No-Fault Collections & Litigation

Before the dates run. After a denial, filing for arbitration or suing within 30 days keeps interest running; after that it pauses until you act (11 NYCRR 65-3.9(c)). That is an interest rule, not a filing deadline. An overdue bill with no answer can go to arbitration without a denial if you made a demonstrable attempt to get payment (65-4.2(b)(1)(v)). Older receivables are worth reviewing as a group to see which bills, dates and defenses are involved before choosing a route.

The amount payable on each valid bill, generally at the fee-schedule rate; interest at 2% per month on overdue benefits, figured pro rata on a 30-day month and subject to the pause after a denial; the $40 filing fee if you prevail in arbitration; and an attorney’s fee paid by the insurer within the regulation’s caps. Benefits are subject to the policy’s limits; other items, such as court costs in a lawsuit, depend on the forum.

In arbitration the rules set the steps: conciliation up to 60 days; the insurer’s 30 days, plus 30 on request, to respond; the hearing; an award within 30 days; then payment within 30 days unless the insurer appeals to a master arbitrator. File within 90 days of the denial or overdue date and you can ask for a hearing within 45 days of transmittal. Court actions follow the court’s schedule. We do not quote totals; calendars vary.

When a valid claim was overdue or denied, the insurer pays the provider’s attorney’s fee on top of the benefits and interest, within the regulation’s limits: generally 20% of the benefits plus interest, up to $1,360 per applicant per arbitration or court proceeding (11 NYCRR 65-4.6(d)). No insurer-paid fee is due if the claim was not overdue or denied when filed, and generally none if charges exceeded the fee schedule (65-4.6(a), (h)). That fee may not cover all legal costs; your own arrangement with counsel is agreed separately.

Be selective by evidence, not by size alone. Check whether proof of claim was timely or justified, whether verification was answered, whether the assignment is in order, what ground the denial states, what the medical records show, and whether the charges match the fee schedule. A claim that holds up on those points is worth filing; one with a defect you cannot cure may not be. Bills from the same accident can be grouped.

The arbitration forum consolidates disputes that arise out of the same accident and share common issues of fact, unless that is impracticable (11 NYCRR 65-4.5(c)). Insurer-paid attorney’s fees are calculated per applicant per proceeding (65-4.6(d)), so how claims are grouped affects the fee. Interest pauses on a denied bill if you wait more than 30 days to file, so holding denials back to build a larger batch can cost interest.

No. If you do not request arbitration or start a lawsuit within 30 days after receiving a denial, interest stops accumulating on the disputed amount until you do (11 NYCRR 65-3.9(c)). This is an interest rule, not a deadline to sue or arbitrate. Once a dispute is filed, interest continues unless the provider unreasonably delays the proceeding (65-3.9(d)). The rate is 2% per month, figured pro rata on a 30-day month; the regulation does not provide for compounding.

Hand over the complete file at the start: the rules generally require all supporting documents with an arbitration request; later the applicant may add bills for ongoing benefits, and other papers only if the arbitrator asks for or approves them (11 NYCRR 65-4.2(b)(3)). Keep answering any open verification. Tell us about any payment or offer you receive. Do not ask the patient for more than the authorized charges (Insurance Law 5108(c)).

The no-fault rules provide interest on overdue benefits and an insurer-paid attorney’s fee within set limits; the regulations discussed here do not describe penalties or punitive damages, and this page does not describe any separate bad-faith claim. If an insurer’s conduct seems to go beyond an ordinary payment dispute, tell us the facts and we will tell you whether any other remedy is worth considering.

Compare the offer with what the file can prove: the bill, interest, the filing-fee refund and the capped attorney’s fee, weighed against the strength of the insurer’s defense. Before the case goes to an arbitrator, the insurer may make a written offer; if you reject it, the arbitrator is not told about it (11 NYCRR 65-4.2(b)(4)). An insurer may not require you to waive interest as a condition of settlement (65-3.9(b)).