Relates to limits on certain supplementary insurance; permits insured to refuse supplementary insurance; requires certain disclaimer; relates to payments to durable medical equipment providers.
STATE OF NEW YORK
________________________________________________________________________
7787
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 payments to durable
medical equipment providers
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 auto-
8 mobile insurance policy[, subject to a maximum of two hundred fifty
9 thousand dollars because of bodily injury to or death of one person in
10 any one accident and, subject to such limit for one person, up to five
11 hundred thousand dollars because of bodily injury to or death of two or
12 more persons in any one accident, or a combined single limit policy of
13 five hundred thousand dollars because of bodily injury to or death of
14 one or more persons in any one accident. Provided however, an insurer
15 issuing such policy, in lieu of offering to the insured the coverages
16 stated above, may provide supplementary uninsured/underinsured motorists
17 insurance for bodily injury, in an amount up to the bodily injury
18 liability insurance limits of coverage provided under such policy,
19 subject to a maximum of one hundred thousand dollars because of bodily
20 injury to or death of one person in any one accident and, subject to
21 such limit for one person, up to three hundred thousand dollars because
22 of bodily injury to or death of two or more persons in any one accident,
23 or a combined single limit policy of three hundred thousand dollars
24 because of bodily injury to or death of one or more persons in any one
25 accident, if such insurer also makes available a personal umbrella poli-
26 cy with liability coverage limits up to at least five hundred thousand
27 dollars which also provides coverage for supplementary
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD15532-07-2
S. 7787 2
1 uninsured/underinsured motorists claims]. The coverage required under
2 this paragraph is not applicable when, or to the extent that, an insured
3 named in the policy makes a rejection of the coverage on behalf of all
4 insureds under the policy. Such rejection shall be memorialized by the
5 insurer through a signed writing, audio recording, electronic signature
6 or any other means evidencing the insured's rejection of such coverage.
7 Supplementary uninsured/underinsured motorists insurance shall provide
8 coverage, in any state or Canadian province, if the limits of liability
9 under all bodily injury liability bonds and insurance policies of
10 [another] any other motor vehicle liable for damages are in a lesser
11 amount than the bodily injury liability insurance limits of coverage
12 provided by such policy. Upon written request by any insured covered by
13 supplemental uninsured/underinsured motorists insurance or his duly
14 authorized representative and upon disclosure by the insured of the
15 insured's bodily injury and supplemental uninsured/underinsured motor-
16 ists insurance coverage limits, the insurer of any other owner or opera-
17 tor of another motor vehicle against which a claim has been made for
18 damages to the insured shall disclose, within forty-five days of the
19 request, the bodily injury liability insurance limits of its coverage
20 provided under the policy or all bodily injury liability bonds. The time
21 of the insured to make any supplementary uninsured/underinsured motorist
22 claim, shall be tolled during the period the insurer of any other owner
23 or operator of another motor vehicle that may be liable for damages to
24 the insured, fails to so disclose its coverage. As a condition precedent
25 to the obligation of the insurer to pay under the supplementary
26 uninsured/underinsured motorists insurance coverage, the limits of
27 liability of all bodily injury liability bonds or insurance policies
28 applicable at the time of the accident shall be exhausted by payment of
29 judgments or settlements.
30 (B) [In addition to the notice provided, upon issuance of a policy of
31 motor vehicle liability insurance pursuant to regulations promulgated by
32 the superintendent, insurers shall notify insureds, in writing, of the
33 availability of supplementary uninsured/underinsured motorists coverage.
34 Such notification shall contain an explanation of supplementary
35 uninsured/underinsured motorists coverage and the amounts in which it
36 can be purchased. Subsequently, a notification of availability shall be
37 provided at least once a year and may be simplified pursuant to regu-
38 lations promulgated by the superintendent, but must include a concise
39 statement that supplementary uninsured/underinsured motorists coverage
40 is available, an explanation of such coverage, and the coverage limits
41 that can be purchased from the insurer.] If the rejection or selection
42 of lower supplementary uninsured/underinsured motorists coverage is in
43 written or electronic form, that rejection or selection shall be made on
44 a form provided to the insured at the time the policy is sold, purchased
45 and/or negotiated that shall fully advise the insured of the nature of
46 the coverage and shall state that the coverage is equal to bodily injury
47 liability limits unless lower limits are requested or the coverage is
48 rejected. Where such selection or rejection is made verbally, a memori-
49 alization in writing or electronic signature may be received by the
50 insurer subsequent to the sale, purchase and/or negotiation of the poli-
51 cy. The form shall be in 12-point bold type and shall state: "Supple-
52 mentary uninsured/underinsured motorists coverage (SUM Coverage)
53 protects against the possibility of an accident involving another motor
54 vehicle whose owner or operator was negligent and who may have no insur-
55 ance whatsoever; or even if insured, is only insured for third-party
56 bodily injury at relatively low liability limits, in comparison to the
S. 7787 3
1 policyholder's own liability limits for bodily injury sustained by
2 third-parties. By purchasing SUM coverage, the policyholder and any
3 insured under the policy can be protected for bodily injury to them-
4 selves and receive from the policyholder's own insurer payment for bodi-
5 ly injury sustained due to the negligence of the other motor vehicle's
6 owner or operator. SUM coverage shall be equal to bodily injury liabil-
7 ity limits unless lower limits are requested or the coverage is
8 rejected. A policyholder is urged to consider purchasing the maximum SUM
9 coverage available." If rejection or selection of lower limits is made
10 verbally, the insurer or their agent shall read the identical or
11 substantially similar language as is in the above rejection of matching
12 limits form and confirm the client has heard and understood the same,
13 and shall restate the above information as often as is necessary until
14 the insured has verbally confirmed that they fully understand the same.
15 The insurer shall notify the named insured at least annually of her or
16 his options as to the coverage required by this paragraph pursuant to
17 regulations issued by the superintendent, if any, at the time of or
18 within sixty days prior to the renewal of the policy. Receipt of this
19 notice does not constitute an affirmative waiver of the insured's right
20 to uninsured motorist coverage where the insured has not signed a
21 selection or rejection form.
22 § 2. The insurance law is amended by adding a new section 5109-a to
23 read as follows:
24 § 5109-a. Unauthorized providers of durable medical equipment. (a) The
25 superintendent may prohibit a provider of durable medical equipment from
26 demanding or requesting payment under this article for durable medical
27 equipment for a period to be determined by the superintendent if the
28 superintendent determines, after notice and a hearing, that the provider
29 of durable medical equipment:
30 (1) has engaged in a pattern and practice of fraudulent, excessive or
31 unlawful billing of insurance companies for durable medical equipment;
32 (2) has engaged in a pattern and practice of billing insurance compa-
33 nies for durable medical equipment which was not provided;
34 (3) has engaged in a pattern and practice of billing insurance compa-
35 nies for durable medical equipment which was not necessary;
36 (4) has committed a fraudulent insurance act as defined in section
37 176.05 of the penal law;
38 (5) has been convicted of a crime involving fraudulent or dishonest
39 practices;
40 (6) has refused to appear before, or answer any question upon request
41 of, the superintendent or any duly authorized officer of this state or
42 refused to produce any relevant information concerning the conduct of
43 the provider of durable medical equipment in connection with durable
44 medical equipment provided under this article; or
45 (7) has violated any provision of this article or regulations promul-
46 gated thereunder.
47 (b) A provider of durable medical equipment shall not demand or
48 request payment under this article for durable medical equipment during
49 the term of the prohibition ordered by the superintendent pursuant to
50 subsection (a) of this section.
51 (c) The superintendent shall maintain a database containing a list of
52 providers of durable medical equipment prohibited by this section from
53 demanding or requesting payment for durable medical equipment rendered
54 under this article and shall make the information available to the
55 public.
S. 7787 4
1 (d) Nothing in this section shall be construed as limiting in any
2 respect the powers and duties of any other state or federal agency or
3 insurers to investigate instances of misconduct by durable medical
4 equipment providers and take appropriate action pursuant to any other
5 provision of law.
6 § 3. This act shall take effect on the one hundred eightieth day after
7 it shall have become a law, and shall apply to insurance policies and
8 contracts issued, entered into or renewed on and after such effective
9 date.
