Simplifies the procedure by which injured workers obtain treatment for injuries covered by the workers' compensation law; provides that the list of pre-authorized procedures is to be used only as a list of treatment that does not require insurance carrier approval.
STATE OF NEW YORK
________________________________________________________________________
6205
2025-2026 Regular Sessions
IN ASSEMBLY
February 27, 2025
___________
Introduced by M. of A. DURSO -- read once and referred to the Committee
on Labor
AN ACT to amend the workers' compensation law, in relation to simplify-
ing the procedure by which injured workers obtain treatment for inju-
ries covered by the workers' compensation law
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. Subdivision 5 of section 13-a of the workers' compensation
2 law, as amended by section 8 of part CC of chapter 55 of the laws of
3 2019, is amended to read as 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 one thousand
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 board. The
15 board, with the approval of the superintendent of financial services,
16 shall issue and maintain a list of pre-authorized procedures under this
17 section. Such list of pre-authorized procedures shall be issued and
18 maintained solely for the purpose of expediting authorization of treat-
19 ment of injured workers. Such list of pre-authorized procedures shall
20 not prohibit varied treatment [when the treating provider demonstrates
21 the appropriateness and medical necessity of such treatment], nor shall
22 the list be used as a basis to deny treatment not contained therein.
23 Requests for varied treatment need only comply with the provisions of
24 this subdivision.
25 § 2. This act shall take effect immediately.
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD01207-01-5
