Important Changes in Workers’ Compensation Law

Medical Treatment Guidelines

As of December 1, 2010, the New York State Workers’ Compensation Board has implemented new Medical Treatment Guidelines for injuries to the Back, Neck, Shoulder, Knee and Carpal Tunnel Syndrome.

  • Under the new Guidelines, treatment is required every 90 days as opposed to every 45 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 request a variance using the prescribed MG-2 form and submit a copy to both the insurance carrier and Workers’ Compensation Board.
  • The MG-2 form places strict deadlines on the time the insurance company has to respond to the request, and if they do not meet the deadlines, the physician’s request is approved and the insurance company must pay.
  • Once the MG-2 is submitted, the insurance company has five days to set up an independent medical exam that must take place withing 30 days of the variance request, or if the insurance company does not want an independent exam, it has 15 days to authorize or deny the variance request.

Injuries to body parts other than the Back, Neck, Shoulder, Knee or Carpal Tunnel Syndrome are not addressed in the new Guidelines, and treatment falls under previously established Workers’ Compensation regulations (i.e. authorization for any treatment over $1,000 needs insurance company authorization).

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……………………………………..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