What Is 11 NYCRR Part 216 (Regulation 64) and How Does It Protect New York Policyholders?

Part 216 is organized as a series of claim-handling standards. Section 216.4 covers acknowledging your claim and replying to your communications. Section 216.5 covers starting the investigation and telling you which forms and statements the insurer will need. Section 216.6 is the core settlement section: it defines actual cash value, sets the 15-business-day decision window after a properly executed proof of loss, requires 90-day status letters when a claim stays open, and requires payment within 5 business days of an agreed settlement.

Section 216.3 makes it an unfair practice to misrepresent policy terms, to deny an element of a claim without putting the policy provision in writing, or to make an unexplained offer that leaves out amounts that should have been included. Section 216.11 requires the insurer to keep every communication, note, and work paper in the claim file so DFS examiners can reconstruct what happened.

Part 216 does not decide whether your loss is covered — your policy language does that. What it does is give you a timeline you can hold the carrier to, and a paper trail requirement. If an adjuster verbally tells you something is not covered, Part 216 says the denial has to be in writing with the provision identified. If your offer is lower than the damage you documented and no one explains why items were left out, Part 216 treats that unexplained shortfall as a misrepresentation of your policy.

In practice, the most useful move for a policyholder is to put every request in writing, keep dates, and ask the carrier to identify in writing the specific policy provision behind any reduction or denial. That single request often changes the tone of a claim.