Department of Civil Service

New York State Health Insurance Program: Coordination of Workers' Compensation Medical Coverage

TheDepartment of Civil Service administers health insurance programs for State and localgovernment employees and their dependents. The primary such program is the Empire Plan,which provides services costing more than $1.4 billion a year. In certain circumstances, thepeople covered by the Empire Plan may also be covered by other health insurers. In suchcircumstances, any claims covered by the other insurers should be paid by these insurersrather than by the Empire Plan. For example, as required by State law, employees in NewYork receive medical coverage from their employers for work-related injuries or illnesses. Therefore, work-related medical claims should not be paid by the Empire Plan. However,when we examined the medical claims paid by the Empire Plan over a 51-month period, weidentified about $1 million in work-related claims that had been paid by the Empire Plan. We recommend that these payments be recovered from the appropriate insurers and procedures beimproved to prevent such payments by the Empire Plan in the future.

For a complete copy of 94-S-68 click here.
For a copy of the associated follow-up report click here.
For a copy of the 90-day response click here.