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This entry was published on 2014-09-22
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SECTION 20
Determination of claims for compensation
Workers' Compensation (WKC) CHAPTER 67, ARTICLE 2
§ 20. Determination of claims for compensation. 1. At any time
after the expiration of the first seven days of disability on the part
of an injured employee, or at any time after the employee's death, a
claim for compensation may be presented to the employer or to the chair.
The board shall have full power and authority to determine all questions
in relation to the payment of claims presented to it for compensation
under the provisions of this chapter. The chair or board shall make or
cause to be made such investigation as it deems necessary, and upon
application of either party, shall order a hearing, and within thirty
days after a claim for compensation is submitted under this section, or
such hearing closed, shall make or deny an award, determining such claim
for compensation, and file the same in the office of the chair.
Immediately after such filing the chair shall send to the parties a copy
of the decision. Upon a hearing pursuant to this section either party
may present evidence and be represented by counsel. The decision of the
board shall be final as to all questions of fact, and, except as
provided in section twenty-three of this article, as to all questions of
law. Except as provided in section twenty-seven of this article, all
awards of the board 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. Whenever a hearing or proceeding for
the determination of a claim for compensation is begun before a referee,
pursuant to the provisions of this chapter, such hearing or proceeding
or any adjourned hearing thereon shall continue before the same referee
until a final determination awarding or denying compensation, except in
the absence, inability or disqualification to act of such referee, or
for other good cause, in which event such hearing or proceeding may be
continued before another referee by order of the chair or board.

2. (a) Notwithstanding subdivision one of this section, any claim for
compensation by (i) judges, conciliators, and managerial or confidential
employees of the workers' compensation board and state insurance fund
who are allocated to a grade M1 or above pursuant to section one hundred
thirty of the civil service law, (ii) the chair, vice-chair and members
of the workers' compensation board, and (iii) the executive director,
deputy executive directors and members of the board of commissioners of
the state insurance fund shall not be within the jurisdiction of the
workers' compensation board but instead shall be determined by a neutral
outside arbitration process as provided by regulations promulgated by
the chair. Such claims shall be filed in the same manner as any other
claim for compensation under this chapter.

(b) All issues and questions of law or fact pertaining to such claims
shall be resolved by the arbitrator appointed pursuant to this
paragraph. Arbitrators shall be appointed by the chair to adjudicate
claims under this paragraph. Such arbitrators shall have the same
powers and duties as those accorded referees under this chapter,
including powers delegated by the chair. The provisions of this chapter
shall be applicable to claims under this paragraph insofar as they are
not inconsistent herewith.

(c) An award or decision by an arbitrator pursuant to this paragraph
is deemed to be a final decision of the board except if review of such
decision is sought as provided in paragraph (d) of this subdivision. No
modification, rescission or review of such award or decision may be
entertained by the board, notwithstanding any provision of this chapter
to the contrary.

(d) Within thirty days after notice of the filing of an award or
decision by an arbitrator, any party in interest may request review of
the arbitrator's decision by a panel of three arbitrators in the same
manner and to the same extent as the decision by a referee may be
reviewed by the board pursuant to section twenty-three of this article.
The arbitration panel shall consist of one arbitrator nominated by the
chair, one arbitrator nominated by a recognized alternative dispute
resolution organization and one arbitrator nominated by an employee
organization certified pursuant to article fourteen of the civil service
law to represent the collective bargaining unit of the injured employee
or, if the injured employee is not represented by a collective
bargaining unit, by the recognized alternative dispute resolution
organization. A party in interest may seek review of such award or
decision of an arbitration panel only by taking appeal therefrom to the
appellate division of the supreme court, third department and the court
of appeals as provided for decisions of the board pursuant to section
twenty-three of this chapter.

(e) The powers and jurisdiction of the arbitration panel established
pursuant to this subdivision shall be continuing in the same manner and
to the same extent as provided under this chapter to the board.

(f) All fees, costs and expenses of arbitration shall be borne by the
board and the state insurance fund as administration expenses pursuant
to sections eighty-eight and one hundred fifty-one of this chapter.

(g) Any claim for compensation by an officer or employee of the board
or state insurance fund not required to be determined by a neutral
outside arbitration process pursuant to paragraph (a) of this
subdivision shall be determined initially by a referee with review of
such determination available pursuant to section twenty-three of this
chapter.

(h) For any claim for compensation by an officer or employee of the
workers' compensation board or the state insurance fund whether or not
such claim is required to be determined by a neutral outside arbitration
process pursuant to paragraph (a) of this subdivision, the referee or
arbitrator making the initial finding of fact concerning any medical
issue present in the case shall develop the record with opinion evidence
from an impartial specialist who is an expert in the appropriate medical
specialty. Such impartial specialist shall be subject to
cross-examination at the request of any party in interest.

(i) The state insurance fund shall administer the claim of any
officer or employee of the state insurance fund at an office of the
state insurance fund other than the office which was, at the time of
injury, disablement or death of such officer or employee, his or her
principal workplace.

(j) The chair shall promulgate regulations necessary to implement
this subdivision. Such regulations shall include provisions in relation
to this subdivision for a single arbitrator to determine a claim in the
first instance and a panel of three arbitrators to review such decision
upon the application of any party in interest prior to judicial review.
Such regulations shall also include all special procedures relating to
the handling of claims of officers or employees of the workers'
compensation board and the state insurance fund pursuant to paragraph
(f) of this subdivision.

3. Notwithstanding any other provision of law to the contrary, a
member of the workers' compensation board, a referee or any arbitrator
in connection with the adjudication of any claim arising under this
chapter shall recuse himself or herself on any ground a judge may be
disqualified pursuant to section fourteen of the judiciary law.