How Quickly Must a New York Insurer Start Investigating a Property Claim?
Under 11 NYCRR § 216.5, a New York insurer must have procedures to begin investigating a claim within 15 business days of notice, and must send you a notification of all items, statements, and forms it reasonably believes it will require from you within 15 business days of receiving notice of the claim. A claim filed with the insurer's agent counts as filed with the insurer. If the insurer has a reasonable, documented basis to suspect the claimant fraudulently caused or contributed to the loss, the Part 216 requirements are suspended while it investigates that issue.
Key Points
- Investigation must begin within 15 business days of notice of the claim.
- Within the same 15 business days, the insurer must tell you every item, statement, and form it expects to need.
- That list is important: it starts the paper trail for what you actually have to produce.
- Filing with the insurer's agent counts as filing with the insurer, with narrow exceptions.
- Suspected claimant fraud suspends the Part 216 clocks while that issue is investigated, and triggers a separate report to DFS.
The requested-documents list is the leverage
The most practical part of § 216.5 is the requirement that the carrier tell you up front what it will need. Claims often drag because requests arrive in waves — first photos, then receipts, then a sworn statement, then a contractor's breakdown — each restarting the wait.
If you have the § 216.5 list in writing, you can produce everything at once and then point to the list when new demands appear late in the process. It also matters for the § 216.6 decision clock, which runs from receipt of a properly executed proof of loss and all requested items.
The fraud exception, in plain terms
Section 216.5(b) lets an insurer pause Part 216's requirements when there is a reasonable basis, supported by specific information a DFS examiner could review, that the claimant fraudulently caused or contributed to the loss. It is not a general excuse for slow handling — the basis has to be documented, and the insurer must file the report required for suspect losses.
If a claim goes quiet after an examination under oath or a special investigation unit contact, this is often what happened. That is a point at which professional representation matters most.
Official text and citation
This page is a plain-English summary written for policyholders. The controlling language is the official text of 11 NYCRR § 216.5, and your own policy governs your claim. Nothing here is legal advice.
Read 11 NYCRR § 216.5 (official text)Prompt Investigation of Claims: Frequently Asked Questions
Common questions New York policyholders ask about this rule.