Section 13-A. Selection of authorized physician by employee  


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  • (1) 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.  In  such  instance  the
      remuneration  of  the  physician whose services are being dispensed with
      shall be  limited  to  the  value  of  treatment  rendered  at  fees  as
      established  in  the schedule for his or her location, unless payment in
      higher amounts has been approved  as  authorized  in  section  thirteen,
      paragraph  a.  If  a claimant shall receive treatment in any hospital or
      other institution operated in whole or in part by the state of New York,
      the  employer  shall  be  liable  for  food,  clothing  and  maintenance
      furnished  by the hospital or other institution to such employee. If the
      employee is unable due to the  nature  of  the  injury  to  select  such
      authorized  physician  and  the  emergency nature of the injury requires
      immediate medical treatment and care, or if he or she does not desire to
      select a physician, and in writing so advises the employer, the employer
      shall promptly provide him or  her  with  the  necessary  medical  care,
      provided however, that nothing herein contained shall operate to prevent
      such  employee,  when  subsequently  able  to  do so, from selecting for
      continuance of any medical treatment or  care  required,  any  physician
      authorized by the chair to render medical care as hereinafter provided.
        (2)  The  chairman  shall  prescribe  the  form  of a notice informing
      employees of their privilege under this chapter, and such  notice  shall
      be  posted  and  maintained  by  the  employer in a conspicuous place or
      places in and about his place or places of business.
        (3) The employer shall have the right  to  transfer  the  care  of  an
      injured employee from the attending physician, whether chosen originally
      by  the employee or by the employer, to another authorized physician (1)
      if the interest of the injured employee necessitates the transfer or (2)
      if the physician has not been  authorized  to  treat  injured  employees
      under  this  act  or (3) if he has not been authorized under this act to
      treat  the  particular  injury  or  condition  as  provided  by  section
      thirteen-b  (2).  An  authorized  physician  from whom the case has been
      transferred shall have the right of appeal to an  arbitration  committee
      as  provided  in  subdivision  two  of  section  thirteen-g  and if said
      arbitration committee finds that the transfer was not authorized by this
      section, said employer shall pay to the physician a  sum  equal  to  the
      total  fee  earned  by  the  physician  to  whom the care of the injured
      employee has been transferred, or such proportion of  said  fee  as  the
      arbitration committee shall deem adequate.
        (4)  (a) No claim for medical or surgical treatment shall be valid and
      enforceable, as  against  such  employer,  or  employee,  unless  within
      forty-eight  hours  following  the  first treatment the physician giving
      such treatment furnishes to the employer and directly  to  the  chair  a
      preliminary  notice  of  such  injury and treatment, within fifteen days
      thereafter a  more  complete  report  and  subsequent  thereto  progress
      reports  if  requested  in  writing  by  the  chair,  board, employer or
      insurance carrier at intervals of not less than three weeks apart or  at
      less  frequent  intervals if requested on forms prescribed by the chair.
      The board may excuse failure to give such notices within the  designated
      periods when it finds it to be in the interest of justice to do so.
        (b)  Upon  receipt of the notice provided for by paragraph (a) of this
      subdivision, the employer, the carrier, and the claimant each  shall  be
      entitled  to have the claimant examined by a physician authorized by the
      chair  in  accordance  with  sections   thirteen-b   and   one   hundred
    
      thirty-seven  of  this  chapter, at a medical facility convenient to the
      claimant and in the presence of the claimant's physician, and refusal by
      the claimant to submit to such independent medical examination  at  such
      time  or  times  as  may  reasonably  be necessary in the opinion of the
      board, shall bar the  claimant  from  recovering  compensation  for  any
      period during which he or she has refused to submit to such examination.
      No  hospital  shall  be  required to produce the records of any claimant
      without receiving its customary fees or charges for reproduction of such
      records.
        (c) Where it would place an unreasonable burden upon the  employer  or
      carrier  to  arrange  for, or for the claimant to attend, an independent
      medical examination by an authorized physician, the employer or  carrier
      shall  arrange  for  such  examination  to  be  performed by a qualified
      physician in a medical facility convenient to the claimant.
        (d) The independent medical examiner shall provide  such  reports  and
      shall submit to investigation as required by the chair.
        (e)  In  order to qualify as admissible medical evidence, for purposes
      of adjudicating any claim under this chapter, any  report  submitted  to
      the  board  by  an independent medical examiner licensed by the state of
      New York shall include the following:
        (i) a signed statement certifying  that  the  report  is  a  full  and
      truthful   representation   of   the   independent   medical  examiner's
      professional opinion with respect to the claimant's condition:
        (ii) such examiner's board issued authorization number;
        (iii) the name of the individual or entity requesting the examination;
        (iv) if applicable, the registration number  as  required  by  section
      thirteen-n of this article; and
        (v) such other information as the chair may require by regulation.
        Any  report  by an independent medical examiner who is not authorized,
      and who performs an independent medical examination in  accordance  with
      paragraph  (c)  of  this  subdivision,  which  is  to be used as medical
      evidence  under  this  chapter,  shall  include  in  the   report   such
      information as the chair may require by regulation.
        (5)  No  claim  for  specialist  consultations,  surgical  operations,
      physiotherapeutic or occupational therapy procedures, x-ray examinations
      or special diagnostic laboratory tests costing more  than  one  thousand
      dollars shall be valid and enforceable, as against such employer, unless
      such  special  services shall have been authorized by the employer or by
      the board, or unless such authorization has been unreasonably  withheld,
      or  withheld for a period of more than thirty calendar days from receipt
      of a request for authorization, or  unless  such  special  services  are
      required in an emergency, provided, however, that the basis for a denial
      of  such  authorization  by  the employer must be based on a conflicting
      second opinion rendered by a physician  authorized  by  the  board.  The
      board, with the approval of the superintendent of insurance, shall issue
      and maintain a list of pre-authorized procedures under this section.
        (6)  Any  interference  by any person with the selection by an injured
      employee of an authorized  physician  to  treat  him,  except  when  the
      selection  is  made  pursuant  to article ten-A of this chapter, and the
      improper influencing or attempt by any person  improperly  to  influence
      the  medical  opinion  of  any  physician who has treated or examined an
      injured employee, shall be a misdemeanor;  provided,  however,  that  it
      shall  not  constitute  interference  or  improper  influence if, in the
      presence of such injured employee's physician, an employer, his  carrier
      or   agent   should   recommend   or   provide   information  concerning
      rehabilitation services  or  the  availability  thereof  to  an  injured
      employee or his family.
    
        (7)(a)  Notwithstanding  any  other  provision  of this chapter to the
      contrary, any insurance carrier authorized to transact the  business  of
      workers' compensation insurance in this state, self-insurer or the state
      insurance  fund  may  contract  with  a network or networks, legally and
      properly  organized,  to  perform  diagnostic tests, x-ray examinations,
      magnetic resonance imaging, or other radiological examinations or  tests
      of  claimants  and  may  require  claimant  to  obtain  or  undergo such
      diagnostic test, x-ray examinations, magnetic resonance imaging or other
      radiological examinations or tests with a provider or at a facility that
      is affiliated with the  network  or  networks  with  which  the  carrier
      contracts,  except  if a medical emergency occurs requiring an immediate
      diagnostic test, x-ray examination, magnetic resonance imaging or  other
      radiological  examination  or  test  or  if  the  network with which the
      insurance carrier, self-insurer or the state  insurance  fund  contracts
      does  not have a provider or facility able to perform the examination or
      test within a reasonable distance from the claimant's residence or place
      of employment, as defined by regulation of the board.
        (b) Any insurance carrier, self-insurer or the  state  insurance  fund
      which  requires  claimants  to obtain or undergo diagnostic tests, x-ray
      examinations,  magnetic  resonance   imaging   or   other   radiological
      examinations or tests with a provider or at a facility affiliated with a
      network or networks with which it contracts, must notify the claimant of
      the name and contact information for the network or networks at the same
      time  the  written  statement  of  the  claimant's rights as required by
      subdivision  two  of  section  one  hundred  ten  of  this  chapter   or
      immediately  after  imposing  such requirement if the time period within
      which the written statement of the  claimant's  rights  as  required  by
      subdivision two of section one hundred ten of this chapter has expired.
        (c)  At  the  time  a request for authorization for special diagnostic
      tests,  x-ray  examinations,  magnetic  resonance   imaging   or   other
      radiological  examinations  or  tests  costing  more  than  one thousand
      dollars as required by subdivision five of this section is approved, the
      insurance carrier, self-insurer  or  state  insurance  fund,  or  if  so
      delegated  the network with which the insurance carrier, self-insurer or
      state  insurance  fund  has  contracted,  shall  notify  the   physician
      requesting  authorization of the requirement that the claimant obtain or
      undergo  the  special  diagnostic  test,  x-ray  examination,   magnetic
      resonance  imaging  or  other  radiological  examination  or test with a
      provider or at a facility affiliated with the network or  networks  with
      which  it  has contracted, the contact information for the network and a
      list of the providers and facilities within  the  claimant's  geographic
      location,  as  defined  by  regulation  of  the  board. The claimant, in
      consultation with the provider  who  requested  the  special  diagnostic
      test,   x-ray   examination,   magnetic   resonance   imaging  or  other
      radiological test or exam, will determine the provider or facility  from
      within  the  network  which  will  perform  such  diagnostic test, x-ray
      examination,  magnetic   resonance   imaging   or   other   radiological
      examination or test.
        (d)  The  results  of  the special diagnostic test, x-ray examination,
      magnetic resonance imaging or other radiological test or  exam  must  be
      sent  to  the  physician who requested the test or exam immediately upon
      completion of the report detailing the results.