N.Y. Comp. Codes R. & Regs. tit. 18 § 542.1

Current through Register Vol. 46, No. 51, December 18, 2024

Section 542.1 - Claims to which social services officials are subrogated

(a) Pursuant to the Social Services Law, the department, a social services district or a social services official may become subrogated to any rights a person or such person's legally responsible relative may have to health insurance, other medical care coverage, medical support or third party reimbursement as a result of:

(1) an assignment by an applicant for or recipient of medical assistance as required by section 366(4)(h) of such law;

(2) an implied contract created by law when a responsible relative refuses or fails to provide necessary care and assistance as described in section 366(3)(a) of such law;

(3) subrogation by law when a legally responsible relative agrees to or is ordered by a court or administrative tribunal of competent jurisdiction to provide health insurance or other medical care coverage for his or her dependents or other persons as described in section 366(3)(b) of such law;

(4) any assignment by agreement to a social services official; or

(5) any other circumstance by which the department, a social services district or a social services official may become subrogated by law, including common law, to rights to receive benefits or payment from a third party.

(b) Pursuant to section 3212 (e)(3) and (4) of the Insurance Law, any right of subrogation to benefits which the department, a social services district or a social services official is entitled is valid and enforceable to the extent that benefits are available under an insurance policy or contract and the right of subrogation attaches to any benefits paid or provided under any policy, plan or contract upon receipt of a written notice of the exercise of such subrogation rights.

(c) When the department, a social services district or a social services official is subrogated to the right to receive third party reimbursement, claims for such reimbursement may be submitted to liable third parties by representatives or agents of the department, a social services district or a social services official. When a third party is liable for the reimbursement of such claims, the payment of such reimbursement must be made in any lawful manner specified by such representatives or agents.

N.Y. Comp. Codes R. & Regs. Tit. 18 § 542.1