STATE OF NEW YORK
________________________________________________________________________
6380
IN SENATE
February 2, 2012
___________
Introduced by Sen. MAZIARZ -- read twice and ordered printed, and when
printed to be committed to the Committee on Labor
AN ACT to amend the workers' compensation law, in relation to authoriz-
ing certain care and treatment to injured employees
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. Subdivision (a) of section 13 of the workers' compensation
2 law, as amended by chapter 6 of the laws of 2007, is amended to read as
3 follows:
4 (a) The employer shall promptly provide for an injured employee such
5 medical, dental, surgical, optometric or other attendance or treatment,
6 nurse and hospital service, medicine, optometric services, crutches,
7 eye-glasses, false teeth, artificial eyes, orthotics, prosthetic
8 devices, functional assistive and adaptive devices and apparatus for
9 such period as the nature of the injury or the process of recovery may
10 require. The employer shall be liable for the payment of the expenses of
11 medical, dental, surgical, optometric or other attendance or treatment,
12 nurse and hospital service, medicine, optometric services, crutches,
13 eye-glasses, false teeth, artificial eyes, orthotics, prosthetic
14 devices, functional assistive and adaptive devices and apparatus, as
15 well as artificial members of the body or other devices or appliances
16 necessary in the first instance to replace, support or relieve a portion
17 or part of the body resulting from and necessitated by the injury of an
18 employee, for such period as the nature of the injury or the process of
19 recovery may require, and the employer shall also be liable for replace-
20 ments or repairs of such artificial members of the body or such other
21 devices, eye-glasses, false teeth, artificial eyes, orthotics, prosthet-
22 ic devices, functional assistive and adaptive devices or appliances
23 necessitated by ordinary wear or loss or damage to a prosthesis, with or
24 without bodily injury to the employee. Damage to or loss of a prosthetic
25 device shall be deemed an injury except that no disability benefits
26 shall be payable with respect to such injury under section fifteen of
27 this article. Such a replacement or repair of artificial members of the
28 body or such other devices, eye-glasses, false teeth, artificial eyes,
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD09319-04-2
S. 6380 2
1 orthotics, prosthetic devices, functional assistive and adaptive devices
2 or appliances or the providing of medical treatment and care as defined
3 herein shall not constitute the payment of compensation under section
4 twenty-five-a of this article. All fees and other charges for such
5 treatment and services shall be limited to such charges as prevail in
6 the same community for similar treatment of injured persons of a like
7 standard of living.
8 The chair shall prepare and establish a schedule for the state, or
9 schedules limited to defined localities, of charges and fees for such
10 medical treatment and care, and including all medical, dental, surgical,
11 optometric or other attendance or treatment, nurse and hospital service,
12 medicine, optometric services, crutches, eye-glasses, false teeth, arti-
13 ficial eyes, orthotics, prosthetic devices, functional assistive and
14 adaptive devices and apparatus in accordance with and to be subject to
15 change pursuant to rules promulgated by the chair. Before preparing such
16 schedule for the state or schedules for limited localities the chair
17 shall request the president of the medical society of the state of New
18 York and the president of the New York state osteopathic medical society
19 to submit to him or her a report on the amount of remuneration deemed by
20 such society to be fair and adequate for the types of medical care to be
21 rendered under this chapter, but consideration shall be given to the
22 view of other interested parties. In the case of physical therapy fees
23 schedules the chair shall request the president of a recognized profes-
24 sional association representing physical therapists in the state of New
25 York to submit to him or her a report on the amount of remuneration
26 deemed by such association to be fair and reasonable for the type of
27 physical therapy services rendered under this chapter, but consideration
28 shall be given to the views of other interested parties. The chair
29 shall also prepare and establish a schedule for the state, or schedules
30 limited to defined localities, of charges and fees for outpatient hospi-
31 tal services not covered under the medical fee schedule previously
32 referred to in this subdivision, to be determined in accordance with and
33 to be subject to change pursuant to rules promulgated by the chair.
34 Before preparing such schedule for the state or schedules for limited
35 localities the chair shall request the president of the hospital associ-
36 ation of New York state to submit to him or her a report on the amount
37 of remuneration deemed by such association to be fair and adequate for
38 the types of hospital outpatient care to be rendered under this chapter,
39 but consideration shall be given to the views of other interested
40 parties. In the case of occupational therapy fees schedules the chair
41 shall request the president of a recognized professional association
42 representing occupational therapists in the state of New York to submit
43 to him or her a report on the amount of remuneration deemed by such
44 association to be fair and reasonable for the type of occupational ther-
45 apy services rendered under this chapter, but consideration shall be
46 given to the views of other interested parties. In the case of massage
47 therapy fee schedules the chair shall request the president of a recog-
48 nized professional association representing licensed massage therapists
49 in the state of New York to submit to him or her a report on the amount
50 of remuneration deemed by such association to be fair and reasonable for
51 the type of occupational therapy services rendered under this chapter,
52 but consideration shall be given to the views of other interested
53 parties. The amounts payable by the employer for such treatment and
54 services shall be the fees and charges established by such schedule.
55 Nothing in this schedule, however, shall prevent voluntary payment of
56 amounts higher or lower than the fees and charges fixed therein, but no
S. 6380 3
1 physician rendering medical treatment or care, and no physical, licensed
2 massage or occupational therapist rendering their respective physical,
3 massage or occupational therapy services may receive payment in any
4 higher amount unless such increased amount has been authorized by the
5 employer, or by decision as provided in section thirteen-g of this arti-
6 cle. Nothing in this section shall be construed as preventing the
7 employment of a duly authorized physician on a salary basis by an
8 authorized compensation medical bureau or laboratory.
9 § 2. Subdivisions 1 and 2 of section 13-g of the workers' compensation
10 law, subdivision 1 as amended by chapter 674 of the laws of 1994 and
11 subdivision 2 as amended by chapter 649 of the laws of 1985, are amended
12 to read as follows:
13 (1) Within forty-five days after a bill has been rendered to the
14 employer by the hospital, physician or self-employed physical, licensed
15 massage or occupational therapist who has rendered treatment pursuant to
16 a referral from the injured employee's authorized physician or author-
17 ized podiatrist for treatment to the injured employee, such employer
18 must pay the bill or notify the hospital, physician or self-employed
19 physical, licensed massage or occupational therapist in writing that the
20 bill is not being paid and explain the reasons for non-payment. In the
21 event that the employer fails to make payment or notify the hospital,
22 physician or self-employed physical, licensed massage or occupational
23 therapist within such forty-five day period that payment is not being
24 made, the hospital, physician, self-employed physical therapist or self-
25 employed licensed massage therapist or self-employed occupational thera-
26 pist may notify the chair in writing that the bill has not been paid and
27 request that the board make an award for payment of such bill. The board
28 or the chair may make an award not in excess of the established fee
29 schedules for any such bill or part thereof which remains unpaid after
30 said forty-five day period or thirty days after all other questions duly
31 and timely raised in accordance with the provisions of this chapter,
32 relating to the employer's liability for the payment of such amount,
33 shall have been finally determined adversely to the employer, whichever
34 is later, in accordance with rules promulgated by the chair, and such
35 award may be collected in like manner as an award of compensation. The
36 chair shall assess the sum of fifty dollars against the employer for
37 each such award made by the board, which sum shall be paid into the
38 state treasury.
39 In the event that the employer has provided an explanation in writing
40 why the bill has not been paid, in part or in full, within the aforesaid
41 time period, and the parties can not agree as to the value of medical
42 aid rendered under this chapter, such value shall be decided by arbi-
43 tration if requested by the hospital, physician or self-employed phys-
44 ical, licensed massage or occupational therapist, in accordance with the
45 provisions of subdivision two or subdivision three of this section, as
46 appropriate, and rules and regulations promulgated by the chair.
47 Where a physician, physical, licensed massage or occupational thera-
48 pist bill has been determined to be due and owing in accordance with the
49 provisions of this section the board shall include in the amount of the
50 award interest of not more than one and one-half per cent (1 1/2%) per
51 month payable to the physician, physical, licensed massage or occupa-
52 tional therapist, in accordance with the rules and regulations promul-
53 gated by the board. Interest shall be calculated from the forty-fifth
54 day after the bill was rendered or from the thirtieth day after all
55 other questions duly and timely raised in accordance with the provisions
56 of this chapter, relating to the employer's liability for the payment of
S. 6380 4
1 such amount, shall have been finally determined adversely to the employ-
2 er, whichever is later, in accordance with rules promulgated by the
3 chair.
4 (2) If the parties fail to agree as to the value of medical aid
5 rendered under this chapter, such value shall be decided by an arbi-
6 tration committee consisting of one physician designated by the presi-
7 dent of the medical society of the county in which the medical services
8 were rendered, one physician who is a member of the medical society of
9 the state of New York, appointed by the employer or carrier, and one
10 physician, also a member of the medical society of the state of New
11 York, appointed by the [chairman] chair of the workers' compensation
12 board. The majority decision of any such committee shall be conclusive
13 upon the parties as to the value of the services rendered. If the physi-
14 cian whose charges are being arbitrated is a member in good standing of
15 the New York osteopathic society or the New York homeopathic society,
16 the members of such arbitration committee shall be physicians of such
17 organization, one to be appointed by the president of that organization,
18 one by the employer or carrier and the third by the [chairman] chair of
19 the workers' compensation board. Where the value of physical therapy
20 services is at issue the arbitration committee shall consist of a member
21 in good standing of a recognized professional association representing
22 physical therapists in the state of New York appointed by the president
23 of such organization, a physician designated by the employer or carrier
24 and a physician designated by the [chairman] chair of the workers'
25 compensation board provided however, that the [chairman] chair finds
26 that there are a sufficient number of physical therapy arbitrations in a
27 geographical area comprised of one or more counties to warrant a commit-
28 tee so comprised. In all other cases where the value of physical therapy
29 services is at issue, the arbitration committee shall be similarly
30 selected and identical in composition, provided that the physical thera-
31 pist member shall serve without remuneration, and provided further that
32 in the event a physical therapist is not available, the committee shall
33 be comprised of three physicians designated in the same manner as in
34 cases where the value of medical aid is at issue.
35 Where the value of occupational therapy services is at issue the arbi-
36 tration committee shall consist of a member in good standing of a recog-
37 nized professional association representing occupational therapists in
38 the state of New York appointed by the president of such organization; a
39 physician designated by the employer or carrier and a physician desig-
40 nated by the [chairman] chair of the workers' compensation board
41 provided, however, that the [chairman] chair finds that there are a
42 sufficient number of occupational therapy arbitrations in a geographical
43 area comprised of one or more counties to warrant a committee so
44 comprised. In all other cases where the value of occupational therapy
45 services is at issue, the arbitration committee shall be similarly
46 selected and identical in composition, provided that the occupational
47 therapist member shall serve without remuneration, and provided further
48 that in the event an occupational therapist is not available, the
49 committee shall be comprised of three physicians designated in the same
50 manner as in cases where the value of medical aid is at issue.
51 § 3. This act shall take effect immediately.
