First-Party Property Damage Demand Letter - New York

FIRST-PARTY PROPERTY DAMAGE DEMAND LETTER

State of New York

[LAW FIRM LETTERHEAD]

SETTLEMENT COMMUNICATION — FOR RESOLUTION PURPOSES ONLY
ADMISSIBILITY GOVERNED BY N.Y. CPLR § 4547 AND, IF APPLICABLE, FED. R. EVID. 408

VIA CERTIFIED MAIL, RETURN RECEIPT REQUESTED — ARTICLE NO. [________________________________]
AND VIA EMAIL TO: [________________________________]

Date: [__/__/____]

[INSURANCE COMPANY FULL LEGAL NAME]
Property Claims Department
[________________________________]
[________________________________]
[City], [State] [Zip]

Attention: [________________________________], [Title/Position]
Re: FORMAL DEMAND FOR FIRST-PARTY PROPERTY INSURANCE BENEFITS — NEW YORK LAW
Insured: [________________________________]
Property Address: [________________________________]
Policy Number: [________________________________]
Claim Number: [________________________________]
Date of Loss: [__/__/____]
Type of Loss: [________________________________]
Dwelling Limit (Cov. A): $[________________________________]
Amount in Dispute: $[________________________________]
Response Deadline: [__/__/____] at 5:00 p.m. Eastern Time

Dear [________________________________]:

I. INTRODUCTION AND FORMAL DEMAND

This firm represents [________________________________] ("our client" or "the insured") in connection with the first-party property insurance claim described above. This letter constitutes a formal demand for payment of all amounts owed under the policy for covered losses sustained at [________________________________] (the "Property"), together with notice of [________________________________]'s (the "Company" or "[short carrier name]") violations of New York insurance law in handling this claim.

Our client purchased insurance from [short carrier name] to protect against exactly the type of loss that occurred here. Despite a covered loss, clear liability, and documentation submitted by our client, [short carrier name] has [underpaid / denied / unreasonably delayed] this claim. That conduct violates the policy, N.Y. Ins. Law § 2601, and 11 NYCRR Part 216, and exposes [short carrier name] to consequential damages beyond policy limits under Bi-Economy Market, Inc. v. Harleysville Ins. Co., 10 N.Y.3d 187 (2008).

II. NEW YORK PROPERTY INSURANCE LAW — APPLICABLE FRAMEWORK

A. The New York Standard Fire Policy (N.Y. Ins. Law § 3404)

New York is one of the few states to mandate a standard fire policy form by statute. N.Y. Ins. Law § 3404 prescribes the exact language of the 165-line Standard Fire Policy that must be incorporated (in whole or by reference) into every fire insurance contract covering property in New York. No policy provision may be less favorable to the insured than the standard form.

Key features of the § 3404 standard policy:

• Insurer must pay the actual cash value (ACV) of property destroyed (unless replacement cost coverage is purchased)
• Concealment, fraud, and misrepresentation void the policy only if "willful" — innocent misstatement does not forfeit coverage
• Vacancy and unoccupancy restrictions apply after 60 consecutive days — coverage is not automatically voided; specific conditions apply
• The standard fire-policy text calls for a sworn proof of loss within 60 days after the loss unless the insurer extends the time in writing, but Insurance Law § 3407(a) separately protects the insured unless the insurer gives a post-loss written demand with suitable proof-of-loss forms. After that demand and forms are received, § 3407(a) treats a proof furnished within 60 days—or a longer period stated in the notice—as timely.

B. Prompt Investigation and Payment — 11 NYCRR Part 216 (Regulation 64)

The NYDFS Regulation 64, codified at 11 NYCRR Part 216, imposes specific enforceable timing requirements on all New York property insurers:

C. Appraisal (N.Y. Ins. Law § 3408)

The standard fire policy mandated by N.Y. Ins. Law § 3404, and most homeowners and commercial property policies in New York, include an appraisal clause pursuant to N.Y. Ins. Law § 3408. Appraisal resolves disputes over the amount of loss only — coverage questions are reserved for litigation or declaratory judgment.

New York appraisal process:

1. Either party may invoke appraisal when there is a dispute over the amount of loss
2. Each party selects a competent, impartial appraiser within 20 days of demand (or as specified in policy)
3. The two appraisers select an umpire; if they cannot agree within 15 days, either party may petition the court to appoint an umpire
4. Award of any two of the three (two appraisers, or one appraiser and the umpire) is binding on the amount of loss
5. Each party pays its own appraiser; the umpire's fee is shared

D. Disclaimer and Coverage Defense Rules

Important distinction from bodily injury claims: N.Y. Ins. Law § 3420(d)(2)'s strict timely-disclaimer rule (approximately 30 days) applies only to bodily injury and death claims. For property damage coverage disputes, New York applies the more flexible common law standards of waiver and equitable estoppel — meaning an insurer may still lose a coverage defense through untimely assertion, conduct inconsistent with disclaiming, or prejudice to the insured. Cozen O'Reilly v. Roberts & Holland, LLP, 2014 (discussing § 3420(d)(2) scope); Hartford Accident & Indem. Co. v. Village of Hempstead, 48 N.Y.2d 218 (1979).

Nevertheless, [short carrier name] must provide a written denial identifying the specific policy provision and the facts on which it relies under 11 NYCRR § 216.6(d).

E. Consequential Damages for Bad Faith

Under Bi-Economy Market and Panasia Estates (2008), an insurer who breaches the covenant of good faith and fair dealing may be liable for consequential damages beyond the policy limits, provided such damages were reasonably foreseeable at contracting. The nature of property insurance — especially business interruption, homeowners, and replacement-cost coverage — makes it foreseeable that delay or wrongful denial will cause losses exceeding the policy itself.

III. POLICY INFORMATION AND COVERAGE

A. Policy Details

B. Applicable Coverages and Limits

C. Valuation Method

☐ Replacement Cost Value (RCV) — Policy obligates [short carrier name] to pay full replacement cost without deduction for depreciation, subject to actual repair/replacement within the time specified in the policy.

☐ Actual Cash Value (ACV) — Standard measure under N.Y. Ins. Law § 3404 / standard fire policy: fair market value at time of loss, or replacement cost less reasonable depreciation. New York courts apply a broad evidence rule — ACV may be established by any relevant evidence including market value, replacement cost less depreciation, and income-producing potential.

IV. THE LOSS EVENT

A. Description of Loss

On [__/__/____], at approximately [____] [AM/PM], the insured property at [________________________________] sustained significant damage due to [________________________________].

[DETAILED NARRATIVE OF THE LOSS: Origin and cause, sequence of events, areas affected, immediate response, emergency services involved]

B. Cause of Loss — Covered Peril

The cause of this loss is a covered peril under the policy:

☐ Fire (accidental) — covered under standard fire policy (N.Y. Ins. Law § 3404) and homeowners/commercial form
☐ Lightning
☐ Windstorm / Hail — [________________________________]
☐ Named storm / Hurricane — note: if wind vs. water dispute exists, burden is on insurer to apportion
☐ Water damage — sudden and accidental discharge from: ☐ Plumbing ☐ HVAC ☐ Appliance ☐ Roof penetration
☐ Frozen pipes
☐ Vandalism / Malicious mischief
☐ Theft
☐ Weight of ice and snow
☐ Collapse (as defined in policy)
☐ Other: [________________________________]

No policy exclusion bars coverage because: [EXPLAIN — e.g., exclusion does not apply, exclusion was waived, efficient proximate cause doctrine, etc.]

C. Proof of Loss

Our client [has submitted / is hereby submitting] a sworn proof of loss as required by N.Y. Ins. Law § 3407 and the policy. The proof of loss is dated [__/__/____] and was [mailed via certified mail / delivered in person] to [short carrier name] on [__/__/____].

Proof-of-loss timing gate: The standard fire-policy language in Insurance Law § 3404 uses 60 days after the loss unless extended in writing. Insurance Law § 3407(a), however, says failure to furnish contractual proofs does not invalidate or diminish the claim unless the insurer gives a post-loss written notice requesting proofs on suitable forms. A proof furnished within 60 days after receipt of that notice and forms—or within a longer period stated in the notice—complies with the contract’s proof-timing provision. Record the policy language, the insurer’s notice date, the forms received, and any written extension before stating a deadline.

D. Mitigation Efforts

Our client took immediate and reasonable steps to mitigate further damage as required by the policy and New York law:

All mitigation costs are recoverable as covered expenses. Documentation enclosed.

V. CLAIM HISTORY AND INSURER'S CONDUCT

A. Claim Timeline

B. [short carrier name]'s Position and Our Response

[short carrier name] has taken the following position: [DESCRIBE INSURER'S POSITION — denial, underpayment, disputed scope, exclusion asserted, depreciation dispute, etc.]

This position is legally unsound and/or factually unsupported under New York law for the following reasons:

1. [REASON 1 — e.g., exclusion cited does not apply; efficient proximate cause is a covered peril]
2. [REASON 2 — e.g., depreciation applied is excessive and not supported by the broad evidence rule]
3. [REASON 3 — e.g., scope of damage confirmed by independent licensed contractor and engineer]
4. [REASON 4 — e.g., law and ordinance costs are covered under policy endorsement]

VI. SCOPE OF DAMAGE AND CLAIMED AMOUNTS

A. Dwelling / Building Damage (Coverage A)

The following damage was sustained to the dwelling/building structure:

Basis for our estimate: Licensed contractor [________________________________], report dated [__/__/____]. Engineering report by [________________________________] attached.

B. Law and Ordinance / Code Upgrade Costs

New York building codes may require upgrades beyond like-for-like restoration. If law and ordinance coverage is included:

C. Other Structures (Coverage B)

D. Personal Property (Coverage C)

E. Additional Living Expenses / Loss of Use (Coverage D)

Our client has been displaced from the Property since [__/__/____] and is incurring the following additional living expenses:

F. Business Income / Extra Expense (if applicable — BOP/Commercial)

G. Claim Summary

VII. OVERHEAD AND PROFIT

Our client is entitled to general contractor overhead and profit (O&P — customarily 10% overhead and 10% profit, or as established by the market) because:

• The scope of repairs requires coordination of multiple trades (structural, electrical, plumbing, HVAC, finish work)
• A licensed general contractor is reasonably necessary — and in many cases required by New York City or local building codes
• O&P is an industry-standard and insurable cost of repair, recognized in Xactimate and all professional estimating platforms
• [short carrier name]'s omission of O&P is contrary to New York insurance industry practice and policyholder expectations

O&P Claimed: $[________________________________]

VIII. APPRAISAL DEMAND (ALTERNATIVE DISPUTE RESOLUTION)

A. Formal Appraisal Demand

Pursuant to N.Y. Ins. Law § 3408 and the appraisal clause of the policy, and due to [short carrier name]'s failure to fairly evaluate the amount of loss, we hereby invoke the appraisal process to resolve the dispute over the amount of loss.

Our client's appraiser:
[________________________________]
[________________________________], NY [____]
License No.: [________________________________]

Please designate [short carrier name]'s appraiser within [____] days (or as required by the policy).

B. Scope of Appraisal / Coverage Reservation

The following items are submitted to appraisal as disputes over the amount of loss:

☐ Scope and cost of dwelling repairs (Coverage A)
☐ Amount of personal property loss (Coverage C)
☐ Amount of additional living expenses (Coverage D)
☐ Amount of business income loss
☐ Appropriate depreciation methodology
☐ [________________________________]

Coverage questions — including any exclusion disputes — are expressly reserved for litigation or declaratory judgment and are not within the scope of appraisal.

IX. STATUTORY VIOLATIONS

A. Regulation 64 / 11 NYCRR Part 216 Violations

[short carrier name] has violated the following specific requirements of Regulation 64:

☐ § 216.4(a) — Failed to acknowledge claim within 15 business days of notice
☐ § 216.6(c) — Failed to accept or deny claim within 15 business days after complete proof and all requested items (delayed [____] days)
☐ § 216.6(c) — Failed to explain in writing why more investigation time was needed
☐ § 216.6(c) — Failed to send 90-day follow-up notices during an extended investigation
☐ § 216.6 — Failed to conduct a fair, thorough, and objective investigation before issuing estimate
☐ § 216.7 — Failed to promptly pay undisputed amounts while investigating disputed portions
☐ Other: [________________________________]

B. N.Y. Ins. Law § 2601 Violations

[short carrier name]'s conduct violates N.Y. Ins. Law § 2601(a), which prohibits unfair claim settlement practices including:

☐ Misrepresenting pertinent facts or policy provisions relating to coverage at issue
☐ Failing to acknowledge and act reasonably promptly upon communications
☐ Failing to adopt and implement reasonable standards for prompt investigation
☐ Refusing to pay claims without conducting a reasonable investigation
☐ Not attempting in good faith to effectuate prompt, fair, and equitable settlements when liability is reasonably clear
☐ Compelling insured to initiate litigation by offering substantially less than clearly owed
☐ Attempting to settle a claim for less than the amount a reasonable person would believe owed
☐ Failing to promptly provide a reasonable explanation of the basis for denial or compromise offer

Note: N.Y. Ins. Law § 2601 does not provide a private right of action. Violations are enforced by the NYDFS and are relevant as evidence of bad faith in a breach of contract claim. Rocanova v. Equitable Life, 83 N.Y.2d at 613.

X. BAD FAITH AND CONSEQUENTIAL DAMAGES

Under Bi-Economy Market, Inc. v. Harleysville Ins. Co., 10 N.Y.3d 187, 886 N.E.2d 127 (2008), an insurer's breach of the implied covenant of good faith and fair dealing — by failing to investigate in good faith and pay covered claims — may give rise to consequential damages beyond policy limits. The Court of Appeals held that the very purpose of the insurance policy makes the potential for consequential loss foreseeable at the time of contracting.

The foreseeable consequential damages our client faces from [short carrier name]'s conduct include:

☐ Continued displacement from residence (additional ALE accruing)
☐ Loss of business income (beyond policy period)
☐ Deterioration of property from unrepaired damage
☐ Carrying costs on mortgage while property is uninhabitable
☐ Credit damage from inability to pay obligations during prolonged claim delay
☐ Emotional distress from loss of home (if egregious conduct)
☐ [________________________________]

Estimated Consequential Damages: $[________________________________] (to be established at trial if necessary)

XI. FORMAL DEMAND

A. Monetary Demand

We hereby demand payment of the following amounts:

B. Additional Demands

In addition to monetary payment, we demand:

☐ Written confirmation that [short carrier name] will not contest the insured's proof of loss
☐ Production of the complete claims file, including all adjuster notes, internal communications, reserve data, and guidelines used in evaluating this claim (in anticipation of litigation — preserve all ESI)
☐ Identification of all experts retained by [short carrier name] in connection with this claim
☐ Written explanation, with specific policy and factual citations, for any disputed items not included in this demand

XII. RESPONSE DEADLINE AND CONSEQUENCES

THIS DEMAND MUST BE ACCEPTED IN WRITING BY 5:00 P.M. EASTERN TIME ON [__/__/____].

Consequences of Non-Response or Rejection

If [short carrier name] fails to accept this demand by the deadline, we will:

1. File suit in New York Supreme Court ([________________________________] County) seeking:
   - All policy benefits owed
   - Pre-judgment interest at 9% per annum (CPLR § 5004)
   - Consequential damages under Bi-Economy Market
   - Punitive damages (if conduct meets Rocanova standard)
   - Attorney's fees and costs (note: each party generally bears its own fees under the American Rule in New York, but fees may be awarded in exceptional circumstances)

2. File a formal complaint with the NYDFS through dfs.ny.gov/complaint or with assistance from the consumer hotline at (800) 342-3736
   Alleging violations of N.Y. Ins. Law § 2601 and 11 NYCRR Part 216

3. Invoke formal appraisal (if not already invoked above) pursuant to N.Y. Ins. Law § 3408

4. Continue to document consequential damages accruing as a result of [short carrier name]'s delay or denial

XIII. DOCUMENT PRESERVATION NOTICE

This letter constitutes formal notice to preserve all documents and electronically stored information (ESI) related to this claim, including without limitation:

• Complete claims file in all versions, including draft documents
• All written and electronic communications with the insured or any third party concerning this claim
• All adjuster notes, diaries, activity logs, and reserve documentation
• All inspection reports, photographs, and videos
• All expert reports, engineering assessments, estimates (Xactimate or other), and evaluations
• Claim handling guidelines, procedures, training materials, and reserve manuals
• Internal communications regarding coverage analysis and claim strategy
• All communications with reinsurers or excess carriers
• Quality assurance reviews and audit reports related to this claim

Destruction of any potentially relevant document or ESI may constitute spoliation and will be raised in any subsequent litigation.

XIV. CONCLUSION

Our client purchased insurance from [short carrier name] for one purpose: to be made whole when a covered loss occurs. That purpose has not been fulfilled. The loss is covered, the damages are documented, and the claim is ripe for payment. We urge [short carrier name] to honor its contractual obligations under New York law and resolve this claim fairly and promptly.

Respectfully submitted,

[________________________________]

By: _______________________________
[________________________________], Esq.
NY Bar Registration No.: [________________________________]
[________________________________]
[________________________________], NY [____]
Tel: [________________________________]
Fax: [________________________________]
Email: [________________________________]

Counsel for [________________________________]

ENCLOSURES:

• Policy declarations page and all endorsements
• Sworn proof of loss (if not previously submitted)
• Licensed contractor scope and estimate
• Engineering / cause and origin report (if applicable)
• Personal property inventory and receipts/supporting documentation
• ALE receipts and documentation
• Business income documentation (if applicable)
• Photographs of all damage areas
• Mitigation invoices and receipts
• Prior correspondence with [short carrier name]

CC:

• [________________________________] (client)
• [________________________________] (mortgagee/lienholder, if applicable)

SOURCES AND REFERENCES

• N.Y. Ins. Law § 3404 (standard fire policy / 165 lines): nysenate.gov/legislation/laws/ISC/3404
• N.Y. Ins. Law § 3407 (notice and proof of loss): nysenate.gov/legislation/laws/ISC/3407
• N.Y. Ins. Law § 3408 (appraisal): nysenate.gov/legislation/laws/ISC/3408
• N.Y. Ins. Law § 2601 (unfair claims practices): nysenate.gov/legislation/laws/ISC/2601
• 11 NYCRR Part 216 (Regulation 64): law.cornell.edu/regulations/new-york/title-11/chapter-IX/part-216
• 11 NYCRR § 216.6 (settlement standards): nyrules.elaws.us/nycrr/title11_chapterix_part216_s216.6
• Bi-Economy Market v. Harleysville, 10 N.Y.3d 187 (2008): caselaw.findlaw.com/court/ny-court-of-appeals/1014104.html
• Rocanova v. Equitable Life, 83 N.Y.2d 603 (1994): law.justia.com/cases/new-york/court-of-appeals/1994/83-n-y-2d-603-0.html
• Igbara Realty Corp. v. NY Property Ins. Underwriting Ass'n, 63 N.Y.2d 201 (1984): proof of loss / waiver doctrine
• NYDFS complaint filing: dfs.ny.gov/complaint
• CPLR § 213(2) (six-year limitation): law.justia.com/codes/new-york/cvp/article-2/213/

This template reflects New York law as of April 2026. New York property insurance law, including the standard fire policy requirements and Regulation 64 timing standards, is subject to regulatory updates by the NYDFS. Verify all statutory references and policy-specific requirements with a licensed New York attorney before use.