Relates to limits on certain supplementary insurance; permits insured to refuse supplementary insurance; requires certain disclaimer; relates to certain claims of durable medical equipment providers.
STATE OF NEW YORK
________________________________________________________________________
7779
IN SENATE
June 18, 2012
___________
Introduced by Sen. SEWARD -- read twice and ordered printed, and when
printed to be committed to the Committee on Rules
AN ACT to amend the insurance law, in relation to limits on certain
supplementary insurance; and in relation to providers of durable
medical equipment
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. Paragraph 2 of subsection (f) of section 3420 of the insur-
2 ance law, as separately amended by chapters 547 and 568 of the laws of
3 1997, is amended to read as follows:
4 (2) (A) Any [such] private passenger automobile insurance policy
5 shall[, at the option of the insured, also] provide supplementary
6 uninsured/underinsured motorists insurance for bodily injury[, in an
7 amount up to] in the same amount as the bodily injury liability insur-
8 ance limits of coverage provided under [such] the private passenger
9 automobile insurance policy[, subject to a maximum of two hundred fifty
10 thousand dollars because of bodily injury to or death of one person in
11 any one accident and, subject to such limit for one person, up to five
12 hundred thousand dollars because of bodily injury to or death of two or
13 more persons in any one accident, or a combined single limit policy of
14 five hundred thousand dollars because of bodily injury to or death of
15 one or more persons in any one accident. Provided however, an insurer
16 issuing such policy, in lieu of offering to the insured the coverages
17 stated above, may provide supplementary uninsured/underinsured motorists
18 insurance for bodily injury, in an amount up to the bodily injury
19 liability insurance limits of coverage provided under such policy,
20 subject to a maximum of one hundred thousand dollars because of bodily
21 injury to or death of one person in any one accident and, subject to
22 such limit for one person, up to three hundred thousand dollars because
23 of bodily injury to or death of two or more persons in any one accident,
24 or a combined single limit policy of three hundred thousand dollars
25 because of bodily injury to or death of one or more persons in any one
26 accident, if such insurer also makes available a personal umbrella poli-
27 cy with liability coverage limits up to at least five hundred thousand
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD16335-01-2
S. 7779 2
1 dollars which also provides coverage for supplementary
2 uninsured/underinsured motorists claims]. The coverage required under
3 this paragraph is not applicable when, or to the extent that, an insured
4 named in the policy makes a rejection of the coverage on behalf of all
5 insureds under the policy. Such rejection may be memorialized by the
6 insurer through a signed writing, audio recording, electronic signature
7 or any other means evidencing the insured's rejection of such coverage.
8 Supplementary uninsured/underinsured motorists insurance shall provide
9 coverage, in any state or Canadian province, if the limits of liability
10 under all bodily injury liability bonds and insurance policies of
11 [another] any other motor vehicle liable for damages are in a lesser
12 amount than the bodily injury liability insurance limits of coverage
13 provided by such policy. Upon written request by any insured covered by
14 supplemental uninsured/underinsured motorists insurance or his duly
15 authorized representative and upon disclosure by the insured of the
16 insured's bodily injury and supplemental uninsured/underinsured motor-
17 ists insurance coverage limits, the insurer of any other owner or opera-
18 tor of another motor vehicle against which a claim has been made for
19 damages to the insured shall disclose, within forty-five days of the
20 request, the bodily injury liability insurance limits of its coverage
21 provided under the policy or all bodily injury liability bonds. The time
22 of the insured to make any supplementary uninsured/underinsured motorist
23 claim, shall be tolled during the period the insurer of any other owner
24 or operator of another motor vehicle that may be liable for damages to
25 the insured, fails to so disclose its coverage. As a condition precedent
26 to the obligation of the insurer to pay under the supplementary
27 uninsured/underinsured motorists insurance coverage, the limits of
28 liability of [all] bodily injury liability bonds or insurance policies
29 applicable at the time of the accident shall be exhausted by payment of
30 judgments or settlements.
31 (B) [In addition to the notice provided, upon issuance of a policy of
32 motor vehicle liability insurance pursuant to regulations promulgated by
33 the superintendent,] At the time the policy is sold, purchased or nego-
34 tiated insurers shall notify insureds, in [writing] written, verbal or
35 electronic format, of the nature and availability of supplementary
36 uninsured/underinsured motorists coverage and shall state that the
37 coverage is equal to bodily injury liability limits unless lower limits
38 are requested or the coverage is rejected. Such notification shall
39 contain an explanation of supplementary uninsured/underinsured motorists
40 coverage and the amounts in which it can be purchased. Such notice
41 shall state the following or include information substantially similar
42 to the following:
43 "Supplementary uninsured/underinsured motorists coverage (SUM Cover-
44 age) shall be equal to bodily injury liability limits unless lower
45 limits are requested or the coverage is rejected. A policyholder should
46 consider purchasing SUM coverage in order to protect against the possi-
47 bility of an accident involving another motor vehicle whose owner or
48 operator was negligent and who may have no insurance whatsoever; or even
49 if insured, is only insured for third-party bodily injury at relatively
50 low liability limits, in comparison to the policyholder's own liability
51 limits for bodily injury sustained by third-parties. By purchasing SUM
52 coverage, which cannot be purchased in an amount exceeding the amount of
53 third party liability coverage purchased, the policyholder and any
54 insured under the policy can be protected for bodily injury to them-
55 selves, up to the limit of the SUM coverage purchased; and receive from
56 the policyholder's own insurance payment for bodily injury sustained due
S. 7779 3
1 to the negligence of the other motor vehicle's owner or operator."
2 Subsequently, a notification of availability shall be provided at least
3 once a year and may be simplified pursuant to regulations promulgated by
4 the superintendent, but must include a concise statement that supplemen-
5 tary uninsured/underinsured motorists coverage is available, an explana-
6 tion of such coverage, and the coverage limits that can be purchased
7 from the insurer.
8 (C) When there is a dispute between an insurer and insured over the
9 amount of supplementary uninsured/underinsured motorists coverage avail-
10 able on a claim and the insurer ultimately provides coverage higher than
11 the amount of premium the insurer is charging for, an insurer may deduct
12 any premium due from a re-rating of the policy back to the policy issue
13 date against any benefits due on the claim.
14 § 2. The insurance law is amended by adding a new section 5109-a to
15 read as follows:
16 § 5109-a. Unauthorized providers of durable medical equipment. (a) The
17 superintendent may prohibit a provider of durable medical equipment from
18 demanding or requesting payment under this article for durable medical
19 equipment for a period to be determined by the superintendent if the
20 superintendent determines, after notice and a hearing, that the provider
21 of durable medical equipment:
22 (1) has engaged in fraudulent, excessive or unlawful billing of insur-
23 ance companies for durable medical equipment;
24 (2) has billed insurance companies for durable medical equipment which
25 was not provided;
26 (3) has billed insurance companies for durable medical equipment which
27 was not necessary;
28 (4) has committed a fraudulent insurance act as defined in section
29 176.05 of the penal law;
30 (5) has been convicted of a crime involving fraudulent or dishonest
31 practices;
32 (6) has refused to appear before, or answer any question upon request
33 of, the superintendent or any duly authorized officer of this state or
34 refused to produce any relevant information concerning the conduct of
35 the provider of durable medical equipment in connection with durable
36 medical equipment provided under this article; or
37 (7) has violated any provision of this article or regulations promul-
38 gated thereunder.
39 (b) A provider of durable medical equipment shall not demand or
40 request payment under this article for durable medical equipment during
41 the term of the prohibition ordered by the superintendent pursuant to
42 subsection (a) of this section.
43 (c) The superintendent shall maintain a database containing a list of
44 providers of durable medical equipment prohibited by this section from
45 demanding or requesting payment for durable medical equipment rendered
46 under this article and shall make the information available to the
47 public.
48 (d) Nothing in this section shall be construed as limiting in any
49 respect the powers and duties of any other state or federal agency or
50 insurers to investigate instances of misconduct by durable medical
51 equipment providers and take appropriate action pursuant to any other
52 provision of law.
53 § 3. This act shall take effect on the one hundred eightieth day
54 after it shall have become a law, and shall apply to insurance policies
55 and contracts issued, entered into or renewed on and after such date.
