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Eric R. Dinallo   Superintendent of Insurance  25 Beaver Street  New York, N.Y. 10004

ISSUED 12/03/2007 FOR IMMEDIATE RELEASE

 

INSURANCE DEPARTMENT ISSUES DRAFT WORKERS’ COMPENSATION MEDICAL TREATMENT GUIDELINES

State’s first guidelines designed to deliver quality, lower-cost care for injured workers

Proposed medical treatment guidelines for treating workers injured on the job will benefit those workers while helping to hold down the cost of workers’ compensation insurance for all New Yorkers, New York State Insurance Superintendent Eric Dinallo said today.

“Putting medical treatment guidelines in place will mean injured workers get faster and more effective medical care at a lower cost to employers,” Dinallo said. “These guidelines will standardize treatments so injured workers get quality and appropriate care for their condition. Without guidelines, disputes and inappropriate treatments can lead to higher cost but not better care.”

Dinallo sent the State’s first ever medical treatment guidelines, drafted as a result of the 2007 Workers’ Compensation Reform Act, to the Workers’ Compensation Board today for its consideration in promulgating regulations.

Previous reforms enacted in accordance with the Act have resulted in an employer cost reduction for workers’ compensation of more than 20%, a savings of about $1 billion per year, and encouraged new competition among insurance companies in order to further reduce premiums. The reforms are expected to reduce the time required to resolve disputed workers’ compensation claims by more than half, getting benefits to injured workers much more quickly.

The medical treatment guidelines were developed under the guidance of the Department’s Workers’ Compensation Reform Task Force, headed by Executive Director Bruce Topman and Project Manager Dr. Elain Sobol Berger, working with representatives of labor, business and other state agencies. The participants selected highly credentialed physicians and other professionals to serve as essential advisors in the creation of the guidelines, which express the consensus of the expert professionals.

The guidelines provide a consistent quality standard for the medical care of injured workers. They are evidence-based and reflect the sound clinical judgment of the physicians. These medical treatment guidelines translate the medical literature into a usable and practical tool that assists busy medical providers in the provision of appropriate health care.

The guidelines focus on the treatment of injuries of the lower back, cervical spine, knee and shoulder. The Workers’ Compensation Research Institute recently reported these injuries account for nearly 60% of total medical costs in New York’s system.

Recent data indicate medical costs are consuming an increasingly larger share of the total cost of New York’s workers’ compensation system. Medical costs in New York increased to 38% of workers’ compensation benefit costs in 2003 from 34% in 1994. The medical cost of claims by workers out more than seven days grew substantially faster than the rate of medical inflation each year from 1997 to 2002, in some years rising more than double the climb in the medical Consumer Price Index.

Since New York does not now have medical treatment guidelines, neither medical practitioners nor claims examiners for insurance carriers have agreed-upon, easily accessible standards of care. This could result in disputes over how to treat an injured worker. Such disputes may delay care and, with the added costs for dispute resolution, harm both employee and employer.

In addition, because different insurance administrators or carriers may use different tools to assess appropriateness of care and control costs – a process called utilization management or review – workers with the same condition may be treated differently simply because they are covered by different insurance companies. Use of the new guidelines will help eliminate such variations in treatment, reduce disputes about appropriate medical care, and lead to decisions rooted in sound, evidence-based medicine, promoting quality care.

The expert professionals who were essential in providing advice for the formulation of the guidelines were:

Pamela Caggianelli, RN, C.C.M, C.D.M.S, COHN-S, LNCC, CIPP
Manager, Corporate Health and Global Privacy
Bausch & Lomb

David Deitz, M.D., Ph.D.
Vice President, National Medical Director
Liberty Mutual Insurance Company

Avital Fast, M.D.
Chairman and Professor
Department of Rehabilitation Medicine
Montefiore Medical Center and Albert Einstein Medical Center

Robert Goldberg, D.O.
President, Medical Society of the State of New York
Associate Dean of Community Medical Affairs and Advocacy, Professor of Physical Medicine and Rehabilitation, Touro College of Osteopathic Medicine
Clinical Assoc. Professor of Rehabilitation Medicine, New York Medical College

Stephen Levin, M.D.
Medical Director
Mount Sinai- IJ Selikoff Center for Occupational & Environmental Medicine

James McCarthy, Esq.
Injured Workers Bar Association

Jaime Szeinuk, M.D.
Assistant Professor, Community and Preventative Medicine
Mount Sinai – IJ Selikoff Center for Occupational & Environmental Medicine

James Tacci, M.D., J.D., M.P.H.
Manager of Medical Services, Xerox Corporation
Assistant Professor and Residency Program Director
Department of Community and Preventive Medicine
University of Rochester Medical Center

Link to the following documents:

Cover Letter to Honorable Zachary Weiss, Chair, Workers' Compensation Board

Medical Treatment Guidelines Education Plan

Proposed Cervical Spine Injury Medical Treatment Guidelines

Proposed General Principles Medical Treatment Guidelines

Proposed Knee Injury Medical Treatment Guidelines

Proposed Low Back Injury Medical Treatment Guidelines

Proposed Shoulder Injury Medical Treatment Guidelines


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