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This entry was published on 2022-06-24
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Fair claims settlement
Insurance (ISC) CHAPTER 28, ARTICLE 51
§ 5106. Fair claims settlement. (a) Payments of first party benefits
and additional first party benefits shall be made as the loss is
incurred. Such benefits are overdue if not paid within thirty days
after the claimant supplies proof of the fact and amount of loss
sustained. If proof is not supplied as to the entire claim, the amount
which is supported by proof is overdue if not paid within thirty days
after such proof is supplied. All overdue payments shall bear interest
at the rate of two percent per month. If a valid claim or portion was
overdue, the claimant shall also be entitled to recover his attorney's
reasonable fee, for services necessarily performed in connection with
securing payment of the overdue claim, subject to limitations
promulgated by the superintendent in regulations.

(b) Every insurer shall provide a claimant with the option of
submitting any dispute involving the insurer's liability to pay first
party benefits, or additional first party benefits, the amount thereof
or any other matter which may arise pursuant to subsection (a) of this
section to arbitration pursuant to simplified procedures to be
promulgated or approved by the superintendent. Such simplified
procedures shall include an expedited eligibility hearing option, when
required, to designate the insurer for first party benefits pursuant to
subsection (d) of this section. The expedited eligibility hearing option
shall be a forum for eligibility disputes only, and shall not include
the submission of any particular bill, payment or claim for any specific
benefit for adjudication, nor shall it consider any other defense to

(c) An award by an arbitrator shall be binding except where vacated or
modified by a master arbitrator in accordance with simplified procedures
to be promulgated or approved by the superintendent. The grounds for
vacating or modifying an arbitrator's award by a master arbitrator shall
not be limited to those grounds for review set forth in article
seventy-five of the civil practice law and rules. The award of a master
arbitrator shall be binding except for the grounds for review set forth
in article seventy-five of the civil practice law and rules, and
provided further that where the amount of such master arbitrator's award
is five thousand dollars or greater, exclusive of interest and
attorney's fees, the insurer or the claimant may institute a court
action to adjudicate the dispute de novo.

(d) (1) Except as provided in paragraph two of this subsection, where
there is reasonable belief more than one insurer would be the source of
first party benefits, the insurers may agree among themselves, if there
is a valid basis therefor, that one of them will accept and pay the
claim initially. If there is no such agreement, then the first insurer
to whom notice of claim is given shall be responsible for payment. Any
such dispute shall be resolved in accordance with the arbitration
procedures established pursuant to section five thousand one hundred
five of this article and regulations as promulgated by the
superintendent, and any insurer paying first-party benefits shall be
reimbursed by other insurers for their proportionate share of the costs
of the claim and the allocated expenses of processing the claim, in
accordance with the provisions entitled "other coverage" contained in
regulation and the provisions entitled "other sources of first-party
benefits" contained in regulation. If there is no such insurer and the
motor vehicle accident occurs in this state, then an applicant who is a
qualified person as defined in article fifty-two of this chapter shall
institute the claim against the motor vehicle accident indemnification

(2) A group policy issued pursuant to section three thousand four
hundred fifty-five or three thousand four hundred fifty-eight of this
chapter shall provide first party benefits when a dispute exists as to
whether a driver was using or operating a motor vehicle in connection
with a transportation network company or peer-to-peer car sharing
program when loss, damage, injury, or death occurs. A transportation
network company or peer-to-peer car sharing program administrator shall
notify the insurer that issued the owner's policy of liability insurance
of the dispute within ten business days of becoming aware that the
dispute exists. When there is a dispute, the group insurer liable for
the payment of first party benefits under a group policy shall have the
right to recover the amount paid from the driver's insurer or in the
case of a peer-to-peer car sharing program, the shared vehicle owner's
insurer to the extent that the driver would have been liable to pay
damages in an action at law.