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New York medical treatment guides add to workers comp costs: Study

New York medical treatment guides add to workers comp costs: Study

NEW YORK—Medical treatment guidelines implemented by the New York State Workers' Compensation Board have created an estimated $60 million in additional workers compensation costs, according to a report from the New York Workers Compensation Alliance.

The guidelines, enacted in December 2010, set standards of care for work-related back, knee, shoulder and neck injuries. Physicians who seek to provide treatment outside of those guidelines must request a variance or seek prior approval from insurers or the state workers comp board.

The workers comp board has received 202,643 variance requests and 28,901 prior-approval requests, according to analysis from the workers comp alliance released Friday. About 65,000 of those requests were rejected by the workers comp board before insurers responded to the applications, the alliance said.

The alliance estimates that rejected applications, variance reviews and board hearings related to the treatment guidelines have created $37 million in additional annual costs for insurers and $22.5 million in added expenses for the workers comp board.

“The cost of the litigation process associated with the (guidelines) far outweighs the cost of the medical treatment it prohibits,” the report reads. “By our analysis, the cost of the litigation process is at least three times the cost of the medical treatment requested.”

Many of the guideline-related costs resulted from the board's decision to apply the guidelines retroactively, the alliance said in its report. The New York Senate is considering legislation that would prevent the treatment guidelines from being applied to previous workers comp claims.

“The board currently applies the (guidelines) to cases in which accidents occurred and treatment was approved long before the (guidelines) were created,” the report reads. “This retroactive implementation has resulted in the board disapproving medical care that it had previously authorized for years and in some cases for decades.”