The New York State Workers’ Compensation Board system places a heavy and unrealistic burden on physicians and chiropractors. This burden pertains to the documentation requested of form MG-2, variance request forms.
It is painful obvious that the Workers’ Compensation Board’s sole purpose in enacting the Medical Treatment Guidelines is to curtail medical costs for insurance carriers. Anyone who believes otherwise is far removed from reality. Regardless, medical providers can put their patients in the best position to receive necessary medical treatment by properly completing the MG-2 form.
When medical treatment varies from the treatment guidelines, this form must be completed with excruciating detail. While medical offices routinely submit these forms, they almost always fail to properly detail and specify why the requested procedure is medically necessary. This explanation should be provided under Section C and it must be more than a cursory blurb about conservative treatment having failed or a first surgical procedure having failed. That does not document a medical necessity and a Judge will always deny the request.
The best way to document medical necessity is to explain in as much detail as possible why the treatment noted in the Guidelines is insufficient in this instance. If the Guidelines state that epidural steroid injections should be utilized before surgery and the orthopedic surgeon does not agree in a specific case they should explain why the injections are not necessary, but surgery is.
The statement of medical necessity should document objective findings supportive of the request, a clear statement outlining the goal of the requested treatment in terms of functional outcome and whether or not any functional improvement can be expected without the requested treatment.
If a series of treatments are being requested such as multiple injections or an extensive course of physical therapy, the specific duration or frequency should be documented. I have had Judges deny variance requests because a specific number of chiropractic visits or physical therapy sessions are not listed on the form.
Having practiced Workers’ Compensation Law for 20 years, it is mind boggling that the Workers’ Compensation Board requires that medical providers detail and document their requests with such excruciating detail. It is time consuming and wasteful but unless it is properly done, variances requests will continue to be denied and patients victimized.