NY State Senate Bill 2015-S4724A

Senate Bill S4724A

2015-2016 Legislative Session

Relates to verification of claims made under the comprehensive motor vehicle insurance reparations act

download bill text pdf

Archive: Last Bill Status - In Senate Committee Insurance Committee

Introduced
- In Committee Assembly
- In Committee Senate
- On Floor Calendar Assembly
- On Floor Calendar Senate
- Passed Assembly
- Passed Senate
Delivered to Governor
Signed By Governor

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Actions

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	Assembly Actions - Lowercase Senate Actions - UPPERCASE
Jan 06, 2016	referred to insurance
Jun 08, 2015	print number 4724a
Jun 08, 2015	amend and recommit to insurance
Apr 10, 2015	referred to insurance

Bill Amendments

Original

A (Active)

co-Sponsors

View additional co-sponsors

2015-S4724 - Details

See Assembly Version of this Bill:: A6421
Current Committee:: Senate Insurance
Law Section:: Insurance Law
Laws Affected:: Amd §5106, Ins L
Versions Introduced in Other Legislative Sessions:: 2017-2018: S5509, A3571
2019-2020: S3003, A3053
2021-2022: A5699
2023-2024: A1541

2015-S4724 - Summary

Relates to verification of claims made under the comprehensive motor vehicle insurance reparations act.

2015-S4724 - Sponsor Memo

                                BILL NUMBER:S4724

TITLE OF BILL:  An act to amend the insurance law, in relation to
verification of claims made under the comprehensive motor vehicle
insurance reparations act

SUMMARY OF PROVISIONS:

This legislation will allow injured accident victims to continue
receiving the No-Fault benefits they need and are entitled to, if they
can provide a reasonable justification for missing an examination or
are willing to reschedule a missed examination within a reasonable
time period.

This legislation will also protect hospitals by ensuring that payment
for emergency medical care provided within 48 hours - that hospitals
are obligated to provide - shall not be denied simply because an
accident victim subsequently failed to appear for an examination.

JUSTIFICATION:

Increasingly, insurance carriers are denying critical no fault
benefits to injured auto accident victims simply for missing a single
medical examination or examination under oath. At the most basic
level, this practice is unfair to New Yorkers who have already been
suffered as a result of an auto accident. An innocent injured accident

victim should not be denied the critical benefits they need if they
have a valid reason for not appearing at an examination and are
willing to comply with an examination request.

This practice also undermines the No-Fault system, which was created
to ensure that victims of auto accidents would be quickly compensated
for all basic economic loss, including specifically the costs of
medical care, without regard to fault. Many accident victims denied
access to No-Fault benefits, for no good cause, will be forced instead
to rely on taxpayers to cover their medical expenses through Medicare
and other State assistance programs. Injured accident victims will no
longer be assured the swift compensation No-Fault law was designed to
guarantee, and New Yorkers will pick up the tab.

The costs of this practice also fall on health care providers who are
being denied payment for treatments already provided to accident
victims. Hospitals that provide emergency care in the immediate
after-math of an auto accident are particularly at risk as they are
obligated to provide that care but can be denied payment if an
accident victim misses an examination months later.

By stopping insurance carriers cutting off critical benefits in
circumstances where accident victims are willing to comply with
requests for examinations or other verifications, this legislation
will strengthen the No-Fault system and protect innocent injured
victims of auto accidents. This legislation will also protect
emergency care providers, by ensuring that emergency medical bills,
incurred in the first 48 hours after an accident will be paid.

LEGISLATIVE HISTORY:


This is a new bill.

FISCAL IMPLICATIONS:

None.

EFFECTIVE DATE:

This act shall take effect immediately and shall be applicable to: (i)
all claims made, and actions and proceedings brought, under article 51
of this chapter and commenced on or after the effective date of this
act; and (ii) all claims made, and actions and proceedings brought,
under article 51 of this chapter and commenced prior to the effective
date of this act and pending on the effective date of this act.

2015-S4724 - Bill Text download pdf

                            
                    S T A T E   O F   N E W   Y O R K
________________________________________________________________________

                                  4724

                       2015-2016 Regular Sessions

                            I N  S E N A T E

                             April 10, 2015
                               ___________

Introduced  by  Sen. MARTINS -- read twice and ordered printed, and when
  printed to be committed to the Committee on Insurance

AN ACT to amend the insurance law, in relation to verification of claims
  made under the comprehensive motor vehicle insurance reparations act

  THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
BLY, DO ENACT AS FOLLOWS:

  Section  1.  Section  5106  of  the  insurance  law, subsection (b) as
amended and subsection (d) as added by chapter 452 of the laws of  2005,
is amended to read as follows:
  S  5106.  Fair claims settlement. (a) Payments of first party benefits
and additional first party  benefits  shall  be  made  as  the  loss  is
incurred.    Such  benefits  are  overdue if not paid within thirty days
after the claimant supplies  proof  of  the  fact  and  amount  of  loss
sustained.  If  proof is not supplied as to the entire claim, the amount
which is supported by proof is overdue if not paid  within  thirty  days
after  such  proof is supplied. All overdue payments shall bear interest
at the rate of two percent per month. If a valid claim  or  portion  was
overdue,  the  claimant shall also be entitled to recover his attorney's
reasonable fee, for services necessarily performed  in  connection  with
securing payment of the overdue claim, subject to limitations promulgat-
ed by the superintendent in regulations.
  (b)  THE  INSURER IS ENTITLED TO RECEIVE ALL ITEMS NECESSARY TO VERIFY
THE CLAIM, INCLUDING MEDICAL EXAMINATION AND EXAMINATION UNDER  OATH  OF
THE INJURED PARTY OR ANY ADDITIONAL VERIFICATION REQUIRED BY THE INSURER
TO  ESTABLISH PROOF OF CLAIM. THE FAILURE OF THE INJURED PARTY TO APPEAR
FOR A SCHEDULED MEDICAL EXAMINATION OR  EXAMINATION  UNDER  OATH  OR  TO
PROVIDE  ANY  OTHER  ADDITIONAL  VERIFICATION  SHALL NEITHER BE A POLICY
VIOLATION NOR BE UTILIZED AS THE BASIS FOR THE  DENIAL  OF  A  CLAIM  OR
DISCLAIMER,  PROVIDED  THE  INJURED PARTY SUBMITS TO THE INSURER WRITTEN
PROOF OFFERING EITHER (1) REASONABLE JUSTIFICATION FOR  THE  FAILURE  TO
COMPLY; OR (2) A DEMONSTRABLE WILLINGNESS TO COMPLY WITHIN THIRTY CALEN-
DAR DAYS FROM THE DATE OF THE INJURED PARTY'S FAILURE TO APPEAR OR OTHER
VERIFICATION  BECOMES  OVERDUE.  IF  SUCH  WRITTEN PROOF IS NOT PROVIDED
WITHIN A REASONABLE TIME PERIOD, THE INSURER MAY ONLY DENY THAT  PORTION

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD09927-01-5

S. 4724                             2

OF  THE  CLAIM  FOR WHICH THE REQUESTED MEDICAL EXAMINATION, EXAMINATION
UNDER OATH OR ADDITIONAL VERIFICATION WAS REQUIRED AS PROOF OF THE  FACT
AND  AMOUNT  OF  LOSS  SUSTAINED.  IN  NO EVENT SHALL THE FAILURE OF THE
INJURED  PARTY TO APPEAR FOR A SCHEDULED MEDICAL EXAMINATION OR EXAMINA-
TION UNDER OATH OR TO PROVIDE ANY OTHER ADDITIONAL VERIFICATION SERVE AS
THE BASIS FOR THE DENIAL OF THAT PORTION OF A CLAIM RELATING TO EMERGEN-
CY MEDICAL CARE PROVIDED WITHIN FORTY-EIGHT HOURS OF AN ACCIDENT.
  (C) Every insurer shall provide a claimant with the option of  submit-
ting  any  dispute  involving the insurer's liability to pay first party
benefits, or additional first party benefits, the amount thereof or  any
other  matter which may arise pursuant to subsection (a) of this section
to arbitration pursuant to simplified procedures to  be  promulgated  or
approved by the superintendent. Such simplified procedures shall include
an expedited eligibility hearing option, when required, to designate the
insurer  for  first  party  benefits pursuant to subsection [(d)] (E) of
this section. The expedited eligibility hearing option shall be a  forum
for  eligibility  disputes only, and shall not include the submission of
any particular bill, payment or claim for any specific benefit for adju-
dication, nor shall it consider any other defense to payment.
  [(c)] (D) An award by an arbitrator  shall  be  binding  except  where
vacated or modified by a master arbitrator in accordance with simplified
procedures  to  be  promulgated  or  approved by the superintendent. The
grounds for vacating or modifying an  arbitrator's  award  by  a  master
arbitrator shall not be limited to those grounds for review set forth in
article seventy-five of the civil practice law and rules. The award of a
master arbitrator shall be binding except for the grounds for review set
forth  in  article seventy-five of the civil practice law and rules, and
provided further that where the amount of such master arbitrator's award
is five thousand dollars or greater, exclusive of  interest  and  attor-
ney's  fees, the insurer or the claimant may institute a court action to
adjudicate the dispute de novo.
  [(d)] (E) Where there is reasonable belief more than one insurer would
be the source of first party benefits,  the  insurers  may  agree  among
themselves,  if  there  is a valid basis therefor, that one of them will
accept and pay the claim initially. If there is no such agreement,  then
the  first insurer to whom notice of claim is given shall be responsible
for payment. Any such dispute shall be resolved in accordance  with  the
arbitration procedures established pursuant to section five thousand one
hundred five of this article and regulation as promulgated by the super-
intendent,  and  any  insurer paying first-party benefits shall be reim-
bursed by other insurers for their proportionate share of the  costs  of
the claim and the allocated expenses of processing the claim, in accord-
ance  with  the  provisions entitled "other coverage" contained in regu-
lation and the provisions entitled "other sources of  first-party  bene-
fits" contained in regulation. If there is no such insurer and the motor
vehicle accident occurs in this state, then an applicant who is a quali-
fied person as defined in article fifty-two of this chapter shall insti-
tute  the  claim  against  motor vehicle accident indemnification corpo-
ration.
  S 2. This act shall take effect immediately and  shall  be  applicable
to:    (i)  all  claims made, and actions and proceedings brought, under
article fifty-one of this chapter and commenced on or after  the  effec-
tive  date  of  this  act;  and  (ii)  all  claims made, and actions and
proceedings  brought,  under  article  fifty-one  of  this  chapter  and
commenced  prior  to  the  effective date of this act and pending on the
effective date of this act.

co-Sponsors

View additional co-sponsors

2015-S4724A (ACTIVE) - Details

See Assembly Version of this Bill:: A6421
Current Committee:: Senate Insurance
Law Section:: Insurance Law
Laws Affected:: Amd §5106, Ins L
Versions Introduced in Other Legislative Sessions:: 2017-2018: S5509, A3571
2019-2020: S3003, A3053
2021-2022: A5699
2023-2024: A1541

2015-S4724A (ACTIVE) - Summary

Relates to verification of claims made under the comprehensive motor vehicle insurance reparations act.

2015-S4724A (ACTIVE) - Sponsor Memo

                                BILL NUMBER:S4724A

TITLE OF BILL:  An act to amend the insurance law, in relation to
verification of claims made under the comprehensive motor vehicle
insurance reparations act

SUMMARY OF PROVISIONS:

This legislation will allow injured accident victims to continue
receiving the No-Fault benefits they need and are entitled to, if they
can provide a reasonable justification for missing an examination or
are willing to reschedule a missed examination within a reasonable
time period.

This legislation will also protect hospitals by ensuring that payment
for emergency medical care provided within 48 hours - that hospitals
are obligated to provide - shall not be denied simply because an
accident victim subsequently failed to appear for an examination.

JUSTIFICATION:

Increasingly, insurance carriers are denying critical no fault
benefits to injured auto accident victims simply for missing a single
medical examination or examination under oath. At the most basic
level, this practice is unfair to New Yorkers who have already been
suffered as a result of an auto accident. An innocent injured accident

victim should not be denied the critical benefits they need if they
have a valid reason for not appearing at an examination and are
willing to comply with an examination request.

This practice also undermines the No-Fault system, which was created
to ensure that victims of auto accidents would be quickly compensated
for all basic economic loss, including specifically the costs of
medical care, without regard to fault. Many accident victims denied
access to No-Fault benefits, for no good cause, will be forced instead
to rely on taxpayers to cover their medical expenses through Medicare
and other State assistance programs. Injured accident victims will no
longer be assured the swift compensation No-Fault law was designed to
guarantee, and New Yorkers will pick up the tab.

The costs of this practice also fall on health care providers who are
being denied payment for treatments already provided to accident
victims. Hospitals that provide emergency care in the immediate
after-math of an auto accident are particularly at risk as they are
obligated to provide that care but can be denied payment if an
accident victim misses an examination months later.

By stopping insurance carriers cutting off critical benefits in
circumstances where accident victims are willing to comply with
requests for examinations or other verifications, this legislation
will strengthen the No-Fault system and protect innocent injured
victims of auto accidents. This legislation will also protect
emergency care providers, by ensuring that emergency medical bills,
incurred in the first 48 hours after an accident will be paid.

LEGISLATIVE HISTORY:


This is a new bill.

FISCAL IMPLICATIONS:

None.

EFFECTIVE DATE:

This act shall take effect immediately.

2015-S4724A (ACTIVE) - Bill Text download pdf

                            
                    S T A T E   O F   N E W   Y O R K
________________________________________________________________________

                                 4724--A

                       2015-2016 Regular Sessions

                            I N  S E N A T E

                             April 10, 2015
                               ___________

Introduced  by  Sens. MARTINS, ADDABBO, AMEDORE, DILAN, LATIMER, PARKER,
  RITCHIE, SAVINO -- read twice and ordered printed, and when printed to
  be committed to the Committee on Insurance  --  committee  discharged,
  bill  amended,  ordered  reprinted  as amended and recommitted to said
  committee

AN ACT to amend the insurance law, in relation to verification of claims
  made under the comprehensive motor vehicle insurance reparations act

  THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
BLY, DO ENACT AS FOLLOWS:

  Section  1.  Section  5106  of  the  insurance  law, subsection (b) as
amended and subsection (d) as added by chapter 452 of the laws of  2005,
is amended to read as follows:
  S  5106.  Fair claims settlement. (a) Payments of first party benefits
and additional first party  benefits  shall  be  made  as  the  loss  is
incurred.    Such  benefits  are  overdue if not paid within thirty days
after the claimant supplies  proof  of  the  fact  and  amount  of  loss
sustained.  If  proof is not supplied as to the entire claim, the amount
which is supported by proof is overdue if not paid  within  thirty  days
after  such  proof is supplied. All overdue payments shall bear interest
at the rate of two percent per month. If a valid claim  or  portion  was
overdue,  the  claimant shall also be entitled to recover his attorney's
reasonable fee, for services necessarily performed  in  connection  with
securing payment of the overdue claim, subject to limitations promulgat-
ed by the superintendent in regulations.
  (b)  THE  INSURER IS ENTITLED TO RECEIVE ALL ITEMS NECESSARY TO VERIFY
THE CLAIM, INCLUDING MEDICAL EXAMINATION AND EXAMINATION UNDER  OATH  OF
THE INJURED PARTY OR ANY ADDITIONAL VERIFICATION REQUIRED BY THE INSURER
TO  ESTABLISH PROOF OF CLAIM. THE FAILURE OF THE INJURED PARTY TO APPEAR
FOR A SCHEDULED MEDICAL EXAMINATION OR  EXAMINATION  UNDER  OATH  OR  TO
PROVIDE  ANY  OTHER  ADDITIONAL  VERIFICATION  SHALL NEITHER BE A POLICY
VIOLATION NOR BE UTILIZED AS THE BASIS FOR THE  DENIAL  OF  A  CLAIM  OR

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD09927-03-5

S. 4724--A                          2

DISCLAIMER,  PROVIDED  THE  INJURED PARTY SUBMITS TO THE INSURER WRITTEN
PROOF OFFERING EITHER (1) REASONABLE JUSTIFICATION FOR  THE  FAILURE  TO
COMPLY; OR (2) A DEMONSTRABLE WILLINGNESS TO COMPLY WITHIN THIRTY CALEN-
DAR DAYS FROM THE DATE OF THE INJURED PARTY'S FAILURE TO APPEAR OR OTHER
VERIFICATION  BECOMES  OVERDUE.  IF  SUCH  WRITTEN PROOF IS NOT PROVIDED
WITHIN A REASONABLE TIME PERIOD, THE INSURER MAY ONLY DENY THAT  PORTION
OF  THE  CLAIM  FOR WHICH THE REQUESTED MEDICAL EXAMINATION, EXAMINATION
UNDER OATH OR ADDITIONAL VERIFICATION WAS REQUIRED AS PROOF OF THE  FACT
AND  AMOUNT  OF  LOSS  SUSTAINED.  IN  NO EVENT SHALL THE FAILURE OF THE
INJURED PARTY TO APPEAR FOR A SCHEDULED MEDICAL EXAMINATION OR  EXAMINA-
TION UNDER OATH OR TO PROVIDE ANY OTHER ADDITIONAL VERIFICATION SERVE AS
THE BASIS FOR THE DENIAL OF THAT PORTION OF A CLAIM RELATING TO EMERGEN-
CY MEDICAL CARE PROVIDED WITHIN FORTY-EIGHT HOURS OF AN ACCIDENT.
  (C)  Every insurer shall provide a claimant with the option of submit-
ting any dispute involving the insurer's liability to  pay  first  party
benefits,  or additional first party benefits, the amount thereof or any
other matter which may arise pursuant to subsection (a) of this  section
to  arbitration  pursuant  to simplified procedures to be promulgated or
approved by the superintendent. Such simplified procedures shall include
an expedited eligibility hearing option, when required, to designate the
insurer for first party benefits pursuant to  subsection  [(d)]  (E)  of
this  section. The expedited eligibility hearing option shall be a forum
for eligibility disputes only, and shall not include the  submission  of
any particular bill, payment or claim for any specific benefit for adju-
dication, nor shall it consider any other defense to payment.
  [(c)]  (D)  An  award  by  an arbitrator shall be binding except where
vacated or modified by a master arbitrator in accordance with simplified
procedures to be promulgated or  approved  by  the  superintendent.  The
grounds  for  vacating  or  modifying  an arbitrator's award by a master
arbitrator shall not be limited to those grounds for review set forth in
article seventy-five of the civil practice law and rules. The award of a
master arbitrator shall be binding except for the grounds for review set
forth in article seventy-five of the civil practice law and  rules,  and
provided further that where the amount of such master arbitrator's award
is  five  thousand  dollars or greater, exclusive of interest and attor-
ney's fees, the insurer or the claimant may institute a court action  to
adjudicate the dispute de novo.
  [(d)] (E) Where there is reasonable belief more than one insurer would
be  the  source  of  first  party benefits, the insurers may agree among
themselves, if there is a valid basis therefor, that one  of  them  will
accept  and pay the claim initially. If there is no such agreement, then
the first insurer to whom notice of claim is given shall be  responsible
for  payment.  Any such dispute shall be resolved in accordance with the
arbitration procedures established pursuant to section five thousand one
hundred five of this article and regulation as promulgated by the super-
intendent, and any insurer paying first-party benefits  shall  be  reim-
bursed  by  other insurers for their proportionate share of the costs of
the claim and the allocated expenses of processing the claim, in accord-
ance with the provisions entitled "other coverage"  contained  in  regu-
lation  and  the provisions entitled "other sources of first-party bene-
fits" contained in regulation. If there is no such insurer and the motor
vehicle accident occurs in this state, then an applicant who is a quali-
fied person as defined in article fifty-two of this chapter shall insti-
tute the claim against motor  vehicle  accident  indemnification  corpo-
ration.
  S 2. This act shall take effect immediately.

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Senate Bill S4724A

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Sponsored By

Archive: Last Bill Status - In Senate Committee Insurance Committee

Bill Amendments

co-Sponsors

2015-S4724 - Details

2015-S4724 - Summary

2015-S4724 - Sponsor Memo

2015-S4724 - Bill Text download pdf

co-Sponsors

2015-S4724A (ACTIVE) - Details

2015-S4724A (ACTIVE) - Summary

2015-S4724A (ACTIVE) - Sponsor Memo

2015-S4724A (ACTIVE) - Bill Text download pdf

Comments