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
________________________________________________________________________
7780
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
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 policy shall[, at the option of the insured, also]
5 provide supplementary uninsured/underinsured motorists insurance for
6 bodily injury[, in an amount up to] in the same amount as the bodily
7 injury liability insurance limits of coverage provided under such poli-
8 cy[, subject to a maximum of two hundred fifty thousand dollars because
9 of bodily injury to or death of one person in any one accident and,
10 subject to such limit for one person, up to five hundred thousand
11 dollars because of bodily injury to or death of two or more persons in
12 any one accident, or a combined single limit policy of five hundred
13 thousand dollars because of bodily injury to or death of one or more
14 persons in any one accident. Provided however, an insurer issuing such
15 policy, in lieu of offering to the insured the coverages stated above,
16 may provide supplementary uninsured/underinsured motorists insurance for
17 bodily injury, in an amount up to the bodily injury liability insurance
18 limits of coverage provided under such policy, subject to a maximum of
19 one hundred thousand dollars because of bodily injury to or death of one
20 person in any one accident and, subject to such limit for one person, up
21 to three hundred thousand dollars because of bodily injury to or death
22 of two or more persons in any one accident, or a combined single limit
23 policy of three hundred thousand dollars because of bodily injury to or
24 death of one or more persons in any one accident, if such insurer also
25 makes available a personal umbrella policy with liability coverage
26 limits up to at least five hundred thousand dollars which also provides
27 coverage for supplementary uninsured/underinsured motorists claims].
28 The coverage required under this paragraph is not applicable when, or to
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD16327-02-2
S. 7780 2
1 the extent that, an insured named in the policy makes a rejection of the
2 coverage on behalf of all insureds under the policy. Such rejection
3 shall be memorialized by the insurer through a signed writing, audio
4 recording or electronic signature evidencing the insured's rejection of
5 such coverage. The failure of the carrier to maintain the memorializa-
6 tion of such rejection of coverage through the time a claim is made
7 shall result in the supplementary uninsured/underinsured motorist cover-
8 age being equal to the bodily injury liability coverage in effect at the
9 time a claim arises. Supplementary uninsured/underinsured motorists
10 insurance shall provide coverage, in any state or Canadian province, if
11 the limits of liability under all bodily injury liability bonds and
12 insurance policies of [another] any other motor vehicle liable for
13 damages are in a lesser amount than the bodily injury liability insur-
14 ance limits of coverage provided by such policy. Upon written request by
15 any insured covered by supplemental uninsured/underinsured motorists
16 insurance or his duly authorized representative and upon disclosure by
17 the insured of the insured's bodily injury and supplemental
18 uninsured/underinsured motorists insurance coverage limits, the insurer
19 of any other owner or operator of another motor vehicle against which a
20 claim has been made for damages to the insured shall disclose, within
21 forty-five days of the request, the bodily injury liability insurance
22 limits of its coverage provided under the policy or all bodily injury
23 liability bonds. The time of the insured to make any supplementary
24 uninsured/underinsured motorist claim, shall be tolled during the period
25 the insurer of any other owner or operator of another motor vehicle that
26 may be liable for damages to the insured, fails to so disclose its
27 coverage. As a condition precedent to the obligation of the insurer to
28 pay under the supplementary uninsured/underinsured motorists insurance
29 coverage, the limits of liability of [all] any one bodily injury liabil-
30 ity [bonds] bond or insurance [policies] policy applicable at the time
31 of the accident shall be exhausted by payment of judgments or settle-
32 ments.
33 (B) [In addition to the notice provided, upon issuance of a policy of
34 motor vehicle liability insurance pursuant to regulations promulgated by
35 the superintendent, insurers shall notify insureds, in writing, of the
36 availability of supplementary uninsured/underinsured motorists coverage.
37 Such notification shall contain an explanation of supplementary
38 uninsured/underinsured motorists coverage and the amounts in which it
39 can be purchased. Subsequently, a notification of availability shall be
40 provided at least once a year and may be simplified pursuant to regu-
41 lations promulgated by the superintendent, but must include a concise
42 statement that supplementary uninsured/underinsured motorists coverage
43 is available, an explanation of such coverage, and the coverage limits
44 that can be purchased from the insurer.] If the rejection or selection
45 of lower supplementary uninsured/underinsured motorists coverage is in
46 written or electronic form, that shall be made on a form approved by the
47 superintendent and furnished to the insured at the time the policy is
48 sold, purchased, negotiated and/or renewed. The form shall fully advise
49 the insured of the nature of the coverage and shall state that the
50 coverage is equal to bodily injury liability limits unless lower limits
51 are requested or the coverage is rejected. The heading of the form
52 shall be in 12-point bold type and shall state: "Supplementary
53 uninsured/underinsured motorists coverage (SUM Coverage) shall be equal
54 to bodily injury liability limits unless lower limits are requested or
55 the coverage is rejected. A policyholder IS URGED TO consider purchasing
56 THE MAXIMUM SUM coverage AVAILABLE in order to protect against the
S. 7780 3
1 possibility of an accident involving another motor vehicle whose owner
2 or operator was negligent and who may have no insurance whatsoever; or
3 even if insured, is only insured for third-party bodily injury at rela-
4 tively low liability limits, in comparison to the policyholder's own
5 liability limits for bodily injury sustained by third-parties. By
6 purchasing SUM coverage, which cannot be purchased in an amount exceed-
7 ing the amount of third party liability coverage purchased, the policy-
8 holder and any insured under the policy can be protected for bodily
9 injury to themselves, up to the limit of the SUM coverage purchased; and
10 receive from the policyholder's own insurer payment for bodily injury
11 sustained due to the negligence of the other motor vehicle's owner or
12 operator." If rejection or selection of lower limits is made verbally,
13 the insurer or their agent shall read the identical language as is in
14 the above rejection of matching limits form and confirm the client has
15 heard and understood the same, and shall re-read the form as often as is
16 necessary until the insured has verbally confirmed that they fully
17 understand the same. The insurer shall notify the named insured at
18 least annually of her or his options as to the coverage required by this
19 paragraph. Such notice shall be part of, and attached to, the notice of
20 premium, shall provide for a means to allow the insured to request such
21 coverage, and shall be given in a manner approved by the superintendent.
22 If the insured has rejected coverage under this paragraph or has
23 selected lower limits, the notice of premium shall clearly indicate the
24 level of coverage accepted. Receipt of this notice does not constitute
25 an affirmative waiver of the insured's right to uninsured motorist
26 coverage where the insured has not signed a selection or rejection form.
27 § 2. The insurance law is amended by adding a new section 5109-a to
28 read as follows:
29 § 5109-a. Unauthorized providers of durable medical equipment. (a) The
30 superintendent may prohibit a provider of durable medical equipment from
31 demanding or requesting payment under this article for durable medical
32 equipment for a period to be determined by the superintendent if the
33 superintendent determines, after notice and a hearing, that the provider
34 of durable medical equipment:
35 (1) has engaged in fraudulent, excessive or unlawful billing of insur-
36 ance companies for durable medical equipment;
37 (2) has billed insurance companies for durable medical equipment which
38 was not provided;
39 (3) has billed insurance companies for durable medical equipment which
40 was not necessary;
41 (4) has committed a fraudulent insurance act as defined in section
42 176.05 of the penal law;
43 (5) has been convicted of a crime involving fraudulent or dishonest
44 practices;
45 (6) has refused to appear before, or answer any question upon request
46 of, the superintendent or any duly authorized officer of this state or
47 refused to produce any relevant information concerning the conduct of
48 the provider of durable medical equipment in connection with durable
49 medical equipment provided under this article; or
50 (7) has violated any provision of this article or regulations promul-
51 gated thereunder.
52 (b) A provider of durable medical equipment shall not demand or
53 request payment under this article for durable medical equipment during
54 the term of the prohibition ordered by the superintendent pursuant to
55 subsection (a) of this section.
S. 7780 4
1 (c) The superintendent shall maintain a database containing a list of
2 providers of durable medical equipment prohibited by this section from
3 demanding or requesting payment for durable medical equipment rendered
4 under this article and shall make the information available to the
5 public.
6 (d) Nothing in this section shall be construed as limiting in any
7 respect the powers and duties of any other state or federal agency or
8 insurers to investigate instances of misconduct by durable medical
9 equipment providers and take appropriate action pursuant to any other
10 provision of law.
11 § 3. This act shall take effect on the thirtieth day after it shall
12 have become a law, and shall apply to insurance policies and contracts
13 issued, entered into or renewed on and after such effective date.