S 304: 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.
The proposed law aims to simplify the procedure for injured workers to obtain treatment for injuries covered by the workers' compensation law. The law will limit claims for certain medical services, such as specialist consultations, surgical operations, and diagnostic tests, to only those that have been authorized by the employer or the board. Authorization can be withheld for a period of 30 calendar days or for a conflicting second opinion, but only if the basis for denial is based on a legitimate medical reason. A list of pre-authorized procedures will be maintained by the board to expedite treatment authorization. This list will not restrict varied treatment if the treating provider demonstrates its medical necessity, and it will not be used to deny treatment not contained in the list. The law will take effect immediately.
| Jan. 07, 2026 | REFERRED TO LABOR |
| Apr. 08, 2025 | REPORTED AND COMMITTED TO FINANCE |
| Jan. 08, 2025 | REFERRED TO LABOR |
STATE OF NEW YORK ________________________________________________________________________ 304 2025-2026 Regular Sessions IN SENATE (Prefiled) January 8, 2025 ___________ Introduced by Sen. RHOADS -- read twice and ordered printed, and when printed to be committed 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 demonstrates21the 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