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Insurance Carrier Denied Surgery Request

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Under the New York State Workers’ Compensation Board’s Medical Treatment Guidelines a physician must file form C-4AUTH if a recommended surgical procedure is not consistent with the Board’s Medical Treatment Guidelines. In the vast majority of cases, form C-4AUTH is denied by the insurance carrier. However, many times the carrier has not properly filed their […]

New York Maximum Medical Impairment in Form C-4.3

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Form C-4.3, created by the Workers’ Compensation Board in January 2012, represents somewhat drastic changes in the way that physicians document permanent impairments in New York State Workers’ Compensation claims. The new form has been modified to accommodate the 2012 permanency guidelines. In classifiable cases, the physician must document whether or not maximum medical improvement […]

Lumbar Fusion In New York State Workers’ Compensation Cases

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Before the implementation of the Medical Treatment Guidelines, patients in New York State Workers’ Compensation cases were often afforded lumbar fusion surgery. However, since the Guidelines became effective, it is much more difficult to get lumbar fusion surgery approved. Under A.14 a lumbar fusion is listed as one of the specific medical procedures requiring pre-authorization. […]