N.Y. Comp. Codes R. & Regs. tit. 12 § 300.19

Current through Register Vol. 46, No. 45, November 2, 2024

Section 300.19 - Interest on unpaid awards and unpaid medical bills

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.

N.Y. Comp. Codes R. & Regs. Tit. 12 § 300.19

Amended New York State Register January 29, 2020/Volume XLII, Issue 04, eff. 1/29/2020