New York Insurance Law and Regulations
New York Insurance Law and Regulations
This domain tests New York-specific licensing, claim conduct, and regulatory deadlines. The exam expects you to know which conduct is prohibited and which timelines apply to insurers and adjusters.
Licensing and prohibited conduct
Public adjusters are licensed under Insurance Law Article 21 and supervised by DFS. Unlicensed adjustment for compensation is prohibited. A public adjuster may not represent an insurer on a claim, misrepresent policy terms, or share fees with unlicensed persons. Records must support the claim.
Claim practice standards
Regulation 64 (11 NYCRR 216) sets standards for claim acknowledgment, investigation, and communication. Insurers must acknowledge claim notifications promptly, provide necessary forms, and conduct prompt investigation. For property claims, after receipt of a properly executed proof of loss, the insurer must pay or deny within 30 days, or provide a written explanation. Unfair claim settlement practices under Insurance Law §2601 include unreasonable delay, failure to explain denial, and coercion.
Worked example
An insured submits a signed proof of loss on March 1. The insurer neither pays nor denies by March 31 and gives no written explanation. That is a prompt-payment concern under Regulation 64 and may support a §2601 unfair-claim-practice complaint. The public adjuster should document the submission date, keep delivery proof, request a written status, and preserve appraisal or suit rights. Reasoning: the deadline runs from a proper proof of loss, so the adjuster must prove when it was received.
Traps
Do not assume the 30-day clock starts at first notice instead of proof of loss. Do not rely on oral denials. Do not miss the policy's suit-limitation period. Do not advise the insured to exaggerate a claim. Do not act after license suspension.
Key points
- Article 21 licensing is required for public adjusting in New York.
- Regulation 64 governs acknowledgment, investigation, and communication.
- Property claims require payment or denial within 30 days after a proper proof of loss.
- §2601 prohibits unfair claim settlement practices such as unreasonable delay.
- Document delivery dates to prove regulatory deadlines.