New York unfair claims settlement practices and claim cost control measures, and the prohibition against geographical redlining (Part 216 = Regulation 64; Part 218 = Regulation 90)

What this document is

11 NYCRR Chapter IX (Unfair Trade Practices), Parts 216 and 218 - New York unfair claims settlement practices and claim cost control measures, and the prohibition against geographical redlining (Part 216 = Regulation 64; Part 218 = Regulation 90) is a regulation published by New York State Department of State, Division of Administrative Rules - Official Compilation of Codes, Rules and Regulations of the State of New York (NYCRR). Served for free public access at govt.westlaw.com/nycrr by Thomson Reuters under contract with the Department of State, which manages NYCRR; the site's own footer names the Department of State as its principal.. It is one of the New York documents that insurance license exam questions are written from, including new york property & casualty, new york personal lines practice questions. This page summarizes it and points to the official version, which is the text to rely on.

Sections cited in practice questions

Each practice answer shows the exact passage it comes from. These are sections of this document that questions cite, with a short excerpt from the source text.

• 11 NYCRR 216.6(g) (Standards for prompt, fair and equitable settlements; checks or drafts in payment of claims; releases)

  “No insurer shall issue a check or draft in payment of a first-party claim or any element thereof, arising under any policy subject to this Part, that contains any language or provision that expressly or impliedly states that acceptance of such check or draft shall constitute a final settlement or...”

• 11 NYCRR 218.3(a) (Prohibition against geographical redlining; notices to insureds or applicants; furnishing and transmitting applications)

  “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...”

• 11 NYCRR 218.4(a), (b) (Prohibition against geographical redlining; notices to agents or brokers)

  “(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...”

• 11 NYCRR 216.4(a) (Regulation 64; failure to acknowledge pertinent communications)

  “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...”

• 11 NYCRR 216.6(b) (Regulation 64; standards for prompt, fair and equitable settlements; actual cash value)

  “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...”

• N.Y. Comp. Codes R. & Regs. tit. 11, Sec. 216.7(b)(2) (Regulation 64; motor vehicle physical damage claims; designated representative)

  “Before negotiating a loss with the insured's designated representative, the insurer must receive written proof of such designation, properly executed and signed by the insured. The designated representative form shall be accepted by the insurer or its representative when it is offered by either the...”

• 11 NYCRR 216.6(c) (Regulation 64; standards for prompt, fair and equitable settlements; advice of acceptance or rejection after proof of loss)

  “Within 15 business days after receipt by the insurer of a properly executed proof of loss and receipt of all items, statements and forms which the insurer requested from the claimant, the claimant, or the claimant's authorized representative, shall be advised in writing of the acceptance or...”

• 11 NYCRR 216.7(b)(16) (Regulation 64; motor vehicle physical damage claims; salvage vehicle branding)

  “This paragraph shall be applicable to claims involving vehicles that are eight model years or newer on the date of the loss. (ii) If the insurer determines that the cost to repair a damaged vehicle exceeds 75 percent of the vehicle's actual cash value and if the insurer does not take possession of...”

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