Subject Numbers Regarding Health Provider Authorizations

Authorization No. 224593-4I

July 29, 2013

Pursuant to Workers' Compensation Law Section 13-d(5), the Chair of the New York State Workers' Compensation Board has exercised his authority to revoke Dr. Payman Simoni's authorization to perform independent medical examinations in the New York State workers' compensation system effective close of business June 30, 2013. Dr. Simoni's last known business address is 50 N. La Cienega Boulevard, Suite 150, Beverly Hills, California 90211.

The Workers' Compensation Board has determined that Dr. Simoni's board certification from the American Board of Otolaryngology expired on June 30, 2013.

Dr. Simoni is prohibited from performing independent medical examinations of injured workers. Reports submitted by Dr. Simoni for independent medical examinations performed prior to July 1, 2013, are valid, but are invalid for any independent medical examinations performed on or after that date. Requests to cross-examine Dr. Simoni for independent medical examinations performed prior to July 1, 2013, should not be denied due to the revocation of his authorization.

Any questions regarding the authorized lists should be referred to the Medical Director's Office at 1 (800) 781-2362.