Section 5106. Fair claims settlement  


Latest version.
  • (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)  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  regulation  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  motor  vehicle  accident  indemnification
      corporation.