New York Codes, Rules and Regulations
Title 12 - DEPARTMENT OF LABOR
Chapter V - Workers' Compensation
Subchapter H - Disability Benefits
Article 2 - Rules Under Disability Benefits Law
Part 380 - Paid Family Leave
Subpart 380-9 - Disputes
Section 380-9.4 - Initiation of process

Universal Citation: 12 NY Comp Codes Rules and Regs ยง 380-9.4

Current through Register Vol. 46, No. 12, March 20, 2024

(a) All requests for arbitration shall be initiated by submitting the completed request for arbitration to the dispute resolution forum and the responding party, and by submitting to the dispute resolution forum a filing fee in the amount of $25 that may be refunded as set forth in paragraph (3) of this subdivision.

(1) If the request is initiated by an employee (including an employee claiming employment or eligibility), the employee shall attach copies of all documents previously submitted to the carrier or self-insured employer as proof of eligibility, and the rejection of claim form.

(2) If the request is initiated to dispute the identity of the proper insurance carrier or to establish coverage for a paid family leave period, the party initiating arbitration must attach documentation to support its request.

(3) If the employee prevails on his or her claim, $25 will be added to the benefits paid to an employee by the insurance carrier or self-insured employer.

(b) Within two business days of receipt of the completed request for arbitration and filing fee, the dispute resolution forum shall acknowledge receipt of the request for arbitration by notifying all parties by electronic communication. In his or her request for arbitration, an employee may request communication by regular mail.

(c) Any request for arbitration which is not accompanied by the necessary documents or filing fee shall be returned with an acknowledgment stating there will be no further action on the claim. An incomplete request for arbitration may be completed and resubmitted in its entirety subject to section 380-9.3(a) of this Subpart and receipt of the filing fee of $25.

(d) Within 14 days after receipt of acknowledgment of the completed request for arbitration from the dispute resolution forum, the responding party shall submit to the dispute resolution forum, and all other parties, a response to the request for arbitration and copies of any documents supporting its denial of the request for family leave benefits.

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