Editor's note: For related unconsolidated provisions, see Appendix A at L.L. 2006/011.
For the purposes of this chapter, the following terms shall have the following meanings:
1. "Clinic" shall mean any private, non-residential medical facility or practice, other than a hospital as defined in article 28 of the public health law, which provides health care services in the city of New York relating to injuries sustained as a result of motor vehicle accidents.
2. "Control", including the terms "controlling", "controlled by" and "under common control by or with", shall mean the possession, direct or indirect, of the power to direct or cause the direction of the management and policies of an institution, whether through ownership of voting securities, by contract or otherwise.
3. "Health care provider" shall mean any physician or other health care professional, including, but not limited to, dentists, nurses, x-ray technicians, physical or occupational therapists, massage therapists, acupuncturists, chiropractors and mental health service professionals, licensed to practice in New York state.
4. "Health care services" shall mean any health or mental health services provided by a health care provider relating to injuries sustained as a result of an actual or alleged motor vehicle accident, including but not limited to medical, hospital, surgical, nursing, dental, ambulance, x-ray, diagnostic, prescription drug, prosthetic, psychiatric, massage, acupuncture, chiropractic, and physical or occupational therapy and rehabilitation services.
5. "Insured" shall mean any person who owns a policy of insurance issued by a no-fault motor vehicle insurer that insures against losses or liabilities arising out of the ownership, operation, or use of a motor vehicle.
6. "Medical benefits" shall mean full or partial payments for health care services.
7. "Motor vehicle" shall mean any vehicle operated upon a public highway or public street propelled by any power other than muscular power.
8. "No-fault insurance medical clinic" shall mean any clinic that is subject to the requirements of this chapter.
9. "No-fault motor vehicle insurance medical claim" shall mean any claim for medical benefits submitted to a no-fault motor vehicle insurer under a policy issued by such no-fault motor vehicle insurer pursuant to article 51 of the New York state insurance law, which provides "first party benefits" as that term is defined in section 5102 (b) of such article.
10. "No-fault motor vehicle insurer" shall mean any insurer, company, corporation, partnership or other individual or entity authorized to transact or transacting business in New York state, or controlling or controlled by or under common control by or with such insurer, company, corporation, partnership or other individual or entity, which sells policies of insurance that insure against losses or liabilities arising out of the ownership, operation, or use of a motor vehicle.
11. "Owner" shall mean any owner, manager, operator or other person or persons having control of a clinic and any authorized agent thereof.
12. "Runner" shall mean any person who, for a pecuniary benefit, procures or attempts to procure a client, patient or customer when such person knows, or a reasonable person would know, that the purpose of an owner of a no-fault motor vehicle insurance medical clinic is to falsely or fraudulently: (i) obtain medical benefits from a no-fault motor vehicle insurer; or (ii) assert a claim against an insured or a no-fault motor vehicle insurer for the provision of health care services to such client, patient or customer; provided, however, that such term shall not include a person who procures or attempts to procure clients, patients or customers through public media or a person who refers clients, patients or customers as authorized by law. Nothing in this chapter shall be deemed to prohibit an agent, broker or employee of a health maintenance organization from seeking to sell health maintenance organization coverage or health insurance coverage to any individual or group.
Editor's note: For related unconsolidated provisions, see Appendix A at L.L. 2006/011.
Loading...