New York: WC board publishes proposed treatment regs

The New York State Workers' Compensation Board published proposed regulations that would make the state's revised medical treatment guidelines mandatory for providers, employers, and insurance carriers in the workers' comp system.

The guidelines, which were a significant component of the 2007 legislative reforms, cover the treatment of workplace injuries involving the knee, shoulder, neck and back. They were initially formulated by the governor's Workers' Compensation Reform Task Force and its advisory committee, which included medical professionals appointed by business, labor, and the New York State Insurance Department. Over the past year, the board's medical director and staff have reviewed and updated all four protocols in light of public comments and recent developments in medical literature.

Robert Beloten, chairman of the NYSWCB, said the goal of the guidelines is to improve the quality of medical care, speed the delivery of medical treatment to injured workers, reduce litigation and friction costs, and eliminate unnecessary and potentially harmful treatment. Guidelines, the board noted, have reduced medical costs in other state workers' comp systems by reducing ineffective or unnecessary medical care and improving the quality of care provided to injured workers.

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"It is my strong belief that the guidelines will improve both the quality and timeliness of the medical care provided to injured workers while at the same time reducing system costs," he said.

The guidelines set forth the recommended standard of care for treatment of workplace injuries based on established medical evidence and the consensus of experienced medical professionals. Most diagnostic testing and medical treatment within the guidelines are deemed pre-authorized if performed in accordance with the regulations and therefore not subject to prior authorization by the employer or insurance carrier. Certain recommended treatments, including several complex surgical procedures, do require prior authorization from the carrier or employer.

The board will offer Web-based training on the guidelines for medical professionals, attorneys, medical office staff, and claims staff and adjusters, starting in September.

Read more at the WorkersComp Forum homepage.

August 23, 2010

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