Medical Treatment Guidelines Apply to Out of State Treatment

In regard to injured workers who live out of New York State and are receiving treatment outside of New York State, the Workers’ Compensation Board has recently changed how they will interpret the application of the Medical Treatment Guidelines. Previously, the Workers’ Compensation Board of New York had said that the Medical Treatment Guidelines did not apply to out of state treatment; this decision has now been reversed.

Workers Compensation Board Findings

The board has found that the Medical Treatment Guidelines provide evidence based standards for appropriate medical treatment. In the eyes of the Workers’ Compensation Board this ensures a claimants’ ability to receive the most effective medical care, determined by medical specialists and the medical community. It was found that effective treatment should be rendered without regard to the claimant’s place of residency or the location of the medical practice in which the claimant is to receive medical care.

“Once a claimant moves out of state the claimant may seek medical treatment in his new location and advise the out-of-state physicians that they can request payment at the prevailing fees in their area and not necessarily receive only the fees under the New York Workers’ Compensation Board’s fee schedule (see Matter of Liberty Eagle Plumbing and Heating, 2010 NY Wrk Comp G0024849). In keeping with more recent and expressive precedent, the Board Panel finds that it is more important to advance the broad ameliorative purposes of the Workers’ Compensation Law and to not interfere with a non-resident claimant’s ability to obtain treatment out-of-state (see e.g., Matter of Home Depot, 2012 NY Wrk Comp 30303792, Matter of United Parcel Service, 2013 NY Wrk Comp 08446351, and Matter of Harrison Division, 2013 NY Wrk Comp 89216935).”

This decision which is in favor of workers, has determined that the Medical Treatment Guidelines for workers in New York State apply regardless of where or by whom medical treatment is rendered when evidenced by a medical specialist. The guidelines will not change that out of state medical providers treating out of state claimants are reimbursed at the local medical fees customary to the area; or that out of state medical providers cannot request administrative awards or arbitration. While the findings apply to out-of-state treatment, it is not requiring out-of-state providers to use the New York State Workers Compensation Forms. It is preferred that they are used however, treatment should not be denied by a carrier as a result of failure to use the proper form.