2010 New York Code
WKC - Workers' Compensation
Article 2 - (9 - 35) COMPENSATION
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.