New York Insurance Law and Regulations
The statutes a claims adjuster must know
Insurance Law Article 21 governs licensing: independent adjusters, public adjusters, and brokers must be licensed, and a public adjuster's compensation is capped (generally 12.5% of the amount recovered, with a lower cap for declared disasters). An individual may not act as both public adjuster and company adjuster on the same claim.
Article 26, §2601 lists unfair claim settlement practices - no good-faith attempt to settle where liability is reasonably clear, failure to acknowledge or act promptly, refusal to pay without a reasonable investigation, failure to explain a denial. Trap: §2601 creates no private right of action; enforcement is by the Department of Financial Services.
Regulation 64 (11 NYCRR 216) supplies the time standards: written acknowledgment of a claim within 15 business days of notification, with forms; a written response within 15 business days to claimant communications; and prompt payment or written denial after proof of loss, with a specific explanation of the basis for denial.
§3420(d) requires a liability insurer to send a written disclaimer or reservation of rights as soon as reasonably possible; an unjustified delay waives exclusion-based defenses. Remember §3420(a) allows a judgment creditor to sue the insurer directly if a judgment is unsatisfied for 30 days.
Also know Article 51 no-fault ($50,000 minimum PIP, 30-day application, 30-day denial after proof, serious-injury threshold), the New York Standard Fire Policy mandated by §3404, cancellation/nonrenewal rules for auto and property policies, and §409 fraud-prevention plans with special investigation units.
Rule of thumb: acknowledge in 15 business days, then calendar every statutory clock from the date proof of loss is received, not the date the file is assigned.