New York No-Fault Claim Forms (NF-1A – NF-13, AOB)
Every prescribed no-fault form published by the New York State Department of Financial Services — downloadable in one place.
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All prescribed no-fault forms in one PDF · 449 KB
Key filing deadlines (Regulation 68)
- NF-2
- Written notice of claim / application due within 30 days of the accident.
- NF-3
- Provider proof of claim due within 45 days of the date of service.
- Verification
- Insurer generally must request verification within 15 business days of receiving the claim.
- NF-10
- Insurer must pay or deny within 30 days of receiving proof of claim.
Summary of 11 NYCRR Part 65. Late notice may be excused with a reasonable justification. Not legal advice.
Starting a claim
Cover letter — policies effective on or after September 1, 2001
Sent with the claim packet when the policy took effect on or after 9/1/2001.
Cover letter — policies effective prior to September 1, 2001
Sent with the claim packet when the policy took effect before 9/1/2001.
Application for Motor Vehicle No-Fault Benefits
The injured person's application for benefits — due to the insurer within 30 days of the accident.
Verification & proof of loss
Verification of Treatment by Attending Physician or Other Provider of Health Service
The provider's bill and proof of claim — due within 45 days of the date of service.
Verification of Hospital Treatment
Hospital verification of inpatient or outpatient treatment related to the accident.
Hospital Facility Form
The hospital's facility billing form, submitted with the UB-04 where applicable.
Employer's Wage Verification Report
Employer confirmation of earnings and lost time, used to calculate lost-wage benefits.
Verification of Self-Employment Income
Income verification for self-employed claimants seeking lost-earnings benefits.
Agreements & elections
Agreement to Pursue Social Security Disability Benefits
Claimant's agreement to apply for Social Security disability where benefits may offset.
Agreement to Pursue Workers' Compensation or N.Y.S. Disability Benefits
Used where workers' compensation or NYS disability benefits may be primary.
Additional PIP Subrogation Agreement
Subrogation agreement for additional personal injury protection coverage.
Lump-Sum Settlement Agreement
Agreement to resolve future no-fault benefits for a single lump sum.
Election of Option — Optional Basic Economic Loss Coverage
Policyholder's election of optional basic economic loss (OBEL) coverage.
No-Fault Assignment of Benefits Form
Assigns the claimant's no-fault benefits to the treating provider (accidents on/after 3/1/02).
Denials
Denial of Claim Form
The carrier's denial — the starting point for arbitration strategy and timeliness review.
Complete set
Complete Set of No-Fault Claim Forms
Every prescribed no-fault form published by DFS in a single PDF.
Frequently asked questions
Which form does an injured person file first?
The NF-2 Application for Motor Vehicle No-Fault Benefits, sent to the insurer within 30 days of the accident.
Which form does a medical provider bill on?
Providers usually bill on the NF-3 Verification of Treatment (or a CMS-1500), due within 45 days of the date of service.
What is an NF-10?
The NF-10 is the insurer's Denial of Claim form. It must state the specific reason for the denial, and it is the starting point for arbitration or litigation.
What is the NF-AOB used for?
The Assignment of Benefits lets the injured person assign their no-fault benefits to the treating provider, so the provider can bill and pursue payment directly.
Are these the current official versions?
They are the prescribed forms published by the NY Department of Financial Services, checked on the date shown below. Always confirm on the DFS site before filing.
Got an NF-10 denial? See how no-fault arbitration works or look up the carrier.
About these forms
These are the official prescribed forms published by the New York State Department of Financial Services, reproduced here unaltered for convenience. Last checked September 12, 2026. Always confirm you are using the current version before filing — view the DFS no-fault forms page. Nothing here is legal advice.
Looking for plain-English explainers? Browse the Resources hub.
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