How were the Guidelines developed?
The Guidelines are an important component of the 2007 workers’ compensation reform, and were initially developed by the Governor’s Workers’ compensation Reform Task Force and its advisory committee comprised of well credentialed medical professionals and representatives of business and labor. The Board’s Medical Director and other staff have reviewed and updated the Guidelines in light of the comments received by the Board and recent developments in medical literature. The guidelines are a compilation of guidelines from ACOEM and the State of New York, and input from the advisory committee.
Do the Medical Treatment Guidelines apply to all work related injuries and illnesses?
The Guidelines apply only to medical treatment to the mid and low back, the knee, the shoulder and the neck.
Why were the back, neck, shoulder and knee selected for Treatment Guidelines?
These areas of the body represent the most common and most costly workplace injuries. Together they account for 40% of workers compensation claims and 60% of the system’s medical costs.
Are insurance carriers required to comply with Medical Treatment Guidelines?
Yes, the regulations require insurance carriers to incorporate the Medical Treatment Guidelines into their policies, procedures and practices and report their compliance to the Workers’ Compensation Board.
What if the claim is several years old and the injured worker has already received more than the recommended amount physical therapy treatment? Do the Guidelines apply?
Yes, however the Guidelines will be applied on individual patients. Therefore, the Guidelines’ recommended limits will apply to treatments on, or after, December 1, 2010. For example, if the doctor prescribes six weeks of physical therapy two times per week in mid November, the portion of that therapy that occurs before December 1, 2010 is not subject to the Medical Treatment Guidelines. Beginning December 1, 2010, physical therapy may continue for 3 more weeks and then, as required in the general principles of the Guidelines, the injured worker must be re-evaluated to determine if it is medically necessary for continued physical therapy. Subsequent physical therapy must be consistent with the Guidelines or be approved through the variance process.
Do injured workers still have to obtain diagnostic tests from within a diagnostic network for treatment covered under the Medical Treatment Guidelines?
Yes. The Medical Treatment Guidelines have no effect on the insurance carrier’s right to direct an injured worker to their diagnostic network.