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

                                  4657

                       2009-2010 Regular Sessions

                          I N  A S S E M B L Y

                            February 5, 2009
                               ___________

Introduced  by M. of A. MORELLE, PHEFFER, ENGLEBRIGHT -- Multi-Sponsored
  by -- M. of A.  CHRISTENSEN, DelMONTE, GALEF,  HOOPER,  JACOBS,  KOON,
  ORTIZ,  PERRY,  SCHIMMINGER -- read once and referred to the Committee
  on Labor

AN ACT to amend the workers' compensation law, in relation to payment of
  medical expenses of claimants by their health insurance carrier

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

  Section  1.  Paragraph 1 of subdivision (d) of section 13 of the work-
ers' compensation law, as amended by chapter 419 of the laws of 2000, is
amended to read as follows:
  (1) (I) PENDING THE OUTCOME OF A DETERMINATION AS TO THE COMPENSABILI-
TY OF A CLAIM, AN INSURER OR HEALTH BENEFITS PLAN  SHALL  MAKE  PAYMENTS
FOR  OR  ON  BEHALF OF THE INJURED EMPLOYEE IF SUCH PLAN WOULD OTHERWISE
COVER SUCH MEDICAL AND/OR HOSPITAL SERVICES. In the event that an insur-
er or health benefits plan makes payments for  medical  and/or  hospital
services  for or on behalf of an injured employee they shall be entitled
to be reimbursed for such payments by the carrier or employer within the
limits of the [medical and hospital] WORKERS' COMPENSATION fee schedules
if the board determines that the claim is compensable.
  (II) IN ORDER TO RECEIVE PAYMENT UNDER THE PROVISIONS  OF  THIS  PARA-
GRAPH,  THE  PROVIDER  OF  MEDICAL  OR  HOSPITAL  SERVICES MUST FILE THE
BOARD'S ATTENDING DOCTOR'S REPORT (C-4 FORM) WITH THE INSURER OR  HEALTH
BENEFITS  PLAN  PROVIDER, THE WORKERS' COMPENSATION INSURER OR EMPLOYER,
IF SELF INSURED, AND THE BOARD.
  (III) For the purposes of this section, an insurer or health  benefits
plan  includes  a  medical  expense  indemnity  corporation, a health or
hospital service corporation, a commercial insurance company licensed to
write accident and health insurance in the state of New York,  a  health
maintenance  organization  operating  in  accordance with article forty-
three of the insurance law or article forty-four of  the  public  health

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD08436-01-9
              

A. 4657                             2

law, or a self-insured or self-funded health care benefits plan operated
by, or on behalf of, any business, municipality or other entity (includ-
ing  an  employee  welfare  fund as defined in article forty-four of the
insurance  law  or  any  other union trust fund or union health benefits
plan).
  (IV) Notwithstanding any other provision of law, in no event shall the
carrier or employer be required to reimburse the insurer or health bene-
fits plan in an amount greater than the  amount  paid  for  medical  and
hospital services for or on behalf of the injured [employer] EMPLOYEE by
such  corporation  or company PLUS INTEREST, WHICH SHALL ACCRUE FROM THE
DATE PAYMENT IS MADE BY THE INSURER OR HEALTH BENEFITS  PLAN;  provided,
however,  if  the  carrier or employer does not reimburse the insurer or
health benefits plan within thirty days after the board determines  that
the  claim  is  compensable, the carrier or employer shall reimburse the
insurer or health benefits plan at the amount the  carrier  or  employer
would  be  obligated  to  reimburse  the  hospital  or other provider of
medical services if the carrier or employer made payment directly to the
provider of medical and/or hospital services pursuant  to  this  chapter
(or,  in the case of inpatient hospital services, pursuant to paragraphs
(b) and (b-1) of subdivision one of section twenty-eight hundred seven-c
of the public health law) PLUS INTEREST, WHICH  SHALL  ACCRUE  FROM  THE
DATE  PAYMENT  IS  MADE  BY  THE INSURER OR HEALTH BENEFITS PLAN.   Upon
reimbursement to the insurer or health benefits plan  pursuant  to  this
subdivision,  the carrier or employer shall be relieved of liability for
the medical and/or hospital services for which payment has been made  by
the  insurer  or  health benefits plan.  FOR PURPOSES OF THIS PARAGRAPH,
INTEREST SHALL MEAN SIMPLE INTEREST AT THE FEDERAL FUNDS MARKET RATE  AT
CLOSE  ON THE DATE SUCH PAYMENT IS MADE BY THE INSURER OR HEALTH BENEFIT
PLAN.
  (V) NOTWITHSTANDING ANY OTHER PROVISION OF LAW,  AN  INJURED  EMPLOYEE
SHALL  BE  PROMPTLY REIMBURSED FOR ALL COSTS INCURRED PROVIDED THAT SUCH
COSTS WOULD HAVE BEEN OTHERWISE REIMBURSABLE UNDER THIS CHAPTER BUT  FOR
THE FACT THAT THE CLAIM FOR BENEFITS WAS CONTROVERTED.
  S  2.  This act shall take effect immediately and shall apply to work-
ers' compensation claims denied on or after such effective date.