Bill Text: NY A06591 | 2021-2022 | General Assembly | Introduced


Bill Title: Enacts the New York automobile insurance fraud and premium reduction act; provides that this act is aimed at reducing insurance fraud and thus lowering the cost of insurance premiums; provides a provision for compensation to a person that reports insurance fraud to the authorities; further provides that this act also increases the penalty for insurance fraud; appropriates $3,100,000 therefor.

Spectrum: Partisan Bill (Republican 8-0)

Status: (Introduced - Dead) 2022-01-05 - referred to insurance [A06591 Detail]

Download: New_York-2021-A06591-Introduced.html



                STATE OF NEW YORK
        ________________________________________________________________________

                                          6591

                               2021-2022 Regular Sessions

                   IN ASSEMBLY

                                     March 19, 2021
                                       ___________

        Introduced  by  M.  of  A.  BLANKENBUSH -- read once and referred to the
          Committee on Insurance

        AN ACT to amend the insurance law, the penal law and the executive  law,
          in  relation  to  establishing the New York automobile insurance fraud
          and premium reduction act; and making an appropriation therefor

          The People of the State of New York, represented in Senate and  Assem-
        bly, do enact as follows:

     1    Section  1.  This act shall be known and may be cited as the "New York
     2  automobile insurance fraud and premium reduction act".
     3    § 2. The insurance law is amended by adding a new section 5110 to read
     4  as follows:
     5    § 5110. Certification of managed care organizations. (a)(1) Any  indi-
     6  vidual  or  group  authorized  to  provide  medical or other health care
     7  services in this state may, directly or through an  authorized  insurer,
     8  make  written  application  to the superintendent to become certified to
     9  provide managed care to injured covered persons under this article.
    10    (2) Certification shall be valid for such period and for such  service
    11  areas  as  the  superintendent  may  prescribe,  unless  sooner revoked,
    12  suspended or amended.
    13    (3) Each application for  certification  shall  be  accompanied  by  a
    14  reasonable  fee  prescribed by the superintendent and a proposed managed
    15  care program detailing its significant features, methods and procedures.
    16    (b) Application for certification shall  be  made  in  such  form  and
    17  manner, and shall set forth such information regarding the proposed plan
    18  of managed care for providing medical and other health care services, as
    19  the superintendent may prescribe, including:
    20    (1) the names and credentials of all individuals or organizations that
    21  will  provide  services  under  the  managed care program, together with
    22  appropriate evidence of compliance with any licensing  or  certification
    23  requirements  for  such individuals or organizations to practice in this
    24  state;

         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD02950-01-1

        A. 6591                             2

     1    (2) a description  of  the  times,  places  and  manner  of  providing
     2  services under the managed care program;
     3    (3)  a  description of the times, places and manner of providing other
     4  related optional services the applicant may wish to provide; and
     5    (4) a description and representative copies of  all  remuneration  and
     6  related  arrangements between the managed care organization and individ-
     7  ual providers of services under the managed care program.
     8    (c) The superintendent shall certify an applicant, if the  superinten-
     9  dent finds that the managed care program:
    10    (1) provides medical and other health care services that meet quality,
    11  continuity  and  other treatment standards prescribed by the superinten-
    12  dent or the commissioner of health, in a manner that is  timely,  effec-
    13  tive and convenient for injured persons;
    14    (2) includes a sufficient number of each category of provider through-
    15  out  the  proposed service areas to give injured persons adequate flexi-
    16  bility to choose an authorized provider from  among  those  health  care
    17  providers who participate in the managed care program;
    18    (3)  provides  appropriate financial incentives or other approaches to
    19  reduce costs and minimize improper utilization without sacrificing qual-
    20  ity of service;
    21    (4) provides adequate methods of peer review, utilization review,  and
    22  dispute  resolution,  including where applicable, access to the external
    23  appeal process as provided in article forty-nine  of  this  chapter,  in
    24  order  to:  (A)  prevent inappropriate or excessive treatment; (B) avoid
    25  conflicts  of interest; (C) exclude from participation  in  the  program
    26  those  providers  who  violate  reasonable  treatment standards; and (D)
    27  provide for the resolution of medical disputes;
    28    (5) provides a timely and accurate method of reporting to  the  super-
    29  intendent or the commissioner of health as appropriate, necessary infor-
    30  mation regarding medical and health care service cost and utilization to
    31  monitor the effectiveness of the managed care program;
    32    (6)  provides  a  mechanism  for an injured person to obtain treatment
    33  outside of the managed care program if the services are not available or
    34  accessible within the program;
    35    (7) provides for a reasonable and appropriate coordination with anoth-
    36  er health care provider where the  injured  person  has  been  receiving
    37  treatment  from  another  health care provider for a previously existing
    38  condition or injury which has been aggravated by the motor vehicle acci-
    39  dent;
    40    (8) provides for a mechanism for  notification  about  and  transition
    41  from emergency care; and
    42    (9)  complies with any other requirement the superintendent determines
    43  is necessary to provide quality medical and other health  care  services
    44  to injured persons.
    45    (d)  The  superintendent may certify a health maintenance organization
    46  issued a certificate of authority under article forty-four of the public
    47  health law or licensed under article forty-three of this chapter, if  it
    48  meets  the  requirements  of  this  section. The superintendent may also
    49  certify an accident and health insurer, including a  corporation  organ-
    50  ized  under article forty-three of this chapter, which has a participat-
    51  ing or preferred network of providers if such insurer meets the require-
    52  ments of this section. To the extent a  managed  care  organization  has
    53  been  reviewed,  approved  or  certified  by  another state agency as to
    54  accessibility, quality or continuity of care or for  any  of  the  other
    55  matters  within  the  superintendent's  review, the superintendent shall
    56  consider the review, approval or certification of another  state  agency

        A. 6591                             3

     1  so  as  not  to  duplicate  those  reviews, approvals or certifications.
     2  However, nothing in this subsection shall be deemed to limit the  super-
     3  intendent's  authority  to  impose and review additional requirements or
     4  standards  above and beyond those imposed by another state agency to the
     5  extent those requirements or standards are necessary or appropriate  for
     6  implementation of this section.
     7    (e)  The  superintendent  shall  refuse  to certify, or may revoke, or
     8  suspend or amend the certification of, any managed care organization, if
     9  the superintendent finds that:
    10    (1) the managed care program for providing services fails to meet  the
    11  requirements of this section; or
    12    (2)  service  under  the managed care program is not being provided in
    13  accordance with its terms as described in the  application  for  certif-
    14  ication.
    15    (f)  For  purposes  of  this  section, the superintendent may consider
    16  whether providers utilized by a managed care organization  or  otherwise
    17  authorized  to  provide  services  under  the contract are authorized to
    18  render medical care in accordance with section thirteen-b of  the  work-
    19  ers' compensation law.
    20    (g)  Utilization  review, quality assurance and peer review activities
    21  pursuant to this section shall be subject to review by  the  superinten-
    22  dent  and  the  commissioner  of health. Findings by the commissioner of
    23  health of professional misconduct, or disciplinary actions  in  relation
    24  thereto,  shall  be reported to the appropriate licensing boards and the
    25  superintendent.
    26    (h) Data generated by or received in connection with these activities,
    27  including written reports, notes or records of any such activities or of
    28  the review thereof, shall be confidential and shall  not  be  disclosed,
    29  except to the extent determined to be necessary by the superintendent or
    30  the  commissioner  of  health.  No data generated by utilization review,
    31  quality assurance or peer review activities pursuant to this section, or
    32  the review thereof, shall be used in any  action,  suit  or  proceeding,
    33  except to the extent determined to be necessary by the superintendent or
    34  the commissioner.
    35    (i)  A  person participating in utilization review, quality assurance,
    36  or peer review activities pursuant to this section shall not be examined
    37  as to any communication made in the course of  such  activities  or  the
    38  findings thereof, nor shall any such person be subject to a civil action
    39  for actions taken or statements made in good faith.
    40    (j) Provided that there is compliance with standards governing managed
    41  care  established  by  the superintendent, no person who participates in
    42  forming any network, collectively negotiating fees, or otherwise  solic-
    43  its  or enters into contracts in a good faith effort, to provide medical
    44  or other health care services on a managed care basis in accordance with
    45  the provisions of this section, shall be subject to antitrust  liability
    46  regarding such participation.
    47    (k) The provisions of this section shall not affect the confidentiali-
    48  ty or admission in evidence of a claimant's medical treatment records.
    49    (l)  The  superintendent,  in  consultation  with  the commissioner of
    50  health, shall adopt such rules as may be  necessary  to  carry  out  the
    51  provisions of this section.
    52    §  3.  Paragraph  1 of subsection (a) of section 5102 of the insurance
    53  law, as amended by chapter 298 of the laws of 2006, is amended  to  read
    54  as follows:
    55    (1)  All  necessary  expenses  incurred  for:  (i)  medical,  hospital
    56  (including services rendered in compliance with article forty-one of the

        A. 6591                             4

     1  public health law, whether or not such services are rendered directly by
     2  a hospital), surgical, nursing, dental, ambulance,  x-ray,  prescription
     3  drug   and  prosthetic  services;  (ii)  psychiatric,  physical  therapy
     4  (provided that treatment is rendered pursuant to a referral) and occupa-
     5  tional  therapy  and rehabilitation; (iii) any non-medical remedial care
     6  and treatment rendered in accordance with a religious method of  healing
     7  recognized  by  the  laws of this state; and (iv) any other professional
     8  health services; all without limitation as to time, provided that within
     9  one year after the date of the accident causing the injury it is  ascer-
    10  tainable  that further expenses may be incurred as a result of the inju-
    11  ry. For the purpose of determining basic  economic  loss,  the  expenses
    12  incurred  under  this  paragraph shall be in accordance with the limita-
    13  tions of section five  thousand  one  hundred  eight  of  this  article.
    14  Medical treatments, diagnostic tests and services provided by the policy
    15  shall  be  rendered  in  accordance with commonly accepted protocols and
    16  professional standards and practices  which  are  commonly  accepted  as
    17  being beneficial for the treatment of the covered injury.  Protocols and
    18  professional  standards  and  practices  which are deemed to be commonly
    19  accepted pursuant to this section shall be those recognized by  national
    20  standard setting organizations, national or state professional organiza-
    21  tions  of  the  same discipline as the treating provider or those desig-
    22  nated or approved by the superintendent  in  consultation  with  profes-
    23  sional  licensing  boards in the department of health and the department
    24  of education. The superintendent, in consultation with the commissioners
    25  of health and education, may reject the use of protocols, standards  and
    26  practices  or  lists  of diagnostic tests set by any organization deemed
    27  not to have standing or general recognition by the provider community or
    28  applicable licensing boards.   Protocols shall be  deemed  to  establish
    29  guidelines as to standard appropriate treatment and diagnostic tests for
    30  injuries  sustained  in  automobile  accidents, but the establishment of
    31  standard treatment protocols or  protocols  for  the  administration  of
    32  diagnostic  tests  shall  not  be  interpreted  in  such  a manner as to
    33  preclude variance when warranted by reason  of  medical  necessity.  The
    34  policy  form  may  provide  for pre-certification of certain procedures,
    35  treatments, diagnostic tests or other services or for  the  purchase  of
    36  durable  medical  goods  or  equipment, except that no pre-certification
    37  requirement shall apply within ten days of the accident giving  rise  to
    38  the injury.
    39    § 4. Subsection (d) of section 5103 of the insurance law is amended to
    40  read as follows:
    41    (d)  Insurance  policy forms for insurance to satisfy the requirements
    42  of subsection (a) [hereof] of this section shall be subject to  approval
    43  pursuant to article twenty-three of this chapter. Minimum benefit stand-
    44  ards for such policies and for self-insurers, and rights of subrogation,
    45  examination  and  other such matters, shall be established by regulation
    46  pursuant to section three hundred one of this chapter, provided,  howev-
    47  er,  that  effective  immediately  such  regulation  shall  be deemed to
    48  include new provisions applicable to injuries which occur  on  or  after
    49  the effective date of the chapter of the laws of two thousand twenty-one
    50  that  amended  this  subsection  and established the New York automobile
    51  insurance fraud and  premium  reduction  act.    Such  regulation  shall
    52  provide  that the initial filing of a notice of the existence of a claim
    53  or claims for first party benefits by a covered  person  shall  be  made
    54  within  thirty  days  of  sustaining  an  injury for which such claim or
    55  claims may be made, but which permit the filing of such  initial  notice
    56  of  the existence of a claim or claims as soon as reasonably practicable

        A. 6591                             5

     1  after the expiration of such thirty day period where the nature  of  the
     2  injury  results  in a reasonably justifiable delay in filing the initial
     3  notice during such thirty day period.
     4    §  5.  Section  5108  of  the insurance law is amended by adding a new
     5  subsection (d) to read as follows:
     6    (d) Proof of the fact and cost of  a  medical  or  health  service  or
     7  treatment  which  is  needed  for a covered person to receive payment or
     8  reimbursement for that portion of a claim or claims attributable to such
     9  service or treatment, whether such proof is submitted to a  first  party
    10  or  additional  first  party  benefits  insurer by the covered person or
    11  directly by a medical professional or health services provider on behalf
    12  of such covered person, for a service rendered by the medical or  health
    13  services  provider  to  the  covered  person  shall  be submitted within
    14  forty-five days from the date the service was rendered  to  the  covered
    15  person.  At  the  option  of  the insurer, in any case where multiple or
    16  continuing medical or health treatments or services are  required,  such
    17  time  limit  may be waived and the claims of one or more such medical or
    18  health service providers may be bundled.
    19    § 6. Section 5106 of the insurance law, subsection (b) as  amended  by
    20  chapter 452 of the laws of 2005 and subsection (d) as amended by section
    21  8  of  part AAA of chapter 59 of the laws of 2017, is amended to read as
    22  follows:
    23    § 5106. Fair claims settlement. (a) Payments of first  party  benefits
    24  and  additional  first  party  benefits  shall  be  made  as the loss is
    25  incurred. Such benefits are overdue if not paid within  [thirty]  forty-
    26  five  days  after  the claimant supplies proof of the fact and amount of
    27  loss sustained. If proof is not supplied as to  the  entire  claim,  the
    28  amount  which is supported by proof is overdue if not paid within [thir-
    29  ty] forty-five days after such proof is supplied. All  overdue  payments
    30  shall  bear  interest  at  the rate of two percent per month. If a valid
    31  claim or portion was overdue, the claimant shall  also  be  entitled  to
    32  recover   his   attorney's  reasonable  fee,  for  services  necessarily
    33  performed in connection with securing  payment  of  the  overdue  claim,
    34  subject to limitations promulgated by the superintendent in regulations.
    35  The failure to issue a denial of a claim within the forty-five day peri-
    36  od  provided  for in this subsection shall not preclude the insurer from
    37  raising a defense to the claim where the insurer has made  a  report  to
    38  the  insurance  frauds  bureau  pursuant to section four hundred five of
    39  this chapter. An insurer will also not be  precluded  from  establishing
    40  that the claimant has failed to meet its prima facie burden of proof.
    41    (b)  Every  insurer shall [provide] notify a claimant [with the option
    42  of submitting] that any dispute involving the insurer's liability to pay
    43  first party benefits, or additional first  party  benefits,  the  amount
    44  thereof  or  any other matter which may arise pursuant to subsection (a)
    45  of this section [to] must be settled by arbitration pursuant to  simpli-
    46  fied  procedures  to  be  promulgated or approved by the superintendent.
    47  Such simplified procedures shall include an expedited eligibility  hear-
    48  ing  option,  when  required,  to  designate the insurer for first party
    49  benefits pursuant to subsection  (d)  of  this  section.  The  expedited
    50  eligibility  hearing  option  shall  be a forum for eligibility disputes
    51  only, and shall not include  the  submission  of  any  particular  bill,
    52  payment or claim for any specific benefit for adjudication, nor shall it
    53  consider any other defense to payment.
    54    (c) An award by an arbitrator shall be binding except where vacated or
    55  modified by a master arbitrator in accordance with simplified procedures
    56  to  be  promulgated  or  approved by the superintendent. The grounds for

        A. 6591                             6

     1  vacating or modifying an arbitrator's award by a master arbitrator shall
     2  not be limited to those grounds for review set forth in  article  seven-
     3  ty-five of the civil practice law and rules. The award of a master arbi-
     4  trator  shall  be binding except for the grounds for review set forth in
     5  article seventy-five of the civil practice law and rules[, and  provided
     6  further  that where the amount of such master arbitrator's award is five
     7  thousand dollars or greater, exclusive of interest and attorney's  fees,
     8  the  insurer  or the claimant may institute a court action to adjudicate
     9  the dispute de novo].
    10    (d) (1) Except as provided in paragraph two of this subsection,  where
    11  there  is reasonable belief more than one insurer would be the source of
    12  first party benefits, the insurers may agree among themselves, if  there
    13  is  a  valid  basis  therefor,  that one of them will accept and pay the
    14  claim initially. If there is no such agreement, then the  first  insurer
    15  to  whom  notice of claim is given shall be responsible for payment. Any
    16  such dispute shall be resolved in accordance with the arbitration proce-
    17  dures established pursuant to section five thousand one hundred five  of
    18  this  article  and regulations as promulgated by the superintendent, and
    19  any insurer paying first-party benefits shall  be  reimbursed  by  other
    20  insurers for their proportionate share of the costs of the claim and the
    21  allocated  expenses  of  processing  the  claim,  in accordance with the
    22  provisions entitled "other coverage" contained  in  regulation  and  the
    23  provisions entitled "other sources of first-party benefits" contained in
    24  regulation.  If  there is no such insurer and the motor vehicle accident
    25  occurs in this state, then an applicant who is  a  qualified  person  as
    26  defined  in  article fifty-two of this chapter shall institute the claim
    27  against the motor vehicle accident indemnification corporation.
    28    (2) A group policy issued pursuant  to  section  three  thousand  four
    29  hundred  fifty-five  of  this chapter shall provide first party benefits
    30  when a dispute exists as to whether a driver was using  or  operating  a
    31  motor  vehicle  in connection with a transportation network company when
    32  loss, damage, injury, or death occurs. A transportation network  company
    33  shall  notify  the  insurer  that issued the owner's policy of liability
    34  insurance of the dispute within ten business days of becoming aware that
    35  the dispute exists. When there is a dispute, the  group  insurer  liable
    36  for  the payment of first party benefits under a group policy shall have
    37  the right to recover the amount paid from the driver's  insurer  to  the
    38  extent  that  the  driver  would  have  been liable to pay damages in an
    39  action at law.
    40    § 7.  Subsection (c) of section 5303 of the insurance law  is  amended
    41  to read as follows:
    42    (c)  Such  plan  shall  provide  for  the method of classifying risks,
    43  establishing territories  and  making  rates  applicable  thereto.  Such
    44  rates[, except with respect to rates for the minimum limits of insurance
    45  required  by article six or seven of the vehicle and traffic law,] shall
    46  be based upon loss and expense experience of the risks insured  pursuant
    47  to the plan.
    48    §  8.  The  insurance  law is amended by adding a new section 405-a to
    49  read as follows:
    50    § 405-a.  Compensation for report of insurance fraud to  law  enforce-
    51  ment  authorities.  (a)  Any  person,  other  than  persons described in
    52  subsection (a) of section four hundred five of  this  article,  who  has
    53  reason to believe that a fraudulent insurance act prohibited pursuant to
    54  article  one  hundred seventy-six of the penal law has been committed or
    55  that an insurance transaction may be fraudulent, or has knowledge that a
    56  fraudulent insurance transaction is about to take place,  or  has  taken

        A. 6591                             7

     1  place  may report such act or transaction and any additional information
     2  relative to the factual circumstances of the transaction and the parties
     3  involved to the attorney general, district attorney or insurance  frauds
     4  bureau.
     5    (b)  If the insurance frauds bureau recommends to the attorney general
     6  or district attorney to commence an action or if the attorney general or
     7  district attorney commences an action based on information provided by a
     8  person pursuant to subsection (a) of  this  section,  then  such  person
     9  shall  be  entitled to receive an award of at least fifteen percent, but
    10  not more than twenty-five percent of  the  proceeds  of  the  action  or
    11  settlement of the claim up to a maximum of twenty-five thousand dollars.
    12  The  attorney  general or district attorney shall recommend to the court
    13  when a settlement is entered the amount of such award. The  court  shall
    14  base such award decision on the extent to which the person substantially
    15  contributed to the prosecution of the action.
    16    §  9.  Section  176.00 of the penal law is amended by adding three new
    17  subdivisions 6, 7 and 8 to read as follows:
    18    6. "Provider" means an attorney, a health care professional, an  owner
    19  or  operator  of  a  health  care  practice  or facility, any person who
    20  creates the impression that he or  she,  or  his  or  her  practice  can
    21  provide  legal or health care services, or any person employed or acting
    22  on behalf of any such person.
    23    7. "Public media" means telephone directories,  professional  directo-
    24  ries,  newspapers  and  other  periodicals,  radio and television, bill-
    25  boards, and mailed or electronically transmitted written  communications
    26  that  do  not  involve  in-person  contact  with  a specific prospective
    27  client, patient, or customer.
    28    8. "Runner" means a person who, for a pecuniary benefit,  procures  or
    29  attempts  to  procure a client, patient or customer at the direction of,
    30  request of or in cooperation with a provider when such person  knows  or
    31  has  reason  to  know  that  the  purpose of such provider is to seek to
    32  falsely or fraudulently: obtain benefits under a contract of  insurance;
    33  or assert a claim against an insured or an insurance carrier for provid-
    34  ing  services  to  the  client, patient or customer. Such term shall not
    35  include a person who procures or attempts to procure  clients,  patients
    36  or  customers for a provider through public media or a person who refers
    37  clients, patients or customers as authorized by law.   Nothing  in  this
    38  article  shall  be  deemed to prohibit an agent, broker or employee of a
    39  health maintenance organization from seeking to sell health  maintenance
    40  organization  coverage  or health insurance coverage to an individual or
    41  group.
    42    § 10. Subdivision 1 of section 176.05 of the penal law, as amended  by
    43  chapter 211 of the laws of 2011, is amended to read as follows:
    44    1.  any written statement as part of, or in support of, an application
    45  for the issuance of, or the rating of a policy insuring  against  losses
    46  or  liabilities  arising  out  of  the ownership, operation, or use of a
    47  motor vehicle, a commercial insurance policy, or certificate or evidence
    48  of self insurance for commercial insurance or commercial self insurance,
    49  or a claim for payment or other benefit pursuant to an insurance  policy
    50  or  self  insurance program for commercial or personal insurance that he
    51  or she knows to:
    52    (a) contain materially false information concerning any fact  material
    53  thereto; or
    54    (b) conceal, for the purpose of misleading, information concerning any
    55  fact material thereto; or

        A. 6591                             8

     1    §  11. The penal law is amended by adding a new section 176.66 to read
     2  as follows:
     3  § 176.66 Unlawful procurement of clients, patients or customers.
     4    A  person  is  guilty  of unlawful procurement of clients, patients or
     5  customers when, he or she knowingly:
     6    1. acts as a runner; or
     7    2. uses, solicits, directs, hires or employs another person to act  as
     8  a runner.
     9    Unlawful  procurement  of  clients, patients or customers is a class E
    10  felony.
    11    § 12. Section 176.15 of the penal law, as amended by  chapter  515  of
    12  the laws of 1986, is amended to read as follows:
    13  § 176.15 Insurance fraud in the fourth degree.
    14    A  person is guilty of insurance fraud in the fourth degree when he or
    15  she commits a fraudulent insurance act  and  thereby  wrongfully  takes,
    16  obtains or withholds, or attempts to wrongfully take, obtain or withhold
    17  property with a value in excess of [one thousand] five hundred dollars.
    18    Insurance fraud in the fourth degree is a class E felony.
    19    §  13.  Section  176.20 of the penal law, as amended by chapter 515 of
    20  the laws of 1986, is amended to read as follows:
    21  § 176.20 Insurance fraud in the third degree.
    22    A person is guilty of insurance fraud in the third degree when  he  or
    23  she  commits  a  fraudulent  insurance act and thereby wrongfully takes,
    24  obtains or withholds, or attempts to wrongfully take, obtain or withhold
    25  property with a value in excess of [three]  one  thousand  five  hundred
    26  dollars.
    27    Insurance fraud in the third degree is a class D felony.
    28    §  14. Section 176.25 of the penal law, as added by chapter 515 of the
    29  laws of 1986, is amended to read as follows:
    30  § 176.25 Insurance fraud in the second degree.
    31    A person is guilty of insurance fraud in the second degree when he  or
    32  she  commits  a  fraudulent  insurance act and thereby wrongfully takes,
    33  obtains or withholds, or attempts to wrongfully take, obtain or withhold
    34  property with a value in excess of [fifty] twenty-five thousand dollars.
    35    Insurance fraud in the second degree is a class C felony.
    36    § 15. Section 176.30 of the penal law, as added by chapter 515 of  the
    37  laws of 1986, is amended to read as follows:
    38  § 176.30 Insurance fraud in the first degree.
    39    A  person  is guilty of insurance fraud in the first degree when he or
    40  she commits a fraudulent insurance act  and  thereby  wrongfully  takes,
    41  obtains or withholds, or attempts to wrongfully take, obtain or withhold
    42  property  with  a value in excess of [one million] five hundred thousand
    43  dollars.
    44    Insurance fraud in the first degree is a class B felony.
    45    § 16. Section 176.35 of the penal law, as added by chapter 635 of  the
    46  laws of 1996, is amended to read as follows:
    47  § 176.35 Aggravated insurance fraud in the third degree.
    48    A person is guilty of aggravated insurance fraud in the [fourth] third
    49  degree  when  he or she commits [a fraudulent insurance act] the offense
    50  of insurance  fraud  in  the  fifth  degree,  and  has  been  previously
    51  convicted  within  the preceding five years of any offense, an essential
    52  element of which is the commission of a fraudulent insurance act.
    53    Aggravated insurance fraud in the [fourth] third degree is a  class  D
    54  felony.
    55    §  17.  The penal law is amended by adding two new sections 176.36 and
    56  176.37 to read as follows:

        A. 6591                             9

     1  § 176.36 Aggravated insurance fraud in the second degree.
     2    A  person is guilty of aggravated insurance fraud in the second degree
     3  when he or she commits the offense of  insurance  fraud  in  the  fourth
     4  degree,  and  has  been  previously  convicted within the preceding five
     5  years of any offense, an essential element of which is the commission of
     6  a fraudulent insurance act.
     7    Aggravated insurance fraud in the second degree is a class C felony.
     8  § 176.37 Aggravated insurance fraud in the first degree.
     9    A person is guilty of aggravated insurance fraud in the  first  degree
    10  when  he  or  she  commits  the  offense of insurance fraud in the third
    11  degree, and has been previously  convicted  within  the  preceding  five
    12  years of any offense, an essential element of which is the commission of
    13  a fraudulent insurance act.
    14    Aggravated insurance fraud in the first degree is a class B felony.
    15    § 18. Paragraph (a) of subdivision 2 of section 846-m of the executive
    16  law,  as  amended  by  section  6 of part T of chapter 57 of the laws of
    17  2000, is amended to read as follows:
    18    (a) The moneys received by the fund shall be expended in a manner that
    19  is consistent with the plan of  operation,  pursuant  to  appropriation,
    20  only  to reimburse costs incurred by provider agencies for pilot program
    21  activities relating to the detection, prevention or reduction  of  motor
    22  vehicle theft and motor vehicle insurance fraud, provided, however, that
    23  beginning  January  first,  two  thousand  twenty-two, additional monies
    24  received by the fund pursuant to an appropriation made by a  chapter  of
    25  the laws of two thousand twenty-one establishing the New York automobile
    26  insurance  fraud  and premium reduction act shall be used exclusively to
    27  support efforts undertaken by district attorneys to detect, identify and
    28  prosecute fraud pertaining to article fifty-one of the insurance law.
    29    § 19. No later than eighteen months after the effective date  of  this
    30  act,  the superintendent of financial services shall study, evaluate and
    31  report to the governor and legislature on the impact and effect of  this
    32  act  on private passenger automobile insurance costs, by rating territo-
    33  ry, in New York state. The superintendent of  financial  services  shall
    34  recommend  for  each  insurer,  by  rating territory, a one-time premium
    35  reduction for the insurance required  pursuant  to  article  51  of  the
    36  insurance law that reflects the reduced cost of this type of coverage as
    37  a result of the provisions enacted pursuant to this act. Notwithstanding
    38  the  provisions of article 23 of the insurance law, any such recommended
    39  reduction shall be binding unless demonstrated by an insurer,  based  on
    40  sound underwriting and actuarial principles reasonably related to actual
    41  or  anticipated  loss  experience,  that  such reduction would result in
    42  underwriting losses for policies issued in such rating territory.
    43    § 20.    The  sum  of  three  million  one  hundred  thousand  dollars
    44  ($3,100,000),  or  so much thereof as may be necessary, is hereby appro-
    45  priated to the department of transportation out of  any  moneys  in  the
    46  state  treasury  in  the general fund to the credit of the motor vehicle
    47  theft and insurance fraud prevention fund, not  otherwise  appropriated,
    48  and  made  immediately  available,  for  the purpose of carrying out the
    49  provisions of paragraph (a) of subdivision 2 of  section  846-m  of  the
    50  executive  law,  as  amended  pursuant  to section eighteen of this act.
    51  Such moneys shall be payable on the audit and warrant of the comptroller
    52  on vouchers certified or approved by the commissioner of  transportation
    53  in the manner prescribed by law.
    54    § 21.  Severability clause. If any clause, sentence, paragraph, subdi-
    55  vision,  section  or  part  contained  in  any part of this act shall be
    56  adjudged by any court of competent  jurisdiction  to  be  invalid,  such

        A. 6591                            10

     1  judgment  shall not affect, impair, or invalidate the remainder thereof,
     2  but shall be confined in its operation to the  clause,  sentence,  para-
     3  graph,  subdivision,  section  or part of this act contained in any part
     4  thereof  directly  involved  in  the  controversy in which such judgment
     5  shall have been rendered. It is hereby declared to be the intent of  the
     6  legislature  that  this act would have been enacted even if such invalid
     7  provisions had not been included herein.
     8    § 22. This act shall take effect on the ninetieth day after  it  shall
     9  have become a law.
feedback