The Medical Treatment Guidelines (MTG’s) are a set of treatment guidelines issued by the New York State Workers’ Compensation Board (WCB) that became effective in December 2010. There are separate guidelines that cover the Neck, Mid and Low Back, Shoulder, Knee, Carpal Tunnel Syndrome and Non-Acute/Chronic Pain.
The purported reason that the WCB issued the guidelines was to streamline treatment in the NYS Workers’ Compensation system by making certain treatments automatically authorized if they are found in the guidelines. For example, an injured worker is entitled to chiropractic care for the mid/low back up to 3 times per week for a maximum duration of 3 months. This means that the insurance carrier will be required to pay for chiropractic care for that set frequency and duration once an injured worker begins chiropractic treatment.
Once the maximum treatment allowed under the MTG’s has been reached, the injured worker’s medical provider must request additional treatment by way of a variance request. The medical provider must list the reasons why additional treatment that varies from the guidelines is warranted. This is called the burden of proof, and is outlined in the rules and regulations that govern NYS Workers’ Compensation Law.
The variance request, also known as an MG-2 (the name of the form), is sent to the insurance carrier who then has 15 days in most circumstances to grant or deny the variance request. If the request is granted, the insurance carrier will send the form back indicating as such and the injured worker can schedule the treatment. If the variance is denied, the injured worker has 21 business days to request a hearing to have a Workers’ Compensation Law Judge review the denial.
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