No-Fault Regulation 68
Current Regulation 68: Effective April 5, 2002
The Current Regulation 68 was to be implemented effective as of September 1, 2001. However, due to a lawsuit filed in the New York State Supreme Court seeking a stay of enforcement of the revised regulation, the revised Regulation 68 (that included subparts one through four) became effective as of April 5, 2002. Subpart five was subsequently added and became effective November 13, 2013.
Regulation 68 is divided into five different subparts that each address a separate regulated aspect of the No-Fault reparations system as follows: Regulation 68-A - Prescribed Policy Endorsements; Regulation 68-B - Rights and Liabilities of Self Insurers; Regulation 68-C - Claims for Personal Injury Protection Benefits; Regulation 68-D - No-Fault Arbitration; and Regulation 68-E - Unauthorized Providers of Health Services.
On April 11, 2002 the Department promulgated, on an emergency basis, the First Amendment to Regulation No. 68-C (11 NYCRR 65) and the First Amendment to Regulation No. 68-D (11 NYCRR 65). These two emergency regulations amended the provisions of the Current Regulation 68 to conform it with the 25th Amendment to the old regulation, and were finally adopted on April 5, 2003.
Subsequently, the Department promulgated both the Second and Third Amendments to Regulation 68-D (11NYCRR65) to take effect on February 4, 2004.
On April 30, 2004 the Department promulgated the Second Amendment to Regulation 68-C which resulted in the repeal and re-issuance of Appendix 13 to Regulation 68, which contains a complete set of the prescribed No-Fault claim forms.
On August 31, 2006 the Department promulgated, on an emergency basis, the Third Amendment to Regulation No. 68-C (11 NYCRR 65) and the Fourth Amendment to Regulation No. 68-D (11 NYCRR 65). These two amendments to Regulation 68 were finally adopted effective March 14, 2007, requiring insurers to issue no-fault denials with specific wording so that the applicants will be aware that they can apply for special expedited arbitration to resolve the issue of which eligible insurer is designated for first party benefits, and providing the procedures for administration of the special expedited arbitration for disputes regarding the designation of the insurer for first part benefits.
On April 26, 2011 the Department promulgated the First Amendment to Regulation 68-A and the First Amendment to Regulation 68-B implementing the amendment to section 5103(b)(2) of the New York Insurance Law (effective January 26, 2011) providing limited no-fault coverage to an applicant while intoxicated.
On April 1, 2013 the Fourth Amendment to Regulation 68-C became effective and established a new 120 calendar day time frame for an applicant to respond to a verification request from a no-fault insurer, and also established a rule to prevent an applicant from receiving reimbursement in excess of the fee schedules or for services not rendered due to a late denial by the insurer.
On June 1, 2013 the Fifth Amendment to Regulation 68-C (Consensus Amendment) became effective and resulted in the repeal and re-issuance of an updated prescribed No-Fault Denial of Claim Form (NYS Form NF-10) to Appendix 13.
On August 1, 2013 the consolidated amendment to multiple parts of 11 NYCRR took effect and resulted in the Second Amendment to Regulation 68-A, the Sixth Amendment to Regulation 68-C, the Fifth Amendment to Regulation 68-D, and the repeal and re-issuance of prescribed forms NF-1A, NF-1B, NF-4 and NF-5 of Appendix 13. The consolidated amendment revised references that were outdated as a result of the consolidation of the New York State Insurance and Banking Departments into a new Department of Financial Services.
On November 13, 2013, the final adoption of new subpart 65-5 (Insurance Regulation 68-E) took effect. The new subpart establishes standards and procedures for investigating and suspending or removing the authorization for providers of health services to demand or request payment upon findings of certain unlawful conduct reached after investigation, notice, and a hearing pursuant to 5109 of the NYIL.
On February 4, 2015, the Sixth Amendment to Regulation 68 took effect revising the structure of fees that are awarded to attorneys who prevail in no-fault disputes on behalf of applicants - (1) eliminates the $60 minimum attorney’s fee; (2) eliminates the $60-or-$80 attorney-fee limit that applies during the conciliation phase of the arbitration process; and (3) increases the maximum fee to be awarded to an attorney who prevails in court or at arbitration to $1,360.
NOTE TO READER
In order to assist you in viewing Regulation 68 in totality and in its most current form, the following two documents contain the full text of all five subparts of Regulation 68 as well as Appendix 13 to the Regulation, which contains all prescribed No-Fault forms. These two documents are inclusive of all modifications affected by all subsequently issued amendments to the Regulation.
Although reasonable efforts have been made to ensure that these two documents are current, complete and accurate, the Department of Financial Services does not warrant or represent that this information is current, complete and accurate. All information is subject to change on a regular basis, without notice.
The Department of Financial Services assumes no responsibility for any errors in the information provided, nor assumes any liability for any damages incurred as a consequence, directly or indirectly, of the use and application of these two documents, or any of the contents of the Department of Financial Services Web site.
If, for historical purposes, you require access to the unmodified complete text of Regulation 68 (as initially promulgated) that became effective as of April 5, 2002, or any of the subsequent amendments to the individual subparts of the Regulation, these documents can be individually accessed as follows:
The above document includes all four subparts of Regulation 68 as well as Appendix 13, as initially promulgated.
NOTE that the above document does NOT reflect the subsequent issuance of amendments to Regulation 68, each of which are each individually listed below. Each document is in PDF format unless otherwise noted:
- First Amendment to Regulation 68-A
- Second Amendment to Regulation 68-A
- First Amendment to Regulation 68-B
- First Amendment to Regulation No. 68-C
- Second Amendment to Regulation 68-C
- Third Amendment to Regulation 68-C
- Fourth Amendment to Regulation 68-C
- Fifth Amendment to Regulation 68-C
- Sixth Amendment to Regulation 68-C
- Cover letter to be used with policies effective on or after September 1, 2001 (NF-1A)
- Cover letter to be used with policies effective prior to September 1, 2001 (NF-1B)
- Verification of Hospital Treatment (NF-4)
- Hospital Facility Form (NF-5)
- First Amendment to Regulation No. 68-D
- Second Amendment to Regulation 68-D
- Third Amendment to Regulation 68-D
- Fourth Amendment to Regulation 68-D
- Fifth Amendment to Regulation 68-D
- Sixth Amendment to Regulation 68-D effective February 4, 2015
- Regulation 68-E (Subpart 65-5) effective November 13, 2013