This is the video from our August 20, 2018 live webinar. Attorney Greg Lois discusses treatment under the Medical Treatment Guidelines in New York worker’s compensation cases.
- What to do about variance requests.
- How to dispute unnecessary treatment.
- The recent (May, 2017) Board Panel decision finding MTG’s DO apply to out of state medical providers.
- Non-Acute Pain Management Guidelines.
Subject: New York, Workers’ Compensation Law, benefits, Medical Treatment Guidelines
Date Presented: August 21, 2017
Presenter(s): Jeremy Janis and Greg Lois
Run time: 24:35
Continue reading Video: Medical Treatment Guidelines and Opioid Management in New York
In a Board Panel Decision dated May 24, 2017, the Board found that the Medical Treatment Guidelines apply to the out of state treatment of a claimant residing outside of New York State. The decision in In Re Hospice is important because it reverses the Board’s previous statements that out-of-state treatment was immune from the application of the restrictive Medical Treatment Guidelines (“MTG”). This meant that New York claimants merely had to “cross the river” into New Jersey or any other state and obtain medical treatment and medications which far exceeded the treatment or medications allowed under the Medical Treatment Guidelines, needlessly increasing the costs in their cases. Now employers and carriers have a Board Panel decision supporting the argument that law judges should apply the MTG’s to out of state cases. Continue reading Medical Treatment Guidelines Apply to Out of State Claimants
Opioids is one of the hottest topics in the workers’ compensation arena. As a result of the epidemic across the country, the New York Workers’ Compensation Board has implemented new procedures to address opioids. You can locate our recent articles about opioid abuse, requesting a weaning program with the assistance of the Non-Acute Pain Medical Treatment Guidelines, and the recent Board Bulletin released by the Workers’ Compensation Board that reiterates a growing need to stop the proliferation of long-term opioid use. Continue reading Emergency Room Opioids?
Recognizing that opioid addiction is a major public health crisis, the New York Workers’ Compensation Board today announced a new hearing process to address opioid weaning issues. In 2014, the Board implemented the “Non-Acute Pain Medical Treatment Guidelines” (“MTG”) to address opioid usage in workers’ compensation claims.
As the “Non-Acute Pain Medical Treatment Guildeines” makes clear, long-term opioid use is only recommended in limited circumstances, and must involve constant clinical monitoring and re-evaluation. The guidelines also includes best practices for safely weaning injured workers from opioids and other narcotics.
Requesting a Hearing
Under the new process, the insurance carrier or self-insured employer can now request a hearing to address whether the claimant should be weaned from opioids. In order to request the hearing, the Board requires an IME report or Records Review, “which indicates weaning goals and recommended weaning program or resource” be submitted with the RFA-2.
Continue reading New York Workers’ Compensation Board Announces New Hearing Process for Opioid Weaning Issues
Timeline of the “Typical” case: Admitted Traumatic Accident with Lost Time.
- Initial investigation to confirm loss.
- If there is medical and lost time, begin benefits.
- File FROI-00 (Electronic Data Interchange, “EDI”).
- File update EDI documents as the case progresses.
The Board’s initiative to enforce EDI (“eClaims”).
Beginning in 2013, the Board has begun an increased tempo of “monitoring and compliance” initiatives intended to enforce the eClaims guidelines and generate more penalty income for the State. The Board has now established a “Compliance Unit” intended to do the following:
- monitor performance standards for timely submission of First Report of Injury,
- confirm timely first payment of indemnity benefits,
- check for timely submission of Subsequent Report of Injury showing first payment,
- monitor timely submission of Controversy; and
- track the Percentage of Claims Controverted (how many cases is the carrier denying?).