Bill Text: NY A04657 | 2009-2010 | General Assembly | Introduced
Bill Title: An act to amend the workers' compensation law, in relation to payment of medical expenses of claimants by their health insurance carrier
Spectrum: Partisan Bill (Democrat 12-0)
Status: (Introduced - Dead) 2010-01-06 - referred to labor [A04657 Detail]
Download: New_York-2009-A04657-Introduced.html
S T A T E O F N E W Y O R K ________________________________________________________________________ 4657 2009-2010 Regular Sessions I N A S S E M B L Y February 5, 2009 ___________ Introduced by M. of A. MORELLE, PHEFFER, ENGLEBRIGHT -- Multi-Sponsored by -- M. of A. CHRISTENSEN, DelMONTE, GALEF, HOOPER, JACOBS, KOON, ORTIZ, PERRY, SCHIMMINGER -- read once and referred to the Committee on Labor AN ACT to amend the workers' compensation law, in relation to payment of medical expenses of claimants by their health insurance carrier THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM- BLY, DO ENACT AS FOLLOWS: 1 Section 1. Paragraph 1 of subdivision (d) of section 13 of the work- 2 ers' compensation law, as amended by chapter 419 of the laws of 2000, is 3 amended to read as follows: 4 (1) (I) PENDING THE OUTCOME OF A DETERMINATION AS TO THE COMPENSABILI- 5 TY OF A CLAIM, AN INSURER OR HEALTH BENEFITS PLAN SHALL MAKE PAYMENTS 6 FOR OR ON BEHALF OF THE INJURED EMPLOYEE IF SUCH PLAN WOULD OTHERWISE 7 COVER SUCH MEDICAL AND/OR HOSPITAL SERVICES. In the event that an insur- 8 er or health benefits plan makes payments for medical and/or hospital 9 services for or on behalf of an injured employee they shall be entitled 10 to be reimbursed for such payments by the carrier or employer within the 11 limits of the [medical and hospital] WORKERS' COMPENSATION fee schedules 12 if the board determines that the claim is compensable. 13 (II) IN ORDER TO RECEIVE PAYMENT UNDER THE PROVISIONS OF THIS PARA- 14 GRAPH, THE PROVIDER OF MEDICAL OR HOSPITAL SERVICES MUST FILE THE 15 BOARD'S ATTENDING DOCTOR'S REPORT (C-4 FORM) WITH THE INSURER OR HEALTH 16 BENEFITS PLAN PROVIDER, THE WORKERS' COMPENSATION INSURER OR EMPLOYER, 17 IF SELF INSURED, AND THE BOARD. 18 (III) For the purposes of this section, an insurer or health benefits 19 plan includes a medical expense indemnity corporation, a health or 20 hospital service corporation, a commercial insurance company licensed to 21 write accident and health insurance in the state of New York, a health 22 maintenance organization operating in accordance with article forty- 23 three of the insurance law or article forty-four of the public health EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD08436-01-9 A. 4657 2 1 law, or a self-insured or self-funded health care benefits plan operated 2 by, or on behalf of, any business, municipality or other entity (includ- 3 ing an employee welfare fund as defined in article forty-four of the 4 insurance law or any other union trust fund or union health benefits 5 plan). 6 (IV) Notwithstanding any other provision of law, in no event shall the 7 carrier or employer be required to reimburse the insurer or health bene- 8 fits plan in an amount greater than the amount paid for medical and 9 hospital services for or on behalf of the injured [employer] EMPLOYEE by 10 such corporation or company PLUS INTEREST, WHICH SHALL ACCRUE FROM THE 11 DATE PAYMENT IS MADE BY THE INSURER OR HEALTH BENEFITS PLAN; provided, 12 however, if the carrier or employer does not reimburse the insurer or 13 health benefits plan within thirty days after the board determines that 14 the claim is compensable, the carrier or employer shall reimburse the 15 insurer or health benefits plan at the amount the carrier or employer 16 would be obligated to reimburse the hospital or other provider of 17 medical services if the carrier or employer made payment directly to the 18 provider of medical and/or hospital services pursuant to this chapter 19 (or, in the case of inpatient hospital services, pursuant to paragraphs 20 (b) and (b-1) of subdivision one of section twenty-eight hundred seven-c 21 of the public health law) PLUS INTEREST, WHICH SHALL ACCRUE FROM THE 22 DATE PAYMENT IS MADE BY THE INSURER OR HEALTH BENEFITS PLAN. Upon 23 reimbursement to the insurer or health benefits plan pursuant to this 24 subdivision, the carrier or employer shall be relieved of liability for 25 the medical and/or hospital services for which payment has been made by 26 the insurer or health benefits plan. FOR PURPOSES OF THIS PARAGRAPH, 27 INTEREST SHALL MEAN SIMPLE INTEREST AT THE FEDERAL FUNDS MARKET RATE AT 28 CLOSE ON THE DATE SUCH PAYMENT IS MADE BY THE INSURER OR HEALTH BENEFIT 29 PLAN. 30 (V) NOTWITHSTANDING ANY OTHER PROVISION OF LAW, AN INJURED EMPLOYEE 31 SHALL BE PROMPTLY REIMBURSED FOR ALL COSTS INCURRED PROVIDED THAT SUCH 32 COSTS WOULD HAVE BEEN OTHERWISE REIMBURSABLE UNDER THIS CHAPTER BUT FOR 33 THE FACT THAT THE CLAIM FOR BENEFITS WAS CONTROVERTED. 34 S 2. This act shall take effect immediately and shall apply to work- 35 ers' compensation claims denied on or after such effective date.