Medical Treatment Guidelines

In December 2010, the New York State Workers’ Compensation Board implemented a program of medical treatment guidelines that changed how injured employees receive care. These guidelines exist to reduce the number of disputes that occur between the insurance company and medical treatment providers by providing clear instructions for recommended treatment.

The program includes guidelines for the treatment of injuries and illnesses to the following body parts:

  • Non-acute pain
  • Mid and low back injury
  • Carpal tunnel
  • Shoulder injury
  • Neck Injury
  • Knee injury

The 2010 guidelines were the mandatory standard of care up until December 15, 2014 when updated versions of the medical treatment guidelines went in to affect. Most recently, the Workers’ Compensation Board changed some of the guidelines used in the treatment of non-acute, long-term pain. The new rules alter the guidelines physicians must use when prescribing pain medications,

The treatment guidelines do not have to be adhered to if emergency medical care is required.

The medical treatment guidelines, which apply only to those specific areas of the body, are designed to be evidence-based standards of care and best practices for medical treatment of work-related injuries. They offer a means by which doctors can ensure that their treatment of your injuries or condition is paid for by the insurance company without having to obtain pre-approval.

If your medical provider feels you should be treated differently than what is stipulated for in the guidelines, they can apply for a variance. The burden of proof to establish that a variance is appropriate and medically necessary is on the medical provider requesting the variance.

Variance requests must be submitted prior to the doctor giving treatment. If the treatment is performed prior to requesting a variance, the insurance carrier may deny the variance request on the basis that is was not requested before the medical care was provided.

In these situations, it pays to have an experienced workers’ compensation attorney working with the medical provider on your behalf.

Workers’ Compensation Dispute Attorney

At Erwin, McCane & Daly, an Albany, New York, workers’ compensation law firm, we stay up to date with the Workers’ Compensation Board guidelines in order to help ensure that our clients receive the treatment they need and deserve. Take advantage of our collective experience representing individuals with workers’ compensation claims.

If you are an injured worker in need of assistance filing for workers’ compensation, contact our office today. We offer a free initial consultation in which a lawyer will assess the facts of your case and give you a prediction of the outcome and benefits you can expect to receive. Call 518-449-2245 or fill out the form below to schedule an appointment.