Senate Bill S7361

                                 
BILL NUMBER: S7361

SPONSOR: RHOADS
 
TITLE OF BILL:

An act to amend the workers' compensation law, in relation to medical
treatment for workers' compensation claimants when the workers' compen-
sation claim has been controverted

 
PURPOSE:

Relates to medical treatment for certain workers' compensation claim-
ants.

 
SUMMARY OF PROVISIONS:

Section 1. Subdivision 2 of section 25 of the workers' compensation law
is amended by adding a new paragraph (d) to read as follows: (d) (i) In
the event the employer or insurance carrier elects to controvert the
right to compensation, and it is confirmed that the claimant holds a
valid policy of insurance from a health insurance provider in effect on
the date of the injury, such employer or insurance carrier shall provide
              

medical treatment to the injured worker pursuant to the provision of
section thirteen of this chapter, and payment to health care providers
pursuant to procedures established by the board without regard to such
controversy.

(ii) In the event the board makes a final determination that the claim
is not compensable, the employer or insurance carrier may seek
reimbursement for medical bills from the claimants health insurance
provider in an amount not to exceed the actual payment made by the
claimant for such medical treatment. Within thirty days of receipt by
the health insurance provider of the medical reports, bill and proof of
payment, such health insurance provider shall reimburse the employer or
insurance carrier for the full amount of the actual payment made.

(iii) The New York compensation insurance rating board shall, no less
frequently than on an annual basis, request that insurance carriers
report the number of claims in which reimbursement is sought, the
amounts of reimbursement, and the amounts of reimbursements received.

§ This act shall take effect immediately.

 
JUSTIFICATION:

This bill ensures the provision of medical treatment to injured workers.
Currently, if an employer elects to controvert an injured worker's claim
to compensation, they do not need to provide medical treatment to the
injured worker until the board makes a final determination on the claim.
This leaves the injured workers without the ability to seek medical
treatment nor is the injured worker permitted to seek treatment through
their private health insurance or pay privately. No employee should
withhold from getting necessary medical treatment while a board deter-
mines if their employer will pay for it or not.

This bill ensures that these injured workers receive medical treatment
by mandating that the treatment is paid for by their employer, given
that the injured employee holds a valid policy of insurance at the time
of injury, without regard to the state of decision from the board. This
ensures that injured workers are treated timely and do not need to worry
about the financial burden that their injuries may cause.

The bill also allows employers to then seek reimbursement for medical
bills paid for their injured workers if the board were to determine that
the injured workers claim was not compensable. Insurance providers then
have thirty days after providing a receipt to reimburse the employer for
the full amount paid. This bill goes further by allowing employers to
retain a private right of action against the health insurance providers
if they fail to make a reimbursement payment on time. The bill further
extends its intention of protecting injured workers by stating that in
no event may the employer, carrier or health insurance provider seek
reimbursement of any kind from the injured employee, their spouse,
dependent, or estate. This will ensure that injured workers do not
neglect self-treatment in fear of retaliation or that they will someday
owe the bill.

This bill also aims to make the reimbursement procedure as transparent
as possible. At least once a year, the NYS Compensation insurance rating
board shall request that insurance carriers report the number of claims
in which reimbursement is sought, the amounts of reimbursement sought,
and the amount of reimbursement received.

 
LEGISLATIVE HISTORY:

New bill.

 
FISCAL IMPLICATIONS:

To be determined.

 
EFFECTIVE DATE:
This act shall take effect immediately.