Expand Workers’ Comp Benefits

Section 1. Subdivision 4 of section 10 of the workers' compensation law is REPEALED.

§ 2. Section 12 of the workers' compensation law, as amended by chapter 500 of the laws of 1965, is amended to read as follows:

§ 12. Compensation not allowed for first seven days. No compensation shall be allowed for the first seven days of disability, except the benefits provided for in section thirteen of this chapter, provided, however, that in case the injury results in disability of more than [fourteen] seven days, the compensation shall be allowed from the date of the disability.

§ 3. Subdivision 5 of section 13-a of the workers' compensation law, as amended by chapter 6 of the laws of 2007 and as further amended by section 104 of part A of chapter 62 of the laws of 2011, is amended to read as follows:

(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] two 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] seven calendar days from receipt of a request for authorization, or unless such special services are required in an emergency, provided, however, that the basis

EXPLANATION--Matter in italics (underscored) is new; matter in brackets

[ ] is old law to be omitted.

LBD03224-01-7

A. 4825 2

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. Such list of pre-authorized procedures shall be issued and maintained for the purpose of expediting authorization of treatment of injured workers. Such list of pre-authorized procedures shall not be construed or relied upon to support the premise that procedures not included on the pre-authorized list should be denied. Pre-authorized procedures shall not be given preference over alternative forms of treatment that are not on the pre-authorized procedures list.

§ 4. Paragraph (c) of subdivision 7 of section 13-a of the workers' compensation law, as added by chapter 6 of the laws of 2007, is amended to read as follows:

(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] two 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.

§ 5. Section 2 of the workers' compensation law is amended by adding a new subdivision 24 to read as follows:

24. "Examiner" means an individual qualified and authorized to perform independent medical examinations pursuant to sections thirteen-b and thirteen-bb of this chapter and registered with the board pursuant to section thirteen-bb of this chapter.

§ 6. The workers' compensation law is amended by adding a new section 13-bb to read as follows:

§ 13-bb. Regulation of independent medical examinations. 1. (a) There is hereby established in the workers' compensation board an advisory committee on independent medical examinations which shall consist of three members. One member shall be appointed by the governor; the chief executive officers of the New York State American Federation of Labor- Congress of Industrial Organizations and the Business Council of New York State shall be members by virtue of their offices. The chief executive officers of the New York State American Federation of Labor-Congress of Industrial Organizations and the Business Council of New York State may designate representatives to act in their place or stead and on their behalf as members of such advisory committee. In addition, the chair, executive director and the commissioner of labor or their designated representatives shall be invited to attend and participate in all meetings.

A. 4825 3

(b) It shall be the duty of the advisory committee hereby established to advise, counsel and confer with the chair and executive director on matters of policy in connection with the administration and enforcement of laws and regulations relating to independent medical examinations. The advisory committee shall specifically examine the frequency of use of independent medical examinations, the qualifications of examiners, the existence of conflicts of interest involving examiners and independent medical examination organizations, the frequency with which recommendations resulting from independent medical examinations are invalidated or amended and the adequacy of continuing education programs for examiners to ensure that use of independent medical examinations is not adversely impacting the timeliness or quality of care injured workers receive. The advisory committee shall review existing and proposed state laws and regulations pertaining to independent medical examinations and recommend to the chair, executive director and the chairpersons of the assembly and senate standing committees on labor and insurance, necessary changes or additions to laws, regulations and board programs to improve medical care for injured workers, the effectiveness of the board's regulation of independent medical examinations, examiners and independent medical examination organizations and enforcement activities. The committee shall review and revoke authorizations of individual examiners if such examiners exhibit bias, conflicts of interest or otherwise fail to uphold their obligations under this chapter.

(c) The chair shall assign staff to assist the advisory committee as necessary and shall provide necessary information and space for meetings of the advisory committee. The advisory committee shall keep a record of its meetings and recommendations.

(d) The advisory committee shall meet at the call of the chair or any member and at such other times as it may deem necessary and at such places as may be convenient. In any event, meetings shall be held at least once per state fiscal quarter. An initial meeting shall be held within sixty days after the effective date of this section.

2. All examiners and all individuals with ownership interests in independent medical examination organizations must file statements of financial disclosure with the board on an annual basis as described in subdivision four of this section.

3. The annual statement of financial disclosure shall contain the following information and shall be in the form set forth below: Annual statement of financial disclosure - (For calendar year) 1. Name 2. (a) check one

( ) Examiner

( ) Owner of independent medical examination organization

Name and address of independent medical examination

organization ________________________________________________________________________ ________________________________________________________________________

(b) Address of Present Office

(c) Office Telephone Number 3. (a) Marital Status If married, please give spouse's full name including maiden name where applicable. (b) List the names of all unemancipated children. ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________

A. 4825 4

Answer each of the following questions completely, with respect to calendar year , unless another period or date is otherwise specified. If additional space is needed, attach additional pages. Whenever a "value" or "amount" is required to be reported herein, such value or amount shall be reported as being within one of the following Categories in Table I or Table II of this subdivision as called for in the question: A reporting individual shall indicate the Category by letter only. Whenever "income" is required to be reported herein, the term "income" shall mean the aggregate net income before taxes from the source identified. The term "calendar year" shall mean the year ending the December 31st preceding the date of filing of the annual statement. 4. (a) List any office, trusteeship, directorship, partnership, or position of any nature, whether compensated or not, held by the reporting individual with any firm, corporation, association, partnership, or other organization. Include compensated honorary positions; do not list membership or uncompensated honorary positions. Position Organization ________________________________________________________________________ ________________________________________________________________________ (b) List any office, trusteeship, directorship, partnership, or position of any nature, whether compensated or not, held by the spouse or unemancipated child of the reporting individual, with any firm, corporation, association, partnership, or other organization. Include compensated honorary positions; do not list membership or uncompensated honorary positions. Position Organization ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ 5. List the name, address and description of any occupation, employment (other than the employment listed under Item 2 above), trade, business or profession engaged in by the reporting individual.

Name & Address of Organization Position Description ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ 6. List each source of gifts in excess of $500, received during the reporting period for which this statement is filed by the reporting individual or such individual's spouse or unemancipated child from the same donor, excluding gifts from a relative. Include the name and address of the donor. The term "gifts" does not include reimbursements, which term is defined in item 7. Indicate the value and nature of each such gift. Category Self, Spouse or Name of Nature of Value of

Child Donor Gift Gift ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ 7. Identify and briefly describe the source of any reimbursements for expenditures, in excess of $250 from each such source. For purposes of this item, the term "reimbursements" shall mean any travel-related expenses provided by sources and for activities related to the reporting individual's official duties such as, speaking engagements, conferences,

A. 4825 5

or fact finding events. The term "reimbursements" does not include gifts reported under item 6.

Source Description ________________________________________________________________________ ________________________________________________________________________ 8. List the identity and value, if reasonably ascertainable, of each interest in a trust, estate or other beneficial interest, including retirement plans, and deferred compensation plans (e.g. 401, 403(b), 457, etc.) established in accordance with the internal revenue code, in which the reporting individual held a beneficial interest in excess of $1,000 at any time during the preceding year. Do not report interests in a trust, estate or other beneficial interest established by or for, or the estate of, a relative.

Identity Category of Value* (In Table II) ________________________________________________________________________ ________________________________________________________________________