Department of Civil Service

New York State Health Insurance Program: Coordination of Workers' Compensation Medical Coverage (Follow-Up Review)

In the New York State Health Insurance Program, the Department of Civil Service administers health insurance programs for State and local government employees and their dependents. The primary such program is the Empire Plan, which provides services costing more than $1.6 billion a year. Work- related medical claims should not be paid by the Empire Plan, because employers in New York are required by State law to provide medical coverage to their employees for work-related injuries or illnesses. However, in our prior audit report 94-S-68, we identified about $1 million in work-related claims that were paid by the Empire Plan over a 51-month period. We recommended that these payments be recovered from the appropriate insurers and procedures be improved to prevent such payments in the future. In our follow-up review, we found that these recommendations generally have not been implemented.

For a complete copy of Report 97-F-26 click here.