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Legislative Memo

518.465.7511

BILL:

S.4208 (Velella) / A.7211-A (John)

Support

SUBJECT:

Health Care Provider Notice

 

DATE:

June 2, 2003

 

This legislation would allow the Workers' Compensation Board to notify health care providers that negotiations for a Section 32 settlement have commenced between a claimant and an employer or a carrier. The bill would allow the health care provider 15 days to submit any unpaid bills to the Workers' Compensation Board to be considered as part of the Section 32 settlement.

Under current law, if the Board approves a Section 32 agreement the claimant is given the right to waive any or all indemnity and medical payments in exchange for a lump sum settlement which is agreed upon by the parties. The Business Council opposes this bill because we believe that it would delay and add an unnecessary layer of bureaucracy to Section 32 agreements.

On a technical point, the legislation is not clear as to who is responsible for providing notice of the Section 32 proceedings and may be interpreted to require employers or carriers to search for and provide notice to medical providers. This would be a costly venture for whichever party is subject to providing notice whether it is the carriers, employers or the Board.

Workers' Compensation Law provides an arbitration mechanism for resolving disputes between medical providers and employers or carriers. Under present law, if the dispute involves the value of medical treatment, the amount of a bill or the frequency of medical services for example, the dispute is resolved through its arbitration process. If the dispute revolves around the denial of medical services, the Board resolves the dispute through its hearing process. The Business Council sees no reason for adding another arena for the resolution of these disputes.

The legislation would allow medical providers to resubmit bills that have been disputed and are already part of the arbitration or hearing proceedings. The provider would simply resubmit the bills during the Section 32 approval hearing before a Workers' Compensation Board Commissioner. Further, providers that have not yet submitted bills, and are concerned that they may be disputed, would be able to circumvent the arbitration or hearing process by submitting the bills to the Workers' Compensation Board when they receive notice of a pending Section 32 settlement.

It must be noted that under the current system arbitration and hearing procedures are still available to providers when a Section 32 agreement has been approved. Health care providers are not a party of interest. Therefore, a Section 32 settlement is not binding upon them and they are afforded the right to pursue the remedies that are provided under the current system. Additionally, because a provider is not a party to the Section 32 agreement and not bound by its terms, the employers and carriers cannot use the agreement as an excuse to refuse payment of the bills.

The Business Council of New York State, Inc. opposes this bill and urges its defeat.