Medical Treatment Guidelines

As of December 1, 2010, the New York State Workers’ Compensation Board has implemented new Medical Treatment Guidelines for all injuries to all body parts.

• Under the new Guidelines, treatment is required every 90 days.
• These new Guidelines also prescribe detailed courses of treatment for theses injury sites, and if the physician follows these Guidelines, then there is no pre-authorization for treatment needed from the insurance company.
  1. The only exception to this is for twelve specified major surgical interventions or for a repeat surgery.
  2. All other procedures and tests contained in the Guidelines are deemed authorized.
  3. Should the physician want to pursue treatment not contained in the Guidelines, the physician must file a PAR request through the Workers’ Compensation Board portal.
• The PAR form places strict deadlines on the time the insurance company has to respond to the request.  There is a three step process for authorization.  If a carrier denies at level one or two the Workers’ Compensation Board will make a final determination at level three.
• The Workers’ Compensation Board has a staff dedicated to help in this process.  They can be reached by calling: 800-781-2362.

For more information about the Medical Treatment Guidelines, or to read them in their entirety, go to http://www.wcb.state.ny.us/content/main/hcpp/MedicalTreatmentGuidelines/FAQs.jsp

2007 Workers’ Compensation Reform Legislation

As of 7/1/07, the Workers’ Compensation system and law has undergone a radical change. The good news is that the maximum rates will increase incrementally over the years to come. The bad news is that certain cases will now have caps on the years an injured worker can collect weekly checks. This web site has some general information on the law changes, but to fully advise any injured worker requires a professional consultation on the phone or in person. Call us for answers.

Capped Benefits
Cases where a worker has been legally classified as permanent partially disabled have caps on benefits. This requires immediate analysis of your case to maximize its potential.

Mandatory Settlement Offer
In certain cases, insurance carriers will be required to make a “good faith settlement offer” on a required date. You need to contact us immediately to best evaluate settlement possibilities.
If you are classified with a permanent partial disability after 7/1/07, surgery or a significant change/deterioration in your condition may reset/hold yearly benefit caps previously imposed.

PROPOSED NEW COMP LAWS:

RATE CHANGES
EFFECTIVE DATE …..WAGE BASE……..MAX………….MIN
7/1/07………………………….. 750…………..500…………..100
7/1/08………………………….. 825…………..550…………..100
7/1/09………………………….. 900…………..600…………..100
7/1/10…………………….1,109.75………739.83………….100
7/1/11…………………….1,159.44………772.96………….100
7/1/12…………………….1,188.10………792.07………….100
5/1/13…………………….1,188.10………792.07………….150
7/1/13…………………….1,204.81………803.21………….150
7/1/14…………………….1,212.98………808.65………….150
7/1/15…………………….1,266.44………844.29………….150
7/1/16…………………….1,296.48………864.32………….150
7/1/17…………………….1,305.92………870.61………….150
7/1/18…………………….1,357.11………904.74………….150
7/1/19…………………….1,401.17………934.11………….150
7/1/20…………………….1,450.17………966.78………….150
7/1/21…………………….1,594.57……1,063.05………….150
7/1/22…………………….1,688.19……1,125.46………….150
7/1/23……………………………………..2/3 AWW NYS

EFFECTIVE DATE 7/1/07 PPD CAP ON WEEKS OF BENEFITS
% LOSS OF EARNING CAPACITY………….MAX WEEKS
96-99%………………………………………………..525
91-95%………………………………………………..500
86-90%………………………………………………..475
81-85%………………………………………………..450
76-80%………………………………………………..425
71-75%………………………………………………..400
61-70%………………………………………………..375
51-60%………………………………………………..350
41-50%………………………………………………..300
31-40%………………………………………………..275
16-30%………………………………………………..250
0-15%………………………………………………….225