New York Claims Dispute & Statutory Guide
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.
Statutory Framework & Jurisdiction
Mandatory No-Fault (Regulation 68 / Article 51)
PIP / MedPay Coverage & Medical Fee Rules
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
Official Medical Fee Schedule & Reimbursement Standards
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
Preauthorization & Decision Point Review
requirement
Certain special procedures (e.g. non-emergency surgery over $1,000) require statutory notice and insurer confirmation under Regulation 68.
deadlines
Insurers must respond within 30 days of receipt of complete verification.
penalty For Non Compliance
Potential verification delays or denial based on lack of medical necessity.
Administrative Appeals & Dispute Mechanism
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
Critical Statutory & Dispute Deadlines
| Dispute Phase / Trigger Event | Statutory Timeline / Deadline |
|---|---|
| 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 |
Required Evidentiary Filing 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
Official Primary Sources & Legislative Authorities
Official Forms & Downloads for New York
NY AAA Form AR1 No Fault Arbitration Request
Arbitration Forms reference for New York Auto Accident. Available for download.
NY NF 3 Verification Of Treatment Attending Physician
PIP / No-Fault Forms reference for New York Auto Accident. Available for download.
Governing Regulatory Authorities
Need Case Preparation Support in New York?
Millennova Legal assists healthcare providers, revenue cycle teams, and law firms with comprehensive dispute documentation, arbitration filing bundles, and fee schedule calculations.
Request Dispute Consultation