New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter H - Disability Benefits › Article 1 - Regulations Under Disability Benefits Law › Part 363 - Claims › Section 363.12 - Payment of disability benefits pending determination of controverted workers' compensation or volunteer firemen's benefit claims; claim for reimbursement out of workers' compensation or volunteer firemen's benefit awards

Current through Register Vol. 46, No. 28, July 10, 2024
(a) If an employee
					 claims workers' compensation under the Workers' Compensation Law or benefits
					 under the Volunteer Firemen's Benefit Law, and if such claim is controverted on
					 the ground that the employee's disability was not caused by an accident that
					 arose out of and in the course of his employment or by an occupational disease
					 under the Workers' Compensation Law or on the ground that the employee's
					 disability was not caused by an injury in line of duty as a volunteer fireman,
					 the chairman, employer or employer's disability benefits carrier shall,
					 regardless of any additional issues raised in controverting the claim under the
					 Workers' Compensation Law or Volunteer Firemen's Benefit Law, forthwith pay
					 benefits under the Disability Benefits Law to the employee for his disability,
					 if the employee is otherwise eligible and entitled to benefits under the
					 Disability Benefits Law.
(b) An
					 employer or carrier controverting a claim for workers' compensation or
					 volunteer firemen's benefits is required promptly to furnish a copy of the
					 prescribed notice of controversy and medical report(s) to the chairman,
					 employer or employer's disability benefits carrier. In such event, furnishing
					 of the copy of the notice of controversy and medical reports shall, for
					 purposes of the Disability Benefits Law, constitute furnishing of written
					 notice and proof of disability in behalf of the employee to the chairman,
					 employer or employer's disability benefits carrier subject to the provisions of
					 section 217 (1)  of the Workers' Compensation Law. In the event such claim for
					 benefits under the Disability Benefits Law is rejected, the employer or
					 employer's disability benefits carrier shall mail written notice of rejection
					 to the employee as required under section 217 (6)  of the Workers' Compensation
					 Law. A copy of such notice of rejection shall, on request, be promptly filed
					 with the chairman.
(c) The
					 chairman, employer or employer's disability benefits carrier making disability
					 benefits payments pursuant to the provisions of section 206 (2)  of the Workers'
					 Compensation Law shall have a lien against the award, if any, made in the
					 controverted workers' compensation or volunteer firemen's benefits case,
					 provided claim for reimbursement is filed with the board before the award is
					 made, and either:
(1) the board's decision
					 and award direct reimbursement thereform; or
(2) the insurance carrier liable for payment
					 of the award receives, before the award is made, a copy of the claim for
					 reimbursement from the chairman, employer or carrier who paid the disability
					 benefits.