NY Work Comp L § 13-G (2021)
2021 New York Laws WKC - Workers' Compensation Article 2 - 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 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.