N.Y. Workers' Compensation Law § 13-g: Payment of bills for medical care

§ 13-g. Payment of bills for medical care. (1) Within forty-five days

after a bill for medical care or supplies delivered pursuant to section

thirteen of this article has been rendered to the employer, such

employer must pay the bill or notify the medical care provider or

supplier in the format prescribed by the chair 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 medical care provider

or supplier within such forty-five day period that payment is not being

made, the medical care provider or supplier may notify the board in the

format prescribed by the chair 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 as set forth in rules and regulations promulgated by the

chair.

Where a bill for medical care or supplies 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 percent (1 1/2%) per month payable to the medical care

provider or supplier, 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 to the value of medical aid rendered

under this chapter, such value shall be decided by a single arbitrator

process, pursuant to rules promulgated by the chair. The chair shall

appoint a physician who is a member in good standing of the medical

society of the state of New York to determine the value of such disputed

medical bill. Where the physician whose charges are being arbitrated is

a member in good standing of the New York osteopathic society, the value

of such disputed bill shall be determined by a member in good standing

of the New York osteopathic society appointed by the chair. Where the

physician whose charges are being arbitrated is a member in good

standing of the New York homeopathic society, the value of such disputed

bill shall be determined by a member in good standing of the New York

homeopathic society appointed by the chair. Where the value of any other

authorized provider's services are at issue, such value shall be

determined by a member in good standing of one or more recognized

professional associations representing its respective profession in the

state of New York appointed by the chair. Decisions rendered under the

single arbitrator process shall be conclusive upon the parties as to the

value of the services in dispute.

(3) A provider or supplier initiating a single arbitrator process,

pursuant to this section shall not pay a fee to cover the costs related

to the conduct of such arbitration. (4) 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 services, supplies or treatment rendered to such employees, in

accordance with the schedules of fees and charges prepared and

established under the provisions of this chapter. Such award shall be

made to the medical care provider or supplier 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 article.

In all cases coming under this subdivision the payment of the claim

for medical care or supplies shall be subordinate to that of the

claimant or his or her beneficiaries.