§ 5108. Limit on charges by providers of health services. (a) The\ncharges for services specified in paragraph one of subsection (a) of\nsection five thousand one hundred two of this article and any further\nhealth service charges which are incurred as a result of the injury and\nwhich are in excess of basic economic loss, shall not exceed the charges\npermissible under the schedules prepared and established by the chairman\nof the workers' compensation board for industrial accidents, except\nwhere the insurer or arbitrator determines that unusual procedures or\nunique circumstances justify the excess charge.\n (b) The superintendent, after consulting with the chairman of the\nworkers' compensation board and the commissioner of health, shall\npromulgate rules and regulations implementing and coordinating the\nprovisions of this article and the workers' compensation law with\nrespect to charges for the professional health services specified in\nparagraph one of subsection (a) of section five thousand one hundred two\nof this article, including the establishment of schedules for all such\nservices for which schedules have not been prepared and established by\nthe chairman of the workers' compensation board.\n (c) No provider of health services specified in paragraph one of\nsubsection (a) of section five thousand one hundred two of this article\nmay demand or request any payment in addition to the charges authorized\npursuant to this section. Every insurer shall report to the commissioner\nof health any patterns of overcharging, excessive treatment or other\nimproper actions by a health provider within thirty days after such\ninsurer has knowledge of such pattern.\n
N.Y. Ins. Law § 5108
Limit on charges by providers of health services
Applied in 8 court decisions — leading case Saddle Brook Surgicenter, LLC v. All State Insurance (2015)
Most recently applied in Healthplus Surgery Ctr., LLC v. American Tr. Ins. Co. (April 2022)
2014-09-22
How often courts cite this section
Court decisions citing this, by year. The dip in the last several years is a data-coverage gap, not a real trend — our corpus holds fewer opinions from the most recent years, so recent citations are undercounted.
Official source: NYS Open Legislation (New York State Senate). Reproduced from public-domain New York statutes; confirm against the official source for the current text. Not legal advice.