Provides that where an employer or insurance carrier elects to controvert the right to compensation and such claimant holds a valid insurance policy, the employer or insurance carrier shall provide medical treatment to the injured claimant and payment to health care providers without regard to such controversy.
STATE OF NEW YORK
________________________________________________________________________
7361
2025-2026 Regular Sessions
IN SENATE
April 10, 2025
___________
Introduced by Sen. RHOADS -- read twice and ordered printed, and when
printed to be committed to the Committee on Labor
AN ACT to amend the workers' compensation law, in relation to medical
treatment for workers' compensation claimants when the workers'
compensation claim has been controverted
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. Subdivision 2 of section 25 of the workers' compensation
2 law is amended by adding a new paragraph (d) to read as follows:
3 (d) (i) In the event the employer or insurance carrier elects to
4 controvert the right to compensation, and it is confirmed that the
5 claimant holds a valid policy of insurance from a health insurance
6 provider in effect on the date of injury, such employer or insurance
7 carrier shall provide medical treatment to the injured worker pursuant
8 to the provisions of section thirteen of this chapter, and payment to
9 health care providers pursuant to procedures established by the board
10 without regard to such controversy.
11 (ii) In the event the board makes a final determination that the claim
12 is not compensable, the employer or insurance carrier may seek
13 reimbursement for medical bills from the claimant's health insurance
14 provider in an amount not to exceed the actual payments made by the
15 employer or insurance carrier on behalf of the claimant for such medical
16 treatment. Within thirty days of receipt by the health insurance provid-
17 er of the medical reports, bills and proof of payment, such health
18 insurance provider shall reimburse the employer or insurance carrier for
19 the full amount of the actual payments made. Bills submitted for
20 reimbursement under this section may not be challenged on the grounds of
21 medical necessity; utilization of an out of network provider or if the
22 established reimbursement rate for the health insurance provider is less
23 than what is provided under the workers' compensation fee schedule.
24 Should the health insurance provider fail to make timely payment, the
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD11581-01-5
S. 7361 2
1 employer or insurance carrier shall retain a private right of action
2 against such health insurance provider on behalf of the claimant. In no
3 event may the employer, carrier or health insurance provider seek
4 reimbursement of any kind, including the payment of co-payments, from
5 the injured employee, such employee's surviving spouse, dependents, or
6 estate.
7 (iii) The New York compensation insurance rating board shall, no less
8 frequently than on an annual basis, request that insurance carriers
9 report the number of claims in which reimbursement is sought, the
10 amounts of reimbursement sought, and the amounts of reimbursement
11 received. Insurance carriers shall provide data responsive to such
12 request. The New York compensation insurance rating board shall, upon
13 request, provide such data to the board.
14 § 2. This act shall take effect immediately.
