Live Outside of New York? The Medical Treatment Guidelines Still Apply
In a recent Board Panel Decision, In the Matter of Hospice Inc., 2017 NY Wrk Comp 59513410, the Board found that the Medical Treatment Guidelines apply to any treatment provided to any claimant, regardless of where the claimant lives or where the treatment is provided, for treatment to the neck, mid and low back, shoulder, knee, carpal tunnel, and non-acute pain. Notably, the Board held that the applicability of the Medical Treatment Guidelines is not limited to treatment rendered to New York State residents or to treatment rendered in New York. If a claimant moves out of state and is no longer a New York resident, the claimant may seek treatment for a causally related injury from a physician located in the claimant’s area. Prior to this Board Panel Decision, this out-of-state treatment was exempt from the application of the restrictive Medical Treatment Guidelines leading to excessive and unnecessarily costly treatment.
As described In the Matter of Hospice Inc., the Medical Treatment Guidelines provide an evidence-based medical standard for appropriate medical care. The standards for treatment contained in the Medical Treatment Guidelines ensure that claimants receive the most effective medical care as recommended by best practices in the medical community, and as adopted by the Board in consultation with medical specialists. The Board explained that such recommended treatment and care should be rendered without regard to the location of the claimant’s home or the medical provider’s practice. As such, this decision allows employers and carrier to challenge out of state treatment in excess or outside of the Medical Treatment Guidelines.