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Downstate In-Person Session Comments


1996 - Theory that reducing litigation would reduce costs. This has actually forced claimants to get attorneys because it is too complicated. Making the system more complicated has made it more litigious. There are so many uncertainties everything needs a hearing and a decision.
Attorneys, Brooklyn

99% of people are practitioners in good faith. Look at a hearing with a pro se client and see the world without attorneys!
Attorneys, Queens

A big hole is that there is no way to assess vocational factors because it is gone from the Board. Partially disabled cannot get help. We used to have a vocational rehabilitation program.
Attorneys, Hempstead

A narrative report from the doctor is the most informative.
Attorneys, Brooklyn

A paperless system is essential to the future. Make the system mandatory—if you do not have the software you cannot be part of the system (like bankruptcy practice). We could then submit all data directly into the system.
Attorneys, Queens

Abuse is there; there are no controls in place. There are claimants with 18 or 19 claims that are working around their body to get money. They are not managing their health; they are managing their claims.
TPAs/Carriers, Hempstead

Administrative Determinations/Proposed Decisions are wrong and they exacerbate the problem—they have the wrong injuries, the wrong language, the quality just is not there.
Attorneys, Hempstead

All the forms are so confusing and complicated. Examiners cannot tell you any more what you need to fill out. Attorneys cannot understand it; doctors fill in the wrong form or fill the right form incorrectly. People are wasting away at home waiting for their treatment.
Attorneys, Hempstead

Allow us to get more engaged, allow us to work cases out, stop burdening us with complicated regulations. It’s not just us, it's also the judges. Let them make decisions.
Attorneys, Hempstead

AMA6 is even worse—people say to use that but no. It is additive. Lose the first arm and get x, lose the second arm and get y , which is less than x— what sense does that make?
Attorneys, Brooklyn

At hearings judges find in favor of the providers without going through each C8.1.
TPAs/Carriers, Hempstead

At our occupational health clinics on Long Island we cannot make referrals because of the exodus of specialists from the system. There is a total lack of non-surgical specialists taking workers' compensation—ENT, dermatologists. We look at a list of specialty providers from the Board and it is out of date.
Providers, Hempstead

At the hearing level there are set times to meet, but at the appeals level there are no guidelines and cases languish. There is a disconnect between the original case and the appeals process in terms of process.
Attorneys, Queens

At the other end appeals are taking a year to 18 months— the ultimate decision is usually good and consistent with the law and the facts but the delay is the problem.
Attorneys, Brooklyn

I estimate that the average cost of a case is now more than $100K, attributable to increases in the weekly wage and to fees.
MTA/NYC, Manhattan

Schedule Loss of Use (SLU) awards are so high they should not be done on forms. They should require a hearing.
Attorneys, Queens

Because family practitioners cannot afford to be in the workers' compensation system, injured workers are not seen by their regular doctor who could make a more accurate assessment of what is related to the injury or disease and what was caused outside of work. The worker is uncomfortable seeing a stranger, and there is no time to make sure that the patient's history is known. This can result in misdiagnosis, mistreatment and incorrect assessment of the relationship between the accident and the harm to the worker's health.
Providers, Hempstead

Bifurcated system of assembly and indexing. Carrier does not have to do anything until indexing occurs. It's all delay, delay.
Attorneys, Queens

Big problem is Schedule Loss of Use (SLU) awards. It was right that the weekly payment was increased but eliminating the SLU partial rate cap was wrong. SLUs have gone through the roof. There are more of them, they cost more, and we have a doctor lottery because the treating doctor says one thing then we pay for an independent medical examiner (IME) and he says completely the opposite. Should the judge split the difference? No, but how does the judge decide between an opinion that there is 40 % impairment from one and 15% impairment from the other? And people say the IMEs are the carriers’ doctors. They are not. They are independent.
TPAs/Carriers, Hempstead

The Board expects the doctors to do so much now. They are not there to fill in forms. They are here to treat patients. If you want doctors to be in the system you have to make it less onerous.
Attorneys, Brooklyn

The Board fails to comply with the law–Proposed Decision/Administrative Determination. If there is an objection there should be a hearing. Instead they tinker with the decision, there is another objection, and so it goes on—delay after delay.
Attorneys, Brooklyn

The Board is more interested in statistics. Cases are not closed any more they are marked NFA. The mindset is that hearings are bad. The Board is trying to put in examiners that thwart the process by making decisions without the necessary expertise. Examiners used to have 30 years of experience and knew as much as the attorneys.
Attorneys, Queens

The Board is refusing to index until after the first hearing, defeats timely first payment. Carriers do not act until after indexing.
Attorneys, Brooklyn

The Board will not transfer files from district to district even when the claimant moves. But they will accept telephone hearings!
Attorneys, Brooklyn

The C4 form has become the C4 "family". Doctors don't know what to submit. Judges will not allow into evidence anything not perfectly filled in. We get narratives from doctors that are much more informative but the judge won’t allow them. This is another delay.
Attorneys, Queens

The C4.3 impairment form is hard to use. Doctors don't like it, but a 15 page narrative from a doctor will not be admitted.
Attorneys, Queens

The C8.1s waste time. Judges don't comprehend multiple c8.1s if the I's are not dotted and the T's are not crossed, it is rejected. Treatment is authorized but because the case is not established the claimant cannot actually get treated—doctors are looking for the WCB case number.
Attorneys, Queens

Can we contact the examiner directly? Right now we cannot talk to the examiner because we are not parties of interest.
Attorneys, Hempstead

Cannot get bills paid.
Providers, Queens

Cannot get treatment approved.
Providers, Queens

Cannot give physical therapy to patients who need it in order to keep functioning.
Providers, Queens

Cannot keep cutting staff and expect to get stuff done. How many cases can one examiner be expected to handle effectively?
Attorneys, Hempstead

Carriers are paying money on cases that for not require payment because there is no hearing.
Attorneys, Hempstead

Carriers cannot keep up; they are overwhelmed.
Attorneys, Queens

Carriers do not want indexing to occur right away—no that is not it—often the wrong carrier is in the system and we need time to make sure the right one is pulled into the case. Board was receiving C7s from carriers all the time because they were not the correct carrier. Now there is time to correct the problem before the carrier has to act.
Attorneys, Hempstead

Carriers need a better way to deny a bill than the C8.1. This is too cumbersome. Some reasons for denial just do not need this level of bureaucracy; a letter to the provider copied to the claimant's attorney should be enough.
Attorneys, Hempstead

Claimants’ attorneys do not understand how to apply impairment—how can a doctor fill out the form he doesn't understand.
Attorneys, Brooklyn

Claimants’ firms do not allow nurse managers or other employer's representatives to speak to claimants because they are working for the carriers. We would never stop an employer speaking to his employee.
Attorneys, Brooklyn

Clients are out of work, untreated, the job goes away. The employer is "twisted" because the employee is not back. No one is happy.
Attorneys, Queens

Claimant attorney sends injured worker to his doctor and not an independent doctor.
Providers, Brooklyn

Delayed approvals lead to higher addiction to narcotics. While patients wait for appropriate treatment they have to resort to pain medications and then they are addicted.
Providers, Hempstead

Do you have any statistics on the costs associated with independent medical examinations (IMEs), hearings, and depositions? We go over the same information over and over again. I know how to treat the patient, but I have to go through depositions, IMEs and a hearing only to get approved for treatment I knew the patient needed in the first place. A deposition is so costly: my time, two attorneys, the judge, the reporter. The cost of opposing the treatment is more than the cost of the treatment itself! This project should measure the cost of adversarial actions.
Providers, Hempstead

Doctor’s notes are inadequate.
TPAs/Carriers, Hempstead

Early access to care is key to good medical outcomes for patient.
Providers, Brooklyn

eCase is something that the Board has done right but it needs to be upgraded.
TPAs/Carriers, Hempstead

eCase works well. We have access to everything that the Board has. The technology needs work and the timeframe for being kicked out is ridiculously low.
Attorneys, Hempstead

EDI is the right direction. Medical providers should be made to submit electronically. The same doctors are treating over and over. Use the data and curb abuse across the entire system.
MTA/NYC, Manhattan

Everything is "SLU-able" except for the neck, the back and the abdomen. Business will be driven out of the state and that is not good for anyone. People work their way through the body parts.
TPAs/Carriers, Hempstead

Examiners are confused because there has been so much change. They do not know what to do. They are making decisions that they are not qualified to make. They are not attorneys or judges. These are decisions that should be in front of a judge. Judges cannot review all the Administrative Determinations and this results in more delays, more appeals, and more objections. Simplify and educate.

There is much more happening off calendar now. If we request an Administrative Determination/Proposed Decision nothing happens or it is wrong. Penalties are not consistent across different types of decisions. Substantive decisions are being made by non-lawyers. They are determining Average Weekly Wage and authorizing treatment—on what basis?
Attorneys, Brooklyn

Examiners are determining whether medical evidence is prima facie evidence or whether Workers ‘ Compensation Board has jurisdiction (and getting it wrong).
Attorneys, Brooklyn

Expedited hearings work - they get on calendar.
Attorneys, Queens

Fighting the Board to get the case on calendar, fighting to get a decision or an appeal.
Attorneys, Brooklyn

Follow a case from start to conclusion and see the obstacles and the frustration.
Attorneys, Brooklyn

Fraud and abuse is there. Everyone goes to the same doctor, and they all get the same treatments.
TPAs/Carriers, Hempstead

From top to bottom the Board does not want to give hearings. They push to an Administrative Determination or Proposed Decision and they are often wrong.
Attorneys, Hempstead

Get a hearing, get a decision. But it is harder and harder to get on calendar.
Attorneys, Queens

Go back to how the system used to be, it was better then.
Attorneys, Brooklyn

Have eCase automatically email parties of interest when something new is added to the case.
TPAs/Carriers, Hempstead

Having hearings on every single issue is a colossal waste of time. What are you requesting a hearing on? Not all requests merit a hearing.
Attorneys, Hempstead

If a doctor sends a detailed narrative assessment instead of a C4.2 or a C4.3 the judge will not admit it. All the information is there, but because it is not on the form it is not entered into evidence. This is not the right outcome for injured workers.
Attorneys, Brooklyn

If doctors get treatment approved and get paid what is the problem?
Attorneys, Hempstead

If the SSA says "totally disabled" why do we have to re-litigate? (Note: Another attorney countered that SSA standards are different and classification is not permanent.)
Attorneys, Hempstead

If you don't have a completely filled out C4.3 according to a complicated Medical Treatment Guideline that no one understands then the case is over. These are not rules they are directives! Nobody can see where or who they came from—it is all hidden. Go through a proper rule-making process.
Attorneys, Brooklyn

Independent medical exams are a joke.
Providers, Brooklyn

In a union shop we pay four hours for a hearing and then the worker can either take the rest of the day off or come in and earn his other four hours. Now they can call in in their kitchen— that is a labor issue. What should we pay him for that? It doesn't matter because the agreement is already there that hearing means 4 hours pay.
TPAs/Carriers, Hempstead

In law school I expected the courts to be impartial. There are too many obstacles to getting justice. I should be fighting my opposite number instead I am fighting the Board.
Attorneys, Brooklyn

In person is better than phone contact, more gets done, things get resolved.
Attorneys, Queens

In the old days it was more centralized. There was a records room; the examiner was available to speak to us. Why doesn't eCase give the name of the examiner and let us contact them? We call up and we are told that they are not there and no one else can help us.
Attorneys, Queens

In the old days there was a hearing every two or three months. This was a check on the status. The judge could assess what was happening on the case, a representative of the employer was across the table. Now the claimant can go 90 days without having to see a doctor. Hearings give a sense of the big picture and keep the case on track.
Attorneys, Queens

Injuries to multiple parts of the body are problematic in this system.
Providers, Brooklyn

Interface between Apple and eCase does not work well.
Attorneys, Queens

Isn't FROI/SROI supposed to speed up input? Of course it won't simplify the process but it will get things in quicker.
Attorneys, Queens

It is carriers v. claimants and the Board is stuck in the middle of that.
Attorneys, Brooklyn

It is easier to deny than pay. What about the injured worker and his right to be heard?
Attorneys, Brooklyn

It is good business for carriers not to pay. Administration of claims takes people; they do not want to hire more people. The Board does not penalize and keeps reducing the number of Board employees. What about due process? It takes 30 days to get a hearing on non-payment.
Attorneys, Brooklyn

It is not just that the amount they are billing is wrong, but they are not following the guidelines. They treat for unrelated conditions. If there is a penalty on us for late payment, there should be a 15% penalty on them for false/inflated claims. They would soon learn the guidelines then.
TPAs/Carriers, Hempstead

It is taking far too long to get patients treatment. Often the original injury has cleared up but now the combination of stress and consequential injuries and illnesses prevents a good outcome and prevents return to work.
Providers, Hempstead

It should not be held against us that we make money. My job representing carriers is to look good and save them money. I should be giving up little or nothing on behalf of my client.
Attorneys, Queens

It takes longer and longer to get claimants treatment or indemnity and it costs carriers more and more.
Attorneys, Hempstead

Judge discounts the evidence from the independent medical exam in practically every case because of this perception that these doctors are "carriers' doctors". The Board should be required to go out and get the independent examination.
TPAs/Carriers, Hempstead

Judges regard the independent medical examiner as the "carrier's doctor" and discount evidence as a result. This is not true. That is why they are called "independent" medical examiners.
TPAs/Carriers, Hempstead

Judges should be required to report the amount of abuse they see. They should be able to spot that the same doctors are prescribing the same treatments over and over and over again regardless of the injury involved.
TPAs/Carriers, Hempstead

Judges shouldn't decide what care is appropriate. This delays treatment, which delays return to work and causes loss of strength and motion.
Providers, Brooklyn

Judges used to be involved. They made things happen but now they have been taken away. Now we take depositions and judges that have not seen anything in the case make decisions without seeing anyone or anything except what is written down. That is not the way to get the best decisions.
Attorneys, Hempstead

Judges would need medical expertise to make good decisions. Let medical professionals make medical decisions.
TPAs/Carriers, Hempstead

KISS–The Board has made everything so complicated. The system is about ready to collapse.
Attorneys, Hempstead

Let there be a dialog again! Attorneys should not be the opposition. We are not the enemy. We used to have dialog. Now there is nothing.
Attorneys, Brooklyn

Look at the other models, procedural issues in SSA, tort system etc. There is dialog. This is the only system where it does not happen.
Attorneys, Brooklyn

LWEC and average weekly wage are the big issues right now in terms of consistency of decisions. I don't know what judges have been told about LWEC but we are getting decisions that are all over the place.
Attorneys, Hempstead

LWEC and impairment is convoluted. Most doctors don't understand it. When you litigate the judges don’t understand it or they fill in the gaps with their knowledge. They should be deciding on the evidence, not their personal knowledge.
TPAs/Carriers, Hempstead

LWEC just started and there is a lack of guidance which results in inconsistent opinions.
Attorneys, Hempstead

Major problem with the doctors is the HP1 process. Attorneys are not allowed to be involved to help them get their payment, even when payment is approved they do not get paid.
Attorneys, Hempstead

Make it simpler. We have legislation creep. We end up creating monsters as we incorporate compromises so that everyone can have their piece. So many people get input. Simple really did work; it was transparent. There are unintended consequences—cannot change one little thing without affecting lots of other things. For example, we do not use standardized, national guidelines because Unions said "we will not use AMA".
Attorneys, Brooklyn

Many people wait a year for authorization for a treatment. Nurses are unable to go back to work because they cannot get their treatment—they cannot get assessed. The hospitals cannot let them come back to work until they have been assessed. Even when the carriers have been ordered to pay, they don't. Evaluation may not happen for years after what was initially a fairly minor injury, but the outcome is bad because of delayed evaluation and treatment.
Providers, Hempstead

Medicine has advanced so that after surgery many people are actually better than they were before. The Schedule Loss of Use (SLU) awards don't reflect those advances and with the increase in the weekly amounts SLUs are through the roof.
TPAs/Carriers, Hempstead

Most doctors do not fill in the work status section of the C4.
TPAs/Carriers, Hempstead

Medical Treatment Guidelines have resulted in 90% of decisions being in favor of the carrier.
MTA/NYC, Manhattan

Medical Treatment Guidelines–I put a foil request into the Board to see if these are working.
Attorneys, Queens

Medical Treatment Guidelines are clearly an improvement. They are objective, but medical billing is not reflecting the fee schedules.
TPAs/Carriers, Hempstead

Medical Treatment Guidelines are not clearly defined. They need to be revisited and made less complicated to follow.
Attorneys, Hempstead

Medical Treatment Guidelines have changed. The paperwork is overwhelming, application of the guidelines is confusing and we are educated people who know the guidelines. We ask for authorization—there is a set time to respond of 30 days and when we don't hear the Board says wait an additional 10 days for "mailing" before we can get an Order of the Chair. In the meantime the patient is still waiting for treatment.
Providers, Hempstead

Medical Treatment Guidelines in theory take some surgeries out of the list requiring authorization. Has that made it easier? No. Doctor does the surgery, doesn't get paid, carrier says "you did not get authorization" even though it is not required under the Medical Treatment Guidelines. Nurse case managers do not get notice if they opted out of the optional prior approval program. They lost the right to notice but they use it against us. Medical Treatment Guidelines say no authorization is required, but the carriers still hassle us.
Providers, Hempstead

Medical Treatment Guidelines turned out to be effective. They are incredibly complicated and the paperwork is burdensome, but they achieve their goal. The Medical Director's Office took the initiative to provide an objective view of the process and went in the right direction but it needs to be streamlined. The Medical Treatment Guidelines keep the judge out of the medical which is good.
MTA/NYC, Manhattan

Multiple treating doctors (specialties) is the rule not the exception and the workers' compensation system only accepts opinions of the treating physician.
Providers, Brooklyn

New cases in New York State have gone down by 30% in the last few years. Thirty years ago fewer judges were dealing with more cases, now with fewer cases everything takes longer. The system was more efficient and cases did not go "wild". There is no hearing; carriers are unaware of the case.
Attorneys, Queens

No mechanism for collaboration between providers and the injured worker.
Providers, Brooklyn

No one understands Medical Treatment Guidelines or how to apply them—not the doctors, not the judges and not the claimants. We cannot understand them so how would anyone else?
Attorneys, Brooklyn

Not everyone gets maximum medical improvement in two years.
Providers, Brooklyn

Nothing happens automatically except denials. Nothing is timely. We are constantly following up.
Providers, Hempstead

New York is its own system. The hearing system adopted 100 years ago is not used in other states. In New Jersey there is one hearing, one shot with witnesses, the claimant and the doctors.
Attorneys, Brooklyn

OCCP was set up to ensure good care to all workers but we rely on specialists. There is a real disincentive to be in workers' comp as compared to regular health care. Workers are harmed as a result. All the changes are driving doctors out of business. We cannot afford to be part of the workers’ compensation system.
Providers, Hempstead

Overall theme is that changes are made, a year later we are inundated with new regulations. We need to be able to get with the other stakeholders and get things done.
Attorneys, Hempstead

Papers are filed, four weeks later the case is still not assembled, not indexed. Claimant cannot get treatment because no case has been established.
Attorneys, Queens

Patient outcomes are getting worse. They do not get physical therapy. Their condition gets worse; they get secondary injuries and illnesses; they cannot work; they end up on pain medications and that is the end of them.
Providers, Hempstead

People are not computers. We are the only ones that deal with people. We are the only ones that speak to claimants. For everyone else in this system it is about the numbers not the people or their experience.
Attorneys, Brooklyn

People like hearings—they want to talk, they want to be heard.
Attorneys, Brooklyn

People want their day in court.
Attorneys, Brooklyn

Post-op physical therapy very important— should go on 3-6 months.
Providers, Brooklyn

Permanent partial disability (PPD) parts–I asked under what section of the law they are imparting penalties and judge cannot answer. It is a mandate from management.
Attorneys, Brooklyn

Pre-hearing conferences are skewed. The claimant does not have to produce anything. It makes it very hard to investigate and mount a proper defense. We should not be made to proceed if the claimant has not filled in the pre-hearing form. Most of our cases come through our agencies. The problem cases are the ones that do not come to us that way.
MTA/NYC, Manhattan

Providers are driving the Schedule Loss of Use (SLU) problem because claimants need medical evidence to get SLU. Relatively minor injuries become a cash cow for the claimant.
MTA/NYC, Manhattan

Physical therapists can't see people directly; need to go through a doctor and that's a problem.
Providers, Brooklyn

Physical therapist reimbursement is lowest in the country and hasn't been changed since 1996—must be a volume business as fees are so low and only the mills can survive in this environment.
Providers, Brooklyn

Physical therapy should involve movement—passive modalities (heat, ice, stim) should be discouraged.
Providers, Brooklyn

Physical therapists are considered "suppliers" in the system and not providers and this is insulting.
Providers, Brooklyn

Medical Treatment Guideline physical therapists can't submit directly, have to go through a doctor and the doctor has no incentive to forward MG-2 on. Similarly if MG2 is approved, approval goes to the doctor and the physical therapist doesn't even know about it.
Providers, Brooklyn

Redo the C8.1 process—take it away from attorneys, this should be something that doctors sort out.
Attorneys, Queens

Reinstate the policy and practice committees. They stopped in the late '90s and since then nothing. There used to be dialog—a back and forth—now it is "this is what we are doing".
Attorneys, Brookly

Report cards would not tell us anything we do not already know but they could be used to show the trends.
MTA/NYC, Manhattan

Return to work programs are a Workers' Compensation Board myth; they do not exist. We mainly deal with heavy labor and home health aides or union workers. They are not going to return to work.
Attorneys, Brooklyn

Same facts can result in different decisions. A few years ago an appellate decision required that judges document the factual and legal basis for their decision. The real problem is not the decisions it is the time it takes to get them.
Attorneys, Queens

Silent PPOs–It is virtually impossible to get out of them. They reduce the schedule payment. There is no contract and yet they somehow enforce the adjustment of the fee. Someone is in charge of PPOs. I can send them lots of data. Help me!
Providers, Hempstead

Schedule Loss of Use–wrong party put on notice. We cannot add them. Judge says they have to write in. This causes delays.
Attorneys, Queens

Schedule Loss of Use awards can be done without a hearing, but these are large awards now. Should they be done this way?
Attorneys, Queens

Schedule Loss of Use is operating outside the Medical Treatment Guidelines. We should be applying the same standards.
MTA/NYC, Manhattan

Schedule Loss of Use/permanency awards are increasing in number and size. Normally if you slip and twist your ankle this is not a permanent injury. In the real world you would not even go to the doctor. After a week or so it would be better. In the workers’ compensation world you see a doctor even though the injury is de minimis. There is no surgery, no fracture, and no treatment but a year later they are in front of a judge and no one challenges this.
MTA/NYC, Manhattan

Some aspects of the Medical Treatment Guidelines are good. More freedom to get certain treatments (MRIs arthroscopies). It can run smoothly if everyone understands it but many doctors don’t.
TPAs/Carriers, Hempstead

Somehow the system should change so payment is based on outcomes and not service rendered.
Providers, Brooklyn

Statute says the Board shall schedule a hearing within 30 days for any objection but they do not. We tell them the law and they laugh at you. Board has reinterpreted the statute and says this is only for controverted cases.
Attorneys, Hempstead

Tackle fraud. In theory the Workers' Compensation Board has the biggest database of treatment codes and yet you don't have a way to mine the data. Inspector General's office should be able to use this data. This is not just related to fraud but to monitoring trends in treatment—it could be used to inform changes to the Medical Treatment Guidelines. That data could justify changes in rates.
MTA/NYC, Manhattan

Technology was computerized 15 years ago; the system is not available late; it is not available on Thursday evening; it does not work properly with apple technology; it doesn't use Flash.
Attorneys, Brooklyn

Tell us what it all means. Tell us what to do with multiple body parts—you say it is not additive, so how do we deal with it? It means nothing and every decision is arbitrary.
Attorneys, Brooklyn

The better judges say that attorneys are the oil that keeps the system moving. We explain the process to the claimant; unrepresented claimants cause a drag on the judges. Attorneys move things along and get things settled quicker, but many things have to be resolved by a judge—not on the phone or by Administrative Determinations.
Attorneys, Hempstead

The biggest problem is that the appeals process takes over a year.
Attorneys, Hempstead

The Board has added a new process to allow claimants to appear telephonically. How do you do stips without seeing the claimant? They need to appear so that the judge can ensure they know this is the end of the case. There is no coming back. Also identifying the claimant is important. Go back to in person appearance absent exigent circumstances.
TPAs/Carriers, Hempstead

The Board is not facilitating resolution of claims.
Attorneys, Brooklyn

The Board thinks we are the enemy.
Attorneys, Hempstead

The Board's purpose is to adjudicate hearings.
Attorneys, Hempstead

The Board's technology needs work. The system is always crashing. It is not available late at night when we have time to catch up. It is closed at random times and times out after a really short period. It should be more accessible. Often there are too many people on the system and we get locked out.
Attorneys, Queens

The burden on carriers and employers is much higher than on the claimants. Independent medical exam reports must be completed within 10 days. There is lots of paperwork and if we are late, we lose our rights. The claimant has another bite at the cherry. Often in our arena the original accident is reported to the wrong agency. By the time it gets to us it is already too late and we are barred from controverting a claim that is not legitimate. The Board has advised judges not to use discretion. If we are a couple of days late and the hearing is not for another month who is hurt? But we are penalized anyway. Under Schedule Loss of Use awards there is no real prejudice. The statute says reports must "substantially comply" but Judges look for 100% compliance. Claimants change attorneys all the time. We send our reports to the attorney of record at the start of the case only to find out that it is a new attorney. Any attorney can open eCase and see what is on file, but because we did not notify we get penalized.
MTA/NYC, Manhattan

The center of this is supposed to be the injured worker—the outcome these days for them is worse than it should be.
Providers, Hempstead

The form naming convention is making things confusing. All the forms say FROI + suffix so all the forms in the case look the same and you have to open each one to see what it is. Why not keep the old form names that we know already.
Attorneys, Queens

The major issue is that we cannot get a hearing. Board does everything to prevent hearings. RFA1 don’t get them, RFA 2 you do. (One dissenter said this is not true.)
Attorneys, Hempstead

The only way to make it uniform across the state is to go to a judge.
Attorneys, Hempstead

The purpose of the Medical Treatment Guidelines is good but the execution is too complex and cumbersome. How do you determine that a person is only 49% impaired and not 51%? And that difference at today's rates can make a big difference to everyone.
TPAs/Carriers, Hempstead

The quicker we address issues along the way the better for all parties.
Attorneys, Hempstead

The system is not designed to deal with occupational diseases.
Providers, Brooklyn

The timeframe running against the carrier does not kick in because the case is not indexed. Carriers ask why they would act if they do not have to. They won't file the necessary papers or respond.
Attorneys, Brooklyn

The ultimate payer is the taxpayer. Suffolk has $60 million budgeted for workers' compensation. Add in the other counties and it is $150 million for Long Island. Taxpayers either pay to stop the abuse through investigations or they pay for the abuse through false claims and charges.
TPAs/Carriers, Hempstead

The view of the Board toward attorneys is horrible. We are the gateways to the system. We are not the enemy—we seek resolutions.
Attorneys, Queens

There are cutbacks and fewer staff.
Attorneys, Queens

There are no major problems with workers' compensation. It has been around for 100 years. It is small changes.
Attorneys, Brooklyn

There are so many appeals related to the C8.1. Do away with MG2s. Forms are rejected if there is a period in the wrong place.
Attorneys, Hempstead

There are very few providers that will see patients with head injuries. They do not get the specialist care that they need and their outcomes are not as good as they could and should be.
Providers, Hempstead

There is a secret rule to give penalties against both sides.
Attorneys, Brooklyn

There is an exodus from the system of OD specialists because of workers' compensation forms, fee schedule and failure to pay.
Providers, Brooklyn

There is no one here to explain to claimants except attorneys. We speak with them every day. No one else does. Judges do not tell injured workers that they have a right to an attorney any more.
Attorneys, Queens

There should be more hearings and more parts.
Attorneys, Brooklyn

There was a backlog of cases which led to keeping cases off the calendar, but this has become the normal mode of operation. It is now the goal itself, not speedy resolution but fewer cases on calendar.
Attorneys, Queens

There was a secret meeting somewhere when someone said if it is in this column then it's this code. Levels of disability used to make sense, not any more. Class 2 severity H—what does that mean?
Attorneys, Brooklyn

This agency has completely lost sight of its purpose. Now they tell us what to do—it is supposed to be impartial.
Attorneys, Brooklyn

This is a system where form is rated higher than substance.
Attorneys, Queens

This is meant to be a simple system. In the past judges did not have to deal with all this minutiae. We need clarity, transparency, simplification.
Attorneys, Queens

This is not a system where carriers work with us. It is very adversarial. There is an institutional attempt to avoid paying for services. None of us is in this because we expect to make a lot of money. We just want to get paid what we are owed for treating our patients.
Providers, Hempstead

This used to be a system of substance over form; it has become a system of form over substance.
Attorneys, Brooklyn

Third Party Administrator (TPA) total billing was $6.4million of which $2.2million was overbilling. There is abuse in medical billing.
TPAs/Carriers, Hempstead

Train the judges. If we had a jury trial they would not award $57 K for a minor injury. Why should someone get much much more than they would in a tort claim? This system is supposed to protect the worker's rights and protect the employer from excessive claims. We are not talking about people who are really permanently injured, but there must be objective medical evidence.
MTA/NYC, Manhattan

Treatment guidelines are not bad. They make sense. If a doctor treats according to the Medical Treatment Guidelines they can go ahead and not be delayed. If they want something different they must explain and justify. That is reasonable.
Attorneys, Hempstead

Triage requests and prioritize the ones that impact the outcome to the claimant. C8.1s could be handled administratively.
Attorneys, Hempstead

Underlying assumption should be that most injuries do not result in permanent deficit. If you want to prove permanency, do just that—prove it!
MTA/NYC, Manhattan

Use technology—require electronic billing and submissions of required information.
Providers, Hempstead

Used to be that claimant could only be on the phone if there were exigent circumstances. It seems obscene that such a dramatic change can be made without any consultation even as we are being told that we are being consulted through this project.
Attorneys, Hempstead

Video hearings would work great if only the Board would accept evidence. We are told that we cannot submit evidence of more than a couple of pages because of the faxing.
Attorneys, Queens

Workers' compensation is supposed to be a wage replacement program but it has become an entitlement program. People are making $803 per week and don't have to go to the doctor for 90 days.
TPAs/Carriers, Hempstead

WC law does not preclude you working another job while you are out on workers’ compensation, it pushes the claim higher.
TPAs/Carriers, Hempstead

The Workers' Compensation Board budget is paid for completely by carriers and the self-insured. It is not paid for by the taxpayer. Not one cent. Should take the Board outside of the State budget. The Workers' Compensation Board has become a political football.
Attorneys, Hempstead

The Workers' Compensation Board is doing a horrendous job of managing the costs of workers' compensation and closing an eye to the providers not filling in the forms correctly. We get penalized for being a couple of days late!
TPAs/Carriers, Hempstead

The Workers' Compensation Board is understaffed. HP1s are a year behind. It takes 15 minutes to reach a person.
Providers, Hempstead

WCLJs and attorneys don't understand causal relationship as it is related to ODs.
Providers, Brooklyn

We are all winging it, no guidelines to the industry or the judges for LWEC or average weekly wage.
Attorneys, Hempstead

We are denied automatically by the carriers. Initial consultations are billed at $1000 and are denied because there is no established injury. There is a policy of blanket denial; most expensive treatments don't get approved. Independent medical examiners are assessing patients without the specialized knowledge needed to assess the patient's deficit.
Providers, Hempstead

We are frustrated that it takes all this to get a decision and then another year or 16 months to get through an appeal.
Attorneys, Hempstead

We are not averse to the claimant speaking to the employer. How else does he get back to work? He should not speak to the carrier, but we encourage them to speak to the employer if they ever want to get back into their job.
Attorneys, Queens

We are not paid timely; our fees are negotiated away; we are not allowed to treat effectively or quickly; we cannot get approvals. This is bad for us and more importantly for the injured or sick worker.
Providers, Hempstead

We are now waiting 16 months for a decision in an appeal.
TPAs/Carriers, Hempstead

We don't require authorization for basic treatments which is good. The goal of the system is adequate and prompt medical care.
MTA/NYC, Manhattan

We get an Administrative Determination, an amended Administrative Determination, an objection another revision—we just want a decision!
Attorneys, Hempstead

We get caught out because of the small print in our agreements. Silent PPOs reduce the fee that is paid. So we are not getting the schedule fees but a reduced fee. Workers' compensation should be outside these agreements as it has its own schedule. It is not negotiated. We don't have the time to chase all these payments and adjustments.
Providers, Hempstead

We get negotiated down and then ignored. We cannot check the status of a case. We do not know that the carrier has controverted. Doctors need to be a bigger part of the system. They need a voice. The impartial committee (MAC) does not have a neuropsychologist or other specialists but it is making recommendations for the Medical Treatment Guidelines.
Providers, Hempstead

We have so many safety-sensitive positions that people become unemployable on paper with a 20% loss of use even though in reality they are fine. They do not come back to work. What do you do with a school bus driver who after 20 years twists his ankle and a doctor finds 40% loss of use? We cannot let him drive the bus but what else can he do?
MTA/NYC, Manhattan

We live in a different medical era. Surgeries make people better than even before they were injured. Outcomes are better, and yet we assume that if there is a surgery there should be a higher award. The more treatment, the more sophisticated that treatment, the greater the severity and the higher the Schedule Loss of Use award. The goal of treatment is recovery and that is why they have the more sophisticated treatment to get better.
MTA/NYC, Manhattan

We need a greater sense of reality in the system. You walk through the portal of the Workers' Compensation Board and everything you know in the real world goes out the window.
MTA/NYC, Manhattan

We request hearings because there is no other course of action for us. Carriers only request hearings when they need a decision—not for any other reason. It costs money to attend a hearing. We don't request them lightly.
Attorneys, Hempstead

We should have a state panel that understands the guidelines and makes the assessment of impairment. When the claimant is ready they go to the panel and it is cut and dried, no argument.
TPAs/Carriers, Hempstead

We should have remote hearings—Skype for example. Not for evidentiary hearings, but for procedural ones. That would make things more flexible and efficient.
Attorneys, Queens

We took an oath but why would I operate when I don't think I will get paid? We are not asking more than we are owed. The breaking point will not occur in the metropolitan areas, but in rural areas, where the providers are small, it is not financially viable to take on workers' compensation cases.
Providers, Hempstead

We used to classify routinely after about two years. Not anymore.
Attorneys, Queens

We used to have a presumption of maximum medical improvement—it was a working convention—and there would be a stip. Now the claimant's attorney will not consider classification. There should be a statutory presumption of maximum medical improvement after two years.
TPAs/Carriers, Hempstead

We want access to the Board. Attorneys, carriers have access to the case, why can't we get to see the status instead of having to wait on the phone. Attorneys are non-responsive. We have to spend too much time chasing down basic information.
Providers, Hempstead

We wish we could always do everything perfectly and on time, but that is not the real world. Board may notify us of a case we do not know about through our channels. We have to investigate. We may file a C7 after more than 25 days, for example, after 27 days and the case is not really a valid workers' compensation case but we have lost all defenses. Judge could use discretion to allow C7 to stand. Why should claimants get a windfall if they were not entitled in the first place?
MTA/NYC, Manhattan

What does it mean that people are looking for a job? Someone in FLA has a loose leaf piece of paper with his work experience scrawled on it and has been to some stores to ask for work and the judge accepts that!
TPAs/Carriers, Hempstead

What does the Board get by assembling a case before indexing? Why not just index right away? We cannot get a hearing until it is indexed; claimant cannot get treatment. A notice of assembly does not mean that the carrier has to do anything.
Attorneys, Hempstead

What is the mission supposed to be? It is supposed to be to money and treatment to those legitimately injured on the job.
Attorneys, Brooklyn

What is the scope? What are we fixing?
Attorneys, Hempstead

What jobs are out there for these people—the 51 year old with no skills and limited English? He is not returning to work. Back to work sounds great!
Attorneys, Brooklyn

What was the point of the new HP1 form? Why does the Board not accept old versions of the HP1 when the Board will accept old versions of any and every other type of form?
Providers, Hempstead

When a hearing is scheduled a lot gets accomplished.
Attorneys, Queens

When businesses look at their costs of employment it is made up of (i) salary, (ii) healthcare, and (iii) workers' compensation. Workers' compensation should never be third in that list!
TPAs/Carriers, Hempstead

When statute changes are proposed the Board needs to consult the claimants bar, the carriers bar, carriers as they used to. Now there are cockamamie ideas from the Board that no one gets to vet. We could suggest changes to make these things work when they are implemented.
Attorneys, Hempstead

Who is making these directives?
Attorneys, Brooklyn

Why aren't the workers' compensation practitioners involved in the conversation?
Attorneys, Brooklyn

Why do we have case assembly and case indexing? If the case is not indexed the doctor will not see the patient.
Attorneys, Brooklyn

WISK calendar works well.
TPAs/Carriers, Hempstead

With workers' compensation, doctors and physical therapists have to document everything they do. With regular insurance they don't have to do all the documentation.
Providers, Brooklyn

Years ago there were 28 or 29 calendars running each day.
Attorneys, Brooklyn

You are denying people the right to get their issues resolved.
Attorneys, Hempstead

You need to unravel some of the complication. I am educated, but I cannot answer some of the questions I am asked because it has become so complicated.
Attorneys, Hempstead