2023 New York Laws › WKC - Workers' Compensation › Article 2 - Compensation › 20 - Determination of Claims for Compensation.

§  20.    Determination  of claims for compensation.   1.  At any time
after the expiration of the first seven days of disability on  the  part
of  an  injured  employee,  or at any time after the employee's death, a
claim for compensation may be presented to the employer or to the chair.
The board shall have full power and authority to determine all questions
in relation to the payment of claims presented to  it  for  compensation
under  the provisions of this chapter.  The chair or board shall make or
cause to be made such investigation as  it  deems  necessary,  and  upon
application  of  either  party, shall order a hearing, and within thirty
days after a claim for compensation is submitted under this section,  or
such hearing closed, shall make or deny an award, determining such claim
for  compensation,  and  file  the  same  in  the  office  of the chair.
Immediately after such filing the chair shall send to the parties a copy
of the decision.  Upon a hearing pursuant to this section  either  party
may present evidence and be represented by counsel.  The decision of the
board  shall  be  final  as  to  all  questions  of fact, and, except as
provided in section twenty-three of this article, as to all questions of
law.  Except as provided in section twenty-seven of  this  article,  all
awards  of  the  board shall draw simple interest from thirty days after
the making thereof at the rate provided in section five thousand four of
the civil practice law and rules.  Whenever a hearing or proceeding  for
the determination of a claim for compensation is begun before a referee,
pursuant  to  the provisions of this chapter, such hearing or proceeding
or any adjourned hearing thereon shall continue before the same  referee
until  a final determination awarding or denying compensation, except in
the absence, inability or disqualification to act of  such  referee,  or
for  other  good cause, in which event such hearing or proceeding may be
continued before another referee by order of the chair or board.
2. (a) Notwithstanding subdivision one of this section, any claim  for
compensation by (i) judges, conciliators, and managerial or confidential
employees  of  the  workers' compensation board and state insurance fund
who are allocated to a grade M1 or above pursuant to section one hundred
thirty of the civil service law, (ii) the chair, vice-chair and  members
of  the  workers'  compensation board, and (iii) the executive director,
deputy executive directors and members of the board of commissioners  of
the  state  insurance  fund  shall not be within the jurisdiction of the
workers' compensation board but instead shall be determined by a neutral
outside arbitration process as provided by  regulations  promulgated  by
the  chair.   Such claims shall be filed in the same manner as any other
claim for compensation under this chapter.
(b) All issues and questions of law or fact pertaining to such  claims
shall   be  resolved  by  the  arbitrator  appointed  pursuant  to  this
paragraph.  Arbitrators shall be appointed by the  chair  to  adjudicate
claims  under  this  paragraph.    Such  arbitrators shall have the same
powers and  duties  as  those  accorded  referees  under  this  chapter,
including powers delegated by the chair.  The provisions of this chapter
shall  be  applicable to claims under this paragraph insofar as they are
not inconsistent herewith.
(c)  An award or decision by an arbitrator pursuant to this  paragraph
is  deemed  to be a final decision of the board except if review of such
decision is sought as provided in paragraph (d) of this subdivision.  No
modification, rescission or review of such  award  or  decision  may  be
entertained  by the board, notwithstanding any provision of this chapter
to the contrary.
(d)  Within thirty days after notice of the  filing  of  an  award  or
decision  by  an arbitrator, any party in interest may request review of
the arbitrator's decision by a panel of three arbitrators  in  the  same
manner  and  to  the  same  extent  as  the decision by a referee may be

reviewed by the board pursuant to section twenty-three of this  article.
The  arbitration  panel shall consist of one arbitrator nominated by the
chair, one arbitrator nominated  by  a  recognized  alternative  dispute
resolution  organization  and  one  arbitrator  nominated by an employee
organization certified pursuant to article fourteen of the civil service
law to represent the collective bargaining unit of the injured  employee
or,  if  the  injured  employee  is  not  represented  by  a  collective
bargaining  unit,  by  the  recognized  alternative  dispute  resolution
organization.    A  party  in  interest may seek review of such award or
decision of an arbitration panel only by taking appeal therefrom to  the
appellate  division of the supreme court, third department and the court
of appeals as provided for decisions of the board  pursuant  to  section
twenty-three of this chapter.
(e)   The powers and jurisdiction of the arbitration panel established
pursuant to this subdivision shall be continuing in the same manner  and
to the same extent as provided under this chapter to the board.
(f)  All fees, costs and expenses of arbitration shall be borne by the
board  and  the state insurance fund as administration expenses pursuant
to sections eighty-eight and one hundred fifty-one of this chapter.
(g)  Any claim for compensation by an officer or employee of the board
or state insurance fund not required  to  be  determined  by  a  neutral
outside   arbitration   process   pursuant  to  paragraph  (a)  of  this
subdivision shall be determined initially by a referee  with  review  of
such  determination  available  pursuant to section twenty-three of this
chapter.
(h)  For any claim for compensation by an officer or employee  of  the
workers'  compensation  board or the state insurance fund whether or not
such claim is required to be determined by a neutral outside arbitration
process pursuant to paragraph (a) of this subdivision,  the  referee  or
arbitrator  making  the  initial  finding of fact concerning any medical
issue present in the case shall develop the record with opinion evidence
from an impartial specialist who is an expert in the appropriate medical
specialty.     Such   impartial   specialist   shall   be   subject   to
cross-examination at the request of any party in interest.
(i)    The  state  insurance  fund  shall  administer the claim of any
officer or employee of the state insurance fund  at  an  office  of  the
state  insurance  fund  other  than the office which was, at the time of
injury, disablement or death of such officer or  employee,  his  or  her
principal workplace.
(j)    The  chair  shall promulgate regulations necessary to implement
this subdivision.  Such regulations shall include provisions in relation
to this subdivision for a single arbitrator to determine a claim in  the
first  instance and a panel of three arbitrators to review such decision
upon the application of any party in interest prior to judicial  review.
Such  regulations  shall also include all special procedures relating to
the handling  of  claims  of  officers  or  employees  of  the  workers'
compensation  board  and  the state insurance fund pursuant to paragraph
(f) of this subdivision.
3.  Notwithstanding any other provision of  law  to  the  contrary,  a
member  of  the workers' compensation board, a referee or any arbitrator
in connection with the adjudication of  any  claim  arising  under  this
chapter  shall  recuse  himself  or herself on any ground a judge may be
disqualified pursuant to section fourteen of the judiciary law.