NEW YORK

Employee Selects

An injured employee may, when care is required, select to treat him or her any physician authorized by the chair to render medical care, as hereafter provided. (NY CLS § 13-a (1))

Change of Provider

An injured employee may, when care is required, select to treat him or her any physician authorized by the chair to render medical care, as hereafter provided. If for any reason during the period when medical treatment and care is required, the employee wishes to transfer his or her treatment and care to another authorized physician, he or she may do so, in accordance with rules prescribed by the chair. (NY CLS § 13-a (1))

Panels

Not addressed

Panel Provisions

See Direction of Care law.

NEW YORK ROC

Employee Selects

The employer may recommend a designated network or health care provider to an injured employee, but the employee may select any authorized provider of their choice. (12 NYCRR § 325-2.3)

Change of Provider

Any employee handouts, postings, or other written materials provided by the employer or carrier related to the employee's utilization of an employer or carrier recommended network or health care provider must clearly indicate that utilization of such network or provider is purely voluntary, that a full list of authorized health care providers is available from the Workers' Compensation Board, and that employees may select or change their provider at any time without jeopardizing their medical or indemnity benefits. (12 NYCRR § 325-2.3 (b))

Panels

Allowed*

Panel Provisions

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. (12 NYCRR 325-2.4) Form C3.1: http://www.wcb.ny.gov/content/main/forms/c3_1.pdf

NEW YORK PPO

Employee Selects from Network

An employee may seek medical treatment from outside the preferred provider organization 30 days after his or her first visit to a preferred provider organization provider (NY CLS Work Comp 10A-354 (2))

Each PPO shall provide at least 2 providers in every medical specialty from which the employee may choose and at least 2 hospitals from which the employee may choose in the event that hospitalization is necessary. The commissioner of health may waive such numerical requirements upon a finding that the geographical area in which the preferred provider organization is located cannot meet the requirements. (NY CLS Work Comp 10A-354)

Medical Specialties:
Family Practice (Board Cert. GP), Orthopedic Surgery,
Neurology, Internal Medicine, Physical Therapy,
Chiropractor, Surgeon, Anesthesiology,
Physical Medicine, Rehabilitation,
Psychiatry, Psychology, Radiology,
Dermatology, Cardiology,
Pulmonary Disease,
Ophthalmology, Hand Surgery, Pathology,
Plastic Surgery, Urology,
Podiatrist, Occupational Therapist, Neurological Surgery,
Otolaryngology, Thoracic Surgeon,
Allergy & Immunology (10 NYCRR § 732-1.2 (b)(10))

Change of Provider

An employee may seek medical treatment from outside the preferred provider organization 30 days after his or her first visit to a PPO provider. In the event that employee seeks medical treatment outside the PPO, the employer may require a second opinion from a provider within the PPO. (NY CLS Work Comp 10A-354 (2))

Panels

Not addressed

Panel Provisions

See Direction of Care law for network access requirements.

The information on this website constitutes summary information only and does not constitute legal advice. Review of the full text of the referenced statutes and regulations may be necessary. Coventry Health Care Workers' Compensation, Inc. makes no representations or warranties about the accuracy of the information contained on this website.