N.Y. Insurance Law § 4913: Conflict of interest

§ 4913. Conflict of interest. (a) No external appeal agent or officer,

director, or management employee thereof; or clinical peer reviewer

employed or engaged thereby to conduct any external appeal pursuant to

this title, shall have any material professional affiliation, material

familial affiliation, material financial affiliation, or other

affiliation prescribed pursuant to regulation, with any of the

following:

(1) the health care plan;

(2) any officer, director, or management employee of the health care

plan;

(3) any health care provider, physician's medical group, independent

practice association, or provider of pharmaceutical products or services

or durable medical equipment, proposing to provide or supply the health

service;

(4) the facility at which the health service would be provided;

(5) the developer or manufacturer of the principal health service

which is the subject of the appeal; or

(6) the insured whose health care service is the subject of the

appeal, or the insured's designee.

(b) Notwithstanding subsection (a) of this section, the superintendent

shall promulgate regulations to minimize any conflict of interest where

such conflict may be unavoidable.