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 300.19 - Interest on unpaid awards and unpaid medical bills

Current through Register Vol. 46, No. 28, July 10, 2024
Interest on an award of compensation or death benefits
					 shall, except where an award is affirmed on appeal, as provided for in section 24  of the Workers' Compensation Law, be computed from 30 days after the date of
					 filing of the award made by the Board until the date of payment of the award.
					 The following shall apply solely to interest for medical bills rendered to an
					 insurance carrier or an employer (or its third-party administrator), and shall
					 be in lieu of any other interest provided for in the Workers' Compensation Law
					 and rules promulgated thereunder. Medical bills, as referred to herein, shall
					 mean any bills for treatment by an authorized medical provider or other legally
					 permitted provider of Medical Care (as that term is defined in section
					 325-1.25 
					 of this Chapter).
(a) Where a medical
				  bill which identifies the injured employee, his or her employer and date of
				  injury, was timely rendered for payment to an insurance carrier or an employer
				  (or its third-party administrator) who has not timely requested an impartial
				  examination of the fairness of such bill or timely raised any other questions
				  as to the employer's liability for the payment of such bill as provided in
				  section 13-g, 13-k, 13-l or 13-m  of the Workers' Compensation Law, and the bill
				  has not been paid within 60 days after the bill was rendered to the insurance
				  carrier or an employer (or its third-party administrator), interest shall be
				  paid in addition to the amount of the bill, computed commencing 30 days from
				  the date the bill was rendered to the insurance carrier or an employer (or its
				  third-party administrator), to the date of payment.
(b) Where a medical bill, which identifies
				  the injured employee, his or her employer and date of injury, was timely
				  rendered for payment to the insurance carrier or an employer (or its
				  third-party administrator) who timely requested an impartial examination of the
				  fairness of such bill or timely raised questions as to the employer's liability
				  for the payment of such an amount as provided in section 13-g, 13-k, 13-l or
				  13-m  of the Workers' Compensation Law and a decision was rendered granting the
				  full amount demanded in the bill, interest shall be computed commencing 30 days
				  from the date the bill was rendered to the insurance carrier or an employer (or
				  its third-party administrator), to the date of payment.
(c) Where a medical bill which identifies the
				  injured employee, his or her employer and date of injury, was timely rendered
				  to the insurance carrier or an employer (or its third-party administrator) who
				  timely requested an impartial examination of the fairness of such bill or
				  timely raised questions as to the employer's liability for such amount and the
				  authorized medical provider or other legally permitted provider of Medical Care
				  (as that term is defined in section
				  325-1.25 
				  of this Chapter) is granted only part of the amount demanded in the bill,
				  interest computed commencing 30 days from the date the award, which resolved
				  the bill, is filed, to the date of the payment, shall be paid in addition to
				  the amount found due and owing.
(d)
				  In the event a decision or award made by a Workers' Compensation Law Judge,
				  establishing the liability of the employer or carrier (or a third-party
				  administrator) for the payment of a medical bill in whole or in part, is
				  reviewed by a panel of the Board, and such decision or award is affirmed, and
				  it is determined that the amount of the bill is due and owing in whole or in
				  part, interest computed, commencing 30 days after the filing of such award made
				  by the Workers' Compensation Law Judge who originally decided the claim to the
				  date of payment, shall be paid in addition to the amount found due and
				  owing
(e) In the case where a
				  Workers' Compensation Law Judge finds that the employer is not liable for the
				  payment of the medical bill and the Board on review established that the
				  employer is liable, and the bill rendered is resolved in whole or in part in
				  favor of the authorized medical provider or other legally permitted provider of
				  Medical Care (as that term is defined in section
				  325-1.25 
				  of this Chapter), interest computed, commencing 30 days from the date of the
				  filing of the award, establishing the amount due, to the date of payment, shall
				  be paid in addition to the amount found due and owing.
(f) In the event the Workers' Compensation
				  Law Judge and the Board find that the employer is not liable for the payment of
				  the medical bill and the case is appealed to the courts, which reverse the
				  Board, and the bill is resolved in whole or in part in favor of the authorized
				  medical provider or other legally permitted provider of Medical Care (as that
				  term is defined in section
				  325-1.25 
				  of this Chapter), interest computed, commencing 30 days from the date of the
				  filing of the final award establishing the amount due, to the date of payment,
				  shall be paid in addition to the amount due and owing.
(g) Whenever a medical bill, which identifies
				  the injured employee, his or her employer and date of injury, was timely
				  rendered to the insurance carrier or an employer (or its third-party
				  administrator) during the time while a case is closed, adjourned for failure to
				  prosecute, or unduly delayed by the claimant, interest computed, commencing 30
				  days from the date the award is filed establishing the liability of the
				  employer or carrier (or a third-party administrator) and the amount of the bill
				  in whole or in part, to the date of payment, shall be paid in addition to the
				  amount found due and owing.
(h)
				  Where an arbitrator determined that an authorized medical provider or other
				  legally permitted provider of Medical Care (as that term is defined in section
				  325-1.25 
				  of this Chapter) willfully exaggerated the amount of the bills submitted to
				  arbitration or rendered excessive or unnecessary treatment to claimant, or
				  rendered a bill without properly identifying the claimant and employer,
				  interest shall not be paid
(i)
				  Where an arbitrator determines that an insurance carrier or an employer (or its
				  third-party administrator) willfully failed to pay a reasonable portion of the
				  medical bill being controverted, interest may be directed to be paid on that
				  portion of the bill which should have been paid by the employer or carrier (or
				  a third-party administrator), computed commencing 30 days from the date the
				  bill was rendered. Where an issue of proration of a bill is presented for
				  arbitration, no interest shall be added unless the employer or its insurance
				  carrier (or its third-party administrator) willfully failed to pay a reasonable
				  portion of the medical bill at issue.
(j) In any circumstance, other than
				  hereinabove described, when interest is due, it shall be paid for medical bills
				  timely rendered, computed commencing 30 days from the date an award,
				  establishing the amount due is filed.
(k) When paying a medical bill, the employer
				  or insurance carrier (or its third-party administrator) shall separately
				  identify any interest payment made pursuant to the provisions of this
				  section.
(l) Interest referred to
				  herein shall be simple interest computed at the rate of 1 1/2 percent for each
				  30-day period after the bill has become due and payable and in which the bill
				  has not been paid. The interest shall become payable at the end of such 30-day
				  period. Interest as herein provided shall be in lieu of any other interest
				  provisions provided for in the Workers' Compensation Law and the rules
				  promulgated thereunder.
(m)
				  Wherever a bill is submitted by mail an additional five days from the date of
				  mailing of said bill shall be allowed.
(n) The foregoing provisions relating to
				  interest on medical bills shall not apply to the special fund for reopened
				  cases until after a filing of liability for payment of compensation by such
				  fund has been made in the case.
(o)
				  The foregoing provisions in this rule shall be inapplicable to the Uninsured
				  Employers' Fund until liability for payment of compensation by such fund has
				  been established pursuant to section 26-a  of the Workers' Compensation Law, and
				  awards for such medical bills have been made by the Board and defaulted by the
				  employer.
(p) Effective dates. This
				  regulation shall be effective on January 1, 2020.