NY Property & Casualty cheat sheet

Regulation 64 requires an insurer to acknowledge notification of a first-party claim within 15 business days and to pay or deny the claim within 30 calendar days after receiving proof of loss.

Regulation 68 governs no-fault: written notice of claim within 30 days of the accident and proof of claim (such as medical bills) within 45 days.

Insurance Law section 2601 defines unfair claim settlement practices, including misrepresenting policy provisions, failing to act promptly on claims communications, and refusing to pay without a reasonable investigation.

Minimum New York auto liability limits are $25,000 per person and $50,000 per accident for bodily injury and $10,000 for property damage; no-fault adds a minimum $50,000 per person.

Regulation 35-D requires supplementary uninsured/underinsured motorists (SUM) coverage at limits equal to the policy's liability limits unless the insured requests lower limits in writing.

Rebating is prohibited: no producer may offer any inducement not stated in the policy, and commissions may not be shared with an unlicensed person.

A newly delivered life insurance policy must give the owner a free-look right of at least 10 days to return the policy for a full premium refund.

The Superintendent of Financial Services, appointed by the Governor, heads the Department of Financial Services and enforces the Insurance Law through regulations published in 11 NYCRR.

For homeowners policies in effect more than 60 days, mid-term cancellation is permitted only for specified reasons, and at least 10 days' written notice is required for nonpayment of premium.

Principle of indemnity: the insured is restored to approximately the pre-loss financial position and may not profit from a loss; it underlies actual cash value and limit-of-insurance rules.

Coinsurance formula: (insurance carried / insurance required) x loss, then subtract the deductible, where insurance required = coinsurance percentage x value at time of loss.

Insurable interest must exist at the time of loss for property insurance and at policy inception for life insurance.

Subrogation transfers the insured's right of recovery against a third party to the insurer after payment, preventing double recovery and helping hold down premiums.

Utmost good faith imposes duties of disclosure and no misrepresentation of material facts; a material misrepresentation may allow the insurer to rescind.

Insurance contracts are aleatory (unequal exchange of values) and contracts of adhesion (insurer drafts the wording, so ambiguities are construed against the insurer).

Hazards: physical (icy steps, faulty wiring), moral (intentional acts such as arson or fraud), and morale (indifference, such as leaving keys in an unlocked car).

Proximate cause is the unbroken chain of events between a peril and a loss; an intervening cause breaks the chain and may defeat coverage.

The law of large numbers lets insurers predict losses from a large pool of similar units; adverse selection is the tendency of higher-risk buyers to seek or keep coverage.

Actual cash value = replacement cost minus depreciation; replacement cost pays to repair or replace with new property of like kind and quality, often conditioned on actual repair or replacement.

A coinsurance clause requires the limit to equal a stated percentage (commonly 80%) of the property's value at the time of loss, or the loss is reduced by the carried/required ratio.

Typical duties after loss: give prompt notice, protect the property from further damage, prepare an inventory of damaged property, submit a signed proof of loss, and submit to examination under oath.

Appraisal settles a dispute over the amount of loss: each party names a competent appraiser, the appraisers select an umpire, and an agreement by any two is binding.

Other insurance: concurrent policies share the loss pro rata by their limits, and total recovery may not exceed the actual loss.

A mortgagee clause protects the lender's interest by providing loss payment and notice of cancellation even when the insured's own acts impair coverage.

Valuation methods include actual cash value, replacement cost, functional replacement cost, agreed value, and market value.

Special (open-peril) forms insure risks of direct physical loss unless excluded, while named-peril forms pay only for perils specifically listed.

Deductibles apply per occurrence to first-party property coverage; liability coverages generally have no deductible.

HO-3 insures Coverages A and B on an open-peril basis and Coverage C for broad named perils; HO-2 covers all property on a broad named-peril basis.

Standard HO limits: A = dwelling limit; B = 10% of A; C = 50% of A; D = 30% of A; E = $100,000 personal liability; F = $1,000 medical payments to others.

HO-4 (tenants) covers personal property and personal liability, with limited coverage for building additions and alterations made by the tenant.

HO-6 (unit-owners) covers building property within the condominium unit, improvements and betterments, loss assessment, contents, and liability.

HO-8 (modified form) is written for older or architecturally unique homes and uses functional replacement cost with reduced limits.

Coverage C special limits include money ($200), securities ($1,500), theft of jewelry, watches and furs ($1,500), theft of firearms ($2,500), theft of silverware ($2,500), and business property on the premises ($2,500).

Section I exclusions include earth movement, water damage from flood or surface water, ordinance or law, neglect, intentional loss, and governmental action.

Coverage D pays additional living expense and fair rental value for the shortest time needed to repair or replace the residence or to permanently relocate.

Dwelling forms DP-1 (basic), DP-2 (broad), and DP-3 (special) provide property coverage only; liability must be added by endorsement.

Commercial property causes-of-loss forms are Basic, Broad, and Special; the Special form is open peril subject to stated exclusions.

The Building and Personal Property Coverage Form insures the building, business personal property, personal property of others in the insured's care, and tenant improvements and betterments.

Coinsurance percentages are commonly 80%, 90%, or 100% of value; the agreed value option suspends coinsurance when the limit equals 100% of value.

Business income coverage pays net income plus continuing normal operating expenses during the period of restoration, after a 72-hour waiting period.

Extra expense coverage pays the costs of continuing operations to avoid or minimize shutdown, without a waiting period.

Equipment breakdown covers mechanical, electrical, and pressure-equipment failure, which commercial property forms exclude.

Inland marine policies are frequently written on a filed-value basis, paying the stated value on a total loss without coinsurance.

Motor truck cargo insures goods in transit; bailee coverage insures property of others in the insured's care, custody, or control.

Builders risk insures a structure under construction, including materials, supplies, and equipment intended to become part of the completed building.

Negligence requires four elements: a duty owed, a breach of that duty, proximate cause, and actual damages.

New York follows pure comparative negligence, so a plaintiff's recovery is reduced by his or her percentage of fault and is barred only at 100% fault.

Res ipsa loquitur allows an inference of negligence when the injuring instrumentality was in the defendant's exclusive control and the event would not ordinarily occur without negligence.

Compensatory damages are special (medical bills, lost wages) or general (pain and suffering); punitive damages punish gross, reckless, or intentional conduct.

Occurrence policies are triggered by injury or damage during the policy period; claims-made policies are triggered by a claim made and reported during the period, subject to a retroactive date.

CGL Coverage A covers liability for bodily injury and property damage; Coverage B covers personal and advertising injury; Coverage C provides medical payments without regard to fault.

CGL limits include each occurrence, general aggregate, products-completed operations aggregate, damage to premises rented to you, and medical expense per person.

Strict liability imposes liability without fault for abnormally dangerous activities and certain statutory situations; vicarious liability attaches for the acts of others such as employees.

Additional insured status extends liability coverage to another party, generally limited to liability arising out of the named insured's work or premises.

New York minimum liability limits are $25,000 per person and $50,000 per accident for bodily injury and $10,000 for property damage; no-fault PIP minimum is $50,000 per person.

New York PIP pays necessary medical expenses, 80% of lost earnings up to $2,000 per month for up to three years, up to $25 per day for other expenses for one year, and a $2,000 death benefit.

The no-fault serious injury threshold requires death, fracture, significant disfigurement, loss of a body member or function, or impairment lasting at least 90 days to sue for pain and suffering.

Personal auto policy parts: A liability, B medical payments (not offered in New York), C uninsured/underinsured motorists, D damage to your auto, and E duties after an accident or loss.

New York requires SUM coverage in addition to UM, providing benefits when the at-fault driver has some but insufficient liability insurance.

PAP exclusions include intentional damage, use of a vehicle as a public livery, racing, and use without a reasonable belief of permission.

Commercial auto covered-auto symbols: 1 any auto, 2 owned autos only, 7 specifically described autos, 8 hired autos only, 9 nonowned autos only.

Hired autos are short-term rentals or leases used in the business; nonowned autos are vehicles such as employees' cars used in the employer's business.

Physical damage: collision covers impact with another vehicle or object, while other than collision covers theft, fire, hail, vandalism, and glass breakage.

Workers compensation pays statutory benefits regardless of fault: medical care (no dollar limit in New York), wage replacement at two-thirds of average weekly wage subject to a statutory maximum, disability, and death benefits.

The exclusive remedy doctrine makes workers compensation the employee's sole remedy against the employer for covered work-related injury or disease.

New York employers must secure workers compensation coverage; failure to do so exposes the employer to direct suits and statutory penalties.

CGL products-completed operations coverage responds to bodily injury or property damage occurring away from the premises and arising from the insured's product or completed work.

Umbrella policies provide limits excess of scheduled underlying policies and may drop down to cover gaps, usually subject to a self-insured retention.

Crime coverages include employee theft, forgery or alteration, inside the premises robbery, safe burglary, computer fraud, and funds transfer fraud.

Loss-sustained crime forms cover loss discovered during the policy period or within a stated discovery period after termination; discovery forms cover only loss discovered during the period.

Surety bonds are three-party agreements among the obligee, the principal, and the surety, unlike two-party insurance contracts.