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This entry was published on 2016-04-08
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Determination of contested claims for disability and family leave benefits
Workers' Compensation (WKC) CHAPTER 67, ARTICLE 9
§ 221. Determination of contested claims for disability and family
leave benefits. In accordance with regulations adopted by the chair,
within twenty-six weeks of written notice of rejection of claim, the
employee may file with the chair a notice that his or her claim for
disability or family leave benefits has not been paid, and the employee
shall submit proof of disability or entitlement to family leave and of
his or her employment, wages and other facts reasonably necessary for
determination of the employee's right to such benefits. Failure to file
such notice within the time provided, may be excused if it can be shown
not to have been reasonably possible to furnish such notice and that
such notice was furnished as soon as possible. On demand the employer or
carrier shall forthwith deliver to the board the original or a true copy
of the health care provider's report, wage and employment data and all
other documentation in the possession of the employer or carrier with
respect to such claim.

The chair or designee, shall have full power and authority to
determine all issues in relation to every such claim for disability
benefits required or provided under this article, and shall file its
decision in the office of the chairman. Upon such filing, the chairman
shall send to the parties a copy of the decision. Either party may
present evidence and be represented by counsel at any hearing on such
claim. The decision of the board shall be final as to all questions of
fact and, except as provided in section twenty-three of this chapter, as
to all questions of law. Every decision shall be complied with in
accordance with its terms within ten days thereafter except as permitted
by law upon the filing of a request for review, and any payments due
under such decision shall draw simple interest from thirty days after
the making thereof at the rate provided in section five thousand four of
the civil practice law and rules. The chair shall adopt rules and
regulations to carry out the provisions of this article including but
not limited to resolution of contested claims and requests for review
thereof, and payment of costs for resolution of disputed claims by
carriers. Any designated process shall afford the parties the
opportunity to present evidence and to be represented by counsel in any
such proceeding. The chair shall have the authority to provide for
alternative dispute resolution procedures for claims arising under
family leave, including but not limited to referral and submission of
disputed claims to a neutral arbitrator under the auspices of an
alternative dispute resolution association pursuant to article
seventy-five of the civil practice law and rules. Neutral arbitrator
shall mean an arbitrator who does not have a material interest in the
outcome of the arbitration proceeding or an existing and substantial
relationship, including but not limited to pecuniary interests, with a
party, counsel or representative of a party. Any determination made by
alternative dispute resolution shall not be reviewable by the board and
the venue for any appeal shall be to a court of competent jurisdiction.