NY Allows Employer to Utilize a Preferred Provider Organization (PPO) for the First 30 Days of Treatment

In NY either the carrier or self-insured employer may contract with a PPO and care is limited to the PPO for treatment within the first 30 days.

The employer cannot create the panel but it can choose a PPO with which it contracts if it is self-insured or obtain insurance from a carrier which has a contract with a PPO.

Pursuant to 12 NYCRR § 325-8.2(a), the employer must notify its employees in writing “of the preferred provider organization arrangement for the treatment of all workers’ compensation injuries and illnesses. Such written notice shall also advise potential claimants that they may obtain more detailed informational materials regarding the preferred provider organization from the employer.”  <em>See </em><span style="text-decoration: underline;">Headway Corporate Staffing,</span> 2002 NY Wrk. Comp. 9926360, 2002 NY Wrk. Comp. LEXIS 96994 (10/23/2002).  “In addition, the record is completely devoid of any evidence regarding whether the employer properly provided the claimant with written notice that she was covered by a PPO prior to her accident.” The regulation does not specifically state when the notice should be provided but it seems that one could infer from the language requiring that notice be given to all employees that it is disassociated from the occurrence of an accident and therefore should be provided before an injury.

Also, proof of the notice should be retained to challenge treatment obtained outside the network.  A link to the active PPOs can be found <a href="https://thelomad.com/getmad.today/wp-contentwww.wcb.ny.gov/content/main/hcpp/PrefProviderOrg/ActivePPOList.pdf" target="_blank" rel="noopener">here</a>.