New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter A - General Provisions › Part 300 - Procedure before the Board › Section 300.22 - Procedure by carrier, special fund, or TPA following disability event when compensation controverted and when no controversy, including temporary payments of compensation without prejudice

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
Definitions.
The following terms shall have the following meanings when
					 used herein:
(1)
Disability
				  event
means any accident, including death resulting therefrom,
				  occurring in the course of employment or any alleged accident, including death
				  resulting therefrom, that results in personal injury which has caused or will
				  cause a loss of time from regular duties of one day beyond the working day or
				  shift on which the accident or alleged accident occurred, or which has required
				  or will require medical treatment beyond ordinary first aid or more than two
				  treatments by a person rendering first aid; or any disease or alleged disease,
				  including death resulting therefrom, claimed to have been caused by the nature
				  of the employment and contracted therein.
(2)
Electronic trading partner
				  agreement
means the agreement between the carrier, special fund or
				  TPA, and the board that establishes the method and frequency of sending and
				  receiving electronic reports including those required by this
				  section.
(3)
Filed
				  electronically
means that the electronic transmission submitted by the
				  carrier, special fund, or TPA has been accepted and acknowledged by the board.
				  For the purpose of determining whether an electronic transmission has been
				  timely submitted, any electronic transmission that is submitted to and accepted
				  by the board within the time required by subdivisions (b), (c), (d) and (f) of
				  this section shall be considered timely submitted when such electronic
				  transmission is later acknowledged by the board even though the acknowledgement
				  by the board may have occurred after the time required by subdivisions (b),
				  (c), (d) and (f) of this section.
(4)
Special fund
means any
				  special fund maintained by the board or any administrator of such special fund
				  that is responsible for paying compensation or medical treatment and care of
				  injured workers, including but not limited to, the Special Fund for Reopened
				  Cases created and governed by Workers' Compensation Law section 25-a and the
				  Uninsured Employers' Fund created and governed by Workers' Compensation Law
				  section 26-a. The chair may waive a special fund's obligations under this
				  section.
(5)
Third party
				  administrator or TPA
means third party administrators responsible for
				  all or part of the claims handling, pursuant to a contract, for the claims of
				  the State Insurance Fund, stock corporations, mutual corporations or reciprocal
				  insurers with which employers are insured to provide workers' compensation
				  coverage, employers permitted to pay compensation directly under the provisions
				  of Workers' Compensation Law section 50(3), (3-a) or (4), and any special fund
				  maintained by the board that is responsible for paying for compensation
				  benefits or medical treatment and care of injured workers.