S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   1541
 
                        2023-2024 Regular Sessions
 
                           I N  A S S E M B L Y
 
                             January 17, 2023
                                ___________
 
 Introduced by M. of A. JOYNER -- 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, subsection (d) as amended by
 section  8 of part AAA of chapter 59 of the laws of 2017 and paragraph 2
 of subsection (d) as amended by chapter 129 of  the  laws  of  2022,  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.
                                                            LBD05394-01-3
              

 A. 1541                             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. 1541                             3
 
   (2) A group policy issued pursuant  to  section  three  thousand  four
 hundred  fifty-five  or  three thousand four hundred fifty-eight 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  or  peer-to-peer  car sharing
 program when loss, damage, injury, or  death  occurs.  A  transportation
 network  company or peer-to-peer car sharing program administrator 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 or in the
 case of a peer-to-peer car sharing program, the shared  vehicle  owner'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.