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New York Workers' Compensation Law Section 25-a - Procedure And Payment Of Compensation In Certain Claims; Limitation Of Right To Compensation.Legal Research Home > New York Lawyer > Workers' Compensation > New York Workers' Compensation Law Section 25-a - Procedure And Payment Of Compensation In Certain Claims; Limitation Of Right To Compensation.
§ 25-a. Procedure and payment of compensation in certain claims;
limitation of right to compensation. 1. Notwithstanding other provisions
of this chapter, when an application for compensation is made by an
employee or for death benefits in behalf of the dependents of a deceased
employee, and the employer has secured the payment of compensation in
accordance with section fifty of this chapter, (1) after a lapse of
seven years from the date of the injury or death and claim for
compensation previously has been disallowed or claim has been otherwise
disposed of without an award of compensation, or (2) after a lapse of
seven years from the date of the injury or death and also a lapse of
three years from the date of the last payment of compensation, or (3)
where death resulting from the injury shall occur after the time limited
by the foregoing provisions of (1) or (2) shall have elapsed, subject to
the provisions of section one hundred and twenty-three of this chapter,
testimony may be taken, either directly or through a referee and if an
award is made it shall be against the special fund provided by this
section. Such an application for compensation or death benefits must be
made on a form prescribed by the chairman for that purpose and must, if
a change in condition is claimed, be accompanied by a verified medical
or surgical report setting forth facts on which the board may order a
hearing. Any award which shall be made against such special fund after
the effective date of this act upon such an application for compensation
or death benefits shall not be retroactive for a period of disability or
for death benefits longer than the two years immediately preceding the
date of filing of such application.
2. Claims for further services or treatment rendered or supplies
furnished as required by section thirteen hereof shall be paid from such
fund when such service, treatment or supplies shall be authorized by the
chairman. In cases where a surgical operation has previously been
authorized by the board pursuant to the provisions of subdivision five
of section thirteen-a of this chapter, no further authorization therefor
by the chairman under this section shall be required. The provisions of
this chapter with respect to procedure and the right to appeal shall be
preserved to the claimant and to the employer originally liable for the
payment of compensation and to such fund through its representative as
hereinafter provided.
3. Any awards so made shall be payable out of the special fund
heretofore created for such purpose, which fund is hereby continued and
shall be known as the fund for reopened cases. The employer, or, if
insured, his insurance carrier shall pay into such fund, or, in the case
of awards made on or after July first, nineteen hundred sixty-nine,
either into such fund or the uninsured employers' fund under section
twenty-six-a of this chapter in accordance with the provisions thereof,
for every case of injury causing death for which there are no persons
entitled to compensation the sum of three hundred dollars where such
injury occurred prior to July first, nineteen hundred forty and the sum
of one thousand dollars where such injury shall occur on or after said
date and prior to April first, nineteen hundred forty-five, and the sum
of fifteen hundred dollars where such injury shall occur on or after
April first, nineteen hundred forty-five and prior to September first,
nineteen hundred seventy-eight and the sum of three thousand dollars
where such injury shall occur on or after September first, nineteen
hundred seventy-eight, and in each case of death resulting from injury
sustained on or after July first, nineteen hundred forty and prior to
September first, nineteen hundred seventy-eight, where there are persons
entitled to compensation but the total amount of such compensation is
less than two thousand dollars exclusive of funeral benefits, the
employer, or, if insured, his insurance carrier, shall pay into such
fund, or, in the case of awards made on or after July first, nineteen
hundred sixty-nine and prior to September first, nineteen hundred
seventy-eight, either into such fund or the uninsured employers' fund
under section twenty-six-a of this chapter in accordance with the
provisions thereof, the difference between the sum of two thousand
dollars and the compensation, exclusive of funeral benefits, and in each
case of death resulting from injury sustained on or after September
first, nineteen hundred seventy-eight, the employer, or if insured, his
insurance carrier shall pay into such fund or the uninsured employers'
fund under section twenty-six-a of this chapter in accordance with the
provisions thereof, the difference between the sum of five thousand
dollars and the compensation, exclusive of funeral benefits actually
paid to or for the dependents of the deceased employee together with any
expense charge required by section twenty-seven of this chapter;
provided, however, that where death shall occur subsequent to the
periods limited by subdivision one of this section no payment into such
special fund nor to the special fund provided by subdivision nine of
section fifteen nor to the uninsured employers' fund provided by section
twenty-six-a of this chapter shall be required. In addition to the
assessments made against all insurance carriers for the expenses of
administering the workmen's compensation law provided for under the
provisions of section one hundred and fifty-one of this chapter, and the
payments above provided, the employer, or, if insured, his insurance
carrier, shall pay the sum of five dollars into said fund for each case
in which an award is made pursuant to the provisions of paragraphs a to
s inclusive of subdivision three of section fifteen of this chapter, by
reason of injury sustained between July first, nineteen hundred forty
and June thirtieth, nineteen hundred forty-two, both dates inclusive,
and the sum of ten dollars for each such case by reason of injury
sustained between July first, nineteen hundred forty-two and June
thirtieth, nineteen hundred fifty, both dates inclusive, which payment
shall be in addition to any payment of compensation to the injured
employee as provided in this chapter.
There shall be maintained in the special fund at all times assets at
least equal in value to the sum of (1) the value of awards charged
against such fund, (2) the value of all claims that have been reopened
by the board as a charge against such fund but as to which awards have
not yet been made, (3) effective January first, nineteen hundred
seventy-one, the total supplemental benefits paid from such fund as
reimbursement pursuant to subdivision nine of this section during the
calendar year immediately preceding, and (4) a reserve equal to ten per
cent of the sum of items (1) and (2). For the purpose of accumulating
funds for the payment of supplemental benefits pursuant to subdivision
nine of this section, the chairman shall impose against all carriers an
assessment in the sum of five million dollars to be collected in the
respective proportions established in the fiscal year commencing April
first, nineteen hundred sixty-eight, under the provisions of section one
hundred fifty-one of this chapter for each carrier. Annually, as soon as
practicable after January first in each year, the chairman shall
ascertain the condition of the fund and whenever the assets shall fall
below the prescribed minimum as herein provided the chairman shall
assess and collect from all insurance carriers, in the respective
proportions established in the prior fiscal year under the provisions of
section one hundred fifty-one of this chapter for each carrier, an
amount sufficient to restore the fund to the prescribed minimum. The
chairman before making an assessment as herein provided shall give
thirty days' notice to the representative of the fund, designated
pursuant to subdivision five of this section, that an itemized statement
of the condition of the fund is open for his inspection. The
superintendent of insurance may examine into the condition of the fund
at any time on his own initiative or on request of the chairman or
representative of the fund.
Such assessment and the payments made into said fund shall not
constitute an element of loss for the purpose of establishing rates for
workers' compensation insurance as provided in the insurance law but
shall for the purpose of recoupment be treated as separate costs by
carriers. Carriers shall assess such costs on their policyholders in
accordance with rules set forth by the New York compensation insurance
rating board, as approved by the superintendent of insurance.
The provisions of this subdivision shall not apply with respect to
policies containing coverage pursuant to subdivision four-a of section
one hundred sixty-seven of the insurance law relating to every policy
providing comprehensive personal liability insurance on a one, two,
three or four family owner-occupied dwelling.
4. The commissioner of taxation and finance shall be the custodian of
such special fund for reopened cases and shall invest any surplus monies
thereof in securities which constitute legal investments for savings
banks under the laws of this state and in interest bearing certificates
of deposit of a bank or trust company located and authorized to do
business in this state or of a national bank located in this state
secured by a pledge of direct obligations of the United States or of the
state of New York in an amount equal to the amount of such certificates
of deposit, and may sell any of the securities or certificates of
deposit in which such fund is invested, if necessary for the proper
administration or in the best interest of such fund. Disbursements from
such fund for compensation provided by this section shall be paid by the
commissioner of taxation and finance upon vouchers signed by the
chairman.
The commissioner of taxation and finance, as custodian of such fund,
annually as soon as practicable after January first, shall furnish to
the chairman a statement of the fund, setting forth the balance of
monies in the said fund as of the beginning of the year, the income of
the fund, a summary of payments out of the fund on account of
compensation ordered to be paid by the board, medical and other expense,
and all other charges against the fund, and setting forth the balance of
the fund remaining to its credit on December thirty-first. Such
statement shall be open to public inspection in the office of the
chairman, and a copy thereof shall be transmitted by the chairman to the
superintendent of insurance. The superintendent of insurance may
examine into the condition of such fund at any time on his own
initiative or on request of the chairman or representative of the fund.
He shall verify the receipts and disbursements of the fund, and shall
ascertain the liability of the fund upon all cases in which awards of
compensation have been made and charged against said fund and shall
render a report of such facts to the chairman. Such report shall also be
open to public inspection in the office of the chairman.
5. When an application for compensation is made under this section,
the chairman shall appoint a representative of such fund in such
proceedings and, insofar as practicable, such representative shall be a
person designated by the employer originally liable for the payment of
compensation, or his insurance carrier, but whenever it shall appear to
the chairman that through any committee, board or organization or
representative of the interest of the insurance carriers an attorney has
been appointed to act for and on behalf of such carriers generally to
represent such fund in any proceedings brought hereunder, the chairman
shall designate such attorney as the representative of the fund in
proceedings brought to enforce a claim against such fund. Such
representative may apply to the chairman for authority to hire such
medical or other experts and to defray the expense thereof and of such
witnesses as are necessary to a proper defense of the application within
an amount in the discretion of the chairman and, if authorized, it shall
be a charge against the special fund provided herein.
6. Notwithstanding any other provision of this chapter, no award of
compensation or death benefits shall be made against said special fund
or against an employer or an insurance carrier where application
therefor is made after a lapse of eighteen years from the date of the
injury or death and also a lapse of eight years from the date of the
last payment of compensation.
7. For the purposes of this section the date of the last payment of
compensation shall be deemed to mean the date of actual payment of the
last installment of compensation previously awarded; provided, however,
that where the case is disposed of by the payment of a lump sum, the
date of last payment for the purpose of this section shall be considered
as the date to which the amount paid in the lump sum settlement would
extend if the award had been made on the date the lump sum payment was
approved at the maximum compensation rate which is warranted by the
employee's earning capacity as determined by the board under section
fifteen of this chapter.
8. The provisions of this section shall not apply to any open case
pending before the board on April twenty-fourth, nineteen hundred
thirty-three or to any closed case in which an application for reopening
was received prior to such date, or to awards for deficiency
compensation made pursuant to section twenty-nine of this chapter, nor
shall it apply during the pendency of an appeal provided for by section
twenty-three of this chapter; provided, however, that such provisions
shall be retroactive in effect except as to payments into the special
fund provided for an employer or his insurance carrier, and except as
otherwise herein provided.
9. (a) Notwithstanding any other provision of this chapter, every
employee who is receiving workers' compensation under this chapter for a
permanent and total disability resulting from an accidental injury or
occupational disablement which occurred prior to January first, nineteen
hundred seventy-nine and every widow or widower who is receiving death
benefits under this chapter on account of the death of his or her spouse
prior to January first, nineteen hundred seventy-nine shall receive
supplemental benefits upon application therefor to the board, which
shall be payable in the first instance by the employer or its insurance
carrier in accordance with the provisions of this subdivision. These
supplemental benefits shall commence on July first, nineteen hundred
ninety and shall continue during the period of such permanent total
disability or entitlement to death benefits.
(b) If such employee, widow or widower is receiving the statutory
maximum benefit in effect at the time of the accidental injury or death,
the supplemental benefit shall be an amount which, when added to the
regular benefit established for the case, shall equal the maximum weekly
benefit in effect for a permanently totally disabled employee, widow or
widower whose claim arose on January first, nineteen hundred
seventy-nine.
(c) If such employee, widow or widower is receiving a weekly benefit
which is less than the statutory maximum benefit which was in effect on
the date of the accidental injury or death, the supplemental benefit
shall be an amount equal to the difference between the regular benefit
being received and a percentage of the maximum benefit in effect on
January first, nineteen hundred seventy-nine, determined by multiplying
the latter benefit by a fraction, the numerator of which is the regular
benefit and the denominator of which is the statutory maximum benefit in
effect at the time of the accidental injury or death.
(d) In the event the supplemental benefit computed under this
subdivision amounts to less than five dollars, then the supplemental
benefit allowed shall be a minimum of five dollars, less the amount, if
any, by which the combination of such supplemental benefit and the
regular benefit exceeds the maximum weekly benefit in effect for a
permanently totally disabled employee, widow or widower whose claim
arose on January first, nineteen hundred seventy-nine.
(e) The employer or his insurance carrier paying the supplemental
benefits required under this subdivision shall claim reimbursement for
each such case from the reopened cases fund under this section,
commencing one year from the date of the first such payment and annually
thereafter while such supplemental payments continued, on a form
prescribed by the chairman.
(f) The special disability fund created under subdivision eight of
section fifteen and the reopened cases fund created under section
twenty-five-a and the aggregate trust fund created under section
twenty-seven of this chapter shall be deemed to be insurance carriers
for purposes of this subdivision, other than the payment of the
assessment under the provisions of subdivision three of this section.
(g) Whenever payment of the supplemental benefits prescribed hereunder
is not made by the insurance carrier by reason of the insolvency of such
insurance carrier, or in the case of a self-insurer, by reason of the
insolvency of such self-insurer or the discontinuance of its operations,
such payment shall be made directly out of the reopened cases fund under
this section by the commissioner of taxation and finance upon vouchers
approved by the chairman of the workmen's compensation board.
Last modified: July 31, 2006 |