N.Y. Work. Comp. Law § 13-g

§ 13-g. Payment of bills for medical care. (1) Within forty-five days\nafter a bill has been rendered to the employer by the hospital,\nphysician or self-employed physical or occupational therapist who has\nrendered treatment pursuant to a referral from the injured employee's\nauthorized physician or authorized podiatrist for treatment to the\ninjured employee, such employer must pay the bill or notify the\nhospital, physician or self-employed physical or occupational therapist\nin writing that the bill is not being paid and explain the reasons for\nnon-payment. In the event that the employer fails to make payment or\nnotify the hospital, physician or self-employed physical or occupational\ntherapist within such forty-five day period that payment is not being\nmade, the hospital, physician, self-employed physical therapist or\nself-employed occupational therapist may notify the chair in writing\nthat the bill has not been paid and request that the board make an award\nfor payment of such bill. The board or the chair may make an award not\nin excess of the established fee schedules for any such bill or part\nthereof which remains unpaid after said forty-five day period or thirty\ndays after all other questions duly and timely raised in accordance with\nthe provisions of this chapter, relating to the employer's liability for\nthe payment of such amount, shall have been finally determined adversely\nto the employer, whichever is later, in accordance with rules\npromulgated by the chair, and such award may be collected in like manner\nas an award of compensation. The chair shall assess the sum of fifty\ndollars against the employer for each such award made by the board,\nwhich sum shall be paid into the state treasury.\n In the event that the employer has provided an explanation in writing\nwhy the bill has not been paid, in part or in full, within the aforesaid\ntime period, and the parties can not agree as to the value of medical\naid rendered under this chapter, such value shall be decided by\narbitration if requested by the hospital, physician or self-employed\nphysical or occupational therapist, in accordance with the provisions of\nsubdivision two or subdivision three of this section, as appropriate,\nand rules and regulations promulgated by the chair.\n Where a physician, physical or occupational therapist bill has been\ndetermined to be due and owing in accordance with the provisions of this\nsection the board shall include in the amount of the award interest of\nnot more than one and one-half per cent (1 1/2%) per month payable to\nthe physician, physical or occupational therapist, in accordance with\nthe rules and regulations promulgated by the board. Interest shall be\ncalculated from the forty-fifth day after the bill was rendered or from\nthe thirtieth day after all other questions duly and timely raised in\naccordance with the provisions of this chapter, relating to the\nemployer's liability for the payment of such amount, shall have been\nfinally determined adversely to the employer, whichever is later, in\naccordance with rules promulgated by the chair.\n (2) (a) If the parties fail to agree to the value of medical aid\nrendered under this chapter and the amount of the disputed bill is one\nthousand dollars or less, or if the amount of the disputed medical bill\nexceeds one thousand dollars and the health care provider expressly so\nrequests, such value shall be decided by a single arbitrator process,\npursuant to rules promulgated by the chair. The chair shall appoint a\nphysician who is a member in good standing of the medical society of the\nstate of New York to determine the value of such disputed medical bill.\nWhere the physician whose charges are being arbitrated is a member in\ngood standing of the New York osteopathic society, the value of such\ndisputed bill shall be determined by a member in good standing of the\nNew York osteopathic society appointed by the chair. Where the physician\nwhose charges are being arbitrated is a member in good standing of the\nNew York homeopathic society, the value of such disputed bill shall be\ndetermined by a member in good standing of the New York homeopathic\nsociety appointed by the chair. Where the value of physical therapy\nservices or occupational therapy services is at issue, such value shall\nbe determined by a member in good standing of a recognized professional\nassociation representing its respective profession in the state of New\nYork appointed by the chair. Decisions rendered under the single\narbitrator process shall be conclusive upon the parties as to the value\nof the services in dispute.\n (b) If the parties fail to agree as to the value of medical aid\nrendered under this chapter and the amount of the disputed bill exceeds\none thousand dollars, such value shall be decided by an arbitration\ncommittee unless the health care provider expressly requests a single\narbitrator process in accordance with paragraph (a) of this subdivision.\nThe arbitration committee shall consist of one physician designated by\nthe president of the medical society of the county in which the medical\nservices were rendered, one physician who is a member of the medical\nsociety of the state of New York, appointed by the employer or carrier,\nand one physician, also a member of the medical society of the state of\nNew York, appointed by the chair of the workers' compensation board. If\nthe physician whose charges are being arbitrated is a member in good\nstanding of the New York osteopathic society or the New York homeopathic\nsociety, the members of such arbitration committee shall be physicians\nof such organization, one to be appointed by the president of that\norganization, one by the employer or carrier and the third by the chair\nof the workers' compensation board. Where the value of physical therapy\nservices is at issue and the amount of the disputed bill exceeds one\nthousand dollars, the arbitration committee shall consist of a member in\ngood standing of a recognized professional association representing\nphysical therapists in the state of New York appointed by the president\nof such organization, a physician designated by the employer or carrier\nand a physician designated by the chair of the workers' compensation\nboard provided however, that the chair finds that there are a sufficient\nnumber of physical therapy arbitrations in a geographical area comprised\nof one or more counties to warrant a committee so comprised. In all\nother cases where the value of physical therapy services is at issue and\nthe amount of the disputed bill exceeds one thousand dollars, the\narbitration committee shall be similarly selected and identical in\ncomposition, provided that the physical therapist member shall serve\nwithout remuneration, and provided further that in the event a physical\ntherapist is not available, the committee shall be comprised of three\nphysicians designated in the same manner as in cases where the value of\nmedical aid is at issue.\n (c) Where the value of occupational therapy services is at issue the\narbitration committee shall consist of a member in good standing of a\nrecognized professional association representing occupational therapists\nin the state of New York appointed by the president of such\norganization; a physician designated by the employer or carrier and a\nphysician designated by the chair of the workers' compensation board\nprovided, however, that the chair finds that there are a sufficient\nnumber of occupational therapy arbitrations in a geographical area\ncomprised of one or more counties to warrant a committee so comprised.\nIn all other cases where the value of occupational therapy services is\nat issue and the amount of the disputed bill exceeds one thousand\ndollars, the arbitration committee shall be similarly selected and\nidentical in composition, provided that the occupational therapist\nmember shall serve without remuneration, and provided further that in\nthe event an occupational therapist is not available, the committee\nshall be comprised of three physicians designated in the same manner as\nin cases where the value of medical aid is at issue. The majority\ndecision of any such arbitration committee shall be conclusive upon the\nparties as to the value of the services in dispute.\n (3) (a) If an employer shall have notified the hospital in writing, as\nprovided in subdivision one of this section, why the bill has not been\npaid, in part or in full, and the amount of the disputed bill is one\nthousand dollars or less, or where the amount of the disputed medical\nbill exceeds one thousand dollars and the hospital expressly so\nrequests, such value shall be decided by a single arbitrator process,\npursuant to rules promulgated by the chair. The chair shall appoint a\nphysician in good standing licensed to practice in New York state to\ndetermine the value of such disputed bill. Decisions rendered under the\nadministrative resolution procedure shall be conclusive upon the parties\nas to the value of the services in dispute.\n (b) If an employer shall have notified the hospital in writing, as\nprovided in subdivision one of this section, why the bill has not been\npaid, in part or in full, and the amount of the disputed bill exceeds\none thousand dollars, the value of such bill shall be determined by an\narbitration committee appointed by the chair for that purpose, which\ncommittee shall consider all of the charges of the hospital, unless the\nhospital expressly requests a single arbitrator process pursuant to\nparagraph (a) of this subdivision. The committee shall consist of three\nphysicians. One member of the committee may be nominated by the chair\nupon recommendation of the president of the hospital association of New\nYork state and one member may be nominated by the employer or insurance\ncarrier. The majority decision of any such committee shall be conclusive\nupon the parties as to the value of the services rendered. The chair may\nmake reasonable rules and regulations consistent with the provisions of\nthis section.\n (4) A provider initiating an arbitration, including a single\narbitrator process, pursuant to this section shall not pay a fee to\ncover the costs related to the conduct of such arbitration. Each member\nof an arbitration committee for medical bills, and each member of an\narbitration committee for hospital bills shall be entitled to receive\nand shall be paid a fee for each day's attendance at an arbitration\nsession in any one count in an amount fixed by the chair of the workers'\ncompensation board.\n (5) In claims where the employer has failed to secure compensation to\nhis employees as required by section fifty of this chapter, the board\nmay make an award for the value of medical and podiatry services or\ntreatment rendered to such employees, in accordance with the schedules\nof fees and charges prepared and established under the provisions of\nsection thirteen, subdivision a, and section thirteen-k, subdivision\ntwo, of this chapter, and for the reasonable value of hospital care in\naccordance with the charges currently in force in hospitals in the same\ncommunity for cases coming within the provisions of this chapter. Such\naward shall be made to the physician, podiatrist, or hospital entitled\nthereto. A default in the payment of such award may be enforced in the\nmanner provided for the enforcement of compensation awards as set forth\nin section twenty-six of this chapter.\n In all cases coming under this subdivision the payment of the claim of\nthe physician, podiatrist, or hospital for medical, podiatry, or\nsurgical services or treatment shall be subordinate to that of the\nclaimant or his beneficiaries.\n (6) Notwithstanding any inconsistent provision of law, arbitration\nregarding payments for inpatient hospital services for any patient\ndischarged on or after January first, nineteen hundred ninety-one and\nprior to December thirty-first, nineteen hundred ninety-six shall be\nresolved in accordance with paragraph (d) of subdivision three of\nsection twenty-eight hundred seven-c of the public health law.\n