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.