N.Y. Comp. Codes R. & Regs. Tit. 11 § 216.4 - Failure to acknowledge pertinent communications
(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.
Notes
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