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Arbitration agreements in workers’ compensation disputes

Last time, we briefly mentioned a New York Supreme Court Case in which it was ruled that several employers were bound by compulsory arbitration agreements they had signed, which were in turn governed by the Federal Arbitration Act. As we noted, arbitration is sometimes used in the workers’ compensation process here in New York to resolve disputes.

Arbitration is used by health care providers to dispute a workers’ compensation insurance carrier’s failure to cover services provided to injured workers with open Workers’ Compensation cases. Arbitration is specifically used when the insurance carrier has provided a timely response to submitted bills, but has chosen not to provide coverage. 

According to the Workers’ Compensation Board, there are two types of arbitration available in such cases: desk arbitration, which involves a single arbitrator review of paper submissions and then a decision without a hearing; and panel arbitration, which does include a hearing. Only desk arbitration is available for cases in which $1,000 or less is in dispute. In cases where more is in dispute, a hearing is option.

Providers must fill out and submit specific forms in order to proceed with the arbitration process, and specific timelines must be met. It is important, of course, for providers to provide the most accurate records possible to ensure their case is as strong as possible. It also helps to work with an experienced advocate in the arbitration process to ensure one has the best possible chance of a favorable outcome. This is especially true of cases involving a panel hearing.

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