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New York Workers' Compensation Law Section 13-g - Payment Of Bills For Medical Care.Legal Research Home > New York Lawyer > Workers' Compensation > New York Workers' Compensation Law Section 13-g - Payment Of Bills For Medical Care.
§ 13-g. Payment of bills for medical care. (1) Within forty-five days
after a bill has been rendered to the employer by the hospital,
physician or self-employed physical or occupational therapist who has
rendered treatment pursuant to a referral from the injured employee's
authorized physician or authorized podiatrist for treatment to the
injured employee, such employer must pay the bill or notify the
hospital, physician or self-employed physical or occupational therapist
in writing that the bill is not being paid and explain the reasons for
non-payment. In the event that the employer fails to make payment or
notify the hospital, physician or self-employed physical or occupational
therapist within such forty-five day period that payment is not being
made, the hospital, physician, self-employed physical therapist or
self-employed occupational therapist may notify the chair in writing
that the bill has not been paid and request that the board make an award
for payment of such bill. The board or the chair may make an award not
in excess of the established fee schedules for any such bill or part
thereof which remains unpaid after said forty-five day period or thirty
days after all other questions duly and timely raised in accordance with
the provisions of this chapter, relating to the employer's liability for
the payment of such amount, shall have been finally determined adversely
to the employer, whichever is later, in accordance with rules
promulgated by the chair, and such award may be collected in like manner
as an award of compensation. The chair shall assess the sum of fifty
dollars against the employer for each such award made by the board,
which sum shall be paid into the state treasury.
In the event that the employer has provided an explanation in writing
why the bill has not been paid, in part or in full, within the aforesaid
time period, and the parties can not agree as to the value of medical
aid rendered under this chapter, such value shall be decided by
arbitration if requested by the hospital, physician or self-employed
physical or occupational therapist, in accordance with the provisions of
subdivision two or subdivision three of this section, as appropriate,
and rules and regulations promulgated by the chair.
Where a physician, physical or occupational therapist bill has been
determined to be due and owing in accordance with the provisions of this
section the board shall include in the amount of the award interest of
not more than one and one-half per cent (1 1/2%) per month payable to
the physician, physical or occupational therapist, in accordance with
the rules and regulations promulgated by the board. Interest shall be
calculated from the forty-fifth day after the bill was rendered or from
the thirtieth day after all other questions duly and timely raised in
accordance with the provisions of this chapter, relating to the
employer's liability for the payment of such amount, shall have been
finally determined adversely to the employer, whichever is later, in
accordance with rules promulgated by the chair.
(2) If the parties fail to agree as to the value of medical aid
rendered under this chapter, such value shall be decided by an
arbitration committee consisting of one physician designated by the
president of the medical society of the county in which the medical
services were rendered, one physician who is a member of the medical
society of the state of New York, appointed by the employer or carrier,
and one physician, also a member of the medical society of the state of
New York, appointed by the chairman of the workers' compensation board.
The majority decision of any such committee shall be conclusive upon the
parties as to the value of the services rendered. If the physician whose
charges are being arbitrated is a member in good standing of the New
York osteopathic society or the New York homeopathic society, the
members of such arbitration committee shall be physicians of such
organization, one to be appointed by the president of that organization,
one by the employer or carrier and the third by the chairman of the
workers' compensation board. Where the value of physical therapy
services is at issue the arbitration committee shall consist of a member
in good standing of a recognized professional association representing
physical therapists in the state of New York appointed by the president
of such organization, a physician designated by the employer or carrier
and a physician designated by the chairman of the workers' compensation
board provided however, that the chairman finds that there are a
sufficient number of physical therapy arbitrations in a geographical
area comprised of one or more counties to warrant a committee so
comprised. In all other cases where the value of physical therapy
services is at issue, the arbitration committee shall be similarly
selected and identical in composition, provided that the physical
therapist member shall serve without remuneration, and provided further
that in the event a physical therapist is not available, the committee
shall be comprised of three physicians designated in the same manner as
in cases where the value of medical aid is at issue.
Where the value of occupational therapy services is at issue the
arbitration committee shall consist of a member in good standing of a
recognized professional association representing occupational therapists
in the state of New York appointed by the president of such
organization; a physician designated by the employer or carrier and a
physician designated by the chairman of the workers' compensation board
provided, however, that the chairman finds that there are a sufficient
number of occupational therapy arbitrations in a geographical area
comprised of one or more counties to warrant a committee so comprised.
In all other cases where the value of occupational therapy services is
at issue, the arbitration committee shall be similarly selected and
identical in composition, provided that the occupational therapist
member shall serve without remuneration, and provided further that in
the event an occupational therapist is not available, the committee
shall be comprised of three physicians designated in the same manner as
in cases where the value of medical aid is at issue.
(3) If an employer shall have notified the hospital in writing, as
provided in subdivision one of this section, why the bill has not been
paid, in part or in full, the value of such bill shall be determined by
an arbitration committee appointed by the chair for that purpose, which
committee shall consider all of the charges of the hospital. The
committee shall consist of three physicians. One member of the committee
may be nominated to the chair by the president of the hospital
association of New York state and one member may be nominated by the
employer or insurance carrier. The majority decision of any such
committee shall be conclusive upon the parties as to the value of the
services rendered. The chair may make reasonable rules and regulations
consistent with the provisions of this section.
(4) A provider initiating an arbitration pursuant to this section
shall pay a fee as determined by regulations promulgated by the chair,
to be used to cover the costs related to the conduct of such
arbitration. Upon resolution in favor of such party, the amount due,
based upon the bill in dispute, shall be increased by the amount of the
fee paid by such party. Where a partial award is made, the amount due,
based upon the bill in dispute, shall be increased by a part of such
fee. Each member of an arbitration committee for medical bills, and
each member of an arbitration committee for hospital bills shall be
entitled to receive and shall be paid a fee for each day's attendance at
an arbitration session in any one count in an amount fixed by the chair
of the workers' compensation board.
(5) In claims where the employer has failed to secure compensation to
his employees as required by section fifty of this chapter, the board
may make an award for the value of medical and podiatry services or
treatment rendered to such employees, in accordance with the schedules
of fees and charges prepared and established under the provisions of
section thirteen, subdivision a, and section thirteen-k, subdivision
two, of this chapter, and for the reasonable value of hospital care in
accordance with the charges currently in force in hospitals in the same
community for cases coming within the provisions of this chapter. Such
award shall be made to the physician, podiatrist, or hospital entitled
thereto. A default in the payment of such award may be enforced in the
manner provided for the enforcement of compensation awards as set forth
in section twenty-six of this chapter.
In all cases coming under this subdivision the payment of the claim of
the physician, podiatrist, or hospital for medical, podiatry, or
surgical services or treatment shall be subordinate to that of the
claimant or his beneficiaries.
(6) Notwithstanding any inconsistent provision of law, arbitration
regarding payments for inpatient hospital services for any patient
discharged on or after January first, nineteen hundred ninety-one and
prior to December thirty-first, nineteen hundred ninety-six shall be
resolved in accordance with paragraph (d) of subdivision three of
section twenty-eight hundred seven-c of the public health law.
Last modified: July 31, 2006 |