How to Complete the New York NF-AOB No-Fault Assignment of Benefits Form

The New York NF-AOB no-fault assignment of benefits form is a one-page document that transfers an injured person’s right to collect no-fault insurance payments to the healthcare provider treating them. Once the patient and an authorized representative of the provider sign it, the auto insurer pays the provider directly instead of reimbursing the patient. The form is prescribed under 11 NYCRR 65-3.11 and appears as Appendix 13 of Regulation 68.¹

Where to Get the Form

The Department of Financial Services posts downloadable copies on its no-fault information page.² Most carriers will send a blank on request, and many medical offices already keep them at the front desk. A provider may use an equivalent version with minor formatting changes, but the assignment language on the face of the form cannot be altered.¹

A standalone NF-AOB isn’t always necessary. Assignment language is already built into the NF-3 (Verification of Treatment by Attending Physician), the NF-4 (Verification of Hospital Treatment), and the NF-5 (Hospital Facility Form). Providers use the separate NF-AOB when they want a dedicated assignment document rather than relying on the shorter clause embedded in a billing form.

What Information the Form Requires

The form is short, and every field matters. Missing or mismatched information gives the insurer a reason to reject the assignment and delay payment.

Assignor: the injured person’s full legal name and current residential address.
Assignee: the name and business address of the healthcare provider or facility that will receive direct payment.
Accident and claim identifiers: date, time, and circumstances of the collision, along with the insurance policy number and the claim number assigned by the carrier. If the claim number isn’t available yet because the NF-2 application hasn’t been processed, include the policy number and date of loss at minimum.
Patient signature: the injured person signs to transfer their right to receive benefits.
Provider signature: an authorized representative signs to accept the assignment. By signing, the provider certifies that no payment has been received from the patient for these services and that the patient will not be billed directly for covered treatment.

Both signatures need to be dated. The form does not require notarization. Keep the original signed form in your file; carriers may later request it, so submit a copy with your initial billing unless the specific insurer’s procedures direct otherwise.¹

A Note on the Social Security Number

The NF-AOB itself has no field for the patient’s Social Security number. It sits on the NF-2 application that opens the claim, where 11 NYCRR 65-3.4(c)(3) requires it, and the insurer can ask for it as additional verification if it was left off.³ If the patient doesn’t respond to a verification request, the carrier can hold the claim in limbo. A perfectly executed NF-AOB won’t produce a check while the patient’s side of the file is incomplete.

How to Submit It to the Insurer

Getting the form signed is half the job. It has to reach the insurer with the right paperwork and within the right windows.

Confirm the NF-2 Has Been Filed

Before provider billing goes anywhere, the injured person, or someone acting for them, must give the insurer written notice of the accident within 30 days of the collision. The usual notice is Form NF-2, though a DMV Accident Report (MV-104) can satisfy the requirement.⁴ Missing the 30-day window can defeat the entire claim unless the patient can show a clear and reasonable justification for the delay.⁵ Confirm the NF-2 is in before you invest time in billing. A valid assignment is worthless if the underlying claim was never opened.

Send It With the First Bill

Submit the NF-AOB alongside the initial medical bill, on Form NF-3, NF-4, or NF-5, whichever applies. Sending the assignment with the first claim establishes the direct-payment right from the start. If the assignment isn’t in the package, the insurer may cut the check to the patient instead.¹

Medical bills must be submitted within 45 days of the date each service is rendered.⁶ Missing that window without a reasonable excuse gives the carrier grounds to deny the claim.⁷ Many offices use certified mail with return receipt to lock in proof of timely delivery; most carriers also accept electronic submission through secure portals.

Once the insurer has a complete claim, it has 30 calendar days to pay or deny, subject to any timely request for additional verification.⁸ Note the date verification was completed on your end. That date starts the countdown.

What the Patient Is Giving Up, and Gaining

The NF-AOB isn’t only a payment routing slip. It transfers the patient’s rights under Article 51 of the Insurance Law, including the right to pursue unpaid claims through arbitration or court.⁹ The form’s standard language assigns “all rights, privileges and remedies to payment for health care services” to the provider. Once it’s signed, the provider stands in the patient’s shoes for the covered bills and can challenge denials directly.

The patient gets a protection in exchange. The form includes the provider’s certification that it “shall not pursue payment directly from the Assignor for services provided by said Assignee for injuries sustained due to the motor vehicle accident…notwithstanding any prior written agreement to the contrary.” A general financial responsibility form signed at the front desk does not override this. For accident-related care under the assignment, the NF-AOB controls.

When the Assignment Can Be Revoked

Once services have been rendered, the patient cannot unilaterally revoke the assignment as to those services. The provider has already performed the work in reliance on the assignment, and the insurer keeps paying accordingly.¹

For services not yet rendered, the patient can revoke, but the revocation must be in writing to the insurer and must confirm that the provider has been notified. Telling the insurer alone doesn’t meet the requirement.

The provider also has a limited right to step away. Under the form’s language, the assignee can revoke the assignment when benefits aren’t payable because the patient lacks coverage or violated a policy condition through their own actions.¹⁰ That path matters most when an exclusion surfaces mid-treatment.

Situations That Can Defeat a Valid Assignment

A signed NF-AOB does not guarantee payment. Insurance Law § 5103(b) lets the carrier deny benefits when the injured person fits any of these categories:¹¹

Self-inflicted injury.
Operating a vehicle while intoxicated or drug-impaired under Vehicle and Traffic Law § 1192. Emergency hospital and ambulance services remain covered until the person is stabilized; if a DWI conviction follows, the insurer can sue to recover what it paid for that emergency care.¹²
Committing a felony or fleeing lawful apprehension when injured.
Operating a vehicle in a race or speed contest.
Operating or riding in a vehicle known to be stolen.
Riding in one’s own vehicle when that vehicle didn’t carry required no-fault coverage.

Independent medical examinations are another common pressure point. Insurers can require the patient to attend an IME to verify continued medical necessity, and while 11 NYCRR 65-3.8 bars carriers from stopping benefits during a pending IME, that protection disappears when the patient or their attorney is the reason for the delay.⁸ If the patient no-shows or refuses, the insurer gains grounds to deny future bills. The NF-AOB transfers rights; it cannot manufacture patient cooperation.

One more boundary worth knowing: New York’s basic no-fault coverage caps total benefits at $50,000 per person.¹³ Some policies add an optional $25,000. Once cumulative payments reach the limit, the carrier issues a notice of exhaustion and payments stop. The assignment doesn’t expire, but there is nothing left for the insurer to pay under it, and billing typically shifts to the patient’s health insurance, Medicare, or Medicaid.

1
Legal Information Institute. New York Comp Codes R and Regs Tit 11 65-3.11 – Direct Payments
2
Department of Financial Services. No-Fault Information for Insurers
3
New York State Department of Financial Services. OGC Opinion No. 07-11-11
4
New York State Department of Financial Services. OGC Opinion No. 08-06-01 – NF-2 Submission Timeframe
5
Legal Information Institute. New York Comp Codes R and Regs Tit 11 65-1.1 – Requirements for Policies
6
New York State Department of Financial Services. OGC Opinion No. 03-02-13 – Time Requirement to Submit Medical Proof of Claim to Insurer
7
Department of Financial Services. Consumer FAQs About No-Fault Insurance
8
Legal Information Institute. New York Comp Codes R and Regs Tit 11 65-3.8 – Payment or Denial of Claim
9
New York Department of Financial Services. OGC Opinion No. 03-01-26 – No-Fault Assignment of Benefits 11 NYCRR 65 (Regulation 68)
10
New York State Department of Financial Services. OGC Opinion No. 02-09-02 – Assignment of No-Fault Benefits
11
New York State Senate. New York Insurance Law Section 5103
12
New York Department of Financial Services. Insurance Circular Letter No. 4
13
New York State Senate. New York Insurance Law Section 5102 – Definitions