§ 20 — Determination of claims for compensation

New York § 20

• Jurisdiction: New York
• Law WKC: Workers' Compensation
• Art. 2: Compensation

Text

§ 20. Determination of claims for compensation. 1. At any time\nafter the expiration of the first seven days of disability on the part\nof an injured employee, or at any time after the employee's death, a\nclaim for compensation may be presented to the employer or to the chair.\nThe board shall have full power and authority to determine all questions\nin relation to the payment of claims presented to it for compensation\nunder the provisions of this chapter. The chair or board shall make or\ncause to be made such investigation as it deems necessary, and upon\napplication of either party, shall order a hearing, and within thirty\ndays after a claim for compensation is submitted under this section, or\nsuch hearing closed, shall make or deny an award, determining such claim\nfor compensation, and file the same in the office of the chair.\nImmediately after such filing the chair shall send to the parties a copy\nof the decision. Upon a hearing pursuant to this section either party\nmay present evidence and be represented by counsel. The decision of the\nboard shall be final as to all questions of fact, and, except as\nprovided in section twenty-three of this article, as to all questions of\nlaw. Except as provided in section twenty-seven of this article, all\nawards of the board shall draw simple interest from thirty days after\nthe making thereof at the rate provided in section five thousand four of\nthe civil practice law and rules. Whenever a hearing or proceeding for\nthe determination of a claim for compensation is begun before a referee,\npursuant to the provisions of this chapter, such hearing or proceeding\nor any adjourned hearing thereon shall continue before the same referee\nuntil a final determination awarding or denying compensation, except in\nthe absence, inability or disqualification to act of such referee, or\nfor other good cause, in which event such hearing or proceeding may be\ncontinued before another referee by order of the chair or board.\n 2. (a) Notwithstanding subdivision one of this section, any claim for\ncompensation by (i) judges, conciliators, and managerial or confidential\nemployees of the workers' compensation board and state insurance fund\nwho are allocated to a grade M1 or above pursuant to section one hundred\nthirty of the civil service law, (ii) the chair, vice-chair and members\nof the workers' compensation board, and (iii) the executive director,\ndeputy executive directors and members of the board of commissioners of\nthe state insurance fund shall not be within the jurisdiction of the\nworkers' compensation board but instead shall be determined by a neutral\noutside arbitration process as provided by regulations promulgated by\nthe chair. Such claims shall be filed in the same manner as any other\nclaim for compensation under this chapter.\n (b) All issues and questions of law or fact pertaining to such claims\nshall be resolved by the arbitrator appointed pursuant to this\nparagraph. Arbitrators shall be appointed by the chair to adjudicate\nclaims under this paragraph. Such arbitrators shall have the same\npowers and duties as those accorded referees under this chapter,\nincluding powers delegated by the chair. The provisions of this chapter\nshall be applicable to claims under this paragraph insofar as they are\nnot inconsistent herewith.\n (c) An award or decision by an arbitrator pursuant to this paragraph\nis deemed to be a final decision of the board except if review of such\ndecision is sought as provided in paragraph (d) of this subdivision. No\nmodification, rescission or review of such award or decision may be\nentertained by the board, notwithstanding any provision of this chapter\nto the contrary.\n (d) Within thirty days after notice of the filing of an award or\ndecision by an arbitrator, any party in interest may request review of\nthe arbitrator's decision by a panel of three arbitrators in the same\nmanner and to the same extent as the decision by a referee may be\nreviewed by the board pursuant to section twenty-three of this article.\nThe arbitration panel shall consist of one arbitrator nominated by the\nchair, one arbitrator nominated by a recognized alternative dispute\nresolution organization and one arbitrator nominated by an employee\norganization certified pursuant to article fourteen of the civil service\nlaw to represent the collective bargaining unit of the injured employee\nor, if the injured employee is not represented by a collective\nbargaining unit, by the recognized alternative dispute resolution\norganization. A party in interest may seek review of such award or\ndecision of an arbitration panel only by taking appeal therefrom to the\nappellate division of the supreme court, third department and the court\nof appeals as provided for decisions of the board pursuant to section\ntwenty-three of this chapter.\n (e) The powers and jurisdiction of the arbitration panel established\npursuant to this subdivision shall be continuing in the same manner and\nto the same extent as provided under this chapter to the board.\n (f) All fees, costs and expenses of arbitration shall be borne by the\nboard and the state insurance fund as administration expenses pursuant\nto sections eighty-eight and one hundred fifty-one of this chapter.\n (g) Any claim for compensation by an officer or employee of the board\nor state insurance fund not required to be determined by a neutral\noutside arbitration process pursuant to paragraph (a) of this\nsubdivision shall be determined initially by a referee with review of\nsuch determination available pursuant to section twenty-three of this\nchapter.\n (h) For any claim for compensation by an officer or employee of the\nworkers' compensation board or the state insurance fund whether or not\nsuch claim is required to be determined by a neutral outside arbitration\nprocess pursuant to paragraph (a) of this subdivision, the referee or\narbitrator making the initial finding of fact concerning any medical\nissue present in the case shall develop the record with opinion evidence\nfrom an impartial specialist who is an expert in the appropriate medical\nspecialty. Such impartial specialist shall be subject to\ncross-examination at the request of any party in interest.\n (i) The state insurance fund shall administer the claim of any\nofficer or employee of the state insurance fund at an office of the\nstate insurance fund other than the office which was, at the time of\ninjury, disablement or death of such officer or employee, his or her\nprincipal workplace.\n (j) The chair shall promulgate regulations necessary to implement\nthis subdivision. Such regulations shall include provisions in relation\nto this subdivision for a single arbitrator to determine a claim in the\nfirst instance and a panel of three arbitrators to review such decision\nupon the application of any party in interest prior to judicial review.\nSuch regulations shall also include all special procedures relating to\nthe handling of claims of officers or employees of the workers'\ncompensation board and the state insurance fund pursuant to paragraph\n(f) of this subdivision.\n 3. Notwithstanding any other provision of law to the contrary, a\nmember of the workers' compensation board, a referee or any arbitrator\nin connection with the adjudication of any claim arising under this\nchapter shall recuse himself or herself on any ground a judge may be\ndisqualified pursuant to section fourteen of the judiciary law.\n