S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   3053
 
                        2019-2020 Regular Sessions
 
                           I N  A S S E M B L Y
 
                             January 28, 2019
                                ___________
 
 Introduced  by M. of A. JOYNER, GOTTFRIED, ENGLEBRIGHT, DINOWITZ, AUBRY,
   PERRY -- Multi-Sponsored by -- M. of A. BLAKE, BUCHWALD, COOK,  HEVESI
   -- read once and referred to the Committee on Insurance
 
 AN ACT to amend the insurance law, in relation to verification of claims
   made under the comprehensive motor vehicle insurance reparations act

   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. Section 5106  of  the  insurance  law,  subsection  (b)  as
 amended by chapter 452 of the laws of 2005 and subsection (d) as amended
 by  section  8 of part AAA of chapter 59 of the laws of 2017, is amended
 to read as follows:
   § 5106. Fair claims settlement. (a) Payments of first  party  benefits
 and  additional  first  party  benefits  shall  be  made  as the loss is
 incurred.  Such benefits are overdue if  not  paid  within  thirty  days
 after  the  claimant  supplies  proof  of  the  fact  and amount of loss
 sustained. If proof is not supplied as to the entire claim,  the  amount
 which  is  supported  by proof is overdue if not paid within thirty days
 after such proof is supplied. All overdue payments shall  bear  interest
 at  the  rate  of two percent per month. If a valid claim or portion was
 overdue, the claimant shall also be entitled to recover  his  attorney's
 reasonable  fee,  for  services necessarily performed in connection with
 securing payment of the overdue claim, subject to limitations promulgat-
 ed by the superintendent in regulations.
   (b) THE INSURER IS ENTITLED TO RECEIVE ALL ITEMS NECESSARY  TO  VERIFY
 THE  CLAIM,  INCLUDING MEDICAL EXAMINATION AND EXAMINATION UNDER OATH OF
 THE INJURED PARTY OR ANY ADDITIONAL VERIFICATION REQUIRED BY THE INSURER
 TO ESTABLISH PROOF OF CLAIM. THE FAILURE OF THE INJURED PARTY TO  APPEAR
 FOR  A  SCHEDULED  MEDICAL  EXAMINATION  OR EXAMINATION UNDER OATH OR TO
 PROVIDE ANY OTHER ADDITIONAL VERIFICATION  SHALL  NEITHER  BE  A  POLICY
 VIOLATION  NOR  BE  UTILIZED  AS  THE BASIS FOR THE DENIAL OF A CLAIM OR
 DISCLAIMER, PROVIDED THE INJURED PARTY SUBMITS TO  THE  INSURER  WRITTEN
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
              

                                                            LBD00273-01-9

 A. 3053                             2
 
 PROOF  OFFERING  EITHER  (1) REASONABLE JUSTIFICATION FOR THE FAILURE TO
 COMPLY; OR (2) A DEMONSTRABLE WILLINGNESS TO COMPLY WITHIN THIRTY CALEN-
 DAR DAYS FROM THE DATE OF THE INJURED PARTY'S FAILURE TO APPEAR OR OTHER
 VERIFICATION  BECOMES  OVERDUE.  IF  SUCH  WRITTEN PROOF IS NOT PROVIDED
 WITHIN A REASONABLE TIME PERIOD, THE INSURER MAY ONLY DENY THAT  PORTION
 OF  THE  CLAIM  FOR WHICH THE REQUESTED MEDICAL EXAMINATION, EXAMINATION
 UNDER OATH OR ADDITIONAL VERIFICATION WAS REQUIRED AS PROOF OF THE  FACT
 AND  AMOUNT  OF  LOSS  SUSTAINED.  IN  NO EVENT SHALL THE FAILURE OF THE
 INJURED PARTY TO APPEAR FOR A SCHEDULED MEDICAL EXAMINATION OR  EXAMINA-
 TION UNDER OATH OR TO PROVIDE ANY OTHER ADDITIONAL VERIFICATION SERVE AS
 THE BASIS FOR THE DENIAL OF THAT PORTION OF A CLAIM RELATING TO EMERGEN-
 CY MEDICAL CARE PROVIDED WITHIN FORTY-EIGHT HOURS OF AN ACCIDENT.
   (C)  Every insurer shall provide a claimant with the option of submit-
 ting any dispute involving the insurer's liability to  pay  first  party
 benefits,  or additional first party benefits, the amount thereof or any
 other matter which may arise pursuant to subsection (a) of this  section
 to  arbitration  pursuant  to simplified procedures to be promulgated or
 approved by the superintendent. Such simplified procedures shall include
 an expedited eligibility hearing option, when required, to designate the
 insurer for first party benefits pursuant to  subsection  [(d)]  (E)  of
 this  section. The expedited eligibility hearing option shall be a forum
 for eligibility disputes only, and shall not include the  submission  of
 any particular bill, payment or claim for any specific benefit for adju-
 dication, nor shall it consider any other defense to payment.
   [(c)]  (D)  An  award  by  an arbitrator shall be binding except where
 vacated or modified by a master arbitrator in accordance with simplified
 procedures to be promulgated or  approved  by  the  superintendent.  The
 grounds  for  vacating  or  modifying  an arbitrator's award by a master
 arbitrator shall not be limited to those grounds for review set forth in
 article seventy-five of the civil practice law and rules. The award of a
 master arbitrator shall be binding except for the grounds for review set
 forth in article seventy-five of the civil practice law and  rules,  and
 provided further that where the amount of such master arbitrator's award
 is  five  thousand  dollars or greater, exclusive of interest and attor-
 ney's fees, the insurer or the claimant may institute a court action  to
 adjudicate the dispute de novo.
   [(d)]  (E) (1) Except as provided in paragraph two of this subsection,
 where there is reasonable belief more than  one  insurer  would  be  the
 source of first party benefits, the insurers may agree among themselves,
 if there is a valid basis therefor, that one of them will accept and pay
 the  claim  initially.  If  there  is  no such agreement, then the first
 insurer to whom notice of  claim  is  given  shall  be  responsible  for
 payment. Any such dispute shall be resolved in accordance with the arbi-
 tration  procedures  established  pursuant  to section five thousand one
 hundred five of this article  and  regulations  as  promulgated  by  the
 superintendent,  and  any  insurer  paying first-party benefits shall be
 reimbursed by other insurers for their proportionate share of the  costs
 of  the  claim  and  the  allocated expenses of processing the claim, in
 accordance with the provisions entitled "other  coverage"  contained  in
 regulation  and  the  provisions  entitled "other sources of first-party
 benefits" contained in regulation. If there is no such insurer  and  the
 motor  vehicle accident occurs in this state, then an applicant who is a
 qualified person as defined in article fifty-two of this  chapter  shall
 institute  the  claim against the motor vehicle accident indemnification
 corporation.

 A. 3053                             3
 
   (2) A group policy issued pursuant  to  section  three  thousand  four
 hundred  fifty-five  of  this chapter shall provide first party benefits
 when a dispute exists as to whether a driver was using  or  operating  a
 motor  vehicle  in connection with a transportation network company when
 loss,  damage, injury, or death occurs. A transportation network company
 shall notify the insurer that issued the  owner's  policy  of  liability
 insurance of the dispute within ten business days of becoming aware that
 the  dispute  exists.  When there is a dispute, the group insurer liable
 for the payment of first party benefits under a group policy shall  have
 the  right  to  recover the amount paid from the driver's insurer to the
 extent that the driver would have been  liable  to  pay  damages  in  an
 action at law.
   § 2. This act shall take effect immediately.