Relates to seeking medical treatment from outside the preferred provider organization

BILL NUMBER:S5526 REVISED 5/18/15

Title of bill

An act to amend the workers' compensation law, in relation to seeking medical treatment from outside the preferred provider organization

Purpose

This bill would extend the period during which an employee may seek medical treatment from outside the preferred provider organization from 30 days to 90 days.

Summary of provisions

Section 1: Amends subdivision 2 of section 354 of the workers' compensation law, as added by chapter 635 of the laws of 1996, to allow an employee to seek medical treatment from outside the preferred provider organization (PPO) ninety days after their first visit to a PPO provider.

Section 2: Sets the effective date.

Justification

Providing the best care for injured workers thus allowing them to heal and return to work as soon as possible should be the primary goal of New York's Workers' Compensation system. To that end, extending the period within which an injured worker may be directed to care inside a preferred provider network (PPO) has been proven to reduce the amount of days lost at work per claim, increased worker satisfaction with the care and has been more cost-effective for private and municipal employers' alike. Data shows that workers who use a PPO lost a median number of 8.7 days at work per claim as opposed to 24.5 days per claim for those workers not using a PPO (almost 3 times slower than those workers who do not use a PPO).

New York State currently limits the number of days, under a collectively bargained agreement, that an employee may be directed to a provider at 30 days. In other states, a longer period has proven to be more effective. Under current New York State law, the 30 day period leads to a median of 70 lost days. In general, an employer with a 90 day period in which an employee may seek a PPO provider leads to only a median of 9.3 lost days.

In addition, this legislation does not disregard collective bargaining. It respects collective bargaining while getting injured employees healthy and back to work more quickly. This legislation is meant to enhance the employee experience. Furthermore, it will reduce litigation, reduce disputes between employees and employers, help to provide more specialized care, and drive costs out of the workers' compensation system at no additional cost to the State.

Legislative history

This is a new bill.

Fiscal implications

To be determined.

Effective date

This act shall take effect on the ninetieth day after it shall have become law.