New York Workers Compensation – Are Guidelines Good

Employers of all sizes, businesses great and small, have hoped for good cost containment measures to be implemented in New York. A state where businesses have left, sometimes in droves, due to high taxes, the workers compensation insurances costs are seen as another burden for them.

 

 

In 2007, then Governor Spitzer successfully negotiated acceptance of sweeping changes in the Workers Compensation Law. This came after years of complaints and was the new hope for reduced premium costs. There were many important changes: a cap in all permanent partial disabilities including head, neck and back injuries; an increase of lost wages benefits for the injured workers; final and irrevocable lump sum settlements; and a plan for new medical treatment guidelines which could curb the ever-rising costs of medical treatment. (WCxKit)

 

 

While the Workers’ Compensation Board and the Rating Bureau artificially pushed a reduction in premiums as a result of the new legislation, this was short lived. For the most part, the cost containment benefits of this new law could only be realized over the next two years as new claims under the law came up for conclusion. However an immediate reduction was necessary. Politically, in order to satisfy the stakeholders.

 

 

Unfortunately, the WCB now some three plus years post-implementation is now just getting around to implementation. The premium costs began to rise again in 2009. Then last summer, the Board came up with a draft of the Medical Treatment Guidelines. It was released to all by October 2010. Better late than never, or so we thought. All the parties have been in an uproar as the WCB implemented the guidelines on December 1, 2010. The trouble is that no one was or is ready. Medical providers are not up to date with the requirements. Claimants and their attorneys are in an uproar as the Treatment Guidelines vary severely from the actual medical practice of the last thirty years. Insurance carriers and self-insured employers have had no time to adapt their computer systems or train their case managers and adjusters based on the new guidelines.

 

 

Over the last three decades, the WCB moved from employing a medical director to firing all physicians employed by the Board. Now, in the wake of 9/11 and the legislative changes they have again hired, though part-time, a physician to act as a medical director for the WCB. Though late, this is a good change for an organization whose judges make medical decisions affecting injured workers. Regarding the all-important caps on the period and extent of permanent partial disabilities, the WCB judges began assessing permanency and establishing caps for disability over the last nine months, and the process is slow, as most require negotiations by the parties before a law judge will make a findings. All of this has caused an increase of costs for many businesses and insecurity for the medical providers and injured workers. Expectedly, this is far from the “win-win” expectation announced in 2007.

 

 

So, the New York State Workers Compensation System is at a turning point of change, either for good or for — let us say — not so good. It is too soon to tell just yet what the outcome will be. As all stakeholders struggle to get a handle on the new Treatment Guidelines, we expect to see many requests by medical providers for a Variance from the Guidelines. As an example, a three-year-old permanent claim is now handled like a new injury as of December 1st, 2010 for treatment purposes. Assuming the Guidelines approve 8 weeks of chiropractic treatment or 6 weeks of physical therapy with an expected standard of the condition resolving, those who have been getting symptomatic treatment one time a month will be cut off from continued treatment at the end of January. Those who find it impossible to live (financially) once their disability payments are capped (a future issue), will also have the ability to ask the WCB for continued indemnity payments because of their financial hardship. (WCxKit)

 

 

The employers in New York do not feel secure about their workers compensation system, either their premiums or the welfare of their employees. It is just too soon to tell where we will be when all the dust settles in the coming year.

 

 

Author/Consultant: Eileen Wojnar (our newest contributor) completed a 34-year career for the New York State Insurance Fund, as Assistant Director of Business Operations. She is a graduate of CUNY, earning a BA in communications from Hunter College and an MS in Education from Queens College. She also holds the designation of Workers Comp Professional. She can be contacted at [email protected].