Establishes criteria for medical examinations to determine disability status; specifies an applicant's treating health care practitioner's opinion shall be generally controlling.
STATE OF NEW YORK
________________________________________________________________________
6356
2019-2020 Regular Sessions
IN ASSEMBLY
March 6, 2019
___________
Introduced by M. of A. REYES -- read once and referred to the Committee
on Governmental Employees
AN ACT to amend the retirement and social security law, in relation to
criteria for medical examinations to determine disability status
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. The retirement and social security law is amended by adding
2 a new section 65 to read as follows:
3 § 65. Criteria for medical examinations. a. In instances where an
4 applicant for disability benefits under this title is given a medical
5 examination, the health care practitioner who performs such examination
6 of the applicant shall:
7 1. review and consider all records or information provided by the
8 applicant or his or her treating health care practitioner that are
9 pertinent to the claimed medical condition;
10 2. make a specific diagnosis as evidenced by medically appropriate
11 tests or evaluations in determination of the applicant's claimed condi-
12 tion;
13 3. render to the applicant and the comptroller, an opinion, particu-
14 larizing the presence or absence of the alleged condition;
15 4. in the event that he or she identifies a condition, other than the
16 alleged condition, that may interfere with the individual's ability to
17 fully engage in work activities, the practitioner shall report such
18 condition; and
19 5. determine whether the individual is:
20 (a) disabled and eligible for benefits under this title; or
21 (b) neither disabled nor work limited.
22 b. If the practitioner to whom the applicant is referred issues an
23 opinion that differs from the applicant's treating health care practi-
24 tioner, the practitioner shall provide a written determination that
25 specifies why the practitioner disagrees with the applicant's treating
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD08883-01-9
A. 6356 2
1 health care practitioner's disability determination and present evidence
2 that supports the opinion.
3 c. In the event the practitioner to whom the applicant is referred
4 issues an opinion that differs from the applicant's treating health care
5 practitioner's opinion, the applicant's treating health care practition-
6 er's opinion shall be generally controlling, subject to, but not limited
7 to, the following factors:
8 1. the length and frequency of the treatment provided;
9 2. consistency of the opinion with the record as a whole;
10 3. the degree to which the opinion is supported by concrete evidence;
11 and
12 4. such practitioner's specialty.
13 § 2. This act shall take effect on the ninetieth day after it shall
14 have become a law.
