To applicant: see reverse side if you wish to contest this denial.
Arbitration: you may submit this dispute to arbitration.
Complaints: although the Department of Financial Services will attempt to resolve disputed claims, it cannot order or require an insurer to pay a disputed claim.
Lawsuit: you may bring a lawsuit to recover the amount of benefits you claim to be entitled to.
| Question | Answer |
|---|---|
| Form Name | NYS Form NF-10 |
| Form Length | 3 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 9 min |
| Edition | Rev 6/2026 |
| Who completes it | The insurer, who sends two copies to the applicant |
| Matches the agency's file | Yes, checked October 2, 2026 |
| Other names | NF-10, NF10, NF 10, NYS Form NF-10, No-Fault Denial of Claim Form, Denial of Claim Form |
| Official source | NYS Form NF-10 (Rev 6/2026), New York State Department of Financial Services |
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