Requires that insurers providing no-fault coverage reimburse other insurers for the payment of claims to providers which should have been covered by a no-fault insurer.
STATE OF NEW YORK
________________________________________________________________________
6360
2025-2026 Regular Sessions
IN ASSEMBLY
March 4, 2025
___________
Introduced by M. of A. SEPTIMO, BORES, KELLES, SIMON, SIMONE, PAULIN --
read once and referred to the Committee on Insurance
AN ACT to amend the insurance law, in relation to the coordination of
no-fault benefits for persons injured in motor vehicle accidents
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. The insurance law is amended by adding a new section 5110
2 to read as follows:
3 § 5110. Payment for services provided for motor vehicle injuries. 1.
4 Any provider of treatment to any covered person, who renders care or
5 supplies a product within seventy-two hours of the motor vehicle acci-
6 dent, in the absence of fraud or deception by the claimant, is conclu-
7 sively presumed to have accepted, and to have consented to, an assign-
8 ment of no-fault benefits under this article in the form prescribed by
9 the superintendent. The provisions of this subdivision shall apply if
10 the provider knows, or is on notice of facts that indicate that the
11 injuries or conditions treated are the result of a motor vehicle acci-
12 dent which occurred in the preceding seventy-two hours.
13 2. Any provider of treatment to a covered person who mistakenly or
14 otherwise bills an insurer other than the no-fault insurer for claims
15 eligible for first-party benefits under this article must, upon presen-
16 tation with proof of applicable coverage under article six, eight or
17 forty-four-B of the vehicle and traffic law, return such fees and seek
18 payment for services from the no-fault insurer instead. A provider shall
19 be permitted to maintain insurance information in the event it is estab-
20 lished that there are no first-party benefits available for emergency
21 treatment under this article.
22 3. The time limit for presentation of invoices to an insurer shall be
23 measured from the first date on which the provider or the patient first
24 presented the invoice to any insurer.
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD03788-01-5
A. 6360 2
1 4. Any compensation provider that, notwithstanding the other
2 provisions of this law, pays for the emergency treatment of a covered
3 person, has a right of direct action against the insurer liable for
4 coverage under this article for reimbursement, but in no case will the
5 reimbursement exceed the amount of lawful benefits according to state-
6 promulgated fee schedules.
7 5. No insurer providing coverage under this article shall exclude
8 reimbursement for first-party benefits which have been paid to a health
9 care provider or medical equipment supplier by a compensation provider
10 not under this article.
11 § 2. This act shall take effect immediately.
