N.Y. Comp. Codes R. & Regs. Tit. 11 §§ 65-4.3

Current through Register Vol. 46, No. 50, December 11, 2024

Section 65-4.3 - Jurisdiction of arbitration forums

(a) Insurance Department Arbitration (IDA) forum. IDA jurisdiction shall be limited to requests for no-fault arbitration filed prior to December 1, 1999 and shall include only those disputes where the remaining issues after expiration of the conciliation period involve:

(1) correct computation of health service provider fees, whether or not such fees are specifically covered by the fee schedules promulgated in Part 68 of this Title (Regulation 83);

(2) where the amount in dispute is less than $400 and such dispute does not involve a coverage question or affect the outcome of any other portion of the applicant's claim; or

(3) whether the claim was overdue at the time it was paid, how long the claim was overdue, or whether the correct amount of interest or attorney's fee on an overdue claim was paid.

(b) No-fault arbitration forum. All disputes remaining after expiration of the conciliation period, involving issues other than those to be resolved pursuant to subdivision (a) of this section, shall be forwarded to the no-fault arbitration forum which shall be the forum for their resolution.

(c) Where a request for arbitration involves issues which fall within the jurisdiction of both of the forums specified in this section, the dispute shall be resolved by the no-fault arbitration forum, except disputes specified in paragraph (a)(1) of this section and filed prior to December 1, 1999 shall be resolved by IDA arbitration.

N.Y. Comp. Codes R. & Regs. Tit. 11 §§ 65-4.3