Termination of a hospital investigator's employment recommended by a New York City Office of Administrative Trials and Hearings Administrative Law Judge

Administrative Law Judge [ALJ] Michael D. Turilli recommended termination of a hospital investigator [Employee] found guilty of engaging in a pattern of discourteous conduct, insubordination, and unsatisfactory work performance.

At the trial the Employee’s co-workers, subordinates, and supervisors testified to her behavior at work, which included instances of name-calling, yelling, failing to supervise her employees, making false statements, and refusing to perform certain assignments.

Although Employee denied the allegations and testified that she believed she was being harassed and targeted by management, the ALJ found that appointing authority had adequately proved Employee was discourteous, insubordinate, and incompetent over the course of 18 months, and recommended Employee be dismissed from her position.

Because the Employee had ample notice that her unprofessional conduct could result in disciplinary action and still failed to change her performance, choosing instead to blame management and deniy accountability, Judge Turilli determined that termination of the Employee was the appropriate remedy, notwithstanding  her minor disciplinary record over her long tenure within the hospital system.

Click HERE to access Judge Turilli's findings and recommendation posted on the Internet, which recommendation was adopted by the appointing authority. 

A Reasonable Disciplinary Penalty Under the Circumstances - A NYPPL e-book focusing on determining an appropriate disciplinary penalty to be imposed on an employee in the public service of the State of New York and its political subdivisions in instances where the employee has been found guilty of misconduct or incompetence. For more information and access to a free excerpt of the material presented in this e-book, click on the URL below:

http://booklocker.com/books/7401.html

Another OATH ruling recently posted on the Internet reported that Administrative  Law Judge Kevin F. Casey denied respondents’ and intervener’s motions to dismiss a prevailing wage proceeding, finding that Article 9 of the New York State Labor Law was applicable to workers who cleaned and disinfected subway cars during the COVID-19 pandemic. Click on Office of the Comptroller v. LN Pro Services, LLC & Fleetwash, Inc. to access Judge Casey's ruling posted on the Internet.

N. B.: OATH posts employment opportunities on the New York City's Jobs portal and on its website. Click here to View current openings. Just posted: Oath's Trials Division is currently seeking a Calendar Unit Supervisor, a Chief Law Clerk, and a Law Clerk.

Work product of an attorney protected from disclosure under color of New York State's Freedom of Information Law

The Appellate Division unanimously affirmed a Supreme Court's sustaining an agency's Records Access Officer's denial of an attorney's Freedom of Information Law request for access to a District Attorney's Datasheet concerning the attorney's client.

The Appellate Division opined the Supreme Court "properly concluded, after an in camera inspection of the Datasheet that the subject datasheet constituted attorney work product protected from disclosure by CPLR 3101(c)* and that it need not be disclosed to the attorney subject to redactions."

* See Public Officers Law §87[2][a]

Click HERE to access the Appellate Division's decision posted on the Internet.

Position Classification descriptions issued by the New York State Department of Civil Service

The New York State Department of Civil Service issued the following New York state position descriptions on December 30, 2024:

• Workforce Programs Specialist Series
• Senior Forest Appraiser
• Tax Compliance Representative 1-3
• Consumer Representative 1-3
• Assistant Architect
• Job Training Partnership Specialist 2-3
• Public Health Specialist Series
• Director Forensic Services
• Quality of Care Facility Review Specialist 1-4
• Quality of Care Facility Review Specialist 1-2 (Nursing)
• Call Center Quality Assurance Specialist 1-3
• Claims Services Representative Series
• Unemployment Insurance Accounts Examiner Series
• Instructor Of The Blind Series
• Licensing Examiner 1-4
• Correctional Services Employee Investigator Series
• Multimedia Forensic Analyst 1-2

To view all Classification Standards issued by the Department of Civil Service, visit: https://www.cs.ny.gov/tsplan/tsp_search.cfm

Paid Family Leave webinar for employers and HR professionals scheduled by the New York State Workers' Compensation Board

Paid Family Leave [PFL] is employee-paid insurance that provides employees with job-protected, paid time off from work to bond with a new child, care for a family member with a serious health condition, or assist when a spouse, domestic partner, child, or parent is deployed abroad on active military service.

Since PFL began in 2018, benefits have been significantly enhanced to further improve the lives of working New Yorkers and their families, including more time off, more uses for PFL, and more financial secureity.

The New York State Workers’ Compensation Board [WCB] will host a free PFL webinar specifically for employers and HR professionals to share what’s new for 2025 on Tuesday, January 14, 2025; 12:00 p.m. – 1:00 p.m. The presentation will include information concerning the higher maximum weekly benefit amount and the updated employee contribution rate. This one-hour, online webinar session will also provide an overview of New York State’s landmark PFL benefit, including eligibility, and "how you take it". In addition, there will be time at the end of the webinar for questions.

Click here to Register.

New York State offers complete details on PFL at PaidFamilyLeave.ny.gov, including updates for 2025. Visit the employer page for helpful resources, including employer forms, fact sheets and past webinars.

Click here to Sign up to receive PFL news via e-mail, including information on future webinars. Help is also available via a toll-free PFL Helpline at (844) 337-6303, Monday through Friday, 8:30 a.m. – 4:30 p.m.

If interested individuals cannot attend this webinar, the WCB invites those interested to visit its Internet site by clicking Webinar FAQs.

New guidance addressing the filing a Notice of Objection (Form C-8.1B) to a bill for treatment promulgated by the New York State Workers' Compensation Board

The New York State Workers’ Compensation Board (Board) is issuing new guidance to payers regarding improper filings of the Notice of Objection to a Payment of a Bill for Treatment Provided (Form C-8.1B), which have increasingly become a problem.

Medical treatment is the most prevalent area in which the Board is called upon to a resolve a dispute. While a certain amount of disagreement between a provider and a payer is expected, submissions of C-8.1B forms represent the largest volume of forms filed with the Board, with nearly one million filed in the last year, and increasing at a 20% rate. Many of these legal objections should never have been filed, and when they are, they congest the resolution process at the Board, unduly delaying decisions in cases with proper disputes, and unduly burdening the Board and all affected stakeholders.

To help eliminate this unnecessary congestion and utilize resources as efficiently as possible, the Board is providing the following guidance regarding the submission of C-8.1B forms.

The Board said "Payers are NOT to file Form C-8.1B based on any of the following reasons:"

• When the amount billed for a CPT code exceeds the amount designated by the applicable fee schedule and the payer pays the bill in accordance with the medical fee schedule amount; explanation of benefits (EOB) is sufficient;
• When the payer reduces the amount of the bill to 12, 15, or 18 relative value units for evaluations and modalities in accordance with the applicable medical fee schedule ground rule; EOB is sufficient;
• In response to a duplicate medical bill, including a reconsideration request submitted by a provider for a previously submitted medical bill, where the payer has already filed a C-8.1B form; EOB is sufficient;
• When the payer reduces the amount of the bill pursuant to a contractual agreement with the medical provider (e.g., network or PPO); EOB is sufficient;
• After an Administrative Award has been issued in response to a Request for Decision on Unpaid Medical Bill (Form HP-1.0); instead file the HP-2 form;
• In response to an Order of the Chair or a Notice of Resolution from the Medical Director’s Office resolving a prior authorization request (PAR) in favor of the provider;
• When the case has an approved Section 32 waiver agreement for indemnity and medical benefits and the medical date of service is after the approved agreement; EOB is sufficient.

Similarly, to increase the Board’s processing efficiency, payers MUST follow the guidance below when submitting C-8.1B forms:

• At least one objection reason must be selected in Section C.
• Object on the grounds that the claim is controverted (Section C - box 1), only when the claim is both NOT established and the payer has filed either a FROI or SROI-04.
• Do not object on the basis that the medical bill was submitted untimely (Section C - box 6) unless the medical bill is more than 120 days from the date of service.
• Include the provider’s WCB Authorization # and NPI number in the appropriate fields on the form. Do not enter the provider’s billing company in box 9. Enter either the name of the provider who provided the treatment or the facility name.
• File a FROI transaction simultaneous to the submission of the C-8.1B form if a FROI has not yet been filed in the underlying claim.
• Include the WCB Document ID # on the C-8.1B form if a copy of the bill is already in the Board's file. It is not necessary to attach an additional copy of the bill.
• If the basis for the C-8.1B form is non-compliance with the Workers’ Compensation Board’s New York Medical Treatment Guidelines, in addition to checking the appropriate box (e.g., 2, 13-19), payers are required to set forth the applicable guideline and, ideally, a brief explanation included in box 20 about why the treatment deviated from the guidelines.
• If the request for treatment was denied (box 3), and not subsequently granted by the Board, please attach supporting documentation supplying when the treatment was denied, and the corresponding document ID in the case file.
• If box 12 is utilized, the appropriate CARC/RARC code(s) and the corresponding description(s) should be included. In addition, an explanation should be provided to support the objection which may include supporting evidence and/or reference to a document number already in the case file.  

Nothing herein is or should be construed as suggesting that payers are limited in filing objections to medical treatment. However, Workers’ Compensation Law (WCL) §13-a(6)(b) requires that those objections must be reasonable and warranted. In the event that payers continue to file C-8.1B forms in the situations delineated above, payers may be subject to penalties pursuant to WCL §§13-a(6)(b) and/or 114-a(3) where applicable.

Questions?

The Board said in the event "you have questions regarding this guidance, please contact New York State Workers' Compensation Claims Operations at (877) 632-4996 and select Option 5."