2013 New York Consolidated Laws
WKC - Workers' Compensation
Article 2 - (9 - 35) COMPENSATION
13-A - Selection of authorized physician by employee.

 
    §  13-a. Selection of authorized physician by employee. (1) An injured
  employee may, when care is required, select to  treat  him  or  her  any
  physician  authorized  by the chair to render medical care, as hereafter
  provided. If for any reason during the period when medical treatment and
  care is required, the employee wishes to transfer his or  her  treatment
  and  care  to  another  authorized  physician,  he  or she may do so, in
  accordance with rules prescribed by the  chair.  In  such  instance  the
  remuneration  of  the  physician whose services are being dispensed with
  shall be  limited  to  the  value  of  treatment  rendered  at  fees  as
  established  in  the schedule for his or her location, unless payment in
  higher amounts has been approved  as  authorized  in  section  thirteen,
  paragraph  a.  If  a claimant shall receive treatment in any hospital or
  other institution operated in whole or in part by the state of New York,
  the  employer  shall  be  liable  for  food,  clothing  and  maintenance
  furnished  by the hospital or other institution to such employee. If the
  employee is unable due to the  nature  of  the  injury  to  select  such
  authorized  physician  and  the  emergency nature of the injury requires
  immediate medical treatment and care, or if he or she does not desire to
  select a physician, and in writing so advises the employer, the employer
  shall promptly provide him or  her  with  the  necessary  medical  care,
  provided however, that nothing herein contained shall operate to prevent
  such  employee,  when  subsequently  able  to  do so, from selecting for
  continuance of any medical treatment or  care  required,  any  physician
  authorized by the chair to render medical care as hereinafter provided.
    (2)  The  chairman  shall  prescribe  the  form  of a notice informing
  employees of their privilege under this chapter, and such  notice  shall
  be  posted  and  maintained  by  the  employer in a conspicuous place or
  places in and about his place or places of business.
    (3) The employer shall have the right  to  transfer  the  care  of  an
  injured employee from the attending physician, whether chosen originally
  by  the employee or by the employer, to another authorized physician (1)
  if the interest of the injured employee necessitates the transfer or (2)
  if the physician has not been  authorized  to  treat  injured  employees
  under  this  act  or (3) if he has not been authorized under this act to
  treat  the  particular  injury  or  condition  as  provided  by  section
  thirteen-b  (2).  An  authorized  physician  from whom the case has been
  transferred shall have the right of appeal to an  arbitration  committee
  as  provided  in  subdivision  two  of  section  thirteen-g  and if said
  arbitration committee finds that the transfer was not authorized by this
  section, said employer shall pay to the physician a  sum  equal  to  the
  total  fee  earned  by  the  physician  to  whom the care of the injured
  employee has been transferred, or such proportion of  said  fee  as  the
  arbitration committee shall deem adequate.
    (4)  (a) No claim for medical or surgical treatment shall be valid and
  enforceable, as  against  such  employer,  or  employee,  unless  within
  forty-eight  hours  following  the  first treatment the physician giving
  such treatment furnishes to the employer and directly  to  the  chair  a
  preliminary  notice  of  such  injury and treatment, within fifteen days
  thereafter a  more  complete  report  and  subsequent  thereto  progress
  reports  if  requested  in  writing  by  the  chair,  board, employer or
  insurance carrier at intervals of not less than three weeks apart or  at
  less  frequent  intervals if requested on forms prescribed by the chair.
  The board may excuse failure to give such notices within the  designated
  periods when it finds it to be in the interest of justice to do so.
    (b)  Upon  receipt of the notice provided for by paragraph (a) of this
  subdivision, the employer, the carrier, and the claimant each  shall  be
  entitled  to have the claimant examined by a physician authorized by the
  chair  in  accordance  with  sections   thirteen-b   and   one   hundred

  thirty-seven  of  this  chapter, at a medical facility convenient to the
  claimant and in the presence of the claimant's physician, and refusal by
  the claimant to submit to such independent medical examination  at  such
  time  or  times  as  may  reasonably  be necessary in the opinion of the
  board, shall bar the  claimant  from  recovering  compensation  for  any
  period during which he or she has refused to submit to such examination.
  No  hospital  shall  be  required to produce the records of any claimant
  without receiving its customary fees or charges for reproduction of such
  records.
    (c) Where it would place an unreasonable burden upon the  employer  or
  carrier  to  arrange  for, or for the claimant to attend, an independent
  medical examination by an authorized physician, the employer or  carrier
  shall  arrange  for  such  examination  to  be  performed by a qualified
  physician in a medical facility convenient to the claimant.
    (d) The independent medical examiner shall provide  such  reports  and
  shall submit to investigation as required by the chair.
    (e)  In  order to qualify as admissible medical evidence, for purposes
  of adjudicating any claim under this chapter, any  report  submitted  to
  the  board  by  an independent medical examiner licensed by the state of
  New York shall include the following:
    (i) a signed statement certifying  that  the  report  is  a  full  and
  truthful   representation   of   the   independent   medical  examiner's
  professional opinion with respect to the claimant's condition:
    (ii) such examiner's board issued authorization number;
    (iii) the name of the individual or entity requesting the examination;
    (iv) if applicable, the registration number  as  required  by  section
  thirteen-n of this article; and
    (v) such other information as the chair may require by regulation.
    Any  report  by an independent medical examiner who is not authorized,
  and who performs an independent medical examination in  accordance  with
  paragraph  (c)  of  this  subdivision,  which  is  to be used as medical
  evidence  under  this  chapter,  shall  include  in  the   report   such
  information as the chair may require by regulation.
    (5)  No  claim  for  specialist  consultations,  surgical  operations,
  physiotherapeutic or occupational therapy procedures, x-ray examinations
  or special diagnostic laboratory tests costing more  than  one  thousand
  dollars shall be valid and enforceable, as against such employer, unless
  such  special  services shall have been authorized by the employer or by
  the board, or unless such authorization has been unreasonably  withheld,
  or  withheld for a period of more than thirty calendar days from receipt
  of a request for authorization, or  unless  such  special  services  are
  required in an emergency, provided, however, that the basis for a denial
  of  such  authorization  by  the employer must be based on a conflicting
  second opinion rendered by a physician  authorized  by  the  board.  The
  board,  with  the  approval of the superintendent of financial services,
  shall issue and maintain a list of pre-authorized procedures under  this
  section.
    (6)  Any  interference  by any person with the selection by an injured
  employee of an authorized  physician  to  treat  him,  except  when  the
  selection  is  made  pursuant  to article ten-A of this chapter, and the
  improper influencing or attempt by any person  improperly  to  influence
  the  medical  opinion  of  any  physician who has treated or examined an
  injured employee, shall be a misdemeanor;  provided,  however,  that  it
  shall  not  constitute  interference  or  improper  influence if, in the
  presence of such injured employee's physician, an employer, his  carrier
  or   agent   should   recommend   or   provide   information  concerning
  rehabilitation services  or  the  availability  thereof  to  an  injured
  employee or his family.

    (7)(a)  Notwithstanding  any  other  provision  of this chapter to the
  contrary, any insurance carrier authorized to transact the  business  of
  workers' compensation insurance in this state, self-insurer or the state
  insurance  fund  may  contract  with  a network or networks, legally and
  properly  organized,  to  perform  diagnostic tests, x-ray examinations,
  magnetic resonance imaging, or other radiological examinations or  tests
  of  claimants  and  may  require  claimant  to  obtain  or  undergo such
  diagnostic test, x-ray examinations, magnetic resonance imaging or other
  radiological examinations or tests with a provider or at a facility that
  is affiliated with the  network  or  networks  with  which  the  carrier
  contracts,  except  if a medical emergency occurs requiring an immediate
  diagnostic test, x-ray examination, magnetic resonance imaging or  other
  radiological  examination  or  test  or  if  the  network with which the
  insurance carrier, self-insurer or the state  insurance  fund  contracts
  does  not have a provider or facility able to perform the examination or
  test within a reasonable distance from the claimant's residence or place
  of employment, as defined by regulation of the board.
    (b) Any insurance carrier, self-insurer or the  state  insurance  fund
  which  requires  claimants  to obtain or undergo diagnostic tests, x-ray
  examinations,  magnetic  resonance   imaging   or   other   radiological
  examinations or tests with a provider or at a facility affiliated with a
  network or networks with which it contracts, must notify the claimant of
  the name and contact information for the network or networks at the same
  time  the  written  statement  of  the  claimant's rights as required by
  subdivision  two  of  section  one  hundred  ten  of  this  chapter   or
  immediately  after  imposing  such requirement if the time period within
  which the written statement of the  claimant's  rights  as  required  by
  subdivision two of section one hundred ten of this chapter has expired.
    (c)  At  the  time  a request for authorization for special diagnostic
  tests,  x-ray  examinations,  magnetic  resonance   imaging   or   other
  radiological  examinations  or  tests  costing  more  than  one thousand
  dollars as required by subdivision five of this section is approved, the
  insurance carrier, self-insurer  or  state  insurance  fund,  or  if  so
  delegated  the network with which the insurance carrier, self-insurer or
  state  insurance  fund  has  contracted,  shall  notify  the   physician
  requesting  authorization of the requirement that the claimant obtain or
  undergo  the  special  diagnostic  test,  x-ray  examination,   magnetic
  resonance  imaging  or  other  radiological  examination  or test with a
  provider or at a facility affiliated with the network or  networks  with
  which  it  has contracted, the contact information for the network and a
  list of the providers and facilities within  the  claimant's  geographic
  location,  as  defined  by  regulation  of  the  board. The claimant, in
  consultation with the provider  who  requested  the  special  diagnostic
  test,   x-ray   examination,   magnetic   resonance   imaging  or  other
  radiological test or exam, will determine the provider or facility  from
  within  the  network  which  will  perform  such  diagnostic test, x-ray
  examination,  magnetic   resonance   imaging   or   other   radiological
  examination or test.
    (d)  The  results  of  the special diagnostic test, x-ray examination,
  magnetic resonance imaging or other radiological test or  exam  must  be
  sent  to  the  physician who requested the test or exam immediately upon
  completion of the report detailing the results.