N.Y. Comp. Codes R. & Regs. tit. 9 § 525.13

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

Section 525.13 - Review of a decision on a claim

(a) The claimant may, within 30 days after receipt of the decision of the office, make an application in writing to the office for reconsideration of such decision. Such application shall include the claim number and an original signature of the claimant.

(b) Upon receipt of an application pursuant to subdivision (a) of this section, the director and/or his or her designee(s) shall either re-open the claim for reconsideration based upon new information or approve the application for the director and/or his or her designee(s) to review the record, to affirm or modify the decision of the office. The director shall ensure the person or persons reviewing the record shall not include the person who made the determination which is being reviewed. If the application for reconsideration is based wholly upon the law under which the office operates, a decision may be issued without a hearing. If the application for reconsideration is based in part or wholly upon the facts of the claim, the office shall notify the claimant of the date and time during which the director and/or his or her designee(s) will consider their application. The claimant may request to personally appear or otherwise make him or herself available in a manner prescribed by the director and/or his or her designee(s) at such time for a hearing pursuant to section 525.8 of this Part prior to the rendering of a decision. If such hearing is requested and the claimant fails to appear or be available in the manner prescribed by the director and/or his or her designee(s), the hearing shall be considered waived by the claimant and the director and/or his or her designee(s) shall review the record to make its final determination, unless the director and/or his or her designee(s), for good cause shown, finds such failure to have been justified. If such hearing is not requested, the director and/or his or her designee(s) shall review the record and make its determination. The decision of the director and/or his or her designee(s) shall become the final determination of the office. The director and/or his or her designee(s) shall issue a written determination. The determination shall state in writing the reason(s) therefor. Should the determination contain a specific payment or payments to the claimant or provider(s), the determination shall state in writing the projected date of such payment(s). A copy of the determination shall become part of the claim's file and the claimant and/or his or her attorney shall be provided a copy of such determination.

(c) A written determination shall have printed or typed thereon notices to the claimant and/or attorney. These notices shall include any rights to appeal that the claimant may have of the decision and a projected date of payment in the case of an award to the claimant.

(d) If no application is received pursuant to subdivision (a) of this section, the decision of the office shall become the final determination.

(e) The office may reinvestigate or reopen cases at any time, as the office deems necessary.

N.Y. Comp. Codes R. & Regs. Tit. 9 § 525.13