New York no-fault: claim forms, IME cutoffs and arbitration

A New York no-fault claim runs on short, rule-bound clocks. You give your insurer written notice of the crash within 30 days, return the application (form NF-2) the insurer sends, and submit proof of each bill and each month of lost pay on time. The insurer then has 30 calendar days after it has the proof to pay or deny, and if it denies, you can take the dispute to arbitration or to court. The $50,000 basic economic loss benefit, New York's version of personal injury protection, is paid whoever caused the crash.

Most of the real friction comes in the middle: the verification requests, the independent medical exam that ends treatment coverage, and the denial form. This article follows a claim step by step using the state's no-fault regulation, 11 NYCRR Part 65, and ends with the serious injury threshold that decides whether you can sue for pain and suffering. Rules for lawsuits changed in 2026, so that section carries dates. It is general information; for a live dispute, a New York attorney or the Department of Financial Services is the place to go.

What the $50,000 covers

Under Insurance Law 5102, basic economic loss is capped at $50,000 per person and includes three parts:

• Medical and related services. Necessary hospital, surgical, nursing, dental, ambulance, X-ray, prescription and prosthetic care, psychiatric care, physical and occupational therapy and rehabilitation, and other professional health services, paid under fee schedules set by Insurance Law 5108.
• Lost earnings and replacement services. Up to $2,000 a month for no more than three years from the date of the accident. First-party benefits are reduced by 20 percent of lost earnings.
• Other reasonable and necessary expenses. Up to $25 a day for one year.

A death benefit of $2,000 is paid to the estate of an eligible injured person, in addition to the $50,000. Drivers can buy an optional extra $25,000 under the statute. The prescribed policy text in 11 NYCRR 65-1.1 states these terms, and our PIP bucket-by-bucket article compares them with other states.

The first 30 days: notice and the NF-2

Three different clocks run early, and people confuse them.

Written notice of the accident. The endorsement requires written notice with enough detail to identify the injured person, along with reasonably obtainable information about the time, place and circumstances, as soon as reasonably practicable and in no event more than 30 days after the accident, unless the injured person gives written proof of clear and reasonable justification for being late. A DMV accident report (form MV-104) or other accident report showing injuries counts as written notice, according to 11 NYCRR 65-3.3. So does the insurer's receipt of a completed NF-2 or a hospital facility form (NF-5).

The application. Unless it will pay the claim as submitted within 30 days, the insurer must send the prescribed application (NF-2) with a cover letter within five business days after it receives notice at its claims office, and in no case later than 10 business days after the first notice anywhere (65-3.4). If the form has not come back 30 calendar days after it was mailed, the insurer must send a second one within 10 calendar days (65-3.6). The 30-day number belongs to notice, not to the NF-2 itself, but returning the form quickly keeps the file moving.

Proof of claim. For health service expenses, written proof of claim must reach the insurer as soon as reasonably practicable and no later than 45 days after the services are rendered. For work loss and other necessary expenses, the outer limit is 90 days after the loss is incurred or the service rendered. Both deadlines can be excused with written proof of clear and reasonable justification. When an insurer denies for lateness, the denial must say that late notice will be excused where the applicant shows reasonable justification (65-3.3(e)).

The forms you will see

These come from the prescribed list in 65-3.4(c). The insurer must accept proof submitted on another form if it carries substantially the same information, though it may require the prescribed application, the physician verification and the hospital form.

The insurer's clocks: verification, payment and denial

Once the application is in, the insurer's duties are stated in 65-3.5 and 65-3.8:

1. Within 10 business days after receiving the completed NF-2, it must send the verification forms it will require before paying the initial claim.
2. Within 15 business days after receiving those forms, it must request any additional verification; this request need not use a prescribed form.
3. Benefits are overdue if not paid within 30 calendar days after the insurer receives proof of claim, which includes all the verification it requested. If the verification is an examination under oath or a medical examination, it counts as received on the day the exam is performed.
4. Within those 30 days it must pay or deny in whole or in part. A denial uses the prescribed denial form (NF-10). If it denies part, it must pay the undisputed part.
5. If verification has not arrived 30 days after the request, the insurer must follow up and tell the applicant in writing which item is missing.

The applicant has a clock too. Under 65-3.5(o), a person asked for verification has 120 calendar days from the initial request to submit everything under their control or give written, reasonable justification, and the insurer's request must say that. Missing it can allow a denial, with exceptions for the prescribed NF forms, medical examination requests and examination-under-oath requests.

A worked example of the 30-day clock

The dates here are invented. Say the crash happens on March 3 and the insurer receives written notice on March 6. A complete treatment bill with all requested verification reaches the insurer on May 4. The claim is overdue if not paid by June 3, which is 30 calendar days later. If the insurer pays on June 20, the late portion earns interest at two percent per month, calculated pro rata on a 30-day month (65-3.9). Change the facts: if the insurer asks on May 12 for a missing wage form and gets it on May 30, the 30 days run from May 30, not May 4.

Denials for coverage reasons (no coverage on the date, an accident not covered by no-fault, or a statutory exclusion) must be sent within 10 business days of the insurer's determination, though a late notice does not stop the insurer from raising the defense.

Independent medical exams and cutoffs

An independent medical exam (IME) is how most treatment cutoffs happen. The rules:

• Timing. If the extra verification the insurer wants is a medical exam, it must schedule the exam within 30 calendar days of receiving the prescribed verification forms.
• Place and time. Exams and examinations under oath must be at a time and place reasonably convenient to the applicant, at a facility properly equipped for the exam. The insurer must tell you when it schedules that you will be reimbursed for lost earnings and reasonable transportation costs of attending.
• No interruption while waiting. An insurer may not interrupt payment of benefits pending an exam unless the applicant or the applicant's attorney is responsible for the delay or inability to schedule it.
• Clear evidence of recovery. If the insurer has information that "clearly demonstrates" the applicant is no longer disabled, it can discontinue benefits by sending an NF-10.
• The report. If a medical exam or peer review report is the specific reason for a denial, the insurer must release a copy on written request to the applicant, the applicant's attorney or the treating physician.
• Objective grounds for an examination under oath. The insurer's demand must rest on objective standards with specific justification.

No-show cutoffs

When a claimant misses the exam, insurers often deny on that ground. Courts have set out what the insurer must prove. In Valdan Acupuncture, P.C. v. Global Liberty Insurance Co. of New York, decided October 18, 2019, the Appellate Term summarized that the insurer must show timely mailing of the letters scheduling the initial and follow-up exams, the claimant's failure to attend both, and a timely denial on that ground; it then falls to the provider to raise a factual issue (FindLaw copy). The practical points are to open mail from the insurer, tell it in writing if a date does not work, ask for a new date before the first one passes, and keep proof you did so.

Our article on exam-based cutoffs covers medical arguments and the same issue in other states, and arbitration and mediation in claim disputes compares dispute routes more broadly.

What to do after a denial

1. Read the NF-10 line by line. It must state the reason. A partial denial may be based on the fee schedule or on a medical opinion.
2. Ask for the report. If an exam or peer review is the reason, request a copy in writing.
3. Send a rebuttal. A treating doctor's narrative explaining necessity can answer a cutoff.
4. Watch interest. Under 65-3.9(c), if you do not request arbitration or sue within 30 days after receiving the denial or the payment calculation, interest stops accruing on the disputed amount until you do.
5. Decide the forum. Arbitration is the usual low-cost path; suing is the alternative.

Arbitration step by step

Insurance Law 5106 requires insurers to let claimants submit no-fault disputes to arbitration under simplified procedures set by the superintendent. The path under 11 NYCRR 65-4:

1. File. The applicant mails the denial form with the reasons for contesting it and an itemized list of the expenses in dispute to the address on the form, or uses the arbitration request form where no denial was issued. In the version of the regulation posted by Cornell's Legal Information Institute in November 2026, the filing fee is $40, which the insurer must return if the applicant prevails in whole or in part.
2. Conciliation. The organization the superintendent designates reviews the request and tries to resolve it by phone or other means. If it cannot be resolved within 60 days, it is referred to arbitration.
3. Documents. The applicant submits all supporting documents with the request. The insurer has 30 calendar days after notice to provide its documents, extendable by 30 more for reasonable cause.
4. Hearing format. If the amount is under $2,000, the arbitrator may decide on written submissions alone.
5. Award. The arbitrator decides under the Insurance Law and regulations. The award is binding unless a master arbitrator modifies or vacates it on the grounds the regulation lists (the Article 75 grounds, an award above policy limits, an error of law, or an attorney fee not computed within the regulation).
6. Court. Under Insurance Law 5106(c), if the master arbitrator's award is $5,000 or more, excluding interest and attorney's fees, either the insurer or the claimant may bring a court action to have the dispute decided anew.

Who pays

Insurers fund the conciliation function through assessments. The applicant's filing fee is refundable if the applicant wins. Attorney's fees are regulated: 20 percent of the benefits plus interest in most disputes, up to $1,360, with no fee at all if the claim was neither denied nor overdue when the proceeding began, and no fee when a provider-applicant's charges exceed the fee schedule (65-4.6). Overdue claims also carry the two percent monthly interest.

The serious injury threshold

No-fault benefits do not end your claim against the at-fault driver for pain and suffering, but New York limits it with a verbal tort threshold. Under Insurance Law 5104(a), a claimant cannot recover non-economic loss in a suit between covered persons unless the injury is a "serious injury" as defined in 5102(d). The definition currently lists death, dismemberment, significant disfigurement, a fracture, loss of a fetus, permanent loss of use of a body organ, member, function or system, permanent consequential limitation of use of a body organ or member, and significant limitation of use of a body function or system.

What changed in 2026: the old ninth category, a medically determined non-permanent injury that kept a person from substantially all usual daily activities for 90 of the 180 days after the accident, no longer appears in the statute. A Barclay Damon law-firm alert says the change was signed May 26, 2026, takes effect immediately and applies to suits filed on or after that date, and that pending actions are not subject to it. The same alert describes a switch to modified comparative negligence that bars a claimant whose fault exceeds the other side's, and a $100,000 cap on non-economic recovery for certain at-fault claimants who were uninsured, impaired or committing a felony. The statute's text for the cap is in section 5104(d). The Department of Financial Services described the budget as "tightening standards governing serious injury claims" in an October 20, 2026 release.

Section 5104(a) also sets the order of decision: the fact-finder determines who is at fault before deciding whether the injury is serious. If you are weighing a lawsuit, a lawyer can say how the new text applies to your date of filing.

Questions to put to the insurer

Ask the claims adjuster these in writing, and for how premiums in the state reflect these rules, see what drives car insurance costs in New York.

• Which forms have you received and which are still missing, by date?
• When did you receive the last item you requested, so I can calculate the 30 days?
• What objective standard supports this examination under oath or exam request?
• Has the exam been scheduled within 30 days of the verification forms, and will you reimburse travel and lost earnings?
• Is the reduction due to the fee schedule or to a medical opinion? Please send the report.

Common questions

Is the 30-day deadline for the NF-2?

No. The 30 days in the endorsement is for written notice of the accident, with an exception for justified lateness. The insurer sends the NF-2 within five business days after it gets notice.

Can the insurer stop paying while it waits for an exam?

Not generally. The regulation bars interrupting payment pending an exam unless the applicant or attorney caused the delay.

Do I have to arbitrate?

Arbitration is an option the claimant has. Court is available too, and a master arbitrator award of $5,000 or more can be reviewed by a court anew.

Does a fraud investigation delay my claim?

Verification requests can extend the clock, but the regulations still set time limits. See the medical mill fraud article for how the rules aim at fraudulent clinics rather than honest patients.

Key takeaways

• Give written notice within 30 days of the crash and return the NF-2; proof of claim has its own 45- and 90-day limits.
• The insurer has 30 calendar days after it has the proof to pay or deny, and interest of two percent a month runs on late payments.
• An exam can end coverage, but the insurer must follow scheduling and mailing rules; do not miss an exam without rescheduling in writing.
• Arbitration is the low-cost route; interest stops 30 days after a denial unless you start arbitration or sue.
• The 90/180-day serious injury category was removed in 2026 for suits filed on or after May 26, 2026, according to a law-firm alert; check with an attorney.