N.Y. Comp. Codes R. & Regs. tit. 12 § 363.15

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

Section 363.15

(a) A carrier or self-insured employer who receives a request for benefits in any format other than the format prescribed by the chair shall immediately provide the employee with an acknowledgment of receipt with a claim identification number.

(b) If the request for benefits is made telephonically, the carrier or self-insured employer shall create a written form, or use the format prescribed by the chair, to capture the information reported by the employee. The carrier or self-insured employer shall provide a copy of the completed written form with any notice of rejection or notice of denial. If the carrier or self-insured employer accepts the medical certification telephonically, such carrier or self-insured employer may not deny the claim based on insufficient medical certification.

(c) If the carrier or self-insured employer determines the application for disability benefits is incomplete, it shall provide the employee within five business days a list of each piece of required information which is missing with the corresponding data field on the Notice and Proof of Claim for Disability Benefits prescribed by the chair identified. Such list shall also provide the employee with an explanation of how to properly complete Notice and Proof of Claim for Disability Benefits.

N.Y. Comp. Codes R. & Regs. Tit. 12 § 363.15

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