Requires medical proof in no-fault actions.
TITLE OF BILL: An act to amend the insurance law, in relation to medical proof in no-fault actions, and provides for the repeal of such provisions upon expiration thereof
PURPOSE: This bill expedites the efficiency in which No-Fault cases are handled by the New York City Civil Court system. This bill will allow the New York City Civil Court system to try four times as many legitimate cases by relaxing the rules of evidence and therefore relieving the dockets.
SUMMARY OF PROVISIONS: Section 1: Medical proof in no-fault actions. A party who initiates an action which seeks reimbursement for medical treatment, testing, or supplies pursuant to section 5106 of the insurance law, shall at trial, submit the sworn statement of the licensed medical professional that rendered, prescribed or ordered the medical treatment on the issue(s} of medical necessity or a sworn statement from a representative that the claimed services had been billed in accordance with the workers compensation fee schedule pursuant to section 5108 of the insurance law.
The licensed medical professional shall affirm that no-fault benefits were duly assigned to the plaintiff, the claimed treatment, testing or supplies were rendered, prescribed or ordered by the plaintiff, medically necessary to treat accident related injuries and shall include the material facts and documents upon which the opinion of medical necessity was based; or, the representative shall include the relevant sections of the fee schedule and the material facts and documents that support the claimed services were billed in accordance with the fee schedule. Submission of such sworn statement does not create a presumption of medical necessity or provide greater deference to the treating medical professional or adherence to the fee schedule.
A party opposing said action may submit a sworn statement on the issue(s} of medical necessity or that the claimed services were not billed in accordance with the workers compensation fee schedule pursuant to section 5108 of the insurance law. Such statement shall include the material facts and/or documents upon which that opinion was based.
A copy of the sworn statement(s) shall be furnished to all parties no later than the time the statement is submitted to the court. The sworn statement shall be accepted by the court in lieu of testimony unless, after submission of the sworn statement, the court determines that it wishes to hear testimony wherein the court shall then direct that all parties submitting a sworn statement shall have that person appear and testify in person.
This act shall take effect immediately and shall apply to all actions and proceedings commenced on or after such date and shall also apply
to any action or proceeding which was commenced prior to such effective date where, as of such date, either (a) a trial of the issues has not yet commenced, or (b) the parties have not yet entered into a stipulation of settlement. This act shall expire December 31, 2018.
EXISTING LAW: Current law and practice, when defending at trial, the No-Fault insurer must produce an expert to testify as to the basis for denying payment of medical and other health-related bills.
LEGISLATIVE HISTORY: 2010: S.8246 - Held in Rules
JUSTIFICATION: Under the current law, when defending at trial, the No-Fault insurer must produce an expert to testify as to the basis for denying payment of medical and other health-related bills. There are not enough resources for all the No-Fault medical provider cases to be heard in a venue on the scheduled trial date.
During the last two years civil filings have increased by 25% in the New York City Civil Courts. By October of 2009 alone, there were over 225,000 No-Fault medical provider claims filed in the NYC civil Court and it is projected by the end of 2009 there will be 257,000 cases filed. These No-Fault cases only involve the insurance carriers and the medical providers. The NYC Civil Court is where individual litigants go to resolve their everyday civil legal problems. Whether you are a local merchant, a consumer, a debtor, or a creditor, the Civil Court is where you go to have a legal matter resolved. Unfortunately, since the No-Fault cases account for at least 41.1% of the cases in the NYC Civil Court most of the court resources are tied up in No-Fault matters. The cases for the individual litigants will be heard quicker and more efficiently when this proposed bill is passed.
The court's resources are currently funneled into the No-Fault Civil Courtrooms in an attempt to manage the daily dockets. The NYC Civil Court's workload has more than doubled since 2001 and will only continue to grow as a result of the mounting No-Fault cases.
In 2008 approximately $18,677,383 of the $54,529,232 NYC Civil Court budget was allocated to the ever growing No-Fault cases. The NYC Civil Court 2007-2008 budget request stated that the "civil caseload increased dramatically in recent years, with over 150,000 No-Fault insurance claims a major contributor...the request also includes $500,000 to support judicial hearing officers, some of whom are dedicated to handling the over 150,000 No-Fault insurance cases which account for the largest component of the workload."
To manage the Court's No-Fault caseload in 2009 the amount allocated was approximately $23,765,958 of the $57,824,715 NYC Civil Court budget. The 2008-2009 NYC civil Court budget request stated that the budget increase was due to the No-Fault cases. "The most dramatic workload increase in City and District Courts has occurred in the Civil Court due to the growth in no-fault cases...in the past year,
the civil workload grew by 28 percent and has more than doubled since 2001. To assist in managing this voluminous caseload, additional staffing was provided in 2006 through relaxation of hiring controls. Also, the 2008-09 request continues the use of judicial hearing officers and back-office overtime."
The Judiciary budget request continues to include the need for increases in staff and overtime to assist in managing the unprecedented growth in the No-Fault medical provider caseload every year. The 2009-2010 NYC Civil Court Budget Request states that "civil caseload has increased dramatically in recent years; in the past two years alone, civil filings increased by 24% statewide and by 25% in New York city Civil court. No-fault insurance claims are a major contributor to this growth.. e growth of no-fault cases is most evident in the New york city Civil Court, which receives over 225,000 no-fault filings a year."
The influx of the personal Injury Protection (No-Fault) suits is hindering the NYC Civil Courts' efforts to adjudicate the suits on their individual merits. During today's cost cutting economic environment, deserving courts such as the Family Courts which serve the neediest in society lose resources to the NYC Civil Courts' No-Fault caseloads.
New York state's courts are closing 2009 with 4.7 million cases, the highest tally ever according to the December 28, 2009 New York Times article The Recession Begins Flooding Into the Courts. The court dockets are overloaded and people are seeing more and more delays in their cases. Even though the number of cases continues to rise the courts are being forced to do a lot more with a lot less.
By the end of 2009 the NYC Civil Court No-Fault medical provider cases will cost $23,777,640 for the Court to maintain and New York insurance to defend with witnesses.
The amendment would allow any party to an action for money, which seeks reimbursement for medical treatment, services, supplies, or testing pursuant to Article 51 of the insurance law to submit, at trial, the sworn statement of a licensed medical professional on the issue of the necessity of the medical treatment, services, supplies, or testing. such statement shall state the opinion of the medical professional and the material facts upon which that opinion is based. A copy of the sworn statement shall be furnished to all parties no later than the time the statement is submitted to the court. The sworn statement shall be accepted by the court in lieu of testimony by the medical professional. The use of a sworn statement in lieu of live testimony shall not give rise to any adverse inference concerning the lack of live testimony of the licensed medical professional.
The proposed bill will help save the courts millions of dollars by eliminating the need for redundant court appearances, the filing of unnecessary papers and briefs, and the delays caused by courthouse backlogs and inefficiencies due to the numerous No-Fault cases.
This minor change to the rules of evidence in No-Fault matters will allow the courts to adjudicate the cases on their merits while moving the cases off the court's docket at four times the current pace.
The current state of extended adjournments, in every venue, exacerbates the costs to maintain the Court's caseload to an unbelievable level considering the number of No-Fault cases initiated each year.
The resulting quicker pace will save the courts millions of dollars by shortening the length of time the court must house a case and therefore eliminate the need for increase of staff and overtime pay.
EFFECTIVE DATE: This bill shall take effect immediately, with provisions.
STATE OF NEW YORK ________________________________________________________________________ 3593--A 2011-2012 Regular Sessions IN SENATE February 28, 2011 ___________Introduced by Sen. ADAMS -- read twice and ordered printed, and when printed to be committed to the Committee on Insurance -- recommitted to the Committee on Insurance in accordance with Senate Rule 6, sec. 8 -- committee discharged, bill amended, ordered reprinted as amended and recommitted to said committee AN ACT to amend the insurance law, in relation to medical proof in no-fault actions, and provides for the repeal of such provisions upon expiration thereof THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM- BLY, DO ENACT AS FOLLOWS: Section 1. The insurance law is amended by adding a new section 5110 to read as follows: S 5110. MEDICAL PROOF IN NO-FAULT ACTIONS. 1. A PARTY WHO INITIATES AN ACTION FOR MONEY, EXCLUSIVE OF INTEREST AND COSTS AND ATTORNEY FEES, WHICH SEEKS REIMBURSEMENT FOR MEDICAL TREATMENT, TESTING, OR SUPPLIES PURSUANT TO SECTION FIVE THOUSAND ONE HUNDRED SIX OF THIS ARTICLE, SHALL AT TRIAL, SUBMIT THE SWORN STATEMENT OF THE LICENSED MEDICAL PROFES- SIONAL THAT RENDERED, PRESCRIBED OR ORDERED THE MEDICAL TREATMENT ON THE ISSUE OR ISSUES OF MEDICAL NECESSITY OR A SWORN STATEMENT FROM A REPRE- SENTATIVE THAT CLAIMED SERVICES HAD BEEN BILLED IN ACCORDANCE WITH THE WORKERS COMPENSATION FEE SCHEDULE PURSUANT TO SECTION FIVE THOUSAND ONE HUNDRED EIGHT OF THIS ARTICLE. 2. THE LICENSED MEDICAL PROFESSIONAL SHALL AFFIRM THAT NO-FAULT BENE- FITS WERE DULY ASSIGNED TO THE PLAINTIFF, THE CLAIMED TREATMENT, TESTING OR SUPPLIES WERE RENDERED, PRESCRIBED OR ORDERED BY THE PLAINTIFF, MEDICALLY NECESSARY TO TREAT ACCIDENT RELATED INJURIES AND SHALL INCLUDE THE MATERIAL FACTS AND DOCUMENTS UPON WHICH THE OPINION OF MEDICAL NECESSITY WAS BASED; OR, THE REPRESENTATIVE SHALL INCLUDE THE RELEVANT SECTIONS OF THE FEE SCHEDULE AND THE MATERIAL FACTS AND DOCUMENTS THAT SUPPORT THE CLAIMED SERVICES WERE BILLED IN ACCORDANCE WITH THE FEE SCHEDULE. SUBMISSION OF SUCH SWORN STATEMENT SHALL NOT CREATE A PRESUMP-EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD07585-02-1 S. 3593--A 2
TION OF MEDICAL NECESSITY OR PROVIDE GREATER DEFERENCE TO THE TREATING MEDICAL PROFESSIONAL OR ADHERENCE TO THE FEE SCHEDULE. 3. A PARTY OPPOSING SUCH ACTION MAY SUBMIT A SWORN STATEMENT ON THE ISSUE OR ISSUES OF MEDICAL NECESSITY OR THAT THE CLAIMED SERVICES WERE NOT BILLED IN ACCORDANCE WITH THE WORKERS COMPENSATION FEE SCHEDULE PURSUANT TO SECTION FIVE THOUSAND ONE HUNDRED EIGHT OF THIS ARTICLE. SUCH STATEMENT SHALL INCLUDE THE MATERIAL FACTS AND/OR DOCUMENTS UPON WHICH SUCH STATEMENT IS BASED. 4. A COPY OF THE SWORN STATEMENT OR STATEMENTS SHALL BE FURNISHED TO ALL PARTIES NO LATER THAN THE TIME THAT THE STATEMENT IS SUBMITTED TO THE COURT. THE SWORN STATEMENT SHALL BE ACCEPTED BY THE COURT IN LIEU OF TESTIMONY UNLESS, AFTER SUBMISSION OF THE SWORN STATEMENT, THE COURT DETERMINES THAT IT WISHES TO HEAR TESTIMONY WHEREIN THE COURT SHALL THEN DIRECT THAT ALL PARTIES SUBMITTING A SWORN STATEMENT SHALL HAVE THAT PERSON APPEAR AND TESTIFY IN PERSON. S 2. This act shall take effect immediately and shall: 1. apply to all actions and proceedings commenced on or after such date; 2. apply to any action or proceeding which was commenced prior to such effective date where, as of such date, either: (a) a trial of the issues has not yet commenced, or (b) the parties have not yet entered into a stipulation of settlement; and 3. expire and be deemed repealed December 31, 2018.