NY State Senate Bill 2017-S5509A

Senate Bill S5509A

2017-2018 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
May 02, 2018	print number 5509a
May 02, 2018	amend and recommit to insurance
Jan 03, 2018	referred to insurance
Apr 04, 2017	referred to insurance

Bill Amendments

Original

A (Active)

co-Sponsors

2017-S5509 - Details

See Assembly Version of this Bill:: A3571
Current Committee:: Senate Insurance
Law Section:: Insurance Law
Laws Affected:: Amd §5106, Ins L
Versions Introduced in Other Legislative Sessions:: 2015-2016: S4724, A6421
2019-2020: S3003, A3053
2021-2022: A5699
2023-2024: A1541

2017-S5509 - Summary

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

2017-S5509 - Sponsor Memo

                                 BILL NUMBER:  S5509

 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
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 cost of this practice also falls on health care providers who are
being denied payment for treatments already provided to the accident
victims. Hospitals that provide emergency care in the immediate
aftermath 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 :

S.4724A/A.6421A of 2015-16; Referred to Insurance.

 FISCAL IMPLICATIONS :

None.

 EFFECTIVE DATE :
This act shall take effect immediately.

2017-S5509 - Bill Text download pdf

                            
 
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   5509
 
                        2017-2018 Regular Sessions
 
                             I N  S E N A T E
 
                               April 4, 2017
                                ___________
 
 Introduced  by  Sens.  FUNKE, GALLIVAN, GOLDEN -- read twice and ordered
   printed, and when printed to be committed to the Committee  on  Insur-
   ance
 
 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:
   § 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
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.

                                                            LBD06715-01-7

 S. 5509                             2
 
 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.
   § 2. This act shall take effect immediately.

co-Sponsors

2017-S5509A (ACTIVE) - Details

See Assembly Version of this Bill:: A3571
Current Committee:: Senate Insurance
Law Section:: Insurance Law
Laws Affected:: Amd §5106, Ins L
Versions Introduced in Other Legislative Sessions:: 2015-2016: S4724, A6421
2019-2020: S3003, A3053
2021-2022: A5699
2023-2024: A1541

2017-S5509A (ACTIVE) - Summary

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

2017-S5509A (ACTIVE) - Sponsor Memo

                                
 
BILL NUMBER: S5509A

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

 
SUMMARY OF PROVISIONS:

This legislation will allow injured accident victims to continue receiv-
ing 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 circum-
stances 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 acci-
dents. 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:

2017: Referred to Insurance
2015-16: Ordered to Third Reading

 
FISCAL IMPLICATIONS:

None.

 
EFFECTIVE DATE:
This act shall take effect immediately.

2017-S5509A (ACTIVE) - Bill Text download pdf

                            
 
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                  5509--A
 
                        2017-2018 Regular Sessions
 
                             I N  S E N A T E
 
                               April 4, 2017
                                ___________
 
 Introduced  by  Sens. FUNKE, GALLIVAN, GOLDEN, PERALTA -- read twice and
   ordered printed, and when printed to be committed to the Committee  on
   Insurance  --  recommitted to the Committee on Insurance in accordance
   with Senate Rule 6, sec. 8  --  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 by chapter 452 of the laws of 2005 and subsection (d) as amended
 by  section  8 of part AAA of chapter 59 of the laws of 2017, is amended
 to read as follows:
   § 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
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.

                                                            LBD06715-03-8

 S. 5509--A                          2
 
 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
 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) (1) Except as provided in paragraph two of this subsection,
 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 arbi-
 tration  procedures  established  pursuant  to section five thousand one
 hundred five of this article  and  regulations  as  promulgated  by  the
 superintendent,  and  any  insurer  paying first-party benefits shall be
 reimbursed by other insurers for their proportionate share of the  costs
 of  the  claim  and  the  allocated expenses of processing the claim, in
 accordance with the provisions entitled "other  coverage"  contained  in
 regulation  and  the  provisions  entitled "other sources of first-party
 benefits" contained in regulation. If there is no such insurer  and  the
 motor  vehicle accident occurs in this state, then an applicant who is a
 qualified person as defined in article fifty-two of this  chapter  shall

 S. 5509--A                          3
 
 institute  the  claim against the motor vehicle accident indemnification
 corporation.
   (2)  A  group  policy  issued  pursuant to section three thousand four
 hundred fifty-five of this chapter shall provide  first  party  benefits
 when  a  dispute  exists as to whether a driver was using or operating a
 motor vehicle in connection with a transportation network  company  when
 loss,  damage, injury, or death occurs. A transportation network company
 shall notify the insurer that issued the  owner's  policy  of  liability
 insurance of the dispute within ten business days of becoming aware that
 the  dispute  exists.  When there is a dispute, the group insurer liable
 for the payment of first party benefits under a group policy shall  have
 the  right  to  recover the amount paid from the driver's insurer to the
 extent that the driver would have been  liable  to  pay  damages  in  an
 action at law.
   § 2. This act shall take effect immediately.

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Senate Bill S5509A

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Sponsored By

Archive: Last Bill Status - In Senate Committee Insurance Committee

Bill Amendments

co-Sponsors

2017-S5509 - Details

2017-S5509 - Summary

2017-S5509 - Sponsor Memo

2017-S5509 - Bill Text download pdf

co-Sponsors

2017-S5509A (ACTIVE) - Details

2017-S5509A (ACTIVE) - Summary

2017-S5509A (ACTIVE) - Sponsor Memo

2017-S5509A (ACTIVE) - Bill Text download pdf

Comments