BILL NUMBER:S8246

TITLE OF BILL:

An act
to amend the insurance law, in relation to medical proof in no-fault
actions, and provides for the repeal of such provisions
upon expiration thereof

PURPOSE:

This bill expedites the efficiency in which No-Fault cases are handled
by the New York City Civil Court system. This bill will allow the New
York City Civil Court system to try four times as many legitimate
cases by relaxing the rules of evidence and therefore relieving the
dockets.

SUMMARY OF PROVISIONS:

Section 1: Medical proof in no-fault actions. A party who initiates an
action which seeks reimbursement for medical treatment, testing, or
supplies pursuant to section 5106 of the insurance law, shall at
trial, submit the sworn statement of the licensed medical
professional that rendered, prescribed or ordered the medical
treatment on the issue(s) of medical necessity or a sworn statement
from a representative that the claimed services had been billed in
              

accordance with the workers compensation fee schedule pursuant to
section 5108 of the insurance law.

The licensed medical professional shall affirm that no-fault benefits
were duly assigned to the plaintiff, the claimed treatment, testing
or supplies were rendered, prescribed or ordered by the plaintiff,
medically necessary to treat accident related injuries and shall
include the material facts and documents upon which the opinion of
medical necessity was based; or, the representative shall include the
relevant sections of the fee schedule and the material facts and
documents that support the claimed services were billed in accordance
with the fee schedule. Submission of such sworn statement does not
create a presumption of medical necessity or provide greater
deference to the treating medical professional or adherence to the
fee schedule.

A party opposing said action may submit a sworn statement on the
issue(s) of medical necessity or that the claimed services were not
billed in accordance with the workers compensation fee schedule
pursuant to section 5108 of the insurance law. Such statement shall
include the material facts and/or documents upon which that opinion
was based.

A copy of the sworn statement(s) shall be furnished to all parties no
later than the time the statement is submitted to the court. The

sworn statement shall be accepted by the court in lieu of testimony
unless, after submission of the sworn statement, the court determines
that it wishes to
hear testimony wherein the court shall then direct that all parties
submitting a sworn statement shall have that person appear and
testify in person.

This act shall take effect immediately and shall apply to all actions
and proceedings commenced on or after such date and shall also apply
to any action or proceeding which was commenced prior to such
effective date where, as of such date, either (a) a trial of the
issues has not yet commenced, or (b) the parties have not yet entered
into a stipulation of settlement. This act shall expire December 31,
2016.

EXISTING LAW:
Current law and practice, when defending at trial, the No-Fault
insurer must produce an expert to testify as to the basis for denying
payment of medical and other health-related bills.

LEGISLATIVE HISTORY:
This is a new bill.

JUSTIFICATION:
Under the current law, when defending at trial, the No-Fault insurer
must produce an expert to testify as to the basis for denying payment
of medical and other health-related bills. There are not enough
resources for all the No-Fault medical provider cases to be heard in
a venue on the scheduled trial date.

During the last two years civil filings have increased by 25% in the
New York City Civil Courts. By October of 2009 alone, there were over
225,000 No-Fault medical provider claims filed in the NYC Civil Court
and it is projected by the end of 2009 there will be 257,000 cases
filed. These No-Fault cases only involve the insurance carriers and
the medical providers. The NYC Civil Court is where individual
litigants go to resolve their everyday civil legal problems.
Whether you are a local merchant, a consumer, a debtor, or a creditor,
the Civil Court is where you go to have a legal matter resolved.
Unfortunately, since the No-Fault cases account for at least 41.1%
of the cases in the NYC Civil Court most of the court resources are
tied up in No-Fault matters. The cases for the individual litigants
will be heard quicker and more efficiently when this proposed bill is
passed.

The court's resources are currently funneled into the No-Fault Civil
Courtrooms in an attempt to manage the daily dockets. The NYC Civil
Court's workload has more than doubled since 2001 and will only
continue to grow as a result of the mounting No-Fault cases.

In 2008 approximately $18,677,383 of the $54,529,232 NYC Civil Court
budget was allocated to the ever growing No-Fault cases. The NYC

Civil Court 2007-2008 budget request stated that the "civil caseload
increased dramatically in recent years, with over 150,000 No-Fault
insurance claims a major contributor... the request also includes
$500,000 to support judicial hearing officers, some of whom are
dedicated to handling the over 150,000 No-Fault insurance cases which
account for the largest component of the workload."

To manage the Court's No-Fault caseload in 2009 the amount allocated
was approximately $23,765,958 of the $57,824,715 NYC Civil Court
budget. The 2008-2009 NYC
Civil Court budget request stated that the budget increase was due to
the No-Fault cases. "The most dramatic workload increase in City and
District Courts has occurred in the Civil Court due to the growth in
no-fault cases...in the past year, the civil workload grew by 28
percent and has more than doubled since 2001. To assist in managing
this voluminous caseload, additional staffing was provided in 2006
through relaxation of hiring controls. Also, the 2008-09 request
continues the use of judicial hearing officers and back-office
over-time."

The Judiciary budget request continues to include the need for
increases in staff and overtime to assist in managing the
unprecedented growth in the No-Fault medical provider caseload every
year. The 2009-2010 NYC Civil Court Budget Request states that "civil
caseload has increased dramatically in recent years; in the past two
years alone, civil filings increased by 24% statewide and by 25% in
New York City Civil Court. No-fault insurance claims are a major
contributor to this growth.. .The growth of no-fault cases is most
evident in the New York City Civil Court, which receives over 225,000
no-fault filings a year."

The influx of the Personal Injury Protection (No-Fault) suits is
hindering the NYC Civil Courts' efforts to adjudicate the suits on
their individual merits. During today's cost cutting economic
environment, deserving courts such as the Family Courts which serve
the neediest in society lose resources to the NYC Civil Courts'
No-Fault caseloads.

New York State's courts are closing 2009 with 4.7 million cases, the
highest tally ever according to the December 28, 2009 New York Times
article The Recession Begins Flooding Into the Courts. The court
dockets are overloaded and people are seeing more and more delays in
their cases. Even though the number of cases continues to rise the
courts are being forced to do a lot more with a lot less.

By the end of 2009 the NYC Civil Court No-Fault medical provider cases
will cost $23,777,640 for the Court to maintain and New York
insurance to defend with witnesses.

The amendment would allow any party to an action for money, which
seeks reimbursement for medical treatment, services, supplies, or
testing pursuant to Article 51 of the insurance law to submit, at

trial, the sworn statement of a licensed medical professional on the
issue of the necessity of the medical treatment, services, supplies,
or testing. Such statement shall state the opinion of the medical
professional and the material facts upon which that opinion is based.
A copy of the sworn statement shall be furnished to all parties no
later than the time the statement is submitted to the court. The
sworn statement shall be accepted by the court in lieu of testimony
by the medical professional. The use of a sworn statement in lieu of
Jive testimony shall not give rise to any adverse inference
concerning the lack of live testimony of the licensed medical
professional.

The proposed bill will help save the courts millions of dollars by
eliminating the need for redundant court appearances, the filing of
unnecessary papers and briefs, and the delays caused by courthouse
backlogs and inefficiencies due to the numerous No-Fault cases.

This minor change to the rules of evidence in No-Fault matters will
allow the courts to adjudicate the cases on their merits while moving
the cases off the court's docket at four times the current pace.

The current state of extended adjournments, in every venue,
exacerbates the costs to maintain the Court's caseload to an
unbelievable level considering the number of No-Fault cases initiated
each year.

The resulting quicker pace will save the courts millions of dollars by
shortening the length of time the court must house a case and
therefore eliminate the need for increase of staff and overtime pay.

BUDGET IMPLICATIONS:

EFFECTIVE DATE:
This bill shall take effect immediately.