N.Y. Insurance Law § 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.