The New York Guide to Property Insurance Claims: Deadlines, Laws, and FAQs

In most cases, promptly or immediately after the loss occurs.

In cases of fire damage claims in New York, you must notify your insurance company immediately. § 3404. Fire insurance contracts; standard policy provisions; permissible variations

Some states, like Florida, have laws that set specific deadlines for filing property insurance claims (for example, one year from the date of loss).  New York is not one of those states, so the deadline in New York to notify your insurer about a loss is set by your insurance policy, not state law.  (This first notice of loss typically starts the claim process, which is why notifying your insurer about a loss and “filing a claim” usually mean the same thing.)

There’s no single timetable for what counts as “prompt” or “immediate” notice.  It depends on what’s reasonable under the circumstances of the particular claim.  If a hurricane devastates your community, knocking out power and other basic life essentials, you probably have more leeway in the time that it takes you to file a claim than if a pipe bursts in your bathroom sink.

But the real takeaway here is simple: file your claim as soon as possible. You don’t want to give your insurance company a reason to deny your claim.

As soon as possible.

To be specific, unless you are absolutely confident that your insurance does not cover your losses or that the cost of your losses will be less than your deductible, you should quickly notify your insurer about your damage or loss. The longer you wait to notify the insurer, the longer it will take to resolve your claim. This can also degrade or compromise important evidence about your claim that the insurance company needs to complete its investigation.

Within 15 days.

New York insurer’s must acknowledge your claim, and respond to all other communications, within 15 business days.

New York Rules and Regs. Title 11 §216.4

You will hear the term “Proof of Loss” a lot, and see it in your insurance policy. Do not be intimidated! This simply means that you must satisfactorily demonstrate to the insurance company that you sustained the loss you sustained, and the value of that loss.

There are some best practices for this — which includes filling out a “proof of loss form” and getting it notarized. This form and the act of notarizing it enables you to explain your losses “under oath,” which elevates your proof to the insurance company.

A proof of loss is a powerful tool for moving claims forward, but it’s not always necessary in New York.  In other words, while you should prepare a robust Proof of Loss document, the requirement can be quite thin in the long run. In some instances, that is as simple as allowing a claims adjuster or other Agent from the Insurance company on your property.

New York law does not impose specific deadlines on policyholders to file a proof of loss. But your policy may very well set deadlines. When reviewing your policy to determine your deadlines to submit a proof of loss, consider these four questions:

Does the policy set a deadline to submit my proof of loss? (It usually does)
Does the deadline apply for all claims, or does it apply only when my insurance company requests that I submit a proof of loss?
When is the deadline to submit my proof of loss? (In New York it must be at least 60 days, but can be extended by agreement)
When is the start date for the deadline — the date of loss or the date when my insurance company requests me to submit a proof of loss?

Once you’ve answered these questions, you should have a much better understanding of your deadline to submit a proof of loss.

Sixty Days

You have sixty calendar days after your insurer provides them to submit your Proof of Loss forms.

New York Statute Ch. 28 § 3407

Within 15 business days.

As with all pertinent communications, your insurer has 15 business days to accept or reject your claim.

If they require more time to conduct an investigation, they have up to 90 days at which point they can extend again when reasonably necessary.

New York Rules and Regs. Title 11 §216.6

While your New York insurer must reject or accept your claim within 15 business days, they have the option to investigate your claim for up to 90 days from the date of the initial letter. This means that it could take the 15 business days plus 90 calendar days. Should they require additional time, they must notify you in writing and state why they are requiring an additional 90 days.

New York Rules and Regs. Title 11 §216.6(c)

You are also entitled to a copy of these inspections.

§ 3406. Copy of examination of insured to be delivered to insured

Five business days.

New York insurance companies have five business days from the receipt of such agreement by you to pay out claims.

New York Rules and Regs. Title 11 §216.6(f)

You must establish that your insurer’s conduct was “a deliberate or reckless failure to place on equal footing the interest of [you] with their own interests when considering a settlement offer.” Roemer v. Allstate Indemnity Ins. Co., 82 N.Y.S.3d 202, 205 (N.Y App. Div. 2018). Typically, this is offering evidence that they violated §2601 the state’s Unfair Claim Settlement Practice law or 11 CRR-NY 216, the rules and regulations guiding property insurance claims.

3 Years

Unless your policy states otherwise, you have three (3) years from the date of loss to file a claim against your insurer.

With regard to fire insurance specifically, you must have complied with the fire policy guidelines to have a claim–this includes giving “immediate notice” and submitting your proof of loss within 60 days.

New York Statute Ch. 8 §214

For fire insurance claims, no unless specifically provided so in your policy

§ 3404. Fire insurance contracts; standard policy provisions; permissible variations

For other claims, look at your policy to determine if your policy is assignable.

Rates shall not be excessive, inadequate, unfairly discriminatory, destructive of competition or detrimental to the solvency of insurers. In determining whether rates comply with the foregoing standards, the superintendent shall include all income earned by such insurer and any insurer controlling or controlled by such insurer or under common control by or with such insurer on all its investments of any kind and wherever located. The superintendent shall further determine whether any component of such rates represent an effort on the part of the insurer to recover losses incurred in another state due to any referendum, law or regulation which requires a general reduction in rates for the kinds of insurance described in section two thousand three hundred two of this article. Such a finding shall be deemed unfairly discriminatory for the purposes of this article.

New York Statute Ch. 28 § 2303

No person shall engage in this state in any trade practice constituting a defined violation or a determined violation as defined herein.

New York Statute Ch. 28 § 2403

(a) If the hearing was on a charge of a defined violation the superintendent shall make an order on his report and serve a copy of the findings and order upon the person charged with the violation and any intervenor. If the superintendent finds that the person complained of has engaged in a defined violation, the order shall require the person to cease and desist from engaging in such defined violation. Furthermore, if the superintendent finds, after notice and hearing, that the person complained of has engaged in an act prohibited by section three thousand two hundred twenty-four-a of this chapter, the superintendent is authorized to levy a civil penalty against such person in an amount up to five hundred dollars per day for each day beyond the date that a bill or claim was to be processed in accordance with section three thousand two hundred twenty-four-a of this chapter, but in no event shall such penalty exceed five thousand dollars.

(b) Until a proceeding for judicial review has been commenced, or the time to commence the proceeding has expired, the superintendent may, upon notice and in the manner he deems proper, modify or set aside all or part of any order issued by him under this section.

(c) If a proceeding for judicial review has not been commenced within the time allowed, the superintendent may, after notice and opportunity for hearing, modify or set aside, all or part, of any order issued by him under this section, whenever in his opinion changed conditions of fact or law or the public interest require.

(d) A cease and desist order issued under this section is final upon the expiration of the time allowed for commencing a proceeding for judicial review if no proceeding has been commenced within such time, or upon the final decision of the court affirming the order or dismissing the proceeding.

(e) Any person who violates a cease and desist order issued by the superintendent under this section after it has become final, and while it is in effect, shall be liable to the people of this state for a penalty in an amount not to exceed five thousand dollars for each violation. In determining the amount of the penalty the question of whether the violation was wilful shall be taken into consideration. Nothing herein shall limit a court in enforcing its own orders.

New York Statute Ch. 28 § 2406

(a) No insurer
doing business in this state shall engage in unfair claim settlement
practices. Any of the following acts by an insurer, if committed without
just cause and performed with such frequency as to indicate a general
business practice, shall constitute unfair claim settlement practices:

(1) knowingly misrepresenting to claimants pertinent facts or policy
provisions relating to coverages at issue;

(2) failing to acknowledge with reasonable promptness pertinent
communications as to claims arising under its policies;

(3) failing to adopt and implement reasonable standards for the prompt
investigation of claims arising under its policies;

(4) not attempting in good faith to effectuate prompt, fair and
equitable settlements of claims submitted in which liability has become
reasonably clear, except where there is a reasonable basis supported by
specific information available for review by the department that the
claimant has caused the loss to occur by arson. After receiving a
properly executed proof of loss, the insurer shall advise the claimant
of acceptance or denial of the claim within thirty working days;

(5) compelling policyholders to institute suits to recover amounts due
under its policies by offering substantially less than the amounts
ultimately recovered in suits brought by them;

(6) failing to promptly disclose coverage pursuant to subsection (d)
or subparagraph (A) of paragraph two of subsection (f) of section three
thousand four hundred twenty of this chapter;

(7) submitting reasonably rendered claims to the independent dispute
resolution process established under article six of the financial
services law; or

(8) artificially deflating or otherwise lowering cost data used for
adjusted claims, or using cost data that is not appropriate for the
region of the state where the loss occurred; this shall include but is
not limited to claims adjusted by a person issued a temporary permit
pursuant to subsection (n) of section two thousand one hundred eight of
this chapter.

(b) Evidence as to numbers and types of complaints to the department
against an insurer and as to the department’s complaint experience with
other insurers writing similar lines of insurance shall be admissible in
evidence in any administrative or judicial proceeding under this section
or article twenty-four or seventy-four of this chapter, but no insurer
shall be deemed in violation of this section solely by reason of the
numbers and types of such complaints.

(c) If it is found, after notice and an opportunity to be heard, that
an insurer has violated this section, each instance of noncompliance
with subsection (a) hereof may be treated as a separate violation of
this section for purposes of ordering a monetary penalty pursuant to
subsection (b) of section one hundred nine of this chapter. A violation
of this section shall not be a misdemeanor.

New York Statute Ch. 28 § 2601

No person shall either (i) wilfully make, circulate or transmit to another any statement written, printed or by word of mouth, which is untrue in fact and is directly or by inference derogatory to the financial condition, or affects the solvency or financial standing, of any insurer doing business in this state, or (ii) knowingly counsel, aid, procure or induce another to start, transmit or circulate any such statement.

New York Statute Ch. 28 § 2604

(a) No insurer shall knowingly misrepresent to a claimant the terms, benefits or advantages of the insurance policy pertinent to the claim.

(b) No insurer shall deny any element of a claim on the grounds of a specific policy provision, condition or exclusion unless reference to such provision, condition or exclusion is made in writing.

(c) Any payment, settlement or offer of settlement which, without explanation, does not include all amounts which should be included according to the claim filed by the claimant and investigated by the insurer shall, provided it is within the policy limits, be deemed to be a communication which misrepresents a pertinent policy provision.

New York Rules and Regs. Title 11 §216.3

(a) Every insurer, upon notification of a claim, shall, within 15 business days, acknowledge the receipt of such notice. Such acknowledgment may be in writing. If an acknowledgment is made by other means, an appropriate notation shall be made in the claim file of the insurer. Notification given to an agent of an insurer shall be notification to the insurer. If notification is given to an agent of an insurer, such agent may acknowledge receipt of such notice. Unless otherwise provided by law or contract, notice to an agent of an insurer shall not be notice to the insurer if such agent notifies the claimant that the agent is not authorized to receive notices of claims.

(b) An appropriate reply shall be made within 15 business days on all other pertinent communications.

(c) Every insurer shall establish an internal department specifically designated to investigate and resolve complaints filed with the Department of Financial Services and to take action necessitated as a result of its complaint investigation findings. Such internal department is to operate in a staff capacity to the entire company with authority to question and change the position taken in individual instances or company practices generally. Responsibility for such department is to be vested in a corporate officer who is also to be entrusted with the duty of executing the Department of Financial Services’ directives. If the Department of Financial Services requests the appearance of an insurer representative to discuss a pending matter, the individual whom the company sends shall be authorized to make any determination warranted after all the facts are elicited at such conference. Each insurer must furnish the superintendent with the name and title of the corporate officer responsible for its internal consumer services department.

(d) Every insurer, upon receipt of any inquiry from the Department of Financial Services respecting a claim, shall, within 10 business days, furnish the department with the available information requested respecting the claim.

(e) As part of its complaint handling function, an insurer’s consumer services department shall maintain an ongoing central log to register and monitor all complaint activity.

New York Rules and Regs. Title 11 §216.4

(a)

(1) Every insurer shall establish procedures to commence an investigation of any claim filed by a claimant, or by a claimant’s authorized representative, within 15 business days of receiving notice of the claim. An insurer shall furnish to every claimant, or claimant’s authorized representative, a notification of all items, statements and forms, if any, that the insurer reasonably believes will be required of the claimant, within 15 business days of receiving notice of the claim. A claim filed with an agent of an insurer shall be deemed to have been filed with the insurer unless, consistent with law or contract, such agent notifies the person filing the claim that the agent is not authorized to receive notices of claim.

(2)

(i) Notwithstanding paragraph (1) of this subdivision and section 216.2(d) of this Part, the provisions of this paragraph shall apply to any claim filed on or after May 30, 2020 for loss of or damage to real property, loss of or damage to personal property, or other liabilities for loss of, damage to, or injury to persons or property resulting from a riot or civil commotion in this State, where the superintendent has determined that it is in the best interests of the people of this State for such provisions to apply.

(ii) Every insurer shall commence an investigation of any claim filed by a claimant, or by a claimant’s authorized representative, within six business days of receiving notice of the claim or June 5, 2020, whichever is later.

(iii) An insurer shall furnish to every claimant, or claimant’s authorized representative, a written notification detailing all items, statements and forms, if any, that the insurer reasonably believes will be required of the claimant, within six business days of receiving notice of the claim or June 5, 2020, whichever is later.

(iv) A claim filed with an agent of an insurer shall be deemed to have been filed with the insurer unless, consistent with law or contract, the agent notifies the person filing the claim that the agent is not authorized to receive notices of claim.

(v) Where necessary to protect health or safety, a claimant may commence immediate repairs to the exterior windows, exterior doors, and, for minor permanent repairs, exterior walls of real property. Any policy requirement that the claimant exhibit the remains of the real or personal property may be satisfied by the claimant submitting reasonable proof of loss documentation of the damaged or destroyed property (without the need for a physical inspection), including photographs or video recordings; material samples, if applicable; and inventories, as well as receipts for any repairs to or replacement of property.

(b) Where there is a reasonable basis, supported by specific information available for review by Department of Financial Services examiners, that the claimant has fraudulently caused or contributed to the loss, the insurer is relieved from the requirements of this Part. The provisions of this Part are suspended for the period required to investigate the alleged fraudulent aspects of the claim. The insurer must submit the report required by Part 86 (Criminal Investigations Unit) of this Title when an insurer determines that a loss is suspect.

New York Rules and Regs. Title 11 §216.5

(a) In any case where there is no dispute as to coverage, it shall be the duty of every insurer to offer claimants, or their authorized representatives, amounts which are fair and reasonable as shown by its investigation of the claim, providing the amounts so offered are within policy limits and in accordance with the policy provisions.

(b) Actual cash value, unless otherwise specifically defined by law or policy, means the lesser of the amounts for which the claimant can reasonably be expected to:

(1) repair the property to its condition immediately prior to the loss; or

(2) replace it with an item substantially identical to the item damaged. Such amount shall include all monies paid or payable as sales taxes on the item repaired or replaced. This shall not be construed to prevent an insurer from issuing a policy insuring against physical damage to property, where the amount of damages to be paid in the event of a total loss to the property is a specified dollar amount.

(c)

(1) Within 15 business days after receipt by the insurer of a properly executed proof of loss and receipt of all items, statements and forms that the insurer requested from the claimant, the claimant, or the claimant’s authorized representative, shall be advised in writing of the acceptance or rejection of the claim by the insurer. When the insurer suspects that the claim involves arson, the foregoing 15 business days shall be read as 30 business days pursuant to section 2601 of the Insurance Law.

(2) If the insurer needs more time to determine whether the claim should be accepted or rejected, it shall so notify the claimant, or the claimant’s authorized representative, within 15 business days after receipt of such proof of loss, or requested information. Such notification shall include the reasons additional time is needed for investigation. If the claim remains unsettled, unless the matter is in litigation or arbitration, the insurer shall, 90 days from the date of the initial letter setting forth the need for further time to investigate, and every 90 days thereafter, send to the claimant, or the claimant’s authorized representative, a letter setting forth the reasons additional time is needed for investigation. If the claim is accepted, in whole or in part, the claimant, or the claimant’s authorized representative, shall be advised in writing of the amount offered. In any case where the claim is rejected, the insurer shall notify the claimant, or the claimant’s authorized representative, in writing, of any applicable policy provision limiting the claimant’s right to sue the insurer.

(3)

(i) Notwithstanding paragraph (2) of this subdivision, the provisions of this paragraph shall apply to any claim filed on or after May 30, 2020 for loss of or damage to real property, loss of or damage to personal property, or other liabilities for loss of, damage to, or injury to persons or property resulting from a riot or civil commotion in this State, where the superintendent has determined that it is in the best interests of the people of this State for such provisions to apply.

(ii) If the insurer needs more time to determine whether the claim should be accepted or rejected, it shall so notify the claimant, or the claimant’s authorized representative, in writing, within 15 business days after receipt of such proof of loss or requested information or June 5, 2020, whichever is later. Such notification shall include the reasons additional time is needed for investigation and the anticipated date a determination on the claim will be provided, including, where the insurer requires a physical inspection, the reason for that inspection. If the claim remains unsettled, unless the matter is in litigation or arbitration, the insurer shall, 30 days from the date of the initial letter setting forth the need for further time to investigate, and every 30 days thereafter, send to the claimant, or the claimant’s authorized representative, a letter setting forth the reasons additional time is needed for investigation and the anticipated date a determination on the claim will be provided. If the claim is accepted, in whole or in part, the claimant, or the claimant’s authorized representative, shall be advised in writing of the amount offered. If the insurer rejects a claim, the insurer shall notify promptly the claimant, or the claimant’s authorized representative, in writing, of any applicable policy provision limiting the claimant’s right to sue the insurer.

(iii) If an insurer has any claim subject to this paragraph under which the claimant, or the claimant’s authorized representative, has not been advised in writing of the insurer’s acceptance or rejection of the claim within the time frames specified in paragraph (1) of this subdivision, the insurer shall submit a report to the superintendent in a form acceptable to the superintendent. The insurer shall submit the report each week that the insurer has any such claims. The insurer shall submit the report on the Tuesday of the week, except if that day is a holiday, then the report shall be submitted on the next business day. For each such claim, the report shall specify:

(a) the alleged date the loss occurred;

(b) the date the claim was filed with the insurer;

(c) the date a properly executed proof of loss and receipt of all items, statements and forms required by the insurer were received by the insurer;

(d) the alleged estimated amount of the loss;

(e) the reason given for the extension;

(f) the anticipated date a determination will be made on the claim provided to the claimant;

(g) how many extensions have been requested on that claim; and

(h) the zip code where the loss occurred.

(d) The company shall inform the claimant in writing as soon as it is determined that there was no policy in force or that it is disclaiming liability because of a breach of policy provisions by the policyholder. The insurer must also explain its specific reasons for disclaiming coverage.

(e) In any case where there is no dispute as to one or more elements of a claim, payment for such element(s) shall be made notwithstanding the existence of disputes as to other elements of the claim where such payment can be made without prejudice to either party.

(f) Every insurer shall pay any amount finally agreed upon in settlement of all or part of any claim not later than five business days from the receipt of such agreement by the insurer, or from the date of the performance by the claimant of any condition set by such agreement, whichever is later, except as provided in section 331 of the Insurance Law as respects liens by tax districts on fire insurance proceeds.

(g) Checks or drafts in payment of claims; releases.
No insurer shall issue a check or draft in payment of a first-party claim or any element thereof, arising under any policy subject to this Part, that contains any language or provision that expressly or impliedly states that acceptance of such check or draft shall constitute a final settlement or release of any or all future obligations arising out of the loss. No insurer shall require execution of a release on a first- or third-party claim that is broader than the scope of the settlement.

(h) Any notice rejecting any element of a claim involving personal property insurance shall contain the identity and the claims processing address of the insurer, the insured’s policy number, the claim number, and the following statement prominently set forth:
“Should you wish to take this matter up with the New York State Department of Financial Services, you may file a complaint with the department either on its website at http://www.dfs.ny.gov/consumer/fileacomplaint.htm or by writing to the Consumer Assistance Unit, New York State Department of Financial Services, at: One State Street, New York, NY 10004; One Commerce Plaza, Albany, NY 12257; 1399 Franklin Avenue, Garden City, NY 11530; or 535 Washington Street, Suite 305, Buffalo, NY 14203.”

New York Rules and Regs. Title 11 §216.6

(a) Except as provided in section one thousand one hundred eight of this chapter, no individual or entity subject to the supervision of the superintendent shall because of race, color, creed, national origin, or disability:
(1) Make any distinction or discrimination between persons as to the premiums or rates charged for insurance policies or in any other manner whatever.

(2) Demand or require a greater premium from any persons than it requires at that time from others in similar cases.

(3) Make or require any rebate, discrimination or discount upon the amount to be paid or the service to be rendered on any policy.

(4) Insert in the policy any condition, or make any stipulation, whereby the insured binds themselves, or their heirs, executors, administrators or assigns, to accept any sum or service less than the full value or amount of such policy in case of a claim thereon except such conditions and stipulations as are imposed upon others in similar cases; and any such stipulation or condition so made or inserted shall be void.

(b) Except as provided in section one thousand one hundred eight of this chapter, no individual or entity subject to the superintendent’s supervision shall solely because of the applicant’s race, color, creed, national origin, or disability:

(1) Reject any application for a policy of insurance issued and/or sold by it.

(2) Refuse to issue, renew or sell such policy after appropriate application therefor.

(3) Fix any lower rate or discriminate in the fees or commissions of agents or brokers for writing or renewing such a policy.

(c) For the purposes of this section “disability” shall have the same meaning as ascribed thereto in subdivision twenty-one of section two hundred ninety-two of the executive law.

(d) The prohibition of subsection (a) of this section shall not preclude an insurer from including a pre-existing condition provision as permitted pursuant to regulations of the superintendent or from establishing selection criteria on the basis of disability where the insurer can prove that its decision was based on sound underwriting and actuarial principles reasonably related to actual or anticipated loss experience. In such case the selection criteria permitted must be based on such principles. The insurer shall notify the insured of its specific reason or reasons for such decision.

(e) If it can be proven that the provisions of subsection (d) of this section are inadequate to address such actual or anticipated loss experience, the prohibition of subsection (b) of this section shall not preclude an insurer from establishing selection criteria on the basis of disability. In such case the selection criteria permitted must be based on such principles. The insurer shall notify the insured of its specific reason or reasons for such decision.

(f) Nothing in this section shall permit an insurer to include a pre-existing condition provision or establish selection criteria for individual and small group health insurance policies which are inconsistent with sections three thousand two hundred thirty-one, three thousand two hundred thirty-two, four thousand three hundred seventeen and four thousand three hundred eighteen of this chapter.

New York Statute Ch. 28 § 2606

(a) No individual or entity shall refuse to issue any policy of insurance, or cancel or decline to renew the policy because of the sex or marital status of the applicant or policyholder or engage in sexual stereotyping.

(b) For the purposes of this section, “sex” shall include sexual orientation, gender identity or expression, and transgender status.

New York Statute Ch. 28 § 2607

(a) No individual or entity shall refuse to issue or renew, or shall cancel any policy of insurance because of any past treatment for a mental disability of the insured.

(b) The prohibition of subsection (a) hereof shall not preclude an insurer from refusing to issue or renew or from cancelling a policy based on sound underwriting and actuarial principles reasonably related to actual or anticipated loss experience. The insurer shall notify the insured or his physician of its specific reason or reasons for refusal to issue or renew or for cancelling such policy.

(c) In this section, mental disability has the meaning defined in subdivision three of section 1.03 of the mental hygiene law.

New York Statute Ch. 28 § 2608

(a) Definitions. In this section “insurance policy” means any:

….

(3) contract of insurance for owners of dwellings consisting of not more than four dwelling units, and for household furnishings and personal property contained in any household unit, written for a divisible or indivisible premium which provides coverage for the peril of fire and extended coverage with or without any other kind of insurance as provided pursuant to subsection (a) of section one thousand one hundred thirteen of this chapter;

….

(b) Exclusions.

(1) This section shall not apply to:

(A) any insurance policy which has been determined to be a security subject to federal jurisdiction;

(2) No other statute of this state or provision of this chapter establishing language simplification standards shall apply to any insurance policy.

(3) Any non-English language insurance policy made, issued or delivered in this state on a risk located or resident in this state shall be deemed to be in compliance with subparagraph (D) of paragraph one of subsection (c) of this section if the insurer certifies that such insurance policy is translated from an English language insurance policy which does comply with such subparagraph.

(c) Readability requirements.

(1) In addition to any other requirements of law, no insurance policy, except as set forth in subsection (b) of this section, shall be made, issued or delivered in this state on a risk located or resident in this state, unless:

(A) it is written in a clear and coherent manner;

(B) wherever practicable, it uses words with common and everyday meanings to facilitate readability and to aid the insured or policyholder in understanding the coverage provided;

(C) it has been filed with and approved by the superintendent;

(D) the text achieves a minimum score of forty-five on the Flesch reading ease test or an equivalent score on any other comparable test as provided in paragraph three of this subsection;

(E) it is printed, except for specification pages, schedules and tables, in not less than ten point type, and except for applications, specification pages, schedules and tables, such type is at least one point leaded;

(F) it is appropriately divided and captioned and presented in meaningful sequence; each section to contain an underlined, boldface or otherwise conspicuous title or caption at the beginning that indicates the nature of the subject matter included in or covered by the section;

(G) it contains a table of contents or an index of the principal sections of the insurance policy if the insurance policy has more than three thousand words or if the insurance policy has more than three pages regardless of the number of words;

(H) it has margins that are adequate for the purposes of readability; and

(I) it is printed in such manner that it includes sufficient contrast of ink and paper to be legible.

……

(f) Prohibition of non-conforming policies. Except as provided in subsection (b) of this section:

(1) no insurance policy described in paragraph one or two of subsection (a) of this section shall be made, issued or delivered in this state on a risk located or resident in this state, unless the policy complies with the requirements of this section;

(2) no insurance policy described in paragraph three or four of subsection (a) of this section and no renewal or extension certificate in connection therewith shall be made, issued or delivered in this state unless the insurance policy complies with the requirements of this section.

New York Statute Ch. 28 § 3102

(a) Except as otherwise specifically provided in this chapter, any policy of insurance or contract of annuity delivered or issued for delivery in this state in violation of any of the provisions of this chapter shall be valid and binding upon the insurer issuing the same, but in all respects in which its provisions are in violation of the requirements or prohibitions of this chapter it shall be enforceable as if it conformed with such requirements or prohibitions.

(b) No policy of insurance or contract of annuity delivered or issued for delivery in this state shall provide that the rights or obligations of the insured or of any person rightfully claiming thereunder, with respect to:

…

(2) a policy of insurance upon property then in this state, or

…

(c) In any action to recover under the provisions of any policy of insurance or contract of annuity delivered or issued for delivery in this state which the superintendent is authorized by this chapter to approve if in his opinion its provisions are more favorable to policyholders, the court shall enforce such policy or contract as if its provisions were the same as those specified in this chapter unless the court finds that its actual provisions were more favorable to policyholders at the date when the policy or contract was issued.

New York Statute Ch. 28 § 3103

(a) A representation is a statement as to past or present fact, made to the insurer by, or by the authority of, the applicant for insurance or the prospective insured, at or before the making of the insurance contract as an inducement to the making thereof. A misrepresentation is a false representation, and the facts misrepresented are those facts which make the representation false.

(b)

(1) No misrepresentation shall avoid any contract of insurance or defeat recovery thereunder unless such misrepresentation was material. No misrepresentation shall be deemed material unless knowledge by the insurer of the facts misrepresented would have led to a refusal by the insurer to make such contract.

(2) With respect to a policy of hospital, medical, surgical, or prescription drug expense insurance subject to articles thirty-two or forty-three of this chapter, no misrepresentation shall avoid any contract of insurance or defeat recovery thereunder unless the misrepresentation was also intentional.

(c) In determining the question of materiality, evidence of the practice of the insurer which made such contract with respect to the acceptance or rejection of similar risks shall be admissible.

(d) A misrepresentation that an applicant for life or accident and health insurance has not had previous medical treatment, consultation or observation, or has not had previous treatment or care in a hospital or other like institution, shall be deemed, for the purpose of determining its materiality, a misrepresentation that the applicant has not had the disease, ailment or other medical impairment for which such treatment or care was given or which was discovered by any licensed medical practitioner as a result of such consultation or observation. If in any action to rescind any such contract or to recover thereon, any such misrepresentation is proved by the insurer, and the insured or any other person having or claiming a right under such contract shall prevent full disclosure and proof of the nature of such medical impairment, such misrepresentation shall be presumed to have been material.

New York Statute Ch. 28 § 3105

(a) In this section “warranty” means any provision of an insurance contract which has the effect of requiring, as a condition precedent of the taking effect of such contract or as a condition precedent of the insurer’s liability thereunder, the existence of a fact which tends to diminish, or the non-existence of a fact which tends to increase, the risk of the occurrence of any loss, damage, or injury within the coverage of the contract. The term “occurrence of loss, damage, or injury” includes the occurrence of death, disability, injury, or any other contingency insured against, and the term “risk” includes both physical and moral hazards.

(b) A breach of warranty shall not avoid an insurance contract or defeat recovery thereunder unless such breach materially increases the risk of loss, damage or injury within the coverage of the contract. If the insurance contract specified two or more distinct kinds of loss, damage or injury which are within its coverage, a breach of warranty shall not avoid such contract or defeat recovery thereunder with respect to any kind or kinds of loss, damage or injury other than the kind or kinds to which such warranty relates and the risk of which is materially increased by the breach of such warranty.

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New York Statute Ch. 28 § 3106

(a) The printed form of a policy of fire insurance, as set forth in subsection (e) hereof, shall be known and designated as the “standard fire insurance policy of the state of New York.”

(b)

(1) No policy or contract of fire insurance shall be made, issued or delivered by any insurer or by any agent or representative thereof, on any property in this state, unless it shall conform as to all provisions, stipulations, agreements and conditions with such form of policy, except policies subject to the provisions of section three thousand one hundred two of this chapter which shall be required to comply with the provisions of paragraph one of subsection (f) of this section.

(2) There shall be printed or typewritten at the head of such policy the name and home office address of the insurer or insurers issuing the policy and a statement whether such insurer or insurers are stock or mutual corporations or are reciprocal insurers or Lloyds underwriters. In lieu of such statement a corporation organized under a special act of the legislature of any state may so indicate upon its policy. The head of the policy may also have such devices as the insurer or insurers issuing it desire.

(3) The standard fire insurance policy need not be used for effecting reinsurance between insurers.

(4) If the policy is issued by a mutual, cooperative or reciprocal insurer having special regulations with respect to the payment by the policyholder of assessments, such regulations shall be printed upon the policy, and any such insurer may print upon the policy such regulations as may be appropriate to or required by its form of organization.

(c) Two or more insurers authorized to do the business of fire insurance in this state may, with the approval of the superintendent, issue a combination standard form of fire insurance policy which shall contain the following provisions:

(1) A provision substantially to the effect that the insurers executing such policy shall be severally liable for the full amount of any loss or damage, according to the terms of the policy, or for specified percentages or amounts thereof, aggregating the full amount of such insurance under such policy.

(2) A provision substantially to the effect that service of process, or of any notice or proof of loss required by such policy, upon any of the insurers executing such policy, shall be deemed to be service upon all such insurers.

(d)

(1) Appropriate forms of a supplemental contract or contracts or extended coverage endorsements insuring against one or more of the perils which the insurer is empowered to insure, in addition to the perils covered by such standard fire insurance policy, may be approved by the superintendent, who may authorize their use in connection with a standard fire insurance policy.

(2) The first page of the policy, in a form approved by the superintendent, may be rearranged to provide space for the listing of amounts of insurance, rates and premiums for the basic coverages insured under the standard form of policy and for additional coverages or perils insured under attached endorsements, and such other data as may be conveniently included for duplication on daily reports for office records.

(e) The form of the standard fire insurance policy of the state of New York (with permission to substitute for the word “company” a more accurate descriptive term for the type of insurer) shall be as follows:
FIRST PAGE OF STANDARD FIRE POLICY
No.
[Space for insertion of name of company or companies issuing the policy and other matter permitted to be stated at the head of the policy.]
[Space for listing amounts of insurance, rates and premiums for the basic coverages insured under the standard form of policy and for additional coverages or perils insured under endorsements attached.]

In Consideration of the Provisions and Stipulations herein or added hereto and of Dollars Premium this Company, for the term of , from the day of , 19 to the day of , 19 at noon, Standard Time, at location of property involved, does insure and legal representatives, TO THE LESSER AMOUNT OF EITHER:
1) THE ACTUAL CASH VALUE OF THE PROPERTY AT THE TIME OF THE LOSS, OR
2) THE AMOUNT WHICH IT WOULD COST TO REPAIR OR REPLACE THE PROPERTY WITH MATERIAL OF LIKE KIND AND QUALITY WITHIN A REASONABLE TIME AFTER SUCH LOSS, WITHOUT ALLOWANCE FOR ANY INCREASED COST OF REPAIR OR RECONSTRUCTION BY REASON OF ANY ORDINANCE OR LAW REGULATING CONSTRUCTION OR REPAIR, AND WITHOUT COMPENSATION FOR LOSS RESULTING FROM INTERRUPTION OF BUSINESS OR MANUFACTURE, OR
3) TO AN AMOUNT NOT EXCEEDING DOLLARS, BUT IN ANY EVENT FOR NO MORE THAN THE INTEREST OF THE INSURED, AGAINST ALL DIRECT LOSS BY FIRE, LIGHTNING AND BY REMOVAL FROM PREMISES ENDANGERED BY THE PERILS INSURED AGAINST IN THIS POLICY, EXCEPT AS HEREINAFTER PROVIDED, to the property described hereinafter while located or contained as described in this policy, or pro rata for five days at each proper place to which any of the property shall necessarily be removed for preservation from the perils insured against in this policy, but not elsewhere.

Assignment of this policy shall not be valid except with the written consent of this Company.

This policy is made and accepted subject to the foregoing provisions and stipulations and those hereinafter stated, which are hereby made a part of this policy, together with such other provisions, stipulations and agreements as may be added hereto, as provided in this policy.
In Witness Whereof, this Company has executed and attested these presents; but this policy shall not be valid unless countersigned by the duly authorized Agent of this Company at
Secretary. President.
Countersigned this day of , 19
Agent.

SECOND PAGE OF STANDARD FIRE POLICY

Concealment, fraud. This entire policy shall be void if, whether before or after a loss, the insured has wilfully concealed or misrepresented any material fact or circumstance concerning this insurance or the subject thereof, or the interest of the insured therein, or in case of any fraud or false swearing by the insured relating thereto.

Uninsurable and excepted property. This policy shall not cover accounts, bills, currency, deeds, evidences of debt, money or securities; nor, unless specifically named hereon in writing, bullion or manuscripts.

Perils not included. This Company shall not be liable for loss by fire or other perils insured against in this policy caused, directly or indirectly, by:

(a) enemy attack by armed forces, including action taken by military, naval or air forces in resisting an actual or an immediately impending enemy attack;

(b) invasion;

(c) insurrection;

(d) rebellion; (e) revolution;

(f) civil war;

(g) usurped power;

(h) order of any civil authority except acts of destruction at the time of and for the purpose of preventing the spread of fire, provided that such fire did not originate from any of the perils excluded by this policy;

(i) neglect of the insured to use all reasonable means to save and preserve the property at and after a loss, or when the property is endangered by fire in neighboring premises;

(j) nor shall this Company be liable for loss by theft.

Other Insurance. Other insurance may be prohibited or the amount of insurance may be limited by endorsement attached hereto. Conditions suspending or restricting insurance. Unless otherwise provided in writing added hereto this Company shall not be liable for loss occurring

(a) while the hazard is increased by any means within the control or knowledge of the insured; or
(b) while a described building, whether intended for occupancy by owner or tenant, is vacant or unoccupied beyond a period of sixty consecutive days; or
(c) as a result of explosion or riot, unless fire ensue, and in that event for loss by fire only.
Other perils or subjects. Any other peril to be insured against or subject of insurance to be covered in this policy shall be by endorsement in writing hereon or added hereto.

Added provisions. The extent of the application of insurance under this policy and of the contribution to be made by this Company in case of loss, and any other provision or agreement not inconsistent with the provisions of this policy, may be provided for in writing added hereto, but no provision may be waived except such as by the terms of this policy is subject to change.

Waiver provisions. No permission affecting this insurance shall exist, or waiver of any provision be valid, unless granted herein or expressed in writing added hereto. No provision, stipulation or forfeiture shall be held to be waived by any requirement or proceeding on the part of this Company relating to appraisal or to any examination provided for herein.

Cancellation of policy. This policy shall be cancelled at any time at the request of the insured, in which case this Company shall, upon demand and surrender of this policy, refund the excess of paid premium above the customary short rates for the expired time. This policy may be cancelled at any time by this Company by giving to the insured a five days’ written notice of cancellation with or without tender of the excess of paid premium above the pro rata premium for the expired time, which excess, if not tendered, shall be refunded on demand. Notice of cancellation shall state that said excess premium (if not tendered) will be refunded on demand.

Mortgagee interests and obligations. If loss hereunder is made payable, in whole or in part, to a designated mortgagee not named herein as the insured, such interest in this policy may be cancelled by giving to such mortgagee a ten days’ written notice of cancellation.

If the insured fails to render proof of loss such mortgagee, upon notice, shall render proof of loss in the form herein specified within sixty (60) days thereafter and shall be subject to the provisions hereof relating to appraisal and time of payment and of bringing suit. If this Company shall claim that no liability existed as to the mortgagor or owner, it shall, to the extent of payment of loss to the mortgagee, be subrogated to all the mortgagee’s rights of recovery, but without impairing mortgagee’s right to sue; or it may pay off the mortgage debt and require an assignment thereof and of the mortgage. Other provisions relating to the interests and obligations of such mortgagee may be added hereto by agreement in writing.

Pro rata liability. This Company shall not be liable for a greater proportion of any loss than the amount hereby insured shall bear to the whole insurance covering the property against the peril involved, whether collectible or not.

Requirements in case loss occurs. The insured shall give immediate written notice to this Company of any loss, protect the property from further damage, forthwith separate the damaged and undamaged personal property, put it in the best possible order, furnish a complete inventory of the destroyed, damaged and undamaged property, showing in detail quantities, costs, actual cash value and amount of loss claimed; and within sixty days after the loss, unless such time is extended in writing by this Company, the insured shall render to this Company a proof of loss, signed and sworn to by the insured, stating the knowledge and belief of the insured as to the following: the time and origin of the loss, the interest of the insured and of all others in the property, the actual cash value of each item thereof and the amount of loss thereto, all encumbrances thereon, all other contracts of insurance, whether valid or not, covering any of said property, any changes in the title, use, occupation, location, possession or exposures of said property since the issuing of this policy, by whom and for what purpose any building herein described and the several parts thereof were occupied at the time of loss and whether or not it then stood on leased ground, and shall furnish a copy of all the descriptions and schedules in all policies and, if required, verified plans and specifications of any building, fixtures or machinery destroyed or damaged. The insured, as often as may be reasonably required, shall exhibit to any person designated by this Company all that remains of any property herein described, and submit to examinations under oath by any person named by this Company, and subscribe the same; and, as often as may be reasonably required, shall produce for examination all books of account, bills, invoices and other vouchers, or certified copies thereof if originals be lost, at such reasonable time and place as may be designated by this Company or its representative, and shall permit extracts and copies thereof to be made.

Appraisal. In case the insured and this Company shall fail to agree as to the actual cash value or the amount of loss, then, on the written demand of either, each shall select a competent and disinterested appraiser and notify the other of the appraiser selected within twenty days of such demand. The appraisers shall first select a competent and disinterested umpire; and failing for fifteen days to agree upon such umpire, then, on request of the insured or this Company, such umpire shall be selected by a judge of a court of record in the state in which the property covered is located. The appraisers shall then appraise the loss, stating separately actual cash value and loss to each item; and, failing to agree, shall submit their differences, only, to the umpire. An award in writing, so itemized, of any two when filed with this Company shall determine the amount of actual cash value and loss. Each appraiser shall be paid by the party selecting him and the expenses of appraisal and umpire shall be paid by the parties equally.

Company’s options. It shall be optional with this Company to take all, or any part, of the property at the agreed or appraised value, and also to repair, rebuild or replace the property destroyed or damaged with other of like kind and quality within a reasonable time, on giving notice of its intention so to do within thirty days after the receipt of the proof of loss herein required.

Abandonment. There can be no abandonment to this Company of any property.

When loss payable. The amount of loss for which this Company may be liable shall be payable sixty days after proof of loss, as herein provided, is received by this Company and ascertainment of the loss is made either by agreement between the insured and this Company expressed in writing or by the filing with this Company of an award as herein provided.

Suit. No suit or action on this policy for the recovery of any claim shall be sustainable in any court of law or equity unless all the requirements of this policy shall have been complied with, and unless commenced within twenty-four months next after inception of the loss.

Subrogation. This Company may require from the insured an assignment of all right of recovery against any party for loss to the extent that payment therefor is made by this Company.

THIRD PAGE OF STANDARD FIRE POLICY
ATTACH FORM BELOW THIS LINE
BACK OF STANDARD FIRE POLICY
(OPTIONAL)
Standard Fire Insurance Policy of the States of
Expires
Property
Assured
No.
(COMPANY)
It is important that the written portions of all policies covering the same property read exactly alike. If they do not, they should be made uniform at once.

(f)

(1) Subject to the approval of the superintendent, a policy which insures solely against the peril of fire or which insures against the peril of fire in combination with other kinds of insurance either for a divisible or indivisible premium need not comply with the provisions of subsection (e) of this section, provided:

(A) the policy contains, with respect to the peril of fire, terms and provisions no less favorable to the insured than those contained in the standard fire policy;

(B) the provisions in relation to mortgagee interests and obligations in such standard fire policy are incorporated without substantive change; and

(C) the policy or contract is complete as to all of its terms without reference to the standard form fire insurance policy or any other policy.

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(g) Notwithstanding any other provision of law to the contrary, the provisions of the appraisal clause set out on the second page of the standard fire policy and the provisions of section three thousand four hundred eight of this article, including determinations as to the amount of loss or damage rendered thereunder, shall be binding on all parties to the contract of insurance evidenced by the policy and may be enforced by either the insurer or the insured by application made pursuant to subsection (c) of section three thousand four hundred eight of this article.

(h) As used in this section, “binder” means a written document (1) which includes the name and address of the insured and any additional named insureds, mortgagees, or lienholders; a description of the property insured; a description of the nature and amount of coverage which shall be deemed to include the terms of the standard fire insurance policy except as conspicuously noted on the binder; the identity of the insurer and of the authorized representative executing the binder; the effective date of coverage; the binder number or the policy number where applicable to a policy extension, and (2) which temporarily obligates the insurer to provide that insurance coverage pending issuance of the insurance policy. The cancellation of such a binder shall be governed at the minimum by the provisions of the standard fire insurance policy and the provisions of this chapter applicable thereto. No exempt organization, as defined in section five hundred ninety of the banking law, or licensed mortgage banker which originates mortgage loans shall, at the time of title closing for a loan secured by a one to four family residential real property, refuse to accept a binder, issued by an insurer, or a duly authorized representative of an insurer, licensed to do business in this state, as evidence that hazard insurance has been procured for the mortgaged premises. Nothing herein is intended to prohibit the mortgage banker or exempt organization from requiring the borrower to also furnish a receipt indicating that the annual or installment premium on such insurance policy has been paid.

New York Statute Ch. 28 § 3404

(a) Insurers issuing the standard fire insurance policy pursuant to section three thousand four hundred four of this article are authorized to affix or include in the policy a written statement that such policy does not cover loss or damage caused by nuclear reaction or nuclear radiation or radioactive contamination, all whether directly or indirectly resulting from an insured peril under such policy.
(b) This section shall not prohibit the attachment to any such policy of an endorsement specifically assuming coverage for loss or damage caused by nuclear reaction or nuclear radiation or radioactive contamination.

New York Statute Ch. 28 § 3405

(a) If any policy or contract of insurance against loss or damage to property located in this state contains any provision requiring the insured to permit any examination by the insurer of the insured, or of a member of his family, or of any employee of the insured, and if any such examination takes place and is reduced to writing, whether or not signed by the insured or by such person so examined, such insurer shall, within ten days from the time when the insured shall have requested the same in writing, deliver to the insured a copy of such examination so reduced to writing.

(b) If such copy is not delivered to the insured as required, no part of the examination shall be used by the insurer as a part of the proof of loss or damage or as evidence in any action or proceeding based upon or involving such policy or contract.

New York Statute Ch. 28 § 3406

(a) The failure of any person insured against loss or damage to property under any contract of insurance, issued or delivered in this state or covering property located in this state, to furnish proofs of loss to the insurer or insurers as specified in such contract shall not invalidate or diminish any claim of such person insured under such contract, unless such insurer or insurers shall, after such loss or damage, give to such insured a written notice that it or they desire proofs of loss to be furnished by such insured to such insurer or insurers on a suitable blank form or forms. If the insured shall furnish proofs of loss within sixty days after the receipt of such notice and such form or forms, or within any longer period of time specified in such notice, such insured shall be deemed to have complied with the provisions of such contract of insurance relating to the time within which proofs of loss are required. Neither the giving of such notice nor the furnishing of such blank form or forms by the insurer shall constitute a waiver of any stipulation or condition of such contract, or an admission of liability thereunder.

(b) If any contract of insurance issued or delivered in this state, covering loss of or damage to property by fire provides that the insured give immediate notice, in writing, to the insurer, of any loss or damage, it shall be sufficient compliance if immediate written notice is given, by or on behalf of the insured, to any licensed agent of the insurer in this state, with particulars sufficient to identify the insured and the property insured under such contract and to notify the insurer of the time and place of such loss or damage.

New York Statute Ch. 28 § 3407

No property/casualty insurance policy or contract shall be issued or issued for delivery on a risk located or resident in this state insuring against damage to the insured’s real property unless it contains in substance the following provision or a provision which is equal or more favorable to the insured: a provision that in the event of a pending claim for damage to real property, upon request, the insurer shall furnish to the insured’s representative, designated in writing, or if none has been designated, to the insured, a copy of any written estimate or estimates of the cost of damages to real property resulting from the loss which the insurer has independently prepared for its own purposes, or had prepared on its behalf for its own purposes, specifying all appropriate deductions, within thirty days after the request or preparation, whichever is later, of such estimate or estimates. An insurer shall not be required to provide an estimate on claims for damages to real property unless it has independently prepared one or had one prepared on its behalf for the insurer’s own purposes.

New York Statute Ch. 28 § 3407a

(a) Whenever application shall be made for the selection of an umpire pursuant to the provisions relating to appraisals contained in the standard fire insurance policy of the state of New York it shall be made to a justice of the supreme court residing in the county or to a county judge of the county in which the lost or damaged property is or was located. The application shall be on five days’ notice in writing to the other party. Any such notice in writing, when served by the insured, may be served upon any local agent of the insurer.

(b) The court shall, on proof by affidavit of the failure or neglect of the appraisers to agree upon and select an umpire within the time provided in such policy, and of the service of notice pursuant to subsection (a) hereof, forthwith appoint a competent and disinterested person to act as such umpire in the ascertainment of the amount of such loss or damage.

(c) In the event of a covered loss, whenever an insured or insurer fails to proceed with an appraisal upon demand of the other, either party may apply to the court in the manner provided in subsection (a) of this section for an order directing the other to comply with such demand. An appraisal shall determine the actual cash value, the replacement cost, the extent of the loss or damage and the amount of the loss or damage which shall be determined as specified in the policy and shall proceed pursuant to the terms of the applicable appraisal clause of the insurance policy and not as an arbitration. Notwithstanding the provisions of this subsection, an appraisal shall not determine whether the policy actually provides coverage for any portion of the claimed loss or damage.

New York Statute Ch. 28 § 3408

(a) Every fire insurance policy insuring the interest of an owner pursuant to this article shall include a statement that, prior to the payment of any proceeds thereunder otherwise payable to the insured for damages resulting to the premises from a loss occasioned by fire, the insurer will deduct and pay the claim of any tax district which renders a certificate of lien pursuant to the provisions of section three hundred thirty-one of this chapter.

(b) Such statement shall further relate that upon the payment of such claim the insurer shall, to the extent of such payment, be released from any obligation to pay the same to the insured and that the payment of any such claim within thirty days of receipt by the insurer of the certificate of lien shall, as between the insured and the insurer, operate as a conclusive presumption that such claim was valid and properly paid.

New York Statute Ch. 28 § 3410

1. Insurers shall provide to their homeowners and dwelling fire personal lines insureds an annual notice prescribed or approved by the superintendent, explaining clearly and in plain language that: (a) such policies do not provide coverage for loss caused by mudslide or flood; and (b) insurance is available under separate policies issued in accordance with the National Flood Insurance Program, 42 U.S.C. § 4001 et seq., including information regarding flood insurance eligibility and access.

2. The policyholder notice required by this section shall accompany all new homeowners and dwelling fire personal lines policies and all renewal homeowners and dwelling fire policies.

New York Statute Ch. 28 § 3444

The superintendent shall by regulation establish disclosure requirements with respect to the operation of any deductible in a homeowner’s insurance policy or dwelling fire personal lines policy which applies as the result of a windstorm. Such regulations shall prescribe the form of a notice to be provided by an insurer to an insured. The notice shall explain in clear and plain language the amount of the deductible, the circumstances under which the deductible applies and any other matters which the superintendent, in his or her discretion, shall deem necessary or appropriate.

New York Statute Ch. 28 § 3445