# 11 NYCRR 65-3.4: Acknowledgment of claim

- Part of: 11 NYCRR Subpart 65-3 (Insurance Regulation 68-C), Claims for Personal Injury Protection Benefits; 11 NYCRR Part 65 (Insurance Regulation 68)
- Page: https://www.beynensonlaw.com/no-fault-regulations/11-nycrr-65-3-4/
- Source: New York State Department of Financial Services, https://www.dfs.ny.gov/system/files/documents/2024/08/reg68_11_nycrr_65_full_txt.pdf (retrieved 2026-10-04)
- Checked against the Department's list of amendments through 2026-10-04
- Unofficial copy. The official compilation is the New York Codes, Rules and Regulations (NYCRR).
- Each provision below starts with its full path, so (a)(2) is paragraph (2) of subdivision (a). Stable IDs have the form `11nycrr:65-3.4(a)(2)`.

## Text

(a) Whenever the insurer receives notice of claim by telephone, the party receiving such notice on behalf of the insurer shall be identified to the caller by name and title and shall request the name, address and telephone number of the applicant and the name of the policyholder or the policy number or both, if available, along with reasonably obtainable information regarding the time, place and circumstances of the accident which will enable the insurer to begin processing the claim.

(b) Unless the insurer will pay the claim as submitted within 30 calendar days, then, within five business days after notice is received by the insurer at the address of its proper claim processing office, either orally pursuant to subdivision (a) of this section or in any other manner, the insurer shall forward to the applicant the prescribed application for motor vehicle no-fault benefits (NYS form N-F 2) accompanied by the prescribed cover letter (NYS form N-F 1). If notice is initially received by the insurer at an address other than the proper claims processing office, the five-day period for forwarding of the prescribed forms shall commence on the day such notice is received at the proper claims processing office, but in no event shall the prescribed forms be forwarded later than 10 business days after receipt of the original notice.

(c) Attached is an appendix (Appendix 13, infra), which includes the following prescribed claim forms that must be used by all insurers, and shall not be altered unless approved by the superintendent:

(c)(1) Cover letter (NYS form N-F 1A)—to be used with policies effective on or after September 1, 2001.

(c)(2) Cover letter (NYS form NF-1B)—to be used with policies effective prior to September 1, 2001.

(c)(3) Application for motor vehicle no-fault benefits (NYS form NF-2).

(c)(4) Verification of treatment by attending physician or other provider of health service (NYS form NF-3).

(c)(5) Verification of hospital treatment (NYS form NF-4).

(c)(6) Hospital facility form (NYS form NF-5).

(c)(7) Employer’s wage verification report (NYS form NF-6).

(c)(8) Verification of self-employment income (NYS form NF-7).

(c)(9) Agreement to pursue social security disability benefits (NYS form NF-8).

(c)(10) Agreement to pursue workers’ compensation or New York State disability benefits (NYS form NF-9).

(c)(11) Denial of claim form (NYS form NF-10).

(c)(12) Subrogation agreement (NYS form NF-11).

(c)(13) Lump-sum settlement agreement (NYS form NF-12).

(c)(14) Election-optional basic economic loss (NYS form NF-13).

## Historical note

Sec. filed Aug. 2, 2001 eff. Sept. 1, 2001.

## Decisions citing this section (42)

From the beynensonlaw.com case-law database, grouped by the subdivision cited. Highest court first, then most-cited first. Compiled automatically from the text of the decisions.

### Subdivision (a) (5)

- [Stephen Fogel Psychological, P.C. v Progressive Cas. Ins. Co. (2004 NY Slip Op 24527)](https://www.beynensonlaw.com/case-law/stephen-fogel-psychological-p-c-v-progressive-cas-ins-co-2004-ny-slip-op-24527/) — Appellate Term, Second Department
- [Alleviation Med. Servs., P.C. v Hertz Co. (2017 NY Slip Op 50046(U))](https://www.beynensonlaw.com/case-law/alleviation-med-servs-p-c-v-hertz-co-2017-ny-slip-op-50046u/) — Appellate Term, Second Department
- [SZ Med., P.C. v Lancer Ins. Co. (2005 NY Slip Op 25112)](https://www.beynensonlaw.com/case-law/sz-med-p-c-v-lancer-ins-co-2005-ny-slip-op-25112/) — Appellate Term, Second Department
- [Medical Select, P.C. v Allstate Ins. Co. (2013 NY Slip Op 23446)](https://www.beynensonlaw.com/case-law/medical-select-p-c-v-allstate-ins-co-2013-ny-slip-op-23446/) — Trial court
- [Sky Med. Supply Inc. v ELRAC Inc. (2014 NY Slip Op 24232)](https://www.beynensonlaw.com/case-law/sky-med-supply-inc-v-elrac-inc-2014-ny-slip-op-24232/) — Trial court

### Subdivision (b) (4)

- [New York & Presbyt. Hosp. v Country-Wide Ins. Co. (2011 NY Slip Op 07149)](https://www.beynensonlaw.com/case-law/new-york-presbyt-hosp-v-country-wide-ins-co-2011-ny-slip-op-07149/) — Court of Appeals
- [Compas Med., P.C. v Fiduciary Ins. Co. of Am. (2016 NY Slip Op 26062)](https://www.beynensonlaw.com/case-law/compas-med-p-c-v-fiduciary-ins-co-of-am-2016-ny-slip-op-26062/) — Appellate Term, Second Department
- [Medical Select, P.C. v Allstate Ins. Co. (2013 NY Slip Op 23446)](https://www.beynensonlaw.com/case-law/medical-select-p-c-v-allstate-ins-co-2013-ny-slip-op-23446/) — Trial court
- [Williams v Kemper Independence Ins. Co. (2025 NY Slip Op 50101(U))](https://www.beynensonlaw.com/case-law/williams-v-kemper-independence-ins-co-2025-ny-slip-op-50101u/) — Trial court

### Subdivision (c) (30)

- [Nyack Hosp. v Metropolitan Prop. & Cas. Ins. Co. (2005 NY Slip Op 02235)](https://www.beynensonlaw.com/case-law/nyack-hosp-v-metropolitan-prop-cas-ins-co-2005-ny-slip-op-02235/) — Appellate Division, Second Department
- [Viviane Etienne Med. Care, P.C. v Country-Wide Ins. Co. (2013 NY Slip Op 08430)](https://www.beynensonlaw.com/case-law/viviane-etienne-med-care-p-c-v-country-wide-ins-co-2013-ny-slip-op-08430/) — Appellate Division, Second Department
- [Nyack Hosp. v State Farm Mut. Auto. Ins. Co. (2004 NY Slip Op 07663)](https://www.beynensonlaw.com/case-law/nyack-hosp-v-state-farm-mut-auto-ins-co-2004-ny-slip-op-07663/) — Appellate Division, Second Department
- [A.B. Med. Servs., PLLC v Liberty Mut. Ins. Co. (2007 NY Slip Op 03636)](https://www.beynensonlaw.com/case-law/a-b-med-servs-pllc-v-liberty-mut-ins-co-2007-ny-slip-op-03636/) — Appellate Division, Second Department
- [New York Univ. Hosp. Rusk Inst. v Government Empls. Ins. Co. (2007 NY Slip Op 03671)](https://www.beynensonlaw.com/case-law/new-york-univ-hosp-rusk-inst-v-government-empls-ins-co-2007-ny-slip-op-03671/) — Appellate Division, Second Department
- [Sound Shore Med. Ctr. v New York Cent. Mut. Fire Ins. Co. (2013 NY Slip Op 02390)](https://www.beynensonlaw.com/case-law/sound-shore-med-ctr-v-new-york-cent-mut-fire-ins-co-2013-ny-slip-op-02390/) — Appellate Division, Second Department
- [NYU-Hospital for Joint Diseases v Esurance Ins. Co. (2011 NY Slip Op 04436)](https://www.beynensonlaw.com/case-law/nyu-hospital-for-joint-diseases-v-esurance-ins-co-2011-ny-slip-op04436/) — Appellate Division, Second Department
- [A.B. Med. Servs., PLLC v GEICO Cas. Ins. Co. (2007 NY Slip Op 03635)](https://www.beynensonlaw.com/case-law/a-b-med-servs-pllc-v-geico-cas-ins-co-2007-ny-slip-op-03635/) — Appellate Division, Second Department
- [New York Univ. Hosp. Rusk Inst. v Hartford Acc. & Indem. Co. (2006 NY Slip Op 06223)](https://www.beynensonlaw.com/case-law/new-york-univ-hosp-rusk-inst-v-hartford-acc-indem-co-2006-ny-slip-op-06223/) — Appellate Division, Second Department
- [NYU Hosp. for Joint Diseases v Country Wide Ins. Co. (2011 NY Slip Op 04219)](https://www.beynensonlaw.com/case-law/nyu-hosp-for-joint-diseases-v-country-wide-ins-co-2011-ny-slip-op04219/) — Appellate Division, Second Department
- [St. Barnabas Hosp. v Allstate Ins. Co. (2009 NY Slip Op 07824)](https://www.beynensonlaw.com/case-law/st-barnabas-hosp-v-allstate-ins-co-2009-ny-slip-op-07824/) — Appellate Division, Second Department
- [Westchester Med. Ctr. v Allstate Ins. Co. (2007 NY Slip Op 08447)](https://www.beynensonlaw.com/case-law/westchester-med-ctr-v-allstate-ins-co-2007-ny-slip-op-08447/) — Appellate Division, Second Department
- [St. Vincent’s Hosp. & Med. Ctr. v New Jersey Mfrs. Ins. Co. (2011 NY Slip Op 01828)](https://www.beynensonlaw.com/case-law/st-vincents-hosp-med-ctr-v-new-jersey-mfrs-ins-co-2011-ny-slip-op01828/) — Appellate Division, Second Department
- [St. Vincent’s Hosp. & Med. Ctr. v Nationwide Mut. Ins. Co. (2007 NY Slip Op 06226)](https://www.beynensonlaw.com/case-law/st-vincents-hosp-med-ctr-v-nationwide-mut-ins-co-2007-ny-slip-op-06226/) — Appellate Division, Second Department
- [Stephen Fogel Psychological, P.C. v Progressive Cas. Ins. Co. (2004 NY Slip Op 24527)](https://www.beynensonlaw.com/case-law/stephen-fogel-psychological-p-c-v-progressive-cas-ins-co-2004-ny-slip-op-24527/) — Appellate Term, Second Department
- [A.B. Med. Servs. PLLC v Utica Mut. Ins. Co. (2005 NY Slip Op 25456)](https://www.beynensonlaw.com/case-law/a-b-med-servs-pllc-v-utica-mut-ins-co-2005-ny-slip-op-25456/) — Appellate Term, Second Department
- [A.B. Med. Servs. PLLC v Peerless Ins. Co. (2006 NY Slip Op 26318)](https://www.beynensonlaw.com/case-law/a-b-med-servs-pllc-v-peerless-ins-co-2006-ny-slip-op-26318/) — Appellate Term, Second Department
- [Aries Chiropractic, P.C. v Ameriprise Ins. Co. (2019 NY Slip Op 52064(U))](https://www.beynensonlaw.com/case-law/aries-chiropractic-p-c-v-ameriprise-ins-co-2019-ny-slip-op-52064u/) — Appellate Term, Second Department
- [A.B. Med. Servs. PLLC v Utica Mut. Ins. Co. (2006 NY Slip Op 51334(U))](https://www.beynensonlaw.com/case-law/a-b-med-servs-pllc-v-utica-mut-ins-co-2006-ny-slip-op-51334u/) — Appellate Term, Second Department
- [A.I.D. Med. Supplies v GEICO Gen. Ins. Co. (2007 NY Slip Op 51044(U))](https://www.beynensonlaw.com/case-law/a-i-d-med-supplies-v-geico-gen-ins-co-2007-ny-slip-op-51044u/) — Appellate Term, First Department
- [Elmont Open MRI & Diagnostic Radiology, P.C. v Country-Wide Ins. Co. (2007 NY Slip Op 27072)](https://www.beynensonlaw.com/case-law/elmont-open-mri-diagnostic-radiology-p-c-v-country-wide-ins-co-2007-ny-slip-op-27072/) — Trial court
- [Prime Psychological Servs., P.C. v American Tr. Ins. Co. (2008 NY Slip Op 28273)](https://www.beynensonlaw.com/case-law/prime-psychological-servs-p-c-v-american-tr-ins-co-2008-ny-slip-op-28273/) — Trial court
- [SK Med. Servs., P.C. v New York Cent. Mut. Fire Ins. Co. (2006 NY Slip Op 26227)](https://www.beynensonlaw.com/case-law/sk-med-servs-p-c-v-new-york-cent-mut-fire-ins-co-2006-ny-slip-op-26227/) — Trial court
- [T&G Med. Supplies, Inc. v State Farm Mut. Auto. Ins. Co. (2005 NY Slip Op 50636(U))](https://www.beynensonlaw.com/case-law/tg-med-supplies-inc-v-state-farm-mut-auto-ins-co-2005-ny-slip-op-50636u/) — Trial court
- [IAV Med. Supply, Inc. v Progressive Ins. Co. (2010 NY Slip Op 50433(U))](https://www.beynensonlaw.com/case-law/iav-med-supply-inc-v-progressive-ins-co-2010-ny-slip-op-50433u/) — Trial court
- [Elmont Open MRI & Diagnostic Radiology, P.C. v GEICO Ins. Co. (2008 NY Slip Op 50113(U))](https://www.beynensonlaw.com/case-law/elmont-open-mri-diagnostic-radiology-p-c-v-geico-ins-co-2008-ny-slipop-50113u/) — Trial court
- [Westchester Med. Ctr. v Encompass Ins. Co. (2007 NY Slip Op 52475(U))](https://www.beynensonlaw.com/case-law/westchester-med-ctr-v-encompass-ins-co-2007-ny-slip-op-52475u/) — Trial court
- [Clinton Med. Off. P.C. v Progressive Max Ins. Co. (2026 NY Slip Op 26094)](https://www.beynensonlaw.com/case-law/clinton-med-off-p-c-v-progressive-max-ins-co-2026-ny-slip-op-26094/) — Trial court
- [Odessa Med. Supply, Inc. (b) v Government Employees Ins. Co. (2007 NY Slip Op 27542)](https://www.beynensonlaw.com/case-law/odessa-med-supply-inc-b-v-government-employees-ins-co-2007-ny-slip-op-27542/) — Trial court
- [Andrew Carothers, M.D., P.C. v Progressive Ins. Co. (2006 NY Slip Op 52479(U))](https://www.beynensonlaw.com/case-law/andrew-carothers-m-d-p-c-v-progressive-ins-co-2006-ny-slip-op-52479u/) — Trial court

### Section cited without a subdivision (5)

- [American Tr. Ins. Co. v Longevity Med. Supply, Inc. (2015 NY Slip Op 06761)](https://www.beynensonlaw.com/case-law/american-tr-ins-co-v-longevity-med-supply-inc-2015-ny-slip-op06761/) — Appellate Division, First Department
- [BNE Clinton Med., P.C. v State Farm Mut. Auto Ins. Co. (2021 NY Slip Op 50083(U))](https://www.beynensonlaw.com/case-law/bne-clinton-med-p-c-v-state-farm-mut-auto-ins-co-2021-ny-slip-op50083u/) — Appellate Term, Second Department
- [Quality Psychological Servs., P.C. v GEICO Ins. Co. (2010 NY Slip Op 51423(U))](https://www.beynensonlaw.com/case-law/quality-psychological-servs-p-c-v-geico-ins-co-2010-ny-slip-op51423u/) — Trial court
- [Mega Supply & Billing, Inc. v American Tr. Ins. Co. (2005 NY Slip Op 51569(U))](https://www.beynensonlaw.com/case-law/mega-supply-billing-inc-v-american-tr-ins-co-2005-ny-slip-op-51569u/) — Trial court
- [Ocean Diagnostic Imaging P.C. v State Farm Mut. Auto. Ins. Co. (2004 NY Slip Op 24356)](https://www.beynensonlaw.com/case-law/ocean-diagnostic-imaging-p-c-v-state-farm-mut-auto-ins-co-2004-ny-slip-op-24356/) — Trial court