N.Y. Comp. Codes R. & Regs. tit. 12 § 363.11

Current through Register Vol. 46, No. 42, October 16, 2024

Section 363.11 - Notice and proof of disability

(a) Notice and proof of disability shall be in the format prescribed by the Chair. Once the employer receives the request for disability benefits from an employee, the employer shall complete the employer information and return it to the employee within three business days.

(b) Such notice and proof shall include statements furnished by the claimant and the claimant's attending physician, podiatrist, certified nurse midwife, chiropractor or dentist in form prescribed for such purpose by the chairman. The attending physician, podiatrist, certified nurse midwife, chiropractor or dentist shall complete and mail such form to the carrier or self-insured employer, or return it to the claimant, within seven days of receipt of the form.

(c) A carrier, employer or the chairman may investigate a claim and for cause require additional information.

(d) Failure to furnish notice or proof within thirty days after commencement of the period of disability shall not invalidate the claim, but no benefits shall be required to be paid for any period more than two weeks prior to the date on which the required proof is furnished. However, if claimant shows it was not reasonably possible to furnish such notice or proof within thirty days and that such notice or proof was furnished as soon as possible (e.g., delay by medical provider, or claimant was incapacitated), such delay may be excused and benefits may be payable for the full period of disability; provided required proof of disability is furnished within 26 weeks after commencement of the period of disability.

N.Y. Comp. Codes R. & Regs. Tit. 12 § 363.11

Amended New York State Register May 10, 2023/Volume XLV, Issue 19, eff. 1/1/2024