WCB Announces Proposals to Improve Medical Care for Injured Workers (At the Cost of Everyone Else?)

Last month, the New York State Workers’ Compensation Board (WCB) announced various proposals to improve medical care for injured workers (Subject Number 046-1058). While these proposals appear to be reasonable improvements for injured workers, if approved, they will come at an increased cost for employers, insurance carriers, and third-party administrators. This cost will not only be felt financially, but also in the ability to defend claims.

First, the financial cost is easily seen and will be felt by the WCB’s proposal to increase medical fees for all medical providers. Specifically, the WCB will be advancing a regulatory proposal in June 2018 to raise provider fees; this will be effective for services provided on or after October 1, 2018. The proposal will include an overall statewide fee increase for all provider types, with additional increases for certain specialty provider groups that have an extreme shortage of authorized providers.

Next, the ability to defend claims will be made difficult by the WCB’s proposals to reduce paperwork and provide injured workers with access to different provider types.

The WCB is proposing replacing the current Board treatment forms (C-4 and C-4.2, and equivalent OT/PT and PS forms) with the CMS-1500 form. The WCB anticipates an easy transition to the CMS-1500 and will be working towards a January 1, 2019, implementation date. Unfortunately, this form is not ideal for the defense of workers’ compensation claims in the State of New York. It does not provide space for a history of accident/occupational disease, causal relationship, or degree of disability. As such, unless the medical provider includes a medical narrative attached to the CMS-1500 form, it will be very difficult to ascertain the information needed to properly establish or litigate a case. This can, in turn, cause delays and additional hearings and filings, all of which can increase the cost to for employers, insurance carriers, and third-party administrators.

Perhaps most damaging to those tasked with administering workers’ compensation claims is the proposed legislation to amend the Workers’ Compensation law to conform with the education law by permitting medical providers who are licensed in New York State to become authorized, opening participation to nurse practitioners, physician’s assistants, licensed clinical social workers, and other providers. This could turn into the proverbial “wild west” with injured workers receiving medical opinions from providers not typically versed in WCB procedures and guidelines. One can easily envision injured workers’ receiving prima facie medical evidence for claims they would not typically be able to produce any for or patterns of increased disability ratings. Again, more compensable claims and higher degrees of disabilities all grow the cost for employers, insurance carriers, and third-party administrators.

While these are all proposals at this stage, if they are not met with opposition, they can and will quickly be enacted. Employers, insurance carriers, and third-party administrators should all voice their concerns to the WCB and the State of New York before it’s too late and they bear the increased costs of these proposals.

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