Fillable Prescribed New York No-Fault Forms

It was on Christmas Eve 2009 that I said "I'll probably wait until after the New York State Insurance Department completes its revisions on Regulation 68 and the prescribed no-fault forms before creating and uploading any more fillable forms."   On that date, I published a fillable NF-2 New York Motor Vehicle No-Fault Insurance Law Application for Motor Vehicle No-Fault Benefits form.  And started my wait.

Well, we no longer have a New York State Insurance Department in this state,and it's looking less and less likely that the Regulation 68 revisions that department proposed back in November 2009 will ever make it through to promulgation and publication in the New York Register.  So, after a client's inquiry of earlier this week, and given that the 1/2004 editions of the prescribed NY PIP forms don't look like they're retiring anytime soon, I put my Adobe Acrobat Pro purchase of several years ago to use and created what may be the only publicly available and soon-to-be collector's edition, complete set of the current Appendix 13 prescribed New York no-fault forms. I'm not a graphic artist and I never played one on TV, so please forgive any format glitches that you may find in any of these forms (but tell me and I'll fix and re-save the forms to my Dropbox account, which is where they will reside for downloading).  Here's the complete, first edition set of the Appendix 13 prescribed forms, in fillable PDF format:

• NF-1A (Rev 1/2004) Cover Letter
• NF-1B (Rev 1/2004) Cover Letter 
• NF-2 (Rev 1/2004) Application for Motor Vehicle No-Fault Benefits 
• NF-3 (Rev 1/2004) Verification of Treatment by Attending Physician of Other Provider of Health Service
• NF-4 (Rev 1/2004) Verification of Hospital Treatment
• NF-5 (Rev 1/2004) Hospital Facility Form
• NF-6 (Rev 1/2004) Employers Wage Verification Report
• NF-7 (Rev 1/2004) Verification of Self-Employment Income
• NF-8 (Rev 1/2004) Agreement to Pursue Social Security Disability Benefits
• NF-9 (Rev 1/2004) Agreement to Pursue Workers' Compensation or N.Y.S. Disability Benefits 
• NF-10 (Rev 1/2004) Denial of Claim Form 
• NF-11 (Rev 1/2004) Additional PIP Subrogation Agreement 
• NF-12 (Rev 1/2004) Lump-Sum Settlement Agreement
• NF-13 (Rev 1/2004) Election of Option -- Optional Basic Economic Loss Coverage 
• NF-AOB (Rev 1/2004) Assignment of Benefits Form

Once the Dropbox document viewer opens, click the Download button in the upper right-hand corner of that page to download the form.  These forms will now accommodate the names and addresses of insurers, self-insurers, applicants, providers and hospitals.  Those of you who may prefer my collection of static New York no-fault claim forms that I separately uploaded in November 2009 can still find them here.   Please let me know if you encounter any bugs in the fillable forms.