No. Neither the New York Insurance Law, nor the regulations promulgated thereunder, obligates an insurer to honor an assignment of benefits request. Use this form if you receive a surprise bill for health care services and want the services to be treated as in network.Next, include your health insurance information if applicable. Strict time deadlines apply to applications for such benefits. In New York State, the deadline to file a no-fault claim is within 30 days of the accident. Access frequently-used workers' compensation and disability benefits forms below. Many of the forms link directly to the Workers' Compensation Board website. Use this form if you get a surprise medical bill or a bill for out-of-network emergency services and want the services to be treated as in-network.