reglab/statecodes huggingface dataset:
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter H - Disability Benefits › Article 2 - Rules Under Disability Benefits Law › Part 380 - Paid Family Leave › Subpart 380-6 - Benefit Rate and Use of Accruals › Section 380-6.1 - Benefit rate

Current through Register Vol. 46, No. 28, July 10, 2024
(a) The benefit
						rate an employee may receive during family leave for a single qualifying event
						in a 52 week period is the maximum rate as set forth in Workers' Compensation
						Law section 204 in effect on the first day of family leave. The family leave
						benefits payable for the qualifying event in that 52 week period shall be the
						liability of the carrier providing coverage on the first day of family leave.
						The carrier may require updates to the request for family leave, or
						certifications under sections
						380-4.2,
						380-4.3
						and
						380-4.4 
						of this Part, during the 52 week period for subsequent periods of family leave
						not covered by the initial claim documentation.
(b) When an employee has multiple covered
						employers:
(1) An employee with multiple
						covered employers is not required to take paid family leave from each covered
						employer during a single period of family leave.
(2) An employee with multiple covered
						employers may not take paid family leave for a single qualifying event from
						different covered employers at separate intervals, but must take family leave
						from all covered employers during the same family leave period.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter H - Disability Benefits › Article 2 - Rules Under Disability Benefits Law › Part 380 - Paid Family Leave › Subpart 380-6 - Benefit Rate and Use of Accruals › Section 380-6.2 - Use of accruals for family leave benefits and reimbursement

Current through Register Vol. 46, No. 28, July 10, 2024
(a) In the event an employer offers, and the
						eligible employee exercises, an option to charge all or part of his or her
						family leave time to unused accruals or other paid time off and receive full
						salary, the employer may request reimbursement out of any family leave benefits
						due or to become due by filing its claim for reimbursement with the carrier
						prior to the carrier's payment of such family leave benefits. The actual
						reimbursement amount may be computed after family leave is complete.
(b) With the election of this option, the
						employee shall receive the full protection of the reinstatement provision set
						forth in section 203-b of the Workers' Compensation Law.
(c) An employer covered by the FMLA (29 U.S.
						Code chapter 28) that designates a concurrent period of family leave under
						section
						380-2.5(g) 
						of this Part may charge an employee's accrued paid time off in accordance with
						the provisions of the FMLA.
(d) In
						no event can an employee utilize family leave beyond 12 weeks, or the maximum
						duration permitted as set forth in paragraph (a) of subdivision 2 of section 204  of the Workers' Compensation Law, per any consecutive 52-week
						period.
(e) This section may not be
						construed in a manner that relieves an employer of any duty of collective
						bargaining the employer may have with respect to the subject matter of this
						section.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter H - Disability Benefits › Article 2 - Rules Under Disability Benefits Law › Part 380 - Paid Family Leave › Subpart 380-7 - Compliance and Coverage › Section 380-7.1 - Paid family leave coverage

Current through Register Vol. 46, No. 28, July 10, 2024
A disability benefits policy issued to satisfy a
						  covered employer's statutory obligations pursuant to Article 9 of the Workers'
						  Compensation Law must also provide paid family leave coverage as of January 1,
						  2018.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter H - Disability Benefits › Article 2 - Rules Under Disability Benefits Law › Part 380 - Paid Family Leave › Subpart 380-7 - Compliance and Coverage › Section 380-7.2 - Employer obligations

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
(1) If a covered employer maintains written
						guidance for employees concerning employee benefits or leave rights, such as in
						an employee handbook, information concerning leave under PFL and employee
						obligations under PFL shall be included in the handbook or other written
						guidance.
(2) If a covered employer
						does not have written policies, manuals, or handbooks describing employee
						benefits and leave provisions, the employer shall provide written guidance to
						each of his or her employees concerning all of the employee's rights and
						obligations under PFL, including information on how to file a claim for paid
						family leave.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter H - Disability Benefits › Article 2 - Rules Under Disability Benefits Law › Part 380 - Paid Family Leave › Subpart 380-7 - Compliance and Coverage › Section 380-7.3 - Health insurance during paid family leave

Current through Register Vol. 46, No. 28, July 10, 2024
In accordance with the Family and Medical Leave Act
						  (29 U.S.C. sections
						  2601-2654)
						  :
(a) An employee who is provided
						health insurance by his or her employer is entitled to the continuation of that
						group health insurance coverage during paid family leave on the same terms as
						if he or she had continued to work. The employee must continue to make any
						normal contributions to the cost of the health insurance premiums.
(b) If an employer provides a new health plan
						or benefits, or changes health plans or benefits while an employee is on paid
						family leave, the employee is entitled to the new or changed plan or benefits
						to the same extent as if the employee was not on leave.
(c) Any share of health plan premiums which
						had been paid by the employee prior to paid family leave shall continue to be
						paid by the employee during the paid family leave period. If the premiums are
						raised or lowered, the employee is required to pay the new premium
						rates.
(d)
(1) A covered employer's obligations to
						maintain health insurance coverage cease under PFL if an employee's premium
						payment during a period of family leave is more than 30 days late. In order to
						drop the coverage for an employee whose premium payment is late, the employer
						must provide written notice to the employee that the payment has not been
						received. Such notice must be mailed to the employee at least 15 days before
						coverage is to cease, advising that coverage will be dropped on a specified
						date at least 15 days after the date of the letter unless payment has been
						received by that date.
(2) If the
						employer has established policies regarding other forms of unpaid leave that
						provide for the employer to cease coverage retroactively to the date the unpaid
						premium payment was due, the employer may drop the employee retroactively in
						accordance with that policy, provided the 15-day notice was given. In the
						absence of such a policy, coverage for the employee may be terminated at the
						end of the 30 day grace period, where the required 15-day notice has been
						provided.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter H - Disability Benefits › Article 2 - Rules Under Disability Benefits Law › Part 380 - Paid Family Leave › Subpart 380-7 - Compliance and Coverage › Section 380-7.4 - Group health insurance benefits during paid family leave

Current through Register Vol. 46, No. 28, July 10, 2024
An employee's group health insurance benefits provided
						  to him or her prior to taking paid family leave must be maintained during paid
						  family leave. If an employee is provided family member health insurance
						  coverage by his or her employer, the family member health insurance coverage
						  must be maintained by the employer during paid family leave. The employee must
						  continue to make any normal contributions to the cost of the health insurance
						  premiums.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter H - Disability Benefits › Article 2 - Rules Under Disability Benefits Law › Part 380 - Paid Family Leave › Subpart 380-7 - Compliance and Coverage › Section 380-7.5 - Coverage information

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
						Carriers shall timely notify the board of changes in coverage for paid family
						leave and disability benefits as prescribed by the chair. Carriers who fail to
						update coverage information in the format prescribed by the chair may face
						penalties.
(b) Carriers providing
						paid family leave coverage may create or coordinate efforts to create an
						electronic portal in order to file and administer claims or paid family leave
						and in order to coordinate benefits.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter H - Disability Benefits › Article 2 - Rules Under Disability Benefits Law › Part 380 - Paid Family Leave › Subpart 380-7 - Compliance and Coverage › Section 380-7.6 - Rights under PFL

Current through Register Vol. 46, No. 28, July 10, 2024
Except as provided in section 380-2.6, employees cannot
						  waive their prospective rights under PFL. Under no circumstance may an employer
						  induce employees to waive any rights under PFL.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter H - Disability Benefits › Article 2 - Rules Under Disability Benefits Law › Part 380 - Paid Family Leave › Subpart 380-7 - Compliance and Coverage › Section 380-7.7 - Coverage

Current through Register Vol. 46, No. 28, July 10, 2024
(a) On January 1,
						2018, and continuing thereafter, every disability benefits policy effective on
						that date that satisfies the employer's obligation to provide disability
						benefits coverage under article 9 of the Workers' Compensation Law, and that is
						not subject to any exemption under the law, shall also include paid family
						leave coverage in the disability benefits policy.
(b) Every carrier that provides statutory
						disability benefits policies in New York State shall also offer paid family
						leave coverage.
(c) Each employee
						covered by his or her employer's statutory disability benefits policy on
						January 1, 2018, who is not subject to any exemption under the law, shall on
						that date be provided paid family leave coverage by the same carrier regardless
						of whether his or her employer has updated their policy or has paid additional
						premiums to include paid family leave coverage in their disability benefits
						coverage.
(d) In order to deny a
						claim based on cancellation of paid family leave coverage, the cancellation
						must have been made effective by the carrier notifying the board of such
						cancellation.
(e) Employers who
						purchase disability benefits insurance coverage from the State Insurance Fund
						or a private carrier shall purchase paid family leave coverage from the same
						carrier and waive the option of self-insuring for paid family leave coverage
						purposes.
(f) A carrier that
						disputes that it provided paid family leave coverage for an employer, must make
						payments to the employee during the family leave period or pendency of the
						dispute, whichever is shorter. Such payments are subject to reimbursement by
						the employer, special fund for disability benefits, or another insurance
						carrier identified during dispute resolution.
(g) A carrier who elects to discontinue
						offering coverage to employers for disability and paid family leave benefits
						must provide to the chair, or the chair's designee, a copy of the written
						notification of proposed discontinuance of coverage as required by the
						Department of Financial Services by:
(1) the
						later of July 1, 2017, or within 60 days of the date the Superintendent of
						Financial Services publishes the community rate for premiums for family leave
						benefits coverage for the policy benefit period beginning on January 1, 2018,
						if discontinuing coverage for calendar year 2018; or
(2) at least 90 days prior to the date of
						discontinuance of such coverage if discontinuing coverage on or after January
						1, 2018.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter H - Disability Benefits › Article 2 - Rules Under Disability Benefits Law › Part 380 - Paid Family Leave › Subpart 380-7 - Compliance and Coverage › Section 380-7.8 - Proof of coverage

Current through Register Vol. 46, No. 28, July 10, 2024
(a) The
						State Insurance Fund and private carriers shall provide proof of paid family
						leave coverage to the board for all covered employers in the format prescribed
						by the chair.
(b) Board employees
						investigating compliance with PFL shall be provided with all requested
						information by the employer upon request.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter H - Disability Benefits › Article 2 - Rules Under Disability Benefits Law › Part 380 - Paid Family Leave › Subpart 380-7 - Compliance and Coverage › Section 380-7.9 - Penalty review process

Current through Register Vol. 46, No. 28, July 10, 2024
Whenever a penalty is issued to an employer and/or
						  carrier under this Part or Article 9, the employer and/or carrier shall have 30
						  days from the date of penalty assessment to request review of the penalty. Such
						  request shall be made in writing and submitted to the Bureau of Compliance at
						  the Workers' Compensation Board. The request for review should set forth the
						  legal and factual basis for the review. If the employer and/or carrier does not
						  seek such a review, or fails to do so in a timely manner, the penalty shall
						  constitute the final determination of the Chair. If the Chair determines that
						  the penalty was correctly issued, the employer and/or carrier shall have 10
						  days from the date of determination to pay the penalty sum to the Chair and
						  such sum will be credited to the Special Fund for Disability
						  Benefits.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter H - Disability Benefits › Article 2 - Rules Under Disability Benefits Law › Part 380 - Paid Family Leave › Subpart 380-7 - Compliance and Coverage › Section 380-7.10 - Reports

Current through Register Vol. 46, No. 28, July 10, 2024
(a) As requested by
						the chair, carriers and self-insured employers providing family leave benefits
						coverage and the arbitration association overseeing the arbitration of paid
						family leave disputes shall provide reports to the board. Such reports may be
						requested quarterly and may include requests for the number of paid family
						leave claims received per quarter, the number of family leave benefit weeks
						used by employees, the type of benefits used by employees, the genders of the
						employees using the benefits, the ages of the employees using the benefits, the
						size of the employers, the employers' zip codes, and the benefit rates. The
						chair has the discretion to require additional information relevant to the
						regulation of PFL be included in such reports.
(b) The chair may also request that carriers
						providing family leave benefits coverage and the arbitration association
						overseeing the arbitration of PFL matters provide the board with reports that
						identify the number of benefit denials, the reason for such denials, the number
						of arbitration requests received, and the results of arbitrations.
(c) Self-insured employers will be subject to
						the regulations of the Department of Financial Services of 11 NYCRR Part
						363.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter H - Disability Benefits › Article 2 - Rules Under Disability Benefits Law › Part 380 - Paid Family Leave › Subpart 380-8 - Reinstatement to Employment › Section 380-8.1 - Reinstatement

Current through Register Vol. 46, No. 28, July 10, 2024
(a) A covered
						employee who has received family leave benefits shall be reinstated to his or
						her employment upon conclusion of his or her leave in accordance with section
						203-b of the Workers' Compensation Law, and need not take any action.
(b) In the event the covered employer
						declines to reinstate the eligible employee, or otherwise violates the
						provisions of section 203-b or 120  of the Workers' Compensation Law, such
						employee shall, file with the employer and the chair a formal request on the
						form prescribed by the chair that the employer come into compliance with the
						provisions of sections 203-b and 120  of the Workers' Compensation
						Law.
(c) Within 30 days of the date
						of a request under subdivision (b) of this section, the covered employer shall
						either take corrective action or file a formal response to the employee, any
						attorney or representative who the employee may have retained, and the chair,
						explaining the reason that corrective action will or will not need to be taken.
						The failure of the employer to fully complete the formal response in a timely
						fashion may result in adverse findings and conclusions.
(d) In the event the employer takes
						corrective action to the satisfaction of the employee, no further action is
						needed.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter H - Disability Benefits › Article 2 - Rules Under Disability Benefits Law › Part 380 - Paid Family Leave › Subpart 380-8 - Reinstatement to Employment › Section 380-8.2 - Discrimination or retaliation

Current through Register Vol. 46, No. 28, July 10, 2024
(a) The
						date of the employer's response to a formal written request under section
						380-8.1(b) 
						of this Subpart, or the day after 30 days after the date of the employee's
						formal request if no such response has been provided, shall be the date as of
						which the employee then has 2 years to file a complaint under section 120  of
						the Workers' Compensation Law.
(b)
						An eligible employee who wishes to file a complaint under section 120  of the
						Workers' Compensation Law shall do so in the format prescribed by the chair.
(1) An employee complaint under this section
						must be served on the employer at the time it is filed with the board, and must
						contain:
(i) date upon which the formal
						request under section 380 8.1(b) of this Subpart was filed with the employer
						and the board;
(ii) proof of the
						employee's receipt of family leave benefits or claim for family leave benefits,
						if family leave benefits were not received;
(iii) information regarding the manner in
						which the employer has failed to comply with section 203-b of the Workers'
						Compensation Law; and
(iv) any
						other information that the chair deems relevant in order to process such
						complaint.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter H - Disability Benefits › Article 2 - Rules Under Disability Benefits Law › Part 380 - Paid Family Leave › Subpart 380-9 - Disputes › Section 380-9.1 - Eligibility for arbitration

Current through Register Vol. 46, No. 28, July 10, 2024
Any claim-related dispute, including eligibility,
						  benefit rate, and duration of paid family leave, arising under the PFL is
						  subject to arbitration as set forth in section 221  of the Workers' Compensation
						  Law.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter H - Disability Benefits › Article 2 - Rules Under Disability Benefits Law › Part 380 - Paid Family Leave › Subpart 380-9 - Disputes › Section 380-9.2 - Appointment of arbitrators

Current through Register Vol. 46, No. 28, July 10, 2024
(a) The
						chair shall review the qualifications of applicants for the position of
						arbitrator of disputed requests for family leave, make appointments, and review
						the arbitrator's performance.
(b)
						An arbitrator shall be an attorney admitted to practice in New York State and
						have a knowledge of the PFL.
(c)
						All arbitrators shall be appointed by, and serve at the pleasure of, the chair.
						An arbitrator candidate shall disclose to the chair any circumstance which is
						likely to create an appearance of bias or which might disqualify such person as
						an arbitrator, and the chair shall determine whether the candidate should be
						disqualified. The chair shall forward the names of all arbitrators to the
						dispute resolution forum, and promptly inform the dispute resolution forum of
						all additions to, and deletions from, the panel of arbitrators.
(d) Any arbitrator appointed by the chair
						shall be subject to disqualification with respect to a particular case for the
						reasons specified in section
						380-9.7 
						of this Subpart.
(e) All
						arbitrators shall be required to take an annual oath of office. Arbitrators
						shall require all witnesses to testify under oath or affirm that their
						statements are true under penalty of perjury.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter H - Disability Benefits › Article 2 - Rules Under Disability Benefits Law › Part 380 - Paid Family Leave › Subpart 380-9 - Disputes › Section 380-9.3 - Requests for arbitration

Current through Register Vol. 46, No. 28, July 10, 2024
(a) A
						request for arbitration shall be submitted to the dispute resolution forum
						within 26 weeks of written notice of denial of the claim for paid family leave
						in the format prescribed by the chair. The party requesting arbitration shall
						submit a complete copy of the request for arbitration to the other parties to
						the claim. When it is alleged that the employer did not have paid family leave
						insurance or was not self-insured, the board shall be sent a complete copy of
						the request for arbitration. In these cases, the initiating party should send
						the board the complete copy of the request for arbitration.
(b) When the basis for a dispute is
						identification of the proper insurance carrier or establishing coverage for a
						paid family leave period, the carrier, employer, or board on behalf of the
						special fund for disability benefits, may file a request for arbitration to
						resolve the dispute.
(1) When the employee's
						eligibility for benefits is not in dispute, the carrier or employer that has
						been identified by the board as being responsible for the claim shall make
						payments to the employee during the family leave period or pendency of the
						dispute, whichever is shorter.
(2)
						Such payments are subject to reimbursement upon resolution of the dispute as
						set forth in section
						380-7.7  of
						this Part.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter H - Disability Benefits › Article 2 - Rules Under Disability Benefits Law › Part 380 - Paid Family Leave › Subpart 380-9 - Disputes › Section 380-9.4 - Initiation of process

Current through Register Vol. 46, No. 28, July 10, 2024
(a) All
						requests for arbitration shall be initiated by submitting the completed request
						for arbitration to the dispute resolution forum and the responding party, and
						by submitting to the dispute resolution forum a filing fee in the amount of $25
						that may be refunded as set forth in paragraph (3) of this subdivision.
(1) If the request is initiated by an
						employee (including an employee claiming employment or eligibility), the
						employee shall attach copies of all documents previously submitted to the
						carrier or self-insured employer as proof of eligibility, and the rejection of
						claim form.
(2) If the request is
						initiated to dispute the identity of the proper insurance carrier or to
						establish coverage for a paid family leave period, the party initiating
						arbitration must attach documentation to support its request.
(3) If the employee prevails on his or her
						claim, $25 will be added to the benefits paid to an employee by the insurance
						carrier or self-insured employer.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter H - Disability Benefits › Article 2 - Rules Under Disability Benefits Law › Part 380 - Paid Family Leave › Subpart 380-9 - Disputes › Section 380-9.5 - Fee structure

Current through Register Vol. 46, No. 28, July 10, 2024
(a) The
						carrier, self-insured employer, or if applicable, the board, shall submit the
						arbitration fee, together with its response to the initiating party's request
						for arbitration. In the event that the carrier, self-insured employer, or the
						board initiates the arbitration, such arbitration fee shall be due when the
						request for arbitration is filed.
(b) The chair shall set the maximum fees for
						arbitration. Such maximum fees may be adjusted from time to time but no more
						frequently than annually. For the year beginning January 1, 2018:
(1) For desk arbitrations, the dispute
						resolution forum will receive a fee not to exceed $350, and the arbitrator
						shall receive a fee not to exceed $200.
(2) For arbitrations in which an oral hearing
						is held, the dispute resolution forum will receive a fee not to exceed $450,
						and the arbitrator shall receive a fee not to exceed $175 per hour.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter H - Disability Benefits › Article 2 - Rules Under Disability Benefits Law › Part 380 - Paid Family Leave › Subpart 380-9 - Disputes › Section 380-9.6 - Withdrawal of arbitration requests

Current through Register Vol. 46, No. 28, July 10, 2024
(a) The parties may, by mutual agreement,
						withdraw the request for arbitration in writing. The document must be signed by
						the parties and filed with the dispute resolution forum.
(b) Additionally, the party requesting
						arbitration may unilaterally withdraw a request for arbitration by filing such
						request for withdrawal with the dispute resolution forum and sending a copy to
						all other parties.
(c) Where the
						request for arbitration has been withdrawn, fees paid to the dispute resolution
						forum shall not be refundable.
(d)
						When a request for arbitration is withdrawn prior to receipt of a response from
						the opposing party and submission of the request for arbitration to an
						arbitrator, no fee shall be due other than the $25 filing fee.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter H - Disability Benefits › Article 2 - Rules Under Disability Benefits Law › Part 380 - Paid Family Leave › Subpart 380-9 - Disputes › Section 380-9.7 - Assignment of arbitrators

Current through Register Vol. 46, No. 28, July 10, 2024
(a) The
						dispute resolution forum shall select from the panel of arbitrators, on a
						rotational basis, an arbitrator who will hear the case and shall submit the
						name of the arbitrator to each party to the arbitration no later than 14 days
						after sending the acknowledgment of the request for arbitration.
(b) Any person appointed as an arbitrator
						shall disclose to the dispute resolution forum any circumstance likely to
						affect impartiality, including any bias, or any actual or apparent conflict of
						interest from financial or personal interest in an arbitration. Upon receipt of
						such information from the arbitrator or another source, the dispute resolution
						forum shall communicate the information to the parties, and if it deems
						appropriate to do so, to the arbitrator and other interested parties.
(c) If a party objects to the appointment of
						an arbitrator, the specific grounds for such objection shall be submitted in
						writing to the dispute resolution forum, which shall determine within seven
						days after receipt of the challenge whether the arbitrator shall be
						disqualified. The dispute resolution forum shall determine whether the
						arbitrator shall be disqualified and shall notify the parties of its decision,
						which shall be final and binding.
(d) In the event an arbitrator shall resign,
						be disqualified or be otherwise unable to perform his or her duties, the
						dispute resolution forum shall appoint another arbitrator.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter H - Disability Benefits › Article 2 - Rules Under Disability Benefits Law › Part 380 - Paid Family Leave › Subpart 380-9 - Disputes › Section 380-9.8 - Desk arbitration and further development of the record

Current through Register Vol. 46, No. 28, July 10, 2024
All disputes shall be resolved by desk arbitration
						  unless the arbitrator, after review of the parties' submissions, finds further
						  development of the record necessary.
(a) Whenever an arbitrator finds further
						development of the record necessary, he or she must also obtain:
(1) the consent of the carrier or
						self-insured employer paying for the arbitration to proceed with such further
						development of the record; or
(2)
						when the carrier or self-insured employer does not consent, the arbitrator must
						obtain the consent of the chair's designee to proceed with such further
						development of the record.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter H - Disability Benefits › Article 2 - Rules Under Disability Benefits Law › Part 380 - Paid Family Leave › Subpart 380-9 - Disputes › Section 380-9.9 - Review of arbitration requests; medical examinations

Current through Register Vol. 46, No. 28, July 10, 2024
(a) The arbitrator shall not be bound by
						common law or statutory rules of evidence or by technical or formal rules of
						procedure. Upon compliance with section
						380-9.7 
						of this Subpart, the arbitrator may make such investigation, inquiry, or
						conduct a hearing, in such manner as he or she deems proper and necessary, and
						shall have the power to issue subpoenas, in accordance with section 7505  of the
						Civil Practice Law and Rules.
(b)
						Medical examinations of the care recipient shall only be required when so
						directed by the arbitrator. In the event that the arbitrator directs the
						submission of a medical examination, it must be a records review unless the
						arbitrator can cite extraordinary circumstances warranting the submission of an
						independent medical examination based on a physical examination.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter H - Disability Benefits › Article 2 - Rules Under Disability Benefits Law › Part 380 - Paid Family Leave › Subpart 380-9 - Disputes › Section 380-9.10 - Decisions of the arbitrator; awards; interest

Current through Register Vol. 46, No. 28, July 10, 2024
(a) The arbitrator shall make a decision in
						writing no later than 14 days after submission of all evidence in the matter.
						The decision shall specify the basis of the decision on the form prescribed by
						the dispute resolution forum for such purpose. The decision may include any
						stipulation made by the parties. The decision shall be delivered to each party
						in the manner prescribed by the chair.
(b) Awards in favor of a represented employee
						will specify the portion of the award to be paid to the employee's attorney as
						a fee commensurate with the services rendered.
(1) To apply for a fee, an employee's
						attorney must complete the portion of the request for arbitration relating to
						attorneys' fees and attach a detailed description of services rendered and time
						spent. If an oral hearing is held, the attorney may apply for an additional
						fee.
(2) If the employee indicates
						in the request for arbitration that he or she objects to the fee, the employee
						may submit a written statement to the dispute resolution forum within 14
						days.
(3) The arbitrator will
						determine the amount of an employee's attorney's fee having due regard for the
						time spent, complexity of the case, the financial status of the employee, and
						the quality of the legal services rendered.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter H - Disability Benefits › Article 2 - Rules Under Disability Benefits Law › Part 380 - Paid Family Leave › Subpart 380-9 - Disputes › Section 380-9.11 - Enforcement and appeals of decisions

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Any decisions of an arbitrator made
						pursuant to the provisions of this Subpart may be enforced, vacated, or
						modified in accordance with the applicable provisions of sections 7509, 7510, 7511, and 7514  of the Civil Practice Law and Rules. No other provisions of
						article 75 of the Civil Practice Law and Rules, except as may be otherwise
						provided in this Subpart, shall be applicable to arbitration pursuant to this
						Subpart.
(b) The arbitrator and
						dispute resolution forum shall not be made parties to a court proceeding
						relating to an arbitration. The board shall not be made a party to a court
						proceeding related to an arbitration award unless its presence as a party is
						pertinent to any issue raised in the litigation.
(c) The participation of a party in such an
						arbitration proceeding shall be a waiver of any claim against an arbitrator or
						the dispute resolution forum for any act or omission in connection with any
						arbitration conducted under this Subpart.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter H - Disability Benefits › Article 2 - Rules Under Disability Benefits Law › Part 380 - Paid Family Leave › Subpart 380-9 - Disputes › Section 380-9.12 - Dispute resolution forum and board guidelines

Current through Register Vol. 46, No. 28, July 10, 2024
(a) The dispute resolution forum and its
						arbitrators shall adhere to any guidelines published by the board for the
						resolution of paid family leave disputes.
(b) All parties subject to the provisions of
						this Subpart shall be subject to any rules promulgated by the dispute
						resolution forum with respect to its own internal procedures regarding the
						administration of disputed claims, to the extent that such rules are not
						inconsistent with guidelines published by the board or this Subpart.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter H - Disability Benefits › Article 2 - Rules Under Disability Benefits Law › Part 380 - Paid Family Leave › Subpart 380-10 - Voluntary Coverage › Section 380-10.1 - Public employers that opt in

Current through Register Vol. 46, No. 28, July 10, 2024
(a) In the
						event that a public employer as defined in section 212-b of the Workers'
						Compensation Law elects to offer family leave benefits to public employees who
						are not represented by an employee organization as described in section 212-b
						of the Workers' Compensation Law, such entity shall:
(1) provide written notice to the chair and
						to all public employees who will be required to make contributions no less than
						90 days prior to collecting the first employee contribution. The notice does
						not need to include the amount of the employee contribution, as long as it
						states that the amount will not exceed the maximum permitted by section 209  of
						the Workers' Compensation Law;
(2)
						follow all applicable statutory and regulatory requirements for the provision
						of family leave benefits in accordance with sections 211 and 212-a of the
						Workers' Compensation Law, including self-insurance requirements in the event
						the entity intends to self-insure;
(3) submit the public employer's paid family
						leave plan to the board; and
(4)
						provide 12 months written notice to the chair and all public employees who have
						been making contributions in accordance with section 209  of the Workers'
						Compensation Law of any decision by the entity to discontinue the provision of
						voluntary coverage;
(i) failure to provide
						proper written notice in accordance with this subdivision shall subject the
						public employer to fines, assessments, and other penalties as prescribed by
						law, including but not limited to, section 220  of the Workers' Compensation
						Law.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter H - Disability Benefits › Article 2 - Rules Under Disability Benefits Law › Part 380 - Paid Family Leave › Subpart 380-10 - Voluntary Coverage › Section 380-10.2 - Voluntary coverage for family leave when already providing voluntary disability benefits coverage

Current through Register Vol. 46, No. 28, July 10, 2024
(a) An
						employer or individual approved for, and providing, voluntary disability
						benefits coverage pursuant to section 212  of the Workers' Compensation Law
						prior to January 1, 2018, is approved to provide voluntary coverage for family
						leave benefits if desired; however, the disability and family leave benefits
						must be provided under a single insurance policy.
(b) An employer or individual approved for,
						and providing, self-insured voluntary disability benefits coverage prior to
						January 1, 2018 who wishes to obtain a separate family leave benefits policy,
						must notify the chair that such policy has been obtained.
(c) An employer who provides voluntary
						disability benefits to its employees on December 1, 2017, and is permitted
						under sections 212, 212-a and 212-b of the Workers' Compensation Law to provide
						only disability benefits or family leave benefits to its employees, must notify
						its employees and the board that it will or will not be providing family leave
						benefits to its employees prior to December 1, 2017.
(d) An employer or individual who is
						permitted and wishes to elect to become a covered employer to provide family
						leave benefits in accordance with section 212  of the Workers' Compensation Law
						who is not an employer or individual described in subdivision (a) or (b) of
						this section:
(1) shall seek prior
						authorization from the chair even where such employer had previously received
						authorization for and canceled such election; and
(2) may be required to explain, to the
						satisfaction of the chair or his or her designee, the reason for the
						cancellation of a prior election before re-authorization is provided.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter I - Actuarial Procedure › Part 390 - Lump-sum Payments › Section 390.1 - Definite award required

Current through Register Vol. 46, No. 28, July 10, 2024
(a) No
				  award shall be made for a lump-sum payment on account of all, or any part, of
				  the remaining compensation due any claimant, unless a definite award has
				  previously been made to such claimant.
(b) By a definite award is meant an award in
				  which compensation payments terminate at a definite date or in the event of
				  death or remarriage of such claimant.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter I - Actuarial Procedure › Part 390 - Lump-sum Payments › Section 390.2 - Basis of award

Current through Register Vol. 46, No. 28, July 10, 2024
Every award for a lump-sum payment on account of all, or
					 any part, of the remaining compensation due any claimant shall be based upon a
					 computation by the actuary.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter I - Actuarial Procedure › Part 390 - Lump-sum Payments › Section 390.3 - Computations by actuary

Current through Register Vol. 46, No. 28, July 10, 2024
(a) The actuary
				  shall make his computation as of the date of hearing when the lump sum is
				  granted.
(b) The actuary shall base
				  his computations upon the survivorship annuitants' table of mortality, the
				  remarriage tables of the Dutch Royal Insurance Institution and interest at 31/2
				  per centum per annum on claims based on accidents occurring up to and including
				  June 30, 1939, and at three per centum per annum on claims based on accidents
				  occurring thereafter, provided that this interest rate shall not apply to
				  computations made under section
				  392.2  of
				  this Title.
(c)
(1) In computing a lump-sum payment to a
				  widow for all of the future payments due her, the actuary shall take into
				  account the probability of the widow receiving the two years' remarriage
				  payment.
(2) In computing the
				  interval of suspension of payments where a commuted partial lump sum is awarded
				  in death cases, the factors of survivorship and interest shall be taken into
				  account, but not the probability of remarriage.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter I - Actuarial Procedure › Part 391 - Third-party Recovery › Section 391.1 - Allocating third-party recovery

Current through Register Vol. 46, No. 28, July 10, 2024
In allocating a third-party recovery by a surviving wife
					 (or dependent husband) and children, unless specifically instructed to the
					 contrary, the actuary shall assume that one third of the amount of recovery has
					 been assigned to the surviving wife (or dependent husband) and the remaining
					 two thirds to the children who share equally. If there be no surviving wife (or
					 dependent husband), the actuary shall assume that all children share equally in
					 the third-party recovery. If parents or brothers and sisters of grandparents
					 share in a third-party recovery, unless specifically instructed to the
					 contrary, the actuary shall assume that all such parents or brothers and
					 sisters or grandparents share equally in the recovery.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter I - Actuarial Procedure › Part 391 - Third-party Recovery › Section 391.2 - Deficiency compensation

Current through Register Vol. 46, No. 28, July 10, 2024
(a) In any
				  disability case involving a recovery by a claimant from a third party under
				  section 29  of the Workers' Compensation Law, the date on which deficiency
				  compensation shall begin shall be the date to which the amount of recovery
				  would extend, in schedule cases from the date of accident and in nonschedule
				  cases from the beginning date of disability, when such recovery is divided by
				  the actual compensation rate.
(b)
				  In any death case involving a recovery by a claimant from a third party under
				  section 29  of the Workers' Compensation Law, the date on which deficiency
				  compensation shall begin shall be the date to which the amount of the recovery,
				  less funeral benefits not to exceed $200, would extend from the date of death
				  when such recovery is divided by the actual compensation rate.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter I - Actuarial Procedure › Part 392 - Computation Of Interest On Awards › Section 392.1 - Date of an award

Current through Register Vol. 46, No. 28, July 10, 2024
For the purpose of computing interest, the date of an award
					 is the date when the award notice is filed in the department.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter I - Actuarial Procedure › Part 392 - Computation Of Interest On Awards › Section 392.2 - Interest rate

Current through Register Vol. 46, No. 28, July 10, 2024
In computing the interest due on an award, the actuary
					 shall use simple interest at the rate provided in section 5004  of the Civil
					 Practice Law and Rules, except as provided in section 27  of the Workers'
					 Compensation Law.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter I - Actuarial Procedure › Part 392 - Computation Of Interest On Awards › Section 392.3 - Computation of interest

Current through Register Vol. 46, No. 28, July 10, 2024
(a) When
				  an award is appealed and subsequently is affirmed by a court, the interest
				  shall be computed from the date on which the award notice was filed in the
				  department to the date of payment of the award, except as provided in section 27  of the Workers' Compensation Law.
(b) In all other cases interest shall be
				  computed from 30 days after the date on which the award notice was filed in the
				  department to the date of payment of the award, except as provided in section 27  of the Workers' Compensation Law.
(c) In any computation under subdivision (a)
				  or (b) of this section, interest shall be computed on the amount of the award,
				  including the attorney's fees, and payable to the claimant. The attorney shall
				  not be entitled to interest on his fixed fee.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter I - Actuarial Procedure › Part 393 - Aggregate Trust Funds › Section 393.1 - Actuarial computation

Current through Register Vol. 46, No. 28, July 10, 2024
When making an award under the mandatory provisions of
					 section 27  of the Workers' Compensation Law, the insurance carrier shall be
					 directed to pay to the claimant, or in death cases to the dependents, the
					 compensation that has accrued to the date of the award and three biweeklies
					 thereafter. The actuary, when computing the amount to be paid into the
					 aggregate trust fund, shall assume such payments have been made by the
					 carrier.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter I - Actuarial Procedure › Part 393 - Aggregate Trust Funds › Section 393.2 - Payment subject to penalty and interest

Current through Register Vol. 46, No. 28, July 10, 2024
Payment into the aggregate trust fund made after the date
					 as of which the award was commuted shall be subject to penalty and interest
					 charges.