N.Y. Workers' Compensation Law Section 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 § 23 (Appeals)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 Civil Practice Law & Rules Law § 5004 (Rate of interest)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.

Source: Section 221 — Determination of contested claims for disability and family leave benefits, https://www.­nysenate.­gov/legislation/laws/WKC/221 (updated Apr. 8, 2016; accessed Jul. 6, 2024).

200
Short title
201
Definitions
202
Covered employer
203
Employees eligible for benefits under section two hundred four of this article
203‑A
Retaliatory action prohibited for family leave
203‑B
Reinstatement following family leave
203‑C
Health insurance during family leave
204
Disability and family leave during employment
205
Disabilities, family leave and periods for which benefits are not payable
206
Non-duplication of benefits
207
Disability while unemployed
208
Payment of disability and family leave benefits
209
Contribution of employees for disability and family leave benefits
210
Employer contributions
211
Provision for payment of benefits
212
Voluntary coverage
212‑A
Notwithstanding the definition of “employer” and “employment” set forth in section two hundred one of this article and the requirement fo...
212‑B
Public employees
213
Non-compliance or default
214
Special fund for disability benefits
215
Commissioner of taxation and finance custodian of fund
216
Disposition of uncommitted balance of employees’ contributions
217
Notice and proof of claim
218
Disability benefit rights inalienable
219
Enforcement of payment in default
220
Penalties
221
Determination of contested claims for disability and family leave benefits
222
Technical rules of evidence or procedure not required
223
Modification of board decisions or orders
224
Appeals
225
Fees for representing employees
226
The insurance contract
227
Actionable injuries in claims for disability benefits
228
Administrative expenses
229
Posting of notice and providing of notice of rights
230
Destruction of records
231
Subpoenas
232
Fees for testimony of physicians, podiatrists, chiropractors, dentists, psychologists and health care providers
233
Inspection of records of employers
234
Disclosures prohibited
235
Exemptions
236
Disposition of accrued benefits upon death
237
Reimbursement for advance payments by employers
238
Payments to minors
239
Representation before the board
240
Non-liability of state
241
Application of other provisions of chapter
242
Separability of provisions

Accessed:
Jul. 6, 2024

Last modified:
Apr. 8, 2016

§ 221’s source at nysenate​.gov

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