(b) The following issues may be interposed by a carrier as objections to requests for reimbursement, in whole or in part, by a health insurer:

1. (1) The compensability of the claim has not been established or the workers' compensation case has been closed without acceptance of the claim or findings of accident or occupational disease, notice and causal relationship, or the compensability of the claim is the subject of a pending application for review to the board or a pending appeal to the courts, and is not subject to arbitration and therefore the claim is not subject to reimbursement.
2. (2) The request for reimbursement has not been timely served in accordance with section 325-6.2 or section 325-6.3(b) of this Subpart.
3. (3) The treatment, services or hospitalization for which the health insurer made payments was on behalf of a person other than the workers' compensation claimant, or was for a condition or injury unrelated to the workers' compensation claim, or for treatment of a part of the body for which causal relationship has not been established.
4. (4) The treatment, services or hospitalization for which the health insurer made payments were not furnished on an emergency basis, and were obtained by the injured employee after authorization for such treatment, services or hospitalization was requested by the injured employee and such authorization was denied by a Workers' Compensation Law judge or other duly designated board employee or such authorization was denied by the carrier and the claimant or health care provider did not seek a board or Workers' Compensation Law judge determination on the denial.
5. (5) The fee was in excess of the workers' compensation fee schedule or, in the case of inpatient hospital bills, in excess of the rate of payment for inpatient hospital services established pursuant to the provisions of the Public Health Law, or the proper fee schedule amount or rate of payment for inpatient hospital services cannot be determined. In any case in which this objection is interposed, the carrier must explain why the fee was in excess of the fee schedule or rate of payment or why the proper amount cannot be determined. If this is the sole objection to the request for reimbursement, the carrier must state the amount which it believes to be the proper amount and must pay the undisputed amount to the health insurer.
6. (6) The bill should have been pro-rated with another physician or health provider.
7. (7) The carrier cannot determine from the documentation served whether it is responsible for payment.
8. (8) The carrier has previously reimbursed the health insurer or paid the health provider with respect to the claim. Proof of payment must be submitted.
9. (9) The treatment was provided on or after the date that the board approved a waiver on the part of the claimant to the right to medical treatment in connection with an agreement made pursuant to Workers’ Compensation Law section 32.
10. (10) The carrier would not be obligated to pay for the treatment pursuant to Workers’ Compensation Law section 29 because the claimant recovered proceeds from a third party and the corresponding carrier lien or offset has not been extinguished.
11. (11) The treatment provided by a board authorized provider was not consistent with the applicable medical treatment guidelines adopted by the board in section 324.2(a) of this Title.

(d) The following issues may not be interposed as objections by a carrier to requests for reimbursement by a health insurer:

1. (1) The failure of a provider to seek prior authorization for treatment pursuant to section 13-a (5) of the Workers' Compensation Law and the rules and regulations promulgated there under.
2. (2) The failure of a provider to file notices and/or reports required by section 13-a(4), 13-k(3), 13-l(3) or 13-m(4) of the Workers' Compensation Law and the rules and regulations promulgated there under.
3. (3) The treatment was excessive or too frequent, except as set forth in the applicable medical treatment guidelines adopted by the board in section 324.2(a) of this Title.
4. (4) The period of hospitalization was excessive and/or unnecessary, except as set forth in the applicable medical treatment guidelines adopted by the board in section 324.2(a) of this Title.