The Office of General Counsel issued the following opinion on August 30, 2005, representing the position of the New York State Insurance Department.

Re: Interpretation of "[A]ny Notice Rejecting Any Element of a Claim Involving Personal Property Insurance" Contained in Section 216.6(h) of Regulation 64

Question Presented:

How does OGC interpret "[a]ny notice rejecting any element of a claim involving personal property insurance" contained in N.Y. Comp. Codes R. & Regs. tit. 11, § 216.6(h) (2003) (Regulation 64) (hereinafter "Section 216.6(h)"), which would trigger the requirement that an insurer provide a notice to the claimant¹ with the identity and the claims processing address of the insurer, the insured’s policy number, the claim number, and notice that the claimant may file a complaint with our Consumer Services Bureau (hereinafter "CSB") by writing to or visiting CSB at an address given or file with the Insurance Department's website?

Conclusion:

If an insurer were to offer less than full payment of the dollar amount of any claim involving personal property insurance the insurer would be rejecting an element of the claim. If an insurer were to exclude coverage of a claim for an item of personal property the insurer would be rejecting an element of the claim.

Facts:

No facts were provided.

Analysis:

Section 216.6(h) states:

If an insurer's notice were to reject any element of any claim involving a personal property insurance policy, pursuant to Section 216.6(h) the insurer must provide the claimant with the information required by Section 216.6(h) as well as notification of the option to file a complaint with CSB.

The term, "personal property insurance" is not defined by N.Y. Comp. Codes R. & Regs. tit. 11, § 216.1 (1984) (Regulation 64), which governs the construction of terms used in Regulation 64. Nor is the term defined in the Insurance Law or any other regulation promulgated thereunder. Generally, "personal property" is used to refer to property other than "real property". Consistent with OGC Opinion Number 04-01-03 (dated January 6, 2004) we interpret the term "personal property insurance" contained in Section 216.6(h) to limit the applicability of this provision to personal lines property insurance and we do not apply this provision to either commercial or liability insurance policies.

If an insurer were to offer less than full payment of the dollar amount requested in a claim involving personal property insurance the insurer would be rejecting an element of a claim.

If an insurer were to exclude coverage requested by the claimant for an item of personal property involving personal property insurance the insurer would be rejecting an element of a claim. For example, if the insurer were to exclude coverage requested by the claimant for jewelry the insurer would be rejecting an element of a claim.

For further information one may contact, Senior Attorney Robert Freedman at the New York City Office.

¹    N.Y. Comp. Codes R. & Regs. tit. 11, § 216.1(b) (1982) (Regulation 64) construes the term "Claimant" for use in Regulation 64 as "any person who attempts to obtain a benefit from an insurer."  Since a lessor, lessee, mortgagee or mortgagor could have a claim involving personal property insurance the notice may not be limited to the insured of an insurance policy involving personal property insurance.  Consistent with OGC Opinion Number 04-01-03 (dated January 6, 2004) we interpret the term 'personal property insurance' contained in Section 216.6(h) to limit the applicability of this provision to personal lines property insurance and we do not apply this provision to either commercial or liability insurance policies.