Procedure before the Board

Aggregated from public-domain New York law; no amendment recorded since codification.

(a) As used in this Part: (1) Affidavit means a declaration or statement of facts made voluntarily and confirmed by the oath of the party making it and taken before a person having authority to administer the oath such as a notary public. (2) Affirmation means a declaration not verified by an oath that the statements made are true under penalty of perjury and can be used by an attorney at law as a substitution for an affidavit. (3) Board means the Workers' Compensation Board, except as pursuant to the Workers' Compensation Law, the decision of the board in particular cases may be by a member or panel of the board or by a Workers' Compensation Law judge. (4) Chair means the Chairman, Chairwoman or Chair of the Workers' Compensation Board. (5) Claim includes any matter over which the board has jurisdiction. (6) Initial expedited hearing means the first hearing scheduled after a pre-hearing conference which is designed to provide an opportunity for the claimant and any lay witnesses to testify. (7) Insurance carrier means the State Insurance Fund, stock corporations, mutual corporations or reciprocal insurers with which employers have insured, and employers permitted to pay compensation directly under the provisions of Workers' Compensation Law, section 50(3), (3-a) or (4). Insurance carrier also means, as applicable, an employer which has failed to obtain the required workers' compensation coverage pursuant to Workers' Compensation Law, section 50. (8) Legal representative means an attorney-at-law or a representative licensed by the board pursuant to Workers' Compensation Law, sections 24, 50(3-b) and (3-d). (9) Prima facie medicine evidence means a medical report referencing an injury, which includes traumas and illnesses, except for an independent livery driver as defined in section 309.1(i) of this Title where it means either: (i) a medical report referencing an injury covered by the Independent Livery Driver Benefit Fund as set forth in Executive Law, section 160-d dd; or (ii) for injuries resulting from a crime as defined in section 309.1(d) of this Title against an independent livery driver, a medical report referencing an injury and a police report indicating that a crime against an independent livery driver occurred. (10) Workers' Compensation Law judge means any person appointed as a referee, pursuant to Workers' Compensation Law, section 150, to hear and decide controversies in accordance with the provisions of the Workers' Compensation Law and to conduct such investigations and further hearings in connection therewith as may be required by the board. Senior Workers' Compensation Law judge means the senior referee; supervising Workers' Compensation Law judge means the supervising referee. This subdivision shall not apply to acting referees.

(1) Affidavit means a declaration or statement of facts made voluntarily and confirmed by the oath of the party making it and taken before a person having authority to administer the oath such as a notary public.

(2) Affirmation means a declaration not verified by an oath that the statements made are true under penalty of perjury and can be used by an attorney at law as a substitution for an affidavit.

(3) Board means the Workers' Compensation Board, except as pursuant to the Workers' Compensation Law, the decision of the board in particular cases may be by a member or panel of the board or by a Workers' Compensation Law judge.

(4) Chair means the Chairman, Chairwoman or Chair of the Workers' Compensation Board.

(5) Claim includes any matter over which the board has jurisdiction.

(6) Initial expedited hearing means the first hearing scheduled after a pre-hearing conference which is designed to provide an opportunity for the claimant and any lay witnesses to testify.

(7) Insurance carrier means the State Insurance Fund, stock corporations, mutual corporations or reciprocal insurers with which employers have insured, and employers permitted to pay compensation directly under the provisions of Workers' Compensation Law, section 50(3), (3-a) or (4). Insurance carrier also means, as applicable, an employer which has failed to obtain the required workers' compensation coverage pursuant to Workers' Compensation Law, section 50.

(8) Legal representative means an attorney-at-law or a representative licensed by the board pursuant to Workers' Compensation Law, sections 24, 50(3-b) and (3-d).

(9) Prima facie medicine evidence means a medical report referencing an injury, which includes traumas and illnesses, except for an independent livery driver as defined in section 309.1(i) of this Title where it means either: (i) a medical report referencing an injury covered by the Independent Livery Driver Benefit Fund as set forth in Executive Law, section 160-d dd; or (ii) for injuries resulting from a crime as defined in section 309.1(d) of this Title against an independent livery driver, a medical report referencing an injury and a police report indicating that a crime against an independent livery driver occurred.

(i) a medical report referencing an injury covered by the Independent Livery Driver Benefit Fund as set forth in Executive Law, section 160-d dd; or

(ii) for injuries resulting from a crime as defined in section 309.1(d) of this Title against an independent livery driver, a medical report referencing an injury and a police report indicating that a crime against an independent livery driver occurred.

(10) Workers' Compensation Law judge means any person appointed as a referee, pursuant to Workers' Compensation Law, section 150, to hear and decide controversies in accordance with the provisions of the Workers' Compensation Law and to conduct such investigations and further hearings in connection therewith as may be required by the board. Senior Workers' Compensation Law judge means the senior referee; supervising Workers' Compensation Law judge means the supervising referee. This subdivision shall not apply to acting referees.

(b) As used in section 10 of the Workers' Compensation Law and in this Part, controlled substance means any substance or substances listed in section 3306 of the Public Health Law.

Aggregated from public-domain New York law; last amended effective 2014-02-26.

(a) Purpose. Pursuant to Workers' Compensation Law, sections 13-a, 13-b, 13-d, 13-k, 13-l, 13-m, 13-n and 137, and in accordance with these regulations, the chair of the Workers' Compensation Board shall: (1) authorize competent providers who meet eligibility requirements to conduct independent medical examinations of persons suffering injuries or illnesses which are the subject of claims under the Workers' Compensation Law, Volunteer Firefighters' Benefits Law and Volunteer Ambulance Workers' Benefit Law; (2) modify or revoke such authorization where there is a failure of continued compliance with such laws and regulations or other provisions governing the professional conduct or obligations of such providers; (3) require that such independent medical examinations are conducted in accordance with Workers' Compensation Law, sections 13-a, 13-b, 13-d, 13-k, 13-l, 13-m, 13-n and 137 and these regulations and that reports of such independent medical examinations are prepared and transmitted in accordance with Workers' Compensation Law, section 137 and these regulations; and (4) require the registration with the chair of entities that derive income from independent medical examinations.

(1) authorize competent providers who meet eligibility requirements to conduct independent medical examinations of persons suffering injuries or illnesses which are the subject of claims under the Workers' Compensation Law, Volunteer Firefighters' Benefits Law and Volunteer Ambulance Workers' Benefit Law;

(2) modify or revoke such authorization where there is a failure of continued compliance with such laws and regulations or other provisions governing the professional conduct or obligations of such providers;

(3) require that such independent medical examinations are conducted in accordance with Workers' Compensation Law, sections 13-a, 13-b, 13-d, 13-k, 13-l, 13-m, 13-n and 137 and these regulations and that reports of such independent medical examinations are prepared and transmitted in accordance with Workers' Compensation Law, section 137 and these regulations; and

(4) require the registration with the chair of entities that derive income from independent medical examinations.

(b) Independent medical examiners; definitions. For purposes of this Part, the following terms have the following meanings:(1) Attending physician or other attending practitioner means those providers or practitioners who have primary responsibility for treating the claimant for the injury or illness for which such claimant is being examined. (2) Authorized examiner means a physician, podiatrist, chiropractor, or psychologist who possesses a current, valid, and unrestricted professional license granted by the New York State Board of Regents, that is without any limitation imposed by the New York State Department of Health, Board of Professional Medical Conduct or the New York State Department of Education, Office of Professional Discipline, is not subject to any restriction on or suspension or revocation of a professional license granted by any other state, and meets the following requirements for authorization by the Chair of the Workers' Compensation Board to conduct independent medical examinations and review of records: (i) Requirements for all professions. Each applicant must complete the application process for independent medical examiners required for the applicant's licensed profession under Workers' Compensation Law section 13-b, 13-k, 13-l or 13-m and paragraph (c)(2) of this section. A physician, podiatrist, chiropractor, or psychologist who is currently authorized to provide treatment to persons in accordance with the Workers' Compensation Law, Volunteer Ambulance Workers' Benefits Law, and Volunteer Firefighters' Benefits Law must apply for and receive a separate or additional authorization in order to conduct independent medical examinations under such laws. (ii) Requirements specific to professions.(a) A physician must have a degree of doctor of medicine, M.D., or doctor of osteopathy, D.O., or an equivalent degree in accordance with the regulations of the Commissioner of Education, and must satisfactorily meet all other licensing requirements of the State Board of Medicine and Commissioner of Education, and must be board certified as defined in paragraph (3) of this subdivision. (b) A podiatrist must have received a doctoral degree in podiatry in accordance with the regulations of the Commissioner of Education, and must satisfactorily meet all other licensing requirements of the State Board for Podiatry and the Commissioner of Education. (c) A chiropractor must have completed two years of pre-professional college study and a four-year resident program in chiropractic in accordance with the regulations of the Commissioner of Education, and must satisfactorily meet all other licensing requirements of the State Board for Chiropractic and the Commissioner of Education. (d) A psychologist must have received a doctoral degree in psychology from a program of psychology registered with the State Education Department or the substantial equivalent thereof in accordance with the regulations of the Commissioner of Education, and must satisfactorily meet all other licensing requirements of the State Board for Psychology and the Commissioner of Education. (e) An authorized examiner does not include the insurance carrier or special fund's medical professional as that term is defined in section 324.1(c) of this Title. (3) Board certified means a physician or surgeon who is certified by a specialty board that is recognized by the American Board of Medical Specialties or the American Osteopathic Association. (4) Independent medical examination means an examination performed by an authorized or qualified independent medical examiner, pursuant to section 13-a, 13-k, 13-l, 13-m or 137 of the Workers' Compensation Law, for purposes of evaluating or providing an opinion with respect to schedule loss, degree of disability, validation of treatment plan or diagnosis, causal relationship, diagnosis or treatment of disability, maximum medical improvement, ability to return to work, permanency, appropriateness of treatment, necessity of treatment, proper treatment, extent of disability, second opinion or any other purpose recognized or requested by the board. An examination that is conducted for any of the purposes described in this section, other than an examination conducted at a clinic that is a member of the occupational health clinics network established pursuant to subdivision (3) of section 151 of the Workers' Compensation Law, shall be deemed an independent medical examination and shall be subject to the requirements governing the conduct and reports of such examinations as set forth under sections 13-a, 13-b, 13-d, 13-k, 13-l, 13-m, 13-n and 137 of the Workers' Compensation Law and this Part. An examination conducted at the request of the chair or the board in accordance with section 13 (e) or 19 of the Workers' Compensation Law shall not constitute an independent medical examination for purposes of this Part, or for purposes of sections 13-b, 13-k, 13-l, 13-m and 137 of the Workers' Compensation Law. (5) Independent medical examiner means a physician, surgeon, podiatrist, chiropractor or psychologist who is authorized to conduct independent medical examinations as defined in paragraph (4) of this subdivision, in accordance with sections 13-b, 13-k, 13-l, 13-m and 137 of the Workers' Compensation Law and this Part, or is found to be qualified to perform such examinations by a Workers' Compensation Law judge as set forth in paragraph (9) of this subdivision. (6) IME entity means an individual or entity that derives income from independent medical examinations performed in accordance with Workers' Compensation Law sections 13-a, 13-k, 13-l, or 13-m and this section or review of records, whether by employing or contracting with independent medical examiners to conduct such independent medical examinations or review of records, or by acting as a referral service or otherwise facilitating such examinations or review of records and is registered with the chair in accordance with Workers' Compensation Law section 13-n and this section. (7) Medical facility means a professional office suitable for a medical, podiatric, chiropractic or psychological examination, where the primary use of the examination location is not residential, commercial, educational, or retail in nature. A professional office that is adjacent to a residence may serve as a medical facility for independent medical examinations if the residence provides a separate entrance for the professional office that is clearly marked as a professional office, provides adequate privacy to the injured worker, and is listed with the Workers' Compensation Board and the State Education Department as an office address for the provider conducting the examination. A medical facility shall have adequate access, heat, light, space and equipment to provide for the safety and integrity of the examination, and shall meet reasonable sanitary requirements. Medical facilities shall meet other requirements consistent with section 137 of the Workers' Compensation Law as may be required by the chair or Workers' Compensation Law judge, and shall meet all applicable standards for accessibility as required under State or Federal law. (8) Preferred provider organization or P.P.O. means a plan licensed by the Commissioner of Health pursuant to section 353 of the Workers' Compensation Law that is owned, operated, or administered by an entity that provides for the delivery of services required under article 10-A of the Workers' Compensation Law. (9) Qualified means, with respect to independent medical examiners, a physician, podiatrist, chiropractor or psychologist who holds a current, valid and unrestricted professional license in the state in which he or she performs the subject independent medical examination or record review, and is found to meet additional professional standards as may be required in the discretion of a Workers' Compensation Law judge or the chair or board based upon the particular facts of a case. A qualified examiner does not include the insurance carrier or special fund's medical professional as that term is defined in section 324.1(c) of this Title. (10) Representative, for purposes of section 137 (A)(1) of the Workers' Compensation Law, means a claimant's attorney or a representative who is licensed and authorized by the board to appear in matters or proceedings before the board in accordance with section 24-a of the Workers' Compensation Law, or a person who is licensed to represent the members of its bona fide charitable or welfare organization or labor or other organization pursuant to section 302- 1.3(b) of this Title. (11) Request for information, for purposes of Workers' Compensation Law section 137(1)(b), except as limited under Civil Practice Law and Rules section 4503, means any substantive communication with an independent medical examiner, or his or her office, regarding the claimant from any person or entity, including a claimant, an insurance carrier, or a third party administrator, that takes place or is initiated outside of the independent medical examination, including a request or referral for examination and any communication related thereto, questions or inquiries related to the claimant or the examination, and the provision of information to the examiner for review in connection with a request for the examiner's professional opinion with regard to the claimant or the examination. When any substantive communication consists of documents, records, reports, and items that are part of the official board file and available to all parties at the time they are provided to the independent medical examiner, or his or her office, the documents, records, reports, and items or copies thereof shall not be filed with the board. (12) Review of records, records review or report made without physical examination means the evaluation of a claimant without physical examination, by a medical provider authorized by the chair to treat claimants or to conduct independent medical examinations or both, or a medical provider qualified within the meaning of paragraph (9) of this subdivision, based on the review of reports and records, including treatment notes, diagnostic test results, depositions or hearing testimony, exhibits, and other records or reports from medical providers or independent medical examiners or both in the electronic case file maintained by the Board. A review of records does not include reviews conducted by the insurance carrier or special fund's medical professional as that term is defined in section 324.1(c) of this Title.

(1) Attending physician or other attending practitioner means those providers or practitioners who have primary responsibility for treating the claimant for the injury or illness for which such claimant is being examined.

(2) Authorized examiner means a physician, podiatrist, chiropractor, or psychologist who possesses a current, valid, and unrestricted professional license granted by the New York State Board of Regents, that is without any limitation imposed by the New York State Department of Health, Board of Professional Medical Conduct or the New York State Department of Education, Office of Professional Discipline, is not subject to any restriction on or suspension or revocation of a professional license granted by any other state, and meets the following requirements for authorization by the Chair of the Workers' Compensation Board to conduct independent medical examinations and review of records: (i) Requirements for all professions. Each applicant must complete the application process for independent medical examiners required for the applicant's licensed profession under Workers' Compensation Law section 13-b, 13-k, 13-l or 13-m and paragraph (c)(2) of this section. A physician, podiatrist, chiropractor, or psychologist who is currently authorized to provide treatment to persons in accordance with the Workers' Compensation Law, Volunteer Ambulance Workers' Benefits Law, and Volunteer Firefighters' Benefits Law must apply for and receive a separate or additional authorization in order to conduct independent medical examinations under such laws. (ii) Requirements specific to professions.(a) A physician must have a degree of doctor of medicine, M.D., or doctor of osteopathy, D.O., or an equivalent degree in accordance with the regulations of the Commissioner of Education, and must satisfactorily meet all other licensing requirements of the State Board of Medicine and Commissioner of Education, and must be board certified as defined in paragraph (3) of this subdivision. (b) A podiatrist must have received a doctoral degree in podiatry in accordance with the regulations of the Commissioner of Education, and must satisfactorily meet all other licensing requirements of the State Board for Podiatry and the Commissioner of Education. (c) A chiropractor must have completed two years of pre-professional college study and a four-year resident program in chiropractic in accordance with the regulations of the Commissioner of Education, and must satisfactorily meet all other licensing requirements of the State Board for Chiropractic and the Commissioner of Education. (d) A psychologist must have received a doctoral degree in psychology from a program of psychology registered with the State Education Department or the substantial equivalent thereof in accordance with the regulations of the Commissioner of Education, and must satisfactorily meet all other licensing requirements of the State Board for Psychology and the Commissioner of Education. (e) An authorized examiner does not include the insurance carrier or special fund's medical professional as that term is defined in section 324.1(c) of this Title.

(i) Requirements for all professions. Each applicant must complete the application process for independent medical examiners required for the applicant's licensed profession under Workers' Compensation Law section 13-b, 13-k, 13-l or 13-m and paragraph (c)(2) of this section. A physician, podiatrist, chiropractor, or psychologist who is currently authorized to provide treatment to persons in accordance with the Workers' Compensation Law, Volunteer Ambulance Workers' Benefits Law, and Volunteer Firefighters' Benefits Law must apply for and receive a separate or additional authorization in order to conduct independent medical examinations under such laws.

(ii) Requirements specific to professions.(a) A physician must have a degree of doctor of medicine, M.D., or doctor of osteopathy, D.O., or an equivalent degree in accordance with the regulations of the Commissioner of Education, and must satisfactorily meet all other licensing requirements of the State Board of Medicine and Commissioner of Education, and must be board certified as defined in paragraph (3) of this subdivision. (b) A podiatrist must have received a doctoral degree in podiatry in accordance with the regulations of the Commissioner of Education, and must satisfactorily meet all other licensing requirements of the State Board for Podiatry and the Commissioner of Education. (c) A chiropractor must have completed two years of pre-professional college study and a four-year resident program in chiropractic in accordance with the regulations of the Commissioner of Education, and must satisfactorily meet all other licensing requirements of the State Board for Chiropractic and the Commissioner of Education. (d) A psychologist must have received a doctoral degree in psychology from a program of psychology registered with the State Education Department or the substantial equivalent thereof in accordance with the regulations of the Commissioner of Education, and must satisfactorily meet all other licensing requirements of the State Board for Psychology and the Commissioner of Education. (e) An authorized examiner does not include the insurance carrier or special fund's medical professional as that term is defined in section 324.1(c) of this Title.

(a) A physician must have a degree of doctor of medicine, M.D., or doctor of osteopathy, D.O., or an equivalent degree in accordance with the regulations of the Commissioner of Education, and must satisfactorily meet all other licensing requirements of the State Board of Medicine and Commissioner of Education, and must be board certified as defined in paragraph (3) of this subdivision.

(b) A podiatrist must have received a doctoral degree in podiatry in accordance with the regulations of the Commissioner of Education, and must satisfactorily meet all other licensing requirements of the State Board for Podiatry and the Commissioner of Education.

(c) A chiropractor must have completed two years of pre-professional college study and a four-year resident program in chiropractic in accordance with the regulations of the Commissioner of Education, and must satisfactorily meet all other licensing requirements of the State Board for Chiropractic and the Commissioner of Education.

(d) A psychologist must have received a doctoral degree in psychology from a program of psychology registered with the State Education Department or the substantial equivalent thereof in accordance with the regulations of the Commissioner of Education, and must satisfactorily meet all other licensing requirements of the State Board for Psychology and the Commissioner of Education.

(e) An authorized examiner does not include the insurance carrier or special fund's medical professional as that term is defined in section 324.1(c) of this Title.

(3) Board certified means a physician or surgeon who is certified by a specialty board that is recognized by the American Board of Medical Specialties or the American Osteopathic Association.

(4) Independent medical examination means an examination performed by an authorized or qualified independent medical examiner, pursuant to section 13-a, 13-k, 13-l, 13-m or 137 of the Workers' Compensation Law, for purposes of evaluating or providing an opinion with respect to schedule loss, degree of disability, validation of treatment plan or diagnosis, causal relationship, diagnosis or treatment of disability, maximum medical improvement, ability to return to work, permanency, appropriateness of treatment, necessity of treatment, proper treatment, extent of disability, second opinion or any other purpose recognized or requested by the board. An examination that is conducted for any of the purposes described in this section, other than an examination conducted at a clinic that is a member of the occupational health clinics network established pursuant to subdivision (3) of section 151 of the Workers' Compensation Law, shall be deemed an independent medical examination and shall be subject to the requirements governing the conduct and reports of such examinations as set forth under sections 13-a, 13-b, 13-d, 13-k, 13-l, 13-m, 13-n and 137 of the Workers' Compensation Law and this Part. An examination conducted at the request of the chair or the board in accordance with section 13 (e) or 19 of the Workers' Compensation Law shall not constitute an independent medical examination for purposes of this Part, or for purposes of sections 13-b, 13-k, 13-l, 13-m and 137 of the Workers' Compensation Law.

(5) Independent medical examiner means a physician, surgeon, podiatrist, chiropractor or psychologist who is authorized to conduct independent medical examinations as defined in paragraph (4) of this subdivision, in accordance with sections 13-b, 13-k, 13-l, 13-m and 137 of the Workers' Compensation Law and this Part, or is found to be qualified to perform such examinations by a Workers' Compensation Law judge as set forth in paragraph (9) of this subdivision.

(6) IME entity means an individual or entity that derives income from independent medical examinations performed in accordance with Workers' Compensation Law sections 13-a, 13-k, 13-l, or 13-m and this section or review of records, whether by employing or contracting with independent medical examiners to conduct such independent medical examinations or review of records, or by acting as a referral service or otherwise facilitating such examinations or review of records and is registered with the chair in accordance with Workers' Compensation Law section 13-n and this section.

(7) Medical facility means a professional office suitable for a medical, podiatric, chiropractic or psychological examination, where the primary use of the examination location is not residential, commercial, educational, or retail in nature. A professional office that is adjacent to a residence may serve as a medical facility for independent medical examinations if the residence provides a separate entrance for the professional office that is clearly marked as a professional office, provides adequate privacy to the injured worker, and is listed with the Workers' Compensation Board and the State Education Department as an office address for the provider conducting the examination. A medical facility shall have adequate access, heat, light, space and equipment to provide for the safety and integrity of the examination, and shall meet reasonable sanitary requirements. Medical facilities shall meet other requirements consistent with section 137 of the Workers' Compensation Law as may be required by the chair or Workers' Compensation Law judge, and shall meet all applicable standards for accessibility as required under State or Federal law.

(8) Preferred provider organization or P.P.O. means a plan licensed by the Commissioner of Health pursuant to section 353 of the Workers' Compensation Law that is owned, operated, or administered by an entity that provides for the delivery of services required under article 10-A of the Workers' Compensation Law.

(9) Qualified means, with respect to independent medical examiners, a physician, podiatrist, chiropractor or psychologist who holds a current, valid and unrestricted professional license in the state in which he or she performs the subject independent medical examination or record review, and is found to meet additional professional standards as may be required in the discretion of a Workers' Compensation Law judge or the chair or board based upon the particular facts of a case. A qualified examiner does not include the insurance carrier or special fund's medical professional as that term is defined in section 324.1(c) of this Title.

(10) Representative, for purposes of section 137 (A)(1) of the Workers' Compensation Law, means a claimant's attorney or a representative who is licensed and authorized by the board to appear in matters or proceedings before the board in accordance with section 24-a of the Workers' Compensation Law, or a person who is licensed to represent the members of its bona fide charitable or welfare organization or labor or other organization pursuant to section 302- 1.3(b) of this Title.

(11) Request for information, for purposes of Workers' Compensation Law section 137(1)(b), except as limited under Civil Practice Law and Rules section 4503, means any substantive communication with an independent medical examiner, or his or her office, regarding the claimant from any person or entity, including a claimant, an insurance carrier, or a third party administrator, that takes place or is initiated outside of the independent medical examination, including a request or referral for examination and any communication related thereto, questions or inquiries related to the claimant or the examination, and the provision of information to the examiner for review in connection with a request for the examiner's professional opinion with regard to the claimant or the examination. When any substantive communication consists of documents, records, reports, and items that are part of the official board file and available to all parties at the time they are provided to the independent medical examiner, or his or her office, the documents, records, reports, and items or copies thereof shall not be filed with the board.

(12) Review of records, records review or report made without physical examination means the evaluation of a claimant without physical examination, by a medical provider authorized by the chair to treat claimants or to conduct independent medical examinations or both, or a medical provider qualified within the meaning of paragraph (9) of this subdivision, based on the review of reports and records, including treatment notes, diagnostic test results, depositions or hearing testimony, exhibits, and other records or reports from medical providers or independent medical examiners or both in the electronic case file maintained by the Board. A review of records does not include reviews conducted by the insurance carrier or special fund's medical professional as that term is defined in section 324.1(c) of this Title.

(c) Independent medical examination provider eligibility requirements and application procedures. (1) Eligibility requirements. A physician, surgeon, podiatrist, chiropractor or psychologist who seeks to become authorized to conduct independent medical examinations of persons suffering injuries or illness which are the subject of claims under the Workers' Compensation Law, Volunteer Firefighters' Benefits Law and Volunteer Ambulance Workers' Benefits Law must meet the requirements set forth for an authorized provider under paragraph (b)(2) of this section and section 13-b, 13-k, 13-l, or 13-m of the Workers' Compensation Law. (2) Application procedures. Application, review and authorization procedures for independent medical examiners shall be conducted in accordance with sections 13-b, 13-k, 13-l and 13-m of the Workers' Compensation Law. Each physician, surgeon, podiatrist, chiropractor or psychologist seeking authorization to conduct independent medical of persons suffering injuries or illness which are the subject of claims under the Workers' Compensation Law, Volunteer Firefighters's Benefits Law and Volunteer Ambulance Workers' Law shall complete Workers' Compensation Board form MR/IME-1, or such other form prescribed by the chair. A physician or surgeon shall submit the application for review to the county medical society in which his or her office is located, or to the New York State Osteopathic Medical Society, or to the panel or board designated by the chair for review as provided in section 13-b of the Workers' Compensation Law. A podiatrist, chiropractor or psychologist shall submit the application to the podiatry, chiropractic or psychology practice committee of the Workers' Compensation Board designated for review of such applications under section 13-k, 13-l or 13-m of the Workers' Compensation Law. The reviewing county medical society, State medical society, panel, board or practice committee shall make an advisory recommendation to the chair regarding each application as required under the Workers' Compensation Law. Upon such recommendation, the chair shall authorize a review of each application by the Workers' Compensation Board, and shall determine whether the applicant may become authorized to conduct independent medical examinations under the Workers' Compensation Law. Upon approval of an application by the chair, the applicant shall receive an authorization notice and a provider authorization number. An applicant who is denied authorization shall receive a notice of denial of authorization. (3) Retaining authorization privileges. (i) An authorized examiner may retain authorization privileges to conduct independent medical examinations and reviews of records only so long as such examiner continues to comply with the laws and regulations governing such authorization and the examiner's profession, and submits to such reports and investigation as may be required by the chair. The chair may remove an independent medical examiner's name from the list of authorized examiners, upon notice to the affected examiner, if: (a) the independent medical examiner is not in compliance with any of the laws and regulations authorizing him or her to conduct independent medical examinations and reviews of records, including any failure by an examiner to possess a required board certification in accordance with paragraph (b)(3) of this section, or the presence of a restriction or restrictions placed by the regulating New York State agency or any agency in any other state charged with oversight of medical licensure compliance and professional conduct, on the examiner's license to practice medicine, podiatry, chiropractic, or psychology; or (b) the independent medical examiner has engaged in professional or other misconduct or incompetence, or fails to comply with the laws and regulations governing his or her conduct. (ii) When an independent medical examiner receives notice of the chair's intent to remove his or her name from the list of authorized examiners for one or more of the reasons in subparagraph (i) of this paragraph, the examiner may be heard, on his or her own behalf or through legal counsel, by offering written proof that he or she is in compliance with the laws and regulations governing authorization to conduct independent medical examinations as a defense to the chair's intended actions. (iii) When an independent medical examiner receives notice of the chair's intent to remove his or her name from the list of authorized examiners for one or more of the reasons in subparagraph (i) of this paragraph, his or her name may be removed from the chair's list of authorized examiners in accordance with Workers' Compensation Law section 13-d, 13-k, 13-l, or 13-m. Professional and other misconduct shall have the same meaning as set forth in Education Law sections 6509, 6509-a, 6530, and 6531 and include any violation of the Workers' Compensation Law or Chapter V of this Title or both, and any violation of the laws or regulations under the jurisdiction of the Centers for Medicare and Medicaid Services. (iv) The chair shall have the authority to designate a representative to represent him or her in the determinations pursuant to subparagraphs (ii) and (iii) of this paragraph.

(1) Eligibility requirements. A physician, surgeon, podiatrist, chiropractor or psychologist who seeks to become authorized to conduct independent medical examinations of persons suffering injuries or illness which are the subject of claims under the Workers' Compensation Law, Volunteer Firefighters' Benefits Law and Volunteer Ambulance Workers' Benefits Law must meet the requirements set forth for an authorized provider under paragraph (b)(2) of this section and section 13-b, 13-k, 13-l, or 13-m of the Workers' Compensation Law.

(2) Application procedures. Application, review and authorization procedures for independent medical examiners shall be conducted in accordance with sections 13-b, 13-k, 13-l and 13-m of the Workers' Compensation Law. Each physician, surgeon, podiatrist, chiropractor or psychologist seeking authorization to conduct independent medical of persons suffering injuries or illness which are the subject of claims under the Workers' Compensation Law, Volunteer Firefighters's Benefits Law and Volunteer Ambulance Workers' Law shall complete Workers' Compensation Board form MR/IME-1, or such other form prescribed by the chair. A physician or surgeon shall submit the application for review to the county medical society in which his or her office is located, or to the New York State Osteopathic Medical Society, or to the panel or board designated by the chair for review as provided in section 13-b of the Workers' Compensation Law. A podiatrist, chiropractor or psychologist shall submit the application to the podiatry, chiropractic or psychology practice committee of the Workers' Compensation Board designated for review of such applications under section 13-k, 13-l or 13-m of the Workers' Compensation Law. The reviewing county medical society, State medical society, panel, board or practice committee shall make an advisory recommendation to the chair regarding each application as required under the Workers' Compensation Law. Upon such recommendation, the chair shall authorize a review of each application by the Workers' Compensation Board, and shall determine whether the applicant may become authorized to conduct independent medical examinations under the Workers' Compensation Law. Upon approval of an application by the chair, the applicant shall receive an authorization notice and a provider authorization number. An applicant who is denied authorization shall receive a notice of denial of authorization.

(3) Retaining authorization privileges. (i) An authorized examiner may retain authorization privileges to conduct independent medical examinations and reviews of records only so long as such examiner continues to comply with the laws and regulations governing such authorization and the examiner's profession, and submits to such reports and investigation as may be required by the chair. The chair may remove an independent medical examiner's name from the list of authorized examiners, upon notice to the affected examiner, if: (a) the independent medical examiner is not in compliance with any of the laws and regulations authorizing him or her to conduct independent medical examinations and reviews of records, including any failure by an examiner to possess a required board certification in accordance with paragraph (b)(3) of this section, or the presence of a restriction or restrictions placed by the regulating New York State agency or any agency in any other state charged with oversight of medical licensure compliance and professional conduct, on the examiner's license to practice medicine, podiatry, chiropractic, or psychology; or (b) the independent medical examiner has engaged in professional or other misconduct or incompetence, or fails to comply with the laws and regulations governing his or her conduct. (ii) When an independent medical examiner receives notice of the chair's intent to remove his or her name from the list of authorized examiners for one or more of the reasons in subparagraph (i) of this paragraph, the examiner may be heard, on his or her own behalf or through legal counsel, by offering written proof that he or she is in compliance with the laws and regulations governing authorization to conduct independent medical examinations as a defense to the chair's intended actions. (iii) When an independent medical examiner receives notice of the chair's intent to remove his or her name from the list of authorized examiners for one or more of the reasons in subparagraph (i) of this paragraph, his or her name may be removed from the chair's list of authorized examiners in accordance with Workers' Compensation Law section 13-d, 13-k, 13-l, or 13-m. Professional and other misconduct shall have the same meaning as set forth in Education Law sections 6509, 6509-a, 6530, and 6531 and include any violation of the Workers' Compensation Law or Chapter V of this Title or both, and any violation of the laws or regulations under the jurisdiction of the Centers for Medicare and Medicaid Services. (iv) The chair shall have the authority to designate a representative to represent him or her in the determinations pursuant to subparagraphs (ii) and (iii) of this paragraph.

(i) An authorized examiner may retain authorization privileges to conduct independent medical examinations and reviews of records only so long as such examiner continues to comply with the laws and regulations governing such authorization and the examiner's profession, and submits to such reports and investigation as may be required by the chair. The chair may remove an independent medical examiner's name from the list of authorized examiners, upon notice to the affected examiner, if: (a) the independent medical examiner is not in compliance with any of the laws and regulations authorizing him or her to conduct independent medical examinations and reviews of records, including any failure by an examiner to possess a required board certification in accordance with paragraph (b)(3) of this section, or the presence of a restriction or restrictions placed by the regulating New York State agency or any agency in any other state charged with oversight of medical licensure compliance and professional conduct, on the examiner's license to practice medicine, podiatry, chiropractic, or psychology; or (b) the independent medical examiner has engaged in professional or other misconduct or incompetence, or fails to comply with the laws and regulations governing his or her conduct.

(a) the independent medical examiner is not in compliance with any of the laws and regulations authorizing him or her to conduct independent medical examinations and reviews of records, including any failure by an examiner to possess a required board certification in accordance with paragraph (b)(3) of this section, or the presence of a restriction or restrictions placed by the regulating New York State agency or any agency in any other state charged with oversight of medical licensure compliance and professional conduct, on the examiner's license to practice medicine, podiatry, chiropractic, or psychology; or

(b) the independent medical examiner has engaged in professional or other misconduct or incompetence, or fails to comply with the laws and regulations governing his or her conduct.

(ii) When an independent medical examiner receives notice of the chair's intent to remove his or her name from the list of authorized examiners for one or more of the reasons in subparagraph (i) of this paragraph, the examiner may be heard, on his or her own behalf or through legal counsel, by offering written proof that he or she is in compliance with the laws and regulations governing authorization to conduct independent medical examinations as a defense to the chair's intended actions.

(iii) When an independent medical examiner receives notice of the chair's intent to remove his or her name from the list of authorized examiners for one or more of the reasons in subparagraph (i) of this paragraph, his or her name may be removed from the chair's list of authorized examiners in accordance with Workers' Compensation Law section 13-d, 13-k, 13-l, or 13-m. Professional and other misconduct shall have the same meaning as set forth in Education Law sections 6509, 6509-a, 6530, and 6531 and include any violation of the Workers' Compensation Law or Chapter V of this Title or both, and any violation of the laws or regulations under the jurisdiction of the Centers for Medicare and Medicaid Services.

(iv) The chair shall have the authority to designate a representative to represent him or her in the determinations pursuant to subparagraphs (ii) and (iii) of this paragraph.

(d) Procedures for notice, conduct and reporting of independent medical examinations. (1) Notice. The claimant shall receive notice of the scheduled independent medical examination at least seven business days prior to the date of such examination. The notice shall be printed on the form prescribed by the chair for such purpose, which shall include all information required thereon, as set forth under Workers' Compensation Law, section 137. A copy of such notice shall be sent to the board on the same day it is sent to the claimant. Where the claimant asserts that notice of the examination was not received at least seven business days prior to the date of the examination and upon request by the board, the party scheduling such examination shall provide proof in the form of an affidavit, or a business record that meets requirements for admissibility under Civil Practice Law and Rules Rule 4518 that the notice was posted by United States mail at least 12 business days prior to the date of the examination or deposited into the custody of an overnight delivery service for overnight delivery, prior to the latest time designated by the overnight delivery service for overnight delivery at least eight business days prior to the date of the examination. In the event that an independent medical examination is required for the purpose of determining authorization for special services for specialist consultations, surgery, physical or occupational therapy, imaging studies or special diagnostic or laboratory tests in accordance with Workers' Compensation Law section 13-a(5), and a delay in authorization for such special services would result in a worsening of the claimant's condition or irreparable harm, and the examination can be scheduled less than 12 business days from the date of the request for the examination, the claimant may, by written consent waive the requirement of seven business days' notice of the examination. However, in case of such a waiver by the claimant of seven business days' notice of the examination, for purposes of scheduling an examination for authorization of such special services, a notice of the examination must be sent to the claimant as soon as possible after the scheduling of the examination in the same manner as otherwise required for notices of examinations under Workers' Compensation Law section 137 and this Part. In no event may the right to such notice be waived pursuant to an employment agreement or a collective bargaining agreement. If a claimant requests that an examination be rescheduled, and the examination is rescheduled less than seven business days after the request, the notice required under section 137 need not be received seven business days prior to the examination, but must be sent to the claimant as soon as possible in the same manner as required for the original notice under said section and this section. A copy of such notice shall be sent to the board on the same day it is sent to the claimant. Upon request by the Board, the party scheduling such examination shall provide proof in the form of an affidavit, or a business record that meets the requirements for admissibility under Civil Practice Law and Rules Rule 4518 that the notice was mailed as soon as possible. (2) Examination requested by claimant. A party requesting an independent medical examination from a provider, other than the attending provider, in accordance with subdivision 4(B) of section 13-a, subdivision 3(B) of section 13-k, subdivision 3(B) of section 13-l, or subdivision 4(B) of section 13-m of the Workers' Compensation Law, for a purpose described under paragraph (b)(4) of this section, shall be liable for all reasonable fees and costs associated with such examination. However, where a claimant can demonstrate to the satisfaction of the board that he or she made a good faith effort to obtain an opinion from his or her attending provider prior to seeking an independent medical examination for any of the purposes described under paragraph (b)(4) of this section, and that the attending provider was unable by reason of death or absence from the State, or unreasonably failed or refused to provide such opinion, the carrier shall be liable for all reasonable fees and costs associated with such examination. Where a claimant seeks an independent medical examination in accordance with subdivision 4(B) of section 13-a, subdivision 3(B) of section 13-k, subdivision 3(B) of section 13-l, or subdivision 4(B) of section 13-m of the Workers' Compensation Law, for a purpose described under paragraph (b)(4) of this section, the independent medical examiner shall inform the claimant in writing on the form prescribed by the chair for notice of such examination that the claimant may be responsible for payment of the cost of such examination, and shall state the actual fee or fee range for such examination. (3) Provision of information. An independent medical examiner may be provided with information, such as documents, reports, records, and/or test results, for review in connection with an independent medical examination or a review of records. Information provided to an independent medical examiner in connection with an independent medical examination or review of records shall be part of the official board file at the time it is provided to the independent medical examiner or his or her office so it is available to all parties. If the party requesting the examination wants to provide information to the independent medical examiner that is not part of the official board file, it shall submit the information to the board for inclusion in the official file on the same day the information is first sent to the independent medical examiner or IME entity. The party requesting the examination or review of records may provide the information to an IME entity and such entity may then provide the information to the independent medical examiner who conducts the independent medical examination or review of records. (4) Reports. (i) The independent medical examiner shall prepare a complete and accurate report following an independent medical examination or review of records that at least shall contain: (a) a description of the examination, if conducted; (b) a list of all of the information, such as documents, reports, records, and/or test results, received and reviewed in preparation for the independent medical examination the report of such exam or the review of records; (c) any test films or results, or other medical information provided by the claimant at the time of the independent medical examination that is related to the condition that is the subject of the independent medical examination; (d) the independent medical examiner's professional opinion; and (e) a signed statement certifying:(1) that the report is a full and truthful representation of the independent medical examiner's professional opinion with respect to the claimant's condition in accordance with Workers' Compensation Law section 13-a (4)(e)(i), 13-k (3)(e)(i), 13-l(3)(e)(i) or 13-m (4)(e)(i), as appropriate; (2) that no person or entity has caused, directed or encouraged the independent medical examiner to submit a report that differs substantially from the professional opinion of the independent medical examiner; and (3) that the independent medical examiner has reviewed the report and attests to its accuracy. (ii) A report that does not bear the signed certification required in subparagraph (ii) of this paragraph shall not be sufficient to meet the requirements of Workers' Compensation Law section 137 or this section, and shall not be admissible as evidence in a workers' compensation proceeding. The signed certification shall contain an original signature of the independent medical examiner made by such examiner after reviewing the report and shall not be a stamp or other method of reproducing a signature. An electronic signature, as that term is defined in State Technology Law section 302(3) and that is affixed remotely by the independent medical examiner, may be used if its use complies with State Technology Law section 304 and section 540.4 of Title 9. (iii) The independent medical examiner shall provide copies of the report of an independent medical examination as required under Workers' Compensation Law section 137(1)(a) together with any questionnaires or intake sheets completed by the claimant at the request of the independent medical examiner by filing such report and questionnaire with the form prescribed by the chair for such purpose with the board and providing copies of such form to the insurance carrier, the claimant's attending physician(s) or other primary attending practitioner(s), the claimant's attorney or licensed representative, and the claimant. Only the form specifically prescribed by the chair for the reports of independent medical examinations shall be filed. The form prescribed by the chair pursuant to paragraph (5) of this subdivision to submit a request for information or a response to such a request shall not be used for the reports of independent medical examinations. When a claimant treats with more than one attending physician or practitioner, the independent medical examiner shall provide a copy of the report of the independent medical examination to any attending physician or practitioner who has treated the claimant in the past six months for the condition that is the subject of the independent medical examination. If no provider has treated the claimant in the last six months, the report should be sent to the provider who last treated the claimant. A provider who has examined the claimant solely for the purpose of consultation or diagnostic examination or test is not an attending physician or other attending practitioner within the meaning of this section and section 137 of the Workers' Compensation Law. All such reports shall be sent on the same day and in the same manner as required by Workers' Compensation Law section 137(1)(a). (iv) Copies of written reports of medical experts, made on behalf of any party without physical examination of the claimant (a review of records), to be used for reference at a hearing, must be filed with the board and submitted to all other parties or their representatives, if any, three business days prior to the hearing. (5) Request for information and response. Requests for information and responses to such requests shall be provided as required under Workers' Compensation Law section 137(1)(b) and (c) and paragraph (b)(11) of this section. Such requests and responses to such requests should be provided on or attached to the form prescribed by the chair for such purpose. The failure to provide such requests or responses to such requests by the independent medical examiner in accordance with Workers' Compensation Law section 137 and this section shall be considered in determining whether the report of any related independent medical examination substantially complies with Workers' Compensation Law section 137 and this section. (6) Reports filed by an IME entity. An independent medical examiner may retain the administrative services of an IME entity. Such IME entity may provide administrative support to the independent medical examiner, including but not limited to those responsibilities described in subdivisions (1) and (7) of Workers' Compensation Law section 137, under the following circumstances: (i) the IME entity retained shall be duly registered and in full compliance with Workers' Compensation Law section 13-n and this section; (ii) the IME entity retained, in addition to the examiner, shall be responsible for the work of any subcontractors performing ancillary services for the examiner and the IME entity. These services may include, but are not limited to, translation and transcription services. The examiner or IME entity may not retain the services of an organization that is not licensed as an IME entity to perform functions central to the examination such as identifying and retaining the services of an examiner, scheduling of the examination, mailing of the report of independent medical examination and any related notices or board forms, and negotiation of payment for the examination; (iii) the independent medical examiner is solely responsible for the content and certification of the written report and for ensuring that the written report is distributed in compliance with Workers' Compensation Law section 137 and these regulations; (iv) the signed certification on the written report shall be an original signature of the independent medical examiner made by the examiner after reviewing the report and shall not be a stamp or other method of reproducing a signature, except that it may be an electronic signature as provided in paragraph (4) of this subdivision; (v) the content of the written report may not be derived by the independent medical examiner completing a checklist or circling or checking or otherwise marking provisions on a form, letter or any other writing or document prepared by another individual or entity; (vi) such IME entity, or any officer, servant, or employee of such IME entity, may not cause, direct or encourage the independent medical examiner to submit a report that differs substantially from the professional opinion of the independent medical examiner; (vii) the IME entity and independent medical examiner do not engage in the splitting of fees in violation of Workers' Compensation Law section 13-d(2)(g), 13-k(10)(g), 13-l(10)(g), or 13-m(11)(g) and Education Law section 6530(18) and (19); (viii) the IME entity shall act on behalf of and at the convenience of the independent medical examiner and may not require that an independent medical examiner use any or all of its services nor may an insurance carrier or third party administrator require that an independent medical examiner use a particular IME entity; and (ix) the IME entity shall disclose in writing to the board if it is owned by, shares common ownership with, owns or is affiliated with the insurance carrier, as defined in section 300.1(a)(7) of this Part, or third party administrator, as defined in section 300.1(a)(10) of this Part, that requested the independent medical examination or review of records. The notice required by subparagraph (ix) of this paragraph shall include the name of the IME entity, the name of claimant who underwent the independent medical examination or review of records, the name of the insurance carrier or third party administrator and whether the IME entity is owned by, shares common ownership with, owns or is affiliated with the insurance carrier or third party administrator. (7) Conduct at examination. The claimant or the examiner may videotape or otherwise record the examination. An independent medical examiner may not refuse to conduct an independent medical examination because the claimant intends to videotape or otherwise record such examination when the claimant has appeared for such examination as scheduled. The claimant and the independent medical examiner and their agents shall not alter or misrepresent the content of the recording and shall not distribute publicly the recording beyond its use in a hearing of the board. The claimant may be accompanied to the examination by an individual or individuals of his or her own choosing. However, neither the examiner nor the claimant may disrupt or interfere with the examination by such recording or as a result of the presence to such companion or companions. the claimant may be accompanied to the examination by an individual or individuals of his or her own choosing. However, neither the examiner nor the claimant may disrupt or interfere with the examination by such recording or as a result of the presence of such companion or companions. (8) Relationship between examiner and claimant. The independent medical examiner shall not provide treatment to the claimant, shall not be a partner, member, or employee of the claimant's attending physician's or practitioner's practice, and only a limited patient-physician or patient-provider relationship is established by conducting an independent medical examination in accordance with Workers' Compensation Law section 13-a, 13-k, 13-l, or 13-m or this section. The limited patient-physician or patient-provider relationship established requires the physician or provider to administer an objective medical evaluation but not to monitor claimants' work related injury or illness over time, treat claimants, or fulfill the other duties traditionally held by attending physicians or providers. However, all laws and regulations governing the confidentiality of medical records and workers' compensation records shall apply to records of an independent medical examination or review of records. Notwithstanding the limitations set forth under Workers' Compensation Law section 137(9), an independent medical examiner who has evaluated a claimant at the request of the employer, carrier or claimant may conduct a subsequent independent medical examination of the claimant for the same injury or illness. (9) Regular business hours. Independent medical examinations shall be conducted between the hours of 8:00 a.m. and 6:00 p.m., Monday through Friday except that they shall not be conducted on official and officially recognized religious holidays. An examination may be scheduled outside of regular business hours only with the consent and for the convenience of the claimant. (10) Unreasonable burden. Where an insurance carrier, third party administrator or claimant finds that it would place an unreasonable burden to arrange for an independent medical examination or review of records, or to attend an independent medical examination by an authorized examiner, the employer, carrier or claimant shall arrange for such examination or review of records to be performed by a qualified provider. Upon request by the board, the person or entity requesting such examination or review of records by a qualified provider must demonstrate the existence of the unreasonable burden to the satisfaction of the board. Where a person or entity is unable to demonstrate to the satisfaction of the board that an unreasonable burden existed which required the examination or review of records to be conducted by a qualified provider rather than an authorized examiner, the report based upon such examination or review of records by a qualified provider shall not be admissible as evidence in a workers' compensation proceeding. (11) Ability of claimant to appear. The physical capability of a claimant to present himself or herself for examination, and the observations of the examiner in relation to the claimant's ability to present for such examination shall not constitute dispositive evidence in determining a claimant's disability, degree of disability or eligibility for compensation or benefits under the Workers' Compensation Law. However, refusal by the claimant to submit to an independent medical examination requested by an employer or carrier in accordance with subdivision 4(B) of section 13-a, subdivision 3(B) of section 13-k, subdivision 3(B) of section 13-l, or subdivision 4(B) of section 13-m of the Workers' Compensation Law, for a purpose described under paragraph (b)(4) of this section, shall bar the claimant from recovering compensation for any period during which he or she has refused to submit to such examination. (12) No waiver of claimant's rights. Except as otherwise provided, a claimant may not waive any of the rights provided under Workers' Compensation Law section 137 in relation to independent medical examinations. A report of an examination that does not substantially comply with the requirements of Workers' Compensation Law section 137 and this section, shall not be admissible as evidence for any of the purposes described in paragraph (b)(4) of this section in a workers' compensation proceeding, unless the party raising an objection to the admissibility of the report does not raise such objection in a timely manner. Except for a waiver that is expressly authorized by the Workers' Compensation Law or this section or by a Workers' Compensation Law judge, and is knowingly executed by the claimant, no agreement between an employee and employer, or employee and carrier shall be binding upon the board; nor shall any such agreement in any way excuse compliance with said section 137 or this section. In no event shall a collective bargaining agreement be binding upon the board or excuse compliance with respect to said section 137 or this section; nor shall a claimant be required or permitted to waive any of the requirements of section 137 or this section pursuant to such agreement. (13) Selection of examiners in a P.P.O. Notwithstanding any provision to the contrary: (i) an employer retains its right as permitted under section 354 of the Workers' Compensation Law and 10 NYCRR 732-2.2(k)(2) to require a second opinion from a provider within a P.P.O. in the event that an employee seeks medical treatment outside the P.P.O.; and (ii) a claimant retains his or her right as permitted under 10 NYCRR 732-2.2(g) to access a second opinion from a provider within a P.P.O. where the claimant has previously been evaluated or treated by another provider within the P.P.O. (14) A written report of an independent medical examination, duly sworn to, shall be filed with the board, and copies thereof furnished to all parties as may be required under the Workers' Compensation Law, within 10 business days after the independent medical examination, or sooner if directed, except that in cases of persons examined outside the State, such reports shall be filed and furnished within 20 business days after the independent medical examination. A written report is filed with the board when it has been received by the board pursuant to the requirements of the Workers' Compensation Law. (15) Copies of written reports of medical experts, made on behalf of any party without physician examination of the claimant, to be used for reference at a hearing, must be furnished to the referee and to all other parties or their representatives, if any, prior to that hearing.

(1) Notice. The claimant shall receive notice of the scheduled independent medical examination at least seven business days prior to the date of such examination. The notice shall be printed on the form prescribed by the chair for such purpose, which shall include all information required thereon, as set forth under Workers' Compensation Law, section 137. A copy of such notice shall be sent to the board on the same day it is sent to the claimant. Where the claimant asserts that notice of the examination was not received at least seven business days prior to the date of the examination and upon request by the board, the party scheduling such examination shall provide proof in the form of an affidavit, or a business record that meets requirements for admissibility under Civil Practice Law and Rules Rule 4518 that the notice was posted by United States mail at least 12 business days prior to the date of the examination or deposited into the custody of an overnight delivery service for overnight delivery, prior to the latest time designated by the overnight delivery service for overnight delivery at least eight business days prior to the date of the examination. In the event that an independent medical examination is required for the purpose of determining authorization for special services for specialist consultations, surgery, physical or occupational therapy, imaging studies or special diagnostic or laboratory tests in accordance with Workers' Compensation Law section 13-a(5), and a delay in authorization for such special services would result in a worsening of the claimant's condition or irreparable harm, and the examination can be scheduled less than 12 business days from the date of the request for the examination, the claimant may, by written consent waive the requirement of seven business days' notice of the examination. However, in case of such a waiver by the claimant of seven business days' notice of the examination, for purposes of scheduling an examination for authorization of such special services, a notice of the examination must be sent to the claimant as soon as possible after the scheduling of the examination in the same manner as otherwise required for notices of examinations under Workers' Compensation Law section 137 and this Part. In no event may the right to such notice be waived pursuant to an employment agreement or a collective bargaining agreement. If a claimant requests that an examination be rescheduled, and the examination is rescheduled less than seven business days after the request, the notice required under section 137 need not be received seven business days prior to the examination, but must be sent to the claimant as soon as possible in the same manner as required for the original notice under said section and this section. A copy of such notice shall be sent to the board on the same day it is sent to the claimant. Upon request by the Board, the party scheduling such examination shall provide proof in the form of an affidavit, or a business record that meets the requirements for admissibility under Civil Practice Law and Rules Rule 4518 that the notice was mailed as soon as possible.

(2) Examination requested by claimant. A party requesting an independent medical examination from a provider, other than the attending provider, in accordance with subdivision 4(B) of section 13-a, subdivision 3(B) of section 13-k, subdivision 3(B) of section 13-l, or subdivision 4(B) of section 13-m of the Workers' Compensation Law, for a purpose described under paragraph (b)(4) of this section, shall be liable for all reasonable fees and costs associated with such examination. However, where a claimant can demonstrate to the satisfaction of the board that he or she made a good faith effort to obtain an opinion from his or her attending provider prior to seeking an independent medical examination for any of the purposes described under paragraph (b)(4) of this section, and that the attending provider was unable by reason of death or absence from the State, or unreasonably failed or refused to provide such opinion, the carrier shall be liable for all reasonable fees and costs associated with such examination. Where a claimant seeks an independent medical examination in accordance with subdivision 4(B) of section 13-a, subdivision 3(B) of section 13-k, subdivision 3(B) of section 13-l, or subdivision 4(B) of section 13-m of the Workers' Compensation Law, for a purpose described under paragraph (b)(4) of this section, the independent medical examiner shall inform the claimant in writing on the form prescribed by the chair for notice of such examination that the claimant may be responsible for payment of the cost of such examination, and shall state the actual fee or fee range for such examination.

(3) Provision of information. An independent medical examiner may be provided with information, such as documents, reports, records, and/or test results, for review in connection with an independent medical examination or a review of records. Information provided to an independent medical examiner in connection with an independent medical examination or review of records shall be part of the official board file at the time it is provided to the independent medical examiner or his or her office so it is available to all parties. If the party requesting the examination wants to provide information to the independent medical examiner that is not part of the official board file, it shall submit the information to the board for inclusion in the official file on the same day the information is first sent to the independent medical examiner or IME entity. The party requesting the examination or review of records may provide the information to an IME entity and such entity may then provide the information to the independent medical examiner who conducts the independent medical examination or review of records.

(4) Reports. (i) The independent medical examiner shall prepare a complete and accurate report following an independent medical examination or review of records that at least shall contain: (a) a description of the examination, if conducted; (b) a list of all of the information, such as documents, reports, records, and/or test results, received and reviewed in preparation for the independent medical examination the report of such exam or the review of records; (c) any test films or results, or other medical information provided by the claimant at the time of the independent medical examination that is related to the condition that is the subject of the independent medical examination; (d) the independent medical examiner's professional opinion; and (e) a signed statement certifying:(1) that the report is a full and truthful representation of the independent medical examiner's professional opinion with respect to the claimant's condition in accordance with Workers' Compensation Law section 13-a (4)(e)(i), 13-k (3)(e)(i), 13-l(3)(e)(i) or 13-m (4)(e)(i), as appropriate; (2) that no person or entity has caused, directed or encouraged the independent medical examiner to submit a report that differs substantially from the professional opinion of the independent medical examiner; and (3) that the independent medical examiner has reviewed the report and attests to its accuracy. (ii) A report that does not bear the signed certification required in subparagraph (ii) of this paragraph shall not be sufficient to meet the requirements of Workers' Compensation Law section 137 or this section, and shall not be admissible as evidence in a workers' compensation proceeding. The signed certification shall contain an original signature of the independent medical examiner made by such examiner after reviewing the report and shall not be a stamp or other method of reproducing a signature. An electronic signature, as that term is defined in State Technology Law section 302(3) and that is affixed remotely by the independent medical examiner, may be used if its use complies with State Technology Law section 304 and section 540.4 of Title 9. (iii) The independent medical examiner shall provide copies of the report of an independent medical examination as required under Workers' Compensation Law section 137(1)(a) together with any questionnaires or intake sheets completed by the claimant at the request of the independent medical examiner by filing such report and questionnaire with the form prescribed by the chair for such purpose with the board and providing copies of such form to the insurance carrier, the claimant's attending physician(s) or other primary attending practitioner(s), the claimant's attorney or licensed representative, and the claimant. Only the form specifically prescribed by the chair for the reports of independent medical examinations shall be filed. The form prescribed by the chair pursuant to paragraph (5) of this subdivision to submit a request for information or a response to such a request shall not be used for the reports of independent medical examinations. When a claimant treats with more than one attending physician or practitioner, the independent medical examiner shall provide a copy of the report of the independent medical examination to any attending physician or practitioner who has treated the claimant in the past six months for the condition that is the subject of the independent medical examination. If no provider has treated the claimant in the last six months, the report should be sent to the provider who last treated the claimant. A provider who has examined the claimant solely for the purpose of consultation or diagnostic examination or test is not an attending physician or other attending practitioner within the meaning of this section and section 137 of the Workers' Compensation Law. All such reports shall be sent on the same day and in the same manner as required by Workers' Compensation Law section 137(1)(a). (iv) Copies of written reports of medical experts, made on behalf of any party without physical examination of the claimant (a review of records), to be used for reference at a hearing, must be filed with the board and submitted to all other parties or their representatives, if any, three business days prior to the hearing.

(i) The independent medical examiner shall prepare a complete and accurate report following an independent medical examination or review of records that at least shall contain: (a) a description of the examination, if conducted; (b) a list of all of the information, such as documents, reports, records, and/or test results, received and reviewed in preparation for the independent medical examination the report of such exam or the review of records; (c) any test films or results, or other medical information provided by the claimant at the time of the independent medical examination that is related to the condition that is the subject of the independent medical examination; (d) the independent medical examiner's professional opinion; and (e) a signed statement certifying:(1) that the report is a full and truthful representation of the independent medical examiner's professional opinion with respect to the claimant's condition in accordance with Workers' Compensation Law section 13-a (4)(e)(i), 13-k (3)(e)(i), 13-l(3)(e)(i) or 13-m (4)(e)(i), as appropriate; (2) that no person or entity has caused, directed or encouraged the independent medical examiner to submit a report that differs substantially from the professional opinion of the independent medical examiner; and (3) that the independent medical examiner has reviewed the report and attests to its accuracy.

(a) a description of the examination, if conducted;

(b) a list of all of the information, such as documents, reports, records, and/or test results, received and reviewed in preparation for the independent medical examination the report of such exam or the review of records;

(c) any test films or results, or other medical information provided by the claimant at the time of the independent medical examination that is related to the condition that is the subject of the independent medical examination;

(d) the independent medical examiner's professional opinion; and

(e) a signed statement certifying:(1) that the report is a full and truthful representation of the independent medical examiner's professional opinion with respect to the claimant's condition in accordance with Workers' Compensation Law section 13-a (4)(e)(i), 13-k (3)(e)(i), 13-l(3)(e)(i) or 13-m (4)(e)(i), as appropriate; (2) that no person or entity has caused, directed or encouraged the independent medical examiner to submit a report that differs substantially from the professional opinion of the independent medical examiner; and (3) that the independent medical examiner has reviewed the report and attests to its accuracy.

(1) that the report is a full and truthful representation of the independent medical examiner's professional opinion with respect to the claimant's condition in accordance with Workers' Compensation Law section 13-a (4)(e)(i), 13-k (3)(e)(i), 13-l(3)(e)(i) or 13-m (4)(e)(i), as appropriate;

(2) that no person or entity has caused, directed or encouraged the independent medical examiner to submit a report that differs substantially from the professional opinion of the independent medical examiner; and

(3) that the independent medical examiner has reviewed the report and attests to its accuracy.

(ii) A report that does not bear the signed certification required in subparagraph (ii) of this paragraph shall not be sufficient to meet the requirements of Workers' Compensation Law section 137 or this section, and shall not be admissible as evidence in a workers' compensation proceeding. The signed certification shall contain an original signature of the independent medical examiner made by such examiner after reviewing the report and shall not be a stamp or other method of reproducing a signature. An electronic signature, as that term is defined in State Technology Law section 302(3) and that is affixed remotely by the independent medical examiner, may be used if its use complies with State Technology Law section 304 and section 540.4 of Title 9.

(iii) The independent medical examiner shall provide copies of the report of an independent medical examination as required under Workers' Compensation Law section 137(1)(a) together with any questionnaires or intake sheets completed by the claimant at the request of the independent medical examiner by filing such report and questionnaire with the form prescribed by the chair for such purpose with the board and providing copies of such form to the insurance carrier, the claimant's attending physician(s) or other primary attending practitioner(s), the claimant's attorney or licensed representative, and the claimant. Only the form specifically prescribed by the chair for the reports of independent medical examinations shall be filed. The form prescribed by the chair pursuant to paragraph (5) of this subdivision to submit a request for information or a response to such a request shall not be used for the reports of independent medical examinations. When a claimant treats with more than one attending physician or practitioner, the independent medical examiner shall provide a copy of the report of the independent medical examination to any attending physician or practitioner who has treated the claimant in the past six months for the condition that is the subject of the independent medical examination. If no provider has treated the claimant in the last six months, the report should be sent to the provider who last treated the claimant. A provider who has examined the claimant solely for the purpose of consultation or diagnostic examination or test is not an attending physician or other attending practitioner within the meaning of this section and section 137 of the Workers' Compensation Law. All such reports shall be sent on the same day and in the same manner as required by Workers' Compensation Law section 137(1)(a).

(iv) Copies of written reports of medical experts, made on behalf of any party without physical examination of the claimant (a review of records), to be used for reference at a hearing, must be filed with the board and submitted to all other parties or their representatives, if any, three business days prior to the hearing.

(5) Request for information and response. Requests for information and responses to such requests shall be provided as required under Workers' Compensation Law section 137(1)(b) and (c) and paragraph (b)(11) of this section. Such requests and responses to such requests should be provided on or attached to the form prescribed by the chair for such purpose. The failure to provide such requests or responses to such requests by the independent medical examiner in accordance with Workers' Compensation Law section 137 and this section shall be considered in determining whether the report of any related independent medical examination substantially complies with Workers' Compensation Law section 137 and this section.

(6) Reports filed by an IME entity. An independent medical examiner may retain the administrative services of an IME entity. Such IME entity may provide administrative support to the independent medical examiner, including but not limited to those responsibilities described in subdivisions (1) and (7) of Workers' Compensation Law section 137, under the following circumstances: (i) the IME entity retained shall be duly registered and in full compliance with Workers' Compensation Law section 13-n and this section; (ii) the IME entity retained, in addition to the examiner, shall be responsible for the work of any subcontractors performing ancillary services for the examiner and the IME entity. These services may include, but are not limited to, translation and transcription services. The examiner or IME entity may not retain the services of an organization that is not licensed as an IME entity to perform functions central to the examination such as identifying and retaining the services of an examiner, scheduling of the examination, mailing of the report of independent medical examination and any related notices or board forms, and negotiation of payment for the examination; (iii) the independent medical examiner is solely responsible for the content and certification of the written report and for ensuring that the written report is distributed in compliance with Workers' Compensation Law section 137 and these regulations; (iv) the signed certification on the written report shall be an original signature of the independent medical examiner made by the examiner after reviewing the report and shall not be a stamp or other method of reproducing a signature, except that it may be an electronic signature as provided in paragraph (4) of this subdivision; (v) the content of the written report may not be derived by the independent medical examiner completing a checklist or circling or checking or otherwise marking provisions on a form, letter or any other writing or document prepared by another individual or entity; (vi) such IME entity, or any officer, servant, or employee of such IME entity, may not cause, direct or encourage the independent medical examiner to submit a report that differs substantially from the professional opinion of the independent medical examiner; (vii) the IME entity and independent medical examiner do not engage in the splitting of fees in violation of Workers' Compensation Law section 13-d(2)(g), 13-k(10)(g), 13-l(10)(g), or 13-m(11)(g) and Education Law section 6530(18) and (19); (viii) the IME entity shall act on behalf of and at the convenience of the independent medical examiner and may not require that an independent medical examiner use any or all of its services nor may an insurance carrier or third party administrator require that an independent medical examiner use a particular IME entity; and (ix) the IME entity shall disclose in writing to the board if it is owned by, shares common ownership with, owns or is affiliated with the insurance carrier, as defined in section 300.1(a)(7) of this Part, or third party administrator, as defined in section 300.1(a)(10) of this Part, that requested the independent medical examination or review of records. The notice required by subparagraph (ix) of this paragraph shall include the name of the IME entity, the name of claimant who underwent the independent medical examination or review of records, the name of the insurance carrier or third party administrator and whether the IME entity is owned by, shares common ownership with, owns or is affiliated with the insurance carrier or third party administrator.

(i) the IME entity retained shall be duly registered and in full compliance with Workers' Compensation Law section 13-n and this section;

(ii) the IME entity retained, in addition to the examiner, shall be responsible for the work of any subcontractors performing ancillary services for the examiner and the IME entity. These services may include, but are not limited to, translation and transcription services. The examiner or IME entity may not retain the services of an organization that is not licensed as an IME entity to perform functions central to the examination such as identifying and retaining the services of an examiner, scheduling of the examination, mailing of the report of independent medical examination and any related notices or board forms, and negotiation of payment for the examination;

(iii) the independent medical examiner is solely responsible for the content and certification of the written report and for ensuring that the written report is distributed in compliance with Workers' Compensation Law section 137 and these regulations;

(iv) the signed certification on the written report shall be an original signature of the independent medical examiner made by the examiner after reviewing the report and shall not be a stamp or other method of reproducing a signature, except that it may be an electronic signature as provided in paragraph (4) of this subdivision;

(v) the content of the written report may not be derived by the independent medical examiner completing a checklist or circling or checking or otherwise marking provisions on a form, letter or any other writing or document prepared by another individual or entity;

(vi) such IME entity, or any officer, servant, or employee of such IME entity, may not cause, direct or encourage the independent medical examiner to submit a report that differs substantially from the professional opinion of the independent medical examiner;

(vii) the IME entity and independent medical examiner do not engage in the splitting of fees in violation of Workers' Compensation Law section 13-d(2)(g), 13-k(10)(g), 13-l(10)(g), or 13-m(11)(g) and Education Law section 6530(18) and (19);

(viii) the IME entity shall act on behalf of and at the convenience of the independent medical examiner and may not require that an independent medical examiner use any or all of its services nor may an insurance carrier or third party administrator require that an independent medical examiner use a particular IME entity; and

(ix) the IME entity shall disclose in writing to the board if it is owned by, shares common ownership with, owns or is affiliated with the insurance carrier, as defined in section 300.1(a)(7) of this Part, or third party administrator, as defined in section 300.1(a)(10) of this Part, that requested the independent medical examination or review of records. The notice required by subparagraph (ix) of this paragraph shall include the name of the IME entity, the name of claimant who underwent the independent medical examination or review of records, the name of the insurance carrier or third party administrator and whether the IME entity is owned by, shares common ownership with, owns or is affiliated with the insurance carrier or third party administrator.

(7) Conduct at examination. The claimant or the examiner may videotape or otherwise record the examination. An independent medical examiner may not refuse to conduct an independent medical examination because the claimant intends to videotape or otherwise record such examination when the claimant has appeared for such examination as scheduled. The claimant and the independent medical examiner and their agents shall not alter or misrepresent the content of the recording and shall not distribute publicly the recording beyond its use in a hearing of the board. The claimant may be accompanied to the examination by an individual or individuals of his or her own choosing. However, neither the examiner nor the claimant may disrupt or interfere with the examination by such recording or as a result of the presence to such companion or companions. the claimant may be accompanied to the examination by an individual or individuals of his or her own choosing. However, neither the examiner nor the claimant may disrupt or interfere with the examination by such recording or as a result of the presence of such companion or companions.

(8) Relationship between examiner and claimant. The independent medical examiner shall not provide treatment to the claimant, shall not be a partner, member, or employee of the claimant's attending physician's or practitioner's practice, and only a limited patient-physician or patient-provider relationship is established by conducting an independent medical examination in accordance with Workers' Compensation Law section 13-a, 13-k, 13-l, or 13-m or this section. The limited patient-physician or patient-provider relationship established requires the physician or provider to administer an objective medical evaluation but not to monitor claimants' work related injury or illness over time, treat claimants, or fulfill the other duties traditionally held by attending physicians or providers. However, all laws and regulations governing the confidentiality of medical records and workers' compensation records shall apply to records of an independent medical examination or review of records. Notwithstanding the limitations set forth under Workers' Compensation Law section 137(9), an independent medical examiner who has evaluated a claimant at the request of the employer, carrier or claimant may conduct a subsequent independent medical examination of the claimant for the same injury or illness.

(9) Regular business hours. Independent medical examinations shall be conducted between the hours of 8:00 a.m. and 6:00 p.m., Monday through Friday except that they shall not be conducted on official and officially recognized religious holidays. An examination may be scheduled outside of regular business hours only with the consent and for the convenience of the claimant.

(10) Unreasonable burden. Where an insurance carrier, third party administrator or claimant finds that it would place an unreasonable burden to arrange for an independent medical examination or review of records, or to attend an independent medical examination by an authorized examiner, the employer, carrier or claimant shall arrange for such examination or review of records to be performed by a qualified provider. Upon request by the board, the person or entity requesting such examination or review of records by a qualified provider must demonstrate the existence of the unreasonable burden to the satisfaction of the board. Where a person or entity is unable to demonstrate to the satisfaction of the board that an unreasonable burden existed which required the examination or review of records to be conducted by a qualified provider rather than an authorized examiner, the report based upon such examination or review of records by a qualified provider shall not be admissible as evidence in a workers' compensation proceeding.

(11) Ability of claimant to appear. The physical capability of a claimant to present himself or herself for examination, and the observations of the examiner in relation to the claimant's ability to present for such examination shall not constitute dispositive evidence in determining a claimant's disability, degree of disability or eligibility for compensation or benefits under the Workers' Compensation Law. However, refusal by the claimant to submit to an independent medical examination requested by an employer or carrier in accordance with subdivision 4(B) of section 13-a, subdivision 3(B) of section 13-k, subdivision 3(B) of section 13-l, or subdivision 4(B) of section 13-m of the Workers' Compensation Law, for a purpose described under paragraph (b)(4) of this section, shall bar the claimant from recovering compensation for any period during which he or she has refused to submit to such examination.

(12) No waiver of claimant's rights. Except as otherwise provided, a claimant may not waive any of the rights provided under Workers' Compensation Law section 137 in relation to independent medical examinations. A report of an examination that does not substantially comply with the requirements of Workers' Compensation Law section 137 and this section, shall not be admissible as evidence for any of the purposes described in paragraph (b)(4) of this section in a workers' compensation proceeding, unless the party raising an objection to the admissibility of the report does not raise such objection in a timely manner. Except for a waiver that is expressly authorized by the Workers' Compensation Law or this section or by a Workers' Compensation Law judge, and is knowingly executed by the claimant, no agreement between an employee and employer, or employee and carrier shall be binding upon the board; nor shall any such agreement in any way excuse compliance with said section 137 or this section. In no event shall a collective bargaining agreement be binding upon the board or excuse compliance with respect to said section 137 or this section; nor shall a claimant be required or permitted to waive any of the requirements of section 137 or this section pursuant to such agreement.

(13) Selection of examiners in a P.P.O. Notwithstanding any provision to the contrary: (i) an employer retains its right as permitted under section 354 of the Workers' Compensation Law and 10 NYCRR 732-2.2(k)(2) to require a second opinion from a provider within a P.P.O. in the event that an employee seeks medical treatment outside the P.P.O.; and (ii) a claimant retains his or her right as permitted under 10 NYCRR 732-2.2(g) to access a second opinion from a provider within a P.P.O. where the claimant has previously been evaluated or treated by another provider within the P.P.O.

(i) an employer retains its right as permitted under section 354 of the Workers' Compensation Law and 10 NYCRR 732-2.2(k)(2) to require a second opinion from a provider within a P.P.O. in the event that an employee seeks medical treatment outside the P.P.O.; and

(ii) a claimant retains his or her right as permitted under 10 NYCRR 732-2.2(g) to access a second opinion from a provider within a P.P.O. where the claimant has previously been evaluated or treated by another provider within the P.P.O.

(14) A written report of an independent medical examination, duly sworn to, shall be filed with the board, and copies thereof furnished to all parties as may be required under the Workers' Compensation Law, within 10 business days after the independent medical examination, or sooner if directed, except that in cases of persons examined outside the State, such reports shall be filed and furnished within 20 business days after the independent medical examination. A written report is filed with the board when it has been received by the board pursuant to the requirements of the Workers' Compensation Law.

(15) Copies of written reports of medical experts, made on behalf of any party without physician examination of the claimant, to be used for reference at a hearing, must be furnished to the referee and to all other parties or their representatives, if any, prior to that hearing.

(e) Registration of entities. (1) Mandatory registration. (i) Any entity that derives income from independent medical examinations performed in accordance with Workers' Compensation Law sections 13-a, 13-k, 13- l or 13-m and 137 or review of records, whether by employing or contracting with independent medical examiners or by contracting with insurance carriers, third party administrators, the Uninsured Employers' Fund or Reopened Case Fund or by acting as a referral service by arranging or otherwise facilitating or providing administrative services for such examinations or review of records, shall register with the chair by filing the following requested documents. Such entity shall meet the definition of IME entity. (ii) The IME entity shall provide the following information: (a) the name or names under which it is registered with the Department of State and a copy of the organizational documents for the entity, such as articles of incorporation or articles of organization; (b) the name or names under which it conducts business; (c) the address or addresses of its administrative office and each of the offices where it conducts any business; (d) the telephone numbers of each business location; (e) the entity's tax identification number; (f) the name, title and telephone number of the contact person for the entity; (g) the names, addresses and telephone numbers of each of the entity organization's officers, owners, or partners, identify if any of the officers, owners, or partners have been convicted of any criminal offenses and if so, detailed information about such conviction, and certify under penalties of perjury that all such officers, owners, or partners are of good moral character; (h) the name or names and address or addresses of all organizations that are affiliated with, share common ownership with, own or are owned by the IME entity, including but not limited to other entities required to register pursuant to Workers' Compensation Law section 13-n, insurance carriers as defined in section 300.1(a)(7) of this Part, or third party administrators as defined in section 300.1(a)(10) of this Part; (i) a statement as to whether the IME entity subcontracts or contracts with an organization that is not a registered IME entity to perform any ancillary services related to independent medical examinations or review of records, and if the IME entity does so subcontract or contract, the IME entity shall provide a statement that such ancillary services performed by a subcontractor do not require registration as an IME entity as they are not functions central to the examination or review of records such as identifying and retaining the services of an examiner, scheduling of the examination, mailing of the report of independent medical examination or review of records and any related notices or board forms, and negotiation of payment for the examination or review of records; (j) description of the services provided by the IME entity and its employees or independent contractors; (k) a description of the relationship between the IME entity and its owners, officers or partners and the independent medical examiners it employs or with whom it contacts to conduct independent medical examinations and reviews of records; (l) the affirmation as set forth in paragraph (2) of this section; and (m) such other information as the chair finds to be necessary and relevant. (iii) The chair may audit any contract between a carrier and an IME entity or examiner, or any contract between an IME entity and an examiner or subcontractor, to ensure compliance with this section and sections 13-n and 137 of the Workers' Compensation Law. (iv) If there are any material changes to the information supplied in clause (a), (b), (c), (d), (e) or (f) of subparagraph (i) of this paragraph, the IME entity shall notify the chair in writing within 30 business days that the information has changed and provide the updated information. The IME entity shall notify the chair in writing by March 31st of each year of any material changes to the information supplied in subclause (g), (h), (i), (j), (k) (l) (m), (n) or (o) of subparagraph (i) of this paragraph. (v) Entities must register every three years by submitting the form required in subparagraph (1) of this paragraph and paying the registration fee set forth in paragraph (5) of this subdivision. (2) Compliance with laws. An officer of each such entity registering with the chair shall affirm under penalty of perjury upon registration that the entity is organized under the laws of New York State or in the state in which it was incorporated in a corporate form that is recognized by the laws of the State of New York, is duly registered with the Department of State, and is in full compliance with the laws of the State of New York, its state of incorporation if outside New York, and the United States, including but not limited to any laws or regulations under the Public Health Law, the Education Law and the Workers' Compensation Law governing the practice of medicine, podiatry, chiropractic and psychology, treatment of injured or ill workers, solicitation and fee-splitting, and any laws or regulations under the jurisdiction of the State Insurance Department, the Federal Centers for Medicare and Medicaid Services, the State Department of Taxation and Finance or the Federal Internal Revenue Service. The officer shall further affirm that he or she has read or is familiar with the fee-splitting and anti-solicitation provisions of the Workers' Compensation Law under sections 13-d, 13-i, 13-k, 13-l and 13-m, and that the entity is not in violation of any such section. (3) Additional information. The chair or his or her designee reserves the right to request any and all information or documentation necessary from any IME entity for the purpose of administering and ensuring compliance with Workers' Compensation Law sections 13-a, 13-b, 13-d, 13-i, 13-k, 13-l, 13-m, 13-n, 137 and other related provisions of such law and this section. All IME entities must cooperate in any investigation and produce for review by the chair or his or her designee any relevant documents, reports or notes. (4) Acceptance of registration not a defense. The acceptance of a registration statement by the chair in accordance with Workers' Compensation Law section 13- n and these regulations shall not be construed as authorization, approval or endorsement of the registering entity, or its services, corporate organization or business practices by the chair or board, and the acceptance of a registration statement by the chair shall not be a defense to any investigation, action or proceeding by any government agency or official enforcing the laws of this State or the United States. (5) Registration fee. The registering entity shall pay a registration fee of $250 to the chair for the purpose of administering the registration and ensuring compliance of such entities in accordance with Workers' Compensation Law section 13-n. (6) Removal from list of registered IME entities. The chair or his or her designee may remove an IME entity from its list of such registered IME entities for failure to comply with Workers' Compensation Law section 13-n or 137 or this section. The following procedure shall apply to such removal: (i) Written notice. (a) The registered IME entity shall be given written notice of the proposed rescission of registration containing the following information: (1) a concise statement of the grounds or the nature of the misconduct upon which the proposed rescission of registration is based; and (2) a recitation of the statute(s), regulation(s), or order(s) allegedly violated by the registered IME entity. (b) The written notice of proposed rescission of registration may be sent in any manner that provides proof of delivery to the registered IME entity or to the registered IME entity's legal counsel, if known. (c) The written notice shall inform the registered IME entity of the opportunity to have the chair or his or her designee administratively review the proposed rescission of registration. (ii) Responses to the written notice. (a) Answer. A registered IME entity that wishes to dispute the allegations contained in the notice of proposed rescission of registration, must serve an answer to the notice of proposed rescission. (1) The registered IME entity must serve any answer to the notice of proposed rescission on the board within twenty days of receipt of the notice. (2) Any answer must set forth responses to the grounds or nature of the misconduct alleged, the statutes, regulations or orders allegedly violated, and any defenses. (3) Failure to provide an answer. Failure to provide an answer within twenty days will result in the allegations in the notice being deemed admitted and the registered IME entity will be prohibited from raising any defenses or any argument in opposition to the allegations set forth in the notice. If the registered IME entity does not submit an answer and request a timely administrative review, then the registered IME entity will be deemed to have waived all rights, all allegations set forth in the notice will be deemed admitted, the registered IME entity will be prohibited from raising any affirmative defenses or any arguments in opposition to the allegations set forth in the notice or from submitting any evidence in its defense, an administrative review will not be held, and the IME entity's registration will be automatically rescinded. A determination of this nature shall be deemed administratively final. (b) Voluntary resignation. At the chair's or his or her designee's discretion, a written statement may be executed at the option of the registered IME entity which affords it the opportunity to voluntarily resign as a registered IME entity without admitting or denying the allegations contained in the notice. If the registered IME entity voluntarily resigns after requesting an administrative review of the allegations, such administrative review shall not be held and will not be rescheduled. (iii) Administrative review. If the registered IME entity submits an answer and requests an administrative review of the allegations: (a) Administrative review of the registered IME entity's authorization shall be scheduled not less than thirty days from the date of receipt of the notice. The administrative review shall be held at the executive offices of the board in Albany, New York. (1) The registered IME entity shall appear with counsel at the administrative review, provide testimony, and cross-examine witnesses. The registered IME entity may also submit documents or other materials for review by the chair or his or her designee either prior to or at the administrative review itself. (2) The chair or his or her designee shall not be bound by common law or statutory rules of evidence in conducting the administrative review and may conduct such investigation or inquiry in a manner which, in his or her discretion, is appropriate, including the preparation of a record of the proceedings or the admission of non-documentary evidence. (3) The registered IME entity shall receive a written decision containing findings of fact and conclusions of law within thirty days of the conclusion of the administrative review. (iv) Notification of decision to rescind registration. After providing written notification to the registered IME entity of the registration rescission, the chair or his or her designee shall notify or direct the registered IME entity to notify any and all appropriate public or private agencies, entities or organizations that the registered IME entity's registration has been rescinded. A decision to rescind an IME entity's registration shall be administratively final. (7) Penalties for materially altering or causing a report to be materially altered. If the chair or his or her designee finds that an IME entity that derives income from independent medical examinations has materially altered an independent medical examination report, or caused such a report to be materially altered, then in addition to revoking or rescinding the registration of such IME entity through the process set forth in paragraph (6) of this subdivision, the chair or his or her designee shall:(i) refer the matter to the attorney general for prosecution; and (ii) impose a penalty not to exceed $10,000 payable to the chair. In determining the amount of the penalty, the chair or his or her designee shall consider: (a) the extent of the alteration to the report; (b) the nature of the alteration; (c) how the IME entity caused the report to be altered; and (d) the impact of the altered report on the decision of the board.

(1) Mandatory registration. (i) Any entity that derives income from independent medical examinations performed in accordance with Workers' Compensation Law sections 13-a, 13-k, 13- l or 13-m and 137 or review of records, whether by employing or contracting with independent medical examiners or by contracting with insurance carriers, third party administrators, the Uninsured Employers' Fund or Reopened Case Fund or by acting as a referral service by arranging or otherwise facilitating or providing administrative services for such examinations or review of records, shall register with the chair by filing the following requested documents. Such entity shall meet the definition of IME entity. (ii) The IME entity shall provide the following information: (a) the name or names under which it is registered with the Department of State and a copy of the organizational documents for the entity, such as articles of incorporation or articles of organization; (b) the name or names under which it conducts business; (c) the address or addresses of its administrative office and each of the offices where it conducts any business; (d) the telephone numbers of each business location; (e) the entity's tax identification number; (f) the name, title and telephone number of the contact person for the entity; (g) the names, addresses and telephone numbers of each of the entity organization's officers, owners, or partners, identify if any of the officers, owners, or partners have been convicted of any criminal offenses and if so, detailed information about such conviction, and certify under penalties of perjury that all such officers, owners, or partners are of good moral character; (h) the name or names and address or addresses of all organizations that are affiliated with, share common ownership with, own or are owned by the IME entity, including but not limited to other entities required to register pursuant to Workers' Compensation Law section 13-n, insurance carriers as defined in section 300.1(a)(7) of this Part, or third party administrators as defined in section 300.1(a)(10) of this Part; (i) a statement as to whether the IME entity subcontracts or contracts with an organization that is not a registered IME entity to perform any ancillary services related to independent medical examinations or review of records, and if the IME entity does so subcontract or contract, the IME entity shall provide a statement that such ancillary services performed by a subcontractor do not require registration as an IME entity as they are not functions central to the examination or review of records such as identifying and retaining the services of an examiner, scheduling of the examination, mailing of the report of independent medical examination or review of records and any related notices or board forms, and negotiation of payment for the examination or review of records; (j) description of the services provided by the IME entity and its employees or independent contractors; (k) a description of the relationship between the IME entity and its owners, officers or partners and the independent medical examiners it employs or with whom it contacts to conduct independent medical examinations and reviews of records; (l) the affirmation as set forth in paragraph (2) of this section; and (m) such other information as the chair finds to be necessary and relevant. (iii) The chair may audit any contract between a carrier and an IME entity or examiner, or any contract between an IME entity and an examiner or subcontractor, to ensure compliance with this section and sections 13-n and 137 of the Workers' Compensation Law. (iv) If there are any material changes to the information supplied in clause (a), (b), (c), (d), (e) or (f) of subparagraph (i) of this paragraph, the IME entity shall notify the chair in writing within 30 business days that the information has changed and provide the updated information. The IME entity shall notify the chair in writing by March 31st of each year of any material changes to the information supplied in subclause (g), (h), (i), (j), (k) (l) (m), (n) or (o) of subparagraph (i) of this paragraph. (v) Entities must register every three years by submitting the form required in subparagraph (1) of this paragraph and paying the registration fee set forth in paragraph (5) of this subdivision.

(i) Any entity that derives income from independent medical examinations performed in accordance with Workers' Compensation Law sections 13-a, 13-k, 13- l or 13-m and 137 or review of records, whether by employing or contracting with independent medical examiners or by contracting with insurance carriers, third party administrators, the Uninsured Employers' Fund or Reopened Case Fund or by acting as a referral service by arranging or otherwise facilitating or providing administrative services for such examinations or review of records, shall register with the chair by filing the following requested documents. Such entity shall meet the definition of IME entity.

(ii) The IME entity shall provide the following information: (a) the name or names under which it is registered with the Department of State and a copy of the organizational documents for the entity, such as articles of incorporation or articles of organization; (b) the name or names under which it conducts business; (c) the address or addresses of its administrative office and each of the offices where it conducts any business; (d) the telephone numbers of each business location; (e) the entity's tax identification number; (f) the name, title and telephone number of the contact person for the entity; (g) the names, addresses and telephone numbers of each of the entity organization's officers, owners, or partners, identify if any of the officers, owners, or partners have been convicted of any criminal offenses and if so, detailed information about such conviction, and certify under penalties of perjury that all such officers, owners, or partners are of good moral character; (h) the name or names and address or addresses of all organizations that are affiliated with, share common ownership with, own or are owned by the IME entity, including but not limited to other entities required to register pursuant to Workers' Compensation Law section 13-n, insurance carriers as defined in section 300.1(a)(7) of this Part, or third party administrators as defined in section 300.1(a)(10) of this Part; (i) a statement as to whether the IME entity subcontracts or contracts with an organization that is not a registered IME entity to perform any ancillary services related to independent medical examinations or review of records, and if the IME entity does so subcontract or contract, the IME entity shall provide a statement that such ancillary services performed by a subcontractor do not require registration as an IME entity as they are not functions central to the examination or review of records such as identifying and retaining the services of an examiner, scheduling of the examination, mailing of the report of independent medical examination or review of records and any related notices or board forms, and negotiation of payment for the examination or review of records; (j) description of the services provided by the IME entity and its employees or independent contractors; (k) a description of the relationship between the IME entity and its owners, officers or partners and the independent medical examiners it employs or with whom it contacts to conduct independent medical examinations and reviews of records; (l) the affirmation as set forth in paragraph (2) of this section; and (m) such other information as the chair finds to be necessary and relevant.

(a) the name or names under which it is registered with the Department of State and a copy of the organizational documents for the entity, such as articles of incorporation or articles of organization;

(b) the name or names under which it conducts business;

(c) the address or addresses of its administrative office and each of the offices where it conducts any business;

(d) the telephone numbers of each business location;

(e) the entity's tax identification number;

(f) the name, title and telephone number of the contact person for the entity;

(g) the names, addresses and telephone numbers of each of the entity organization's officers, owners, or partners, identify if any of the officers, owners, or partners have been convicted of any criminal offenses and if so, detailed information about such conviction, and certify under penalties of perjury that all such officers, owners, or partners are of good moral character;

(h) the name or names and address or addresses of all organizations that are affiliated with, share common ownership with, own or are owned by the IME entity, including but not limited to other entities required to register pursuant to Workers' Compensation Law section 13-n, insurance carriers as defined in section 300.1(a)(7) of this Part, or third party administrators as defined in section 300.1(a)(10) of this Part;

(i) a statement as to whether the IME entity subcontracts or contracts with an organization that is not a registered IME entity to perform any ancillary services related to independent medical examinations or review of records, and if the IME entity does so subcontract or contract, the IME entity shall provide a statement that such ancillary services performed by a subcontractor do not require registration as an IME entity as they are not functions central to the examination or review of records such as identifying and retaining the services of an examiner, scheduling of the examination, mailing of the report of independent medical examination or review of records and any related notices or board forms, and negotiation of payment for the examination or review of records;

(j) description of the services provided by the IME entity and its employees or independent contractors;

(k) a description of the relationship between the IME entity and its owners, officers or partners and the independent medical examiners it employs or with whom it contacts to conduct independent medical examinations and reviews of records;

(l) the affirmation as set forth in paragraph (2) of this section; and

(m) such other information as the chair finds to be necessary and relevant.

(iii) The chair may audit any contract between a carrier and an IME entity or examiner, or any contract between an IME entity and an examiner or subcontractor, to ensure compliance with this section and sections 13-n and 137 of the Workers' Compensation Law.

(iv) If there are any material changes to the information supplied in clause (a), (b), (c), (d), (e) or (f) of subparagraph (i) of this paragraph, the IME entity shall notify the chair in writing within 30 business days that the information has changed and provide the updated information. The IME entity shall notify the chair in writing by March 31st of each year of any material changes to the information supplied in subclause (g), (h), (i), (j), (k) (l) (m), (n) or (o) of subparagraph (i) of this paragraph.

(v) Entities must register every three years by submitting the form required in subparagraph (1) of this paragraph and paying the registration fee set forth in paragraph (5) of this subdivision.

(2) Compliance with laws. An officer of each such entity registering with the chair shall affirm under penalty of perjury upon registration that the entity is organized under the laws of New York State or in the state in which it was incorporated in a corporate form that is recognized by the laws of the State of New York, is duly registered with the Department of State, and is in full compliance with the laws of the State of New York, its state of incorporation if outside New York, and the United States, including but not limited to any laws or regulations under the Public Health Law, the Education Law and the Workers' Compensation Law governing the practice of medicine, podiatry, chiropractic and psychology, treatment of injured or ill workers, solicitation and fee-splitting, and any laws or regulations under the jurisdiction of the State Insurance Department, the Federal Centers for Medicare and Medicaid Services, the State Department of Taxation and Finance or the Federal Internal Revenue Service. The officer shall further affirm that he or she has read or is familiar with the fee-splitting and anti-solicitation provisions of the Workers' Compensation Law under sections 13-d, 13-i, 13-k, 13-l and 13-m, and that the entity is not in violation of any such section.

(3) Additional information. The chair or his or her designee reserves the right to request any and all information or documentation necessary from any IME entity for the purpose of administering and ensuring compliance with Workers' Compensation Law sections 13-a, 13-b, 13-d, 13-i, 13-k, 13-l, 13-m, 13-n, 137 and other related provisions of such law and this section. All IME entities must cooperate in any investigation and produce for review by the chair or his or her designee any relevant documents, reports or notes.

(4) Acceptance of registration not a defense. The acceptance of a registration statement by the chair in accordance with Workers' Compensation Law section 13- n and these regulations shall not be construed as authorization, approval or endorsement of the registering entity, or its services, corporate organization or business practices by the chair or board, and the acceptance of a registration statement by the chair shall not be a defense to any investigation, action or proceeding by any government agency or official enforcing the laws of this State or the United States.

(5) Registration fee. The registering entity shall pay a registration fee of $250 to the chair for the purpose of administering the registration and ensuring compliance of such entities in accordance with Workers' Compensation Law section 13-n.

(6) Removal from list of registered IME entities. The chair or his or her designee may remove an IME entity from its list of such registered IME entities for failure to comply with Workers' Compensation Law section 13-n or 137 or this section. The following procedure shall apply to such removal: (i) Written notice. (a) The registered IME entity shall be given written notice of the proposed rescission of registration containing the following information: (1) a concise statement of the grounds or the nature of the misconduct upon which the proposed rescission of registration is based; and (2) a recitation of the statute(s), regulation(s), or order(s) allegedly violated by the registered IME entity. (b) The written notice of proposed rescission of registration may be sent in any manner that provides proof of delivery to the registered IME entity or to the registered IME entity's legal counsel, if known. (c) The written notice shall inform the registered IME entity of the opportunity to have the chair or his or her designee administratively review the proposed rescission of registration. (ii) Responses to the written notice. (a) Answer. A registered IME entity that wishes to dispute the allegations contained in the notice of proposed rescission of registration, must serve an answer to the notice of proposed rescission. (1) The registered IME entity must serve any answer to the notice of proposed rescission on the board within twenty days of receipt of the notice. (2) Any answer must set forth responses to the grounds or nature of the misconduct alleged, the statutes, regulations or orders allegedly violated, and any defenses. (3) Failure to provide an answer. Failure to provide an answer within twenty days will result in the allegations in the notice being deemed admitted and the registered IME entity will be prohibited from raising any defenses or any argument in opposition to the allegations set forth in the notice. If the registered IME entity does not submit an answer and request a timely administrative review, then the registered IME entity will be deemed to have waived all rights, all allegations set forth in the notice will be deemed admitted, the registered IME entity will be prohibited from raising any affirmative defenses or any arguments in opposition to the allegations set forth in the notice or from submitting any evidence in its defense, an administrative review will not be held, and the IME entity's registration will be automatically rescinded. A determination of this nature shall be deemed administratively final. (b) Voluntary resignation. At the chair's or his or her designee's discretion, a written statement may be executed at the option of the registered IME entity which affords it the opportunity to voluntarily resign as a registered IME entity without admitting or denying the allegations contained in the notice. If the registered IME entity voluntarily resigns after requesting an administrative review of the allegations, such administrative review shall not be held and will not be rescheduled. (iii) Administrative review. If the registered IME entity submits an answer and requests an administrative review of the allegations: (a) Administrative review of the registered IME entity's authorization shall be scheduled not less than thirty days from the date of receipt of the notice. The administrative review shall be held at the executive offices of the board in Albany, New York. (1) The registered IME entity shall appear with counsel at the administrative review, provide testimony, and cross-examine witnesses. The registered IME entity may also submit documents or other materials for review by the chair or his or her designee either prior to or at the administrative review itself. (2) The chair or his or her designee shall not be bound by common law or statutory rules of evidence in conducting the administrative review and may conduct such investigation or inquiry in a manner which, in his or her discretion, is appropriate, including the preparation of a record of the proceedings or the admission of non-documentary evidence. (3) The registered IME entity shall receive a written decision containing findings of fact and conclusions of law within thirty days of the conclusion of the administrative review. (iv) Notification of decision to rescind registration. After providing written notification to the registered IME entity of the registration rescission, the chair or his or her designee shall notify or direct the registered IME entity to notify any and all appropriate public or private agencies, entities or organizations that the registered IME entity's registration has been rescinded. A decision to rescind an IME entity's registration shall be administratively final.

(i) Written notice. (a) The registered IME entity shall be given written notice of the proposed rescission of registration containing the following information: (1) a concise statement of the grounds or the nature of the misconduct upon which the proposed rescission of registration is based; and (2) a recitation of the statute(s), regulation(s), or order(s) allegedly violated by the registered IME entity. (b) The written notice of proposed rescission of registration may be sent in any manner that provides proof of delivery to the registered IME entity or to the registered IME entity's legal counsel, if known. (c) The written notice shall inform the registered IME entity of the opportunity to have the chair or his or her designee administratively review the proposed rescission of registration.

(a) The registered IME entity shall be given written notice of the proposed rescission of registration containing the following information: (1) a concise statement of the grounds or the nature of the misconduct upon which the proposed rescission of registration is based; and (2) a recitation of the statute(s), regulation(s), or order(s) allegedly violated by the registered IME entity.

(1) a concise statement of the grounds or the nature of the misconduct upon which the proposed rescission of registration is based; and

(2) a recitation of the statute(s), regulation(s), or order(s) allegedly violated by the registered IME entity.

(b) The written notice of proposed rescission of registration may be sent in any manner that provides proof of delivery to the registered IME entity or to the registered IME entity's legal counsel, if known.

(c) The written notice shall inform the registered IME entity of the opportunity to have the chair or his or her designee administratively review the proposed rescission of registration.

(ii) Responses to the written notice. (a) Answer. A registered IME entity that wishes to dispute the allegations contained in the notice of proposed rescission of registration, must serve an answer to the notice of proposed rescission. (1) The registered IME entity must serve any answer to the notice of proposed rescission on the board within twenty days of receipt of the notice. (2) Any answer must set forth responses to the grounds or nature of the misconduct alleged, the statutes, regulations or orders allegedly violated, and any defenses. (3) Failure to provide an answer. Failure to provide an answer within twenty days will result in the allegations in the notice being deemed admitted and the registered IME entity will be prohibited from raising any defenses or any argument in opposition to the allegations set forth in the notice. If the registered IME entity does not submit an answer and request a timely administrative review, then the registered IME entity will be deemed to have waived all rights, all allegations set forth in the notice will be deemed admitted, the registered IME entity will be prohibited from raising any affirmative defenses or any arguments in opposition to the allegations set forth in the notice or from submitting any evidence in its defense, an administrative review will not be held, and the IME entity's registration will be automatically rescinded. A determination of this nature shall be deemed administratively final. (b) Voluntary resignation. At the chair's or his or her designee's discretion, a written statement may be executed at the option of the registered IME entity which affords it the opportunity to voluntarily resign as a registered IME entity without admitting or denying the allegations contained in the notice. If the registered IME entity voluntarily resigns after requesting an administrative review of the allegations, such administrative review shall not be held and will not be rescheduled.

(a) Answer. A registered IME entity that wishes to dispute the allegations contained in the notice of proposed rescission of registration, must serve an answer to the notice of proposed rescission. (1) The registered IME entity must serve any answer to the notice of proposed rescission on the board within twenty days of receipt of the notice. (2) Any answer must set forth responses to the grounds or nature of the misconduct alleged, the statutes, regulations or orders allegedly violated, and any defenses. (3) Failure to provide an answer. Failure to provide an answer within twenty days will result in the allegations in the notice being deemed admitted and the registered IME entity will be prohibited from raising any defenses or any argument in opposition to the allegations set forth in the notice. If the registered IME entity does not submit an answer and request a timely administrative review, then the registered IME entity will be deemed to have waived all rights, all allegations set forth in the notice will be deemed admitted, the registered IME entity will be prohibited from raising any affirmative defenses or any arguments in opposition to the allegations set forth in the notice or from submitting any evidence in its defense, an administrative review will not be held, and the IME entity's registration will be automatically rescinded. A determination of this nature shall be deemed administratively final.

(1) The registered IME entity must serve any answer to the notice of proposed rescission on the board within twenty days of receipt of the notice.

(2) Any answer must set forth responses to the grounds or nature of the misconduct alleged, the statutes, regulations or orders allegedly violated, and any defenses.

(3) Failure to provide an answer. Failure to provide an answer within twenty days will result in the allegations in the notice being deemed admitted and the registered IME entity will be prohibited from raising any defenses or any argument in opposition to the allegations set forth in the notice. If the registered IME entity does not submit an answer and request a timely administrative review, then the registered IME entity will be deemed to have waived all rights, all allegations set forth in the notice will be deemed admitted, the registered IME entity will be prohibited from raising any affirmative defenses or any arguments in opposition to the allegations set forth in the notice or from submitting any evidence in its defense, an administrative review will not be held, and the IME entity's registration will be automatically rescinded. A determination of this nature shall be deemed administratively final.

(b) Voluntary resignation. At the chair's or his or her designee's discretion, a written statement may be executed at the option of the registered IME entity which affords it the opportunity to voluntarily resign as a registered IME entity without admitting or denying the allegations contained in the notice. If the registered IME entity voluntarily resigns after requesting an administrative review of the allegations, such administrative review shall not be held and will not be rescheduled.

(iii) Administrative review. If the registered IME entity submits an answer and requests an administrative review of the allegations: (a) Administrative review of the registered IME entity's authorization shall be scheduled not less than thirty days from the date of receipt of the notice. The administrative review shall be held at the executive offices of the board in Albany, New York. (1) The registered IME entity shall appear with counsel at the administrative review, provide testimony, and cross-examine witnesses. The registered IME entity may also submit documents or other materials for review by the chair or his or her designee either prior to or at the administrative review itself. (2) The chair or his or her designee shall not be bound by common law or statutory rules of evidence in conducting the administrative review and may conduct such investigation or inquiry in a manner which, in his or her discretion, is appropriate, including the preparation of a record of the proceedings or the admission of non-documentary evidence. (3) The registered IME entity shall receive a written decision containing findings of fact and conclusions of law within thirty days of the conclusion of the administrative review.

(a) Administrative review of the registered IME entity's authorization shall be scheduled not less than thirty days from the date of receipt of the notice. The administrative review shall be held at the executive offices of the board in Albany, New York. (1) The registered IME entity shall appear with counsel at the administrative review, provide testimony, and cross-examine witnesses. The registered IME entity may also submit documents or other materials for review by the chair or his or her designee either prior to or at the administrative review itself. (2) The chair or his or her designee shall not be bound by common law or statutory rules of evidence in conducting the administrative review and may conduct such investigation or inquiry in a manner which, in his or her discretion, is appropriate, including the preparation of a record of the proceedings or the admission of non-documentary evidence. (3) The registered IME entity shall receive a written decision containing findings of fact and conclusions of law within thirty days of the conclusion of the administrative review.

(1) The registered IME entity shall appear with counsel at the administrative review, provide testimony, and cross-examine witnesses. The registered IME entity may also submit documents or other materials for review by the chair or his or her designee either prior to or at the administrative review itself.

(2) The chair or his or her designee shall not be bound by common law or statutory rules of evidence in conducting the administrative review and may conduct such investigation or inquiry in a manner which, in his or her discretion, is appropriate, including the preparation of a record of the proceedings or the admission of non-documentary evidence.

(3) The registered IME entity shall receive a written decision containing findings of fact and conclusions of law within thirty days of the conclusion of the administrative review.

(iv) Notification of decision to rescind registration. After providing written notification to the registered IME entity of the registration rescission, the chair or his or her designee shall notify or direct the registered IME entity to notify any and all appropriate public or private agencies, entities or organizations that the registered IME entity's registration has been rescinded. A decision to rescind an IME entity's registration shall be administratively final.

(7) Penalties for materially altering or causing a report to be materially altered. If the chair or his or her designee finds that an IME entity that derives income from independent medical examinations has materially altered an independent medical examination report, or caused such a report to be materially altered, then in addition to revoking or rescinding the registration of such IME entity through the process set forth in paragraph (6) of this subdivision, the chair or his or her designee shall:(i) refer the matter to the attorney general for prosecution; and (ii) impose a penalty not to exceed $10,000 payable to the chair. In determining the amount of the penalty, the chair or his or her designee shall consider: (a) the extent of the alteration to the report; (b) the nature of the alteration; (c) how the IME entity caused the report to be altered; and (d) the impact of the altered report on the decision of the board.

(i) refer the matter to the attorney general for prosecution; and

(ii) impose a penalty not to exceed $10,000 payable to the chair. In determining the amount of the penalty, the chair or his or her designee shall consider: (a) the extent of the alteration to the report; (b) the nature of the alteration; (c) how the IME entity caused the report to be altered; and (d) the impact of the altered report on the decision of the board.

(a) the extent of the alteration to the report;

(b) the nature of the alteration;

(c) how the IME entity caused the report to be altered; and

(d) the impact of the altered report on the decision of the board.

Aggregated from public-domain New York law; no amendment recorded since codification.

All hospital records in any pending claim for compensation or true copies thereof coming into the possession of the employer or insurance carrier shall be filed with the chairman, upon the order of the board. When directed by the board the employer or carrier shall subpoena hospital records and produce same at a hearing.

Aggregated from public-domain New York law; no amendment recorded since codification.

Hearings on claims for compensation and for the designation of a person legally responsible for a minor claimant shall be held before a Workers' Compensation Law judge, except as herein otherwise provided.

Aggregated from public-domain New York law; last amended effective 2016-11-02.

(a) In controverted claims the Workers' Compensation Law Judge shall make a reasoned decision upon the contested points. This decision, outlining the evidence supporting said determination, may be made by an oral statement which shall be entered upon the minutes of the hearings, or may be in a written and signed statement which shall be filed with the papers in the record.

(b) (1) Parties to any claim before the board may stipulate to uncontested facts or proposed findings. When a claimant is represented, a stipulation may be made either as an oral statement on the record at a hearing or, in writing outside of a hearing. A written stipulation must be submitted using the form or format prescribed by the Chair. The stipulation must indicate that each party to the stipulation: (i) has been advised of the legal effect of stipulating to the facts or proposed findings contained in said stipulation; and (ii) has affixed their signatures to said stipulation of their own free will. If the stipulation is presented at a hearing, a Workers' Compensation Law Judge shall verify the foregoing through questioning. (2) A stipulation made at a hearing and approved by a Workers' Compensation Law Judge shall be incorporated into the decision of the Workers' Compensation Law Judge and shall be binding upon the parties. A written stipulation made outside of a hearing entered into by a represented claimant and the employer or carrier shall be reviewed and if approved by a Workers' Compensation Law Judge or conciliator shall be incorporated into a decision of the Board. Such stipulation, as incorporated into a decision of the Workers' Compensation Law Judge, shall be subject to the provisions of section 23 of the Workers' Compensation Law and section 300.13 of this Part, and to sections 22 and 123 of the Workers' Compensation Law. The Chair may direct that stipulations properly submitted in the prescribed format and approved by a Workers' Compensation Law Judge or conciliator constitute the decision of the Workers' Compensation Law Judge. (3) When a claimant is not represented, he or she shall give a sworn statement on the record at a hearing indicating an understanding of the facts agreed to and the legal effect of the oral or written stipulation. (4) The provisions of this subdivision shall not be applicable to agreements settling upon and determining claims for compensation pursuant to section 32 of the Workers' Compensation Law and section 300.36 of this Part.

(1) Parties to any claim before the board may stipulate to uncontested facts or proposed findings. When a claimant is represented, a stipulation may be made either as an oral statement on the record at a hearing or, in writing outside of a hearing. A written stipulation must be submitted using the form or format prescribed by the Chair. The stipulation must indicate that each party to the stipulation: (i) has been advised of the legal effect of stipulating to the facts or proposed findings contained in said stipulation; and (ii) has affixed their signatures to said stipulation of their own free will. If the stipulation is presented at a hearing, a Workers' Compensation Law Judge shall verify the foregoing through questioning.

(i) has been advised of the legal effect of stipulating to the facts or proposed findings contained in said stipulation; and

(ii) has affixed their signatures to said stipulation of their own free will. If the stipulation is presented at a hearing, a Workers' Compensation Law Judge shall verify the foregoing through questioning.

(2) A stipulation made at a hearing and approved by a Workers' Compensation Law Judge shall be incorporated into the decision of the Workers' Compensation Law Judge and shall be binding upon the parties. A written stipulation made outside of a hearing entered into by a represented claimant and the employer or carrier shall be reviewed and if approved by a Workers' Compensation Law Judge or conciliator shall be incorporated into a decision of the Board. Such stipulation, as incorporated into a decision of the Workers' Compensation Law Judge, shall be subject to the provisions of section 23 of the Workers' Compensation Law and section 300.13 of this Part, and to sections 22 and 123 of the Workers' Compensation Law. The Chair may direct that stipulations properly submitted in the prescribed format and approved by a Workers' Compensation Law Judge or conciliator constitute the decision of the Workers' Compensation Law Judge.

(3) When a claimant is not represented, he or she shall give a sworn statement on the record at a hearing indicating an understanding of the facts agreed to and the legal effect of the oral or written stipulation.

(4) The provisions of this subdivision shall not be applicable to agreements settling upon and determining claims for compensation pursuant to section 32 of the Workers' Compensation Law and section 300.36 of this Part.

(c) In every claim where the disability exceeds seven days, the Workers' Compensation Law Judge shall make a finding as to whether or not an accident arising out of and in the course of employment or an occupational disease has been established.

(d) The Workers' Compensation Law Judge may excuse the failure of a physician or other health providers to file reports in accordance with the requirements of subdivision (4) of section 13-a, subdivision (3) of section 13-k, subdivision (3) of section 13-l and subdivision (4) of section 13-m of the Workers' Compensation Law whenever after taking testimony the Workers' Compensation Law Judge finds it to be in the interest of justice to excuse such failure, and the decision of the Workers' Compensation Law Judge shall state the reasons therefor.

(e) A claim for reimbursement pursuant to section 15, subdivision 8 of the Workers' Compensation Law shall be filed on a form prescribed by the chair.

Aggregated from public-domain New York law; no amendment recorded since codification.

Whenever it appears in any case that the employer or carrier has violated a section of the Workers' Compensation Law which provides for the imposition of penalty or assessment, or for the accrual of additional compensation, the chairman or the board (as may be indicated) shall take such action thereon as is contemplated by the section violated.

Aggregated from public-domain New York law; no amendment recorded since codification.

(a) Referee calendars. Claims scheduled for referee hearings shall appear on appropriate calendars as may from time to time be established by the chair.

(b) Board calendars. Board hearings shall be appointed for and held at such times and places as may be established by the chair to meet the convenience and requirements of the several districts in the State.

(c) Individual board member hearings. When a claim is before a panel of the board and the panel deems new or additional evidence is necessary for a determination thereof, the panel may hear and receive such evidence. The panel may, however, designate one of its members to do so, in which event the record of such hearing in a readable, viewable or audible format shall be made part of the case file maintained by the board, and the determination of the panel shall be based upon the entire case file maintained by the board.

Aggregated from public-domain New York law; no amendment recorded since codification.

(a) the claimant;

(b) the carrier and their authorized representatives; and

(c) where the employer is alleged to be uninsured at the time of the accident, the notice of hearing shall also be mailed to the employer by both certified mail, return receipt requested and by regular mail; not less than eight days before the date of hearing. In the discretion of the board any issue in a case may be considered and determined although not indicated in the notice of hearing if the administration of justice will thereby be substantially served. Notice of any hearing may be dispensed with by the board when the parties are present or have consented thereto.

Aggregated from public-domain New York law; no amendment recorded since codification.

(a) All hearings and proceedings shall be conducted in an orderly manner in order to ascertain the substantial rights of the parties. All parties and participants in any hearing or proceeding shall maintain a civil, respectful and professional demeanor when appearing before the board or when conducting depositions relative to a claim and comply with the Standards of Civility adopted by the board. Parties and participants who are disrespectful or disruptive in any hearing or proceeding, so as to interfere with the orderly conduct of the hearing or proceeding, will be removed so the hearing or proceeding may continue in an orderly manner.

(b) All witnesses shall testify under oath (or by affirmation). The board and Workers' Compensation Law Judges may examine and cross-examine all parties and witnesses at any hearing or proceeding. The board shall not be bound by common law or statutory rules of evidence or by technical or formal rules of procedure.

(c) The board shall keep a verbatim record of all hearings and proceedings. No other record shall be allowed. The board will maintain in its case file a copy of the verbatim record it prepared in a readable, viewable or audible format. No other record of a hearing or proceeding in a readable, viewable or audible format shall be allowed.

Aggregated from public-domain New York law; no amendment recorded since codification.

(a) If the claimant or his or her attorney or representative fails to appear at the first hearing, the referee may adjourn the hearing, except that the referee may decide an uncontroverted claim if there be in the file a claim and substantial evidence supporting such claim and the referee finds that the information therein is sufficient. The notice to the claimant for the second hearing shall inform him or her that such adjourned hearing is being held because of his or her failure to appear at the first hearing, and that if he or she or his or her attorney or representative fails to appear the case may be decided in his or her absence. If the claimant or his or her attorney or representative again fails to appear at the second hearing, the referee shall then proceed to make a decision unless he or she finds sufficient basis for further adjournment, which reasons shall be noted on the record. Where the claim has been controverted the case may be adjourned and the file referred to the supervising referee for investigation as to the cause of the claimant's nonappearance.

(b) If the employer or its carrier, or a special fund created under the Workers' Compensation Law, fails to present evidence including the testimony of witnesses as directed or scheduled by the board or chair, the referee, upon request of such party, may adjourn the hearing and reschedule the case. If the employer or its carrier or a special fund again fails to present or submit evidence at the second hearing, the referee shall proceed to make a decision unless he or she finds upon extraordinary circumstances shown at such hearing that a further adjournment is warranted. The denial of adjournments under this rule shall not be grounds for application for review to the board.

(c) When the employer or its carrier or special fund desires to produce for cross-examination an attending physician whose report is on file, the referee shall grant an adjournment for such purpose. If the physician is not produced at such adjourned hearing, a further adjournment shall be granted only when the referee finds there is sufficient excuse for the physician's nonappearance, which excuse shall be noted on the record and conditioned upon the resort by the employer or its carrier, or special fund to a subpoena for the next hearing. If such adjournment is granted and the physician does not appear, unless extraordinary circumstances are shown, the referee shall proceed to determine the claim upon the evidence in the record. The obligation to invoke court action for the enforcement of the subpoena shall be that of the employer or its carrier or special fund.

(d) Whenever the records in a claim clearly indicate that the claim is not within the jurisdiction of New York State the referee may at the first hearing disallow the claim for lack of jurisdiction and shall state the reasons for his action.

Aggregated from public-domain New York law; no amendment recorded since codification.

(a) Physical examinations required under section 19 of the Workers' Compensation Law shall be made only by a physician employed or designated by the board or chair. Reports of such examinations shall be duly verified.

(b) When a physician has been designated to examine the claimant and report thereon, in accordance with the provisions of subdivision (e) of section 13 of the Workers' Compensation Law, the claimant shall be given reasonable notice by mail of the time and place where he or she is to appear for such examination. At such examination, neither the claimant, employer or carrier, nor the board shall have a representative present, except that the claimant may be accompanied by a lay member of his or her family. In the judgment and option of such examining physician such person may be excluded from the examination.

(c) All reports of such examinations shall be sworn to and copies in triplicate promptly sent to the board. A copy thereof shall be furnished by the board to each of the parties. The original of such report shall at a hearing be made a part of the case record by admitting it in evidence, and any party desiring shall be given the opportunity to question such physician on the contents of the report and relative thereto. A fee for appearance at a hearing of a physician designated under subdivision (e) of section 13 for testimony on such report shall be paid by the employer or carrier.

Aggregated from public-domain New York law; no amendment recorded since codification.

When a claim presents a novel or important question of law or a question of public policy, a referee before rendering his decision thereon may certify such question to the board. In such a case the referee shall develop the record on the question involved and submit to the board for determination his findings of fact and the question presented by the record for decision.

Aggregated from public-domain New York law; last amended effective 2017-01-11.

(a) Definitions. (1) Administrative review means an administrative appeal from a decision of a compensation claims referee, under section 23 of the Workers' Compensation Law, or an administrative appeal of a finalized administrative determination as set forth in Part 313 of this Title. (2) Full board review means an administrative appeal from a decision of the board pursuant to section 23 of the Workers' Compensation Law. Such review is discretionary unless a board member dissents from the ruling regarding a finding other than the issue of whether to appoint an impartial medical specialist. Upon notice to the claimant, his or her legal representative, if any, the employer or carrier or special fund, the full board may review any case on its own motion. (3) Filing means an application has been received by the board at the designated point of receipt. Upon posting on the board's website, the chair may prescribe the format and method for filing and service including, among other methods, electronic, mail or fax service. (4) Necessary parties of interest means, for the purposes of this section, claimants, self-insured employers, private insurance carriers, the state insurance fund, special funds, no-fault carriers per section 142 of the Workers' Compensation Law, or any surety, including but not limited to the uninsured employer's fund, and the liquidation bureau. Treating medical providers and independent medical examiners are not parties of interest and may not make filings, oral arguments, or otherwise participate in the administrative review process. Attorneys and licensed hearing representatives are not necessary parties of interest under this rule, except that an attorney or representative is a necessary party in an appeal that concerns the amount of a fee payable to an attorney or representative or a penalty imposed against an attorney or licensed hearing representative. A claimant's attorney or licensed hearing representative, properly designated by the claimant as his or her representative, shall receive a copy of any applications or rebuttals filed under this section.

(1) Administrative review means an administrative appeal from a decision of a compensation claims referee, under section 23 of the Workers' Compensation Law, or an administrative appeal of a finalized administrative determination as set forth in Part 313 of this Title.

(2) Full board review means an administrative appeal from a decision of the board pursuant to section 23 of the Workers' Compensation Law. Such review is discretionary unless a board member dissents from the ruling regarding a finding other than the issue of whether to appoint an impartial medical specialist. Upon notice to the claimant, his or her legal representative, if any, the employer or carrier or special fund, the full board may review any case on its own motion.

(3) Filing means an application has been received by the board at the designated point of receipt. Upon posting on the board's website, the chair may prescribe the format and method for filing and service including, among other methods, electronic, mail or fax service.

(4) Necessary parties of interest means, for the purposes of this section, claimants, self-insured employers, private insurance carriers, the state insurance fund, special funds, no-fault carriers per section 142 of the Workers' Compensation Law, or any surety, including but not limited to the uninsured employer's fund, and the liquidation bureau. Treating medical providers and independent medical examiners are not parties of interest and may not make filings, oral arguments, or otherwise participate in the administrative review process. Attorneys and licensed hearing representatives are not necessary parties of interest under this rule, except that an attorney or representative is a necessary party in an appeal that concerns the amount of a fee payable to an attorney or representative or a penalty imposed against an attorney or licensed hearing representative. A claimant's attorney or licensed hearing representative, properly designated by the claimant as his or her representative, shall receive a copy of any applications or rebuttals filed under this section.

(b) Requests for administrative review and requests for full board review filed pursuant to Workers' Compensation Law section 23, and requests for reconsideration of a board panel decision pursuant to section 300.14 of this Part. (1) Application format. Unless submitted by an unrepresented claimant, an application to the board for administrative review of a decision by a Workers' Compensation Law judge shall be in the format as prescribed by the chair. The application in the format prescribed by the chair must be filled out completely by the appellant, except that the requirement to utilize the application format shall not be imposed upon a claimant who is unrepresented. (i) Unless otherwise specified by the chair, the appellant may attach a legal brief of up to eight pages in length, in 12-point font, with one inch margins, on 8.5 inch by 11 paper. A brief longer than eight pages will not be considered, unless the appellant specifies, in writing, why the legal argument could not have been made within eight pages. In no event shall a brief longer than 15 pages be considered. (ii) Documents that are present in the board's electronic case folder at the time the administrative review is submitted shall not be, included with or attached to the application. The board may reject applications for review by an appellant, or an attorney or licensed representative of the appellant, who attaches documents that are already in the case folder at the time of the application. (iii) If the appellant seeks to introduce additional documentary evidence in the administrative appeal that was not presented before the Workers' Compensation Law judge, the appellant must submit a sworn affidavit, setting forth the evidence, and explaining why it could not have been presented before the Workers' Compensation Law judge. The board has discretion to accept or deny such newly filed evidence. Newly filed evidence submitted without the affidavit will not be considered by the board panel. (2) The application for administrative review: (i) shall specify the issues and grounds for the appeal; (ii) shall specify the objection or exception that was interposed to the ruling, and when the objection or exception was interposed; (iii) shall, when filed by an employer or carrier, specify which payments are continuing pending resolution of the administrative appeal, and which payments are stayed pursuant to section 23 and subdivision (3)(f) of section 25 of the Workers' Compensation Law; (iv) shall include proof of service upon all necessary parties of interest, in the format prescribed by the chair. Service upon a party who is not adverse to the interest of the appellant may not render the appeal defective as such party is not a necessary party of interest. Failure to properly serve a necessary party shall be deemed defective service and the application may be rejected by the board. (a) Proof of service in the format prescribed by the chair shall specify the papers served, the person who was served, the date, and method of service including the actual address, email address or fax number where service was transmitted. An affidavit, affirmation, or other satisfactory proof of service as prescribed by the chair, shall be submitted with the application for administrative review to the board. The affidavit, affirmation, or other proof of service must certify that all service was completed within 30 days from the filing of the decision that is the subject of the application for administrative review. (b) There is no requirement that each party be served in the same manner. Service is deemed timely if completed by the party of interest within 30 days of the filing of the decision by the board. (c) Unless the chair directs service by electronic means, the appellant must certify in the affidavit or affirmation of service, that the party served provided explicit permission to receive service by fax, email, or other electronic means. (d) When the administrative appeal is filed by the carrier, self-insured employer, or other payor or potential payor, service shall be upon the claimant, and claimant's attorney or representative, and other necessary parties in interest. (e) Service upon a party who is not adverse to the interest of the appellant is optional, and failure to properly serve an optional party shall not be deemed to render the appeal defective. (v) Shall include any additional fee request in the format prescribed by the chair for fee requests. Failure to request an additional fee in the prescribed format shall result in waiver of such fee. (3) Filing with the board.(i) The application shall be filed with the board within 30 days after the notice of the filing of the decision. All filings must be made using methods designated, permitted, and prescribed by the chair. If more than one filing option is permitted by the chair, the appellant shall choose one method for filing. Any duplicate filings may be deemed to be raising or continuing an issue without reasonable grounds, and may subject the appellant to assessments under 114-a(3) of the Workers' Compensation Law. (ii) Method of filing the application: (a) by mail shall be sent to the board's designated centralized mailing address; (b) by fax shall be sent to the board's designated centralized fax number; (c) by email shall be sent to the board's designated email address for claims documents; (d) by electronic means shall be filed in the method and manner prescribed by the chair. An application that is submitted by electronic means in accordance with this subparagraphs shall not be deemed filed with the board until such submission is received and acknowledged by the board. (iii) The chair may prescribe and require the format and the methods of filing of administrative appeals, including by electronic means, and may set the requirements to include various data fields, except that claimants who are unrepresented are exempt from the requirement to file electronically. (4) Denial of review. The application for review may be denied under the following circumstances: (i) by letter issued by the chair or the chair's designee when the appellant, other than a claimant who is not represented, does not comply with prescribed formatting, completion and service submission requirements; (ii) by decision of the board panel, when the appellant does not file the application within 30 days; (iii) by decision of the board panel, when the appellant does not properly file the application with the board; and (iv) by decision of the board panel, when the appellant does not provide proper proof of timely service upon a necessary party in interest other than a party who is not adverse to the appellant. When the appellant fails to supply proper proof of timely service upon a necessary party. (a) When a rebuttal is submitted, the necessary party shall raise the issue of defective service in its rebuttal. Failure to raise the issue of defective service in the rebuttal shall constitute a waiver of the issue. (b) When no rebuttal is filed, the board may consider whether the application was defectively served, and if so, the board may deny review without decision. (v) By decision of the board panel, where the appellant did not interpose a specific objection or exception to a ruling or award by a Workers' Compensation Law judge. (a) Where a decision is made at a hearing, the appellant did not preserve a specific objection to the ruling or award at the hearing on the record. (b) Where proceedings occur off-calendar, such as at a deposition, the appellant did not preserve objections on the record at the start of or conclusion of the proceeding as to qualifications of the deponent, or admissibility of any medical report or report of independent medical examination. (c) No objection to findings made by reserved decision that have not been previously made at a hearing, need be interposed prior to filing of an application for review. (c) Rebuttal. A party adverse to the application for administrative review may file a rebuttal to such application for review. The rebuttal shall be in writing and, for parties other than an unrepresented claimant, shall be accompanied by a cover sheet in the format prescribed by the chair. The rebuttal shall conform to the requirements for requests for administrative review set forth in subdivision (b) of this section. Such rebuttal shall be served on the board and all necessary parties within 30 days after service of the application for review together with proof of service upon all necessary parties in the form and format prescribed by the chair. (d) The board shall have the verbatim records of all hearings and proceedings placed in the case file it maintains in a readable, viewable or audible format where the issue or issues raised in the application for review were covered, and the case file shall only be considered by a board panel after the verbatim records covering the disputed issues are inserted in the case file. (e) Stay of payments. There is no stay of any payment due to the claimant or the board upon a filing of an application for full board review. (f) When a claimant is not represented, the board shall have discretion to waive the requirements contained in this section. An unrepresented claimant, who subsequently retains counsel, may have the procedural requirements of this section waived for the time when he or she was unrepresented.

(1) Application format. Unless submitted by an unrepresented claimant, an application to the board for administrative review of a decision by a Workers' Compensation Law judge shall be in the format as prescribed by the chair. The application in the format prescribed by the chair must be filled out completely by the appellant, except that the requirement to utilize the application format shall not be imposed upon a claimant who is unrepresented. (i) Unless otherwise specified by the chair, the appellant may attach a legal brief of up to eight pages in length, in 12-point font, with one inch margins, on 8.5 inch by 11 paper. A brief longer than eight pages will not be considered, unless the appellant specifies, in writing, why the legal argument could not have been made within eight pages. In no event shall a brief longer than 15 pages be considered. (ii) Documents that are present in the board's electronic case folder at the time the administrative review is submitted shall not be, included with or attached to the application. The board may reject applications for review by an appellant, or an attorney or licensed representative of the appellant, who attaches documents that are already in the case folder at the time of the application. (iii) If the appellant seeks to introduce additional documentary evidence in the administrative appeal that was not presented before the Workers' Compensation Law judge, the appellant must submit a sworn affidavit, setting forth the evidence, and explaining why it could not have been presented before the Workers' Compensation Law judge. The board has discretion to accept or deny such newly filed evidence. Newly filed evidence submitted without the affidavit will not be considered by the board panel.

(i) Unless otherwise specified by the chair, the appellant may attach a legal brief of up to eight pages in length, in 12-point font, with one inch margins, on 8.5 inch by 11 paper. A brief longer than eight pages will not be considered, unless the appellant specifies, in writing, why the legal argument could not have been made within eight pages. In no event shall a brief longer than 15 pages be considered.

(ii) Documents that are present in the board's electronic case folder at the time the administrative review is submitted shall not be, included with or attached to the application. The board may reject applications for review by an appellant, or an attorney or licensed representative of the appellant, who attaches documents that are already in the case folder at the time of the application.

(iii) If the appellant seeks to introduce additional documentary evidence in the administrative appeal that was not presented before the Workers' Compensation Law judge, the appellant must submit a sworn affidavit, setting forth the evidence, and explaining why it could not have been presented before the Workers' Compensation Law judge. The board has discretion to accept or deny such newly filed evidence. Newly filed evidence submitted without the affidavit will not be considered by the board panel.

(2) The application for administrative review: (i) shall specify the issues and grounds for the appeal; (ii) shall specify the objection or exception that was interposed to the ruling, and when the objection or exception was interposed; (iii) shall, when filed by an employer or carrier, specify which payments are continuing pending resolution of the administrative appeal, and which payments are stayed pursuant to section 23 and subdivision (3)(f) of section 25 of the Workers' Compensation Law; (iv) shall include proof of service upon all necessary parties of interest, in the format prescribed by the chair. Service upon a party who is not adverse to the interest of the appellant may not render the appeal defective as such party is not a necessary party of interest. Failure to properly serve a necessary party shall be deemed defective service and the application may be rejected by the board. (a) Proof of service in the format prescribed by the chair shall specify the papers served, the person who was served, the date, and method of service including the actual address, email address or fax number where service was transmitted. An affidavit, affirmation, or other satisfactory proof of service as prescribed by the chair, shall be submitted with the application for administrative review to the board. The affidavit, affirmation, or other proof of service must certify that all service was completed within 30 days from the filing of the decision that is the subject of the application for administrative review. (b) There is no requirement that each party be served in the same manner. Service is deemed timely if completed by the party of interest within 30 days of the filing of the decision by the board. (c) Unless the chair directs service by electronic means, the appellant must certify in the affidavit or affirmation of service, that the party served provided explicit permission to receive service by fax, email, or other electronic means. (d) When the administrative appeal is filed by the carrier, self-insured employer, or other payor or potential payor, service shall be upon the claimant, and claimant's attorney or representative, and other necessary parties in interest. (e) Service upon a party who is not adverse to the interest of the appellant is optional, and failure to properly serve an optional party shall not be deemed to render the appeal defective. (v) Shall include any additional fee request in the format prescribed by the chair for fee requests. Failure to request an additional fee in the prescribed format shall result in waiver of such fee.

(i) shall specify the issues and grounds for the appeal;

(ii) shall specify the objection or exception that was interposed to the ruling, and when the objection or exception was interposed;

(iii) shall, when filed by an employer or carrier, specify which payments are continuing pending resolution of the administrative appeal, and which payments are stayed pursuant to section 23 and subdivision (3)(f) of section 25 of the Workers' Compensation Law;

(iv) shall include proof of service upon all necessary parties of interest, in the format prescribed by the chair. Service upon a party who is not adverse to the interest of the appellant may not render the appeal defective as such party is not a necessary party of interest. Failure to properly serve a necessary party shall be deemed defective service and the application may be rejected by the board. (a) Proof of service in the format prescribed by the chair shall specify the papers served, the person who was served, the date, and method of service including the actual address, email address or fax number where service was transmitted. An affidavit, affirmation, or other satisfactory proof of service as prescribed by the chair, shall be submitted with the application for administrative review to the board. The affidavit, affirmation, or other proof of service must certify that all service was completed within 30 days from the filing of the decision that is the subject of the application for administrative review. (b) There is no requirement that each party be served in the same manner. Service is deemed timely if completed by the party of interest within 30 days of the filing of the decision by the board. (c) Unless the chair directs service by electronic means, the appellant must certify in the affidavit or affirmation of service, that the party served provided explicit permission to receive service by fax, email, or other electronic means. (d) When the administrative appeal is filed by the carrier, self-insured employer, or other payor or potential payor, service shall be upon the claimant, and claimant's attorney or representative, and other necessary parties in interest. (e) Service upon a party who is not adverse to the interest of the appellant is optional, and failure to properly serve an optional party shall not be deemed to render the appeal defective.

(a) Proof of service in the format prescribed by the chair shall specify the papers served, the person who was served, the date, and method of service including the actual address, email address or fax number where service was transmitted. An affidavit, affirmation, or other satisfactory proof of service as prescribed by the chair, shall be submitted with the application for administrative review to the board. The affidavit, affirmation, or other proof of service must certify that all service was completed within 30 days from the filing of the decision that is the subject of the application for administrative review.

(b) There is no requirement that each party be served in the same manner. Service is deemed timely if completed by the party of interest within 30 days of the filing of the decision by the board.

(c) Unless the chair directs service by electronic means, the appellant must certify in the affidavit or affirmation of service, that the party served provided explicit permission to receive service by fax, email, or other electronic means.

(d) When the administrative appeal is filed by the carrier, self-insured employer, or other payor or potential payor, service shall be upon the claimant, and claimant's attorney or representative, and other necessary parties in interest.

(e) Service upon a party who is not adverse to the interest of the appellant is optional, and failure to properly serve an optional party shall not be deemed to render the appeal defective.

(v) Shall include any additional fee request in the format prescribed by the chair for fee requests. Failure to request an additional fee in the prescribed format shall result in waiver of such fee.

(3) Filing with the board.(i) The application shall be filed with the board within 30 days after the notice of the filing of the decision. All filings must be made using methods designated, permitted, and prescribed by the chair. If more than one filing option is permitted by the chair, the appellant shall choose one method for filing. Any duplicate filings may be deemed to be raising or continuing an issue without reasonable grounds, and may subject the appellant to assessments under 114-a(3) of the Workers' Compensation Law. (ii) Method of filing the application: (a) by mail shall be sent to the board's designated centralized mailing address; (b) by fax shall be sent to the board's designated centralized fax number; (c) by email shall be sent to the board's designated email address for claims documents; (d) by electronic means shall be filed in the method and manner prescribed by the chair. An application that is submitted by electronic means in accordance with this subparagraphs shall not be deemed filed with the board until such submission is received and acknowledged by the board. (iii) The chair may prescribe and require the format and the methods of filing of administrative appeals, including by electronic means, and may set the requirements to include various data fields, except that claimants who are unrepresented are exempt from the requirement to file electronically.

(i) The application shall be filed with the board within 30 days after the notice of the filing of the decision. All filings must be made using methods designated, permitted, and prescribed by the chair. If more than one filing option is permitted by the chair, the appellant shall choose one method for filing. Any duplicate filings may be deemed to be raising or continuing an issue without reasonable grounds, and may subject the appellant to assessments under 114-a(3) of the Workers' Compensation Law.

(ii) Method of filing the application: (a) by mail shall be sent to the board's designated centralized mailing address; (b) by fax shall be sent to the board's designated centralized fax number; (c) by email shall be sent to the board's designated email address for claims documents; (d) by electronic means shall be filed in the method and manner prescribed by the chair. An application that is submitted by electronic means in accordance with this subparagraphs shall not be deemed filed with the board until such submission is received and acknowledged by the board.

(a) by mail shall be sent to the board's designated centralized mailing address;

(b) by fax shall be sent to the board's designated centralized fax number;

(c) by email shall be sent to the board's designated email address for claims documents;

(d) by electronic means shall be filed in the method and manner prescribed by the chair. An application that is submitted by electronic means in accordance with this subparagraphs shall not be deemed filed with the board until such submission is received and acknowledged by the board.

(iii) The chair may prescribe and require the format and the methods of filing of administrative appeals, including by electronic means, and may set the requirements to include various data fields, except that claimants who are unrepresented are exempt from the requirement to file electronically.

(4) Denial of review. The application for review may be denied under the following circumstances: (i) by letter issued by the chair or the chair's designee when the appellant, other than a claimant who is not represented, does not comply with prescribed formatting, completion and service submission requirements; (ii) by decision of the board panel, when the appellant does not file the application within 30 days; (iii) by decision of the board panel, when the appellant does not properly file the application with the board; and (iv) by decision of the board panel, when the appellant does not provide proper proof of timely service upon a necessary party in interest other than a party who is not adverse to the appellant. When the appellant fails to supply proper proof of timely service upon a necessary party. (a) When a rebuttal is submitted, the necessary party shall raise the issue of defective service in its rebuttal. Failure to raise the issue of defective service in the rebuttal shall constitute a waiver of the issue. (b) When no rebuttal is filed, the board may consider whether the application was defectively served, and if so, the board may deny review without decision. (v) By decision of the board panel, where the appellant did not interpose a specific objection or exception to a ruling or award by a Workers' Compensation Law judge. (a) Where a decision is made at a hearing, the appellant did not preserve a specific objection to the ruling or award at the hearing on the record. (b) Where proceedings occur off-calendar, such as at a deposition, the appellant did not preserve objections on the record at the start of or conclusion of the proceeding as to qualifications of the deponent, or admissibility of any medical report or report of independent medical examination. (c) No objection to findings made by reserved decision that have not been previously made at a hearing, need be interposed prior to filing of an application for review. (c) Rebuttal. A party adverse to the application for administrative review may file a rebuttal to such application for review. The rebuttal shall be in writing and, for parties other than an unrepresented claimant, shall be accompanied by a cover sheet in the format prescribed by the chair. The rebuttal shall conform to the requirements for requests for administrative review set forth in subdivision (b) of this section. Such rebuttal shall be served on the board and all necessary parties within 30 days after service of the application for review together with proof of service upon all necessary parties in the form and format prescribed by the chair. (d) The board shall have the verbatim records of all hearings and proceedings placed in the case file it maintains in a readable, viewable or audible format where the issue or issues raised in the application for review were covered, and the case file shall only be considered by a board panel after the verbatim records covering the disputed issues are inserted in the case file. (e) Stay of payments. There is no stay of any payment due to the claimant or the board upon a filing of an application for full board review. (f) When a claimant is not represented, the board shall have discretion to waive the requirements contained in this section. An unrepresented claimant, who subsequently retains counsel, may have the procedural requirements of this section waived for the time when he or she was unrepresented.

(i) by letter issued by the chair or the chair's designee when the appellant, other than a claimant who is not represented, does not comply with prescribed formatting, completion and service submission requirements;

(ii) by decision of the board panel, when the appellant does not file the application within 30 days;

(iii) by decision of the board panel, when the appellant does not properly file the application with the board; and

(iv) by decision of the board panel, when the appellant does not provide proper proof of timely service upon a necessary party in interest other than a party who is not adverse to the appellant. When the appellant fails to supply proper proof of timely service upon a necessary party. (a) When a rebuttal is submitted, the necessary party shall raise the issue of defective service in its rebuttal. Failure to raise the issue of defective service in the rebuttal shall constitute a waiver of the issue. (b) When no rebuttal is filed, the board may consider whether the application was defectively served, and if so, the board may deny review without decision.

(a) When a rebuttal is submitted, the necessary party shall raise the issue of defective service in its rebuttal. Failure to raise the issue of defective service in the rebuttal shall constitute a waiver of the issue.

(b) When no rebuttal is filed, the board may consider whether the application was defectively served, and if so, the board may deny review without decision.

(v) By decision of the board panel, where the appellant did not interpose a specific objection or exception to a ruling or award by a Workers' Compensation Law judge. (a) Where a decision is made at a hearing, the appellant did not preserve a specific objection to the ruling or award at the hearing on the record. (b) Where proceedings occur off-calendar, such as at a deposition, the appellant did not preserve objections on the record at the start of or conclusion of the proceeding as to qualifications of the deponent, or admissibility of any medical report or report of independent medical examination. (c) No objection to findings made by reserved decision that have not been previously made at a hearing, need be interposed prior to filing of an application for review. (c) Rebuttal. A party adverse to the application for administrative review may file a rebuttal to such application for review. The rebuttal shall be in writing and, for parties other than an unrepresented claimant, shall be accompanied by a cover sheet in the format prescribed by the chair. The rebuttal shall conform to the requirements for requests for administrative review set forth in subdivision (b) of this section. Such rebuttal shall be served on the board and all necessary parties within 30 days after service of the application for review together with proof of service upon all necessary parties in the form and format prescribed by the chair. (d) The board shall have the verbatim records of all hearings and proceedings placed in the case file it maintains in a readable, viewable or audible format where the issue or issues raised in the application for review were covered, and the case file shall only be considered by a board panel after the verbatim records covering the disputed issues are inserted in the case file. (e) Stay of payments. There is no stay of any payment due to the claimant or the board upon a filing of an application for full board review. (f) When a claimant is not represented, the board shall have discretion to waive the requirements contained in this section. An unrepresented claimant, who subsequently retains counsel, may have the procedural requirements of this section waived for the time when he or she was unrepresented.

(a) Where a decision is made at a hearing, the appellant did not preserve a specific objection to the ruling or award at the hearing on the record.

(b) Where proceedings occur off-calendar, such as at a deposition, the appellant did not preserve objections on the record at the start of or conclusion of the proceeding as to qualifications of the deponent, or admissibility of any medical report or report of independent medical examination.

(c) No objection to findings made by reserved decision that have not been previously made at a hearing, need be interposed prior to filing of an application for review.

(c) Rebuttal. A party adverse to the application for administrative review may file a rebuttal to such application for review. The rebuttal shall be in writing and, for parties other than an unrepresented claimant, shall be accompanied by a cover sheet in the format prescribed by the chair. The rebuttal shall conform to the requirements for requests for administrative review set forth in subdivision (b) of this section. Such rebuttal shall be served on the board and all necessary parties within 30 days after service of the application for review together with proof of service upon all necessary parties in the form and format prescribed by the chair.

(d) The board shall have the verbatim records of all hearings and proceedings placed in the case file it maintains in a readable, viewable or audible format where the issue or issues raised in the application for review were covered, and the case file shall only be considered by a board panel after the verbatim records covering the disputed issues are inserted in the case file.

(e) Stay of payments. There is no stay of any payment due to the claimant or the board upon a filing of an application for full board review.

(f) When a claimant is not represented, the board shall have discretion to waive the requirements contained in this section. An unrepresented claimant, who subsequently retains counsel, may have the procedural requirements of this section waived for the time when he or she was unrepresented.

Aggregated from public-domain New York law; no amendment recorded since codification.

Whenever, on the board's own motion, a case is accepted for review by the full board, notice thereof shall be mailed to the claimant, his representative, if any, the employer, the carrier and the special fund, if it is a party in interest.

Aggregated from public-domain New York law; last amended effective 2023-01-01.

(a) An attorney or licensed representative shall file a notice of retainer and appearance, and, when appropriate, a notice of substitution, in the format prescribed by the chair, immediately upon being retained. The attorney or licensed representative shall also transmit a copy of such notice to the insurance carrier, self-insured or other representative of the employer at the time of filing.

(b) (1) An attorney or licensed representative, substituted for a former attorney or licensed representative, shall immediately upon being retained serve the former attorney or licensed representative with a copy of the notice of substitution. (2) An attorney or licensed representative may withdraw from representation of a claimant when: (i) a notice of substitution has been filed; or (ii) a withdrawal of representation completed in the format prescribed by the Chair has been filed and approved by a Workers' Compensation Law Judge or conciliator. Failure to obtain the approval of a Workers' Compensation Law Judge or conciliator prior to ceasing representation of a claimant, when a notice of substitution has not been filed, will constitute the basis of a referral for a violation of 22 NYCRR, Part 1200.0, Rules of Professional Conduct, Rule 1.16 for an attorney, and may be the basis for license revocation of a licensed representative.

(1) An attorney or licensed representative, substituted for a former attorney or licensed representative, shall immediately upon being retained serve the former attorney or licensed representative with a copy of the notice of substitution.

(2) An attorney or licensed representative may withdraw from representation of a claimant when: (i) a notice of substitution has been filed; or (ii) a withdrawal of representation completed in the format prescribed by the Chair has been filed and approved by a Workers' Compensation Law Judge or conciliator. Failure to obtain the approval of a Workers' Compensation Law Judge or conciliator prior to ceasing representation of a claimant, when a notice of substitution has not been filed, will constitute the basis of a referral for a violation of 22 NYCRR, Part 1200.0, Rules of Professional Conduct, Rule 1.16 for an attorney, and may be the basis for license revocation of a licensed representative.

(i) a notice of substitution has been filed; or

(ii) a withdrawal of representation completed in the format prescribed by the Chair has been filed and approved by a Workers' Compensation Law Judge or conciliator. Failure to obtain the approval of a Workers' Compensation Law Judge or conciliator prior to ceasing representation of a claimant, when a notice of substitution has not been filed, will constitute the basis of a referral for a violation of 22 NYCRR, Part 1200.0, Rules of Professional Conduct, Rule 1.16 for an attorney, and may be the basis for license revocation of a licensed representative.

(c) An attorney or licensed representative shall file an application in the format prescribed by the Chair in each instance where a fee is requested pursuant to sections 24 and 24-a of the Workers' Compensation Law, except that where the fee requested is not more than $1000, the attorney or licensed representative may, in lieu of such written application, make an oral statement on the record setting forth the calculation used to determine the fee and certifying that the amount is in accordance with subparagraph (2) of Section 24 of the Workers' Compensation Law . Notwithstanding the foregoing, the Board may require an application in the format prescribed by the Chair for a fee of $1000 or less. Any fee application shall be accurately completed.

(d) Whenever a fee is requested in excess of $1000 for services rendered in conciliation, administrative determination, agreement pursuant to section 32 of the Workers' Compensation Law, or conference calendar processing, the request is to be made in the format prescribed by the Chair in each instance where a fee is requested. Such fee request shall set forth the calculation used to determine the fee and certify that the amount is in accordance with subparagraph (2) of Section 24 of the Workers' Compensation Law. Fees awarded in conciliation, administrative determination, agreement pursuant to section 32 of the Workers' Compensation Law, or conference calendar processing, may be approved by a conciliator or designee of the chair.

(e) Whenever an award is made to a claimant who is represented by an attorney or a licensed representative, and a written fee application is submitted, the Board in such case shall approve a fee in an amount commensurate with the services rendered and the amount of compensation awarded, having due regard for the financial status of the claimant . In approving such fee, the Board shall apply the provisions of the schedule set forth in subparagraph (2) of Section 24 of the Workers' Compensation Law.

(f) Whenever an attorney or licensed representative is notified, by notice of substitution or otherwise, that the claimant has terminated his or her retainer, the attorney or licensed representative, in each instance where a fee is requested for services rendered for which no previous fee has been approved, shall file an application for such final fee in the format prescribed by the Chair, within 30 days of the filing of the notice of substitution. Where the fee requested is not more than $1000, the attorney or licensed representative may make an oral statement on the record as to the services rendered at the first hearing held following notice to such attorney or licensed representative that the retainer has been terminated. The Board shall determine the amount of fees allocated to a prior attorney or licensed representative out of the total attorney's fees awarded. A substituted for attorney or licensed representative, and attorney or licensed representative currently retained by the claimant, shall each be given the opportunity to present the Board with their respective positions in writing prior to the allocation of the awarded attorney's fee.

(g) The Chair may require that an attorney or licensed representative with access via the internet to his or her client's electronic case folder receive Board notices via an electronic mailbox.

Aggregated from public-domain New York law; no amendment recorded since codification.

(a) Service of a copy of the notice of appeal shall be made upon all interested parties, and the original notice of appeal, with proof of service thereof, shall be served upon the office of the secretary of the board.

(b) In the event that the appellant wishes additional verbatim records of hearings or proceedings that are not in a viewable or audible format to be transcribed which heretofore have not been transcribed and made part of the case file maintained by the board, the board shall make arrangements for the immediate transcription of same, and such transcript shall be inserted in the case file. A copy of such transcript shall be furnished to the appellant upon the payment of the fees as required by section 122 of the Workers' Compensation Law.

(c) The designation of portions of the file made on behalf of the respondent board shall be made by its general counsel's office with the advice of the Attorney General. In the event that a respondent wishes additional verbatim records of hearing or proceedings that are not in a viewable or audible format to be transcribed which heretofore have not been transcribed and made part of the case file maintained by the board, the board shall make arrangements for the immediate transcription of the same, and such transcript shall be inserted in the case file. A copy of such transcript shall be furnished to the respondent upon the payment of the fees as required by section 122 of the Workers' Compensation Law, except that the board is not required to pay such fee.

(d) Upon the failure of the appellant to comply with the provisions of this section or for any other unreasonable delay in prosecuting an appeal or proceedings, any respondent may move to dismiss for lack of prosecution as provided in section 800.9(d) of the rules of the Appellate Division, Third Department (22 NYCRR 800.9[d]). Upon respondent's failure to comply with any provisions of this section the appellant may make application to the court pursuant to the provisions of such section 800.9(d) for the discretionary imposition of costs and disbursements.

(e) The board, upon request of any party, shall render a written decision in the event that there is an unresolved dispute as to the record list or the contents of the file maintained by the board.

(f) Within 30 days after certification of the record list, the board shall, at the prepaid expense of the respective parties other than the respondent Workers' Compensation Board, make arrangement for and provide each party with copies of the documents, exclusive of transcripts of hearings or proceedings recorded and transcribed by a board employed verbatim reporter, requested by each respective party. In the case of transcripts prepared by a board employed verbatim reporter, the respective parties, except for the Workers' Compensation Board, shall pay for copies of requested minutes directly to the verbatim reporter, and the board, in the interest of expediency, may in its discretion provide photocopies of the same. Any interested party, as authorized by section 110-a of the Workers' Compensation Law, upon prepayment of the appropriate fee, may request a copy of the entire board case file to be furnished to him/her.

(g) In the event an additional appeal is filed from a denial of an application to reconsider or reopen a case pending on appeal, said additional appeal shall be processed concurrently with the prior appeal and in accordance with the procedures and limitations set forth in this section. The record on appeal in such instances shall consist of the record list previously certified in accordance with the provisions of section 800.18(d) of the rules of the Appellate Division, Third Department (22 NYCRR 800.18[d]), and, in addition thereto, the parties may designate any additional documents in the board case file that they wish to include in the record list relative to the second appeal being filed.

(h) The chairman shall designate the secretary of the board or an attorney from the general counsel's office to certify the record on appeal as true and correct.

(i) All appeals to the Appellate Division, Third Department, taken under section 23 of the Workers' Compensation Law, shall conform to the requirements of the Civil Practice Law and Rules and the rules of the Appellate Division, Third Department, as supplemented by the provisions of this section. Nothing in this section is intended to restrict, limit or modify the right of an appellant from proceeding upon an appeal in the manner and form prescribed in the Civil Practice Law and Rules and the rules of the Appellate Division, Third Department.

Aggregated from public-domain New York law; last amended effective 2020-01-29.

(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.

Aggregated from public-domain New York law; no amendment recorded since codification.

(a) If in any claim where the questions of dependency, relationship and present existence are at issue, the persons claiming relation to or dependency upon a decedent employee under sections 16 and 17 of the Workers' Compensation Law cannot for good and sufficient reason appear before and be examined by a diplomatic or consular officer of the United States, as provided by section 121-a of the Workers' Compensation Law the board may require that such claimants appear before a person designated by it and that proofs on the questions at issue be submitted to such designated person as hereinafter provided. The parties in interest may by agreement or stipulation designate the person before whom such claimants are to appear and submit to examination, in which case the parties shall notify the board of such designation on a form prescribed by the chairman. In the absence of such agreement or stipulation and on application of any party in interest the board shall designate the person before whom appearance is to be made and testimony taken. The board shall send notice of the designation to the person designated. No person who has any interest in the claim or is related to any party in interest shall be so designated.

(b) The testimony of any person required to be examined and to appear before a diplomatic or consular officer of the United States or a designated person may be given wholly or partly in oral examination, be taken wholly or partly in written interrogatories, or by taking the deposition of such person. Where testimony is given orally before such officer or designated person, he shall make or cause to be made a full and complete record of the proceedings. Where oral examination is provided, the parties may be represented. Any adverse party may cross-examine such person required to appear and be examined, and shall have the right to so examine as to any oral testimony given even if the examination is partly by written interrogatories and such party has failed to file cross-interrogatories. All questions regarding the admissibility of evidence in connection with an examination by such officer or designated person may be raised at any hearing before the board and shall be determined by the board.

(c) The fees for services rendered and the actual and necessary expenses, disbursements or cost of the officer or person so designated shall be paid by the party making the application in an amount approved by the board, unless the officer or person so designated has waived the payment of the whole or any part thereof, or the parties have by agreement stipulated the amount and manner of such payment.

(d) The notice sent by the board to such designated person, copies of which shall be furnished to the parties in interest, shall contain the following: (1) the name and address of such designated person; (2) the time, place or location where such examination is to be held; (3) the name and address of the person to be examined or such description of an unnamed person as to clearly and definitely disclose his identity; (4) the subject matter about which such person is to be examined; (5) there shall also be sent a copy of this section and any interrogatories or cross-interrogatories to be propounded.

(1) the name and address of such designated person;

(2) the time, place or location where such examination is to be held;

(3) the name and address of the person to be examined or such description of an unnamed person as to clearly and definitely disclose his identity;

(4) the subject matter about which such person is to be examined;

(5) there shall also be sent a copy of this section and any interrogatories or cross-interrogatories to be propounded.

(e) The officer or designated person shall administer an oath to all persons before they testify or submit evidence.

(f) If written interrogatories are the method selected and agreed upon by the parties, and stipulation to such effect is filed with the board, or interrogatories are directed by the board, they may be settled by consent of the parties. When so settled, a signed stipulation with copies of such interrogatories, each in duplicate, shall be promptly sent to the board, which shall promptly issue an order under the seal of the board to the person selected in the manner aforesaid directing the taking of testimony on such interrogatories. If they are not so settled, the interrogatories and cross-interrogatories shall be settled as follows: (1) the interrogatories shall be served within 10 days after the date of agreement and stipulation by the parties to use interrogatories as the method or, after the date the board has directed the use of such method; (2) cross-interrogatories shall be served within 10 days after the service of the interrogatories, unless a different time is set by stipulation of the parties, or the board on application of a party has extended such time and fixed a reasonable time. If a party shall fail to serve cross-interrogatories within the time limited above therefor, he shall be deemed to have waived his right to proposed cross-interrogatories to the person whose deposition is to be taken. Either party within 10 days after the service of cross-interrogatories, or within two days after the time to serve cross-interrogatories has expired, may apply to the board for settlement of the interrogatories. In the absence of such application, the interrogatories and cross-interrogatories are to be deemed settled as served.

(1) the interrogatories shall be served within 10 days after the date of agreement and stipulation by the parties to use interrogatories as the method or, after the date the board has directed the use of such method;

(2) cross-interrogatories shall be served within 10 days after the service of the interrogatories, unless a different time is set by stipulation of the parties, or the board on application of a party has extended such time and fixed a reasonable time. If a party shall fail to serve cross-interrogatories within the time limited above therefor, he shall be deemed to have waived his right to proposed cross-interrogatories to the person whose deposition is to be taken. Either party within 10 days after the service of cross-interrogatories, or within two days after the time to serve cross-interrogatories has expired, may apply to the board for settlement of the interrogatories. In the absence of such application, the interrogatories and cross-interrogatories are to be deemed settled as served.

(g) The person before whom testimony is taken shall comply with the following directions: (1) If an exhibit is produced and proved, he shall annex to the deposition the exhibit, or a copy thereof if the original is not surrendered, subscribed by the witness proving it, and numbered or otherwise identified in writing thereon by the officer or person taking the deposition, who must subscribe his name thereto. (2) He shall subscribe his name to each single sheet of the deposition. (3) He shall annex to the deposition the papers authorizing him to proceed. (4) He shall annex to each deposition his certificate setting forth that the witness was duly sworn, and that the deposition was duly taken and is a true record of the testimony of the witness and of all questions and answers required to be inserted, that the signature of the witness to the deposition and any exhibit or copy attached thereto is genuine; a statement of all appearances by the parties and attorneys. (5) On the completion of the examination, he shall inclose in a single packet, securely sealed, the deposition or depositions and all papers required to be annexed thereto. (6) If the notice, stipulation or order contains a direction to return the deposition by mail, or if there is no direction as to the manner of the return, he must immediately deposit the packet in the post office, postage prepaid, and addressed to the Workers' Compensation Board, New York City, with whom it is required to be filed. (7) If the packet be transmitted through the post office, the clerk receiving it from the post office shall open it, indorse thereon his name and sign a note of the time of the receipt and opening thereof, and immediately file it in the case folder.

(1) If an exhibit is produced and proved, he shall annex to the deposition the exhibit, or a copy thereof if the original is not surrendered, subscribed by the witness proving it, and numbered or otherwise identified in writing thereon by the officer or person taking the deposition, who must subscribe his name thereto.

(2) He shall subscribe his name to each single sheet of the deposition.

(3) He shall annex to the deposition the papers authorizing him to proceed.

(4) He shall annex to each deposition his certificate setting forth that the witness was duly sworn, and that the deposition was duly taken and is a true record of the testimony of the witness and of all questions and answers required to be inserted, that the signature of the witness to the deposition and any exhibit or copy attached thereto is genuine; a statement of all appearances by the parties and attorneys.

(5) On the completion of the examination, he shall inclose in a single packet, securely sealed, the deposition or depositions and all papers required to be annexed thereto.

(6) If the notice, stipulation or order contains a direction to return the deposition by mail, or if there is no direction as to the manner of the return, he must immediately deposit the packet in the post office, postage prepaid, and addressed to the Workers' Compensation Board, New York City, with whom it is required to be filed.

(7) If the packet be transmitted through the post office, the clerk receiving it from the post office shall open it, indorse thereon his name and sign a note of the time of the receipt and opening thereof, and immediately file it in the case folder.

(h) If a deposition has been improperly or irregularly taken or returned, or if either party or his representative has practiced any fraud or unfair conduct in respect to such deposition, the board, upon application of the party aggrieved and notice thereof to the adverse party, may make an order for the suppression of the deposition.

Aggregated from public-domain New York law; no amendment recorded since codification.

The net proceeds received by claimant from a third-party action, less reasonable medical or funeral expenses paid or incurred by him, shall be credited to the carrier in determining whether deficiency compensation is due.

Aggregated from public-domain New York law; last amended effective 2022-01-24.

(a) Definitions. The following terms shall have the following meanings when used herein: (1) Disability event means any accident, including death resulting therefrom, occurring in the course of employment or any alleged accident, including death resulting therefrom, that results in personal injury which has caused or will cause a loss of time from regular duties of one day beyond the working day or shift on which the accident or alleged accident occurred, or which has required or will require medical treatment beyond ordinary first aid or more than two treatments by a person rendering first aid; or any disease or alleged disease, including death resulting therefrom, claimed to have been caused by the nature of the employment and contracted therein. (2) Electronic trading partner agreement means the agreement between the carrier, special fund or TPA, and the board that establishes the method and frequency of sending and receiving electronic reports including those required by this section. (3) Filed electronically means that the electronic transmission submitted by the carrier, special fund, or TPA has been accepted and acknowledged by the board. For the purpose of determining whether an electronic transmission has been timely submitted, any electronic transmission that is submitted to and accepted by the board within the time required by subdivisions (b), (c), (d) and (f) of this section shall be considered timely submitted when such electronic transmission is later acknowledged by the board even though the acknowledgement by the board may have occurred after the time required by subdivisions (b), (c), (d) and (f) of this section. (4) Special fund means any special fund maintained by the board or any administrator of such special fund that is responsible for paying compensation or medical treatment and care of injured workers, including but not limited to, the Special Fund for Reopened Cases created and governed by Workers' Compensation Law section 25-a and the Uninsured Employers' Fund created and governed by Workers' Compensation Law section 26-a. The chair may waive a special fund's obligations under this section. (5) Third party administrator or TPA means third party administrators responsible for all or part of the claims handling, pursuant to a contract, for the claims of the State Insurance Fund, stock corporations, mutual corporations or reciprocal insurers with which employers are insured to provide workers' compensation coverage, employers permitted to pay compensation directly under the provisions of Workers' Compensation Law section 50(3), (3-a) or (4), and any special fund maintained by the board that is responsible for paying for compensation benefits or medical treatment and care of injured workers.

(1) Disability event means any accident, including death resulting therefrom, occurring in the course of employment or any alleged accident, including death resulting therefrom, that results in personal injury which has caused or will cause a loss of time from regular duties of one day beyond the working day or shift on which the accident or alleged accident occurred, or which has required or will require medical treatment beyond ordinary first aid or more than two treatments by a person rendering first aid; or any disease or alleged disease, including death resulting therefrom, claimed to have been caused by the nature of the employment and contracted therein.

(2) Electronic trading partner agreement means the agreement between the carrier, special fund or TPA, and the board that establishes the method and frequency of sending and receiving electronic reports including those required by this section.

(3) Filed electronically means that the electronic transmission submitted by the carrier, special fund, or TPA has been accepted and acknowledged by the board. For the purpose of determining whether an electronic transmission has been timely submitted, any electronic transmission that is submitted to and accepted by the board within the time required by subdivisions (b), (c), (d) and (f) of this section shall be considered timely submitted when such electronic transmission is later acknowledged by the board even though the acknowledgement by the board may have occurred after the time required by subdivisions (b), (c), (d) and (f) of this section.

(4) Special fund means any special fund maintained by the board or any administrator of such special fund that is responsible for paying compensation or medical treatment and care of injured workers, including but not limited to, the Special Fund for Reopened Cases created and governed by Workers' Compensation Law section 25-a and the Uninsured Employers' Fund created and governed by Workers' Compensation Law section 26-a. The chair may waive a special fund's obligations under this section.

(5) Third party administrator or TPA means third party administrators responsible for all or part of the claims handling, pursuant to a contract, for the claims of the State Insurance Fund, stock corporations, mutual corporations or reciprocal insurers with which employers are insured to provide workers' compensation coverage, employers permitted to pay compensation directly under the provisions of Workers' Compensation Law section 50(3), (3-a) or (4), and any special fund maintained by the board that is responsible for paying for compensation benefits or medical treatment and care of injured workers.

(b) Mandatory first reports of injury and reports required by section 110 of the Workers' Compensation Law. (1) Mandatory first reports of injury. On or before the 18th day after the disability event or within 10 days after the employer has knowledge of the disability event, whichever period is the greater, the carrier, special fund, or TPA shall file electronically a first report of injury with the board. The lapse of 18 days from the disability event or 10 days from the employer's knowledge of the disability event does not relieve the carrier, special fund or TPA from its obligation under this subdivision to file electronically a mandatory first report of injury. Such report shall be filed electronically in the format prescribed by the chair and shall contain the data elements prescribed by the chair. (i) Medical only cases. When the disability event has not resulted in any compensable lost time and the carrier does not controvert the claim, the carrier, special fund or TPA must electronically file a mandatory first report of injury in the manner prescribed herein indicating that the carrier, special fund or TPA is providing coverage for medical expenses only. In such cases, the carrier, special fund or TPA is not required to file a subsequent report of injury except as set forth in paragraph (f)(2) of this section. When a carrier, special fund or TPA, takes action on the claim beyond payment of medical expenses, the action may not be included in a first report of injury, but rather must be electronically filed with the board in a subsequent report of injury as set forth in subdivisions (c), (d) and (f) of this section, or must be filed in accordance with subdivision (e) of this section. (ii) A notice of controversy included in a first report of injury. A mandatory first report of injury electronically filed in the manner prescribed herein, may include, but is not required to include, an initial notice of controversy required by subparagraph (a) of subdivision (2) of section 25 of the Workers' Compensation Law. An initial notice of controversy may always be filed as a subsequent report of injury as set forth in subdivision (c) of this section. When a carrier, special fund or TPA, takes action on the claim beyond the initial notice of controversy, the action may not be included in a first report of injury, but rather must be electronically filed with the board in a subsequent report of injury as set forth in subdivision (c) of this section. Unless it is filed on or before the greater of 18 days after the disability event or within 10 days after the employer has knowledge of the disability event as required by paragraph (1) of this subdivision, a notice of controversy may not be filed as a first report of injury. A notice that contains the relevant elements, as prescribed by the chair, of the subsequent report of injury and initial action shall be transmitted to the claimant and his or her attorney or licensed representative, if any, within one business day of the date it is filed electronically with the chair. Such notice shall be served in accordance with section 300.38 of this Part. (2) Reports required by section 110 of the Workers' Compensation Law. A mandatory first report of injury filed electronically by the carrier, special fund, or TPA pursuant to paragraph (1) of this subdivision shall satisfy the employer's obligation under subdivision (2) of section 110 of the Workers' Compensation Law when it is filed electronically within the time required in subdivision (2) of section 110. However, a report of injury filed by an employer in satisfaction of the requirements of subdivision (2) of section 110 of the Workers' Compensation Law is not a mandatory first report of injury unless such report is filed electronically by a carrier, special fund, or TPA in the format prescribed by the chair and contains all data elements prescribed by the chair as required in paragraph (1) of this subdivision. (3) Acquisition of claim from another carrier, special fund or TPA. A carrier, special fund or TPA shall file electronically a supplemental first report of injury with the board within 10 days of acquisition of the transfer of responsibility for a claim from another carrier, TPA or special fund that has previously filed a mandatory first report of injury with respect to the claim. In the event that a carrier, special fund, or TPA acquires responsibility for a claim transferred from another carrier, special fund or TPA, and a mandatory first report of injury has not yet been submitted to the board, such mandatory first report of injury shall be filed within 30 days of rejection by the board of the supplemental first report of injury or within 30 days of the acquisition of responsibility from the previous carrier, special fund or TPA when no supplemental first report of injury has been filed following acquisition. Such reports shall be filed electronically in the format prescribed by the chair and shall contain the data elements prescribed by the chair.

(1) Mandatory first reports of injury. On or before the 18th day after the disability event or within 10 days after the employer has knowledge of the disability event, whichever period is the greater, the carrier, special fund, or TPA shall file electronically a first report of injury with the board. The lapse of 18 days from the disability event or 10 days from the employer's knowledge of the disability event does not relieve the carrier, special fund or TPA from its obligation under this subdivision to file electronically a mandatory first report of injury. Such report shall be filed electronically in the format prescribed by the chair and shall contain the data elements prescribed by the chair. (i) Medical only cases. When the disability event has not resulted in any compensable lost time and the carrier does not controvert the claim, the carrier, special fund or TPA must electronically file a mandatory first report of injury in the manner prescribed herein indicating that the carrier, special fund or TPA is providing coverage for medical expenses only. In such cases, the carrier, special fund or TPA is not required to file a subsequent report of injury except as set forth in paragraph (f)(2) of this section. When a carrier, special fund or TPA, takes action on the claim beyond payment of medical expenses, the action may not be included in a first report of injury, but rather must be electronically filed with the board in a subsequent report of injury as set forth in subdivisions (c), (d) and (f) of this section, or must be filed in accordance with subdivision (e) of this section. (ii) A notice of controversy included in a first report of injury. A mandatory first report of injury electronically filed in the manner prescribed herein, may include, but is not required to include, an initial notice of controversy required by subparagraph (a) of subdivision (2) of section 25 of the Workers' Compensation Law. An initial notice of controversy may always be filed as a subsequent report of injury as set forth in subdivision (c) of this section. When a carrier, special fund or TPA, takes action on the claim beyond the initial notice of controversy, the action may not be included in a first report of injury, but rather must be electronically filed with the board in a subsequent report of injury as set forth in subdivision (c) of this section. Unless it is filed on or before the greater of 18 days after the disability event or within 10 days after the employer has knowledge of the disability event as required by paragraph (1) of this subdivision, a notice of controversy may not be filed as a first report of injury. A notice that contains the relevant elements, as prescribed by the chair, of the subsequent report of injury and initial action shall be transmitted to the claimant and his or her attorney or licensed representative, if any, within one business day of the date it is filed electronically with the chair. Such notice shall be served in accordance with section 300.38 of this Part.

(i) Medical only cases. When the disability event has not resulted in any compensable lost time and the carrier does not controvert the claim, the carrier, special fund or TPA must electronically file a mandatory first report of injury in the manner prescribed herein indicating that the carrier, special fund or TPA is providing coverage for medical expenses only. In such cases, the carrier, special fund or TPA is not required to file a subsequent report of injury except as set forth in paragraph (f)(2) of this section. When a carrier, special fund or TPA, takes action on the claim beyond payment of medical expenses, the action may not be included in a first report of injury, but rather must be electronically filed with the board in a subsequent report of injury as set forth in subdivisions (c), (d) and (f) of this section, or must be filed in accordance with subdivision (e) of this section.

(ii) A notice of controversy included in a first report of injury. A mandatory first report of injury electronically filed in the manner prescribed herein, may include, but is not required to include, an initial notice of controversy required by subparagraph (a) of subdivision (2) of section 25 of the Workers' Compensation Law. An initial notice of controversy may always be filed as a subsequent report of injury as set forth in subdivision (c) of this section. When a carrier, special fund or TPA, takes action on the claim beyond the initial notice of controversy, the action may not be included in a first report of injury, but rather must be electronically filed with the board in a subsequent report of injury as set forth in subdivision (c) of this section. Unless it is filed on or before the greater of 18 days after the disability event or within 10 days after the employer has knowledge of the disability event as required by paragraph (1) of this subdivision, a notice of controversy may not be filed as a first report of injury. A notice that contains the relevant elements, as prescribed by the chair, of the subsequent report of injury and initial action shall be transmitted to the claimant and his or her attorney or licensed representative, if any, within one business day of the date it is filed electronically with the chair. Such notice shall be served in accordance with section 300.38 of this Part.

(2) Reports required by section 110 of the Workers' Compensation Law. A mandatory first report of injury filed electronically by the carrier, special fund, or TPA pursuant to paragraph (1) of this subdivision shall satisfy the employer's obligation under subdivision (2) of section 110 of the Workers' Compensation Law when it is filed electronically within the time required in subdivision (2) of section 110. However, a report of injury filed by an employer in satisfaction of the requirements of subdivision (2) of section 110 of the Workers' Compensation Law is not a mandatory first report of injury unless such report is filed electronically by a carrier, special fund, or TPA in the format prescribed by the chair and contains all data elements prescribed by the chair as required in paragraph (1) of this subdivision.

(3) Acquisition of claim from another carrier, special fund or TPA. A carrier, special fund or TPA shall file electronically a supplemental first report of injury with the board within 10 days of acquisition of the transfer of responsibility for a claim from another carrier, TPA or special fund that has previously filed a mandatory first report of injury with respect to the claim. In the event that a carrier, special fund, or TPA acquires responsibility for a claim transferred from another carrier, special fund or TPA, and a mandatory first report of injury has not yet been submitted to the board, such mandatory first report of injury shall be filed within 30 days of rejection by the board of the supplemental first report of injury or within 30 days of the acquisition of responsibility from the previous carrier, special fund or TPA when no supplemental first report of injury has been filed following acquisition. Such reports shall be filed electronically in the format prescribed by the chair and shall contain the data elements prescribed by the chair.

(c) Mandatory subsequent reports of injury and initial action taken by carrier, special fund, or TPA. Within 18 days of the disability event or within 10 days after the employer has knowledge of the disability event, the carrier, special fund, or TPA shall file electronically one of the subsequent reports of injury and initial action listed below. The subsequent report of injury and initial action shall be filed electronically in the format prescribed by the chair and shall contain the data elements prescribed by the chair. A notice that contains the relevant elements, as prescribed by the chair, of the subsequent report of injury and initial action shall be transmitted to the claimant and his or her attorney or licensed representative, if any, within one business day of the date it is filed electronically with the chair. (1) Initial controversy. Unless submitted as a first report of injury in accordance with subparagraph (b)(1)(i) or (ii) of this section, the initial notice of controversy required by paragraph (a) of subdivision (2) of section 25 of the Workers' Compensation Law shall be filed electronically with the chair either on or before the 18th day after the disability event or within 10 days after the employer has knowledge of the disability event, whichever period is the greater. In addition to the notice to claimant and claimant's attorney or licensed representative set forth in this subdivision, such notice shall be served in accordance with section 300.38 of this Part. (2) Notice that right to compensation is not controverted and payment has begun. If the right to compensation is not controverted and the claimant has compensable lost time, the carrier, special fund, or TPA shall, either on or before the 18th day after the disability event or within ten days after the employer has knowledge of the disability event, whichever period is the greater, begin paying compensation and shall file electronically notice to the chair that payment of compensation has commenced. Such notice shall be made for all claims that are not controverted, including cases that are partially accepted by the carrier, special fund, or TPA or in which the employer is paying wages instead of compensation benefits paid by the carrier, special fund, or TPA. (3) Notice that right to compensation is not controverted, but payment has not begun. Unless submitted as a first report of injury in accordance with subparagraph (b)(1)(ii) of this section, if the right to compensation is not controverted but payment has not begun because no compensation is presently due and the claimant has compensable lost time, the carrier, special fund, or TPA shall file electronically notice with the chair on or before the 18th day after the disability event or within 10 days after the employer has knowledge of the disability event, whichever period is greater.

(1) Initial controversy. Unless submitted as a first report of injury in accordance with subparagraph (b)(1)(i) or (ii) of this section, the initial notice of controversy required by paragraph (a) of subdivision (2) of section 25 of the Workers' Compensation Law shall be filed electronically with the chair either on or before the 18th day after the disability event or within 10 days after the employer has knowledge of the disability event, whichever period is the greater. In addition to the notice to claimant and claimant's attorney or licensed representative set forth in this subdivision, such notice shall be served in accordance with section 300.38 of this Part.

(2) Notice that right to compensation is not controverted and payment has begun. If the right to compensation is not controverted and the claimant has compensable lost time, the carrier, special fund, or TPA shall, either on or before the 18th day after the disability event or within ten days after the employer has knowledge of the disability event, whichever period is the greater, begin paying compensation and shall file electronically notice to the chair that payment of compensation has commenced. Such notice shall be made for all claims that are not controverted, including cases that are partially accepted by the carrier, special fund, or TPA or in which the employer is paying wages instead of compensation benefits paid by the carrier, special fund, or TPA.

(3) Notice that right to compensation is not controverted, but payment has not begun. Unless submitted as a first report of injury in accordance with subparagraph (b)(1)(ii) of this section, if the right to compensation is not controverted but payment has not begun because no compensation is presently due and the claimant has compensable lost time, the carrier, special fund, or TPA shall file electronically notice with the chair on or before the 18th day after the disability event or within 10 days after the employer has knowledge of the disability event, whichever period is greater.

(d) Notice of controversy in the event of a notice of indexing. A notice of controversy that is permitted by subparagraph (b) of subdivision (2) of section 25 of the Workers' Compensation Law shall be filed electronically with the chair within 25 days of the date of mailing by the board of the notice of indexing. Such notice of controversy shall be filed electronically as a subsequent report of injury in the format prescribed by the chair for subsequent reports of injury and shall contain the data elements prescribed by the chair. A notice that contains the relevant elements, as prescribed by the chair, of the subsequent report of injury and initial action shall be transmitted to the claimant and his or her attorney or licensed representative, if any, within one business day of the date it is filed electronically with the chair. Such notice shall be served in accordance with section 300.38 of this Part.

(e) Notices and procedures when payments made pursuant to section 21-a of the Workers' Compensation Law. Notwithstanding any other provisions of this section or section 300.23 of this Part, the following procedures shall apply when a carrier, special fund, or TPA is unsure of the extent of its liability for a claim of compensation made under the Workers' Compensation Law: (1) If the carrier, special fund, or TPA is unsure of the extent of its liability for a claim of compensation, and elects to make temporary payments of compensation or payment for prescribed medicine pursuant to section 21-a of the Workers' Compensation Law, the carrier, special fund, or TPA may, when filing a notice pursuant to subdivision (c) of this section, and prior to any decision of the board establishing or disallowing the claim, begin temporary payments of compensation and/or prescribed medicine has commenced. Such notice shall be filed electronically in the format prescribed by the chair and shall contain the data elements prescribed by the chair. A notice of payments made pursuant to section 21-a of the Workers' Compensation Law that contains the relevant elements, as prescribed by the chair, shall be transmitted to the claimant and his or her attorney or licensed representative, if any, within one business day of the date it is filed electronically with the chair. Payments of temporary compensation and/or prescribed medicine may be made without prejudice and without admitting liability. (2) Upon receipt of the notice set forth in paragraph (1) of this subdivision, the board shall notify the employee that it has received a notice of payment of temporary compensation and/or prescribed medicine that payment of such compensation and the employee's acceptance thereof shall neither be an admission of liability by the carrier, special fund, or TPA nor prejudice the claim of the employee, and that payment of temporary compensation and/or prescribed medicine shall terminate upon either the lapse of one year from the date of first payment, or the filing of a notice of controversy, or the cessation of temporary payments by the carrier, special fund, or TPA upon the filing of notice, whichever is first. The board shall also notify the employee that he or she may be required to enter into a non-prejudicial agreement with the carrier, special fund, or TPA in order to ensure the continued payments of temporary compensation and/or prescribed medicine. (3) A carrier, special fund, or TPA may cease making temporary payments of compensation and/or prescribed medicine by delivering notice to the board and the employee, within five days after the last payment. The notice shall be in a format prescribed by the board and shall indicate whether the carrier, special fund, or TPA is now accepting liability for the claim or whether the carrier, special fund, or TPA is now controverting the claim. In any case in which temporary payments of compensation and/or prescribed medicine have been made and notice has been filed electronically with the board advising that temporary payments without prejudice have commenced, a notice of controversy is not required to be filed electronically on or before the 18th day after the disability event or within 10 days after the employer has knowledge of the disability event, or if applicable, within 25 days from the date of transmittal of the notice of indexing provided, however, that if the carrier, special fund, or TPA ceases making temporary payments of compensation and/or prescribed medicine, the filing electronically of a notice of controversy as prescribed in subdivision (c) of this section or within 10 days after delivery of notice that temporary payments of compensation and/or prescribed medicine have terminated, whichever is later, shall be deemed timely for the purposes of subdivision (2) of section 25 of the Workers' Compensation Law. (4) If the carrier, special fund, or TPA does not file electronically a notice of controversy with the board within one year from the commencement of payment of temporary compensation and/or prescribed medicine, the carrier, special fund, or TPA shall be deemed to have admitted liability for the claim, and a decision shall be issued establishing the claim.

(1) If the carrier, special fund, or TPA is unsure of the extent of its liability for a claim of compensation, and elects to make temporary payments of compensation or payment for prescribed medicine pursuant to section 21-a of the Workers' Compensation Law, the carrier, special fund, or TPA may, when filing a notice pursuant to subdivision (c) of this section, and prior to any decision of the board establishing or disallowing the claim, begin temporary payments of compensation and/or prescribed medicine has commenced. Such notice shall be filed electronically in the format prescribed by the chair and shall contain the data elements prescribed by the chair. A notice of payments made pursuant to section 21-a of the Workers' Compensation Law that contains the relevant elements, as prescribed by the chair, shall be transmitted to the claimant and his or her attorney or licensed representative, if any, within one business day of the date it is filed electronically with the chair. Payments of temporary compensation and/or prescribed medicine may be made without prejudice and without admitting liability.

(2) Upon receipt of the notice set forth in paragraph (1) of this subdivision, the board shall notify the employee that it has received a notice of payment of temporary compensation and/or prescribed medicine that payment of such compensation and the employee's acceptance thereof shall neither be an admission of liability by the carrier, special fund, or TPA nor prejudice the claim of the employee, and that payment of temporary compensation and/or prescribed medicine shall terminate upon either the lapse of one year from the date of first payment, or the filing of a notice of controversy, or the cessation of temporary payments by the carrier, special fund, or TPA upon the filing of notice, whichever is first. The board shall also notify the employee that he or she may be required to enter into a non-prejudicial agreement with the carrier, special fund, or TPA in order to ensure the continued payments of temporary compensation and/or prescribed medicine.

(3) A carrier, special fund, or TPA may cease making temporary payments of compensation and/or prescribed medicine by delivering notice to the board and the employee, within five days after the last payment. The notice shall be in a format prescribed by the board and shall indicate whether the carrier, special fund, or TPA is now accepting liability for the claim or whether the carrier, special fund, or TPA is now controverting the claim. In any case in which temporary payments of compensation and/or prescribed medicine have been made and notice has been filed electronically with the board advising that temporary payments without prejudice have commenced, a notice of controversy is not required to be filed electronically on or before the 18th day after the disability event or within 10 days after the employer has knowledge of the disability event, or if applicable, within 25 days from the date of transmittal of the notice of indexing provided, however, that if the carrier, special fund, or TPA ceases making temporary payments of compensation and/or prescribed medicine, the filing electronically of a notice of controversy as prescribed in subdivision (c) of this section or within 10 days after delivery of notice that temporary payments of compensation and/or prescribed medicine have terminated, whichever is later, shall be deemed timely for the purposes of subdivision (2) of section 25 of the Workers' Compensation Law.

(4) If the carrier, special fund, or TPA does not file electronically a notice of controversy with the board within one year from the commencement of payment of temporary compensation and/or prescribed medicine, the carrier, special fund, or TPA shall be deemed to have admitted liability for the claim, and a decision shall be issued establishing the claim.

(f) Subsequent reports of injury for certain payments and periodic summary of payments. (1) The carrier, special fund, or TPA shall file electronically a notice with the board within 16 days of: (i) a modification of any payment of compensation or payment of wages by the employer instead of compensation and the claim is not disputed; (ii) a suspension of any payment of compensation or payment of wages by the employer instead of compensation and the claim is not disputed; (iii) payment following acquisition of the transfer of responsibility for a claim from another carrier, TPA or special fund. Such notice shall be filed electronically by the carrier, special fund, or TPA when payment is made pursuant to subdivision (1) of section 25 of the Workers' Compensation Law or following direction by the board. Such notices shall be filed electronically in the format prescribed by the chair and shall contain the data elements prescribed by the chair. Such notice shall also include a total reporting of all other types of payments made by the carrier, special fund, or TPA as provided in paragraph (3) of this subdivision. A notice that contains the relevant elements, as prescribed by the chair, shall be transmitted to the claimant and his or her attorney or licensed representative, if any, within one business day of the date it is filed electronically with the chair. (2) Within 18 days of a resumption of payments for a disability becoming due, the carrier, special fund, or TPA shall file electronically with the board a subsequent report of injury indicating payments made to the claimant, or in the event that payments are not being made due to a credit owed to the carrier, special fund or third-party administrator, the amount of such total amount claimed and the amount credited by the carrier, special fund or third-party administrator from the payment due: A notice that contains the relevant elements, as prescribed by the chair, shall be transmitted to the claimant and his or her attorney or licensed representative, if any, within one business day of the date it is filed electronically with the chair. (3) In every case, the carrier, special fund, or TPA shall file electronically with the board a summary of all payments made to a claimant . The summary of payments shall include compensation payments, payment for medical care and treatment, and wages paid instead of compensation and the claim is not disputed. When the carrier, special fund, or TPA or employer has not made any such payments in the preceding 180 days, no report shall be filed. (i) Initial Summary report. The initial summary report shall be due: (A) within 180 days of the date of the disability event or, if there is no known date of disability event, the date of the initial first report of injury; or, (B) if the board directed continuing payments prior to 180 days of (A) herein, then within 180 days of such award. If the case is closed with no continuing payments, the summary report shall be due within 180 days of closure. The initial summary shall be due within 180 days of the initial direction to continue payments or the initial closure. (ii) Subsequent Summary Reports. Following the filing of an initial summary report in accordance with (i) herein, the carrier, special fund, or TPA shall file electronically a subsequent summary of all payments: (a) every 180 days from the initial award directing payment while such benefits continue. (b) Additionally, following a reopening of the case in accordance with section 300.14 of this Part when payment(s) have been directed pursuant to such reopening, a summary report shall be due within 180 days of the subsequent closing of the case following direction of the Board; or if awards are continuing, every 180 days from the initial award directing payment while such benefits continue. Such reports shall be filed electronically in the format prescribed by the chair and shall contain the data elements prescribed by the chair. Such summary shall also include a total reporting of other types of payments made by the carrier, special fund, or TPA as provided in paragraph (3) of this subdivision. (4) Reporting of other types of benefits. Upon submission of a subsequent report of injury required by paragraph (1), (2) or (3) of this subdivision, the carrier, special fund, or TPA shall be responsible for reporting the total amount and type of payments made in connection with the claim, including: (i) all penalties paid to the claimant or New York State; (ii) all medical expenses including payments to physicians, chiropractors, physical therapists or other medical providers, payments to hospitals, payments for pharmaceuticals, payments for dental expenses, payments for durable medical goods, payments for medical and travel expenses reimbursed to the claimant, any other medical expenses; (iii) attorney fees or other legal fees; (iv) interest paid. Such reports shall be filed electronically in the format prescribed by the chair and shall contain the data elements prescribed by the chair. (5) Penalties paid to claimant. A report of any penalty paid in whole or in part to the claimant must be filed electronically with the board within 10 days of such payment. Such reports must be made for penalties issued pursuant to sections 13 (i)(3), 14-a, 23, 25, 220 (4) of the Workers' Compensation Law and subdivision (h) of section 300.36 of this Part.

(1) The carrier, special fund, or TPA shall file electronically a notice with the board within 16 days of: (i) a modification of any payment of compensation or payment of wages by the employer instead of compensation and the claim is not disputed; (ii) a suspension of any payment of compensation or payment of wages by the employer instead of compensation and the claim is not disputed; (iii) payment following acquisition of the transfer of responsibility for a claim from another carrier, TPA or special fund. Such notice shall be filed electronically by the carrier, special fund, or TPA when payment is made pursuant to subdivision (1) of section 25 of the Workers' Compensation Law or following direction by the board. Such notices shall be filed electronically in the format prescribed by the chair and shall contain the data elements prescribed by the chair. Such notice shall also include a total reporting of all other types of payments made by the carrier, special fund, or TPA as provided in paragraph (3) of this subdivision. A notice that contains the relevant elements, as prescribed by the chair, shall be transmitted to the claimant and his or her attorney or licensed representative, if any, within one business day of the date it is filed electronically with the chair.

(i) a modification of any payment of compensation or payment of wages by the employer instead of compensation and the claim is not disputed;

(ii) a suspension of any payment of compensation or payment of wages by the employer instead of compensation and the claim is not disputed;

(iii) payment following acquisition of the transfer of responsibility for a claim from another carrier, TPA or special fund. Such notice shall be filed electronically by the carrier, special fund, or TPA when payment is made pursuant to subdivision (1) of section 25 of the Workers' Compensation Law or following direction by the board. Such notices shall be filed electronically in the format prescribed by the chair and shall contain the data elements prescribed by the chair. Such notice shall also include a total reporting of all other types of payments made by the carrier, special fund, or TPA as provided in paragraph (3) of this subdivision. A notice that contains the relevant elements, as prescribed by the chair, shall be transmitted to the claimant and his or her attorney or licensed representative, if any, within one business day of the date it is filed electronically with the chair.

(2) Within 18 days of a resumption of payments for a disability becoming due, the carrier, special fund, or TPA shall file electronically with the board a subsequent report of injury indicating payments made to the claimant, or in the event that payments are not being made due to a credit owed to the carrier, special fund or third-party administrator, the amount of such total amount claimed and the amount credited by the carrier, special fund or third-party administrator from the payment due: A notice that contains the relevant elements, as prescribed by the chair, shall be transmitted to the claimant and his or her attorney or licensed representative, if any, within one business day of the date it is filed electronically with the chair.

(3) In every case, the carrier, special fund, or TPA shall file electronically with the board a summary of all payments made to a claimant . The summary of payments shall include compensation payments, payment for medical care and treatment, and wages paid instead of compensation and the claim is not disputed. When the carrier, special fund, or TPA or employer has not made any such payments in the preceding 180 days, no report shall be filed. (i) Initial Summary report. The initial summary report shall be due: (A) within 180 days of the date of the disability event or, if there is no known date of disability event, the date of the initial first report of injury; or, (B) if the board directed continuing payments prior to 180 days of (A) herein, then within 180 days of such award. If the case is closed with no continuing payments, the summary report shall be due within 180 days of closure. The initial summary shall be due within 180 days of the initial direction to continue payments or the initial closure. (ii) Subsequent Summary Reports. Following the filing of an initial summary report in accordance with (i) herein, the carrier, special fund, or TPA shall file electronically a subsequent summary of all payments: (a) every 180 days from the initial award directing payment while such benefits continue. (b) Additionally, following a reopening of the case in accordance with section 300.14 of this Part when payment(s) have been directed pursuant to such reopening, a summary report shall be due within 180 days of the subsequent closing of the case following direction of the Board; or if awards are continuing, every 180 days from the initial award directing payment while such benefits continue. Such reports shall be filed electronically in the format prescribed by the chair and shall contain the data elements prescribed by the chair. Such summary shall also include a total reporting of other types of payments made by the carrier, special fund, or TPA as provided in paragraph (3) of this subdivision.

(i) Initial Summary report. The initial summary report shall be due: (A) within 180 days of the date of the disability event or, if there is no known date of disability event, the date of the initial first report of injury; or, (B) if the board directed continuing payments prior to 180 days of (A) herein, then within 180 days of such award. If the case is closed with no continuing payments, the summary report shall be due within 180 days of closure. The initial summary shall be due within 180 days of the initial direction to continue payments or the initial closure.

(A) within 180 days of the date of the disability event or, if there is no known date of disability event, the date of the initial first report of injury; or,

(B) if the board directed continuing payments prior to 180 days of (A) herein, then within 180 days of such award. If the case is closed with no continuing payments, the summary report shall be due within 180 days of closure. The initial summary shall be due within 180 days of the initial direction to continue payments or the initial closure.

(ii) Subsequent Summary Reports. Following the filing of an initial summary report in accordance with (i) herein, the carrier, special fund, or TPA shall file electronically a subsequent summary of all payments: (a) every 180 days from the initial award directing payment while such benefits continue. (b) Additionally, following a reopening of the case in accordance with section 300.14 of this Part when payment(s) have been directed pursuant to such reopening, a summary report shall be due within 180 days of the subsequent closing of the case following direction of the Board; or if awards are continuing, every 180 days from the initial award directing payment while such benefits continue. Such reports shall be filed electronically in the format prescribed by the chair and shall contain the data elements prescribed by the chair. Such summary shall also include a total reporting of other types of payments made by the carrier, special fund, or TPA as provided in paragraph (3) of this subdivision.

(a) every 180 days from the initial award directing payment while such benefits continue.

(b) Additionally, following a reopening of the case in accordance with section 300.14 of this Part when payment(s) have been directed pursuant to such reopening, a summary report shall be due within 180 days of the subsequent closing of the case following direction of the Board; or if awards are continuing, every 180 days from the initial award directing payment while such benefits continue. Such reports shall be filed electronically in the format prescribed by the chair and shall contain the data elements prescribed by the chair. Such summary shall also include a total reporting of other types of payments made by the carrier, special fund, or TPA as provided in paragraph (3) of this subdivision.

(4) Reporting of other types of benefits. Upon submission of a subsequent report of injury required by paragraph (1), (2) or (3) of this subdivision, the carrier, special fund, or TPA shall be responsible for reporting the total amount and type of payments made in connection with the claim, including: (i) all penalties paid to the claimant or New York State; (ii) all medical expenses including payments to physicians, chiropractors, physical therapists or other medical providers, payments to hospitals, payments for pharmaceuticals, payments for dental expenses, payments for durable medical goods, payments for medical and travel expenses reimbursed to the claimant, any other medical expenses; (iii) attorney fees or other legal fees; (iv) interest paid. Such reports shall be filed electronically in the format prescribed by the chair and shall contain the data elements prescribed by the chair.

(i) all penalties paid to the claimant or New York State;

(ii) all medical expenses including payments to physicians, chiropractors, physical therapists or other medical providers, payments to hospitals, payments for pharmaceuticals, payments for dental expenses, payments for durable medical goods, payments for medical and travel expenses reimbursed to the claimant, any other medical expenses;

(iii) attorney fees or other legal fees;

(iv) interest paid. Such reports shall be filed electronically in the format prescribed by the chair and shall contain the data elements prescribed by the chair.

(5) Penalties paid to claimant. A report of any penalty paid in whole or in part to the claimant must be filed electronically with the board within 10 days of such payment. Such reports must be made for penalties issued pursuant to sections 13 (i)(3), 14-a, 23, 25, 220 (4) of the Workers' Compensation Law and subdivision (h) of section 300.36 of this Part.

(g) Effective dates. This regulation shall be effective on April 23, 2014. In order to file electronically, every carrier, special fund and TPAs, shall have completed an electronic trading partner agreement prior to that date.

(h) Where any notice is required to be transmitted to a claimant or his or her attorney or licensed representative, if any, the date such notice is actually mailed or otherwise transmitted shall be the date of transmittal, regardless of when received by the intended recipient.

Aggregated from public-domain New York law; last amended effective 2022-01-24.

(a) In any case where the carrier or employer has made payment without waiting for an award by the board, the filing of an electronic notice as prescribed in section 300.22(f) of this Part is not authority to suspend or reduce payments of compensation unless supporting evidence that the suspension or reduction of payment is justified is submitted in the format prescribed by the chair together with or on the same day as such notice. Supporting evidence may include: (1) a copy of the payroll report if the compensation rate is not based on information contained in the C-2 and is below the maximum; (2) medical or other reports (including notice of return to work) justifying the suspension or reduction of payments, or by indicating on such notice the name and date of the medical or other reports, if they have been previously filed; or (3) proof of incarceration upon conviction of a felony, which allows for the suspension of both wage replacement benefits and payment for causally related medical treatment.

(1) a copy of the payroll report if the compensation rate is not based on information contained in the C-2 and is below the maximum;

(2) medical or other reports (including notice of return to work) justifying the suspension or reduction of payments, or by indicating on such notice the name and date of the medical or other reports, if they have been previously filed; or

(3) proof of incarceration upon conviction of a felony, which allows for the suspension of both wage replacement benefits and payment for causally related medical treatment.

(b) In any case where the board has made an award of compensation for a temporary total or temporary partial disability at an established rate of compensation, and there is a direction for continuation of payments, the employer or carrier shall continue payments at such rate, and such payments shall not be suspended or reduced until: (1) there is filed with the chair in the district office where the case is assigned, a notice of intention to suspend or reduce in a format prescribed by the chair accompanied by supporting evidence justifying such suspension or reduction. A copy of the notice and supporting evidence shall be transmitted to the claimant and his or her attorney or licensed representative, if any, on the same day it is submitted to the board or if submitted electronically within one business day of the date it is filed electronically with the board; and (2) the chair, upon receipt of above, has scheduled a hearing or meeting or conference on the issue within 20 days during any period when regular hearings or meetings or conferences are scheduled, and there is a finding that such suspension or reduction is justified. At said hearing or meeting or conference, if either party fails to appear or fails to submit or file electronically any evidence as to the above issue, the board shall take such action as is appropriate under the circumstances including continuation, suspension or reduction of the award. Cases at hearing points which do not have regularly scheduled hearings or meetings or conferences within the 20 days, may be scheduled at another available hearing point. Upon a determination by the board that a suspension or reduction in payments is justified, the carrier, special fund or TPA shall file electronically the notice prescribed in section 300.22(f)(1) of this Part; (3) notwithstanding any provision to the contrary in this subdivision, the employer or carrier upon the filing of an electronic notice as prescribed in section 300.22(f) of this Part may suspend or reduce such payments: (i) where a notice of return to work, or other written substantial legal evidence of claimant's return to work, has been submitted to the board in the format prescribed by the chair together with or on the same day that the notice to suspend or reduce is electronically filed; or (ii) where the supporting evidence submitted to the board in the format prescribed by the chair together with or on the same day that the notice to suspend or reduce is electronically filed includes payroll records for at least two calendar weeks which warrant such suspension or reduction; or (iii) where the claimant's medical evidence indicates that the claimant has no disability. When such medical evidence is not part of the official board file, it shall be submitted to the board in the format prescribed by the chair together with or on the same day that the notice to suspend or reduce is electronically filed; or (iv) where supporting evidence submitted to the board in the format prescribed by the chair together with or on the same day that the notice to suspend or reduce is electronically filed includes proof of incarceration upon conviction of a felony.

(1) there is filed with the chair in the district office where the case is assigned, a notice of intention to suspend or reduce in a format prescribed by the chair accompanied by supporting evidence justifying such suspension or reduction. A copy of the notice and supporting evidence shall be transmitted to the claimant and his or her attorney or licensed representative, if any, on the same day it is submitted to the board or if submitted electronically within one business day of the date it is filed electronically with the board; and

(2) the chair, upon receipt of above, has scheduled a hearing or meeting or conference on the issue within 20 days during any period when regular hearings or meetings or conferences are scheduled, and there is a finding that such suspension or reduction is justified. At said hearing or meeting or conference, if either party fails to appear or fails to submit or file electronically any evidence as to the above issue, the board shall take such action as is appropriate under the circumstances including continuation, suspension or reduction of the award. Cases at hearing points which do not have regularly scheduled hearings or meetings or conferences within the 20 days, may be scheduled at another available hearing point. Upon a determination by the board that a suspension or reduction in payments is justified, the carrier, special fund or TPA shall file electronically the notice prescribed in section 300.22(f)(1) of this Part;

(3) notwithstanding any provision to the contrary in this subdivision, the employer or carrier upon the filing of an electronic notice as prescribed in section 300.22(f) of this Part may suspend or reduce such payments: (i) where a notice of return to work, or other written substantial legal evidence of claimant's return to work, has been submitted to the board in the format prescribed by the chair together with or on the same day that the notice to suspend or reduce is electronically filed; or (ii) where the supporting evidence submitted to the board in the format prescribed by the chair together with or on the same day that the notice to suspend or reduce is electronically filed includes payroll records for at least two calendar weeks which warrant such suspension or reduction; or (iii) where the claimant's medical evidence indicates that the claimant has no disability. When such medical evidence is not part of the official board file, it shall be submitted to the board in the format prescribed by the chair together with or on the same day that the notice to suspend or reduce is electronically filed; or (iv) where supporting evidence submitted to the board in the format prescribed by the chair together with or on the same day that the notice to suspend or reduce is electronically filed includes proof of incarceration upon conviction of a felony.

(i) where a notice of return to work, or other written substantial legal evidence of claimant's return to work, has been submitted to the board in the format prescribed by the chair together with or on the same day that the notice to suspend or reduce is electronically filed; or

(ii) where the supporting evidence submitted to the board in the format prescribed by the chair together with or on the same day that the notice to suspend or reduce is electronically filed includes payroll records for at least two calendar weeks which warrant such suspension or reduction; or

(iii) where the claimant's medical evidence indicates that the claimant has no disability. When such medical evidence is not part of the official board file, it shall be submitted to the board in the format prescribed by the chair together with or on the same day that the notice to suspend or reduce is electronically filed; or

(iv) where supporting evidence submitted to the board in the format prescribed by the chair together with or on the same day that the notice to suspend or reduce is electronically filed includes proof of incarceration upon conviction of a felony.

(c) (1) In any case where the board has made an award for compensation for permanent total or permanent partial disability, payments shall not be suspended or modified until an application on a prescribed form accompanied by supporting evidence, is made to reconsider the degree of impairment or wage-earning capacity; a copy of the application shall be transmitted to the claimant and his or her attorney or licensed representative, if any, on the same day it is submitted to the board or if submitted electronically within one business day of the date it is filed electronically with the board; and, the board has made a final determination of such application, finding that such suspension or modification is justified; provided, however, that if such supporting evidence includes payroll records which show earnings for at least eight weeks immediately prior to the date of the application which warrant modification of the rate fixed and evidence identifying the claimant as the person whose payroll records are being submitted, the employer or carrier shall continue to pay compensation at such modified rate as the evidence submitted indicates is proper, or may suspend payments if the evidence submitted supports such suspension, pending final determination of the application by the board. Upon a determination by the board that a suspension or reduction in payments is justified, the carrier, special fund or TPA shall file electronically the notice prescribed in section 300.22(f)(1) of this Part. (2) Notwithstanding any provision to the contrary in this subdivision, the employer or carrier may, within 16 days of stopping such payments in accordance with Workers' Compensation Law section 25(1)(d) and upon filing electronically a notice as prescribed in section 300.22(f) of this Part, stop, suspend or reduce such payments: (i) where supporting evidence, submitted to the board in the format prescribed by the chair together with or on the same day as such electronic notice, includes proof of incarceration upon conviction of a felony; or (ii) where compensation payable for permanent partial disability has reached the maximum benefit weeks allowed pursuant to Workers' Compensation Law section 15(3)(w). In either of the above circumstances, the employer or carrier must submit an electronic notice as prescribed in section 300.22(f) of this Part. (3) Payment of death benefits shall not be suspended unless an application in the format prescribed by the chair is made, accompanied by supporting evidence, and the board approves such suspension.

(1) In any case where the board has made an award for compensation for permanent total or permanent partial disability, payments shall not be suspended or modified until an application on a prescribed form accompanied by supporting evidence, is made to reconsider the degree of impairment or wage-earning capacity; a copy of the application shall be transmitted to the claimant and his or her attorney or licensed representative, if any, on the same day it is submitted to the board or if submitted electronically within one business day of the date it is filed electronically with the board; and, the board has made a final determination of such application, finding that such suspension or modification is justified; provided, however, that if such supporting evidence includes payroll records which show earnings for at least eight weeks immediately prior to the date of the application which warrant modification of the rate fixed and evidence identifying the claimant as the person whose payroll records are being submitted, the employer or carrier shall continue to pay compensation at such modified rate as the evidence submitted indicates is proper, or may suspend payments if the evidence submitted supports such suspension, pending final determination of the application by the board. Upon a determination by the board that a suspension or reduction in payments is justified, the carrier, special fund or TPA shall file electronically the notice prescribed in section 300.22(f)(1) of this Part.

(2) Notwithstanding any provision to the contrary in this subdivision, the employer or carrier may, within 16 days of stopping such payments in accordance with Workers' Compensation Law section 25(1)(d) and upon filing electronically a notice as prescribed in section 300.22(f) of this Part, stop, suspend or reduce such payments: (i) where supporting evidence, submitted to the board in the format prescribed by the chair together with or on the same day as such electronic notice, includes proof of incarceration upon conviction of a felony; or (ii) where compensation payable for permanent partial disability has reached the maximum benefit weeks allowed pursuant to Workers' Compensation Law section 15(3)(w). In either of the above circumstances, the employer or carrier must submit an electronic notice as prescribed in section 300.22(f) of this Part.

(i) where supporting evidence, submitted to the board in the format prescribed by the chair together with or on the same day as such electronic notice, includes proof of incarceration upon conviction of a felony; or

(ii) where compensation payable for permanent partial disability has reached the maximum benefit weeks allowed pursuant to Workers' Compensation Law section 15(3)(w). In either of the above circumstances, the employer or carrier must submit an electronic notice as prescribed in section 300.22(f) of this Part.

(3) Payment of death benefits shall not be suspended unless an application in the format prescribed by the chair is made, accompanied by supporting evidence, and the board approves such suspension.

(d) Whenever an employer or carrier shall seek to terminate medical care or refuse authorization for special medical services, except when a request for variance is denied, the chair prescribed form shall be completed and filed with the chair within five days after such termination or refusal, together with: (1) medical report by authorized physician that need for medical care has ended; (2) copy of notice to claimant's physician to discontinue medical care, or to refrain from commencing medical care, together with report of authorized physician establishing basis of discontinuance or refusal; and (3) proof of mailing notice under paragraph (2) of this subdivision to the claimant and his physician.

(1) medical report by authorized physician that need for medical care has ended;

(2) copy of notice to claimant's physician to discontinue medical care, or to refrain from commencing medical care, together with report of authorized physician establishing basis of discontinuance or refusal; and

(3) proof of mailing notice under paragraph (2) of this subdivision to the claimant and his physician.

(e) In any case in which a penalty has been imposed arising out of the failure to make payment of compensation according to the terms of the award within 10 days thereafter, the employer or his insurance carrier must file notice with the chair of the payment of such penalty within 10 days after the imposition thereof as set forth in section 300.22(f)(4) of this Part.

(f) Where any notice is required to be transmitted to a claimant or his or her attorney or licensed representative, if any, the date such notice is actually mailed or otherwise transmitted shall be the date of transmittal, regardless of when received by the intended recipient.

(g) In the event that the carrier, self-insured employer or third-party-administrator seeks to recover for an alleged overpayment of benefits to the claimant, such carrier, self-insured employer or third-party administrator must file notice to the Board in the format prescribed by the Chair that identifies the amount of such overpayment. Such prescribed notice shall be due as follows: (1) When a request for further action is submitted to the Board by the carrier, self-insured employer or third-party administrator, such prescribed notice requesting recovery of an overpayment shall be submitted on the same day as the request for further action. (2) When a hearing is scheduled and the carrier, self- insured employer or third-party administrator will request recovery of an overpayment at the scheduled hearing, the carrier, self- insured employer or third-party administrator must file the prescribed notice identifying the amount of the overpayment no less than ten days before the date of the hearing. The Workers' Compensation Law Judge will not consider any requests to direct recovery of an overpayment that are not timely made. (3) When the Board directs recovery of an overpayment, the carrier, self- insured employer or third-party administrator must file the prescribed notice identifying the amount of the overpayment within ten days of such decision.

(1) When a request for further action is submitted to the Board by the carrier, self-insured employer or third-party administrator, such prescribed notice requesting recovery of an overpayment shall be submitted on the same day as the request for further action.

(2) When a hearing is scheduled and the carrier, self- insured employer or third-party administrator will request recovery of an overpayment at the scheduled hearing, the carrier, self- insured employer or third-party administrator must file the prescribed notice identifying the amount of the overpayment no less than ten days before the date of the hearing. The Workers' Compensation Law Judge will not consider any requests to direct recovery of an overpayment that are not timely made.

(3) When the Board directs recovery of an overpayment, the carrier, self- insured employer or third-party administrator must file the prescribed notice identifying the amount of the overpayment within ten days of such decision.

Aggregated from public-domain New York law; no amendment recorded since codification.

Proceedings under subdivision 5-b of section 15 for approval of nonschedule adjustments may be conducted by a member of the board or a panel of the board. A member of the board may be designated by the chairman to act individually in the hearing and determination of such nonschedule adjustments pursuant to section 15, subdivision 5-b. Referees shall have no authority to approve such adjustments.

Aggregated from public-domain New York law; no amendment recorded since codification.

(a) A claimant residing outside the State more than 50 miles from the place of hearing may submit secondary evidence of such disfigurement in lieu of a personal appearance, unless his appearance is directed by the board or requested by the carrier.

(b) Secondary evidence shall consist of a clear color photograph, measuring at least 8" x 10", showing a close-up view of the face, head and/or neck region, and attached thereto, a notarized statement signed by the claimant, indicating that: (1) claimant resides outside the State and would have to travel more than 50 miles from outside the State to attend the hearing; (2) claimant posed for the photograph; and (3) the date the photograph was taken.

(1) claimant resides outside the State and would have to travel more than 50 miles from outside the State to attend the hearing;

(2) claimant posed for the photograph; and

(3) the date the photograph was taken.

(c) The expense of obtaining the secondary evidence shall be borne by the claimant, if claimant elects not to appear. Where, however, review is requested and secondary evidence is used, the cost shall be borne by the party requesting the review.

(d) The reasonable expense incurred by a claimant in attending a hearing in a disfigurement case, shall be borne by the carrier when: (1) the claimant, residing outside the State, is required to travel from outside the State, and the carrier requires the presence of the claimant at such a hearing; or (2) the claimant, residing and involved in travel within the State (where the carrier requests a board panel review) is required to appear at a hearing at a place other than where the original hearing was held before a Workers' Compensation Law judge.

(1) the claimant, residing outside the State, is required to travel from outside the State, and the carrier requires the presence of the claimant at such a hearing; or

(2) the claimant, residing and involved in travel within the State (where the carrier requests a board panel review) is required to appear at a hearing at a place other than where the original hearing was held before a Workers' Compensation Law judge.

(e) The provisions of this rule shall not in any way affect:(1) the right of the carrier to have the claimant examined by its consultant pursuant to section 13-a (4) of the Workers' Compensation Law; (2) the requirement for a medical report describing the scars, atrophy, deformity or discoloration of any part of the face, head and/or neck indicating their locations and indicating whether these are permanent; or (3) the authority of the board panel or Workers' Compensation Law judge to direct an impartial examination by a doctor in the area where the claimant resides, to be paid for by the carrier.

(1) the right of the carrier to have the claimant examined by its consultant pursuant to section 13-a (4) of the Workers' Compensation Law;

(2) the requirement for a medical report describing the scars, atrophy, deformity or discoloration of any part of the face, head and/or neck indicating their locations and indicating whether these are permanent; or

(3) the authority of the board panel or Workers' Compensation Law judge to direct an impartial examination by a doctor in the area where the claimant resides, to be paid for by the carrier.

Aggregated from public-domain New York law; last amended effective 2021-06-09.

(a) Scope. An injured worker or person entitled to a death benefit may elect to receive workers' compensation indemnity or death benefits by direct deposit to a bank account or bank accounts in the name of the injured worker or person entitled to a death benefit. Such election is not required to be offered for payment of fees due to the representative of the injured worker or person entitled to a death benefit or for payments due to a treating medical provider for payment of medical bills.

(b) Applicability. All carriers, self-insured employers, third-party administrators and Special Funds (including the Uninsured Employers Fund upon default of the uninsured employer) shall comply with this section by complying with subdivision (e) on or before July 1, 2021. Notwithstanding the foregoing, the Chair may toll the provisions of this section to accommodate a transition under Article 6-A to the Workers' Compensation Security Fund currently administered by the Liquidation Bureau of the Department of Financial Services.

(c) Requirements. A carrier, self-insured employer, third-party administrator or Special Fund must, upon receipt of the election of direct deposit from the injured worker or person entitled to a death benefit in the format prescribed by the Chair (Election Form), which includes all the data elements present on the Election Form on the Board's website and does not require additional data elements, allow an injured worker or person entitled to death benefit to receive payment of workers' compensation benefits by direct deposit to a bank account. For the purposes of this section direct deposit shall not include benefit payments loaded electronically onto a debit card associated to a bank. (1) The bank where any deposit is made must be a member of a New York Automated Clearinghouse. (2) Multiple bank accounts: (i) A carrier, self-insured employer and third-party administrator must permit workers' compensation benefits or death benefits to be deposited in at least two bank accounts at the request of the injured worker or person entitled to death benefits; and (ii) A carrier, self-insured employer and third-party administrator must permit an injured worker or person entitled to a death benefit to divide the deposits as a percentage of the total benefit or by a fixed dollar amount for each deposit.

(1) The bank where any deposit is made must be a member of a New York Automated Clearinghouse.

(2) Multiple bank accounts: (i) A carrier, self-insured employer and third-party administrator must permit workers' compensation benefits or death benefits to be deposited in at least two bank accounts at the request of the injured worker or person entitled to death benefits; and (ii) A carrier, self-insured employer and third-party administrator must permit an injured worker or person entitled to a death benefit to divide the deposits as a percentage of the total benefit or by a fixed dollar amount for each deposit.

(i) A carrier, self-insured employer and third-party administrator must permit workers' compensation benefits or death benefits to be deposited in at least two bank accounts at the request of the injured worker or person entitled to death benefits; and

(ii) A carrier, self-insured employer and third-party administrator must permit an injured worker or person entitled to a death benefit to divide the deposits as a percentage of the total benefit or by a fixed dollar amount for each deposit.

(d) A carrier, self-insured employer, third-party administrator or Special Fund may set a minimum amount for deposit into any single bank account when such set minimum amount does not exceed $20 per bi-weekly payment.

(e) One-time Notice to the Injured Worker or Person Entitled to a Death Benefit of Direct Deposit. (1) Within fourteen days of submission of a first report of injury to the Chair or accompanying the initial benefits check, whichever is earlier, the carrier, self-insured employer, third-party administrator or Special Fund shall provide the injured worker or person entitled to a death benefit, in the format prescribed by the Chair, with Notice of the right to receive payment by direct deposit together with the Election Form. In the event of a carrier's acquisition of a claim, any prior election shall remain in effect unless discontinued as otherwise provided in this Part. (2) On or before July 1, 2021, the carrier, self-insured employer, or third-party administrator shall publish on its website such Notice and Election Form in the format prescribed by the Chair together with instructions for submission of the Election Form. (3) When the first report of injury or payment of the initial benefits check was due prior to July 1, 2021, such Notice and Election Form in the format prescribed by the Chair, shall be transmitted to the injured worker or person entitled to a death benefit together with or before the next Subsequent Report of Injury reporting indemnity payments that becomes due or is submitted on or after July 1, 2021 in accordance with section 300.22 of this Title. (4) Unless specifically requested by the Board, such Notice and Form shall not be submitted to the Board, but shall be maintained by the carrier, self-insured employer, third-party administrator or Special Fund. (5) Such Notice and Election Form shall not be due when payment to the injured worker or person entitled to a death benefit is made by the employer in lieu of workers' compensation benefits (currently reported on a SROI-EP) or payment is made pursuant to a schedule loss of use award, or section thirty-two waiver agreement, or when an award is made with a direction that payments are not to continue beyond the date of the award.

(1) Within fourteen days of submission of a first report of injury to the Chair or accompanying the initial benefits check, whichever is earlier, the carrier, self-insured employer, third-party administrator or Special Fund shall provide the injured worker or person entitled to a death benefit, in the format prescribed by the Chair, with Notice of the right to receive payment by direct deposit together with the Election Form. In the event of a carrier's acquisition of a claim, any prior election shall remain in effect unless discontinued as otherwise provided in this Part.

(2) On or before July 1, 2021, the carrier, self-insured employer, or third-party administrator shall publish on its website such Notice and Election Form in the format prescribed by the Chair together with instructions for submission of the Election Form.

(3) When the first report of injury or payment of the initial benefits check was due prior to July 1, 2021, such Notice and Election Form in the format prescribed by the Chair, shall be transmitted to the injured worker or person entitled to a death benefit together with or before the next Subsequent Report of Injury reporting indemnity payments that becomes due or is submitted on or after July 1, 2021 in accordance with section 300.22 of this Title.

(4) Unless specifically requested by the Board, such Notice and Form shall not be submitted to the Board, but shall be maintained by the carrier, self-insured employer, third-party administrator or Special Fund.

(5) Such Notice and Election Form shall not be due when payment to the injured worker or person entitled to a death benefit is made by the employer in lieu of workers' compensation benefits (currently reported on a SROI-EP) or payment is made pursuant to a schedule loss of use award, or section thirty-two waiver agreement, or when an award is made with a direction that payments are not to continue beyond the date of the award.

(f) Discontinuing Direct Deposit or Electing Direct Deposit. Where benefit payments are ongoing, the carrier, self-insured employer or third-party administrator shall implement a request by the injured worker or person entitled to a death benefit to discontinue direct deposit, elect to begin direct deposit or change the bank accounts associated to a direct deposit within forty five days of receipt of the Election Form from the injured worker or person entitled to a death benefit, when such notice is made in the format prescribed by the Chair. When direct deposit is discontinued, payment of benefits shall be by check.

(g) Every Notice and Election Form for direct deposit shall inform the injured worker or person entitled to a death benefit of the obligation to immediately notify the carrier that in the event that the injured worker or person entitled to a death benefit is no longer entitled to such payment, the carrier shall be immediately notified. Further, the injured worker or person entitled to a death benefit shall immediately notify the carrier of any change in circumstances which would affect entitlement to receive the payment. In the event of failure to notify the carrier within 14 days of such change in circumstance, the carrier may avail itself of the procedure set forth in sections 300.23(a)(2) or 300.23(b)(3) of this Chapter.

(h) The carrier, self-insured employer, third-party administrator or Special Fund may annually request that an injured worker or person entitled to a death benefit certify that they continue to elect payment of workers' compensation benefits by direct deposit. Such request must offer options for return by mailing and by electronic means. In the event an injured worker or person entitled to a death benefit does not return the certification within sixty days, the carrier, self-insured employer, third-party administrator or Special Fund may discontinue direct deposit and make indemnity or death benefits due thereafter by check.

Aggregated from public-domain New York law; last amended effective 2016-05-18.

(a) Regular meetings of the Board shall be held monthly, except in the month of August, at the office of the Board [in Albany] in Schenectady, beginning at 10 o'clock in the forenoon on the third Tuesday of the month unless the third Tuesday is a legal holiday, in which event the regular meeting for that month shall be held on the Tuesday next following which is not a legal holiday. Notwithstanding the foregoing, the Board, at a regular meeting, or the Chair, in writing filed with the secretary, may provide that a particular subsequent regular meeting or meetings of the board may be held at any office of the Board at a time and day or days other than as above specified.

(b) In addition to the regular meetings, special meetings of the board may be called by the chair or by not less than five members. Each such call, whether by the chair or by five or more board members, shall be in writing, filed with the secretary, and shall state the business for which the special meeting is called. A copy of the call, together with notice of the place, date and hour of the meeting, shall be delivered [personally or mailed] as prescribed by the Chair to each board member not less than five business days prior to the date fixed for the special meeting.

(c) Notice of regular meetings shall not be required, except that if the place, date or hour of a regular meeting is changed by the chair as provided in subdivision (a) of this section, notice of the place, date or hour of the meeting shall be delivered [personally or mailed] as prescribed by the Chair to each board member not less than five business days prior to the date fixed for the regular meeting.

(d) The chair or, in his or her absence, the vice-chair shall preside at all board meetings. If at any board meeting neither the chair nor vice-chair shall be present, the members present shall designate one of the members to preside at such meeting.

(e) Business transacted at special meetings shall be confined to the business stated in the call, unless all board members shall consent to the transaction of additional or further items of business.

(f) At each regular meeting of the Board, the attorney responsible for overseeing adjudication, or his or her designee, shall report, orally or in writing, on the conduct and the status of the adjudication of claims by the Board, as the Board may require.

(g) Seven members present at any regular or special meeting shall constitute a quorum for the transaction of business, and no action shall be taken except by the assent of not less than seven members. Each member present at a meeting of the board shall vote on each question duly presented for action unless excused by the board, or unless he or she has a direct personal or pecuniary interest in the outcome of such question. An absent member may not be recorded as voting.

(h) The secretary shall keep minutes of all board meetings and provide the members with copies thereof.

(i) At any regular or special meeting of the Board, Board members, the Chair and Vice Chair may, at the discretion of the Chair, convene by electronic means, including but not limited to, teleconferencing and videoconferencing. The means of attendance shall be duly recorded in the minutes of the meeting by the secretary.

Aggregated from public-domain New York law; last amended effective 2014-04-02.

Any party liable for the payment of a compensation award may modify the distribution of such payment without the necessity of a Workers' Compensation Law judge hearing or notice of decision where such modification is made in order to comply with an income execution or income deduction issued pursuant to an order of support as defined in CPLR 5241 and CPLR 5242 which has been served upon said party. Where said party is otherwise required to file electronically a notice of payment modification pursuant to section 300.22, the notice of payment modification and a copy of the income execution or income deduction shall be submitted to the chair with copies thereof upon the claimant and his or her legal representative (if any). Any modification of payment made in compliance with an income execution or income deduction order for support enforcement issued pursuant to an order of support as defined in CPLR 5241 and CPLR 5242 shall not be grounds for imposition of a penalty under the Workers' Compensation Law, so long as the monies paid in compliance with the income execution or income deduction order are limited to those monies which would have been paid to the claimant, after payment of any liens for attorney or licensed representative fees, or for prior payment made by a disability benefits carrier, or for advance payments of compensation by an employer.

Aggregated from public-domain New York law; no amendment recorded since codification.

The board may in its discretion suspend or modify the application of any of these rules.

Aggregated from public-domain New York law; no amendment recorded since codification.

(a) Every contract of insurance, including any amendment, endorsement or rider thereto, which shall secure workers' compensation benefits pursuant to the Workers' Compensation Law, shall meet the requirements of the Workers' Compensation Law, Workers' Compensation Board, the Insurance Law and the Superintendent of Insurance.

(b) On April 1, 1988, each insurance carrier providing benefits pursuant to the Workers' Compensation Law shall file with the chairman, in a manner prescribed by the chairman, notification of the issuance, amendment, endorsement, rider or reinstatement of any workers' compensation insurance contract which took place between January 1, 1988 and April 1, 1988. Thereafter each such insurance carrier shall file with the chairman, in a manner prescribed by the chairman, notification of the issuance, amendment, endorsement, rider or reinstatement of any workers' compensation insurance contract within 30 days after such action by the insurance carrier.

(c) On April 1, 1988, each insurance carrier or the New York Compensation Insurance Rating Board shall notify the chairman, in a manner prescribed by the chairman, of all policies currently in force providing benefits under the Workers' Compensation Law.

(d) The provisions of this rule shall not apply with respect to any policy providing comprehensive personal liability insurance on a one-, two-, three- or four-family owner-occupied dwelling.

Aggregated from public-domain New York law; no amendment recorded since codification.

(a) A person legally responsible for a minor claimant means a natural or adoptive parent, stepparent or other relative who has custody of the claimant, or a court-appointed guardian.

(b) The Workers' Compensation Law judge, in any workers' compensation case in which an award of compensation made on or after January 1, 1989 is payable in whole or in part to a minor claimant, may, upon request of a person legally responsible for such claimant, designate such legally responsible person as payee to receive payments for the benefit of the minor claimant. Such designation shall be made at the same time the award is made.

(c) Notwithstanding a request by a person legally responsible for a minor claimant to be designated as payee to receive payments of compensation for the benefit of the minor claimant, the Workers' Compensation Law judge, when making an award to the minor claimant, may refuse to designate such legally responsible person as payee and may instead direct that payment of the award be made directly to the minor claimant. In making a determination whether to direct payment to the minor claimant, the Workers' Compensation Law judge may consider the ability of the minor claimant to manage the benefit payments in his or her own interest.

(d) A legally responsible person duly designated by a Workers' Compensation Law judge as a payee to receive payments for the benefit of such minor claimant has a responsibility to: (1) use such payments solely for the benefit of the minor claimant in a manner he or she determines to be in the best interest of the claimant; (2) notify the board of any event that will affect the amount of payments the minor claimant receives or the right of the minor claimant to receive payments; (3) notify the board of any change in his or her circumstances that would affect the performance of his or her responsibilities as payee; (4) submit to the chair, annually, or more often if required by the chair, a written report accounting for the payments received. Such report shall show: (i) the amount of benefit payments on hand at the beginning of the accounting period; (ii) the amount of benefit payments received during the accounting period; (iii) how the benefit payments were used; (iv) the balance on hand at the end of the accounting period; (v) where the minor claimant lived during the accounting period. A report made pursuant to this section shall be on a form prescribed by the chair, except that a guardian of the property of a minor appointed by a court of competent jurisdiction, if required to file an annual accounting report to such court, shall be deemed to comply with the requirements of this section by filing a copy of such report with the board.

(1) use such payments solely for the benefit of the minor claimant in a manner he or she determines to be in the best interest of the claimant;

(2) notify the board of any event that will affect the amount of payments the minor claimant receives or the right of the minor claimant to receive payments;

(3) notify the board of any change in his or her circumstances that would affect the performance of his or her responsibilities as payee;

(4) submit to the chair, annually, or more often if required by the chair, a written report accounting for the payments received. Such report shall show: (i) the amount of benefit payments on hand at the beginning of the accounting period; (ii) the amount of benefit payments received during the accounting period; (iii) how the benefit payments were used; (iv) the balance on hand at the end of the accounting period; (v) where the minor claimant lived during the accounting period. A report made pursuant to this section shall be on a form prescribed by the chair, except that a guardian of the property of a minor appointed by a court of competent jurisdiction, if required to file an annual accounting report to such court, shall be deemed to comply with the requirements of this section by filing a copy of such report with the board.

(i) the amount of benefit payments on hand at the beginning of the accounting period;

(ii) the amount of benefit payments received during the accounting period;

(iii) how the benefit payments were used;

(iv) the balance on hand at the end of the accounting period;

(v) where the minor claimant lived during the accounting period. A report made pursuant to this section shall be on a form prescribed by the chair, except that a guardian of the property of a minor appointed by a court of competent jurisdiction, if required to file an annual accounting report to such court, shall be deemed to comply with the requirements of this section by filing a copy of such report with the board.

(e) If the Workers' Compensation Law judge finds after a hearing that the legally responsible person designated as payee to receive payments for the benefit of the minor claimant is using the payments for purposes other than the benefit of the claimant, the Workers' Compensation Law judge shall revoke the designation of such legally responsible person as payee and shall either appoint a new payee, who shall be a person legally responsible for the minor claimant as defined in subdivision (a) of this section or such other suitable person who is responsible for, or contributing to, the care, maintenance or support of the minor claimant as the board may deem appropriate, or direct that payments be made directly to the minor claimant, in accordance with subdivision (c) of this section.

Aggregated from public-domain New York law; last amended effective 2014-04-02.

(a) Statement of purpose. To address the conduct and processing of pre-hearing conferences, to provide a mechanism for the identification of issues and relevant evidence and to permit parties an opportunity to assess their case and to resolve outstanding issues prior to scheduling a hearing regarding those issues.

(b) All cases in which a notice of controversy and a medical report referencing an injury are submitted, shall be scheduled for a pre-hearing conference to be held as soon as practicable, but in no event more than 30 calendar days after receipt by the board of the notice of controversy and a medical report referencing an injury. Cases with outstanding issues, which cannot be processed through conciliation or administrative determination, shall be referred to a pre-hearing conference when necessary to complete any discovery.

(c) In all cases the notice of pre-hearing conference shall be governed by section 300.38(b) of this Part.

(d) All represented parties must file a pre-hearing conference statement in accordance with section 300.38(f) of this Part.

(e) The pre-hearing conference shall be conducted in accordance with, and all parties must comply with, all the provisions in section 300.38(g) of this Part, if the claimant has retained a legal representative on or before the date of the pre-hearing conference.

(f) If the claimant has not retained a legal representative on or before the date of the pre-hearing conference, the following provisions shall apply: (1) Pre-hearing conferences shall be held before a Workers' Compensation Law judge or conciliator, who shall consider at the conference, with the parties or their authorized legal representatives, the following: (i) confirmation that all appropriate information, forms or notices, including completed medical reports, have been submitted and a verification that all information on the forms and notices is accurate; (ii) addition of any other necessary parties, where appropriate; (iii) simplification and limitation of factual and legal issues, where appropriate; (iv) presentation of a list of proposed witnesses, where appropriate; (v) production of depositions of proposed witnesses, where appropriate; (vi) scheduling the case for hearing; and (vii) entering into a stipulation made in writing, in which case it shall be signed by all parties to the stipulation. All parties to the stipulation shall certify that they have been advised of the legal effect of the stipulation and that they have agreed to the stipulation of their own free will. (2) Pre-hearing conferences may, if practicable, be held at each hearing location. (3) The pre-hearing conference shall be recorded. (4) Ten days before the pre-hearing conference, the insurance carrier shall file with the board a pre-hearing conference statement, on a form prescribed by the chair, noting all of the specific issues in dispute. The employer's or carrier's statement shall be accompanied by the carrier or employer's first report of injury and any medical reports, from a treating health provider(s) or consultants, which the employer or carrier has in its possession. (5) Insurance carriers filing pre-hearing conference statements and accompanying material as directed in paragraph (3) of this subdivision shall: (i) at the time of filing, also serve copies on all parties; and (ii) state that all discovery has been completed, or shall detail what further discovery is necessary and why it was not completed prior to the pre-hearing conference; and (iii) bring to the pre-hearing conference two copies of their conference statement and all accompanying material. (6) If the claimant has not filed the appropriate employee claim form described in section 300.37(b)(1)(i) of this Part prior to the pre-hearing conference, the claimant will be directed to complete and file such form at the pre-hearing conference. (7) If the insurance carrier requests an opportunity to have the claimant examined by an independent medical examiner, the independent medical examination report as provided in section 300.2(d)(3) of this Part (hereinafter referred to as IME report) must be completed, filed and served in accordance with Workers' Compensation Law, sections 13-b(4) and 137 and section 300.2(d) of this Part at least three days before the date set by the Workers' Compensation Law judge or conciliator for the hearing pursuant to paragraph (12) of this subdivision. The failure to file and serve the IME report by such date shall be a waiver of the insurance carrier's right to examine the claimant and to have filed on its behalf or otherwise have considered an IME report on the disputed issues, unless the insurance carrier makes a showing of good cause for such failure, and that it acted in good faith and with due diligence. The showing must be made by an affidavit by the insurance carrier or if represented, by its legal representative. Good cause shall include, but not be limited to, the inability to obtain medical records in advance of the hearing or the failure of the claimant to appear for an independent medical exam. (8) At the conclusion of the pre-hearing conference, the Workers' Compensation Law judge or conciliator shall issue an order, in writing: (i) simplifying and limiting the issues to be tried; (ii) setting forth the names of witnesses, the agreements of the parties, if any; (iii) the need for further discovery and its terms and conditions if authorized; (iv) directing the production of deposition transcripts, if appropriate, and further noting that the case is trial ready or will be ready by a specific date. (9) If the claimant fails to appear or is otherwise not prepared to proceed, the case shall be marked as no further action. The case shall be scheduled for another pre-hearing conference upon the claimant's application, advising that he or she is prepared to proceed. (10) If after being sent notice, the insurance carrier or its legal representative fails to appear, a Workers' Compensation Law judge will render a decision based upon the evidence contained in the board file. (11) Decisions containing orders or directions made by the Workers' Compensation Law judge or conciliator at the pre-hearing conference, pursuant to this section, shall be interlocutory, and shall not be reviewable by the board under section 23 of the Workers' Compensation Law until a decision has been rendered on the controverted issues. (12) The Workers' Compensation Law judge or conciliator presiding at the pre-hearing conference shall schedule the hearing date on which the testimony of the claimant and lay and medical witnesses shall be heard, to the extent such testimony is requested by any party, or in their absence, depositions shall be submitted into evidence. The hearing shall be scheduled to take place within 60 calendar days after the conclusion of the pre-hearing conference. Every effort shall be made to complete the presentation of evidence at a single hearing. Adjournments of such hearings shall be granted only as provided in section 300.10 of this Part. (13) Attendance fees for the testimony or deposition of physicians, podiatrists, chiropractors and psychologists directed pursuant to this section shall be governed by Part 301 of this Title.

(1) Pre-hearing conferences shall be held before a Workers' Compensation Law judge or conciliator, who shall consider at the conference, with the parties or their authorized legal representatives, the following: (i) confirmation that all appropriate information, forms or notices, including completed medical reports, have been submitted and a verification that all information on the forms and notices is accurate; (ii) addition of any other necessary parties, where appropriate; (iii) simplification and limitation of factual and legal issues, where appropriate; (iv) presentation of a list of proposed witnesses, where appropriate; (v) production of depositions of proposed witnesses, where appropriate; (vi) scheduling the case for hearing; and (vii) entering into a stipulation made in writing, in which case it shall be signed by all parties to the stipulation. All parties to the stipulation shall certify that they have been advised of the legal effect of the stipulation and that they have agreed to the stipulation of their own free will.

(i) confirmation that all appropriate information, forms or notices, including completed medical reports, have been submitted and a verification that all information on the forms and notices is accurate;

(ii) addition of any other necessary parties, where appropriate;

(iii) simplification and limitation of factual and legal issues, where appropriate;

(iv) presentation of a list of proposed witnesses, where appropriate;

(v) production of depositions of proposed witnesses, where appropriate;

(vi) scheduling the case for hearing; and

(vii) entering into a stipulation made in writing, in which case it shall be signed by all parties to the stipulation. All parties to the stipulation shall certify that they have been advised of the legal effect of the stipulation and that they have agreed to the stipulation of their own free will.

(2) Pre-hearing conferences may, if practicable, be held at each hearing location.

(3) The pre-hearing conference shall be recorded.

(4) Ten days before the pre-hearing conference, the insurance carrier shall file with the board a pre-hearing conference statement, on a form prescribed by the chair, noting all of the specific issues in dispute. The employer's or carrier's statement shall be accompanied by the carrier or employer's first report of injury and any medical reports, from a treating health provider(s) or consultants, which the employer or carrier has in its possession.

(5) Insurance carriers filing pre-hearing conference statements and accompanying material as directed in paragraph (3) of this subdivision shall: (i) at the time of filing, also serve copies on all parties; and (ii) state that all discovery has been completed, or shall detail what further discovery is necessary and why it was not completed prior to the pre-hearing conference; and (iii) bring to the pre-hearing conference two copies of their conference statement and all accompanying material.

(i) at the time of filing, also serve copies on all parties; and

(ii) state that all discovery has been completed, or shall detail what further discovery is necessary and why it was not completed prior to the pre-hearing conference; and

(iii) bring to the pre-hearing conference two copies of their conference statement and all accompanying material.

(6) If the claimant has not filed the appropriate employee claim form described in section 300.37(b)(1)(i) of this Part prior to the pre-hearing conference, the claimant will be directed to complete and file such form at the pre-hearing conference.

(7) If the insurance carrier requests an opportunity to have the claimant examined by an independent medical examiner, the independent medical examination report as provided in section 300.2(d)(3) of this Part (hereinafter referred to as IME report) must be completed, filed and served in accordance with Workers' Compensation Law, sections 13-b(4) and 137 and section 300.2(d) of this Part at least three days before the date set by the Workers' Compensation Law judge or conciliator for the hearing pursuant to paragraph (12) of this subdivision. The failure to file and serve the IME report by such date shall be a waiver of the insurance carrier's right to examine the claimant and to have filed on its behalf or otherwise have considered an IME report on the disputed issues, unless the insurance carrier makes a showing of good cause for such failure, and that it acted in good faith and with due diligence. The showing must be made by an affidavit by the insurance carrier or if represented, by its legal representative. Good cause shall include, but not be limited to, the inability to obtain medical records in advance of the hearing or the failure of the claimant to appear for an independent medical exam.

(8) At the conclusion of the pre-hearing conference, the Workers' Compensation Law judge or conciliator shall issue an order, in writing: (i) simplifying and limiting the issues to be tried; (ii) setting forth the names of witnesses, the agreements of the parties, if any; (iii) the need for further discovery and its terms and conditions if authorized; (iv) directing the production of deposition transcripts, if appropriate, and further noting that the case is trial ready or will be ready by a specific date.

(i) simplifying and limiting the issues to be tried;

(ii) setting forth the names of witnesses, the agreements of the parties, if any;

(iii) the need for further discovery and its terms and conditions if authorized;

(iv) directing the production of deposition transcripts, if appropriate, and further noting that the case is trial ready or will be ready by a specific date.

(9) If the claimant fails to appear or is otherwise not prepared to proceed, the case shall be marked as no further action. The case shall be scheduled for another pre-hearing conference upon the claimant's application, advising that he or she is prepared to proceed.

(10) If after being sent notice, the insurance carrier or its legal representative fails to appear, a Workers' Compensation Law judge will render a decision based upon the evidence contained in the board file.

(11) Decisions containing orders or directions made by the Workers' Compensation Law judge or conciliator at the pre-hearing conference, pursuant to this section, shall be interlocutory, and shall not be reviewable by the board under section 23 of the Workers' Compensation Law until a decision has been rendered on the controverted issues.

(12) The Workers' Compensation Law judge or conciliator presiding at the pre-hearing conference shall schedule the hearing date on which the testimony of the claimant and lay and medical witnesses shall be heard, to the extent such testimony is requested by any party, or in their absence, depositions shall be submitted into evidence. The hearing shall be scheduled to take place within 60 calendar days after the conclusion of the pre-hearing conference. Every effort shall be made to complete the presentation of evidence at a single hearing. Adjournments of such hearings shall be granted only as provided in section 300.10 of this Part.

(13) Attendance fees for the testimony or deposition of physicians, podiatrists, chiropractors and psychologists directed pursuant to this section shall be governed by Part 301 of this Title.

Aggregated from public-domain New York law; no amendment recorded since codification.

(a) Purpose. This rule is promulgated pursuant to the requirements of paragraph (d) of subdivision 3 of section 25 of the Workers' Compensation Law with regard to the special expedited hearing process for cases in which the issues have not been resolved within one year after such issues have been raised before the board, or if multiple claims arise from the same accident or occurrence, or if all parties agree to an expedited hearing, or if the chair otherwise deems it necessary. Cases in which a notice of controversy is filed are governed by section 300.38 of this Part.

(b) If, in any case, the issues have not been resolved within one year after such issues have been raised before the board, or if multiple claims arise from the same accident or occurrence, or if all parties agree to an expedited hearing, or if the chair otherwise deems it necessary, the chair or a person designated by the chair, on his or her own motion, or on motion of any party in interest, may order that the case be transferred to the special expedited hearing process.

(c) Each party shall, within twenty days after the order of transfer has been made, file with the board and serve upon all other parties a pre-hearing conference statement as set forth in section 300.33(c) of this Part if one was not filed before the transfer.

(d) Hearings in the special expedited hearing process:(1) shall be conducted by a Workers' Compensation Law judge; (2) shall be scheduled in such a manner so that, where appropriate, any and all outstanding issues may be addressed at one hearing; and (3) shall be scheduled within 30 days after the order of transfer.

(1) shall be conducted by a Workers' Compensation Law judge;

(2) shall be scheduled in such a manner so that, where appropriate, any and all outstanding issues may be addressed at one hearing; and

(3) shall be scheduled within 30 days after the order of transfer.

(e) Every legal representative or authorized representative of a carrier or self-insured employer who appears in proceedings in the special expedited hearing process shall be familiar with the facts of the case, the documents filed or to be filed, and the applicable law, and shall have the authority to negotiate and settle any and all outstanding issues, including authority to limit any issue previously raised, subject to the provisions of sections 300.5 and 300.36 of this Title.

(f) Adjournments. (1) Adjournments in cases transferred to the special expedited hearing process shall only be granted in accordance with section 300.38 of this Part. (2) If the adjournment is approved by the Workers' Compensation Law judge, the case shall be rescheduled as soon as practicable, but no later than 30 days following such adjournment. If the adjournment is denied, the case shall be decided on the record as it stands.

(1) Adjournments in cases transferred to the special expedited hearing process shall only be granted in accordance with section 300.38 of this Part.

(2) If the adjournment is approved by the Workers' Compensation Law judge, the case shall be rescheduled as soon as practicable, but no later than 30 days following such adjournment. If the adjournment is denied, the case shall be decided on the record as it stands.

(g) If, after reviewing the request for an adjournment, the Workers' Compensation Law judge determines that the request for an adjournment is not an emergency and is frivolous, a penalty shall be imposed as follows: (1) If the request is made by an insurance carrier, $1,000 payable to the board. If such insurance carrier is represented by a legal representative who is not an employee of the insurance carrier, the legal representative shall be responsible for the payment of such penalty. (2) If the request is made by a claimant who is represented by a legal representative, $500 payable to the board. Such penalty shall be paid directly by the legal representative and shall not come out of the claimant's award. (3) No penalty shall be imposed on an unrepresented claimant who requests an adjournment.

(1) If the request is made by an insurance carrier, $1,000 payable to the board. If such insurance carrier is represented by a legal representative who is not an employee of the insurance carrier, the legal representative shall be responsible for the payment of such penalty.

(2) If the request is made by a claimant who is represented by a legal representative, $500 payable to the board. Such penalty shall be paid directly by the legal representative and shall not come out of the claimant's award.

(3) No penalty shall be imposed on an unrepresented claimant who requests an adjournment.

(h) Decisions solely containing determinations, directions or orders made by a Workers' Compensation Law judge in the special expedited hearing process, pursuant to paragraph (d) of subdivision 3 of section 25 of the Workers' Compensation Law and this section, except a determination of accident or occupational disease, notice, and causal relationship or a monetary award, shall be interlocutory and shall not be reviewable by the board under section 23 of the Workers' Compensation Law until the conclusion of the trial and the resolution of all outstanding issues.

(i) This section, as amended, shall take effect immediately, and shall apply to all claims filed after such date.

Aggregated from public-domain New York law; no amendment recorded since codification.

(a) proof of release from custody; and

(b) up-to-date medical evidence where the claimant has not, as of the date of conviction, been classified as permanently partially disabled.

Aggregated from public-domain New York law; last amended effective 2023-01-01.

(a) The parties in interest to a claim for compensation may settle upon and determine any and all issues and matters by agreement, in accordance with section 32 of the Workers' Compensation Law, subject to the terms and conditions of this rule.

(b) Any agreement submitted to the board for approval shall be on a form prescribed by the chair or, alternatively, contain the information prescribed by the chair.

(c) The receipt of an agreement by the board for approval shall act as a stay on all related proceedings before the board.

(d) A represented claimant and an employer, insurance carrier or special fund, who have had a dispute regarding compensation benefits determined by a workers' compensation law judge, may agree to enter into a voluntary binding review process, wherein the parties establish the parameters of a section 32 agreement. Such proposed agreement with the parameters and other terms included therein, shall be submitted to a designee of the Chair. Upon the summary determination by the Chair's designee made pursuant to and within the parameters of the parties' agreement, such determination of compensation benefits set forth therein shall be deemed to be incorporated as a term of the agreement as approved by the board on the date the decision approving the agreement was duly filed and served pursuant to subparagraph b of section 32 of the Workers' Compensation Law.

(e) An agreement submitted pursuant to section 32 of the Workers' Compensation Law shall not be binding on the parties in interest unless it is approved by the chair, a designee of the chair, a member of the board, or a Workers' Compensation Law Judge. The agreement shall be approved unless it is determined that: (1) the agreement is unfair, unconscionable, or improper as a matter of law; or (2) the agreement is the result of an intentional misrepresentation of a material fact; or (3) within 10 days of submission of the agreement, the board has received from any party in interest a written request that the agreement be disapproved by the board. A claimant who cashes or deposits a check made pursuant to the agreement may not request that the agreement be disapproved by the board, provided however that a claimant who has been paid an incorrect amount shall have recourse to recover any unpaid amounts and penalties associated to the late or incorrect payment. When the agreement provides for payment to be made pursuant to section 25 (9) of the Workers' Compensation Law, the claimant must immediately return such payment when requesting disapproval of the agreement or such request for disapproval may be deemed waived and applicable penalties imposed.

(1) the agreement is unfair, unconscionable, or improper as a matter of law; or

(2) the agreement is the result of an intentional misrepresentation of a material fact; or

(3) within 10 days of submission of the agreement, the board has received from any party in interest a written request that the agreement be disapproved by the board. A claimant who cashes or deposits a check made pursuant to the agreement may not request that the agreement be disapproved by the board, provided however that a claimant who has been paid an incorrect amount shall have recourse to recover any unpaid amounts and penalties associated to the late or incorrect payment. When the agreement provides for payment to be made pursuant to section 25 (9) of the Workers' Compensation Law, the claimant must immediately return such payment when requesting disapproval of the agreement or such request for disapproval may be deemed waived and applicable penalties imposed.

(f) The agreement shall be reviewed by the chair, a designee of the chair, a member of the board, or a Workers' Compensation Law Judge, who will make a determination whether to approve or disapprove the agreement. The chair, designee of the chair, member of the board, or Workers' Compensation Law Judge reviewing the agreement may approve or disapprove the agreement administratively, based on a review of the record before the board, or may choose to schedule a meeting to question the parties about the agreement. If the agreement is reviewed administratively, the Board shall advise the parties in writing of the date the agreement shall be deemed submitted for the purposes of section 32 of the Workers' Compensation Law and this section. If a meeting is scheduled to question the parties about the agreement, the agreement will be deemed submitted for the purposes of Section 32 of the Workers' Compensation Law and this section at such meeting. No agreement shall be approved for a period of 10 calendar days after submission to the board.

(g) The board will advise the parties of the approval or disapproval of all agreements by duly filing and serving a notice of approval or disapproval.

(h) An agreement which is approved shall be final and conclusive on the parties in interest, and shall not be subject to review pursuant to section 23 of the Workers' Compensation Law. An agreement which is disapproved shall be subject to review pursuant to section 23 of the Workers' Compensation Law.

(i) The carrier shall make payments of any award as required in the agreement within 10 days of the filing of the decision approving the agreement. If the carrier fails to make such payments, the carrier shall be subject to penalties pursuant to paragraph (f) of subdivision 3 of section 25 of the Workers' Compensation Law.

(j) An agreement may provide for fees commensurate with the services rendered by the claimant's attorney or licensed representative, consistent with subdivision (f) of subparagraph (2) of Section 24 of the Workers' Compensation Law. Whenever a fee is requested in excess of $ 1,000, the requested fee is to be made upon form OC-400.1 attached to the submitted agreement.

(k) Any agreement submitted and approved pursuant to section 32 of the Workers' Compensation Law and this rule may be modified at any time by agreement of all parties in interest provided such modification is approved by the board.

Aggregated from public-domain New York law; last amended effective 2014-04-02.

(a) Case file. Upon receiving any document or notice regarding a claim or potential claim for workers' compensation benefits for which a case number has not been assigned and a case file has not been created, the board shall assign a unique case number and create a case file. The assignment of a case number and creation of a case file is not the indexing of a claim for purposes of filing a notice of controversy in accordance with paragraph (b) of subdivision (2) of section 25 of the Workers' Compensation Law. The board shall assign the case number and create the case file within five business days of receipt of said document for which a case file does not exist. Nothing in this section changes existing law with respect to the filing of a claim for purposes of the limitations period set forth in Workers' Compensation Law, section 28.

(b) Indexing. (1) The board will index a claim for compensation only upon the receipt of these notices or forms: (i) a notice or form prescribed by the chair for an employee, dependent or beneficiary, volunteer firefighter, volunteer ambulance worker, or a volunteer who meets the definition set forth in subdivision (1) of section 161 of the Workers' Compensation Law for a participant in World Trade Center rescue, recovery or cleanup operations to make a claim for compensation, death benefits or volunteer benefits (hereinafter referred to as employee claim form) pursuant to the Workers' Compensation Law, Volunteer Firefighters' Benefit Law or Volunteer Ambulance Workers' Benefit Law, or a notice or form prescribed by the chair for an employer or political subdivision to report an injury or illness of an employee, volunteer firefighter or volunteer ambulance worker as required by Workers' Compensation Law, section 110 and/or Volunteer Firefighters' Benefit Law section 42 and section 57 or Volunteer Ambulance Workers' Benefit Law section 42 and section 57 (hereinafter referred to as employer's report); (ii) a completed report or form as prescribed by the chair for a medical provider treating an injured employee to report on medical treatment which references an injury (hereinafter referred to as medical report), except that the medical report need not be in the prescribed format where: (a) the treating medical provider is based out of state; (b) the claimant was treated in an emergency room; or (c) the claimant is deceased; and (iii) a completed and executed limited authorization to obtain relevant medical records regarding the prior medical history of the body part or illness at issue (hereinafter referred to as limited release). The limited release is only required if the claimant files a completed employee claim form and indicates on the form that he or she had a prior injury to the same body part or similar illness to the one(s) listed on the form. It shall be part of the employee claim form and compliant with the Health Insurance Portability and Accessibility Act. (2) Notwithstanding paragraph (1) of this subdivision, if the chair obtains information that a worker was killed due to injuries or illness sustained in a work related accident, the chair may direct that a claim be indexed if the alleged employer has either failed or refused to submit an employer's report as described in paragraph (1) of this subdivision and neither a beneficiary nor representative of the worker's estate has filed a claim or can be identified to file a claim. (3) Within five business days of receiving the notices or documents required for indexing as set forth in paragraph (1) of this subdivision, except as set forth in subdivision (c) of this section, the board shall index the claim and electronically make available to the insurance carrier and, if applicable, the Uninsured Employers' Fund created by Workers' Compensation Law, section 26-a, all documents which the board has received to date. (4) Notice of indexing. (i) The board shall send the claimant, the claimant's legal representative, if any, the insurance carrier and if applicable, the Uninsured Employers' Fund, the notice of indexing on the form prescribed by the chair. The board shall also make available to the insurance carrier and, if applicable, the Uninsured Employers' Fund, the completed limited release executed by the claimant required by subparagraph (1)(iii) of this subdivision. (ii) The notice of indexing shall include notification that if the insurance carrier submits a notice of controversy:(a) any independent medical examination report as provided in section 300.2(d)(3) of this Part (hereinafter referred to as IME report) shall be filed with the board and served as required by Workers' Compensation Law, section 137(a)(1) at least three days before the date set for the initial expedited hearing; and (b) the failure to so file and serve an IME report shall be a waiver, as provided in section 300.38(g)(8) of this Part, of the insurance carrier's right to examine the claimant and to have filed on its behalf or otherwise have considered an IME report on the threshold issue of causal relationship.

(1) The board will index a claim for compensation only upon the receipt of these notices or forms: (i) a notice or form prescribed by the chair for an employee, dependent or beneficiary, volunteer firefighter, volunteer ambulance worker, or a volunteer who meets the definition set forth in subdivision (1) of section 161 of the Workers' Compensation Law for a participant in World Trade Center rescue, recovery or cleanup operations to make a claim for compensation, death benefits or volunteer benefits (hereinafter referred to as employee claim form) pursuant to the Workers' Compensation Law, Volunteer Firefighters' Benefit Law or Volunteer Ambulance Workers' Benefit Law, or a notice or form prescribed by the chair for an employer or political subdivision to report an injury or illness of an employee, volunteer firefighter or volunteer ambulance worker as required by Workers' Compensation Law, section 110 and/or Volunteer Firefighters' Benefit Law section 42 and section 57 or Volunteer Ambulance Workers' Benefit Law section 42 and section 57 (hereinafter referred to as employer's report); (ii) a completed report or form as prescribed by the chair for a medical provider treating an injured employee to report on medical treatment which references an injury (hereinafter referred to as medical report), except that the medical report need not be in the prescribed format where: (a) the treating medical provider is based out of state; (b) the claimant was treated in an emergency room; or (c) the claimant is deceased; and (iii) a completed and executed limited authorization to obtain relevant medical records regarding the prior medical history of the body part or illness at issue (hereinafter referred to as limited release). The limited release is only required if the claimant files a completed employee claim form and indicates on the form that he or she had a prior injury to the same body part or similar illness to the one(s) listed on the form. It shall be part of the employee claim form and compliant with the Health Insurance Portability and Accessibility Act.

(i) a notice or form prescribed by the chair for an employee, dependent or beneficiary, volunteer firefighter, volunteer ambulance worker, or a volunteer who meets the definition set forth in subdivision (1) of section 161 of the Workers' Compensation Law for a participant in World Trade Center rescue, recovery or cleanup operations to make a claim for compensation, death benefits or volunteer benefits (hereinafter referred to as employee claim form) pursuant to the Workers' Compensation Law, Volunteer Firefighters' Benefit Law or Volunteer Ambulance Workers' Benefit Law, or a notice or form prescribed by the chair for an employer or political subdivision to report an injury or illness of an employee, volunteer firefighter or volunteer ambulance worker as required by Workers' Compensation Law, section 110 and/or Volunteer Firefighters' Benefit Law section 42 and section 57 or Volunteer Ambulance Workers' Benefit Law section 42 and section 57 (hereinafter referred to as employer's report);

(ii) a completed report or form as prescribed by the chair for a medical provider treating an injured employee to report on medical treatment which references an injury (hereinafter referred to as medical report), except that the medical report need not be in the prescribed format where: (a) the treating medical provider is based out of state; (b) the claimant was treated in an emergency room; or (c) the claimant is deceased; and

(a) the treating medical provider is based out of state;

(b) the claimant was treated in an emergency room; or

(c) the claimant is deceased; and

(iii) a completed and executed limited authorization to obtain relevant medical records regarding the prior medical history of the body part or illness at issue (hereinafter referred to as limited release). The limited release is only required if the claimant files a completed employee claim form and indicates on the form that he or she had a prior injury to the same body part or similar illness to the one(s) listed on the form. It shall be part of the employee claim form and compliant with the Health Insurance Portability and Accessibility Act.

(2) Notwithstanding paragraph (1) of this subdivision, if the chair obtains information that a worker was killed due to injuries or illness sustained in a work related accident, the chair may direct that a claim be indexed if the alleged employer has either failed or refused to submit an employer's report as described in paragraph (1) of this subdivision and neither a beneficiary nor representative of the worker's estate has filed a claim or can be identified to file a claim.

(3) Within five business days of receiving the notices or documents required for indexing as set forth in paragraph (1) of this subdivision, except as set forth in subdivision (c) of this section, the board shall index the claim and electronically make available to the insurance carrier and, if applicable, the Uninsured Employers' Fund created by Workers' Compensation Law, section 26-a, all documents which the board has received to date.

(4) Notice of indexing. (i) The board shall send the claimant, the claimant's legal representative, if any, the insurance carrier and if applicable, the Uninsured Employers' Fund, the notice of indexing on the form prescribed by the chair. The board shall also make available to the insurance carrier and, if applicable, the Uninsured Employers' Fund, the completed limited release executed by the claimant required by subparagraph (1)(iii) of this subdivision. (ii) The notice of indexing shall include notification that if the insurance carrier submits a notice of controversy:(a) any independent medical examination report as provided in section 300.2(d)(3) of this Part (hereinafter referred to as IME report) shall be filed with the board and served as required by Workers' Compensation Law, section 137(a)(1) at least three days before the date set for the initial expedited hearing; and (b) the failure to so file and serve an IME report shall be a waiver, as provided in section 300.38(g)(8) of this Part, of the insurance carrier's right to examine the claimant and to have filed on its behalf or otherwise have considered an IME report on the threshold issue of causal relationship.

(i) The board shall send the claimant, the claimant's legal representative, if any, the insurance carrier and if applicable, the Uninsured Employers' Fund, the notice of indexing on the form prescribed by the chair. The board shall also make available to the insurance carrier and, if applicable, the Uninsured Employers' Fund, the completed limited release executed by the claimant required by subparagraph (1)(iii) of this subdivision.

(ii) The notice of indexing shall include notification that if the insurance carrier submits a notice of controversy:(a) any independent medical examination report as provided in section 300.2(d)(3) of this Part (hereinafter referred to as IME report) shall be filed with the board and served as required by Workers' Compensation Law, section 137(a)(1) at least three days before the date set for the initial expedited hearing; and (b) the failure to so file and serve an IME report shall be a waiver, as provided in section 300.38(g)(8) of this Part, of the insurance carrier's right to examine the claimant and to have filed on its behalf or otherwise have considered an IME report on the threshold issue of causal relationship.

(a) any independent medical examination report as provided in section 300.2(d)(3) of this Part (hereinafter referred to as IME report) shall be filed with the board and served as required by Workers' Compensation Law, section 137(a)(1) at least three days before the date set for the initial expedited hearing; and

(b) the failure to so file and serve an IME report shall be a waiver, as provided in section 300.38(g)(8) of this Part, of the insurance carrier's right to examine the claimant and to have filed on its behalf or otherwise have considered an IME report on the threshold issue of causal relationship.

(c) When claim is not indexed. (1) Notwithstanding paragraph (b)(1) of this section, if the insurance carrier submits to the board a notice that serves one of the purposes described in this paragraph before the board receives all of the notices or forms required to index a claim as provided in paragraph (b)(1) of this section, the board is not required to index a claim. The board may take appropriate action without indexing a claim to address any issue(s) or dispute(s) raised by one of the parties in a form that serves one of the purposes described below that has been filed with the board by the insurance carrier. If the board does not index a claim in accordance with this subdivision, the date the board received the notice submitted by the insurance carrier that serves one of the purposes described in this paragraph shall be considered the date of indexing for purposes of Workers' Compensation Law, sections 25(2-b) and 32. The notices are those required by section 300.22 of this Part and that: (i) accept the claim or show that the claim has been accepted; or (ii) agree to make temporary payment of compensation, payment for medical treatment, and payment for prescribed medicine without prejudice and without admitting liability pursuant to Workers' Compensation Law, section 21-a; or (iii) controvert the claim. (2) If the insurance carrier submits notice controverting the claim before the claim is indexed in accordance with paragraph (b)(1) of this section and the board has not received a medical report referencing an injury, the board shall: (i) contact the claimant, the claimant's legal representative if applicable, and the claimant's treating medical provider or providers if known, in writing to advise of the need for and how to file a medical report; (ii) attempt to contact the claimant, claimant's representative if applicable and the claimant's treating medical provider or providers if known by telephone to explain the need for and how to file a medical report; and (iii) if the claimant is unrepresented and a claimant information packet has not been sent in accordance with, subparagraph (d)(2)(ii) of this section, send a claimant information packet as described in subparagraph (d)(2)(ii) of this section to the claimant.

(1) Notwithstanding paragraph (b)(1) of this section, if the insurance carrier submits to the board a notice that serves one of the purposes described in this paragraph before the board receives all of the notices or forms required to index a claim as provided in paragraph (b)(1) of this section, the board is not required to index a claim. The board may take appropriate action without indexing a claim to address any issue(s) or dispute(s) raised by one of the parties in a form that serves one of the purposes described below that has been filed with the board by the insurance carrier. If the board does not index a claim in accordance with this subdivision, the date the board received the notice submitted by the insurance carrier that serves one of the purposes described in this paragraph shall be considered the date of indexing for purposes of Workers' Compensation Law, sections 25(2-b) and 32. The notices are those required by section 300.22 of this Part and that: (i) accept the claim or show that the claim has been accepted; or (ii) agree to make temporary payment of compensation, payment for medical treatment, and payment for prescribed medicine without prejudice and without admitting liability pursuant to Workers' Compensation Law, section 21-a; or (iii) controvert the claim.

(i) accept the claim or show that the claim has been accepted; or

(ii) agree to make temporary payment of compensation, payment for medical treatment, and payment for prescribed medicine without prejudice and without admitting liability pursuant to Workers' Compensation Law, section 21-a; or

(iii) controvert the claim.

(2) If the insurance carrier submits notice controverting the claim before the claim is indexed in accordance with paragraph (b)(1) of this section and the board has not received a medical report referencing an injury, the board shall: (i) contact the claimant, the claimant's legal representative if applicable, and the claimant's treating medical provider or providers if known, in writing to advise of the need for and how to file a medical report; (ii) attempt to contact the claimant, claimant's representative if applicable and the claimant's treating medical provider or providers if known by telephone to explain the need for and how to file a medical report; and (iii) if the claimant is unrepresented and a claimant information packet has not been sent in accordance with, subparagraph (d)(2)(ii) of this section, send a claimant information packet as described in subparagraph (d)(2)(ii) of this section to the claimant.

(i) contact the claimant, the claimant's legal representative if applicable, and the claimant's treating medical provider or providers if known, in writing to advise of the need for and how to file a medical report;

(ii) attempt to contact the claimant, claimant's representative if applicable and the claimant's treating medical provider or providers if known by telephone to explain the need for and how to file a medical report; and

(iii) if the claimant is unrepresented and a claimant information packet has not been sent in accordance with, subparagraph (d)(2)(ii) of this section, send a claimant information packet as described in subparagraph (d)(2)(ii) of this section to the claimant.

(d) Provisions applicable to all claims that have been or may be controverted. (1) If the claimant has retained a legal representative at the time the employee claim form is filed with the board, the legal representative shall file with the employee claim form: (i) a written certification, signed by the legal representative, that to the best of the legal representative's knowledge, information and belief, formed after an inquiry reasonable under the circumstances, the allegations and other factual matters asserted on the employee claim form have evidentiary support or if specifically so identified, are likely to have evidentiary support after a reasonable opportunity for further investigation or discovery; and (ii) a list of all documents in the possession, custody or control of the claimant that may be used to support the claim. (2) If the claimant has not retained a legal representative, the board shall do the following with respect to a claim that has a case number but has not been indexed, has not been accepted by the insurance carrier, or does not have an employee claim form and a medical report in the case file: (i) make readily available, to the employee, assistance in:(a) complying with the indexing requirements in paragraph (b)(1) of this section when applicable; (b) completing the employee claim form; and (c) obtaining a medical report. Such assistance shall include information about the need for a medical report, the services of the Office of the Advocate for Injured Workers, a board employee electronically completing the employee claim form based on information provided by the claimant through a recorded telephone conversation and sending the completed form to the claimant for review, and a telephone hotline exclusively dedicated to these purposes; (ii) provide to the claimant by mail or other effective means the following information and documents (hereinafter referred to as the claimant information packet);(a) an employee claim form; (b) instructions for completing said form that shall include notice of the availability of assistance in completing the form by calling a toll free telephone number; (c) notice of the necessity of a medical report, including the requirement that a medical report referencing an injury must be received in order to schedule a pre-hearing conference if the claim is controverted; (d) notice of the requirement that the employee complete and execute a limited release if the employee indicates on the employee claim form that he or she had a prior injury to the same body part or similar illness as the one(s) listed on such form; (e) notice that the employee has the right to a legal representative in proceedings before the board, accompanied by information about access to an attorney or licensed representative which contains contact information for the State and local bar associations and information on how to obtain a list of licensed representatives; and (f) notice regarding medical treatment for work related injuries, including that:(1) the employee is entitled to medical treatment and prescription drugs for the work related injury and should not pay for such medical treatment; and (2) the insurance carrier may have contracted with a designated pharmacy or pharmacies from which the employee may be required to obtain his or her prescription drugs and the insurance carrier must send notice to the employee about the designated pharmacy or pharmacies; and (3) the insurance carrier may have contracted with a diagnostic network to perform X-rays, computed tomography scans (also known as computerized axial tomography scans) (CT or CAT scans) and/or magnetic resonance imagings (MRI), the employee may be required to obtain such diagnostic tests from a provider that is part of the network, and the insurance carrier must send notice to the employee about such network. (iii) inform the claimant of all available resources in a meaningful fashion, using plain language. All forms, instructions and notices shall be available in English and Spanish; and (iv) notify the claimant semi-annually in writing for two years after the filing of any document with the board of the claimant's right to file a claim, the statute of limitations for doing so, and the assistance available for indexing a claim so long as the board has a valid address for the claimant. (3) The employer's report shall require the employer or its designee to certify that the employer or its designee has delivered to the injured or ill employee the claimant information packet. The contents of the claimant information packet are set forth in subparagraph (2)(ii) of this subdivision except that the notices described in clause (f) of such paragraph shall also include specific information about the designated pharmacy or pharmacies and diagnostic networks claimants must utilize.(i) The information about the designated pharmacy or pharmacies must be in the form of a pharmacy benefit card and include: (a) either the identity of all pharmacy chains and independent pharmacies designated by the insurance carrier, or where more than one pharmacy chain or independent pharmacy is so designated, the identity and contact information of a pharmacy benefits manager or other party, who shall provide a list of all pharmacies in the employee's state to the employee in writing or electronically upon and in accordance with an employee's request; and (b) a toll-free number and website where the employee may access information regarding the procedures by which the employee must fill and refill prescriptions through a remote pharmacy or other means, and may obtain a list of such pharmacies including their name, address and phone number, searchable by geographic location and fully updated as of the date at issue, in that employee's state. (ii) The information about the diagnostic network must include: (a) the identity and contact information for the diagnostic network with which the insurance carrier has contracted; and (b) a toll-free number and website where the employee may access information about providers who are part of the diagnostic network and how to schedule an appointment. The contents of the claimant information packet will be available to employers on the board's website except for the information about the specific designated pharmacy or pharmacies and/or diagnostic network(s). (4) A medical report shall set forth facts and opinions responsive to the questions on the form. A separate narrative or office notes of an authorized medical provider shall not be sufficient to serve as a medical report, although they may be used to supplement information in the medical report. Separate narrative or office notes may serve as a medical report if:(i) the treating medical provider is based out of state; (ii) the claimant was treated in an emergency room; or (iii) the claimant is deceased. A medical provider shall not be paid for examining the claimant and filing a medical report unless the medical report is completed in accordance with this paragraph. The medical report may be filed electronically. (5) A claimant who has not satisfied the indexing requirements may amend the required documents and resubmit them.

(1) If the claimant has retained a legal representative at the time the employee claim form is filed with the board, the legal representative shall file with the employee claim form: (i) a written certification, signed by the legal representative, that to the best of the legal representative's knowledge, information and belief, formed after an inquiry reasonable under the circumstances, the allegations and other factual matters asserted on the employee claim form have evidentiary support or if specifically so identified, are likely to have evidentiary support after a reasonable opportunity for further investigation or discovery; and (ii) a list of all documents in the possession, custody or control of the claimant that may be used to support the claim.

(i) a written certification, signed by the legal representative, that to the best of the legal representative's knowledge, information and belief, formed after an inquiry reasonable under the circumstances, the allegations and other factual matters asserted on the employee claim form have evidentiary support or if specifically so identified, are likely to have evidentiary support after a reasonable opportunity for further investigation or discovery; and

(ii) a list of all documents in the possession, custody or control of the claimant that may be used to support the claim.

(2) If the claimant has not retained a legal representative, the board shall do the following with respect to a claim that has a case number but has not been indexed, has not been accepted by the insurance carrier, or does not have an employee claim form and a medical report in the case file: (i) make readily available, to the employee, assistance in:(a) complying with the indexing requirements in paragraph (b)(1) of this section when applicable; (b) completing the employee claim form; and (c) obtaining a medical report. Such assistance shall include information about the need for a medical report, the services of the Office of the Advocate for Injured Workers, a board employee electronically completing the employee claim form based on information provided by the claimant through a recorded telephone conversation and sending the completed form to the claimant for review, and a telephone hotline exclusively dedicated to these purposes; (ii) provide to the claimant by mail or other effective means the following information and documents (hereinafter referred to as the claimant information packet);(a) an employee claim form; (b) instructions for completing said form that shall include notice of the availability of assistance in completing the form by calling a toll free telephone number; (c) notice of the necessity of a medical report, including the requirement that a medical report referencing an injury must be received in order to schedule a pre-hearing conference if the claim is controverted; (d) notice of the requirement that the employee complete and execute a limited release if the employee indicates on the employee claim form that he or she had a prior injury to the same body part or similar illness as the one(s) listed on such form; (e) notice that the employee has the right to a legal representative in proceedings before the board, accompanied by information about access to an attorney or licensed representative which contains contact information for the State and local bar associations and information on how to obtain a list of licensed representatives; and (f) notice regarding medical treatment for work related injuries, including that:(1) the employee is entitled to medical treatment and prescription drugs for the work related injury and should not pay for such medical treatment; and (2) the insurance carrier may have contracted with a designated pharmacy or pharmacies from which the employee may be required to obtain his or her prescription drugs and the insurance carrier must send notice to the employee about the designated pharmacy or pharmacies; and (3) the insurance carrier may have contracted with a diagnostic network to perform X-rays, computed tomography scans (also known as computerized axial tomography scans) (CT or CAT scans) and/or magnetic resonance imagings (MRI), the employee may be required to obtain such diagnostic tests from a provider that is part of the network, and the insurance carrier must send notice to the employee about such network. (iii) inform the claimant of all available resources in a meaningful fashion, using plain language. All forms, instructions and notices shall be available in English and Spanish; and (iv) notify the claimant semi-annually in writing for two years after the filing of any document with the board of the claimant's right to file a claim, the statute of limitations for doing so, and the assistance available for indexing a claim so long as the board has a valid address for the claimant.

(i) make readily available, to the employee, assistance in:(a) complying with the indexing requirements in paragraph (b)(1) of this section when applicable; (b) completing the employee claim form; and (c) obtaining a medical report. Such assistance shall include information about the need for a medical report, the services of the Office of the Advocate for Injured Workers, a board employee electronically completing the employee claim form based on information provided by the claimant through a recorded telephone conversation and sending the completed form to the claimant for review, and a telephone hotline exclusively dedicated to these purposes;

(a) complying with the indexing requirements in paragraph (b)(1) of this section when applicable;

(b) completing the employee claim form; and

(c) obtaining a medical report. Such assistance shall include information about the need for a medical report, the services of the Office of the Advocate for Injured Workers, a board employee electronically completing the employee claim form based on information provided by the claimant through a recorded telephone conversation and sending the completed form to the claimant for review, and a telephone hotline exclusively dedicated to these purposes;

(ii) provide to the claimant by mail or other effective means the following information and documents (hereinafter referred to as the claimant information packet);(a) an employee claim form; (b) instructions for completing said form that shall include notice of the availability of assistance in completing the form by calling a toll free telephone number; (c) notice of the necessity of a medical report, including the requirement that a medical report referencing an injury must be received in order to schedule a pre-hearing conference if the claim is controverted; (d) notice of the requirement that the employee complete and execute a limited release if the employee indicates on the employee claim form that he or she had a prior injury to the same body part or similar illness as the one(s) listed on such form; (e) notice that the employee has the right to a legal representative in proceedings before the board, accompanied by information about access to an attorney or licensed representative which contains contact information for the State and local bar associations and information on how to obtain a list of licensed representatives; and (f) notice regarding medical treatment for work related injuries, including that:(1) the employee is entitled to medical treatment and prescription drugs for the work related injury and should not pay for such medical treatment; and (2) the insurance carrier may have contracted with a designated pharmacy or pharmacies from which the employee may be required to obtain his or her prescription drugs and the insurance carrier must send notice to the employee about the designated pharmacy or pharmacies; and (3) the insurance carrier may have contracted with a diagnostic network to perform X-rays, computed tomography scans (also known as computerized axial tomography scans) (CT or CAT scans) and/or magnetic resonance imagings (MRI), the employee may be required to obtain such diagnostic tests from a provider that is part of the network, and the insurance carrier must send notice to the employee about such network.

(a) an employee claim form;

(b) instructions for completing said form that shall include notice of the availability of assistance in completing the form by calling a toll free telephone number;

(c) notice of the necessity of a medical report, including the requirement that a medical report referencing an injury must be received in order to schedule a pre-hearing conference if the claim is controverted;

(d) notice of the requirement that the employee complete and execute a limited release if the employee indicates on the employee claim form that he or she had a prior injury to the same body part or similar illness as the one(s) listed on such form;

(e) notice that the employee has the right to a legal representative in proceedings before the board, accompanied by information about access to an attorney or licensed representative which contains contact information for the State and local bar associations and information on how to obtain a list of licensed representatives; and

(f) notice regarding medical treatment for work related injuries, including that:(1) the employee is entitled to medical treatment and prescription drugs for the work related injury and should not pay for such medical treatment; and (2) the insurance carrier may have contracted with a designated pharmacy or pharmacies from which the employee may be required to obtain his or her prescription drugs and the insurance carrier must send notice to the employee about the designated pharmacy or pharmacies; and (3) the insurance carrier may have contracted with a diagnostic network to perform X-rays, computed tomography scans (also known as computerized axial tomography scans) (CT or CAT scans) and/or magnetic resonance imagings (MRI), the employee may be required to obtain such diagnostic tests from a provider that is part of the network, and the insurance carrier must send notice to the employee about such network.

(1) the employee is entitled to medical treatment and prescription drugs for the work related injury and should not pay for such medical treatment; and

(2) the insurance carrier may have contracted with a designated pharmacy or pharmacies from which the employee may be required to obtain his or her prescription drugs and the insurance carrier must send notice to the employee about the designated pharmacy or pharmacies; and

(3) the insurance carrier may have contracted with a diagnostic network to perform X-rays, computed tomography scans (also known as computerized axial tomography scans) (CT or CAT scans) and/or magnetic resonance imagings (MRI), the employee may be required to obtain such diagnostic tests from a provider that is part of the network, and the insurance carrier must send notice to the employee about such network.

(iii) inform the claimant of all available resources in a meaningful fashion, using plain language. All forms, instructions and notices shall be available in English and Spanish; and

(iv) notify the claimant semi-annually in writing for two years after the filing of any document with the board of the claimant's right to file a claim, the statute of limitations for doing so, and the assistance available for indexing a claim so long as the board has a valid address for the claimant.

(3) The employer's report shall require the employer or its designee to certify that the employer or its designee has delivered to the injured or ill employee the claimant information packet. The contents of the claimant information packet are set forth in subparagraph (2)(ii) of this subdivision except that the notices described in clause (f) of such paragraph shall also include specific information about the designated pharmacy or pharmacies and diagnostic networks claimants must utilize.(i) The information about the designated pharmacy or pharmacies must be in the form of a pharmacy benefit card and include: (a) either the identity of all pharmacy chains and independent pharmacies designated by the insurance carrier, or where more than one pharmacy chain or independent pharmacy is so designated, the identity and contact information of a pharmacy benefits manager or other party, who shall provide a list of all pharmacies in the employee's state to the employee in writing or electronically upon and in accordance with an employee's request; and (b) a toll-free number and website where the employee may access information regarding the procedures by which the employee must fill and refill prescriptions through a remote pharmacy or other means, and may obtain a list of such pharmacies including their name, address and phone number, searchable by geographic location and fully updated as of the date at issue, in that employee's state. (ii) The information about the diagnostic network must include: (a) the identity and contact information for the diagnostic network with which the insurance carrier has contracted; and (b) a toll-free number and website where the employee may access information about providers who are part of the diagnostic network and how to schedule an appointment. The contents of the claimant information packet will be available to employers on the board's website except for the information about the specific designated pharmacy or pharmacies and/or diagnostic network(s).

(i) The information about the designated pharmacy or pharmacies must be in the form of a pharmacy benefit card and include: (a) either the identity of all pharmacy chains and independent pharmacies designated by the insurance carrier, or where more than one pharmacy chain or independent pharmacy is so designated, the identity and contact information of a pharmacy benefits manager or other party, who shall provide a list of all pharmacies in the employee's state to the employee in writing or electronically upon and in accordance with an employee's request; and (b) a toll-free number and website where the employee may access information regarding the procedures by which the employee must fill and refill prescriptions through a remote pharmacy or other means, and may obtain a list of such pharmacies including their name, address and phone number, searchable by geographic location and fully updated as of the date at issue, in that employee's state.

(a) either the identity of all pharmacy chains and independent pharmacies designated by the insurance carrier, or where more than one pharmacy chain or independent pharmacy is so designated, the identity and contact information of a pharmacy benefits manager or other party, who shall provide a list of all pharmacies in the employee's state to the employee in writing or electronically upon and in accordance with an employee's request; and

(b) a toll-free number and website where the employee may access information regarding the procedures by which the employee must fill and refill prescriptions through a remote pharmacy or other means, and may obtain a list of such pharmacies including their name, address and phone number, searchable by geographic location and fully updated as of the date at issue, in that employee's state.

(ii) The information about the diagnostic network must include: (a) the identity and contact information for the diagnostic network with which the insurance carrier has contracted; and (b) a toll-free number and website where the employee may access information about providers who are part of the diagnostic network and how to schedule an appointment. The contents of the claimant information packet will be available to employers on the board's website except for the information about the specific designated pharmacy or pharmacies and/or diagnostic network(s).

(a) the identity and contact information for the diagnostic network with which the insurance carrier has contracted; and

(b) a toll-free number and website where the employee may access information about providers who are part of the diagnostic network and how to schedule an appointment. The contents of the claimant information packet will be available to employers on the board's website except for the information about the specific designated pharmacy or pharmacies and/or diagnostic network(s).

(4) A medical report shall set forth facts and opinions responsive to the questions on the form. A separate narrative or office notes of an authorized medical provider shall not be sufficient to serve as a medical report, although they may be used to supplement information in the medical report. Separate narrative or office notes may serve as a medical report if:(i) the treating medical provider is based out of state; (ii) the claimant was treated in an emergency room; or (iii) the claimant is deceased. A medical provider shall not be paid for examining the claimant and filing a medical report unless the medical report is completed in accordance with this paragraph. The medical report may be filed electronically.

(i) the treating medical provider is based out of state;

(ii) the claimant was treated in an emergency room; or

(iii) the claimant is deceased. A medical provider shall not be paid for examining the claimant and filing a medical report unless the medical report is completed in accordance with this paragraph. The medical report may be filed electronically.

(5) A claimant who has not satisfied the indexing requirements may amend the required documents and resubmit them.

Aggregated from public-domain New York law; last amended effective 2023-01-01.

(a) Notice of controversy. An insurance carrier who controverts a claim shall submit to the board and serve upon all other parties a notice of controversy in the format prescribed by the chair in accordance with Workers' Compensation Law, section 25(2)(a) or (b) or section 300.22 of this Part. A notice that contains the relevant elements, as prescribed by the chair, of the first report of injury or subsequent report of injury as more fully set forth in section 300.22 of this Part, shall be transmitted to all other parties within one business day of the date it is filed electronically with the board. The notice of controversy shall comply with the following: (1) it must be complete and provide a factual basis for the insurance carrier's controverting the claim and for any asserted defenses; (2) it must contain a written certification signed by the insurance carrier, or if represented, by its legal representative, that to the best of his or her knowledge, information and belief, formed after an inquiry reasonable under the circumstances that the allegations and other factual matters asserted in controverting the claim or the defenses asserted have evidentiary support, or if specifically so identified, are likely to have evidentiary support after a reasonable opportunity for further investigation or discovery. The written certification may be made at the pre-hearing conference prescribed in subdivisions (g) and (h) of this section. If the initial certification is not signed by a legal representative, then before a legal representative may appear on behalf of the insurance carrier, the legal representative shall file and serve the required certification; (3) it must provide the name and, if known, the address and telephone number of each individual likely to have information that the insurance carrier may use to support its factual basis for controverting the claim or for supporting a defense, and briefly describe the information; and (4) it must provide a list of all documents in the possession, custody or control of the insurance carrier that it may use to support the factual basis for controverting the claim or for supporting a defense.

(1) it must be complete and provide a factual basis for the insurance carrier's controverting the claim and for any asserted defenses;

(2) it must contain a written certification signed by the insurance carrier, or if represented, by its legal representative, that to the best of his or her knowledge, information and belief, formed after an inquiry reasonable under the circumstances that the allegations and other factual matters asserted in controverting the claim or the defenses asserted have evidentiary support, or if specifically so identified, are likely to have evidentiary support after a reasonable opportunity for further investigation or discovery. The written certification may be made at the pre-hearing conference prescribed in subdivisions (g) and (h) of this section. If the initial certification is not signed by a legal representative, then before a legal representative may appear on behalf of the insurance carrier, the legal representative shall file and serve the required certification;

(3) it must provide the name and, if known, the address and telephone number of each individual likely to have information that the insurance carrier may use to support its factual basis for controverting the claim or for supporting a defense, and briefly describe the information; and

(4) it must provide a list of all documents in the possession, custody or control of the insurance carrier that it may use to support the factual basis for controverting the claim or for supporting a defense.

(b) Notice of pre-hearing conference and other matters. Upon receipt of the notice of controversy and a medical report, the board shall send notice to the parties that shall include the following: (1) the date of the pre-hearing conference, which shall not be later than 30 days from receipt of a notice of controversy and a medical report; (2) an order directing the parties, except a claimant that has not retained a legal representative, to serve and file a pre-hearing conference statement no later than 10 days before the date of the pre-hearing conference; and (3) notification that: (i) any independent medical examination report as provided in section 300.2(d)(3) of this Part (hereinafter referred to as IME report) shall be filed with the board and served as required by Workers' Compensation Law, section 137(a)(1) at least three days before the date set for the initial expedited hearing; and (ii) the failure to so file and serve an IME report shall be a waiver, as provided in paragraph (g)(8) of this section, of the insurance carrier's right to examine the claimant and to have filed on its behalf or otherwise have considered an IME report on the threshold issue of causal relationship.

(1) the date of the pre-hearing conference, which shall not be later than 30 days from receipt of a notice of controversy and a medical report;

(2) an order directing the parties, except a claimant that has not retained a legal representative, to serve and file a pre-hearing conference statement no later than 10 days before the date of the pre-hearing conference; and

(3) notification that: (i) any independent medical examination report as provided in section 300.2(d)(3) of this Part (hereinafter referred to as IME report) shall be filed with the board and served as required by Workers' Compensation Law, section 137(a)(1) at least three days before the date set for the initial expedited hearing; and (ii) the failure to so file and serve an IME report shall be a waiver, as provided in paragraph (g)(8) of this section, of the insurance carrier's right to examine the claimant and to have filed on its behalf or otherwise have considered an IME report on the threshold issue of causal relationship.

(i) any independent medical examination report as provided in section 300.2(d)(3) of this Part (hereinafter referred to as IME report) shall be filed with the board and served as required by Workers' Compensation Law, section 137(a)(1) at least three days before the date set for the initial expedited hearing; and

(ii) the failure to so file and serve an IME report shall be a waiver, as provided in paragraph (g)(8) of this section, of the insurance carrier's right to examine the claimant and to have filed on its behalf or otherwise have considered an IME report on the threshold issue of causal relationship.

(c) Medical records. (1) In accordance with the limited release, the parties may seek production of relevant medical records from medical professionals and hospitals that have treated the claimant for previous injury to the same body part or similar illness to the one listed on the employee claim form. (2) Medical professionals authorized to practice before the board shall deliver a copy of duly requested records within 21 days of the request and within 10 business days if the requesting party offers to increase payment to $1.50 per page copied (an expedited request). (3) In addition to any other penalties, a medical professional authorized to practice before the board who fails to produce requested documents within 21 days, or within 10 business days of an expedited request, shall be subject to administrative warning or suspension or revocation of his or her authorization to treat and/or conduct independent medical examinations of injured workers, as determined by the chair or his or her designee. The board shall notify all authorized medical professionals of their professional responsibility to comply timely with requests for medical records and the possible penalties for failure to do so. (4) All medical records obtained by the parties shall be filed with the board so that all parties have access to them.

(1) In accordance with the limited release, the parties may seek production of relevant medical records from medical professionals and hospitals that have treated the claimant for previous injury to the same body part or similar illness to the one listed on the employee claim form.

(2) Medical professionals authorized to practice before the board shall deliver a copy of duly requested records within 21 days of the request and within 10 business days if the requesting party offers to increase payment to $1.50 per page copied (an expedited request).

(3) In addition to any other penalties, a medical professional authorized to practice before the board who fails to produce requested documents within 21 days, or within 10 business days of an expedited request, shall be subject to administrative warning or suspension or revocation of his or her authorization to treat and/or conduct independent medical examinations of injured workers, as determined by the chair or his or her designee. The board shall notify all authorized medical professionals of their professional responsibility to comply timely with requests for medical records and the possible penalties for failure to do so.

(4) All medical records obtained by the parties shall be filed with the board so that all parties have access to them.

(d) Subsequent retention of legal representative. If a claimant retains a legal representative after a claim is indexed or after the carrier submits a notice of controversy when the claim is not indexed, the legal representative shall, within five days thereof, file with the board and serve on all other parties a notice of retainer on the form prescribed by the chair together with: (1) an employee claim form, if not previously filed, or the legal representative's certification of a previously filed employee claim form or, if the previously filed form is incomplete, incorrect or in need of supplementation, an amended employee claim form and certification thereof; and (2) the list of documents required to accompany the employee claim form of a claimant who has retained a legal representative as required in section 300.37(d)(1) of this Part; and if the claimant has retained a legal representative prior to the pre-hearing conference, a pre-hearing conference statement pursuant to subdivision (f) of this section. Certification shall have the same meaning as in section 300.37(d)(1)(i) of this Part.

(1) an employee claim form, if not previously filed, or the legal representative's certification of a previously filed employee claim form or, if the previously filed form is incomplete, incorrect or in need of supplementation, an amended employee claim form and certification thereof; and

(2) the list of documents required to accompany the employee claim form of a claimant who has retained a legal representative as required in section 300.37(d)(1) of this Part; and if the claimant has retained a legal representative prior to the pre-hearing conference, a pre-hearing conference statement pursuant to subdivision (f) of this section. Certification shall have the same meaning as in section 300.37(d)(1)(i) of this Part.

(e) Claimant's retention of a legal representative within 10 days of the pre-hearing conference may constitute good cause for the insurance carrier to obtain an adjournment of that conference if the information and/or documentation provided by the legal representative in accordance with subdivision (d) of this section or any other information or documentation submitted to the board by the legal representative prior to or at the pre-hearing conference is material and new or different from the information and/or documentation submitted by the claimant. Such adjournment shall be within the discretion of the Workers' Compensation Law judge or conciliator as to whether such information is material and new or different from the information previously submitted on behalf of the claimant. Such adjournment shall only be for such time as is necessary to obtain any documents or other information that is relevant and responsive to such new and different documents and information provided by claimant's legal representative.

(f) Pre-Hearing conference statement. (1) Ten days before the pre-hearing conference, the insurance carrier or its legal representative and legal representative of the claimant shall file with the board and serve on all other parties a pre-hearing conference statement. A claimant that has not retained a legal representative on or before the date for the pre-hearing conference shall not be required or asked to file the pre-hearing conference statement. The pre-hearing conference statement shall contain information to facilitate the just, speedy and efficient disposition of the claimant's right to workers' compensation benefits, including settlement. If a claimant retains a legal representative within 10 days of the pre-hearing conference, the legal representative shall complete and file a pre-hearing conference statement in accordance with this subdivision at or prior to the pre-hearing conference. (2) The pre-hearing conference statement shall include:(i) a brief summary of the claim; (ii) the theory of the case with statutory and if appropriate, case citations; (iii) with respect to the insurance carrier's statement, an offer of proof for each defense raised; (iv) a list of lay witnesses, including claimant, the party will call to testify at the initial hearing, including the names, addresses, employers if known, and a summary of, and the estimated time needed for, the testimony; (v) a list of medical witnesses, if known, that the party intends to cross-examine and whether the party wishes such cross-examination to be by deposition or, if the Workers' Compensation Law judge or conciliator permits, at a hearing; (vi) the names of any additional necessary parties; (vii) a statement that all forms necessary to resolve the controversy, including medical reports other than an independent medical examination report (hereinafter referred to as IME report), have been submitted or will be submitted before or at the pre-hearing conference; (viii) a statement that all discovery has been completed or will be completed by the pre-hearing conference, or which shall detail what further discovery is necessary and why it will not be completed prior to the pre-hearing conference; (ix) with respect to the insurance carrier, a statement of whether it alleges that the claimant has not presented prima facie medical evidence, and the basis for such challenge; and (x) if applicable, a request by the carrier for a broader release for medical records than that set forth in section 300.37(b)(1)(iii) of this Part, accompanied by an affidavit by the insurance carrier, or if represented, by the insurance carrier's legal representative setting forth the relevance of the records that may be obtained through use of the broader release. (3) Each party shall attach to the pre-hearing conference statement any and all reports, forms and documents that the party intends to use at the hearing(s), which the party has in its possession or could reasonably have obtained, insofar as they are not already a part of the electronic case file maintained by the board, including hospital records and forms detailing the employer's statement of wages and the claimant's work status. (4) Failure by the insurance carrier to timely serve upon all other parties and file with the board the pre-hearing conference statement, or the filing by the insurance carrier of a materially incomplete statement shall result in a waiver of defenses to the claim; failure to list a witness on, or to include a copy of any document not in the electronic case file with the pre-hearing conference statement, which the insurance carrier had in its possession or could reasonably have obtained, shall constitute a waiver of the right to call such witness or introduce such document in the case. There shall be no waiver if the Workers' Compensation Law judge finds, based on the affidavit of the insurance carrier's legal representative (or if the insurance carrier does not have a legal representative, then by the insurance carrier), that the conduct at issue was due to good cause and the insurance carrier exercised good faith and due diligence.

(1) Ten days before the pre-hearing conference, the insurance carrier or its legal representative and legal representative of the claimant shall file with the board and serve on all other parties a pre-hearing conference statement. A claimant that has not retained a legal representative on or before the date for the pre-hearing conference shall not be required or asked to file the pre-hearing conference statement. The pre-hearing conference statement shall contain information to facilitate the just, speedy and efficient disposition of the claimant's right to workers' compensation benefits, including settlement. If a claimant retains a legal representative within 10 days of the pre-hearing conference, the legal representative shall complete and file a pre-hearing conference statement in accordance with this subdivision at or prior to the pre-hearing conference.

(2) The pre-hearing conference statement shall include:(i) a brief summary of the claim; (ii) the theory of the case with statutory and if appropriate, case citations; (iii) with respect to the insurance carrier's statement, an offer of proof for each defense raised; (iv) a list of lay witnesses, including claimant, the party will call to testify at the initial hearing, including the names, addresses, employers if known, and a summary of, and the estimated time needed for, the testimony; (v) a list of medical witnesses, if known, that the party intends to cross-examine and whether the party wishes such cross-examination to be by deposition or, if the Workers' Compensation Law judge or conciliator permits, at a hearing; (vi) the names of any additional necessary parties; (vii) a statement that all forms necessary to resolve the controversy, including medical reports other than an independent medical examination report (hereinafter referred to as IME report), have been submitted or will be submitted before or at the pre-hearing conference; (viii) a statement that all discovery has been completed or will be completed by the pre-hearing conference, or which shall detail what further discovery is necessary and why it will not be completed prior to the pre-hearing conference; (ix) with respect to the insurance carrier, a statement of whether it alleges that the claimant has not presented prima facie medical evidence, and the basis for such challenge; and (x) if applicable, a request by the carrier for a broader release for medical records than that set forth in section 300.37(b)(1)(iii) of this Part, accompanied by an affidavit by the insurance carrier, or if represented, by the insurance carrier's legal representative setting forth the relevance of the records that may be obtained through use of the broader release.

(i) a brief summary of the claim;

(ii) the theory of the case with statutory and if appropriate, case citations;

(iii) with respect to the insurance carrier's statement, an offer of proof for each defense raised;

(iv) a list of lay witnesses, including claimant, the party will call to testify at the initial hearing, including the names, addresses, employers if known, and a summary of, and the estimated time needed for, the testimony;

(v) a list of medical witnesses, if known, that the party intends to cross-examine and whether the party wishes such cross-examination to be by deposition or, if the Workers' Compensation Law judge or conciliator permits, at a hearing;

(vi) the names of any additional necessary parties;

(vii) a statement that all forms necessary to resolve the controversy, including medical reports other than an independent medical examination report (hereinafter referred to as IME report), have been submitted or will be submitted before or at the pre-hearing conference;

(viii) a statement that all discovery has been completed or will be completed by the pre-hearing conference, or which shall detail what further discovery is necessary and why it will not be completed prior to the pre-hearing conference;

(ix) with respect to the insurance carrier, a statement of whether it alleges that the claimant has not presented prima facie medical evidence, and the basis for such challenge; and

(x) if applicable, a request by the carrier for a broader release for medical records than that set forth in section 300.37(b)(1)(iii) of this Part, accompanied by an affidavit by the insurance carrier, or if represented, by the insurance carrier's legal representative setting forth the relevance of the records that may be obtained through use of the broader release.

(3) Each party shall attach to the pre-hearing conference statement any and all reports, forms and documents that the party intends to use at the hearing(s), which the party has in its possession or could reasonably have obtained, insofar as they are not already a part of the electronic case file maintained by the board, including hospital records and forms detailing the employer's statement of wages and the claimant's work status.

(4) Failure by the insurance carrier to timely serve upon all other parties and file with the board the pre-hearing conference statement, or the filing by the insurance carrier of a materially incomplete statement shall result in a waiver of defenses to the claim; failure to list a witness on, or to include a copy of any document not in the electronic case file with the pre-hearing conference statement, which the insurance carrier had in its possession or could reasonably have obtained, shall constitute a waiver of the right to call such witness or introduce such document in the case. There shall be no waiver if the Workers' Compensation Law judge finds, based on the affidavit of the insurance carrier's legal representative (or if the insurance carrier does not have a legal representative, then by the insurance carrier), that the conduct at issue was due to good cause and the insurance carrier exercised good faith and due diligence.

(g) The pre-hearing conference for represented claimants. (1) The pre-hearing conference shall be held within 30 days of the filing of a notice of controversy and a medical report referencing an injury, and shall proceed as described herein. (2) At the pre-hearing conference, the Workers' Compensation Law judge or conciliator may take appropriate action with respect to the following: (i) confirmation that all forms and notices necessary to resolve the controversy, including medical reports except IME reports, have been submitted to the board and served upon all other parties and a verification from the parties that all information thereon is accurate; (ii) addition of any other necessary parties; (iii) simplification and limitation of factual and legal issues; (iv) stipulations by the parties; (v) presentation of a list of proposed witnesses; (vi) settlement or other disposition of the case; (vii) confirmation that the parties have conferred in a good faith effort to settle or otherwise resolve the case; and (viii) scheduling any hearings or submission of testimony by deposition as to the resolution of disputed threshold issues. (3) If the insurance carrier alleges in the notice of controversy and/or pre-hearing conference statement that the claimant has not presented prima facie medical evidence, the Workers' Compensation Law judge or conciliator shall determine at the pre-hearing conference whether the medical report or reports presented constitute prima facie medical evidence. (i) A finding that the medical report or reports constitute prima facie medical evidence is an evidentiary determination that the case may proceed and is interlocutory and is not reviewable by the board as provided in subdivision (i) of this section. (ii) Upon a finding that the claimant's medical report does not constitute prima facie medical evidence, the case shall be marked as no further action. Claimant may thereafter submit additional information on an amended or other medical report, upon which submission the case shall be scheduled for another pre-hearing conference. (4) The Workers' Compensation Law judge or conciliator shall find a waiver of any defense for which the offer of proof at the pre-hearing conference is insufficient. (5) At the pre-hearing conference, the Workers' Compensation Law judge or conciliator shall: (i) obtain the names and addresses of all health care providers who rendered treatment for a previous injury to the same body part or similar illness to the one claimed in the controverted workers' compensation claim and direct, if necessary, the claimant to sign the appropriate limited medical release; (ii) if the insurance carrier requested a broader release for medical records than that set forth in section 300.37(b)(1)(iii) of this Part, hear arguments from all parties as to whether the request should or should not be granted, render a decision and if the decision is to grant the request, direct the claimant to sign the appropriate broader release; and (iii) determine if there are any prior workers' compensation claims and direct, if necessary, the claimant to sign the prescribed authorization pursuant to Workers' Compensation Law, section 110-a. (6) If the claimant has not filed the employee claim form prior to the pre-hearing conference, the claimant will be directed to complete and file such form at the pre-hearing conference. If the claimant is represented at the pre-hearing conference, the legal representative shall certify the employee claim form in accordance with section 300.37(d)(1)(i) of this Part. (7) The parties shall identify the evidence they intend to present at the initial expedited hearing, including lay witnesses and documents. The Workers' Compensation Law judge or conciliator shall schedule the initial expedited hearing at which testimony of the claimant and all other lay witnesses shall be taken and recorded for a date no more than 30 days after a pre-hearing conference at which the claimant was represented. However, if there is no request for the testimony of the claimant or any other lay witnesses the initial expedited hearing shall not be scheduled and held. (8) If the insurance carrier requests an opportunity to have the claimant examined by an independent medical examiner, the IME report must be completed, filed and served in accordance with Workers' Compensation Law, sections 13-b(4) and 137 and section 300.2(d) of this Part at least three days before the date set by the Workers' Compensation Law judge or conciliator for the initial expedited hearing. If the claimant will not testify and no other lay testimony will be taken so an initial expedited hearing will not be scheduled, the Workers' Compensation Law judge or conciliator shall set a date that is no more than 30 days after the pre-hearing conference for the IME report to be filed and served. The failure to file and serve the IME report by such date shall be a waiver of the insurance carrier's right to examine the claimant and to have filed on its behalf or otherwise have considered an IME report on the threshold issue of causal relationship, unless the insurance carrier makes a showing of good cause for such failure, and that it acted in good faith and with due diligence. The showing must be made by an affidavit by the insurance carrier or if represented, by its legal representative. Good cause shall include, but not be limited to, the inability to obtain medical records in advance of the hearing or the failure of the claimant to appear for an independent medical exam. (9) The parties shall identify any medical witnesses they wish to cross-examine and indicate whether they wish the medical witnesses to appear at a hearing or by deposition. The Workers' Compensation Law judge or conciliator shall decide whether medical witnesses shall appear for cross-examination at a hearing or by deposition. (10) For those medical witnesses to be cross-examined at a hearing, the Workers' Compensation Law judge or conciliator will set a hearing date no more than 60 days from the pre-hearing conference and may permit the medical witnesses to appear at the hearing by telephone. (11) For medical witnesses to be cross-examined by deposition: (i) the Workers' Compensation Law judge or conciliator shall direct that the depositions shall be conducted and the transcripts filed with the board no more than 55 days from the pre-hearing conference; (ii) the Workers' Compensation Law judge or conciliator may permit depositions to be taken by telephone; (iii) any medical report(s) and IME report(s) filed with the board and served on the parties prior to the deposition(s) shall constitute the direct testimony of the medical witnesses and there shall be no direct examination at the deposition unless requested by a party and authorized by the Workers' Compensation Law judge or conciliator upon a finding of exceptional circumstances. Any redirect examination shall be limited to points raised by the cross-examination; and (iv) the decision of the Workers' Compensation Law judge or conciliator setting forth the directions and orders made at the pre-hearing conference, including the direction and order for medical witnesses to be cross-examined by deposition and whether direct examination was authorized, shall be sent to the medical witnesses who the parties are directed to examine. The first part of the decision containing the directions and orders shall prominently set forth: (a) the direction for medical witnesses to be cross-examined by deposition and the transcripts filed with the board within 55 days of the pre-hearing conference or cross-examined at a hearing to be held within 60 days of the pre-hearing conference, which date shall be specified in the decision; (b) whether direct examination of medical witnesses was authorized; and (c) that payment for prior medical services by the insurance carrier may depend upon the medical witnesses' appearance at the deposition or hearing, as the case may be, in order to resolve this controverted claim. (12) A legal representative appearing on behalf of a party must be authorized to enter into stipulations and a settlement or a person authorized to do so shall be available during the pre-hearing conference. (13) If the claim is not settled or otherwise resolved at the pre-hearing conference, the Workers' Compensation Law judge or conciliator shall find that such claim, if otherwise covered by this section, is suitable for expedited hearings, unless the Workers' Compensation Law judge or conciliator finds that there are complex factual or medical issues, the resolution of which are not suitable for resolution through the process set forth in subdivision (h) of this section. Absent a finding to the contrary, claims involving death, occupational disease (not including, for purposes of this section, carpal tunnel syndrome), or sexual assault shall be presumed not suitable for resolution through the process set forth in subdivision (h) of this section. The Workers' Compensation Law judge or conciliator must set forth on the record the reasons for such finding. (14) The Workers' Compensation Law judge or conciliator shall issue a decision stating all determinations, directions and orders made at the pre-hearing conference. (15) The pre-hearing conference shall be recorded. (16) If the claimant fails to appear or is otherwise not prepared to proceed, the case shall be marked as no further action. The case shall be scheduled for another pre-hearing conference upon the claimant's application advising that he or she is prepared to proceed. (17) If the insurance carrier or its legal representative fails to appear, a Workers' Compensation Law judge or conciliator will render a decision based upon the evidence contained in the board file. The insurance carrier will be deemed to have waived its right to have an IME report considered on the issue of causal relationship and to cross-examine the medical providers who have treated the claimant. The foregoing is subject to the insurance carrier making the required showing for an adjournment pursuant to subdivision (j) of this section. (18) Attendance fees for the hearing testimony or deposition of physicians, podiatrists, chiropractors and psychologists directed pursuant to this section shall be governed by Part 301 of this Title.

(1) The pre-hearing conference shall be held within 30 days of the filing of a notice of controversy and a medical report referencing an injury, and shall proceed as described herein.

(2) At the pre-hearing conference, the Workers' Compensation Law judge or conciliator may take appropriate action with respect to the following: (i) confirmation that all forms and notices necessary to resolve the controversy, including medical reports except IME reports, have been submitted to the board and served upon all other parties and a verification from the parties that all information thereon is accurate; (ii) addition of any other necessary parties; (iii) simplification and limitation of factual and legal issues; (iv) stipulations by the parties; (v) presentation of a list of proposed witnesses; (vi) settlement or other disposition of the case; (vii) confirmation that the parties have conferred in a good faith effort to settle or otherwise resolve the case; and (viii) scheduling any hearings or submission of testimony by deposition as to the resolution of disputed threshold issues.

(i) confirmation that all forms and notices necessary to resolve the controversy, including medical reports except IME reports, have been submitted to the board and served upon all other parties and a verification from the parties that all information thereon is accurate;

(ii) addition of any other necessary parties;

(iii) simplification and limitation of factual and legal issues;

(iv) stipulations by the parties;

(v) presentation of a list of proposed witnesses;

(vi) settlement or other disposition of the case;

(vii) confirmation that the parties have conferred in a good faith effort to settle or otherwise resolve the case; and

(viii) scheduling any hearings or submission of testimony by deposition as to the resolution of disputed threshold issues.

(3) If the insurance carrier alleges in the notice of controversy and/or pre-hearing conference statement that the claimant has not presented prima facie medical evidence, the Workers' Compensation Law judge or conciliator shall determine at the pre-hearing conference whether the medical report or reports presented constitute prima facie medical evidence. (i) A finding that the medical report or reports constitute prima facie medical evidence is an evidentiary determination that the case may proceed and is interlocutory and is not reviewable by the board as provided in subdivision (i) of this section. (ii) Upon a finding that the claimant's medical report does not constitute prima facie medical evidence, the case shall be marked as no further action. Claimant may thereafter submit additional information on an amended or other medical report, upon which submission the case shall be scheduled for another pre-hearing conference.

(i) A finding that the medical report or reports constitute prima facie medical evidence is an evidentiary determination that the case may proceed and is interlocutory and is not reviewable by the board as provided in subdivision (i) of this section.

(ii) Upon a finding that the claimant's medical report does not constitute prima facie medical evidence, the case shall be marked as no further action. Claimant may thereafter submit additional information on an amended or other medical report, upon which submission the case shall be scheduled for another pre-hearing conference.

(4) The Workers' Compensation Law judge or conciliator shall find a waiver of any defense for which the offer of proof at the pre-hearing conference is insufficient.

(5) At the pre-hearing conference, the Workers' Compensation Law judge or conciliator shall: (i) obtain the names and addresses of all health care providers who rendered treatment for a previous injury to the same body part or similar illness to the one claimed in the controverted workers' compensation claim and direct, if necessary, the claimant to sign the appropriate limited medical release; (ii) if the insurance carrier requested a broader release for medical records than that set forth in section 300.37(b)(1)(iii) of this Part, hear arguments from all parties as to whether the request should or should not be granted, render a decision and if the decision is to grant the request, direct the claimant to sign the appropriate broader release; and (iii) determine if there are any prior workers' compensation claims and direct, if necessary, the claimant to sign the prescribed authorization pursuant to Workers' Compensation Law, section 110-a.

(i) obtain the names and addresses of all health care providers who rendered treatment for a previous injury to the same body part or similar illness to the one claimed in the controverted workers' compensation claim and direct, if necessary, the claimant to sign the appropriate limited medical release;

(ii) if the insurance carrier requested a broader release for medical records than that set forth in section 300.37(b)(1)(iii) of this Part, hear arguments from all parties as to whether the request should or should not be granted, render a decision and if the decision is to grant the request, direct the claimant to sign the appropriate broader release; and

(iii) determine if there are any prior workers' compensation claims and direct, if necessary, the claimant to sign the prescribed authorization pursuant to Workers' Compensation Law, section 110-a.

(6) If the claimant has not filed the employee claim form prior to the pre-hearing conference, the claimant will be directed to complete and file such form at the pre-hearing conference. If the claimant is represented at the pre-hearing conference, the legal representative shall certify the employee claim form in accordance with section 300.37(d)(1)(i) of this Part.

(7) The parties shall identify the evidence they intend to present at the initial expedited hearing, including lay witnesses and documents. The Workers' Compensation Law judge or conciliator shall schedule the initial expedited hearing at which testimony of the claimant and all other lay witnesses shall be taken and recorded for a date no more than 30 days after a pre-hearing conference at which the claimant was represented. However, if there is no request for the testimony of the claimant or any other lay witnesses the initial expedited hearing shall not be scheduled and held.

(8) If the insurance carrier requests an opportunity to have the claimant examined by an independent medical examiner, the IME report must be completed, filed and served in accordance with Workers' Compensation Law, sections 13-b(4) and 137 and section 300.2(d) of this Part at least three days before the date set by the Workers' Compensation Law judge or conciliator for the initial expedited hearing. If the claimant will not testify and no other lay testimony will be taken so an initial expedited hearing will not be scheduled, the Workers' Compensation Law judge or conciliator shall set a date that is no more than 30 days after the pre-hearing conference for the IME report to be filed and served. The failure to file and serve the IME report by such date shall be a waiver of the insurance carrier's right to examine the claimant and to have filed on its behalf or otherwise have considered an IME report on the threshold issue of causal relationship, unless the insurance carrier makes a showing of good cause for such failure, and that it acted in good faith and with due diligence. The showing must be made by an affidavit by the insurance carrier or if represented, by its legal representative. Good cause shall include, but not be limited to, the inability to obtain medical records in advance of the hearing or the failure of the claimant to appear for an independent medical exam.

(9) The parties shall identify any medical witnesses they wish to cross-examine and indicate whether they wish the medical witnesses to appear at a hearing or by deposition. The Workers' Compensation Law judge or conciliator shall decide whether medical witnesses shall appear for cross-examination at a hearing or by deposition.

(10) For those medical witnesses to be cross-examined at a hearing, the Workers' Compensation Law judge or conciliator will set a hearing date no more than 60 days from the pre-hearing conference and may permit the medical witnesses to appear at the hearing by telephone.

(11) For medical witnesses to be cross-examined by deposition: (i) the Workers' Compensation Law judge or conciliator shall direct that the depositions shall be conducted and the transcripts filed with the board no more than 55 days from the pre-hearing conference; (ii) the Workers' Compensation Law judge or conciliator may permit depositions to be taken by telephone; (iii) any medical report(s) and IME report(s) filed with the board and served on the parties prior to the deposition(s) shall constitute the direct testimony of the medical witnesses and there shall be no direct examination at the deposition unless requested by a party and authorized by the Workers' Compensation Law judge or conciliator upon a finding of exceptional circumstances. Any redirect examination shall be limited to points raised by the cross-examination; and (iv) the decision of the Workers' Compensation Law judge or conciliator setting forth the directions and orders made at the pre-hearing conference, including the direction and order for medical witnesses to be cross-examined by deposition and whether direct examination was authorized, shall be sent to the medical witnesses who the parties are directed to examine. The first part of the decision containing the directions and orders shall prominently set forth: (a) the direction for medical witnesses to be cross-examined by deposition and the transcripts filed with the board within 55 days of the pre-hearing conference or cross-examined at a hearing to be held within 60 days of the pre-hearing conference, which date shall be specified in the decision; (b) whether direct examination of medical witnesses was authorized; and (c) that payment for prior medical services by the insurance carrier may depend upon the medical witnesses' appearance at the deposition or hearing, as the case may be, in order to resolve this controverted claim.

(i) the Workers' Compensation Law judge or conciliator shall direct that the depositions shall be conducted and the transcripts filed with the board no more than 55 days from the pre-hearing conference;

(ii) the Workers' Compensation Law judge or conciliator may permit depositions to be taken by telephone;

(iii) any medical report(s) and IME report(s) filed with the board and served on the parties prior to the deposition(s) shall constitute the direct testimony of the medical witnesses and there shall be no direct examination at the deposition unless requested by a party and authorized by the Workers' Compensation Law judge or conciliator upon a finding of exceptional circumstances. Any redirect examination shall be limited to points raised by the cross-examination; and

(iv) the decision of the Workers' Compensation Law judge or conciliator setting forth the directions and orders made at the pre-hearing conference, including the direction and order for medical witnesses to be cross-examined by deposition and whether direct examination was authorized, shall be sent to the medical witnesses who the parties are directed to examine. The first part of the decision containing the directions and orders shall prominently set forth: (a) the direction for medical witnesses to be cross-examined by deposition and the transcripts filed with the board within 55 days of the pre-hearing conference or cross-examined at a hearing to be held within 60 days of the pre-hearing conference, which date shall be specified in the decision; (b) whether direct examination of medical witnesses was authorized; and (c) that payment for prior medical services by the insurance carrier may depend upon the medical witnesses' appearance at the deposition or hearing, as the case may be, in order to resolve this controverted claim.

(a) the direction for medical witnesses to be cross-examined by deposition and the transcripts filed with the board within 55 days of the pre-hearing conference or cross-examined at a hearing to be held within 60 days of the pre-hearing conference, which date shall be specified in the decision;

(b) whether direct examination of medical witnesses was authorized; and

(c) that payment for prior medical services by the insurance carrier may depend upon the medical witnesses' appearance at the deposition or hearing, as the case may be, in order to resolve this controverted claim.

(12) A legal representative appearing on behalf of a party must be authorized to enter into stipulations and a settlement or a person authorized to do so shall be available during the pre-hearing conference.

(13) If the claim is not settled or otherwise resolved at the pre-hearing conference, the Workers' Compensation Law judge or conciliator shall find that such claim, if otherwise covered by this section, is suitable for expedited hearings, unless the Workers' Compensation Law judge or conciliator finds that there are complex factual or medical issues, the resolution of which are not suitable for resolution through the process set forth in subdivision (h) of this section. Absent a finding to the contrary, claims involving death, occupational disease (not including, for purposes of this section, carpal tunnel syndrome), or sexual assault shall be presumed not suitable for resolution through the process set forth in subdivision (h) of this section. The Workers' Compensation Law judge or conciliator must set forth on the record the reasons for such finding.

(14) The Workers' Compensation Law judge or conciliator shall issue a decision stating all determinations, directions and orders made at the pre-hearing conference.

(15) The pre-hearing conference shall be recorded.

(16) If the claimant fails to appear or is otherwise not prepared to proceed, the case shall be marked as no further action. The case shall be scheduled for another pre-hearing conference upon the claimant's application advising that he or she is prepared to proceed.

(17) If the insurance carrier or its legal representative fails to appear, a Workers' Compensation Law judge or conciliator will render a decision based upon the evidence contained in the board file. The insurance carrier will be deemed to have waived its right to have an IME report considered on the issue of causal relationship and to cross-examine the medical providers who have treated the claimant. The foregoing is subject to the insurance carrier making the required showing for an adjournment pursuant to subdivision (j) of this section.

(18) Attendance fees for the hearing testimony or deposition of physicians, podiatrists, chiropractors and psychologists directed pursuant to this section shall be governed by Part 301 of this Title.

(h) Expedited hearing process in controverted cases when the claimant is represented. (1) The initial expedited hearing: (i) within 30 days following a pre-hearing conference at which the claimant is represented, the Workers' Compensation Law judge shall hold an initial expedited hearing at which testimony of the claimant and all other lay witnesses shall be taken and recorded. However, if there is no request for the testimony of the claimant or any other lay witnesses the initial expedited hearing shall not be held and the testimony of the medical witnesses shall be taken as set forth at the pre-hearing conference. (ii) If a party's witness does not appear, then the party shall have waived the right to have the witness testify in-person or by deposition, unless the party makes a showing of good cause that he or she should be granted additional time, and that he or she acted with good faith and due diligence. The showing must be made by an affidavit of the legal representative of the party or, if the party does not have a legal representative, then by the party. (iii) Independent medical examination. All IME reports shall be filed and served pursuant to Workers' Compensation Law, section 137(1)(a) and section 300.2(d)(11) of this Part no later than three days before the date of the initial expedited hearing as provided in subdivision (g)(8) of this section. If the IME report was filed and served in the five days before the initial expedited hearing, the insurance carrier's legal representative must bring copies of the IME report and proof of service to the initial expedited hearing for the Workers' Compensation Law judge and other parties. Failure to timely file and serve an IME report in a controverted claim shall be a waiver of the insurance carrier's right to examine the claimant and to have filed on its behalf or otherwise have considered an IME report on the issue of casual relationship, unless the insurance carrier makes a showing of good cause that it should be granted additional time, and that it acted in good faith and with due diligence. The showing must be made by an affidavit by the insurance carrier, or if represented, by its legal representative. (iv) If the insurance carrier filed and served an IME report at least three days prior to the initial expedited hearing, the claimant's legal representative must advise the Workers' Compensation Law judge if it still requests the cross-examination of the independent medical examiner. (2) Hearing for medical witnesses when the claimant is represented. (i) If the Workers' Compensation Law judge directs the testimony of any medical witness at a hearing, the Workers' Compensation Law judge shall hold a hearing that is no more than 30 days after the initial expedited hearing at which such medical testimony shall be taken unless the party to produce a medical witness shows good cause why the medical witness cannot appear by that date, and that it acted in good faith and with due diligence, in which case the hearing shall be scheduled as soon as practicable. (ii) At such hearing, any medical report(s) and IME report(s) previously filed with the board and served on the parties shall constitute the direct testimony of the medical witnesses and there shall be no direct examination at the hearing unless requested by a party and authorized by the Workers' Compensation Law judge upon a finding of exceptional circumstances. Any redirect examination shall be limited to points raised by the cross-examination. (iii) If the medical witness to be cross-examined by claimant's legal representative fails to appear as scheduled, then the insurance carrier's right to introduce the IME report from the witness or have the medical witness testify at a hearing or by deposition shall be waived, unless the insurance carrier makes a showing that the witness did not appear because of good cause, and that the insurance carrier acted in good faith and with due diligence. The showing must be made by an affidavit of the legal representative of the insurance carrier or, if the insurance carrier does not have a legal representative, then by the insurance carrier. (iv) If the medical witness to be cross-examined by the insurance carrier does not appear for cross-examination as scheduled, then his or her testimony shall be taken by deposition at the earliest date practicable but no more than 30 days after the date the medical witness was originally scheduled to testify unless the claimant makes a showing that the witness could not appear within that period because of good cause, and the claimant acted in good faith and with due diligence. Such deposition may be taken by telephone. With respect to any such medical witness authorized by the chair or his or her designee to treat and/or conduct independent medical examinations of injured workers, the board shall promptly direct the witness to appear at such deposition. If the witness does not appear for the deposition, the testimony of the witness shall not be rescheduled at either a hearing or deposition and the chair or his or her designee shall take such action as it deems appropriate with respect to the witness' authorization to treat and/or conduct independent medical examinations of injured workers. (3) Summations, memoranda of law and briefs. The parties shall be permitted to make oral summations at the last hearing to present evidence on the controverted issues, or the last deposition of a medical witness regarding causal relationship. In all cases, written post-hearing summations of the evidence, memoranda of law, and/or briefs are not permitted, unless the Workers' Compensation Law judge finds, on the record, that the claim presents extensive and complicated factual determinations or novel and important questions of law. All such post-hearing submissions, must be filed with the board and served on all other parties within five business days from such order or conclusion of the evidence, as described in paragraph (4) of this subdivision, whichever is later. (4) Decisions. (i) When the close of evidence occurs at a hearing, the Workers' Compensation Law judge shall advise the parties, on the record, of his or her decision, including the reasons and evidence supporting the decision, and that a notice of decision will be sent after the close of the hearing unless the Workers' Compensation Law judge determines on the record that there are extensive and complicated factual determinations or novel and important questions of law, in which case the written decision shall be issued within five business days of the hearing, or if post-hearing submissions have been ordered, within five business days of the date the post-hearing submissions are received or the post-hearing submissions were due, whichever is earlier. (ii) Where the close of the evidence does not occur at a hearing, it shall occur no later than 60 days after the pre-hearing conference, subject to any adjournment of a hearing or deposition having been granted or unless the Workers' Compensation Law judge on the record finds exceptional circumstances respecting submission of additional documentation that warrants a longer period and states the basis therefore. If the close of the evidence does not occur at a hearing, but upon the submission of deposition transcript(s) and/or documentation directed or ordered by the Workers' Compensation Law Judge, then the Workers' Compensation Law Judge shall issue a decision within five business days from the close of the evidence. (5) Applicability of section 300.34 of this Part. Notwithstanding any other provision to the contrary, the provisions of section 300.34 of this Part only apply to the resolution of claims covered by this section as specifically referenced in this section.

(1) The initial expedited hearing: (i) within 30 days following a pre-hearing conference at which the claimant is represented, the Workers' Compensation Law judge shall hold an initial expedited hearing at which testimony of the claimant and all other lay witnesses shall be taken and recorded. However, if there is no request for the testimony of the claimant or any other lay witnesses the initial expedited hearing shall not be held and the testimony of the medical witnesses shall be taken as set forth at the pre-hearing conference. (ii) If a party's witness does not appear, then the party shall have waived the right to have the witness testify in-person or by deposition, unless the party makes a showing of good cause that he or she should be granted additional time, and that he or she acted with good faith and due diligence. The showing must be made by an affidavit of the legal representative of the party or, if the party does not have a legal representative, then by the party. (iii) Independent medical examination. All IME reports shall be filed and served pursuant to Workers' Compensation Law, section 137(1)(a) and section 300.2(d)(11) of this Part no later than three days before the date of the initial expedited hearing as provided in subdivision (g)(8) of this section. If the IME report was filed and served in the five days before the initial expedited hearing, the insurance carrier's legal representative must bring copies of the IME report and proof of service to the initial expedited hearing for the Workers' Compensation Law judge and other parties. Failure to timely file and serve an IME report in a controverted claim shall be a waiver of the insurance carrier's right to examine the claimant and to have filed on its behalf or otherwise have considered an IME report on the issue of casual relationship, unless the insurance carrier makes a showing of good cause that it should be granted additional time, and that it acted in good faith and with due diligence. The showing must be made by an affidavit by the insurance carrier, or if represented, by its legal representative. (iv) If the insurance carrier filed and served an IME report at least three days prior to the initial expedited hearing, the claimant's legal representative must advise the Workers' Compensation Law judge if it still requests the cross-examination of the independent medical examiner.

(i) within 30 days following a pre-hearing conference at which the claimant is represented, the Workers' Compensation Law judge shall hold an initial expedited hearing at which testimony of the claimant and all other lay witnesses shall be taken and recorded. However, if there is no request for the testimony of the claimant or any other lay witnesses the initial expedited hearing shall not be held and the testimony of the medical witnesses shall be taken as set forth at the pre-hearing conference.

(ii) If a party's witness does not appear, then the party shall have waived the right to have the witness testify in-person or by deposition, unless the party makes a showing of good cause that he or she should be granted additional time, and that he or she acted with good faith and due diligence. The showing must be made by an affidavit of the legal representative of the party or, if the party does not have a legal representative, then by the party.

(iii) Independent medical examination. All IME reports shall be filed and served pursuant to Workers' Compensation Law, section 137(1)(a) and section 300.2(d)(11) of this Part no later than three days before the date of the initial expedited hearing as provided in subdivision (g)(8) of this section. If the IME report was filed and served in the five days before the initial expedited hearing, the insurance carrier's legal representative must bring copies of the IME report and proof of service to the initial expedited hearing for the Workers' Compensation Law judge and other parties. Failure to timely file and serve an IME report in a controverted claim shall be a waiver of the insurance carrier's right to examine the claimant and to have filed on its behalf or otherwise have considered an IME report on the issue of casual relationship, unless the insurance carrier makes a showing of good cause that it should be granted additional time, and that it acted in good faith and with due diligence. The showing must be made by an affidavit by the insurance carrier, or if represented, by its legal representative.

(iv) If the insurance carrier filed and served an IME report at least three days prior to the initial expedited hearing, the claimant's legal representative must advise the Workers' Compensation Law judge if it still requests the cross-examination of the independent medical examiner.

(2) Hearing for medical witnesses when the claimant is represented. (i) If the Workers' Compensation Law judge directs the testimony of any medical witness at a hearing, the Workers' Compensation Law judge shall hold a hearing that is no more than 30 days after the initial expedited hearing at which such medical testimony shall be taken unless the party to produce a medical witness shows good cause why the medical witness cannot appear by that date, and that it acted in good faith and with due diligence, in which case the hearing shall be scheduled as soon as practicable. (ii) At such hearing, any medical report(s) and IME report(s) previously filed with the board and served on the parties shall constitute the direct testimony of the medical witnesses and there shall be no direct examination at the hearing unless requested by a party and authorized by the Workers' Compensation Law judge upon a finding of exceptional circumstances. Any redirect examination shall be limited to points raised by the cross-examination. (iii) If the medical witness to be cross-examined by claimant's legal representative fails to appear as scheduled, then the insurance carrier's right to introduce the IME report from the witness or have the medical witness testify at a hearing or by deposition shall be waived, unless the insurance carrier makes a showing that the witness did not appear because of good cause, and that the insurance carrier acted in good faith and with due diligence. The showing must be made by an affidavit of the legal representative of the insurance carrier or, if the insurance carrier does not have a legal representative, then by the insurance carrier. (iv) If the medical witness to be cross-examined by the insurance carrier does not appear for cross-examination as scheduled, then his or her testimony shall be taken by deposition at the earliest date practicable but no more than 30 days after the date the medical witness was originally scheduled to testify unless the claimant makes a showing that the witness could not appear within that period because of good cause, and the claimant acted in good faith and with due diligence. Such deposition may be taken by telephone. With respect to any such medical witness authorized by the chair or his or her designee to treat and/or conduct independent medical examinations of injured workers, the board shall promptly direct the witness to appear at such deposition. If the witness does not appear for the deposition, the testimony of the witness shall not be rescheduled at either a hearing or deposition and the chair or his or her designee shall take such action as it deems appropriate with respect to the witness' authorization to treat and/or conduct independent medical examinations of injured workers.

(i) If the Workers' Compensation Law judge directs the testimony of any medical witness at a hearing, the Workers' Compensation Law judge shall hold a hearing that is no more than 30 days after the initial expedited hearing at which such medical testimony shall be taken unless the party to produce a medical witness shows good cause why the medical witness cannot appear by that date, and that it acted in good faith and with due diligence, in which case the hearing shall be scheduled as soon as practicable.

(ii) At such hearing, any medical report(s) and IME report(s) previously filed with the board and served on the parties shall constitute the direct testimony of the medical witnesses and there shall be no direct examination at the hearing unless requested by a party and authorized by the Workers' Compensation Law judge upon a finding of exceptional circumstances. Any redirect examination shall be limited to points raised by the cross-examination.

(iii) If the medical witness to be cross-examined by claimant's legal representative fails to appear as scheduled, then the insurance carrier's right to introduce the IME report from the witness or have the medical witness testify at a hearing or by deposition shall be waived, unless the insurance carrier makes a showing that the witness did not appear because of good cause, and that the insurance carrier acted in good faith and with due diligence. The showing must be made by an affidavit of the legal representative of the insurance carrier or, if the insurance carrier does not have a legal representative, then by the insurance carrier.

(iv) If the medical witness to be cross-examined by the insurance carrier does not appear for cross-examination as scheduled, then his or her testimony shall be taken by deposition at the earliest date practicable but no more than 30 days after the date the medical witness was originally scheduled to testify unless the claimant makes a showing that the witness could not appear within that period because of good cause, and the claimant acted in good faith and with due diligence. Such deposition may be taken by telephone. With respect to any such medical witness authorized by the chair or his or her designee to treat and/or conduct independent medical examinations of injured workers, the board shall promptly direct the witness to appear at such deposition. If the witness does not appear for the deposition, the testimony of the witness shall not be rescheduled at either a hearing or deposition and the chair or his or her designee shall take such action as it deems appropriate with respect to the witness' authorization to treat and/or conduct independent medical examinations of injured workers.

(3) Summations, memoranda of law and briefs. The parties shall be permitted to make oral summations at the last hearing to present evidence on the controverted issues, or the last deposition of a medical witness regarding causal relationship. In all cases, written post-hearing summations of the evidence, memoranda of law, and/or briefs are not permitted, unless the Workers' Compensation Law judge finds, on the record, that the claim presents extensive and complicated factual determinations or novel and important questions of law. All such post-hearing submissions, must be filed with the board and served on all other parties within five business days from such order or conclusion of the evidence, as described in paragraph (4) of this subdivision, whichever is later.

(4) Decisions. (i) When the close of evidence occurs at a hearing, the Workers' Compensation Law judge shall advise the parties, on the record, of his or her decision, including the reasons and evidence supporting the decision, and that a notice of decision will be sent after the close of the hearing unless the Workers' Compensation Law judge determines on the record that there are extensive and complicated factual determinations or novel and important questions of law, in which case the written decision shall be issued within five business days of the hearing, or if post-hearing submissions have been ordered, within five business days of the date the post-hearing submissions are received or the post-hearing submissions were due, whichever is earlier. (ii) Where the close of the evidence does not occur at a hearing, it shall occur no later than 60 days after the pre-hearing conference, subject to any adjournment of a hearing or deposition having been granted or unless the Workers' Compensation Law judge on the record finds exceptional circumstances respecting submission of additional documentation that warrants a longer period and states the basis therefore. If the close of the evidence does not occur at a hearing, but upon the submission of deposition transcript(s) and/or documentation directed or ordered by the Workers' Compensation Law Judge, then the Workers' Compensation Law Judge shall issue a decision within five business days from the close of the evidence.

(i) When the close of evidence occurs at a hearing, the Workers' Compensation Law judge shall advise the parties, on the record, of his or her decision, including the reasons and evidence supporting the decision, and that a notice of decision will be sent after the close of the hearing unless the Workers' Compensation Law judge determines on the record that there are extensive and complicated factual determinations or novel and important questions of law, in which case the written decision shall be issued within five business days of the hearing, or if post-hearing submissions have been ordered, within five business days of the date the post-hearing submissions are received or the post-hearing submissions were due, whichever is earlier.

(ii) Where the close of the evidence does not occur at a hearing, it shall occur no later than 60 days after the pre-hearing conference, subject to any adjournment of a hearing or deposition having been granted or unless the Workers' Compensation Law judge on the record finds exceptional circumstances respecting submission of additional documentation that warrants a longer period and states the basis therefore. If the close of the evidence does not occur at a hearing, but upon the submission of deposition transcript(s) and/or documentation directed or ordered by the Workers' Compensation Law Judge, then the Workers' Compensation Law Judge shall issue a decision within five business days from the close of the evidence.

(5) Applicability of section 300.34 of this Part. Notwithstanding any other provision to the contrary, the provisions of section 300.34 of this Part only apply to the resolution of claims covered by this section as specifically referenced in this section.

(i) Decisions in expedited hearing process. Decisions containing only orders or directions made by a Workers' Compensation Law judge in connection with the pre-hearing conference and expedited hearing process in controverted cases, pursuant to this section, including a finding that the medical report or medical reports constitute prima facie medical evidence, shall not be reviewable by the board under Workers' Compensation Law, section 23 until a decision has been made by a Workers' Compensation Law judge establishing or disallowing the claim.

(j) Adjournments in controverted cases. (1) Adjournments for a deposition to a period of time beyond that specified in this section, a pre-hearing conference, or a hearing in a controverted claim shall only be granted in an emergency. (2) The grounds for adjournment must be established by an affidavit of the legal representative of the requesting party (or if the requesting party is not represented, by the party), that shall be served on all other parties and filed with the board by the party promptly upon learning the circumstances that are the basis for the adjournment requested. In the event that the emergency occurs on the day of the pre-hearing conference or hearing, the legal representative may make an oral application for an adjournment which the Workers' Compensation Law judge may grant, conditioned upon the requesting party promptly filing with board a confirming affidavit, as described in this subsection. (3) An adjournment, if granted, shall be as short as practicable and generally shall not exceed 20 days. (4) Adjournment includes a rescheduling or continuance. (5) An emergency is a serious event that occurs preventing the timely completion of some action ordered or directed by the board or regulation. An emergency includes death in the family, serious illness, significant prior professional or business commitment, and inclement weather that prevents travel. It does not include any event that can be prevented or mitigated by the timely taking of reasonable action. (6) If a Workers' Compensation Law judge finds that a request for an adjournment or continuance is not an emergency and is frivolous, he or she shall impose such penalties as are in accordance with Workers' Compensation Law, section 25(3)(d) and section 300.34(f) and (g) of this Part.

(1) Adjournments for a deposition to a period of time beyond that specified in this section, a pre-hearing conference, or a hearing in a controverted claim shall only be granted in an emergency.

(2) The grounds for adjournment must be established by an affidavit of the legal representative of the requesting party (or if the requesting party is not represented, by the party), that shall be served on all other parties and filed with the board by the party promptly upon learning the circumstances that are the basis for the adjournment requested. In the event that the emergency occurs on the day of the pre-hearing conference or hearing, the legal representative may make an oral application for an adjournment which the Workers' Compensation Law judge may grant, conditioned upon the requesting party promptly filing with board a confirming affidavit, as described in this subsection.

(3) An adjournment, if granted, shall be as short as practicable and generally shall not exceed 20 days.

(4) Adjournment includes a rescheduling or continuance.

(5) An emergency is a serious event that occurs preventing the timely completion of some action ordered or directed by the board or regulation. An emergency includes death in the family, serious illness, significant prior professional or business commitment, and inclement weather that prevents travel. It does not include any event that can be prevented or mitigated by the timely taking of reasonable action.

(6) If a Workers' Compensation Law judge finds that a request for an adjournment or continuance is not an emergency and is frivolous, he or she shall impose such penalties as are in accordance with Workers' Compensation Law, section 25(3)(d) and section 300.34(f) and (g) of this Part.

(k) This section shall not apply to controverted claims where an employer has failed to secure coverage, as referenced in Workers' Compensation Law, section 50, and subdivisions (g), (h) and (i) shall not apply if a claimant is unrepresented at the time of the pre-hearing conference at which hearing or hearings are scheduled for witness testimony.