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Date: July 2, 2008
The neglect or failure of a carrier or self–insured employer to pay awards for medical bills in a timely manner has a significant impact on the ability of all injured workers to obtain effective and immediate treatment, as it discourages health care providers from seeking or retaining authorization to treat workers' compensation claimants. Additionally, it may result in the health care provider seeking direct payment from the claimant, despite the statutory prohibition against direct payments. A claimant's ability to obtain proper medical treatment expeditiously not only benefits the claimant, but also results in lower medical costs for employers. Claimants who receive prompt and proper attention are more likely to be able to return to work swiftly and less likely to have long term disabling conditions.
The integrity of the workers' compensation system is compromised when carriers and self–insured employers do not meet their legal obligations to pay awards. The Board has received an increasing number of complaints by health care providers that bills rendered for the treatment and care of workers' compensation claimants are not being paid in a timely manner. In particular, providers are concerned that bills are not paid in many instances even after issuance of an administrative and/or arbitration award by the Board. Further, concern has been expressed that some bills are automatically rejected by the carrier due solely to a carrier's policy against paying bills for certain specific coded procedures, regardless of the apparent medical necessity for such treatments.
It is the Board's intent that health care provider bills be paid in a timely manner after the carrier or self–insured employer has had a full and fair opportunity to contest the compensability or value of the bills if it elects to do so. Further, effective March 13, 2007, the Workers' Compensation Law, § 54–b was amended to authorize the Chair (or the Chair's designee) to issue a consent to file judgment when a carrier, self–insured employer or the State Insurance Fund fails to pay indemnity or medical benefits to a claimant or medical provider. Failure or neglect to pay awards for medical bills will be subject to judgment collection. In any case where the insurance carrier or self–insured employer has failed to make timely payments after an administrative or arbitration award and all appeals have been exhausted or no timely appeal has been taken, the health care provider may also seek to enter judgment for payment, pursuant to Workers' Compensation Law § 54–b.
Workers' Compensation Law § 54–b specifically provides that in the event an employer or insurance carrier defaults in the payment of an award and/or an award of benefits made by the Board, any party to an award may, with the Chair's consent, file for judgment against the employer with the county clerk for the county in which the injury occurred or the county in which the employer has its principal place of business.
Workers' Compensation Board authorized providers seeking payment of administrative and/or arbitration awards made on or after March 13, 2007 are asked to submit Form HP-J1, Provider's Request for Judgment of Award and to enclose a copy of the original award(s) issued. In order to allow for billing cycle payments, please allow 60 days after issuance of the administrative and/or arbitration award prior to requesting judgment. Send requests to:
Workers' Compensation Board
Bureau of Health Management
Office of Health Provider Administration
100 Broadway – Menands
Albany, NY 12241
The continued viability of the workers' compensation system is substantially dependent upon voluntary compliance of all parties with the Workers' Compensation Law, rules and regulations of the Board, and legal responsibilities imposed upon the parties. The Board remains committed to reducing adjudicatory delay and costs to all participants in the system. Self–insured employers and workers' compensation insurance carriers can contribute significantly to adjudication reform measures instituted by the Governor, the Legislature and the Board by meeting its obligations without the need to resort to extraordinary enforcement measures.
If you have any questions, please contact the Office of Health Provider Administration at 1-800-781-2362.
Zachary S. Weiss