Source: https://www.nysenate.gov/legislation/bills/2019/S3515
Timestamp: 2019-04-26 10:36:04
Document Index: 368898965

Matched Legal Cases: ['§ 2', '§  3', '§ 4', '§ 5110', '§ 5', '§  5109', '§ 6', '§ 5108', '§ 7', '§ 8', '§ 9']

NY State Senate Bill S3515
senate Bill S3515
Get Status Alerts for S3515
S3515 (ACTIVE) - Details
S3515 (ACTIVE) - Summary
S3515 (ACTIVE) - Sponsor Memo
BILL NUMBER: S3515
To enact comprehensive reforms to reduce fraud, abuse and the associated
costs in the New York no-fault system.
Section 1 of the bill amends section 5102 of the insurance law to define
"health service provider".
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-meritorious
claims by providing that interest would be the exclusive remedy when an
insurer fails to issue a timely payment or denial of claim and that
insurers' defenses, such as a lack coverage or fraud, would not be
proof entirely to the insurer to the point whereby a medical provider
(as an "assignee" under an "assignment of benefits") needs only to
provide a bill to establish a claim for benefits. The burden is on the
insurer to request information to "verify" that the services billed for
are medically necessary and in accordance with the no-fault law.
Frequently, a lengthy exchange of paperwork ensues.  This section would
by requiring the medical provider to present information that the
services billed are medically necessary and billed in accordance with
the applicable fee schedule.
no-fault cases are filed annually in the New York City courts. The court
system is not equipped to handle the pending caseload. It currently
takes between eighteen and thirty-six months to adjudicate a no-fault
case. Obviously, this protracted delay was not contemplated by the
legislature when they originally enacted the no-fault system which was
intended to ensure prompt payment for medical costs resulting from auto
accidents. Mandating arbitration for no-fault claims would provide for
the expeditious and streamlined resolution of no-fault disputes and
would reduce the excessive litigation which is currently clogging courts
in New York City.  Unlike the court system, it currently takes only four
Mandating arbitration would also greatly reduce litigation expenses for
insurers and would significantly reduce costs in the no-fault system.
a document, the patient/claimant authorizes the medical provider to
the claim and receive benefits directly from the insurer on behalf of
the patient. The provider does not receive a right to sue any third
party independently; that right remains with the patient/claimant.
commonly used, in that it assigns "all rights and privileges and reme-
dies" to the provider to pursue benefits under the no-fault law. This
allows the provider "assignee" the right to contest all issues, includ-
ing "policy" issues such as coverage eligibility and the
as attending independent medical examinations or examinations under
oath. The result is a huge amount of litigation, instigated by the
providers/assignees with little or no involvement from the injured
right to contest denials of claims involving policy issues would belong
to the claimant only and the assignment would not be valid when coverage
or compliance with policy terms is in dispute.
current provisions authorizing the decertification of medical providers
who engage in fraud and certain other practices from receiving payment
under no-fault so as to allow for the implementation of these
provisions. The existing law authorizing the decertification of medical
payment under the no-fault system has not been implemented due to the
so that the Insurance Department is authorized to review and decertify
unscrupulous medical providers from billing and collecting no-fault
Sections 6 and 7 of the bill amend sections 5108 and 5106 of the insur-
ance law, respectively, to provide for the use of treatment guidelines
in the no-fault system. Treatment guidelines have been adopted in New
York for the workers compensation system and are a valuable tool in
preventing the fraudulent overutilization of unnecessary medical treat-
ments. This section would also prohibit insurers from paying any charge
which exceeds the applicable fee schedule or which is not provided for
the payment proceeds or identity of the policyholder were stolen. It is
common for those engaging in fraud to take out a policy without paying
the premium and with the sole purpose of engaging in insurance fraud.
They will then quickly stage an accident and bill the insurer for frau-
those treatments. When a policy is taken out fraudulently, an insurer
New York's no fault system is plagued by fraud and abuse which is adding
significant costs to auto premiums in New York and a major contributing
factor making New Yorkers pay among the highest auto insurance premiums
in the nation. In fact, a recent Insurance Research Council study found
that in the New York City area, about one in every five no-fault auto
insurance claims closed in 2010 appear to have elements of fraud. In
addition, New York's no-fault claim costs have far outpaced that of
other no-fault states and the overall cost of medical care. From 2004
through the 2nd Quarter of 2010, the average PIP claim cost rose 60.4
percent in New York, nearly 42 points faster than the 18.6 percent
growth rate in the Consumer Price Index cost of medical goods and
services found in the region. The cost of no-fault personal injury
protection (PIP) coverage has also soared. New York's average no-fault
ter 2010. In order to address this rampant fraud and abuse problem and
reduce no-fault costs, comprehensive reform is necessary. This bill
includes a number of important reforms that will give insurers the tools
that they need to fight fraud and abuse and reduce no-fault costs.
Honest New York drivers should not have to pay the price for those that
S.781 of 2018
S.1758 of 2015-16;
S.3538 of 2013-14;
S.2816-A of 2011-12
This act shall take effect immediately and shall apply to all actions
and proceedings commenced on or after such date; and shall also apply to
any action or proceeding which was commenced prior to such effective
date where, as of such date, a trial of the issues has not yet
S3515 (ACTIVE) - Bill Text download pdf
Introduced  by  Sens. BRESLIN, SEWARD -- read twice and ordered printed,
§ 2. Subsection (a) of section 5106 of the insurance law is amended by
LBD09656-01-9
§  3.  Subsection (b) of section 5106 of the insurance law, as amended
§ 4. The insurance law is amended by adding a new section 5110 to read
§ 5110. ASSIGNMENT OF BENEFITS TO  HEALTH  SERVICE  PROVIDERS.  (A)  A
§ 5. Section 5109 of the insurance law, as added by chapter 423 of the
§  5109.  Unauthorized  providers  of health services. (a) [The super-
(b)  The  [commissioner  of  health  and the commissioner of education
under this article because such] SUPERINTENDENT MAY PROHIBIT A  provider
of  health  services  FROM  DEMANDING  OR  REQUESTING PAYMENT FOR HEALTH
SERVICES RENDERED UNDER THIS ARTICLE, FOR A PERIOD NOT  EXCEEDING  THREE
YEARS,  IF  THE  SUPERINTENDENT  DETERMINES, AFTER NOTICE AND A HEARING,
THAT THE PROVIDER OF HEALTH SERVICES:
§ 6. Section 5108 of the insurance law is amended to read as follows:
§ 5108. Limit on charges by providers  of  health  services.  (a)  The
§ 7. Section 5106 of the insurance law is  amended  by  adding  a  new
§ 8. Subsection (b) of section 3425 of the insurance law is amended by
§ 9. This act shall take effect immediately and  shall  apply  to  all