Having practiced Workers’ Compensation Law in New York State for more than 19 years, I have dealt with hundreds of physicians and chiropractors along the way. Understanding the Workers’ Compensation Law is the job of an attorney, not a doctor but some basic principals should be implemented by all physicians who encounter Workers’ Compensation cases. I have chosen three common practice points that will help physicians secure payment for necessary medical treatment, minimize time in depositions and Workers’ Compensation hearings, and, most importantly, achieve the best result for their patients.
Taking an accurate and complete history of injury and pre-existing conditions is often overlooked. It is understood that the doctor’s focus is on treating the patient, not filing comp papers but a complete history including any pre-existing injuries is critical. Defense attorneys feast on inaccurate and incomplete histories and they are the cause of lengthy delays in securing proper treatment. The attending physician should always specifically comment on causal relationship and apportionment to any pre-existing conditions, if applicable. Taking a few minutes to insure these items are addressed could mean the difference between having treatment approved quickly and having to endure litigation before any treatment will be covered.
Degree of Disability
Failure to properly document degree of disability is one of the main reasons that doctors are required to submit to depositions in Workers’ Compensation matters. The treating physician should always keep in mind that the Workers’ Compensation Board needs to know a degree or level of disability as it pertains to all forms of employment. The simply fact that a patient is unable to return to his or her particular job is not helpful to a Law Judge is assessing a degree of disability.
If a patient is unable to do any type of work, even light or sedentary work, then they will likely be 100% disabled. However, if they are unable to perform their particular job but can do some type of less physical work, they will be partially disabled. Assigning a specific percentage of disability is most helpful and it will benefit the doctor and patient alike by expediting any disputes regarding level of disability and keeping the busy physician’s schedule free from legal depositions.
By stating that a patient is “unable to do his usual job or occupation”, the treating physician immediately creates a web of controversy regarding that patient’s true level of disability. The more appropriate practice is to assign a specific percentage degree of disability to that persons overall employability.
Understanding The Medical Treatment Guidelines
As of December 1, 2010 the New York State Workers’ Compensation Board Medical Treatment Guidelines became effective. Unfortunately, physicians and attorneys are still becoming familiar with the Guidelines, their implementation, and applicability.
Physicians treating injuries to the back, neck, knee, or shoulder are well served reviewing the Guidelines and becoming familiar with them. By doing so, physicians will know which modalities of treatment can be proved to patients without any pre-authorization. If the Guidelines are properly followed, physicians need not worry about receiving proper payment per the fee schedule.
Certain procedures do need special approval with is obtained in the form of a variance from the Guidelines. Workers’ Compensation Board form MG-2 is used to request variance approval.
The Board’s Medical Treatment Guidelines can be found by doing a quick Google search “New York State Workers’ Compensation Board Medical Treatment Guidelines”. The website contains a search function which can expedite the physician’s inquiry as to whether or not a specific treatment or procedure can be performed without prior approval.
Utilizing the Medical Treatment Guidelines in certain circumstances can provide quicker medical care to the patient, less paperwork, and assurance that the provider will be paid for the services rendered.