360-7.4 Liability of third parties.
(a) (1) When care and services are or may be provided to an
applicant/recipient for treatment of injury, disease or disability, the State or social
services district will take all reasonable measures to ascertain the legal liability of
third parties (including health insurers) to pay for such care and services.
(2) The social services district, when
determining or redetermining eligibility, must collect sufficient information to enable
the State to pursue claims against such third parties, including all information
specifically required by the department.
(3) As a condition of eligibility, an
applicant/recipient must cooperate with the State or social services district in
identifying third parties who may be liable to pay for care. The applicant/recipient must
provide information to assist the State in pursuing such third parties. An
applicant/recipient may refuse to cooperate only for good cause.
(4) As a condition of eligibility, an
applicant/recipient with the legal capacity to execute an assignment, must assign to the
State and social services district any rights against any third party for support
(specified as support for medical care by a court or administrative order) and for payment
of medical care. The requirement extends to any person with the legal authority to execute
an assignment on behalf of an applicant/recipient.
(5) The State or social services district will
seek reimbursement or MA when there is a third party legal liability and the expected
amount of reimbursement is more than the costs of making the recover.
(6) Upon furnishing MA to a recipient, the
social services district or the department will be subrogated, to the extent of the
expenditures by such district or the department, to any rights the recipient may have to
medical support or third party reimbursement. For purposes of this section, the term
medical support means the right to support for purposes of medical care as specified by
court or administrative order. The social services district or the department will issue a
written notice of the exercise of subrogation rights to the appropriate party or parties.
(b) A recipient is eligible to receive MA even if he/she has a right of
action, suit, claim, counterclaim or demand against a third party for personal injuries
suffered, if all other eligibility requirements are met. If the social services district
finds that the third party has paid or will pay within a reasonable time, the district
will pay only the amount by which the allowable MA claim exceeds the third party
liability. If payment will not be made within a reasonable time, the social services
district must file a lien covering the cost of such assistance in accordance with section
104-b of the Social Services Law. The recipient will be required to assign to the district
the proceeds of such right or demand.
(c) Whenever a social services district authorizes hospital care for
the treatment of a recipient's personal injuries, it must obtain a satisfaction or
discharge of any hospital lien covering such care before or at the time payment to the
hospital is made. The district must file the satisfaction or discharge in accordance with
the Lien Law.