S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   5699
 
                        2021-2022 Regular Sessions
 
                           I N  A S S E M B L Y
 
                             February 24, 2021
                                ___________
 
 Introduced  by  M.  of A. JOYNER, AUBRY -- read once and referred 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 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
 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.
              

                                                            LBD03914-01-1

 A. 5699                             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) (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
 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

 A. 5699                             3
 
 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.