325.958 Physician of Choice in Workers’ Compensation Cases
The Medical Society of the State of New York (MSSNY) will seek a change to Section 13-b of the New York State Workers’ Compensation Law to allow an employee with a Workers’ Compensation related illness or injury, who is requesting a second opinion and/or medically necessary services, the right to obtain an independent evaluation and/or treatment from a physician who does not participate or accept Workers’ Compensation, provided that the patient understands and acknowledges that he/she will not seek reimbursement from the Workers’ Compensation program, or other health insurance plans they may have, and that such understanding between patient and physician is documented appropriately.
The Medical Society of the State of New York (MSSNY) will seek an additional change to the Workers’ Compensation Law to allow a Workers’ Compensation claimant to sign an approved document, such as an Advanced Beneficiary Notification (ABN), which clearly explains that the physician providing the second medical opinion and/or medically necessary services is not a Workers’ Compensation authorized physician, and that the patient has agreed to pay the physician directly, without the expectation of reimbursement or the filing of a Workers’ Compensation or other health insurance claim related to the care provided, and that a physician who evaluates a patient under such an arrangement may not be reported to OPMC for alleged violation of state law and that the recommendation generated from this opinion may not be used in a Workers’ Compensation proceeding. (HOD 2012-266, referred, amended, adopted by Council 1/30/2014; Reaffirmed HOD 2024)
