N.Y. Comp. Codes R. & Regs. Tit. 12 §§ 325-6.1 - Definitions
As used in this Subpart:
(a)
Acceptance of claim
shall mean the filing of notice in the format prescribed by the chair of the
carrier's acceptance of a claim of benefits.
(b)
Accident shall include
both an accident arising out of and in the course of employment and an
occupational disease. In the case of occupational disease, date of accident,
where used in this Subpart, shall mean date of disablement.
(c)
ANCR shall mean
accidental injury or occupational disease, notice and causal
relationship.
(d)
Board shall mean the Workers' Compensation Board, and in the
case of board determinations shall include those made by a member or panel of
the board, by a Workers' Compensation Law judge, conciliator or by the full
board.
(e)
Carrier
shall mean a self-insured or uninsured employer, or workers' compensation
insurance carrier as defined in section
300.1(a)(7) of
this Title, or special fund created by the Workers' Compensation Law for
payment of workers' compensation claims, but shall not include the uninsured
employers' fund.
(f)
Chair shall mean the chairperson of the Workers' Compensation
Board of the State of New York.
(g)
Dispute forum shall mean the American Arbitration Association
or such other private arbitration association or forum for alternative dispute
resolution designated by the chair and posted on the board's website to
arbitrate disputed requests for reimbursement.
(h)
Health insurer shall
mean a health insurer, health benefits plan or other payor of health benefits
as defined in section
13
(d) of the Workers' Compensation Law, when
acting directly or through a HIMP agent.
(i)
HIMP means the Health
Insurance Matching Program authorized by section
13 (d) and
(h) of the Workers' Compensation Law and
refers to processes established by the board to assist a health insurer in
reimbursement from a carrier for payments made for medical and/or hospital
services for or on behalf of an injured employee, and for arbitration of
disputed claims for reimbursement.
(j)
HIMP agent shall mean a
person or entity that is designated and authorized by a health insurer to
submit information for matching under this Subpart and to seek reimbursement
from a carrier under this Subpart on behalf of the health insurer. A HIMP agent
must execute a written agreement, prescribed by the chair, between the HIMP
agent, the health insurer and the board and file such agreement with the board.
In addition a HIMP agent must comply with all laws, regulations and policies
applicable to health insurers as set forth in Workers' Compensation Law section
13(d) and (h), and this Part. Failure to comply with all terms of such written
agreement or such other agreements with the board or with all applicable laws,
regulations, and policies is grounds for termination of an individual or
entity's status as HIMP agent and to preclude its participation in and rights
under Workers' Compensation Law section 13(d) and (h), and this Part.
(k)
Provider shall mean a
physician, hospital, physical or occupational therapist, podiatrist,
chiropractor, psychologist or other health provider to whom payment has been
made by the health insurer.
Notes
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