§ 217 — Notice and proof of claim

§ 217. Notice and proof of claim. 1. Written notice and proof of\ndisability or proof of need for family leave shall be furnished to the\nemployer by or on behalf of the employee claiming benefits or, in the\ncase of a claimant under section two hundred seven of this article, to\nthe chair, within thirty days after commencement of the period of\ndisability. Additional proof shall be furnished thereafter from time to\ntime as the employer or carrier or chair may require but not more often\nthan once each week. Such proof shall include a statement of disability\nby the employee's attending physician or attending podiatrist or\nattending chiropractor or attending dentist or attending psychologist or\nattending certified nurse midwife or family leave care recipient's\nhealth care provider, or in the case of an employee who adheres to the\nfaith or teachings of any church or denomination, and who in accordance\nwith its creed, tenets or principles depends for healing upon prayer\nthrough spiritual means alone in the practice of religion, by an\naccredited practitioner, containing facts and opinions as to such\ndisability in compliance with regulations of the chair. Failure to\nfurnish notice or proof within the time and in the manner above provided\nshall not invalidate the claim but no benefits shall be required to be\npaid for any period more than two weeks prior to the date on which the\nrequired proof is furnished unless it shall be shown to the satisfaction\nof the chair not to have been reasonably possible to furnish such notice\nor proof and that such notice or proof was furnished as soon as\npossible; provided, however, that no benefits shall be paid unless the\nrequired proof of disability is furnished within the period of actual\ndisability or family leave that does not exceed the statutory maximum\nperiod permitted under section two hundred four of this article. No\nlimitation of time provided in this section shall run as against any\ndisabled employee who is mentally incompetent, or physically incapable\nof providing such notice as a result of a serious medical condition, or\na minor so long as such person has no guardian of the person and/or\nproperty.\n 2. An employee claiming disability benefits shall, as requested by the\nemployer or carrier, submit himself or herself at intervals, but not\nmore than once a week, for examination by a physician or podiatrist or\nchiropractor or dentist or psychologist or certified nurse midwife\ndesignated by the employer or carrier. All such examinations shall be\nwithout cost to the employee and shall be held at a reasonable time and\nplace.\n 3. The chair or chair's designee, pursuant to section two hundred\ntwenty-one of this article, may direct the claimant or family leave care\nrecipient to submit to examination by a health care provider designated\nby him or her in any case in which the claim to disability or family\nleave benefits is contested and in claims arising under section two\nhundred seven of this article, and in other cases as the chair or board\nmay require.\n 4. Refusal of the claimant or family leave care recipient without good\ncause to submit to any such examination shall disqualify the claimant or\nemployee from all benefits hereunder for the period of such refusal,\nexcept as to benefits already paid.\n 5. If benefits required to be paid by this article have been paid to\nan employee, further payments for the same disability or family leave\nshall not be barred solely because of failure to give notice or to file\nproof of disability for the period or periods for which such benefits\nhave been paid.\n 6. In the event that a claim for disability benefits is rejected, the\ncarrier or employer shall send by first class mail written notice of\nrejection to the employee within forty-five days of receipt of proof of\ndisability. Failure to mail such written notice of rejection within the\ntime provided, shall bar the employer or carrier from contesting\nentitlement to benefits for any period of disability prior to such\nnotice but such failure may be excused by the chair if it can be shown\nto the satisfaction of the chair not to have been reasonably possible to\nmail such notice and that such notice was mailed as soon as possible.\nSuch notice shall include a statement, in a form prescribed by the\nchair, to the effect that the employee may, for the purpose of review,\nfile notice that his or her claim has not been paid as set forth in\nsection two hundred twenty-one of this article.\n