reglab/statecodes huggingface dataset:
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter C - Medical Treatment and Care › Part 325 - Medical And Surgical Care And Treatment › Subpart 325-1 - General › Section 325-1.6 - The impairment guidelines for schedule loss of use determinations

Current through Register Vol. 46, No. 28, July 10, 2024
(a) All evaluations
					 of permanent impairment for use in a schedule loss of use determination shall
					 be performed in accordance with the
Workers' Compensation Guidelines
					 for Determining Impairment
, First Edition, XXXXXXX, effective January
					 1, 2018, which is herein incorporated by reference. Such evaluations must be
					 completed in the format prescribed by the chair.
(b)
Obtaining the Workers' Compensation
					 Guidelines for Determining Impairment.
The
Workers' Compensation Guidelines for
						Determining Impairment
incorporated by reference herein may be
						examined at the office of the Department of State, 99 Washington Avenue,
						Albany, NY 12231, the Legislative Library, the libraries of the New York State
						Supreme Court, and the district offices of the board. Copies may be downloaded
						from the board's website or obtained from the board by submitting a request in
						writing, with the appropriate fee, identifying the specific guideline requested
						and the choice of format to Publications, New York State Workers' Compensation
						Board, 328 State Street, Schenectady, NY 12305-2318. Information about the
Workers' Compensation Guidelines for Determining Impairment
can be requested by email at GENERAL_INFORMATION@wcb.ny.gov, or by telephone at
						1-800-781-2362. The
Workers' Compensation Guidelines for Determining
						Impairment
are available on paper or compact disc. A fee of $10 will
						be charged for the guideline requested in paper format, and a fee of $5 will be
						charged for a compact disc. Payment of the fee shall be made by check or money
						order payable to "Chair WCB."
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter C - Medical Treatment and Care › Part 325 - Medical And Surgical Care And Treatment › Subpart 325-1 - General › Section 325-1.7 - Duties of superseding physician

Current through Register Vol. 46, No. 28, July 10, 2024
A physician authorized to treat workers' compensation
						cases, when requested to supersede another physician, must, before beginning
						treatment of such patient, make reasonable effort to communicate with the
						attending physician to ascertain the patient' s condition. The superseding
						physician must also advise the attending physician of the name of the person
						who has requested him or her to assume care of the case and state the reason
						therefor. If the superseding physician cannot contact the attending physician,
						and the claimant's condition requires immediate treatment, the superseding
						physician should advise the physician previously in attendance within 48 hours
						that he or she now has the patient in his or her care. The preceding physician
						shall supply the superseding physician with a complete history of the
						case.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter C - Medical Treatment and Care › Part 325 - Medical And Surgical Care And Treatment › Subpart 325-1 - General › Section 325-1.8 - Emergency medical aid and telemedicine

Current through Register Vol. 46, No. 28, July 10, 2024
(a) In the event of a serious accident
					 requiring immediate emergency medical aid, an ambulance or any physician may be
					 called to give first aid treatment.
(b) Telemedicine, using an interactive audio
					 and video telecommunications system that permits real-time communication
					 between an authorized medical provider and a claimant in accordance with
					 guidance from the Centers for Medicare & Medicaid Services, may be used by
					 authorized providers where medically appropriate for social distancing purposes
					 due to the outbreak of COVID-19 to assess current disability status. "Medically
					 appropriate" includes discussion of test results or imaging, follow-up
					 assessments, or counseling. It does not include treatment where physical
					 examination is a necessary component, such as initial visits or assessments,
					 physical therapy or other types of manual therapy. The authorized provider
					 shall indicate on their report that such assessment was done using telemedicine
					 as a result of social distancing due to the outbreak of
					 COVID-19.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter C - Medical Treatment and Care › Part 325 - Medical And Surgical Care And Treatment › Subpart 325-1 - General › Section 325-1.10 - X-ray, consultation bills

Current through Register Vol. 46, No. 28, July 10, 2024
Bills for X-ray and consultation rendered by a specialist
						and bills for X-ray examination, diagnosis or treatment rendered by an X-ray
						laboratory or bureau of a voluntary hospital licensed by the chair shall be
						submitted for payment directly to the employer or carrier. These services must
						be authorized in writing by the physician in attendance.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter C - Medical Treatment and Care › Part 325 - Medical And Surgical Care And Treatment › Subpart 325-1 - General › Section 325-1.11 - Copies of hospital records

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
					 Physicians treating claimants in hospitals may secure the signature of claimant
					 for authorization to obtain copies of any necessary hospital records.
(b) Employers, carriers, claimant's
					 representatives or special funds upon written request to any hospital operating
					 in New York State together with the claimant' s written consent, may obtain for
					 use in board proceedings, the hospital records of a claimant pertaining to his
					 or her compensation claim.
(c)
					 Written notice of such request together with proof of mailing shall be provided
					 to the board.
(d) A hospital has 20
					 days to respond to such request by either:
(1) providing the records; or
(2) notifying in writing the party requesting
					 the records that such records cannot be provided and the reason for not
					 providing such records together with the date upon which the records will be
					 provided. Such date shall not be more than 30 days from the date of the written
					 request.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter C - Medical Treatment and Care › Part 325 - Medical And Surgical Care And Treatment › Subpart 325-1 - General › Section 325-1.12 - Termination of emergency status

Current through Register Vol. 46, No. 28, July 10, 2024
The physician in attendance in public hospitals must be
						the judge as to when the "emergency status" of the case has terminated. In case
						of a dispute, the matter shall be referred to the compensation board of the
						medical society of the county in which the hospital is located for immediate
						decision.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter C - Medical Treatment and Care › Part 325 - Medical And Surgical Care And Treatment › Subpart 325-1 - General › Section 325-1.13 - Insurance company medical inspectors

Current through Register Vol. 46, No. 28, July 10, 2024
Medical inspectors of insurance companies shall be
						admitted to hospitals or other institutions where injured employees are
						confined, upon proper identification, for the purpose of complying with section 13-j  of the Workers' Compensation Law.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter C - Medical Treatment and Care › Part 325 - Medical And Surgical Care And Treatment › Subpart 325-1 - General › Section 325-1.15 - License for emergency treatment not required

Current through Register Vol. 46, No. 28, July 10, 2024
No license is required for an employer to operate a first
						aid station for emergency treatment, but no subsequent treatments are to be
						rendered by anyone, other than a qualified physician on the minimum fee
						schedule basis.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter C - Medical Treatment and Care › Part 325 - Medical And Surgical Care And Treatment › Subpart 325-1 - General › Section 325-1.16 - Advertising by physicians

Current through Register Vol. 46, No. 28, July 10, 2024
(a) A
					 physician shall not advertise or publicize himself or herself in violation of
					 any statute or rule of court or the Workers' Compensation Law and the rules and
					 regulations promulgated thereunder.
(b) A physician on behalf of himself or
					 herself, or partners or associates, shall not use or disseminate or participate
					 in the preparation or dissemination of any public communication containing
					 statements or claims that are false, deceptive or misleading.
(c) Advertising or other publicity by
					 physicians, including participation in public functions, shall not contain
					 puffery, self-laudation, claims regarding the quality of the physician's
					 medical services, or claims that cannot be measured or verified.
(d) It is proper to include information,
					 provided its dissemination does not violate the provisions of subdivisions (b)
					 and (c) of this section, as to education, degrees and other scholastic
					 distinctions; dates of admission to practice; areas of medicine in which the
					 physician practices, and teaching positions held; memberships in medical
					 associations or other professional societies or organizations, including
					 offices and committee assignments therein; foreign language fluency.
(e) Advertising and publicity shall be
					 designed to educate the public to an awareness of medical needs and to provide
					 information relevant to the selection of the most appropriate physician.
					 Information, other than that specifically authorized in subdivision (d) of this
					 section, that is consistent with these purposes may be disseminated providing
					 that it does not violate any other provisions of this section.
(f) If the advertisement is broadcast, it
					 shall be prerecorded or taped and approved for broadcast by the physician, and
					 a recording or videotape of the actual transmission shall be retained by the
					 physician for a period of not less than one year following such
					 transmission.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter C - Medical Treatment and Care › Part 325 - Medical And Surgical Care And Treatment › Subpart 325-1 - General › Section 325-1.17 - Notice to employees form

Current through Register Vol. 46, No. 28, July 10, 2024
No insurance company or self-insurer may reduce the size
						of notice to employees (form C-105) which is to be posted in all places of
						employment covered by the Workers' Compensation Law, unless such permission is
						granted on application to the chair.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter C - Medical Treatment and Care › Part 325 - Medical And Surgical Care And Treatment › Subpart 325-1 - General › Section 325-1.18 - Physician fees for hearing purposes

Current through Register Vol. 46, No. 28, July 10, 2024
A physician who testifies at hearings or examines
						claimants or participates in examinations for evidential material for
						compensation case hearing purposes only, may accept fees for such services from
						claimants, employers or carriers.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter C - Medical Treatment and Care › Part 325 - Medical And Surgical Care And Treatment › Subpart 325-1 - General › Section 325-1.19 - Hospital bills

Current through Register Vol. 46, No. 28, July 10, 2024
Hospitals may render bills for board and room
						accommodations, medical and surgical supplies and nursing facilities. Voluntary
						hospitals may bill for X-ray services when rendered by an X-ray laboratory or
						bureau of such hospital duly licensed by the chair. Hospitals may bill for
						physiotherapeutic, anesthesia and pathologic services when rendered by or under
						the supervision of salaried physicians on the staff. The names and
						qualifications of all physicians and persons rendering services for which
						charges are made by hospitals must be included in all bills, and all medical
						and X-ray reports shall be promptly filed with the board and with the employer
						or its insurance carrier.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter C - Medical Treatment and Care › Part 325 - Medical And Surgical Care And Treatment › Subpart 325-1 - General › Section 325-1.20 - Payment of bills for treatment or services performed prior to october 1, 1994

Current through Register Vol. 46, No. 28, July 10, 2024
The provisions of subdivision 1 of section 13-g,
						subdivision 6 of section 13-k, subdivision 6 of section 13-1 and subdivision 7
						of section 13-m  of the Workers' Compensation Law, relative to the making of an
						award for an unpaid bill rendered to an employer or carrier by a physician,
						hospital, self-employed physical or occupational therapist, podiatrist,
						chiropractor, or psychologist, where an impartial examination of the fairness
						of the amount of such bill has not been timely requested, shall be subject to
						the following:
(a) In the case of a
					 physician's or hospital's bill, the treatment or services shall have been
					 furnished on or after July 27, 1976. In the case of a self-employed physical or
					 occupational therapist's, podiatrist's or chiropractor's bill, the treatment or
					 services shall have been furnished on or after January 1, 1987. In the case of
					 a psychologist' s bill, the treatment or services shall have been furnished on
					 or after January 1, 1990. In all cases the treatment or services shall have
					 been performed prior to October 1, 1994.
(b) The physician's, self-employed physical
					 or occupational therapist's, podiatrist's, chiropractor's or psychologist's
					 bill shall have been submitted to the employer or carrier within 90 days from
					 the last day of the month in which the services were rendered; the hospital's
					 bill shall have been submitted to such parties within 120 days from the last
					 day of the month in which the services were rendered.
(c) Only in the event that the courts, on
					 appeal, disallow a claim for workers' compensation shall the employer or
					 carrier be entitled to reimbursement, in accordance with the provisions of
					 section 23  of the Workers' Compensation Law, for such fair and reasonable
					 doctors' bills paid by the employer or carrier pending the outcome of the
					 appeal.
(d) In the case of
					 treatment or services performed on or after October 1, 1994, regardless of the
					 date of accident or occupational disease, the making of an award for unpaid
					 bills for such services shall be subject to section
					 325-1.24 
					 of this Subpart.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter C - Medical Treatment and Care › Part 325 - Medical And Surgical Care And Treatment › Subpart 325-1 - General › Section 325-1.21 - Failure to treat

Current through Register Vol. 46, No. 28, July 10, 2024
A physician, podiatrist, chiropractor, psychologist,
						operator of a medical bureau or laboratory authorized by the chair to render
						treatment and care to injured employees under the Workers' Compensation
						Law:
(a) shall accept and treat such
					 injured employees in a manner corresponding to that accorded other patients in
					 his or her practice, without discriminating against such injured employees
					 because they are or may be covered by the provisions of the Workers'
					 Compensation Law; and
(b) shall not
					 refuse to provide treatment and care to such injured employees on the basis of
					 a fee request greater than that set forth in the applicable prescribed fee
					 schedule, but shall submit to arbitration such fee dispute in accordance with
					 the provisions of the Workers' Compensation Law, nor shall such treatment and
					 care be denied to such injured employees because the source or manner of
					 payment for such treatment and care is pursuant to the provisions of the
					 Workers' Compensation Law.
Nothing contained in this section shall prevent a
						voluntary payment by the employer or carrier of an amount higher than the fees
						and charges found in the fee schedule where agreed to by the employer or
						carrier. An authorized physician, podiatrist, chiropractor, psychologist,
						operator of a medical bureau or laboratory whose actions violate or are
						inconsistent with the provisions of this section shall be charged with
						misconduct, and his or her authorization to treat workers' compensation cases
						shall be subject to suspension or revocation by the chair in accordance with
						the procedures set forth in the Workers' Compensation Law.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter C - Medical Treatment and Care › Part 325 - Medical And Surgical Care And Treatment › Subpart 325-1 - General › Section 325-1.22 - Objections by the special fund for reopened cases to medical and hospital bills

Current through Register Vol. 46, No. 28, July 10, 2024
The special fund, by its duly designated representative
						under section 25-a  of the Workers' Compensation Law, when objecting to a bill
						rendered by a physician, hospital, podiatrist, chiropractor, psychologist, or
						self-employed occupational or physical therapist, shall comply with all of the
						applicable provisions of sections 13-g, 13-k, 13-l and 13-m  of the Workers'
						Compensation Law and the rules and regulations promulgated
						thereunder.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter C - Medical Treatment and Care › Part 325 - Medical And Surgical Care And Treatment › Subpart 325-1 - General › Section 325-1.23 - Workers' compensation claimant's agreement to pay medical costs in event of the claimant's failure to prosecute the claim or in event of the disallowance of the claim

Current through Register Vol. 46, No. 28, July 10, 2024
An authorized doctor or an occupational or physical
						therapist treating a workers' compensation claimant may require the claimant to
						sign an agreement, on a prescribed form, requiring such claimant to pay said
						doctor or therapist his or her usual and customary fees for services rendered
						to such claimant, in the event said claimant fails to prosecute a claim for
						workers' compensation for such illness or condition, or in the event it is
						determined by the Workers' Compensation Board that the illness or condition for
						which such services were rendered was not the result of a compensable workers'
						compensation claim.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter C - Medical Treatment and Care › Part 325 - Medical And Surgical Care And Treatment › Subpart 325-1 - General › Section 325-1.25 - Payment of and objections to medical bills

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Obligation and liability of employer or
					 insurance carrier (or third-party administrator) to provide Medical Care.
(1) The employer or insurance carrier (or
					 third-party administrator) is required to promptly provide the claimant with
					 such Medical Care, for such period as the nature of the injury, illness, or
					 occupational disease, or process of recovery may require. Medical Care means
					 symptomatic, palliative, maintenance treatment, services, or supplies. When the
					 Medical Care is to or for a part of the body or condition covered by the
					 Medical Treatment Guidelines as set forth in section
					 324.2(a) 
					 of this Title, the employer or insurance carrier (or third-party administrator)
					 is required to provide such Medical Care which is consistent with the Medical
					 Treatment Guidelines or, if applicable, an approved variance from such
					 guidelines.
(2) The employer or
					 insurance carrier (or third-party administrator) is liable for the payment of
					 medically necessary care, services, and supplies to the claimant when it has
					 accepted the claim or the claim has been established as compensable by the
					 Board. When the Medical Care is to or for a part of the body covered by the
					 Medical Treatment Guidelines and the claim has been accepted or established as
					 compensable, the employer or insurance carrier (or third-party administrator)
					 shall be obligated to pay for all Medical Care, in the amount set forth in the
					 applicable fee schedule, or in any other amount as agreed to by the Treating
					 Medical Provider and payor, that is:
(i)
					 within the criteria of the medical treatment guidelines incorporated by
					 reference pursuant to section
					 324.2(a) 
					 of this Title and is based on correct application of such guidelines;
(ii) within a proper variance from the
					 Medical Treatment Guidelines in accordance with the requirements of section
					 324.3(a)
					 (2), or has been authorized pursuant to
					 section
					 325-1.4 
					 or Part 441of this Title;
(iii)
					 agreed to by the employer or insurance carrier (or third-party administrator);
					 or
(iv) as ordered by the Board
					 pursuant to statute or regulation.
The employer or insurance carrier (or third-party
						administrator) shall not be obligated to pay for any Medical Care that is not
						within the criteria of the Medical Treatment Guidelines or is not based on
						correct application of the Medical Treatment Guidelines, except if a variance
						has been approved by the employer, insurance carrier (or third-party
						administrator), or Board in accordance with section
						324.3  of
						this Title or as ordered by the Board pursuant to statute or regulation.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter C - Medical Treatment and Care › Part 325 - Medical And Surgical Care And Treatment › Subpart 325-1 - General › Section 325-1.26 - Telehealth

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Definitions.
					 Telehealth shall mean treatment by physicians, podiatrists, psychologists,
					 nurse practitioners, physician assistants, and licensed clinical social workers
					 authorized by the Chair to provide treatment and care under the Workers'
					 Compensation Law (hereinafter "Authorized Medical Provider") using two-way
					 audio and visual electronic communication, or audio only.
(1) When rendering medical treatment or care
					 via telehealth, an Authorized Medical Provider must be available for an
					 in-person clinical encounter with the claimant should such in-person encounter
					 be medically necessary. This means the Authorized Medical Provider must be able
					 to meet the claimant at the Authorized Medical Provider's office within a
					 reasonable travel time and distance from the claimant's residence.
(2) Telehealth must be used in accordance
					 with this section and any applicable New York State Medical Treatment Guideline
					 incorporated by reference under section
					 324.2  of this Title.
(3) Authorized Medical Providers shall bill
					 using the applicable Evaluation and Management code 99212 using Modifier 95
					 when services are rendered by telehealth using two-way audio and visual
					 communication. When services are rendered by audio only in accordance with
					 section 325-1.8  of this Title, the
					 Authorized Medical Provider shall use Modifier 93. Place of service Code 10
					 shall be used when services are rendered while patient is in their home. Place
					 of service code 02 shall be used when services are rendered while patient is in
					 a healthcare setting that is not their home. When completing the report of
					 treatment, the Authorized Medical Provider shall identify the address from
					 which they rendered Medical Care via telehealth as the Authorized Medical
					 Provider's business address. Notwithstanding the codes listed in this
					 paragraph, appropriate telehealth codes as may appear in any future versions of
					 the Official New York Workers' Compensation Medical Fee Schedule as
					 incorporated by reference in section
					 329-1.3  of this Title may be used
					 and will have the same effective date as the effective date of the future
					 version of the Official New York Workers' Compensation Medical Fee
					 Schedule.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter C - Medical Treatment and Care › Part 325 - Medical And Surgical Care And Treatment › Subpart 325-2 - Recommending Of Authorized Physicians By Insurance Carriers And Employers; Procedure For Medical Inspectors And Consultants › Section 325-2.1 - Statement of purpose

Current through Register Vol. 46, No. 28, July 10, 2024
The purpose of this Subpart is to establish procedures
						and protections governing the ability of an employer or carrier to recommend a
						designated network or provider to an injured employee in accordance with
						sections 13-a (1), 13-i and 13-j (1)  of the Workers' Compensation Law. This
						Subpart does not apply to the binding direction of care which is authorized by
						article 10-A and section 25 (2-c)  of the Workers' Compensation Law.
						Notwithstanding any other provision to the contrary, this Subpart does not
						apply when a carrier or employer has contracted with a network or networks to
						have diagnostic tests, x-ray examinations, magnetic resonance imaging, or other
						radiological examinations or tests of claimants performed by an affiliated
						network provider and requires claimants to undergo all such diagnostic tests
						from a network or networks pursuant to Workers' Compensation Law section
						13-a(7) and Subpart 325-7 of this Part.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter C - Medical Treatment and Care › Part 325 - Medical And Surgical Care And Treatment › Subpart 325-2 - Recommending Of Authorized Physicians By Insurance Carriers And Employers; Procedure For Medical Inspectors And Consultants › Section 325-2.2 - Parties authorized to direct or recommend care of injured workers

Current through Register Vol. 46, No. 28, July 10, 2024
(a) For purposes of
					 this Subpart, direction of care shall mean the binding referral of an injured
					 employee to a designated network or health care provider as authorized under
					 the statutory programs set forth in subdivision (b) of this section.
					 Recommendation of a designated network or health care provider shall mean the
					 act of actively endorsing or promoting the utilization of a designated network
					 or health care provider for the treatment of an injured employee.
(b) Only those parties who are either:
(1) participating in a certified preferred
					 provider organization (PPO) arrangement under article 10-A of the Workers'
					 Compensation Law; or
(2)
					 participating in the alternative dispute resolution pilot program under section 25 (2-c)  of the Workers' Compensation Law may direct the care of injured
					 employees to a designated network or health care provider.
Only those parties who are complying with the provisions
						of sections 13-a (1) and 13-i  of the Workers' Compensation Law may recommend a
						designated network or health care provider to an injured
						employee.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter C - Medical Treatment and Care › Part 325 - Medical And Surgical Care And Treatment › Subpart 325-2 - Recommending Of Authorized Physicians By Insurance Carriers And Employers; Procedure For Medical Inspectors And Consultants › Section 325-2.3 - Employer or carrier recommended networks or providers

Current through Register Vol. 46, No. 28, July 10, 2024
(a) For purposes of this Subpart, an employer
					 or carrier is deemed to have recommended the care of an injured employee to a
					 designated network or health care provider if:
(1) it has a contractual relationship with a
					 network or provider with respect to the treatment of employees' work-related
					 injuries or illnesses other than a contract pursuant to section 25 (2-c) or
					 article 10-A of the Workers' Compensation Law; or
(2) it endorses or promotes the utilization
					 of a specified network or provider in employee handouts, posting or other
					 written materials.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter C - Medical Treatment and Care › Part 325 - Medical And Surgical Care And Treatment › Subpart 325-2 - Recommending Of Authorized Physicians By Insurance Carriers And Employers; Procedure For Medical Inspectors And Consultants › Section 325-2.4 - Prescribed consent forms

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
					 Any injured employee who elects to utilize a designated network or health care
					 provider based upon the recommendation of his or her employer or its carrier
					 must sign a prescribed consent form indicating that he or she voluntarily
					 elects to receive treatment from the employer or carrier recommended network or
					 provider. Such consent forms may not be executed prior to the occurrence of a
					 work-related injury or illness.
(b)
					 Any employer whose employees have signed the above consent form must both
					 maintain a record of the signed, original form and provide a copy of the signed
					 form to each employee signing such consent. Employers' copies of individual
					 employee consent forms may be inspected by the board at any time.
(c) Under no circumstances shall the
					 requirement related to the completion of the required consent form pursuant to
					 subdivision (a) of this section in any way hinder the ability of an injured
					 employee to secure timely, appropriate treatment for a work-related injury or
					 illness.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter C - Medical Treatment and Care › Part 325 - Medical And Surgical Care And Treatment › Subpart 325-2 - Recommending Of Authorized Physicians By Insurance Carriers And Employers; Procedure For Medical Inspectors And Consultants › Section 325-2.5 - Waiver agreements related to medical benefits or treatment

Current through Register Vol. 46, No. 28, July 10, 2024
No waiver agreements with respect to an injured employee'
						s medical benefits or treatment beyond the properly executed prescribed consent
						form shall be valid and enforceable unless reviewed and approved by the board
						in accordance with section 32  of the Workers' Compensation Law and section
						300.36  of
						this Title.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter C - Medical Treatment and Care › Part 325 - Medical And Surgical Care And Treatment › Subpart 325-2 - Recommending Of Authorized Physicians By Insurance Carriers And Employers; Procedure For Medical Inspectors And Consultants › Section 325-2.6 - List of authorized physicians

Current through Register Vol. 46, No. 28, July 10, 2024
Any party may secure a list of all authorized physicians
						in their vicinity by applying to the chair.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter C - Medical Treatment and Care › Part 325 - Medical And Surgical Care And Treatment › Subpart 325-2 - Recommending Of Authorized Physicians By Insurance Carriers And Employers; Procedure For Medical Inspectors And Consultants › Section 325-2.7 - Repealed

Current through Register Vol. 46, No. 28, July 10, 2024
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter C - Medical Treatment and Care › Part 325 - Medical And Surgical Care And Treatment › Subpart 325-2 - Recommending Of Authorized Physicians By Insurance Carriers And Employers; Procedure For Medical Inspectors And Consultants › Section 325-2.8 to 325-2.9 - Repealed

Current through Register Vol. 46, No. 28, July 10, 2024
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter C - Medical Treatment and Care › Part 325 - Medical And Surgical Care And Treatment › Subpart 325-2 - Recommending Of Authorized Physicians By Insurance Carriers And Employers; Procedure For Medical Inspectors And Consultants › Section 325-2.10 - Investigation of complaints

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
					 The chair or the chair's designee shall investigate any complaints regarding
					 direction of care outside of the PPO program under article 10-A of the Workers'
					 Compensation Law or the alternative dispute resolution pilot program under
					 section 25 (2-c)  of the Workers' Compensation Law as well as complaints
					 regarding employer or carrier recommendation of a designated network or
					 provider which is not in compliance with the provisions of this
					 Subpart.
(b) At the chair's
					 discretion, the chair or the chair's designee may collect and examine:
(1) the list of health care providers
					 offering treatment in accordance with the employer/carrier-recommended
					 arrangement;
(2) any contracts
					 between these providers and employers or carriers with respect to workers'
					 compensation related treatment;
(3)
					 any informational materials distributed to employees regarding their workers'
					 compensation related treatment;
(4)
					 any forms or documentation required of injured employees or providers during
					 the course of treatment; and
(5)
					 such other information as may be requested for the purpose of ensuring the
					 accessibility and adequacy of the network as well as the injured employees'
					 voluntary participation in the treatment arrangement.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter C - Medical Treatment and Care › Part 325 - Medical And Surgical Care And Treatment › Subpart 325-3 - Licensing And Operation Of Compensation Medical Bureaus › Section 325-3.1 - Authorization of bureau

Current through Register Vol. 46, No. 28, July 10, 2024
The character and frequency of accidents, the number of
						employees in a given plant and the availability of qualified medical care in
						the immediate vicinity of the place of employment should be considered in
						relation to the authorization of an employer' s compensation medical
						bureau.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter C - Medical Treatment and Care › Part 325 - Medical And Surgical Care And Treatment › Subpart 325-3 - Licensing And Operation Of Compensation Medical Bureaus › Section 325-3.2 - Location of bureau

Current through Register Vol. 46, No. 28, July 10, 2024
The bureau should be located in the industrial plant or
						in the immediate vicinity.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter C - Medical Treatment and Care › Part 325 - Medical And Surgical Care And Treatment › Subpart 325-3 - Licensing And Operation Of Compensation Medical Bureaus › Section 325-3.3 - Determination of physician's hours

Current through Register Vol. 46, No. 28, July 10, 2024
The question of the necessity of the presence of a
						physician during working hours, or the availability of a physician at stated
						hours should be determined by an inspection of the plant to ascertain the
						nature of the hazards and the frequency of accidents.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter C - Medical Treatment and Care › Part 325 - Medical And Surgical Care And Treatment › Subpart 325-3 - Licensing And Operation Of Compensation Medical Bureaus › Section 325-3.4 - Bureau facilities

Current through Register Vol. 46, No. 28, July 10, 2024
The bureau shall be well-housed with sufficient space,
						light and air and shall conform to reasonable sanitary requirements. Proper
						facilities in the form of personnel for assistance in emergencies, instruments,
						sterilizers, dressings, drugs, shall be available at all times and in amounts
						proportionate to the size of the plant and the number of employees. Such
						facilities shall be adequate for more than mere emergency care and for the more
						severe type of industrial injury.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter C - Medical Treatment and Care › Part 325 - Medical And Surgical Care And Treatment › Subpart 325-3 - Licensing And Operation Of Compensation Medical Bureaus › Section 325-3.5 - Limited licenses

Current through Register Vol. 46, No. 28, July 10, 2024
A bureau license may be given for a stated project which,
						because of the hazards of the project and the frequency of accidents, requires
						continued medical care and such license shall be for the life of the given
						project only. In such cases all employees of all subcontractors shall be
						covered by the license.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter C - Medical Treatment and Care › Part 325 - Medical And Surgical Care And Treatment › Subpart 325-3 - Licensing And Operation Of Compensation Medical Bureaus › Section 325-3.6 - License to cover only employer's employees

Current through Register Vol. 46, No. 28, July 10, 2024
No license shall be issued to an employer to cover any
						but his own employees except as indicated in section
						325-3.5  of this
						Subpart.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter C - Medical Treatment and Care › Part 325 - Medical And Surgical Care And Treatment › Subpart 325-3 - Licensing And Operation Of Compensation Medical Bureaus › Section 325-3.7 - First-aid stations

Current through Register Vol. 46, No. 28, July 10, 2024
No license is required to operate a first-aid station by
						an employer of labor. Such first-aid or emergency station should be properly
						equipped for first aid in accordance with the type of hazard encountered at the
						particular place of employment.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter C - Medical Treatment and Care › Part 325 - Medical And Surgical Care And Treatment › Subpart 325-3 - Licensing And Operation Of Compensation Medical Bureaus › Section 325-3.8 - Notice to employees to be posted

Current through Register Vol. 46, No. 28, July 10, 2024
A notice of the rights of an injured employee and the
						responsibilities of the employer, shall be posted in each compensation medical
						bureau and first-aid station.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter C - Medical Treatment and Care › Part 325 - Medical And Surgical Care And Treatment › Subpart 325-3 - Licensing And Operation Of Compensation Medical Bureaus › Section 325-3.9 - License fee for bureaus operated by institutions for profit

Current through Register Vol. 46, No. 28, July 10, 2024
All compensation medical bureaus when operated by summer
						camps and other institutions, wherein such camps and institutions are operating
						for a profit, shall be charged a license fee of $100 per annum for the
						operation of such medical bureaus which are in operation for six months of the
						year or less.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter C - Medical Treatment and Care › Part 325 - Medical And Surgical Care And Treatment › Subpart 325-3 - Licensing And Operation Of Compensation Medical Bureaus › Section 325-3.10 - Authorization of medical center jointly operated by labor and management

Current through Register Vol. 46, No. 28, July 10, 2024
A medical center jointly operated by labor and management
						representatives, approved by and under the supervision of the New York State
						Department of Health, and which complies with the provisions of subdivision 3
						of section 13-c  of the Workers' Compensation Law, may be authorized by the
						chair to provide medical treatment and care under the Workers' Compensation
						Law. Application for such authorization shall be made on a form to be furnished
						by the chair. All rules and procedures of the chair under the Workers'
						Compensation Law pertaining to:
(a)
					 medical and surgical care and treatment, podiatry care and treatment, and
					 chiropractic care and treatment and injured employees;
(b) the schedules of fees to be charged
					 therefore; and
(c) the arbitration
					 of disputed bills for such treatment and care, shall be equally applicable to
					 any authorized medical center to the extent that they are not inconsistent with
					 the provisions of subdivision 3 of section 13-c.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter C - Medical Treatment and Care › Part 325 - Medical And Surgical Care And Treatment › Subpart 325-4 - Authorization Of Hospitals And Health Maintenance Organizations › Section 325-4.1 - Authorization of hospitals and health maintenance organizations to provide out-patient medical care

Current through Register Vol. 46, No. 28, July 10, 2024
A hospital as defined in article 28 of the Public Health
						Law or a health maintenance organization holding a valid certificate of
						authority issued pursuant to article 44 of the Public Health Law or operating
						under the provisions of article 43 of the Insurance Law, which complies with
						the provisions of subdivision 4 of section 13-c  of the Workers' Compensation
						Law, may be authorized by the chair of the Workers' Compensation Board to
						provide out-patient medical treatment and care under the Workers' Compensation
						Law. Application for such authorization shall be made on a form to be furnished
						by the chair. All rules and procedures of the chair under the Workers'
						Compensation Law pertaining to medical care and surgical treatment, podiatry
						care and treatment, and chiropractor care and treatment of injured employees,
						shall be equally applicable to any authorized hospital or health maintenance
						organization to the extent that such rules and procedures are not inconsistent
						with the provisions of subdivision 4 of section 13-c  of the Workers'
						Compensation Law or the rules contained in this Subpart.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter C - Medical Treatment and Care › Part 325 - Medical And Surgical Care And Treatment › Subpart 325-4 - Authorization Of Hospitals And Health Maintenance Organizations › Section 325-4.2 - Duties of hospitals and health maintenance organizations

Current through Register Vol. 46, No. 28, July 10, 2024
A hospital or health maintenance organization authorized
						by the chair to provide out-patient medical treatment and care shall:
(a) provide treatment and services required
					 under section 13  of the Workers' Compensation Law on an out-patient basis to
					 claimants for workers' compensation;
(b) require that full and truthful medical
					 reports be prepared and signed by a doctor who is authorized by the chair to
					 treat workers' compensation claimants and who is actually rendering the
					 treatment, and to submit such reports directly to the chair and the carrier,
					 pursuant to subdivision 4 of section 13-a  of the Workers' Compensation Law, and
					 to section
					 325-1.3 
					 of this Part.
(c) retain in the
					 out-patient facility copies of all reports submitted for each claimant
					 treated;
(d) maintain a log clearly
					 identifying each claimant treated under the provisions of the Workers'
					 Compensation Law;
(e) render only
					 those services specified in the hospital's or health maintenance organization's
					 operating certificate or certificate of authority issued by the New York State
					 Department of Health; and notify the chair immediately of any change in, or
					 renewal of, the operating certificate or certificate of authority and submit a
					 copy of the new certificate; and notify the chair at once in the event the
					 operating certificate or certificate of authority is suspended or
					 revoked;
(f) charge for services
					 rendered under the Workers' Compensation Law in accordance with the appropriate
					 fee schedule(s) established by the chairman and be bound by the provisions of
					 section 13-f  of the Workers' Compensation Law;
(g) be bound by section 13-g  of the Workers'
					 Compensation Law and by the rules for arbitration of disputed bills for
					 treatment and care; and
(h) make
					 available for inspection by the chairman or his authorized representative, the
					 premises, equipment and all books and records of the out- patient
					 facility.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter C - Medical Treatment and Care › Part 325 - Medical And Surgical Care And Treatment › Subpart 325-4 - Authorization Of Hospitals And Health Maintenance Organizations › Section 325-4.3 - Failure to treat

Current through Register Vol. 46, No. 28, July 10, 2024
A hospital or health maintenance organization authorized
						by the chair to provide out-patient medical treatment and care:
(a) shall accept and treat injured employees
					 in a manner corresponding to that accorded other patients, provided they are
					 otherwise eligible to be treated by the hospital or health maintenance
					 organization, without discriminating against such injured employees because
					 they are or may be covered by the provisions of the Workers' Compensation Law
					 or because the manner of payment is pursuant to the provisions of such law;
					 and
(b) shall not refuse to provide
					 treatment and care to such injured employees because the hospital or health
					 maintenance organization wishes to charge a fee greater than that set forth in
					 the applicable prescribed fee schedule. Any fee dispute shall be submitted to
					 arbitration in accordance with the Workers' Compensation Law. Nothing contained
					 in this section shall prevent a voluntary payment by the employer or carrier of
					 an amount higher than the fees and charges found in the fee schedule where
					 agreed to by the employer or carrier.