5 Replies Latest reply: Mar 10, 2018 1:22 PM by Alison Berdnik

Additional PIP and NF11

Pamela Hirschhorn
Visibility: Open to anyone

I just heard an American Transit Case where prior arbitrators found that the workers Comp defense was without merit. Some claims were paid. Respondent’s counsel stated that 50k in basic PIP has been exhausted but that there is 150k in A-PiP on the policy. Respondent’s counsel argues that applicant is not entitled to A-PIP as the insured failed to execute an NF-11 subrogation agreement. Respondent is trying to locate their proof that the NF-11 was mailed to the insured. Has anyone had this issue?  Is the NF11 necessary for release of A-PIP and if so, would the claim be dismissed without prejudice?  This is the first time I’ve seen this issue. Please advise. Many thanks. Pam

  • Re: Additional PIP and NF11
    Mike Rosenberger

    Pam, I am not sure if I am correct but this is what I held:


    Pursuant to 11 NYCRR 65-3.5(h): "When benefits are claimed under an additional personal injury protection endorsement, the insurer may require that the applicant execute a prescribed subrogation agreement (NYS Form N-F 11) prior to the payment of any benefits. If the insurer shall impose the above requirement, it shall deliver the prescribed agreement to the applicant as soon as it is known that the claim is payable under an additional personal injury protection endorsement."


    I have dismissed these without prejudice.

  • Re: Additional PIP and NF11
    Giovanna Tuttolomondo

    I would think that the NF-11 is dispositive and that it could somehow be a form of verification which should only result in a dismissal without prejudice [unless perhaps there was a 120 day denial].


    The Regulation provides [mostly in 65-1.3], in pertinent part, that APIP Additional first-party benefits are payments equal to extended economic loss reduced by:



    (c) amounts recovered or recoverable by the eligible injured person for any element of extended economic loss covered by this [Endorsement] {Footnote 15} under any mandatory source of first-party automobile no-fault benefits required by the laws of any state (other than the State of New York) of the United States...

    Therefore, I would think a Subrogation Agreement is germane to a determination of APIP, reductions and the overall manner of calculation. 

    There is a discussion about extended economic loss and thereunder, a provision which provides:



    In the event of any payment for extended economic loss, the Company is subrogated to the extent of such payments to the rights of the person to whom, or for whose benefit, such payments were made. Such person must execute and deliver instruments and papers and do whatever else is necessary to secure such rights. Such person shall do nothing to prejudice such rights.


    Hope this helps.  Sorry for the weird font.  I was cutting and pasting and couldn't figure out how to make this all uniform.

  • Re: Additional PIP and NF11
    Andrew Horn

    Pam, I've dealt with the issue several times and have ruled that a request for a NF-11 must comport with the verification protocol. I also cite to a decision by arbitrator Gerardi with regards to the issue in one of the cases below. Hope this is helpful. 17-13-9043-4723, 17-16-1039-7992. (The latter case was affirmed by a master arbitrator).

    Best, Andrew