trade Practices › Part 218 - Prohibition Against Geographical Redlining And Discriminating In Certain Property/casualty Policies › Section 218.7 - Reports to superintendent

Current through Register Vol. 46, No. 28, July 10, 2024
(a) In
				order to effectuate this Part insurers shall maintain records by U.S. postal
				ZIP code of their agents and brokers in this State and maintain records by U.S.
				Postal ZIP code of all agents and brokers in this State whose contracts or
				accounts have been terminated.
(b)
				In order to effectuate this insurers shall also maintain by U.S. postal ZIP
				code a record of:
(1) all policies subject to
				this Part issued, renewed, cancelled (other than for nonpayment of premium) or
				nonrenewed; and
(2) all
				applications for insurance subject to this Part on which the insurer refuses to
				issue an insurance policy. For private passenger automobile insurance the ZIP
				code used may be that of the address to which premium notices are mailed. For
				policies with a term of other than one year or no fixed expiration date,
				renewed means the annual anniversary date.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter IX - Unfair Trade Practices › Part 219 - Rules Governing Advertisements Of Life Insurance And Annuity Contracts › Section 219.1 - Purpose

Current through Register Vol. 46, No. 28, July 10, 2024
(a) This department
				is concerned with those instances in which advertisements have tended to
				mislead and deceive the public. It is the purpose of the rules and guidelines
				set forth in this Part to assure truthful and adequate disclosure of all
				material and relevant information in the advertising of life insurance policies
				and annuity contracts through various advertising media in order to provide the
				public with the necessary information upon which to base a decision regarding
				the purchase of life insurance and annuities. The rules and guidelines will
				also serve to prevent unfair competition among insurers.
(b) It should be noted that the lack of a
				specific prohibition in this Part does not necessarily imply acceptance of a
				practice; rather, the principles underlying the rules should be applied to all
				situations so as to carry out the stated and implied purpose of this
				Part.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter IX - Unfair Trade Practices › Part 219 - Rules Governing Advertisements Of Life Insurance And Annuity Contracts › Section 219.2 - Applicability

Current through Register Vol. 46, No. 28, July 10, 2024
(a) This Part shall
				apply to any life insurance or annuity advertisement, as defined herein, which
				is intended for presentation, distribution or dissemination in this State,
				directly or indirectly, by or on behalf of any insurer, agent or broker, as
				those terms are defined in the New York Insurance Law.
(b) Every insurer shall establish and at all
				times maintain a system of control over the content, form and method of
				dissemination of all advertisements of its policies. All such advertisements,
				regardless of by whom written, created, designed or presented, shall be the
				responsibility of the insurer whose policies are so advertised.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter IX - Unfair Trade Practices › Part 219 - Rules Governing Advertisements Of Life Insurance And Annuity Contracts › Section 219.3 - Definitions

Current through Register Vol. 46, No. 28, July 10, 2024
(a) For the
				purposes of this Part:
(1) Advertisement shall
				include, but not necessarily be limited to the following, when designed to be
				used or are actually used, to induce the public to purchase, increase, modify,
				reinstate or retain a policy:
(i) printed and
				published material, audio visual material and descriptive literature of an
				insurer used in direct mail, newspapers, magazines, radio scripts, television
				scripts, billboards and similar displays;
(ii) descriptive literature and sales aids of
				all kinds, including but not limited to circulars, leaflets, booklets,
				depictions, illustrations and form letters, issued by an insurer, agent,
				broker, solicitor or organization sponsoring the insurance for presentation to
				members of the insurance buying public;
(iii) prepared sales talks, presentations and
				material for use with the public by agents, brokers and solicitors;
				or
(iv) material used for the
				recruitment of an insurer's sales personnel, agents, brokers and
				solicitors.