Text of New York State Bill A08601
S T A T E O F N E W Y O R K
________________________________________________________________________
8601--A
1999-2000 Regular Sessions
I N A S S E M B L Y
May 27, 1999
___________
Introduced by COMMITTEE ON RULES -- (at request of M. of A. Nolan, Brag-
man, Colman, Schimminger, Millman, Ortiz, Destito, Seddio, Abbate,
Colton, Cook, Green, Hill Hooper, Jacobs, Lafayette, Markey, Mayer-
sohn, Towns) -- (at request of the State Insurance Fund) -- read once
and referred to the Committee on Labor -- recommitted to the Committee
on Labor in accordance with Assembly Rule 3, sec. 2 -- committee
discharged, bill amended, ordered reprinted as amended and recommitted
to said committee
AN ACT to amend the workers` compensation law, in relation to the
investment of the state insurance fund, determination of claims for
compensation, and providing for an administrative resolution procedure
for disputed medical bills involving sums of five hundred dollars or
less; and in relation to enacting the "injured workers` protection
act"
THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:
1 Section 1. This act enacts into law major components of legislation
2 which are necessary to implement the state fiscal plan for the 2000-2001
3 state fiscal year. Each component is wholly contained within a Part
4 identified as Parts A through D. The effective date for each particular
5 provision contained within such Part is set forth in the last section of
6 such Part. Any provision in any section contained within a Part, includ-
7 ing the effective date of the Part, which makes reference to a section
8 "of this act", when used in connection with that particular component,
9 shall be deemed to mean and refer to the corresponding section of the
10 Part in which it is found. Section three of this act sets forth the
11 general effective date of this act.
12 PART A
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
{ } is old law to be omitted.
LBD09730-04-0
A. 8601--A 2
1 Section 1. Subdivision 1 of section 87 of the workers` compensation
2 law, as amended by chapter 635 of the laws of 1996, is amended to read
3 as follows:
4 1. Any of the surplus or reserve funds belonging to the state insur-
5 ance fund {may}, by order of the commissioners, approved by the super-
6 intendent of insurance, MAY be invested in {or loaned on the pledge of
7 any of the securities in which a savings bank may invest the moneys
8 deposited therein as provided} THE TYPES OF SECURITIES DESCRIBED in
9 subdivisions one, two, three, four, five, six, eleven, twelve, twelve-a,
10 thirteen, fourteen, fifteen, nineteen, twenty, twenty-one, twenty-one-a,
11 twenty-four, twenty-four-a, twenty-four-b, twenty-four-c and twenty-five
12 of section two hundred thirty-five of the banking law OR, UP TO FIFTY
13 PERCENT OF SUCH SURPLUS OR RESERVE FUNDS, IN THE TYPES OF SECURITIES OR
14 INVESTMENTS DESCRIBED IN PARAGRAPHS TWO, THREE, EIGHT AND TEN OF
15 SUBSECTION (A) OF SECTION ONE THOUSAND FOUR HUNDRED FOUR OF THE INSUR-
16 ANCE LAW. ANY OF THE SURPLUS OR RESERVE FUNDS BELONGING TO THE STATE
17 INSURANCE FUND, UPON LIKE APPROVAL OF THE SUPERINTENDENT OF INSURANCE,
18 MAY BE LOANED ON THE PLEDGE OF ANY SUCH SECURITIES. The commissioners
19 {may}, upon like approval of the superintendent of insurance, MAY also
20 sell any of such securities OR INVESTMENTS.
21 S 2. This act shall take effect immediately.
22 PART B
23 Section 1. Legislative intent. It is the intent of this legislature to
24 provide a just and efficient system for the adjudication of workers`
25 compensation claims. Workers injured as a result of hazards in the work-
26 place should receive prompt and appropriate medical care. It is the
27 sense of the legislature that the state`s system of medical adjudication
28 has at times been hampered by problems with the use of independent
29 medical exams. This legislation is intended to address those issues yet
30 continue to provide a fair and efficient adjudication of such claims.
31 S 2. This act shall be known and may be cited as the "injured workers`
32 protection act".
33 S 3. The workers` compensation law is amended by adding a new section
34 137 to read as follows:
35 S 137. INDEPENDENT MEDICAL EXAMINATIONS. (A) (1) COPIES OF REPORTS OF
36 INDEPENDENT MEDICAL EXAMINATIONS PERFORMED AT THE REQUEST OF AN EMPLOYER
37 OR THE INSURANCE CARRIER SHALL BE SUBMITTED BY THE PRACTITIONER ON THE
38 SAME DAY AND IN THE SAME MANNER TO THE BOARD, THE INSURANCE CARRIER, THE
39 CLAIMANT`S ATTENDING PHYSICIAN OR OTHER ATTENDING PRACTITIONER, THE
40 CLAIMANT`S REPRESENTATIVE AND THE CLAIMANT.
41 (2) COPIES OF ALL WRITTEN REQUESTS, INCLUDING FAXED OR ELECTRONICALLY
42 TRANSMITTED REQUESTS, FOR INFORMATION REGARDING A CLAIMANT THAT ARE
43 RECEIVED EITHER BY A PRACTITIONER WHO PERFORMED AN INDEPENDENT MEDICAL
44 EXAMINATION OR BY AN ATTENDING PHYSICIAN OR OTHER ATTENDING PRACTITION-
45 ER, SHALL BE SUBMITTED BY THE RECIPIENT, WITHIN TEN DAYS OF THE RECEIPT
46 OF SUCH REQUEST FOR INFORMATION, TO THE BOARD.
47 (3) COPIES OF ALL RESPONSES TO SUCH REQUESTS FOR INFORMATION AS ARE
48 DESCRIBED IN PARAGRAPH TWO OF THIS SUBDIVISION, INCLUDING ALL MATERIALS
49 WHICH ARE PROVIDED IN RESPONSE TO SUCH A REQUEST, SHALL BE SUBMITTED BY
50 THE RESPONDING PRACTITIONER WHO PERFORMED AN INDEPENDENT MEDICAL EXAM-
51 INATION, THE RESPONDING ATTENDING PHYSICIAN OR OTHER RESPONDING ATTEND-
52 ING PRACTITIONER, WITHIN TEN DAYS OF SUBMISSION OF THE RESPONSE OF THE
53 REQUESTOR, TO THE BOARD.
A. 8601--A 3
1 (B) A REPORT OF AN INDEPENDENT MEDICAL EXAMINATION SHALL NOT BE THE
2 BASIS FOR ELIMINATING OR REDUCING ANY EMPLOYEE BENEFITS UNLESS AND UNTIL
3 THE INJURED WORKER HAS HAD AN OPPORTUNITY FOR A FULL HEARING.
4 (C) (1) ONLY A NEW YORK STATE LICENSED AND BOARD CERTIFIED PHYSICIAN,
5 SURGEON, DENTIST, PODIATRIST OR ANY OTHER PERSON LICENSED TO DIAGNOSE
6 INJURY OR ILLNESS AND CERTIFIED BY THE BOARD SHALL PERFORM SUCH INDE-
7 PENDENT MEDICAL EXAMINATION.
8 (2) ANY PRACTITIONER PERFORMING THE INDEPENDENT MEDICAL EXAM SHALL BE
9 PAID ACCORDING TO THE SAME FEE SCHEDULE AS THAT USED FOR BOARD CERTIFIED
10 PRACTITIONERS AUTHORIZED TO RENDER CARE BY THE BOARD.
11 (D) ALL INDEPENDENT MEDICAL EXAMINATIONS SHALL BE PERFORMED IN MEDICAL
12 FACILITIES SUITABLE FOR SUCH EXAM, WITH DUE REGARD AND RESPECT FOR THE
13 PRIVACY AND DIGNITY OF THE INJURED WORKER AS WELL AS ACCESS AND SAFETY
14 OF THE CLAIMANT. SUCH FACILITIES MUST BE PROVIDED IN A CONVENIENT
15 LOCATION ACCESSIBLE VIA PUBLIC TRANSPORTATION, WITHIN A REASONABLE
16 DISTANCE FROM THE CLAIMANT`S RESIDENCE.
17 (E) ALL INDEPENDENT MEDICAL EXAMINATIONS SHALL BE PERFORMED BY A PRAC-
18 TITIONER WHOSE MEDICAL SPECIALTY IS IN THE FIELD OF INJURY OR DISEASE
19 FROM WHICH THE INJURED WORKER SUFFERS. SUCH EXAMINATION SHALL BE
20 PERFORMED BY A PRACTITIONER LICENSED TO PRACTICE MEDICINE IN THE STATE
21 OF NEW YORK.
22 (F) NO PRACTITIONER DIAGNOSING A CLAIMANT UNDER THIS CHAPTER NOR ANY
23 SUPERVISING AUTHORITY OR PROPRIETOR NOR INSURANCE CARRIER OR EMPLOYER
24 MAY CAUSE, DIRECT OR ENCOURAGE A REPORT TO BE SUBMITTED AS EVIDENCE IN
25 WORKERS` COMPENSATION CLAIM ADJUDICATION WHICH DIFFERS FROM THE PROFES-
26 SIONAL OPINION OF THE DIAGNOSING PRACTITIONER. SUCH AN ACTION SHALL BE
27 CONSIDERED WITHIN THE JURISDICTION OF THE INSPECTOR GENERAL AND MAY BE
28 PROSECUTED AS A FRAUDULENT PRACTICE UNDER SECTION NINETY-SIX OF THIS
29 CHAPTER. SECOND OPINIONS HOWEVER, ARE NOT EXCLUDED WHERE THEY ARE
30 SOUGHT TO BE INTRODUCED INTO EVIDENCE BY THE CLAIMANT.
31 (G) THE CLAIMANT SHALL RECEIVE NOTICE BY MAIL OF THE SCHEDULED DIAG-
32 NOSTIC EXAMINATION AT LEAST SEVEN BUSINESS DAYS PRIOR TO SUCH EXAMINA-
33 TION. SUCH NOTICE SHALL ADVISE THE CLAIMANT IF THE PRACTITIONER INTENDS
34 TO RECORD OR VIDEO TAPE THE EXAMINATION, AND SHALL ADVISE THE CLAIMANT
35 OF THEIR RIGHT TO VIDEO TAPE OR OTHERWISE RECORD THE EXAMINATION. CLAIM-
36 ANTS SHALL BE ADVISED OF THEIR RIGHT TO BE ACCOMPANIED DURING THE EXAM
37 BY AN INDIVIDUAL OR INDIVIDUALS OF THEIR CHOOSING.
38 (H) DIAGNOSTIC EXAMS SHALL BE PERFORMED DURING REGULAR BUSINESS HOURS
39 EXCEPT WITH THE CONSENT AND FOR THE CONVENIENCE OF THE CLAIMANT. CLAIM-
40 ANTS SUBJECT TO SUCH EXAMINATION SHALL BE NOTIFIED AT THE TIME OF THE
41 EXAM IN WRITING OF THE AVAILABLE TRAVEL REIMBURSEMENT UNDER LAW, AS WELL
42 AS THEIR RIGHTS TO APPEAL.
43 (I) NO PRACTITIONER OR PROVIDER OF SUCH INDEPENDENT MEDICAL EXAMINA-
44 TION DIAGNOSTIC SERVICES SHALL BE ELIGIBLE TO PARTICIPATE IN ANY PANEL
45 PROVIDING PREFERRED PROVIDER OR MANAGED CARE PROVIDER TREATMENT TO
46 INJURED WORKERS OR COMPENSATION CLAIMANTS.
47 (J) THE ABILITY OF A CLAIMANT TO APPEAR FOR AN EXAM OR HEARING SHALL
48 NOT BE ADMISSIBLE EVIDENCE IN THE DETERMINATION OF DISABILITY, EXTENT OF
49 DISABILITY OR ELIGIBILITY FOR BENEFITS.
50 (K) A CLAIMANT MAY REQUEST AND SHALL RECEIVE, FREE OF CHARGE, INDE-
51 PENDENT MEDICAL EXAMINATIONS UP TO THE SAME NUMBER OF INDEPENDENT
52 MEDICAL EXAMINATIONS PERFORMED AT THE REQUEST OF THE EMPLOYER AND THE
53 INSURANCE CARRIER.
54 S 4. This act shall take effect immediately.
55 PART C
A. 8601--A 4
1 Section 1. Subdivision 5 of section 13-a of the workers` compensation
2 law, as added by chapter 21 of the laws of 1991, is amended to read as
3 follows:
4 (5) No claim for specialist consultations, surgical operations,
5 physiotherapeutic or occupational therapy procedures, x-ray examinations
6 or special diagnostic laboratory tests costing more than five hundred
7 dollars shall be valid and enforceable, as against such employer, unless
8 such special services shall have been authorized by the employer or by
9 the board, or unless such authorization has been unreasonably withheld,
10 or withheld for a period of more than thirty calendar days from receipt
11 of a request for authorization, or unless such special services are
12 required in an emergency, provided, however, that the basis for a denial
13 of such authorization by the employer must be based on a conflicting
14 second opinion rendered by a physician authorized by the workers`
15 compensation board. UPON DENIAL OF A REQUEST FOR AUTHORIZATION OF SUCH
16 SPECIAL SERVICES, THE CARRIER OR EMPLOYER SHALL NOTIFY THE WORKERS`
17 COMPENSATION BOARD IN WRITING WITHIN FIVE DAYS AFTER SUCH DENIAL, AND
18 UPON RECEIPT OF SUCH NOTICE OF DENIAL THE BOARD SHALL SCHEDULE A HEARING
19 TO BE HELD NO MORE THAN THIRTY DAYS FROM THE RECEIPT OF SUCH NOTICE BY
20 THE BOARD. IF THE CARRIER OR EMPLOYER FAILS TO RESPOND TO THE REQUEST
21 FOR AUTHORIZATION FOR SUCH SPECIAL SERVICES WITHIN FOUR DAYS, IF PATIENT
22 IS HOSPITALIZED, THEN THE CHAIR MAY ISSUE AN ORDER, AFTER INVESTIGATION,
23 AUTHORIZING THE SPECIAL SERVICES, ON THE GROUNDS THAT THE AUTHORIZATION
24 HAS BEEN UNREASONABLY WITHHELD, AND THE CARRIER OR EMPLOYER SHALL BE
25 LIABLE FOR PAYMENT FOR SUCH SPECIAL SERVICES. IF THE CARRIER OR EMPLOYER
26 FAILS TO RESPOND TO THE REQUEST FOR AUTHORIZATION FOR SUCH SPECIAL
27 SERVICES WITHIN THIRTY DAYS, IF PATIENT IS NOT HOSPITALIZED, THEN SUCH
28 REQUEST SHALL BE DEEMED AUTHORIZED AND THE CARRIER OR EMPLOYER SHALL BE
29 LIABLE FOR PAYMENT FOR SUCH SPECIAL SERVICES.
30 S 2. This act shall take effect on the first day of September next
31 succeeding the date on which it shall have become a law.
32 PART D
33 Section 1. Subdivisions 2, 3 and 4 of section 13-g of the workers`
34 compensation law, subdivision 2 as amended by chapter 649 of the laws of
35 1985, subdivision 3 as amended by chapter 674 of the laws of 1994 and
36 subdivision 4 as amended by chapter 639 of the laws of 1996, are amended
37 to read as follows:
38 (2)(A) IF THE PARTIES FAIL TO AGREE AS TO THE VALUE OF MEDICAL AID
39 RENDERED UNDER THIS CHAPTER AND THE AMOUNT OF THE DISPUTED MEDICAL BILL
40 IS FIVE HUNDRED DOLLARS OR LESS, OR WHERE THE AMOUNT OF THE DISPUTED
41 MEDICAL BILL EXCEEDS FIVE HUNDRED DOLLARS AND THE HEALTH CARE PROVIDER
42 EXPRESSLY SO REQUESTS, SUCH VALUE SHALL BE DECIDED BY AN ADMINISTRATIVE
43 RESOLUTION PROCEDURE, PURSUANT TO RULES PROMULGATED BY THE CHAIR. THE
44 CHAIR SHALL APPOINT A PHYSICIAN WHO IS A MEMBER IN GOOD STANDING OF THE
45 MEDICAL SOCIETY OF THE STATE OF NEW YORK TO DETERMINE THE VALUE OF SUCH
46 DISPUTED MEDICAL BILL. WHERE THE PHYSICIAN WHOSE CHARGES ARE BEING ARBI-
47 TRATED IS A MEMBER IN GOOD STANDING OF THE NEW YORK OSTEOPATHIC SOCIETY
48 OR THE NEW YORK HOMEOPATHIC SOCIETY, THE VALUE OF SUCH DISPUTED BILL
49 SHALL BE DETERMINED BY A MEMBER IN GOOD STANDING OF THE NEW YORK OSTEO-
50 PATHIC MEDICAL SOCIETY APPOINTED BY THE CHAIR. WHERE THE VALUE OF PHYS-
51 ICAL THERAPY SERVICES OR OCCUPATIONAL THERAPY SERVICES IS AT ISSUE, SUCH
52 VALUE SHALL BE DETERMINED BY A MEMBER IN GOOD STANDING OF A RECOGNIZED
53 PROFESSIONAL ASSOCIATION REPRESENTING THEIR RESPECTIVE PROFESSIONS IN
54 THE STATE OF NEW YORK APPOINTED BY THE CHAIR. DECISIONS RENDERED UNDER
A. 8601--A 5
1 THE ADMINISTRATIVE RESOLUTION PROCEDURE SHALL BE CONCLUSIVE UPON THE
2 PARTIES AS TO THE VALUE OF THE SERVICES IN DISPUTE.
3 (B) If the parties fail to agree as to the value of medical aid
4 rendered under this chapter AND THE AMOUNT OF THE DISPUTED BILL EXCEEDS
5 FIVE HUNDRED DOLLARS, such value shall be decided by an arbitration
6 committee {consisting} UNLESS THE HEALTH CARE PROVIDER EXPRESSLY
7 REQUESTS AN ADMINISTRATIVE RESOLUTION PROCEDURE IN ACCORDANCE WITH PARA-
8 GRAPH (A) OF THIS SUBDIVISION. THE ARBITRATION COMMITTEE SHALL CONSIST
9 of one physician designated by the president of the medical society of
10 the county in which the medical services were rendered, one physician
11 who is a member of the medical society of the state of New York,
12 appointed by the employer or carrier, and one physician, also a member
13 of the medical society of the state of New York, appointed by the
14 {chairman of the workers` compensation board. The majority decision of
15 any such committee shall be conclusive upon the parties as to the value
16 of the services rendered} CHAIR. If the physician whose charges are
17 being arbitrated is a member in good standing of the New York osteopath-
18 ic society or the New York homeopathic society, the members of such
19 arbitration committee shall be physicians of such organization, one to
20 be appointed by the president of that organization, one by the employer
21 or carrier and the third by the {chairman of the workers` compensation
22 board} CHAIR. Where the value of physical therapy services is at issue
23 AND THE AMOUNT OF THE DISPUTED BILL EXCEEDS FIVE HUNDRED DOLLARS, the
24 arbitration committee shall consist of a member in good standing of a
25 recognized professional association representing physical therapists in
26 the state of New York appointed by the president of such organization, a
27 physician designated by the employer or carrier and a physician desig-
28 nated by the {chairman of the workers` compensation board} CHAIR,
29 provided however, that the {chairman} CHAIR finds that there are a
30 sufficient number of physical therapy arbitrations in a geographical
31 area comprised of one or more counties to warrant a committee so
32 comprised. In all other cases where the value of physical therapy
33 services is at issue AND THE AMOUNT OF THE DISPUTED BILL EXCEEDS FIVE
34 HUNDRED DOLLARS, the arbitration committee shall be similarly selected
35 and identical in composition, provided that the physical therapist
36 member shall serve without remuneration, and provided further that in
37 the event a physical therapist is not available, the committee shall be
38 comprised of three physicians designated in the same manner as in cases
39 where the value of medical aid is at issue.
40 Where the value of occupational therapy services is at issue AND THE
41 AMOUNT OF THE DISPUTED BILL EXCEEDS FIVE HUNDRED DOLLARS, the arbi-
42 tration committee shall consist of a member in good standing of a recog-
43 nized professional association representing occupational therapists in
44 the state of New York appointed by the president of such organization; a
45 physician designated by the employer or carrier and a physician desig-
46 nated by the {chairman of the workers` compensation board} CHAIR,
47 provided, however, that the {chairman} CHAIR finds that there are a
48 sufficient number of occupational therapy arbitrations in a geographical
49 area comprised of one or more counties to warrant a committee so
50 comprised. In all other cases where the value of occupational therapy
51 services is at issue AND THE AMOUNT OF THE DISPUTED BILL EXCEEDS FIVE
52 HUNDRED DOLLARS, the arbitration committee shall be similarly selected
53 and identical in composition, provided that the occupational therapist
54 member shall serve without remuneration, and provided further that in
55 the event an occupational therapist is not available, the committee
56 shall be comprised of three physicians designated in the same manner as
A. 8601--A 6
1 in cases where the value of medical aid is at issue. THE MAJORITY DECI-
2 SION OF ANY SUCH ARBITRATION COMMITTEE SHALL BE CONCLUSIVE UPON THE
3 PARTIES AS TO THE VALUE OF THE SERVICES IN DISPUTE.
4 (3)(A) IF AN EMPLOYER SHALL HAVE NOTIFIED THE HOSPITAL IN WRITING, AS
5 PROVIDED IN SUBDIVISION ONE OF THIS SECTION, WHY THE BILL HAS NOT BEEN
6 PAID, IN PART OR IN FULL, AND THE AMOUNT OF THE DISPUTED BILL IS FIVE
7 HUNDRED DOLLARS OR LESS, OR WHERE THE AMOUNT OF THE DISPUTED BILL
8 EXCEEDS FIVE HUNDRED DOLLARS AND THE HOSPITAL EXPRESSLY SO REQUESTS,
9 SUCH VALUE SHALL BE DECIDED BY AN ADMINISTRATIVE RESOLUTION PROCEDURE,
10 PURSUANT TO RULES PROMULGATED BY THE CHAIR. THE CHAIR SHALL APPOINT A
11 PHYSICIAN IN GOOD STANDING LICENSED TO PRACTICE IN NEW YORK STATE TO
12 DETERMINE THE VALUE OF SUCH DISPUTED BILL. DECISIONS RENDERED UNDER THE
13 ADMINISTRATIVE RESOLUTION PROCEDURE SHALL BE CONCLUSIVE UPON THE PARTIES
14 AS TO THE VALUE OF THE SERVICES IN DISPUTE.
15 (B) If an employer shall have notified the hospital in writing, as
16 provided in subdivision one of this section, why the bill has not been
17 paid, in part or in full, AND THE AMOUNT OF THE DISPUTED BILL EXCEEDS
18 FIVE HUNDRED DOLLARS, the value of such bill shall be determined by an
19 arbitration committee appointed by the chair for that purpose, which
20 committee shall consider all of the charges of the hospital, UNLESS THE
21 HOSPITAL EXPRESSLY REQUESTS AN ADMINISTRATIVE RESOLUTION PROCEDURE
22 PURSUANT TO PARAGRAPH (A) OF THIS SUBDIVISION. The committee shall
23 consist of three physicians. One member of the committee may be nomi-
24 nated {to} BY the chair {by} UPON RECOMMENDATION OF the president of the
25 hospital association of New York state and one member may be nominated
26 by the employer or insurance carrier. The majority decision of any such
27 committee shall be conclusive upon the parties as to the value of the
28 services rendered. The chair may make reasonable rules and regulations
29 consistent with the provisions of this section.
30 (4) A provider initiating an arbitration, OR ADMINISTRATIVE RESOLUTION
31 PROCEDURE, pursuant to this section shall pay a fee as determined by
32 regulations promulgated by the chair, to be used to cover the costs
33 related to the conduct of such arbitration, OR ADMINISTRATIVE RESOLUTION
34 PROCEDURE. Upon resolution in favor of such party, the amount due,
35 based upon the bill in dispute, shall be increased by the amount of the
36 fee paid by such party. Where a partial award is made, the amount due,
37 based upon the bill in dispute, shall be increased by a part of such
38 fee. Each member of an arbitration committee for medical bills{,} and
39 each member of an arbitration committee for hospital bills shall be
40 entitled to receive and shall be paid a fee for each day`s attendance at
41 an arbitration session in any one count in an amount fixed by the chair
42 {of the workers` compensation board}.
43 S 2. Subdivision 6 of section 13-k of the workers` compensation law,
44 as amended by chapter 639 of the laws of 1996, is amended to read as
45 follows:
46 6. (A) The provisions of subdivisions one and three of section thir-
47 teen-g of this article with respect to the conditions under which a
48 hospital, physician or self-employed physical or occupational therapist
49 may request payment or arbitration of a bill, or under which an award
50 may be made for payment of such bill, shall be applicable to bills
51 rendered by a podiatrist for services rendered to an injured employee.
52 (B) IF THE PARTIES FAIL TO AGREE AS TO THE VALUE OF PODIATRY CARE
53 RENDERED UNDER THIS CHAPTER TO A CLAIMANT, AND THE AMOUNT OF THE
54 DISPUTED BILL IS FIVE HUNDRED DOLLARS OR LESS, OR WHERE THE AMOUNT OF
55 THE DISPUTED BILL EXCEEDS FIVE HUNDRED DOLLARS AND THE PODIATRIST
56 EXPRESSLY SO REQUESTS, SUCH VALUE SHALL BE DECIDED BY AN ADMINISTRATIVE
A. 8601--A 7
1 RESOLUTION PROCEDURE, PURSUANT TO RULES PROMULGATED BY THE CHAIR. THE
2 CHAIR SHALL APPOINT A MEMBER IN GOOD STANDING OF A RECOGNIZED PROFES-
3 SIONAL ASSOCIATION REPRESENTING PODIATRISTS IN THE STATE OF NEW YORK TO
4 DETERMINE THE VALUE OF SUCH DISPUTED BILL. DECISIONS RENDERED UNDER THE
5 ADMINISTRATIVE RESOLUTION PROCEDURE SHALL BE CONCLUSIVE UPON THE PARTIES
6 AS TO THE VALUE OF THE SERVICES IN DISPUTE.
7 (C) If the parties fail to agree as to the value of podiatry care
8 rendered under this chapter to a claimant, AND THE AMOUNT OF THE
9 DISPUTED BILL EXCEEDS FIVE HUNDRED DOLLARS, such value shall be decided
10 by an arbitration committee {consisting} UNLESS THE PODIATRIST EXPRESSLY
11 REQUESTS AN ADMINISTRATIVE RESOLUTION PROCEDURE IN ACCORDANCE WITH PARA-
12 GRAPH (B) OF THIS SUBDIVISION. THE ARBITRATION COMMITTEE SHALL CONSIST
13 of three duly registered and licensed podiatrists who are members of a
14 recognized professional association representing podiatrists in the
15 state of New York, one to be appointed by the president of such an asso-
16 ciation, one to be appointed by the employer or carrier and one to be
17 appointed by the chair {of the workers` compensation board} and the
18 majority decision of such committee shall be conclusive upon the parties
19 as to the value of the services rendered.
20 (D) The board or the chair may make an award not in excess of the
21 established fee schedules for any such bill or part thereof which
22 remains unpaid in the same manner as an award for bills rendered under
23 subdivisions one and three of section thirteen-g of this article, and
24 such award may be collected in like manner as an {aware} AWARD of
25 compensation. Where a podiatrist`s bill has been determined to be due
26 and owing in accordance with the provisions of this section the board
27 shall include in the amount of the award interest of not more than one
28 and one-half percent (1 1/2%) per month payable to the podiatrist in
29 accordance with the rules and regulations promulgated by the board. The
30 chair shall assess the sum of fifty dollars against the employer for
31 each such award made by the board, which sum shall be paid into the
32 state treasury.
33 (E) A provider initiating an arbitration, OR ADMINISTRATIVE RESOLUTION
34 PROCEDURE, pursuant to this section shall pay a fee, as determined by
35 regulations promulgated by the chair, to be used to cover the costs
36 related to the conduct of such arbitration, OR ADMINISTRATIVE RESOLUTION
37 PROCEDURE. Upon resolution in favor of such party, the amount due,
38 based upon the bill in dispute, shall be increased by the amount of the
39 fee paid by such party. Where a partial award is made, the amount due,
40 based upon the bill in dispute shall be increased by a part of such fee.
41 Each member of the arbitration committee shall be entitled to receive
42 and shall be paid a fee for each day`s attendance at an arbitration
43 session in an amount fixed by the chair {of the workers` compensation
44 board}.
45 S 3. Subdivision 6 of section 13-1 of the workers` compensation law,
46 as amended by chapter 639 of the laws of 1996, is amended to read as
47 follows:
48 6. (A) The provisions of subdivisions one and three of section thir-
49 teen-g of this article with respect to the conditions under which a
50 hospital, physician or self-employed physical or occupational therapist
51 may request payment or arbitration of a bill, or under which an award
52 may be made for payment of such bill, shall be applicable to bills
53 rendered by a chiropractor for services rendered to an injured employee.
54 (B) IF THE PARTIES FAIL TO AGREE AS TO THE VALUE OF CHIROPRACTIC CARE
55 RENDERED UNDER THIS CHAPTER TO A CLAIMANT, AND THE AMOUNT OF THE
56 DISPUTED BILL IS FIVE HUNDRED DOLLARS OR LESS, OR WHERE THE AMOUNT OF
A. 8601--A 8
1 THE DISPUTED BILL EXCEEDS FIVE HUNDRED DOLLARS AND THE CHIROPRACTOR
2 EXPRESSLY SO REQUESTS, SUCH VALUE SHALL BE DECIDED BY AN ADMINISTRATIVE
3 RESOLUTION PROCEDURE, PURSUANT TO RULES PROMULGATED BY THE CHAIR. THE
4 CHAIR SHALL APPOINT A MEMBER IN GOOD STANDING OF A RECOGNIZED PROFES-
5 SIONAL ASSOCIATION REPRESENTING CHIROPRACTORS IN THE STATE OF NEW YORK
6 TO DETERMINE THE VALUE OF SUCH DISPUTED BILL. DECISIONS RENDERED UNDER
7 THE ADMINISTRATIVE RESOLUTION PROCEDURE SHALL BE CONCLUSIVE UPON THE
8 PARTIES AS TO THE VALUE OF THE SERVICES IN DISPUTE.
9 (C) If the parties fail to agree as to the chiropractic care rendered
10 under this chapter to a claimant, AND THE AMOUNT OF THE DISPUTED BILL
11 EXCEEDS FIVE HUNDRED DOLLARS, such value shall be decided by {the
12 chiropractic practice committee} AN ARBITRATION COMMITTEE UNLESS THE
13 CHIROPRACTOR EXPRESSLY REQUESTS AN ADMINISTRATIVE RESOLUTION PROCEDURE
14 IN ACCORDANCE WITH PARAGRAPH (B) OF THIS SUBDIVISION. THE ARBITRATION
15 COMMITTEE SHALL CONSIST OF THREE DULY REGISTERED AND LICENSED CHIROPRAC-
16 TORS WHO ARE MEMBERS OF A RECOGNIZED PROFESSIONAL ASSOCIATION REPRESENT-
17 ING CHIROPRACTORS IN THE STATE OF NEW YORK, ONE TO BE APPOINTED BY THE
18 PRESIDENT OF SUCH AN ASSOCIATION, ONE TO BE APPOINTED BY THE EMPLOYER OR
19 CARRIER AND ONE TO BE APPOINTED BY THE CHAIR and the majority decision
20 of such committee shall be conclusive upon the parties as to the value
21 of the services rendered.
22 (D) The board or the chair may make an award not in excess of the
23 established fee schedules for any such bill or part thereof which
24 remains unpaid in the same manner as an award for bills rendered under
25 subdivisions one and three of section thirteen-g of this article, and
26 such award may be collected in like manner as an award of compensation.
27 Where a chiropractor`s bill has been determined to be due and owing in
28 accordance with the provisions of this section the board shall include
29 in the amount of the award interest of not more than one and one-half
30 percent (1 1/2%) per month payable to the chiropractor in accordance
31 with the rules and regulations promulgated by the board. The chair
32 shall assess the sum of fifty dollars against the employer for each such
33 award made by the board, which sum shall be paid into the state treas-
34 ury.
35 (E) A provider initiating an arbitration, OR ADMINISTRATIVE RESOLUTION
36 PROCEDURE, pursuant to this section shall pay a fee, as determined by
37 regulations promulgated by the chair, to be used to cover the costs
38 related to the conduct of such arbitration, OR ADMINISTRATIVE RESOLUTION
39 PROCEDURE. Upon resolution in favor of such party, the amount due,
40 based upon the bill in dispute, shall be increased by the amount of the
41 fee paid by such party. Where a partial award is made, the amount due,
42 based upon the bill in dispute, shall be increased by a part of such
43 fee.
44 S 4. Subdivision 7 of section 13-m of the workers` compensation law,
45 as amended by chapter 674 of the laws of 1994 and paragraph (c) as
46 amended by chapter 639 of the laws of 1996, is amended to read as
47 follows:
48 7. (a) The provisions of subdivisions one and three of section thir-
49 teen-g of this article with respect to the conditions under which a
50 hospital, physician or self-employed physical or occupational therapist
51 may request payment or arbitration of a bill, or under which an award
52 may be made for payment of such bill, shall be applicable to bills
53 rendered by a psychologist for services rendered to an injured employee.
54 (B) IF THE PARTIES FAIL TO AGREE AS TO THE VALUE OF PSYCHOLOGICAL CARE
55 RENDERED UNDER THIS CHAPTER TO A CLAIMANT, AND THE AMOUNT OF THE
56 DISPUTED BILL IS FIVE HUNDRED DOLLARS OR LESS, OR WHERE THE AMOUNT OF
A. 8601--A 9
1 THE DISPUTED BILL EXCEEDS FIVE HUNDRED DOLLARS AND THE PSYCHOLOGIST
2 EXPRESSLY SO REQUESTS, SUCH VALUE SHALL BE DECIDED BY AN ADMINISTRATIVE
3 RESOLUTION PROCEDURE, PURSUANT TO RULES PROMULGATED BY THE CHAIR. THE
4 CHAIR SHALL APPOINT A MEMBER IN GOOD STANDING OF A RECOGNIZED PROFES-
5 SIONAL ASSOCIATION REPRESENTING PSYCHOLOGISTS IN THE STATE OF NEW YORK
6 TO DETERMINE THE VALUE OF SUCH DISPUTED BILL. DECISIONS RENDERED UNDER
7 THE ADMINISTRATIVE RESOLUTION PROCEDURE SHALL BE CONCLUSIVE UPON THE
8 PARTIES AS TO THE VALUE OF THE SERVICES IN DISPUTE.
9 (C) If the parties fail to agree as to the psychological care rendered
10 under this chapter to a claimant, AND THE AMOUNT OF THE BILL EXCEEDS
11 FIVE HUNDRED DOLLARS, such value shall be decided by {the psychology
12 practice committee} AN ARBITRATION COMMITTEE UNLESS THE PSYCHOLOGIST
13 EXPRESSLY REQUESTS AN ADMINISTRATIVE RESOLUTION PROCEDURE IN ACCORDANCE
14 WITH PARAGRAPH (B) OF THIS SUBDIVISION. THE ARBITRATION COMMITTEE SHALL
15 CONSIST OF THREE DULY REGISTERED AND LICENSED PSYCHOLOGISTS WHO ARE
16 MEMBERS OF A RECOGNIZED PROFESSIONAL ASSOCIATION REPRESENTING PSYCHOL-
17 OGISTS IN THE STATE OF NEW YORK, ONE TO BE APPOINTED BY THE PRESIDENT OF
18 SUCH AN ASSOCIATION, ONE TO BE APPOINTED BY THE EMPLOYER OR CARRIER AND
19 ONE TO BE APPOINTED BY THE CHAIR and the majority decision of such
20 committee shall be conclusive upon the parties as to the value of the
21 services rendered. {The board or the chair may make an award not in
22 excess of the established fee schedules for any such bill or part there-
23 of which remains unpaid in the same manner as an award for bills
24 rendered under subdivisions one and three of section thirteen-g of this
25 article, and such award may be collected in like manner as an award of
26 compensation. The chair shall assess the sum of fifty dollars against
27 the employer for each such award made by the board, which sum shall be
28 paid into the state treasury.
29 (b)} (D) THE BOARD OR THE CHAIR MAY MAKE AN AWARD NOT IN EXCESS OF THE
30 ESTABLISHED FEE SCHEDULES FOR ANY SUCH BILL OR PART THEREOF WHICH
31 REMAINS UNPAID IN THE SAME MANNER AS AN AWARD FOR BILLS RENDERED UNDER
32 SUBDIVISIONS ONE AND THREE OF SECTION THIRTEEN-G OF THIS ARTICLE, AND
33 SUCH AWARD MAY BE COLLECTED IN LIKE MANNER AS AN AWARD OF COMPENSATION.
34 Where a psychologist`s bill has been determined to be due and owing in
35 accordance with the provisions of this section the board shall include
36 in the amount of the award interest of not more than one and one-half
37 percent (1 1/2%) per month payable to the psychologist in accordance
38 with the rules and regulations promulgated by the board. THE CHAIR SHALL
39 ASSESS THE SUM OF FIFTY DOLLARS AGAINST THE EMPLOYER FOR EACH SUCH AWARD
40 MADE BY THE BOARD, WHICH SUM SHALL BE PAID INTO THE STATE TREASURY.
41 {(c)} (E) A provider initiating an arbitration, OR ADMINISTRATIVE
42 RESOLUTION PROCEDURE, pursuant to this section shall pay a fee, as
43 determined by regulations promulgated by the chair, to be used to cover
44 the costs related to the conduct of such arbitration, OR ADMINISTRATIVE
45 RESOLUTION PROCEDURE. Upon resolution in favor of such party, the
46 amount due, based upon the bill in dispute, shall be increased by the
47 amount of the fee paid by such party. Where a partial award is made,
48 the amount due, based upon the bill in dispute, shall be increased by a
49 part of such fee.
50 S 5. This act shall take effect 120 days after it shall have become a
51 law.
52 S 2. Severability clause. If any clause, sentence, paragraph, subdivi-
53 sion, section or part contained in any part of this act shall be
54 adjudged by any court of competent jurisdiction to be invalid, such
55 judgment shall not affect, impair, or invalidate the remainder thereof,
56 but shall be confined in its operation to the clause, sentence, para-
A. 8601--A 10
1 graph, subdivision, section or part contained in any part thereof
2 directly involved in the controversy in which such judgment shall have
3 been rendered. It is hereby declared to be the intent of the legislature
4 that this act would have been enacted even if such invalid provisions
5 had not been included herein.
6 S 3. This act shall take effect immediately provided, however, that
7 the applicable effective date for Parts A through D of this act shall be
8 as specifically set forth in the last section of such Part.
.SO DOC A 8601A *END* BTXT 1999
Bill A08601
New York State Assembly
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