|Assembly Actions - Lowercase
Senate Actions - UPPERCASE
|Jan 08, 2014||referred to insurance|
|Feb 05, 2013||referred to insurance|
senate Bill S3538
Archive: Last Bill Status - In Senate Committee Insurance Committee
- In Committee
- On Floor Calendar
- Passed Senate
- Passed Assembly
- Delivered to Governor
- Signed/Vetoed by Governor
S3538 (ACTIVE) - Details
S3538 (ACTIVE) - Summary
Enacts provisions relating to comprehensive motor vehicle reparations; provides for limited assignment of benefits; preclusion lift; burden of proof shift… (view more) mandatory arbitration; provider decertification; and treatment guidelines.
S3538 (ACTIVE) - Sponsor Memo
BILL NUMBER:S3538 TITLE OF BILL: An act to amend the insurance law, in relation to comprehensive motor vehicle reparations PURPOSE: To enact comprehensive reforms to reduce fraud, abuse and the associated costs in the New York no-fault system SUMMARY OF PROVISIONS: Section 1 of the bill amends section 5102 of the insurance law to define "health service provider". Section 2 of the bill amends section 5106(a) of the insurance law to clarify that preclusion of defenses to a claim is not the penalty for late paid or denied claims and would make burden of proof requirements more equitable. Current law provides that claims for benefits must be paid or denied within 30 days of receipt and provides for substantial interest (2% per month) as a penalty for the failure of an insurer to meet that standard This provision is intended to ensure the insurers' prompt payment of meritorious claims Case law has added an additional penalty, i.e., that the insurer is precluded from denying a non-meritorious claim, or asserting any defense if it has violated the "30-day rule," thereby mandating the payment of excessive and even fraudulent claims. This section would ensure that insurers are not forced to pay non-metitorious claims by providing that interest would be the exclusive remedy when an
S3538 (ACTIVE) - Bill Text download pdf
S T A T E O F N E W Y O R K ________________________________________________________________________ 3538 2013-2014 Regular Sessions I N S E N A T E February 5, 2013 ___________ Introduced by Sen. SEWARD -- read twice and ordered printed, and when printed to be committed to the Committee on Insurance AN ACT to amend the insurance law, in relation to comprehensive motor vehicle reparations THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM- BLY, DO ENACT AS FOLLOWS: Section 1. Section 5102 of the insurance law is amended by adding a new subsection (n) to read as follows: (N) "HEALTH SERVICE PROVIDER" MEANS ANY MEDICAL PROVIDER THAT SUBMITS A BILL FOR PAYMENT UNDER BENEFITS DEFINED AND PROVIDED BY THIS SECTION FOR ANY OF THE FOLLOWING: (1) MEDICAL, HOSPITAL (INCLUDING SERVICES RENDERED IN COMPLIANCE WITH ARTICLE FORTY-ONE OF THE PUBLIC HEALTH LAW, WHETHER OR NOT SUCH SERVICES ARE RENDERED DIRECTLY BY A HOSPITAL), SURGICAL, NURSING, DENTAL, AMBU- LANCE, X-RAY, PRESCRIPTION DRUG AND PROSTHETIC SERVICES; (2) PSYCHIATRIC, PHYSICAL THERAPY (PROVIDED THAT TREATMENT IS RENDERED PURSUANT TO A REFERRAL) AND OCCUPATIONAL THERAPY AND REHABILITATION; (3) ANY NONMEDICAL REMEDIAL CARE AND TREATMENT RENDERED IN ACCORDANCE WITH A RELIGIOUS METHOD OF HEALING RECOGNIZED BY THE LAWS OF THIS STATE; AND (4) ANY OTHER PROFESSIONAL HEALTH SERVICES. S 2. Subsection (a) of section 5106 of the insurance law is amended by adding two new undesignated paragraphs to read as follows: PAYMENT OF THE INTEREST PENALTY AND REASONABLE ATTORNEY FEES TO A CLAIMANT WHEN PAYMENT OF A CLAIM IS OVERDUE SHALL BE THE EXCLUSIVE REME- DY WHEN AN INSURER FAILS TO MAKE TIMELY PAYMENT. THE FAILURE OF AN INSURER TO MAKE TIMELY PAYMENT OR ISSUE A DENIAL WITHIN THIRTY DAYS AFTER PROOF OF CLAIM HAS BEEN SUBMITTED TO AN INSURER SHALL NOT PRECLUDE SUCH INSURER FROM ISSUING A DENIAL OR ASSERTING A DEFENSE AFTER THE THIRTY DAY PERIOD HAS ELAPSED. EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD08119-01-3
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