Auto Accident, PIP & Medical Billing State Guides
New York Auto Accident, PIP & Medical Billing Laws
New York is a mandatory No-Fault insurance state governed by Article 51 of the New York Insurance Law and 11 NYCRR 65 (Regulation 68). Medical billing disputes are adjudicated through the American Arbitration Association (AAA) or civil court.
Plain-language overview
Mandatory No-Fault (Regulation 68 / Article 51)
New York is a mandatory No-Fault insurance state governed by Article 51 of the New York Insurance Law and 11 NYCRR 65 (Regulation 68). Medical billing disputes are adjudicated through the American Arbitration Association (AAA) or civil court.
PIP and MedPay coverage
Default Coverage
$50,000 basic economic loss coverage per person
Mandatory Deductible
Varies by policy endorsement (optional $200 family deductible common)
Assignment Of Benefits
Governed by statutory NF-3/NF-AOB standard language
Medical fee schedule and reimbursement rules
Name
New York Workers' Compensation Medical Fee Schedule (Adopted for No-Fault)
Rules
Pursuant to 11 NYCRR 68, health services are capped by the Workers' Compensation Board fee schedules with applicable ground rules and geographical conversion factors.
Cpt Basis
Adopted WCB CPT/HCPCS schedule
Appeals and dispute resolution
Pre Service Appeals
Re-verification requests and rebuttal to independent medical examination (IME) cutoffs.
Post Service Appeals
Response to NF-10 denial of claim within statutory 30-day verification windows.
Arbitration Organization
American Arbitration Association (AAA) - New York State No-Fault Arbitration Tribunal
Arbitration Statute
New York Insurance Law Section 5106(b) & 11 NYCRR 65-4
Dispute Resolution Professional
AAA Designated No-Fault Arbitrator
Claim and dispute deadlines
Deadlines can depend on the trigger event and may be affected by agency relief notices. Confirm the live rule before filing.
| Event | Timeframe |
|---|---|
| Notice of Accident (NF-2) | 30 days from date of accident |
| Medical Bill Submission (NF-3) | 45 days from date of medical service (strictly enforced) |
| Insurer Pay or Deny Rule | 30 calendar days from receipt of proof of claim |
| Arbitration Demand Filing | Within statutory 6-year breach of contract limitation or after 30-day denial |
Documentation checklist
- Executed NYS Form NF-3 (Verification of Treatment by Attending Physician)
- Executed Assignment of Benefits (AOB) Form NF-AOB
- Detailed narrative reports, SOAP notes, and objective physical therapy logs
- Proof of mailing or electronic submission within the strict 45-day rule
- Carrier Form NF-10 (Denial of Claim Form) where applicable
Responsible agencies
- New York State Department of Financial Services (DFS)Regulation of No-Fault Insurance and Fee Schedules
- American Arbitration Association (AAA)Administration of New York State No-Fault Arbitrations
Primary legal and regulatory sources
- New York Insurance Law Article 51 (Comprehensive Motor Vehicle Insurance Reparations Act)New York State Legislature · 2024
- New York Codes, Rules and Regulations (11 NYCRR Part 65 - Regulation 68)New York DFS · 2025
This operational reference is educational, is not legal advice, and does not create an attorney-client relationship.
Common questions
- What rules govern auto accident, pip & medical billing state guides in New York?
- New York is a mandatory No-Fault insurance state governed by Article 51 of the New York Insurance Law and 11 NYCRR 65 (Regulation 68). Medical billing disputes are adjudicated through the American Arbitration Association (AAA) or civil court.
- What dispute deadlines should providers track in New York?
- Notice of Accident (NF-2): 30 days from date of accident; Medical Bill Submission (NF-3): 45 days from date of medical service (strictly enforced); Insurer Pay or Deny Rule: 30 calendar days from receipt of proof of claim. Verify the trigger date, current agency notices, and any extension before acting.
- Which agencies administer these rules in New York?
- The guide identifies New York State Department of Financial Services (DFS), American Arbitration Association (AAA). The correct agency depends on the plan and claim jurisdiction.