N.Y. Comp. Codes R. & Regs. Tit. 12 §§ 325-8.5

Current through Register Vol. 46, No. 50, December 11, 2024

Section 325-8.5 - Improper influence or involvement in medical treatment

(a) No person, including but not limited to the employer, insurer, carrier, self-insured employer or any of their agents shall interfere with the selection by an injured employee of an authorized physician for treatment except as authorized by article 10-A, section 354 of the Workers' Compensation Law nor shall any insurer, carrier or self-insured employer improperly influence or attempt to improperly influence the medical opinion of any physician who has treated or examined an injured employee within the meaning of section 13-a (6) of the Workers' Compensation Law.

(b) No insurer, carrier or self-insured employer shall participate in the treatment of an injured employee within the meaning of section 13-j (1) of the Workers' Compensation Law.

(c) All functional activities which are subcontracted by a PPO through a management contract arrangement in accordance with section 732-2.5(b) of Title 10 NYCRR, including case management services, as defined by the parties to the management contract, shall conform to the provisions of section 13-a (6) and 13-j (1) of the Workers' Compensation Law. Copies of all management contracts shall be provided to the chair as well as the Commissioner of Health for compliance purposes. Where necessary, the chair or the Commissioner of Health shall seek additional information from insurers, carriers and self-insured employers who enter into such arrangements with PPOs to ensure compliance with this Part.

N.Y. Comp. Codes R. & Regs. Tit. 12 §§ 325-8.5