Medical Treatment Guidelines In NY Open New Role For Employers

Medical treatment of NY comp claims was virtually unlimited two decades ago, but that has changed. Not all at once, but gradually and, with some proactive participation by employers, with opportunities for significant cost containment.


In prior years, there were no guidelines regarding medical treatment of NY comp claims. This was especially troublesome with old claims, which could be reopened at any time for almost any reason, or occasionally for no reason at all. However, perusing the Board’s new guidelines for treating flare ups of old injuries is like a person who has never played bridge trying to read the rules for the game. It is surely difficult for a medical office, and what will it be like for the injured workers.


Confusion, bottlenecks and uncertainty are the raw material for lawyer participation – UNLESS a bit of help is provided to the worker.



Uncertainty Will Quickly Grow Small Claims To Expensive Propositions


Employers with 100-200 employees rarely have even a dozen active claims in progress, and most of those will be for medical care. An employer who stays in active interaction with its claims will find that small claims stay small. But uncertainty will quickly grown the smallest claims into expensive propositions.


Therefore, the employer should be aware of measures which can keep the size of claims within reasonable limits.





The first is reaching out to persons with claims and ask if they are having problems. Be especially on the lookout for delays in payment of benefits or denials of medical care. Then call the carrier and ask for their version.  This type of communication will have a positive effect.



Going the Extra Mile


The second measure is to go to a Board office and review the Board electronic file for a claim that is being delayed. You will need a request to review the file signed by an officer of the business and notarized. Once it’s in the file, the file can be reviewed by the employer in the future as well. The employer should than call the carrier and inform it that the file has been reviewed and the employer has some questions. An employer going the extra mile will receive a much better reception by the carrier.



A Small Presence Can Make A Large Difference


The employer should then let the employee know that the employer has made efforts to limit further misunderstandings. Large employers are more likely to do these things but smaller employers seldom do. Even a small  presence will make large differences.




Author: Attorney Theodore Ronca is a practicing lawyer from Aquebogue, NY. He is a frequent writer and speaker, and has represented employers in the areas of workers’ compensation, Social Security disability, employee disability plans and subrogation for over 30 years. Attorney Ronca can be reached at 631-722-2100.


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