How to Complete NYS Form NF-9: No-Fault Workers’ Comp Offset

New York State Form NF-9 is a one-page agreement between you and your no-fault auto insurer, used when a workers’ compensation or New York State disability provider has denied all or part of a claim arising from the same accident. By signing it, you let the no-fault insurer pay your lost-earnings benefits in full right now, without deducting what workers’ comp or disability would have covered, and in exchange you promise to keep pursuing that other claim and repay the no-fault insurer if those benefits eventually come through.¹

The NF-9 is not a wage form. Your earnings get reported separately on the NF-6 (if you’re an employee) or NF-7 (if you’re self-employed).²

When You’ll Receive One

New York’s no-fault law requires insurers to reduce your lost-earnings benefits by any amount you can recover from workers’ compensation or state disability.³ That offset works fine when those programs are actually paying. The problem comes when they deny your claim: without something to stop it, the no-fault insurer could still subtract an estimate of what you were “recoverable” for, leaving you shortchanged on both sides.

The NF-9 closes that gap. Under 11 NYCRR 65-3.19(c)(1), when a workers’ comp or disability provider denies liability in whole or in part, the no-fault insurer has to pay your benefits without taking the offset, provided you sign the agreement.¹ So you’ll typically see an NF-9 arrive after the no-fault carrier learns your workers’ comp or disability case was denied. It can also show up if a workers’ comp carrier accepted the claim at first and then reversed itself.

What You’re Agreeing To

The form carries five commitments. Read them carefully before signing, because one of them obligates you to hand money back later.

Your signature is the trigger. The insurer’s duty to pay without the offset kicks in only once you sign.
If workers’ comp or disability eventually pays, you reimburse the no-fault insurer for the amount it would have offset. Any attorney’s fee you paid to win those other benefits is subtracted from what you owe back.
If you don’t reimburse, the insurer can take the unpaid amount out of future no-fault benefits still owed on the same claim.⁴
You have to keep pursuing the workers’ comp or disability claim diligently. You can’t sign the NF-9, collect full benefits, and abandon the other case.
If you drop the other claim or refuse to repay, the insurer can sue you to recover what it paid under the agreement.

The repayment piece is what catches people off guard. Treat the NF-9 as a conditional advance. The no-fault insurer covers you now, but the money ultimately belongs to whichever program accepts responsibility. If workers’ comp pays later, the no-fault carrier is entitled to be made whole, though the reimbursement can never exceed what the original offset would have been.¹

Filling Out the Form

The form itself is short. The insurer usually prints its own information and your claim details in the top portion. You confirm or supply:

Your legal name and current mailing address.
The date of the motor vehicle accident.
The no-fault claim number, which should already appear on correspondence you’ve received.
Your signature and the date.

The insurer signs too. Both signatures have to be on the page for the agreement to take effect. Keep a complete copy of the signed form. If you later need to show you held up your end by continuing to pursue the workers’ comp or disability case, the executed NF-9 is the document you’ll want in hand.

If You Refuse to Sign

Signing isn’t legally mandatory, but refusing has real costs. If you decline and the no-fault insurer later turns out to owe the benefits anyway, it won’t owe you attorney’s fees or interest on the late payments.¹ And if the overlap ever gets paid and you don’t reimburse, the insurer can still take those amounts out of your future no-fault benefits on the same claim.⁴

In most cases, holding out just delays your money without changing the ultimate math. The insurer will either keep applying the offset, reducing each check by what it estimates you could recover from workers’ comp or disability, or slow-walk payment while coordination gets sorted out. Signing puts more money in your pocket now and leaves the accounting to be reconciled later.

Why the Offset Exists

A little background makes the whole arrangement easier to follow. Insurance Law Section 5102 caps lost-earnings recovery under no-fault at $2,000 per month for up to three years after the accident, and the statute automatically pays only 80 percent of what you would have earned. All no-fault benefits combined, medical and wage, cannot exceed $50,000 per person.³

On top of that reduction, the statute tells the insurer to subtract any amount you’ve “recovered or recoverable” from workers’ compensation, state disability, Social Security disability, or Medicare.³ When those programs are actually paying, the offset keeps you from double-recovering. When workers’ comp denies the claim, you aren’t recovering anything, and the NF-9 is the mechanism that tells the no-fault insurer to stop deducting a benefit you aren’t receiving.

Social Security Disability Uses a Different Form

The NF-9 covers only workers’ compensation and New York State disability. If your coordination issue involves Social Security disability, that’s a separate form: the NF-8. If you’re eligible for SSDI and don’t sign the NF-8 within 35 days, the insurer can estimate what SSDI would pay you and deduct that estimate from your lost-earnings benefits.⁵ If you receive both no-fault and SSDI, be aware that the Social Security Administration may also reduce your SSDI payments, since federal rules cap the combined total of SSDI and public disability benefits at 80 percent of your pre-disability average earnings.⁶

If your disability benefits come through a union or employer plan governed by ERISA and that plan requires you to repay out of any recovery, mention it to the no-fault insurer. A Department of Financial Services opinion concluded that benefits you’re contractually obligated to return aren’t truly “recovered” by you, and the no-fault insurer shouldn’t be taking an offset for them.⁷

1
New York Codes, Rules and Regulations. 11 CRR-NY 65-3.19 – Coordination of Benefits
2
Department of Financial Services. No-Fault Information for Insurers
3
New York State Senate. New York Insurance Law 5102 – Definitions
4
Department of Financial Services. NYCRR Part 65 – Insurance Regulation 68
5
Department of Financial Services. New York Motor Vehicle No-Fault Insurance Law – Complete Form Set
6
Social Security Administration. How Workers Compensation and Other Disability Payments May Affect Your Benefits
7
Department of Financial Services. OGC Opinion No. 10-12-04 – No-Fault Lost Wages