New York’s Medical Treatment Guidelines: Give it an “F” for failure

On December 1, 2010, the Workers’ Comp system in New York underwent a major change. Starting on that date, the New York Workers’ Compensation Board (WCB) implemented the new “Medical Treatment Guidelines.” These guidelines, abbreviated “MTG’s,”, apply only to neck, back, knee and shoulder injuries sustained at work.

The WCB made the changes in order to LIMIT treatment paid for by employers and given to injured workers unless the doctor or health provider can show that the treatment will yield “functional improvement” or, as the MTG’s put it, a “positive patient response.”

What does all of this mean, and how have these new Guidelines functioned in real life? These are my observations, and the opinions expressed here are mine and solely mine:

1. The MTG’s have added a lot of unnecessary paperwork for the doctors and their staffs who treat Workers’ Comp claimants. Some doctors have a staff member who just handles Workers’ Comp, for this reason.

2. The employers and the insurance carriers are the big winners, and what I mean is, they are saving tons of $. The reason: Doctors are being cut off from treating injured workers very early in the case, in many instances. Injured workers are being deprived of treatment they need because they cannot show that such treatment would lead to “improvement.”

3. The chiropractors got killed by the MTG’s. Most chiropractors in New York State want nothing to do with Workers’ Comp now, as a result. My personal fear is that injured workers will turn to prescription drugs as an alternative to chiropractic.

4. Lawyers spend a lot of (unpaid) time working on MTG issues. We aren’t allowed to be paid for handling issues that arise from the MTG’s. But handle them, we must.

5. Many injured workers need to continue seeing their doctor just to maintain their ability to function and in many cases, to keep working. The MTG’s won’t allow this type of treatment, since it maintains the worker’s condition, but doesn’t improve it.

6. Overall, I think the Medical Treatment Guidelines have been a colossal failure for my clients and for injured workers in New York. To make matters worse, they were applied retroactively to every single New York Workers’ Comp case involving neck, back, knees or shoulders that ever existed! (I’m not kidding.) So if you had an on-the-job back injury in 2003 and you were told at a hearing in 2006 that you were entitled to “lifetime treatment” at that time, guess what. They were JK (just kidding.)

7. Grade: F.

What to do when you get hurt at work in New York- the basics

Most people think that if they get injured at work, telling their boss and then seeing their family doctor is all they have to do. Actually, it isn’t. Here’s a little advice about what to do when you get injured on the job:

1. File a written incident report and keep a copy for your records.

2. Ask your boss or your HR Department for the name and phone number of your employer’s workers’ compensation insurance company (also called the “carrier.”)

3. Go for treatment with a Workers’ Compensation doctor who is a specialist – NOT your family doctor. Examples of doctors who you could see are orthopedists, neurologists, chiropractors or physical medicine and rehab doctors.

4. File a C-3 form with the New York State Workers’ Compensation Board. This step is required by law- yet most people don’t know about it and YOUR EMPLOYER WILL NOT TELL YOU ABOUT IT BECAUSE IT IS NOT THEIR RESPONSIBILITY TO DO SO! You can file a C-3 form online by going to the Board’s website at The law says you have two years from the accident or injury to file this form with New York State.

When filing for Workers’ Comp, keep in mind that you will be dealing with two completely separate entities: the carrier and the Workers’ Compensation Board. The carrier is your employer’s insurance company that is in business to make money and to pay as little as possible in benefits. The Board, on the other hand, is like a court. The Board, not the carrier, makes the final decisions in your case. Most carriers would like you to think that their decisions are final. However, any decision that a carrier makes about what treatment or surgery you are entitled to or how much money you get for your case can be challenged. You just have to know how. That’s where getting an experienced Workers’ Comp attorney comes into the picture.