The New York Workers’ Compensation Board announced the creation of a Medical Portal to enable electronic submission of C-4AUTH, MG-1 and MG-2 authorization requests. The portal will provide users with real time status of requests and send a notification when a status changes. The Board claims that users will no longer need to know which form to complete when submitting a request and the portal’s user interface will ask the user questions, the answers will determine the correct path and type of treatment authorization request.
Use of the portal is not required
Health care providers may continue to submit requests using the paper forms, if they choose. It is anticipated, however, that electronic submission will make the approval process faster, reduce errors, improve data quality, and eliminate the need to submit paper authorization forms. Additionally, if a health care provider submits a treatment authorization request electronically, the payer will be required to respond to the request electronically. If the medical provider submits a paper form, the payer must respond in kind via paper submission.
Here is the post-webinar video from our most recent presentation, “Defending Motion for Temporary and Medical Benefits” which discusses motion filed by petitioner seeking additional medical care or lost time compensation under the New Jersey Workers’ Compensation Act. To join us for our monthly webinars on New York and New Jersey workers’ compensation law, Click here to register.
In an effort to curtail delays in initial payments made to injured employees, the New York State Workers’ Compensation Board launched the Payor Compliance initiative. The stated goals of Payor Compliance are to increase efficiency, reduce costs, and improve the overall claims administration process. This project was launched in response to a comprehensive Business Process Re-engineering (BPR) review completed in 2014. As a result of the findings from the BPR review, and in accordance with the best industry practices, the Board announced the implementation of procedures for the periodic review and analysis of payor compliance with claims handling statutory and regulatory requirements.
Any final determination of law can be appealed. The requirements for the appeal process in the New York Workers’ Compensation system are found in N.Y. Work. Comp. Law § 23. A party that disagrees with a law judge’s decision under the law can request a review of the decision, if the appeal is timely filed on the proper form within 30 days of the filing of the decision being appealed. Orders of the Chair are not appealable but if a party believes there is an error, a party may request the Board to rescind the Order of the Chair.
Application for Board Review
The first level of appeal is known as an “Application for Board Review.” This appeal is made when a party disagrees with a decision at the hearing level (Notice of Decision or Reserved Decision).
This is an administrative appeal and the appeal is considered by a three member Panel of the Board. The appeal must be filed with the Board within 30 days of the filing date of the decision. The party defending the appeal (respondent) has 30 days to file a rebuttal. 12 NYCRR 300.13(b).
An appeal from an award to the Board operates as a stay of the obligation to make payment for disputed indemnity benefits or medical bills. N.Y. Work. Comp. Law § 25(c).
Most people are very familiar with traumatic or specific injuries. An employee slips and falls at work while she is engaged in her work duties and breaks her ankle – this is an example of a traumatic or specific injury that was suffered in the course of a workers’ employment. In the aforementioned example, after investigation of the facts it is usually easy to ascertain if the employee’s accident “arose out of and in the course of her employment.” Therefore, this type of injury will likely be covered under New York’s Workers’ Compensation Law.
An occupational disease is slightly more difficult to define, but like traumatic injuries, if it is determined by the Workers’ Compensation Board that an occupational disease was developed in the course of a workers’ employment, the person suffering from the disease will be entitled to medical and indemnity benefits associated with the work related disease under New York’s Workers’ Compensation Law. Occupational diseases are injuries and/or conditions that arise out of a workers’ employment, usually through exposure to specific harmful conditions or through repetitive physical actions. Continue reading Defining Occupational Disease in New York→