Section 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 fortyfive 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. N.Y. Work. Comp. Law § 13-G
Amended by New York Laws 2019, ch. 55,Sec. CC-3, eff. 1/1/2020.Amended by New York Laws 2015, ch. 55,Sec. D-3, eff. 4/1/2015.Amended by New York Laws 2013, ch. 57,Sec. GG-4, eff. 3/29/2013.