The Medical Treatment Guidelines Now Apply To Out-Of-State Medical Providers

The Workers’ Compensation Board has recently held that out-of-state providers will be bound by the same limitations that in-state providers are held to when it comes to providing treatment to claimants.


In this unanimous decision which was filed on May 24, 2017, the Board noted that it had previously been of the opinion that out-of-state providers were not bound by the Medical Treatment Guidelines. See Hospice Inc., WCB#5951 3410.   The Board noted that it had previously adhered to the precedent that the Medical Treatment Guidelines and its various processes do not apply if the claimant resides out-of-state and receives medical treatment out of the state.


The Board took the opportunity to outright depart from and disavow from that interpretation on this issue.  Instead, the Board ruled in Hospice, Inc.  that the Medical Treatment Guidelines do apply to a non-resident claimant’s treatment out of state. The Board noted that the Medical Treatment Guidelines are sound and should be rendered without regard to the location of the claimant’s home or the medical provider’s practice.


In justifying its decision, the Board cited to a Court of Appeals case which found that the Board’s Medical Treatment Guidelines reasonably supplement WCL §13 and promote the “overall statutory framework of the Workers’ Compensation Law to provide appropriate medical care to injured workers.” See, Matter of Kigin v. State of NewYork Workers’ Compensation Board, 24 NY3d 459 (2014).  The Court also found that the Board was statutorily authorized…to issue a list of pre-authorized procedures, and that the establishment of the variance procedure was within the Board’s broad regulatory powers.  Id. It should be noted that the Board decided to preserve previous rulings which stated that out of state treatment could not be denied by a carrier solely because the right form (i.e. C-4 AUTHD or MG-2D) was not used.


This decision is extremely favorable for carriers in New York as it allows for uniformity in medical treatment issues within the New York Workers’ Compensation system.  Out of state providers would regularly exceed the prescribed treatment under the Medical Treatment Guidelines and know that carriers would be forced to pay for a majority, if not all, of the treatment.  This new decision to depart from the previous rule should be used by all carriers to put a stop to treatment which exceeds the Medical Treatment Guidelines.


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