How Long Does a New York Insurer Have to Accept or Deny a Claim After Proof of Loss?
Under 11 NYCRR § 216.6, a New York insurer must advise you in writing whether it accepts or rejects your claim within 15 business days after it receives a properly executed proof of loss and all items it requested — 30 business days when it suspects arson. If it needs more time, it must tell you in writing within that same 15 business days and explain why, then send a further explanation every 90 days while the claim stays open. Any amount finally agreed in settlement must be paid within 5 business days, and undisputed parts of a claim must be paid even while other parts are still in dispute.
Key Points
- 15 business days to accept or reject in writing after a properly executed proof of loss and all requested items.
- 30 business days instead of 15 when the insurer suspects arson.
- Written extension notice, with reasons, required inside the original 15 business days.
- A status letter every 90 days while the claim remains unsettled.
- Undisputed elements must be paid even if other elements are still disputed.
- Agreed settlements paid within 5 business days.
- Actual cash value means the lesser of the cost to repair to pre-loss condition or to replace with a substantially identical item, including sales tax.
- Payment checks cannot carry language making acceptance a release of future obligations, and releases cannot be broader than the settlement.
- A rejection notice on a personal property claim must include the DFS complaint information.
The clock starts at a complete submission
The 15-business-day decision window does not start when you report the loss. It starts when the insurer has a properly executed proof of loss plus the items, statements, and forms it requested. That is why the § 216.5 document list and a clean, complete proof of loss matter so much: an incomplete submission simply never starts the clock.
Section 216.6(a) also states the underlying duty — where coverage is not in dispute, the insurer must offer amounts that are fair and reasonable as shown by its own investigation, within policy limits.
Actual cash value, defined by regulation
Section 216.6(b) defines actual cash value, unless your policy or another law defines it differently, as the lesser of what you could reasonably be expected to spend to repair the property to its condition immediately before the loss, or to replace it with a substantially identical item. That figure has to include sales tax paid or payable on the repaired or replaced item.
This is the definition behind the depreciation holdback on a replacement cost policy. Understanding it is usually the difference between accepting an ACV check as final and recovering the withheld replacement cost after repairs.
Partial payments, checks, and releases
Where part of a claim is undisputed, § 216.6(e) requires payment of that part even while other elements remain disputed, as long as paying it does not prejudice either side. In practice, that means a carrier should not hold your entire dwelling payment hostage over a contents disagreement.
Section 216.6(g) bars an insurer from issuing a first-party claim check that states or implies that cashing it is a final settlement or release of future obligations, and bars releases broader than the settlement itself. Section 216.6(h) requires a rejection notice on personal property insurance to prominently include how to file a complaint with the New York State Department of Financial Services.
Official text and citation
This page is a plain-English summary written for policyholders. The controlling language is the official text of 11 NYCRR § 216.6, and your own policy governs your claim. Nothing here is legal advice.
Read 11 NYCRR § 216.6 (official text)Prompt, Fair & Equitable Settlements: Frequently Asked Questions
Common questions New York policyholders ask about this rule.