S T A T E   O F   N E W   Y O R K
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                                  2712

                       2011-2012 Regular Sessions

                          I N  A S S E M B L Y

                            January 20, 2011
                               ___________

Introduced  by  M.  of  A. BING, PAULIN, SWEENEY, JAFFEE, GALEF, REILLY,
  CAHILL, CASTRO, SCHIMEL, N. RIVERA -- Multi-Sponsored by -- M.  of  A.
  COOK,  GABRYSZAK,  GLICK, GOTTFRIED, GUNTHER, MAGEE, M. MILLER, PERRY,
  PHEFFER, SPANO -- read once and referred to the Committee on Insurance

AN ACT to amend the insurance law, in relation to settlement of claims

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

  Section  1.  Subsection (a) of section 3224-a of the insurance law, as
amended by chapter 237 of the laws  of  2009,  is  amended  to  read  as
follows:
  (a)  Except  in a case where the obligation of an insurer or an organ-
ization or corporation licensed or certified pursuant to article  forty-
three or forty-seven of this chapter or article forty-four of the public
health  law to pay a claim submitted by a policyholder or person covered
under such policy ("covered person") or make a payment to a health  care
provider  is  not  reasonably clear, or when there is a reasonable basis
supported by specific information available for  review  by  the  super-
intendent  that such claim or bill for health care services rendered was
submitted fraudulently, such  insurer  or  organization  or  corporation
shall  pay  the  claim  to  a  policyholder  or covered person or make a
payment to a health  care  provider  within  [thirty]  FIFTEEN  days  of
receipt of a claim or bill for services rendered that is transmitted via
the  internet or electronic mail, or [forty-five] THIRTY days of receipt
of a claim or bill for services rendered  that  is  submitted  by  other
means, such as paper or facsimile.
  S  2.  Subsection (a) of section 2406 of the insurance law, as amended
by chapter 666 of the laws of 1997, is amended to read as follows:
  (a) If the hearing was on a charge of a defined violation  the  super-
intendent  shall  make  an  order  on his report and serve a copy of the
findings and order upon the person charged with the  violation  and  any
intervenor.  If  the  superintendent finds that the person complained of

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD07479-01-1
              

A. 2712                             2

has engaged in a defined violation, the order shall require  the  person
to  cease  and desist from engaging in such defined violation.  Further-
more, if the superintendent finds, after notice and  hearing,  that  the
person  complained  of has engaged in an act prohibited by section three
thousand two hundred twenty-four-a of this chapter,  the  superintendent
[is  authorized to] SHALL levy a civil penalty against such person in an
amount up to TWO THOUSAND five hundred dollars  per  day  for  each  day
beyond  the  date that a bill or claim was to be processed in accordance
with section three thousand two hundred twenty-four-a of this  chapter[,
but in no event shall such penalty exceed five thousand dollars].
  S  3.  This  act shall take effect on the ninetieth day after it shall
have become a law.