New York Consolidated Laws

N.Y. Insurance Law § 5108 (2026)

Limit on charges by providers of health services

✓ current as of May 2026

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§ 5108. Limit on charges by providers of health services. (a) The
charges for services specified in paragraph one of subsection (a) of
section five thousand one hundred two of this article and any further
health service charges which are incurred as a result of the injury and
which are in excess of basic economic loss, shall not exceed the charges
permissible under the schedules prepared and established by the chairman
of the workers' compensation board for industrial accidents, except
where the insurer or arbitrator determines that unusual procedures or
unique circumstances justify the excess charge.
  (b) The superintendent, after consulting with the chairman of the
workers' compensation board and the commissioner of health, shall
promulgate rules and regulations implementing and coordinating the
provisions of this article and the workers' compensation law with
respect to charges for the professional health services specified in
paragraph one of subsection (a) of section five thousand one hundred two
of this article, including the establishment of schedules for all such
services for which schedules have not been prepared and established by
the chairman of the workers' compensation board.
  (c) No provider of health services specified in paragraph one of
subsection (a) of section five thousand one hundred two of this article
may demand or request any payment in addition to the charges authorized
pursuant to this section. Every insurer shall report to the commissioner
of health any patterns of overcharging, excessive treatment or other
improper actions by a health provider within thirty days after such
insurer has knowledge of such pattern.

Notes of Decisions

Cited in 52 cases (7 in the last 5 years), 1987–2026 · leading case: Goldberg v. Corcoran, 153 A.D.2d 113 (N.Y. App. Div. 1989).

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Goldberg v. Corcoran, 153 A.D.2d 113 (N.Y. App. Div. 1989). · cites it 14× “In this action for a declaratory judgment, the plaintiffs challenge the constitutionality of Insurance Law § 5108 insofar as it limits the amount that a provider of health services may demand or request in payment for services rendered under Insurance Law article 51, the…”

Gov't Employees Ins. v. Avanguard Med. Grp., PLLC, 49 N.E.3d 711 (NY 2016). · cites it 4× “Expenses for basic economic loss, as described in this paragraph, “shall be in accordance with the limitations of” Insurance Law § 5108 (id.). Section 5108, titled “Limit on charges by providers of health services,” authorizes the Chair of the Workers’ Compensation Board to…”

Med. Soc'y v. Serio, 800 N.E.2d 728 (NY 2003). “Under the revised regulations, attorney fees are no longer to be paid to a health care provider who submits claims in excess of the applicable fee schedules established pursuant to Insurance Law § 5108, except when the charges involve interpretation of the schedules or…”

Gov't Employees Ins. v. Avanguard Med. Grp., PLLC, 127 A.D.3d 60 (N.Y. App. Div. 2015). · cites it 8× “), an insurer must pay first-party benefits of up to $50,000 per person to reimburse a person for covered “basic economic loss” (Insurance Law § 5102 [a]), subject to the limitations of Insurance Law § 5108. One of the components of basic economic loss is, as relevant here, “[a]…”

Saddle Brook Surgicenter, LLC v. All State Ins., 48 Misc. 3d 336 (N.Y. City Civ. Ct. 2015). · cites it 7× “(Insurance Law § 5108 [a]; 11 NYCRR 68.1.) “The purpose of the [no-fault] statute and the fee schedules promulgated thereunder is to ‘significantly reduce the amount paid by insurers for medical services, and thereby help contain the no-fault premium’ ” *340 (Goldberg v…”

Walt v. GEICO Gen. Ins., 16 Misc. 3d 23 (N.Y. App. Term. 2007). · cites it 3× “professional health services” subject to the limitations of Insurance Law § 5108. The latter statute limits the amounts to be charged by providers of health services, and states that the charges for services specified in Insurance Law § 5102 (a) (1) “shall not exceed the charges…”

Allstate Ins. v. Elzanaty, 916 F. Supp. 2d 273 (E.D.N.Y 2013). “Finally, the Defendants point out that if the Plaintiffs believe that Uptown is not properly licensed, they have an initial resort to the New York State Commissioner of Health, citing Insurance Law § 5108(c), which states that “[e]very insurer shall report to the commissioner of…”

Globe Surgical Supply v. GEICO Ins., 59 A.D.3d 129 (N.Y. App. Div. 2008). “Insurance Law § 5108 authorizes the Superintendent of Insurance (hereinafter the Superintendent) to establish a fee schedule for DME, which had been, at all times relevant to this appeal, set forth in former Part E.”

Surgicare Surgical v. Nat'l Interstate Ins., 46 Misc. 3d 736 (N.Y. City Civ. Ct. 2014). · cites it 3× “), a provider’s reimbursement for eligible health services performed in New York “shall not exceed the charges permissible under [the fee schedule established by the New York State Workers’ Compensation Board]” (see Insurance Law § 5108 [a]). Under subdivision (c), “[n]o…”

Surgicare Surgical Assocs. v. Nat'l Interstate Ins., 50 Misc. 3d 85 (N.Y. App. Term. 2015). · cites it 2× “Indeed, the Superintendent’s reliance upon the “permissible cost” in the foreign jurisdiction is consistent with the legislative purpose underlying Insurance Law § 5108 and implementing regulations—to “significantly reduce the amount paid by insurers for medical services, and…”

Geico Indem. Co. v. Virtual Imaging Servs., Inc., 79 So. 3d 55 (Fla. 3d DCA 2011). “N.Y Ins. Law § 5108(b). . N.J.Rev.Stat. 39:6A-4.”

Geico Gen. Ins. v. Virtual Imaging Servs., Inc., 90 So. 3d 321 (Fla. 3d DCA 2012). “N.Y Ins. Law § 5108(b). . NJ.Rev.Stat. 39:6A-4.”

Show all 52 citing cases →

— N.Y. Insurance Law § 5108(a) — 3 cases

East Coast Acupuncture, P.C. v. Hereford Ins., 51 Misc. 3d 441 (N.Y. City Civ. Ct. 2016).

Introna v. Allstate Ins., 850 F. Supp. 161 (E.D.N.Y 1993).

Blano Med., P.C. v. Hereford Ins. Co, 2025 NY Slip Op 51540(U) (Civ. Ct. NYC, Kings Cty. 2025).

— N.Y. Insurance Law § 5108(b) — 2 cases

Geico Indem. Co. v. Virtual Imaging Servs., Inc., 79 So. 3d 55 (Fla. 3d DCA 2011). “N.Y Ins. Law § 5108(b). . N.J.Rev.Stat. 39:6A-4.”

Geico Gen. Ins. v. Virtual Imaging Servs., Inc., 90 So. 3d 321 (Fla. 3d DCA 2012). “N.Y Ins. Law § 5108(b). . NJ.Rev.Stat. 39:6A-4.”

— N.Y. Insurance Law § 5108(c) — 2 cases

Introna v. Allstate Ins., 850 F. Supp. 161 (E.D.N.Y 1993).

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