Commentary by Christopher Stringham, Esq.
On December 1, 2010, the NYS Workers’ Compensation Board instituted Medical Treatment Guidelines for the neck, back, shoulders, and knees. The intent of the treatment guidelines was to have all parties (doctors, attorneys, insurance carriers, and injured workers, etc.) be on the same page when it came to treatment parameters, and to make the treatment authorization process both streamlined and more efficient.
Initially, as all the interested parties became familiar with the treatment guidelines and all of the required forms, a large number of disputes arose as the guidelines only seemed to address new, acute injuries, along with the necessary immediate treatment rendered to one of the covered body sites. There was no way to address ongoing and palliative care for injured workers who required pain management, either from ongoing therapies (i.e. chiropractic, physical therapy, acupuncture, etc.) or from the prolonged use of medications.
The practical effect of the guidelines was that injured workers who had been dependent on this palliative care had their medical treatment cut off due to the new requirements that placed the burden of proof on doctors to show that the ongoing treatment was effectively making their patient “better” and not just alleviating pain. This same set of circumstances arises with newly injured workers who exhaust the care that is prescribed by the guidelines, but who still require some treatment to address ongoing, or even permanent, pain issues.
In order to request the review of a treatment denial, injured workers must ask for review by a Law Judge. This is done by checking the appropriate box on the form MG-2, the same form that the treating doctor used to make the variance request. (The form can be found here)
As of today, the Medical Treatment Guidelines that became mandatory in late 2010 are still in effect and are still being utilized to bring an end to ongoing treatment. However, the Workers’ Compensation Board has recently (March 2013) revised the guidelines so that an ongoing maintenance care program (10 Chiropractic/Physical Therapy treatments per year) will be authorized for those injured workers who have both reached maximum medical improvement and been classified with a permanent disability. The Board is also working to institute chronic pain guidelines.
The Medical Treatment Guidelines were not a positive addition to the Workers’ Compensation system from the perspective of the injured worker. They have been used as the basis to deny an untold number of treatment requests from treating physicians and made it much more difficult for injured workers with serious injuries and the desperate need for chronic pain management to get the treatment that they require. However, I am hopeful that the Board’s review of the last three years and its intent to institute chronic care guidelines will lead to a rebalancing of the way in which treatment is rendered to injured workers in the future.