Filing Claims Under Your Own Policy

A. Reporting an Accident

If you are involved in an auto accident, you should promptly report it to your insurance company, as well as to the local police department. If the amount of damage caused in the accident is over $1,000, or if anyone sustains any injury, you must file an accident report with the Department of Motor Vehicles. This form, MV-104, will usually be included with any claim forms sent to you by your insurer.

The insurance policy is probably the most purchased yet least read contract in existence. It is extremely important that you read your policy to determine exactly what reporting requirements are included, so that you may meet them and reduce any difficulty in the handling of your claim. Some people do not realize what is and is not covered by their policy until it is too late.

B. Filing a No-Fault Claim

In the event you are injured in a motor vehicle accident, you should file a written notice of claim with the No-Fault insurer promptly, no longer than 30 days from the accident date. Generally, if the accident took place in New York State, you should file your No-Fault claim with the insurer of the vehicle you were in when the accident occurred or, if you were a pedestrian, with the insurer of the vehicle that struck you. If the accident was outside of New York State, and you were in a vehicle other than your own, file your claim with your own insurance company. If you were injured in a motor vehicle accident while you were a passenger on a bus your no-fault benefits would be provided by your automobile policy or the automobile policy of a member of your household. If you or a member of your household do not have automobile insurance than the insurer of the bus would provide your no-fault benefits.

If you (or a relative with whom you live) do not have an auto insurance policy, and are injured by or while in an uninsured vehicle, or by a hit-and-run driver, you should file your claim for No-Fault benefits with MVAIC (as discussed in Chapter II under "Uninsured Motorists Coverage"). It is important that the accident is reported to the proper authority within 24 hours.

Within five business days after the insurer (or MVAIC) receives this notice of claim, the insurer is required to send you an Application for Benefits and a letter explaining the No-Fault coverage available and your rights and obligations. Once you receive the Application for Benefits form, complete and return it as soon as possible.

If you need medical treatment, you: (1) can pay the doctor or hospital directly and submit your receipts or bills to the insurer; or (2) may be able to assign your benefits to the doctor or hospital and have them submit their bills directly to the No-Fault insurer for direct payment, or (3) can permit the health care provider to bill the No-Fault insurer directly by providing them with a "direction to pay" for claims occurring on or after March 1, 2002.

No-Fault benefits are paid in accordance with prescribed fee schedules, which the health care provider is required by law to accept as full payment. It is important that you make clear to the health care provider that you are being treated for injuries related to an auto accident. The insurer is required to make payment within 30 days of receipt of your physician’s and hospital’s treatment report, or your employer’s report of earnings you have lost (unless additional verification is required).

If the insurer fails to make a timely payment, it must pay 2% interest per month on the unpaid amounts and any reasonable attorney’s fees (in accordance with Insurance Department regulations) you have incurred in order to collect your overdue No-Fault benefits.

If all or part of your No-Fault benefits are denied or paid late, you may: (1) file a complaint with the Insurance Department, as detailed later in this Guide; (2) request arbitration; or (3) bring an action in court. No-Fault arbitration can be requested if the insurer denies your claim in whole or part, fails to make a timely payment of benefits owed, or fails to inform you in a timely manner if your claim has been denied.

The No-Fault arbitration process is designed to resolve disputes as swiftly as possible. The results of arbitration are final and binding on all parties (unless appealed under certain strict circumstances). For a detailed description of how to file a request for No-Fault arbitration see Chapter XIII.

C. Filing a Physical Damage Claim

If your car is damaged or stolen and you have auto collision or comprehensive insurance coverage, you have the right to a prompt and fair settlement from your insurance company, either for the amount of the damages or the actual cash value of the car, whichever is lower. If your car is stolen and subsequently recovered, your insurer must pay for the damage done to the car while it was missing, the cost of towing, any reasonable storage charges, and substitute transportation expenses.

The Insurance Department’s Regulation 64 is designed to assure a prompt and fair settlement from your insurance company. This regulation provides the guidelines and time limits within which an insurer must handle any claims you make, under auto collision and comprehensive insurance, and with property damage liability claims you make against another driver.

Under these regulatory standards, in responding to a claim made under the comprehensive or collision coverages of your policy, your auto insurer must do the following:

• inspect the damaged vehicle and make a good faith offer within six business days after receiving notification of the loss, provided that your car is available for inspection. A good faith offer is one that can be backed up with the name of a Department of Motor Vehicles-registered repair shop that will perform the repairs at the insurer’s offer;

• promptly give you or your authorized representative a detailed written estimate of the cost of repairs;

• upon your request, identify a conveniently located auto repair shop that will repair your car at the insurance company’s estimated cost of repair and give you a written guarantee, backed by your insurer, of the work performed; however, you retain the right, pursuant to the Insurance Law, to choose which shop will repair your damaged vehicle;

• pay the actual cash value (retail value plus sales tax), which is subject to depreciation and applicable deductions, if your car is a total loss because it was stolen or damaged beyond repair, or replace it with a substantially similar car, in accordance with governing regulatory standards;

• make payment within five (5) business days after you and the insurer have agreed upon a settlement;

• furnish you with a written explanation of the reasons for delay if your claim has not been settled within 30 days after the date you notified the insurer of the loss.

If your car is stolen, most insurers will reimburse you for your car rental expenses up to the amount stated in the policy. Some auto insurers issue a policy with "optional rental car reimbursement coverage", which also pays for such expenses when your car cannot be operated during a covered collision or comprehensive loss, other than theft.

With respect to collision and other physical damage claims, your insurance company is required to obtain from you and your auto body repair shop a "Certification of Automobile Repairs" form, in order to determine the extent to which your damaged car has been repaired. If you fail to submit this form, your loss settlement on a subsequent loss may be reduced. In addition, in the case of a loss that included a deployed or stolen airbag, such airbag is required to be replaced. (The insurer has the right to verify that the airbag was deployed or stolen and to take possession of a deployed airbag.)

Reprinted from New York State's Consumer Guide to Automobile Insurance.