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Comments From Western NY In-Person Sessions


We are pleased to publish the comments and suggestions that were shared with the project team during the outreach sessions in the west of the state – Buffalo, Rochester and Syracuse – between September 30th and October 3rd. We will be publishing comments from the rest of the state over the next two weeks. We are also working on distilling the comments from across the entire state from all participants into common themes, which we will also share, and will be used as an input to the upcoming focus group sessions.


Medical Treatment Guidelines are a step in the right direction
Carrier/TPA, Syracuse

6 years ago Maximum Medical Improvement (MMI)/Permanent Partial Disability (PPD) led to a stipulated settlement. Now these are delayed and get dragged out. This causes too much litigation
Business, Rochester

85-90% of cases just go straight through. Why do those cases need a hearing to ratify the decisions already made and not controverted?
Business, Rochester

Accountants cannot help us fix the system
Attorneys, Syracuse

After 2 weeks 50% of cases could have MMI determined, after 1 month 75% can, after 6 months 90% could have Maximum Medical Improvement (MMI)/ determined.
Business, Rochester

Age is a factor in determining loss of wage earning capacity (LWEC) but we are not consistent. When does work stop? 65, 68, 70? Are the judges applying this factor consistently? No. Consider impairment not just functional outcome.
Business, Rochester

The Impairment Guidelines are difficult to follow and are too complicated. Providers are having a difficult time deciphering the guidelines.
Providers, Buffalo

More people are claiming because awareness of repetitive stress injury has increased. More people are attributing their ailments to work related activity. Health issues that existed and were previously undiagnosed are now linked to work and become workers' compensation cases.
Carrier/TPA, Rochester

AMA guidelines are used in 35 + states, why isn't NY one of them? Do we benefit from having our own guidelines?
Carrier/TPA, Rochester

AMA standards are a nationwide standard and are constantly reviewed and aligned with current medical practice. Medical Treatment Guidelines are annually reviewed by a small panel.
Carrier/TPA, Rochester

Appeals are too slow. They take over a year. That means that surgery and other treatment is delayed and as a result is often ultimately less effective.
Carrier/TPA, Syracuse

Appeals process is too slow (6-18 months) and the carrier usually does not win. When the claimants award is affirmed now the carrier owes interest as well.
Carrier/TPA, Rochester

Appeals take too long - over a year, sometimes 13-16 months or in one case 23 months …..
Attorneys, Syracuse

There are less stipulations on permanency. Why would I stipulate if I am offered less than 80%. For anything remotely colorable as a total disability I will not recommend a stipulation because the Injured Worker could come after me for malpractice later even if their evidence is frankly laughable. They compare with friends and colleagues and see better results on the same facts and we are ridiculed for not having got them a better outcome. Take testimony and let the judge decide.
Attorneys, Buffalo

Are we (the project) reaching out to the medical community?
Attorneys, Syracuse

Assembly and indexing process is dependent on carrier participation - this is something they cannot be forced into which creates delays.
Attorneys, Syracuse

The ATF deposits create disincentives to classify. Caps and LWEC do not work. Caps mean that carriers have to pay a lump sum instead of a continuing obligation that is offset against revenue streams. 2 classes of employee because of ATF - Self insureds get a different amount than privately insured employers because the ATF is reduced by 10% immediately.
Attorneys, Syracuse

ATF transfers do not work.
Carrier/TPA, Syracuse

Attorney representation means the claimant is educated and has realistic expectations set. Unrepresented claimants rely on the judge, the judge has to take more time with them and there are more delays.
Attorneys, Rochester

Attorneys and WCB need to be allies of the providers.
Attorneys, Syracuse

Attorneys don't extend proceedings. They look for resolution - claimants acting pro se would take even longer and judges don't like dealing with self-represented claimants.
Attorneys, Rochester

If you want to reach providers in this area, there are only 6-10 practice groups in Rochester. Set up a room and U of R and let them walk in to give comments.
Attorneys, Rochester

There is an unholy alliance of pill mills, pharmacies mills, attorneys and unions.
Carrier/TPA, Rochester

You will not achieve the change we want because of labor and attorneys.
Business, Rochester

What is the experience that Deloitte brings to the table in WC? Do they have New York experience?
Attorneys, Syracuse

Attorneys not advising people to settle because decisions are inconsistent and they could be faced with malpractice claims if a case with the same facts comes out differently.
Attorneys, Buffalo

Attorneys want to see guidelines for depositions. Their day starts at 6am and goes to 7pm. We need on-call judges and support. We cannot force doctors to come to depositions for the set fee they will receive during the day and give up paying patients. So if we need to accommodate their schedule so should WCB.
Attorneys, Syracuse

Back in the day all doctors practiced workers' compensation. It was simpler. Now even an attorney cannot interpret the rules for the claimants or the doctors.
Attorneys, Rochester

We need better roadmaps from the Board. More certainty means less litigation. If there is a controversy that cannot be resolved by negotiation that results in litigation.
Attorneys, Buffalo

Billing is confusing. Most doctors do not understand it.
Provider, Rochester

Board does not want attorneys in the system, but as things are cannot do without us. Cases are resolved by attorneys. They are the grease in the system
Attorneys, Syracuse

Board makes it harder for doctors with Impairment guidelines, Medical Treatment Guidelines etc
Attorneys, Rochester

Board talks about friction costs and looks at the attorneys. This is always addressed to attorneys, but judges hate self-represented clients, and often times the outcomes for them are seen to be more negative. Attorneys are more knowledgeable about comp than either of the parties and grease the wheels to resolution. Litigation (hearings) are only needed when negotiation fails.
Attorneys, Buffalo

Board sends back notices saying forms have been incorrectly filled in - but no explanation of in what way they are wrong. If the doctor knew how it was incorrect he would have done it right in the first place.
Attorneys, Rochester

The Variance process is cumbersome and delays treatment which in turn delays, and in some cases prevents a person's return to work. The whole process takes so much longer.
Providers, Buffalo

The system does not help return claimants to work and leads to narcotic prescription abuse. In some cases the medical treatment guidelines have resulted in claimants coming to surgeons more quickly, which has reduced the time that the claimant returns to work and reduced narcotic prescription abuse. However, sometimes claimants do not come to his office until the "last minute" meaning they have been out of work for months and are now facing job loss if they don't return. Because the system is so slow, sometimes the doctor can't get all the necessary authorizations to return the claimant to work to meet this tight deadline.
Providers, Buffalo

The WCB system with its paperwork, follow up with carriers, authorization request process, requirements to examine claimants more frequently than necessary, etc. cost 225% more than other patients.
Providers, Buffalo

C4 form is too complicated - it is not a form it is a "family of forms". The date of injury is in on the 2nd page! Why? The system is driven by providers, WCB has driven providers out of the system. Over 200 have left this year in this area. Clients cannot find treatment, they have to travel (and charge travel costs) to other locations including other states, they end up going straight to a specialist that charges more and offers more expensive treatment - narcotics for pain instead of the extra strength motrin that the family practitioner/primary care physician would prescribe.
Attorneys, Syracuse

Cannot go to the family doctor that knows patient history and will prescribe less intrusive treatments, less drugs, will fix the patient more quickly. In some areas doctors do not have to follow rules or guidelines because they are in such short supply.
Attorneys, Syracuse

Carrier has 90 days to get an IME report, then 10 days to file it. Claimant only has 45 days on a non-schedule loss of use. The Carriers have too many ways to delay.
Attorneys, Syracuse

Carriers can get hearings in 20 days, no similar provision for claimants, don't get a hearing they get a proposed decision, or an amended decision - this is just more delay.
Attorneys, Syracuse

Carriers cannot make use of the new pharmacy guidelines.
Carrier/TPA, Syracuse

Carriers costs are $150 per hearing now. Used to be $100. All these continuances mean more costs. Then there are stipulations. Why do they have to attend a hearing when it has already been stipulated?
Carrier/TPA, Rochester

Carriers delay and use technicalities to avoid even answering queries.
Attorneys, Rochester

Carriers do not have to do anything - the Board is creating so many obstacles with the asinine rules that carriers can sit back.
Attorneys, Rochester

Carriers have to produce reports under permanent partial disability where they should not have to but if they fail there is a penalty whereas the claimants just get a continuance.
Carrier/TPA, Syracuse

Carriers TPAs and Employers have a hard time winning anything.
Carrier/TPA, Rochester

Carriers use 3rd party vendors to provide meds. Even carrier approved prescriptions are not filled because the carrier is behind in payments. Used to be that the injured worker could choose how to fill the prescription, now it is up to the carrier. As attorneys we have staff making three calls a month for their clients to get their medications. Many of them require a maintenance dose daily and the delay in refills puts them right back to the bottom. Our remedy is a hearing in 30 days - you are making attorneys go to hearings for prescriptions!
Attorneys, Rochester

Carriers were involved in the medical treatment guidelines project. That was much better.
Carrier/TPA, Syracuse

Change the dynamic of the employer – carrier – employee relationship.
Providers, Syracuse

Chiro costs are $37 a week, my client is working. Then Medical Treatment Guideline says no more chiro. My client stops working and is in pain. Now there is another claim and his pain management is much more expensive than the chiro was. Now it is costing $400 a week to support him NOT working!
Attorneys, Rochester

Claimants believe the Board finds them to lack credibility.
Attorneys, Rochester

Closing hearing points in far flung parts of the state but Albany unscathed. Stop change until this project has completed and see if this project can come up with something good. Give this project a chance and take input before making more changes.
Attorneys, Syracuse

Many injured workers face long delays before diagnostic testing and treatment is approved. Injured workers should not have to wait for medical care while their case is disputed. A mechanism should be developed to allow injured workers to receive testing and care even while the case is controverted, leaving the settling of the payment to later when the case is decided.
Providers, Syracuse

The variance procedure under the medical treatment guidelines is complex and usually a major waste of time as variances are denied.
Providers, Syracuse

The WCB forms are long and time consuming.
Providers, Syracuse

Insurance carriers are too easily allowed to object and under pay for medical care. This requires lengthy responses and time consuming changes in office procedures to try and avoid these objections. These problems are particularly evident with patients who have more than one WC case and/or non-work related health issues that are also attended to.
Providers, Syracuse

The requirement that patients be seen at some arbitrary time interval instead of as medically indicated clogs up practice schedules with unnecessary appointments.
Providers, Syracuse

MDs are called to testify on issues that should be easily resolved without this level of participation.
Providers, Syracuse

Nurse practitioners and Physician Assistants are a critical part of health care in today's world. The WCB should make itself current with modern medical practice by recognizing the role of NPs and Pas in the care of injured workers.
Providers, Syracuse

The WCB should include injured workers in its re-engineering project. Injured workers have direct experience with the WCB process and their perspective is crucial to understanding some of the problems and finding solutions.
Providers, Syracuse

Compliments to the Board for including attorneys in the discussion, we may go at it, but mostly we do the right thing and are looking for reasonable resolutions
Attorneys, Rochester

I am concerned about increased narcotics use.
Provider, Rochester

Concurrent employer is on the hook for higher paying second job since we did away with section 14.6
Attorneys, Syracuse

Contact the doctors that voluntarily left and ask why. Make an exit interview part of the opt out procedure. What happens to WC claimants already in their system when they opt out? They end up going straight to specialists or they do not get follow up.
Providers, Syracuse

Delays early in the case cause the increase in cost.
Business, Rochester

The project must look at the differences between upstate and downstate/Albany. We pay for the sins of Albany and downstate.
Attorneys, Buffalo

Docs would prefer to earn less money from a simpler system.
Attorneys, Rochester

Doctors are leaving in droves. Many doctors may be fine practitioners but will not assess impairment or do so in such a way that they will not face challenges.
Attorneys, Syracuse

Doctors are leaving in droves. There is not one psychologist/psychiatrist in the Rochester area that will take WC. There is no way to get treatment. Claimants are actually paying for their care even though they should not be paying for WC. This is because of the Board's actions.
Attorneys, Rochester

Doctors are overwhelmed with paper.
Attorneys, Rochester

Doctors are so flooded with paper they opt out.
Providers, Syracuse

Doctors are trained and resent people who are less educated than them asking them to justify their opinions. Doctors don't care about nuances, they care about treating patients.
Attorneys, Buffalo

Doctors cannot treat and when they do they cannot get paid.
Attorneys, Rochester

Doctors do not have the time for the C4.3 form.
Attorneys, Buffalo

Doctors should be required under their licensing to take comp for untreated patients.
Attorneys, Syracuse

Documents get lost -particularly those that are faxed. This causes delays we have to refile etc etc. Use electronic dropboxes to share documents. Stop scanning. In 1999 the system was cutting edge. Technology cannot solve everything but it can help!
Attorneys, Syracuse

We do not like the caps on modalities like physical therapy. We have learned to live with them by telling all claimants up front that they will only be getting 10 sessions of physical therapy so don't even ask for more. We don't try to get more because we have learned that they are never granted.
Providers, Buffalo

The Variance process doesn't work for physical therapy (PT) because you request one course of PT and if you need another you have to wait until the authorized weeks are done before asking for additional weeks. This causes at least a months' delay in getting the patient treatment. This causes a deterioration in their condition.
Providers, Buffalo

We like the medical treatment guidelines in some ways because they eliminate some hoops (like seeking prior approval for an MRI that is indicated). We resent the approach of the guidelines -- the idea that someone else can tell us the best way to treat a patient -- but we have found them helpful in getting diagnostic tests done without prior authorization.
Providers, Buffalo

I had an experience where the Medical Treatment Guideline clearly indicated that surgery was required. Nerve damage in the spine was causing drop foot. Instead of performing surgery (as indicated in the Medical Treatment Guideline), I requested authorization and the carrier denied it. Dr. Vigna compared the WC patient to any other patient who has private insurance. The non-comp patient would have received the surgery immediately, but the WC patient must wait which will result in deterioration of his condition.
Providers, Buffalo

The number one problem in the system that is driving physicians out of the system is the reality that they don't get paid in anywhere near a timely fashion. It's like going to a wonderful steak house, enjoying a delicious steak and a great bottle of wine and getting excellent service, then leaving without paying for a year (or giving the restaurant $10 for the meal) after agreeing to the terms of the arrangement as set forth in the menu.
Providers, Buffalo

We do not understand why old bills are not going to be scanned by the Disputed Medical Bills (DMB) unit. Based on our experience since scanning began, we have found that carriers pay bills that are scanned into the CIS system -- because the carrier can see them in CIS. When we asked the WCB DMB to scan the rest of her bills we were told that the board would not do that. We are frustrated and outraged.
Providers, Buffalo

The Medical Treatment Guidelines were written by a team that did not include a surgeon, but did include a physiologist and a medical malpractice attorney!
Providers, Buffalo

E-case is great.
Business, Rochester

Education of claimants falls entirely to us. They are woefully misinformed. By the time they come to us it is already too late for the best outcome because they have had bad information. For example I cannot tell you how many claimants think the claim starts when they report the accident to the employer.
Attorneys, Rochester

Eliminating PT and OT, palliative treatments and primary care physician treatment is pushing claimants toward pain management and increasing opiate use. Seeing our clients addicted is sad. They will never get back to work unless they go to rehab which is more cost. Many of us see these cases turn into death claims and full blown cases. Medical Treatment Guideline shifts burden of proof for treatment onto doctors instead of requiring proof that treatment is NOT appropriate from the carrier.
Attorneys, Syracuse

Employees often get an attorney because they see other people getting settlements and do not know what else to do.
Providers, Syracuse

Employers are being screwed by carriers. Their interests are not the same. Injured workers get less and less and the returns go to those that create the inefficiency in the system.
Attorneys, Buffalo

Employers are not there to support the employee. They sometimes contact the Injured worker without the attorney and they are not acting in the worker's best interest. They are acting in their own interest.
Attorneys, Rochester

Employers should be encouraged to work with employees to get them back to work but are not. Return to work is important. The system handles intermittent absences badly. Employees cannot risk going back to work in case they have subsequent absences without pay.
Attorneys, Syracuse

Even with a perfectly filled in C4 form we may still need depositions. What is wrong with that? We have attorneys to do that, they get paid. If the claimant gets paid, the attorney gets paid, and the carrier makes money, we should just streamline the system and speed things up. No more to do than that. Get rid of Medical Treatment Guideline, return to old guidelines, cut out the forms.
Attorneys, Buffalo

Everyone in the system is at fault.
Business, Rochester

Fast track approach is clearly laid out - the steps and the consequences. All processes should be like that.
Carrier/TPA, Syracuse

Florida has disability duration guidelines and WC is measured against these annually as a benchmark for performance.
Carrier/TPA, Syracuse

FORMS - too many, too complicated, not the necessary information. Why if I have a case number do I have to re-enter the name, date of birth etc.
Attorneys, Buffalo

Forms are too numerous - it is ridiculous - and the information is largely irrelevant.
Attorneys, Buffalo

Get them faster treatment and get them back to work.
Providers, Syracuse

Give employers credit or an incentive for RTW. The Board should not be building a RTW program - it will be too bureaucratic.
Business, Rochester

How can we advise clients when (a) decisions are inconsistent and (b) the other side knows that and would prefer to roll the hearing dice and follow the appeal route?
Attorneys, Buffalo

How do we negotiate with carriers when they know some judges are carrier friendly and they will do better with a hearing?
Attorneys, Buffalo

How will prescriptions be handled under Medical Treatment Guideline?
Carrier/TPA, Syracuse

I feel bad for the providers. They just want to treat patients. They do not understand the lingo that we use, or the standards that we have, it is not clear to them what they need to do. Make their lives easier by using universal guidelines. They lose money by being in the WC system.
Business, Rochester

If we fix the Scheduled Loss of Use issue - particularly for people who do not lose any time - minds would be more open to other changes.
Business, Rochester

If we had more consistency that would make for more predictability and that would mean more settlements and less need for hearings.
Attorneys, Syracuse

If you are consulting us, how is it that you are closing hearing points/customer service centers without finding out the impact to the Injured Worker?
Attorneys, Syracuse

Impairment guidelines don't work. It is too hard to apply a percentage to impairment. What is the difference between 49% and 51% impairment? And yet the difference in award can substantial.
Provider, Rochester

Impairment guidelines with the new codes make no sense. Let the doctors send in their notes with the assessment.
Attorneys, Rochester

In the old days attorneys sat at the back of hearings and learned the process. This was a form of training and helped the process. Now with closed hearings there is the feeling that every hearing is different and there is no knowledge or experience transfer.
Attorneys, Syracuse

Inconsistency = unpredictability - 3 judges with the same case details leads to three different decisions. This means we cannot help but take cases forward because we cannot advise our clients properly on expected outcomes. With consistency we could craft settlements.
Attorneys, Syracuse

Inconsistency is human and every case should be heard on its merits.
Attorneys, Syracuse

Inconsistent legal interpretations, unpredictable results. Decisions are made against precedent. There is a difference between upstate and downstate on how things are interpreted.
Carrier/TPA, Syracuse

Increase communication to providers.
Providers, Syracuse

Inordinate number of cases continued - 237 claims = 1756 hearings! No consistency in approach by judges, Lots of continuations are inappropriate.
Carrier/TPA, Syracuse

Instead of having our own Medical Treatment Guidelines adopt a standard that Providers are familiar with and know how to apply and that are kept current such as AMA6. This is nationally benchmarked. Providers' familiarity would mean little training requirement to implement the change.
Business, Rochester

It does not matter what the Board says, we are being forced into being more adversarial by all the "expedited processes"
Attorneys, Syracuse

Injured worker can get immediate hearings. Everyone else has to wait.
Business, Rochester

Injured worker experience has not improved since the first reform in 1982.
Providers, Syracuse

Injured worker forced to compromise because the prospect of an appeal is too onerous and post appeal awards are based on post case evidence that was not available at the time of injury.
Attorneys, Syracuse

Injured worker thinks that the report to the employer starts the clock on the case. They are uninformed about the process, woefully under prepared and it is left to the attorney to break the bad news.
Attorneys, Syracuse

Judges have too much discretion. They should stick to asking is the evidence credible, is the claimant credible, what is the medical evidence?
Carrier/TPA, Rochester

Legislation should "do no harm".
Business, Rochester

Lifetime benefits make no sense. Stop at retirement age.
Carrier/TPA, Syracuse

Litigation has gone up significantly as the system has become so complex, doctors have left, no-one understands WC any more. The psychology of their injury is very important to claimants. Currently the delays, confusion and lack of certainty is increasing stress on the claimants.
Attorneys, Rochester

Look at directed care. Employers should have some say in the early care. By the time injured worker gets to specialists it is too late. They cannot respond to anything less than surgery.
Attorneys, Syracuse

Lot of time and effort to create paperless system but doctors fill in the C4 and then submit a paper form. Everything gets scanned over and over. It is confusing and time consuming especially for the independent medical examiner who has to look through the prior medicals.
Providers, Syracuse

Loss of Wage Earning Capacity - working in excess of their Average weekly wage, but the judge says you "may have a permanent disability in the future" so they get assessed.
Carrier/TPA, Syracuse

Loss of Wage Earning Capacity is measured by average weekly wage (AWW) at time of injury not lifetime capacity to earn - eg med student injured at Dunkin' Donuts, AWW is $300 even though as a doctor he could have earned much more.
Attorneys, Syracuse

Loss of Wage Earning Capacity - what is the evidence that is available?
Carrier/TPA, Syracuse

Loss of Wage Earning Capacity is the elephant in the room. Impairment and Loss of Wage Earning Capacity not in synch. It is a lengthy process to get a number and letter classification that has no bearing on wage earning. Judges don't understand it which makes decisions inconsistent.
Attorneys, Syracuse

Loss of Wage Earning Capacity is too difficult to work out. Impairment guidelines are confusing - the letter number combination does not mean anything. Good concept because there is an end to the benefits but it is too hard to apply.
Carrier/TPA, Rochester

Many changes that the Board has made HAVE been positive. However, changes to date seem to affirm the view that the Board believes claimants are all trying to take advantage and that attorneys create frictional cost.
Attorneys, Rochester

Many PDs are wrong, they scare the claimant and drive them into the arms of an attorney.
Attorneys, Syracuse

Measures of loss of use are not well defined or objective. Judges left to determine and make inconsistent decisions.
Carrier/TPA, Syracuse

Medical advances mean faster return to work, adaptive technology means easier return to work.
Business, Rochester

Medical set aside accounts bill did not go anywhere and bleeds money out of the system.
Attorneys, Syracuse

MG2 - 15 days to respond, 21 days for MG2R, 20 days for a hearing… delays, delays.
Attorneys, Syracuse

More impediments than incentives for injured worker to return to work. Attorneys only have to refuse rehab services and that is that.
Carrier/TPA, Syracuse

Medical Treatment Guidelines are good and helpful. Scheduled injuries can be classified by a doctor as non-schedule (this has always been the case) but impairment guidelines don't cover SLU injuries so then it is hard to work out how to classify the injury
Provider, Rochester

Medical Treatment Guidelines do give a little bit of a roadmap, but why not go with a standard like AMA?
Attorneys, Buffalo

Be careful, AMA guidelines and Medical Treatment Guidelines can be distinguished and one is not necessarily a replacement for the other.
Attorneys, Buffalo

Medical Treatment Guidelines limits treatment. There is probably data to support them, but claimants see them as an attack on their rights to maintenance and life improving therapy. Physical Therapy, Occupational Therapy & chiro.
Attorneys, Rochester

Medical Treatment Guidelines ranking - letter, number classification - is not intuitive. Doctors sometimes try to do it and then crosswalk to the old classifications but when you look at the crosswalk they do not match. The old mild, moderate, marked, total classification was more intuitive and more aligned with the doctors' everyday assessments. That said, many doctors consider it is the job of the judge or the carrier to determine impairment, they are just about treating their patient, not about assessing them. Restrict the assessment to Pushing, pulling, lifting and mild, moderate, marked or total and you have it.
Attorneys, Buffalo

Medical Treatment Guidelines reduced costs for Ford.
Business, Rochester

Medical Treatment Guidelines bring us to the Board more and involves discussing treatment options, that we do not have the skills to analyze.
Attorneys, Rochester

Must manage prescription costs which have driven costs through the roof.
Attorneys, Syracuse

Narcotics case study - doctors prescribing conflicting meds. They should have to speak to other treating doctors before prescribing.
Business, Rochester

New EDI requirements - this was the first time WCB stepped up, planned, communicated and collaborated.
Carrier/TPA, Syracuse

No primary care doctors are taking WC.
Attorneys, Syracuse

No retraining or return to work efforts until the case is resolved which is often too late.
Providers, Syracuse

No statutory regulation on how long appeals may take - issues that the Board does not want to address they can just leave on the table.
Attorneys, Syracuse

No-one knows the patient better than the family doctor. We send these people to WC doctors that do not know their history, don't see them themselves but use nurse practitioners who charges more than the Family doctor.
Attorneys, Syracuse

Not all patients are fraudulent!
Providers, Syracuse

Not enough access to an in person service. For example penalties incorrectly levied due to mistaken FEINs. Cannot get a person at the Board to address the issue. Goes to collection, cannot get a person there either. Writing in does not work. No-one follows up.
Business, Rochester

Nurse practitioners treat the patient so accept their reports and their testimony. It makes no sense to insist on the doctor giving testimony when he did not see the person and does not know the case.
Attorneys, Syracuse

In New York 1st payment is delayed - this would not happen with directed care.
Carrier/TPA, Syracuse

October pharmacy rules were a good start- carriers give notice to employers who tell their employees but that does not work in WC because of the small employer with a few employees - main street NY employers do not comply.
Carrier/TPA, Syracuse

Often the office manager signs the doctor up to provide workers' comp treatment and they do not even know!
Providers, Syracuse

Having online submission capability is good.
Providers, Syracuse

Other states show better outcomes through directed care.
Carrier/TPA, Syracuse

Our scheduled loss of use (SLU) awards are not taking account of medical advances. With hip and knee replacements for example, injured workers can get back to a state of health that is actually better than before the injury occurred. They lose less time, they get back to work and yet they still get a windfall SLU award. It is like the lottery.
Business, Rochester

Outside workers' comp, carpel tunnel involves surgery and a day off work. In WC it is surgery, follow up surgery, 6 weeks, 3 months off work…
Carrier/TPA, Rochester

Part of the problem is that doctors perceive that their influence and reputation is being diminished. They feel that they are under attack from all sides, that we abuse them by seeking their opinions. Injured workers do not realize that a good treatment doctor is not necessarily going to give a good impairment assessment.
Attorneys, Syracuse

Pay decent fees for depos and treating doctors. Who can blame doctors for wanting to be IMEs when the fees are not capped, instead of treating doctors where the fees are on an outdated schedule.
Attorneys, Syracuse

Pilot programs for new initiatives are a good idea.
Carrier/TPA, Syracuse

Positive thing - the new Medical Treatment Guidelines taking into account vocational factors, that is the first time in a long time, don't lose that.
Attorneys, Syracuse

Hearings are occurring before Maximum Medical Improvement (MMI) is reached. The new expedited process means that attorneys cannot negotiate a settlement and are forced to come back for a hearing 60 days later - the judge has no discretion to allow them some more time.
Attorneys, Buffalo

Permanent Partial Disability (PPD), Loss of Wage Earning Capacity (LWEC) - no consistency on decisions. LWEC is based on impairment, vocational and functional factors but there are no guidelines for how to balance those factors. We end up relying on the judges to do it. Impairment becomes the least important factor - it is simple what could they do before, what can they do now? what is the difference?
Attorneys, Buffalo

Premiums are going up for office workers because of carpel tunnel (CT) but other things cause CT such as pregnancy or diabetes. Typing has been shown NOT to cause CT, we have an aging workforce and other factors but the claimant gets treated for the entire issue under WC. What about pre-existing issues and contributing factors outside the workplace. If he needs a knee replacement because of an injury at work but he has been a lifelong skier why should WC pay.
Carrier/TPA, Rochester

Prescription narcotics leads to depression which leads to anti-depressants which in turn leads to weight gain & diabetes and it is all paid for by WC because the pain is from an injury at work.
Carrier/TPA, Rochester

Real perception that the Board wants lawyers out of the system. PDs for example. Yet each change leaves attorneys with more to do and more entrenched!
Attorneys, Syracuse

Reduce forms. Some states only use SROI/FROI that is it. Whatever we improve, please do not create any new forms as part of the process.
Business, Rochester

Regular predictable communication. Look at Maine website for ideas.
Carrier/TPA, Syracuse

Regulations have just increased in complexity and intricacy. The changes over the years have made it impossible for claimants to proceed with their case without representation. The Board seems to want to drive attorneys out of the system but at the same time keeps implementing changes that guarantee attorneys jobs forever.
Attorneys, Syracuse

Remember - employers foot the bill for the entire system. The injured worker and Employer have common objectives - recovery and return to work, we need appropriate care, appropriate compensation and get them back to work. The employer and employee need to work hand in hand to make the system work.
Business, Rochester

RFA - to get a hearing is challenging.
Carrier/TPA, Syracuse

Rochester is the only area that is excluded from having to fill out forms (because of the shortage of treating physicians), but no one seems to know that we have this exception and the Board still sends out notices that there will be delays because the forms have not been submitted. We have a form letter that we send back to the board stating that the forms are not required. This creates even more unnecessary delay.
Attorneys, Rochester

RTW - attorney can just say no and that is the end of it!
Carrier/TPA, Rochester

Section 20 meant that claimants had a right to be timely heard - case law has eroded that right.
Attorneys, Syracuse

Section 29 (PPD part) takes away judge discretion, expedites the process but removes the opportunity to negotiate the settlement. IW cannot get the treatment or prescriptions he needs. Left to our own devices, attorneys get the job done and keep the system moving.
Attorneys, Buffalo

As a provider I was not aware that WCB has a medical staff/MDO.
Provider, Rochester

I am shocked by lack of understanding of the process by claimants. They don't understand that WCB does not pay, it is the carriers. Some carriers approve & pay up quickly. Others use every delaying tactic they can. Claimants have a sense of entitlement and expect support beyond healthcare and indemnity.
Provider, Rochester

Should be a fixed point of time doctor's assessment of Physical Therapy, Occupational Therapy needed to get injured worker back to work.
Carrier/TPA, Syracuse

Should have focus groups that meet monthly and discuss a different topic each month. This should not just be a project focused initiative.
Provider, Rochester

Simplify, streamline, provide good guidelines (one attorney disagreed and said we are trying to turn the players robotic and not allow them to use discretion and their human intelligence).
Attorneys, Buffalo

Scheduled Loss of Use - used to be measured on actual loss of use, now people with no lost time, no surgery are getting settlements - these are gifts!
Carrier/TPA, Syracuse

Scheduled Loss of Use is not appropriate when there is no loss of time and not loss of work. It is a gift to the claimant. We should be able to consider the severity and type of injury and the lost time.
Carrier/TPA, Rochester

Scheduled Loss of Uses and Medical Treatment Guidelines create a two path system - everything should be related to medical evidence.
Carrier/TPA, Rochester

Scheduled Loss of Use awards are good and bad.
Business, Rochester

Scheduled Loss of Use awards are good and bad. They do help get people back to work because there is no incentive to stay out. 90% of my clients entitled to Scheduled Loss of Use go back to work because compensation is no longer tied to the length of time out of work.
Attorneys, Buffalo

Social Security considers age, education, vocation in the likelihood of return to work. Adopt a points system that adjusts the wage earning capacity based on these factors. A 50 year old person, educated on the job, with English as a second language is significantly less likely to find new employment than a 25 year old college educated kid. 20 is not 50 is not 62.
Attorneys, Buffalo

Social Security total disability should mean that they no longer have to look for work.
Attorneys, Buffalo

Social Security and workers' compensation standards are different, Social Security has no caps and disability is not permanent, so the standard does not apply.
Attorneys, Buffalo

Social security disability should create a presumption in workers comp.
Attorneys, Syracuse

Some clients are interested in increasing SIR limits, but the Board says no.
Business, Rochester

Use a standard duration for directed care by employer/carrier. This works in NJ and other states. Better outcomes. Higher medical costs, but still better overall, gets to Maximum Medical Improvement much quicker.
Carrier/TPA, Syracuse

Still have hearings when something has already been stipulated - why?
Carrier/TPA, Rochester

System needs better communication - attorneys cannot speak to anyone, cannot communicate, cannot collaborate, cannot negotiate. Doctors don't comply and do not cooperate. We do not need to be so adversarial. Reconcile and understand everyone's role, understand how everyone works.
Attorneys, Syracuse

Systems needs to be more user friendly for doctors.
Attorneys, Rochester

Texas has a mandatory electronic billing. Cuts down costs - done through centralized billing service.
Carrier/TPA, Syracuse

The biggest disaster is that we have lost all our doctors.
Attorneys, Rochester

The biggest issue from both providers was the fact that they aren't getting paid for services and the HP process doesn't work because for one thing the HPA/Disputed Bill Unit are approximately 11 months behind in their work. Also, if an Administrative Decision is done awarding a bill or interest the carrier doesn't pay anyway. The frustration lies in the fact there is no way to make the carrier comply. There should be some sanctions we can place on the carrier for not paying legitimate bills. I presently have $128,000.00 billed services owed by carriers.
Providers, Buffalo

The built in lag time of 2 years to report means that many people are outside the 6 month RTW threshold before the accident is even reported. It is well known that people that do not return to work within 6 months are probably not going to.
Carrier/TPA, Syracuse

The lack of clarity on LWEC, MMI, caps means we cannot advise authoritatively on those things these days. What rate is applicable? What cap applies? What obligation is there on the injured worker in the case of a PPD? Not being able to adequately describe the likely outcome precludes early resolution and negotiation.
Attorneys, Rochester

The relationship between scheduled loss of use (SLU) and non-SLU awards is not right.
Business, Rochester

The system is hurting the people we are supposed to help.
Business, Rochester

The way the medical forms are done, the carriers cannot see what testing has been done or how it was conducted so they have to get an IME. Most doctors are not equipped to test a patient - they are not a gym, they cannot have them lift weights to assess impairment. The carrier needs evidence in order to determine the outcome.
Attorneys, Buffalo

There are no individual significant wins. This is like the elastic band ball in the office. You cannot take out the middle band without taking the whole thing apart
Business, Rochester

There has been zero communication by the Board in the last few years. We are interested in ongoing communications and exchanges
Attorneys, Syracuse

There is a fee schedule (for medications) - anyone should be able to fill at the schedule. Take the right to dictate away from the carriers.
Attorneys, Rochester

There is inconsistency throughout. Judges don't make the same decision on the same evidence and yet the Board upholds 92% of judges decisions. How can they do that? We have to wait for the appellate court to finally decide. This leaves uncertainty out there for too long.
Attorneys, Buffalo

There is more paper than ever. Why are the doctors not required to only use the online form?
Providers, Syracuse

There is no benefit to the Medical Treatment Guidelines, show me someone who likes them. Doctors do not trust the WCB.
Attorneys, Buffalo

There is too much input from people who do not know enough e.g. business. People opining on medical evidence and Medical Treatment Guidelines
Carrier/TPA, Rochester

There should be clarity and consistency of process across the state.
Carrier/TPA, Syracuse

Things that work well:- section 32, WISK, ECF. However make sure there is enough calendar time for the Section 32 and WISK hearings. Also, let the carrier stipulate in writing or on the phone. They do not want to come in person, and the carrier does not want to pay for them to. The claimant should see the judge if they want to because they need to understand what the stipulation means for them, the gravity of it.
Attorneys, Rochester

Too many delays all through the system.
Business, Rochester

Total disability presumption based on SSA inappropriate. The standards are not the same. Should not take the assessment from one system and apply it as a presumption in another.
Business, Rochester

Totally incapacitated is not the same as unable to perform prior job.
Carrier/TPA, Syracuse

Treatment guidelines were put in place for good reason but have resulted in complicated process. Doctors do not understand them, and often do not apply them.
Providers, Syracuse

Trial attorneys prevent injured worker from speaking to anyone. The employer cannot even speak to them about return to work.
Business, Rochester

UEF is backwards. They should pay and get the IW treated first and worry about whether this is coverage afterwards. If there is coverage they get the money back, if there isn't they were the appropriate payer anyway. Attorneys will not handle these cases because it takes so long to pay and there is so much dispute. They would never get recommended to other injured workers.
Attorneys, Rochester

Under the Medical Treatment Guidelines changes on 12/1/10, a person that was functioning, supporting his family, going to work and getting chiropractic treatment cannot be treated any more, he stops work and we transfer the burden to other areas of the system. The Medical Treatment Guidelines should not have been retroactively applied.
Attorneys, Syracuse

Unpredictability does not just affect attorneys and claimants, it affects the claims manager who must calculate reserves. It is very hard to do.
Attorneys, Buffalo

Unrepresented clients have no idea what is going on. They don't know the carrier denied, there is no information available to them at all.
Attorneys, Rochester

Virginia has capped medical and indemnity at 400 weeks - this is an example of what other states have done to control costs.
Carrier/TPA, Syracuse

Vendor organizations used by carriers for IMEs, so the carriers do not recognize other people who are qualified to perform assessments. This makes it more expensive to get an IME
Attorneys, Syracuse

Waiver Agreement Management Office (WAMO) - it takes over a year on a proposed settlement
Business, Rochester

WAMO is a mess. Everything is delayed at least 6 months
Attorneys, Syracuse

Way too many hearings and continuations. If we show up without medical for example we face a penalty, if the claimant shows up without they get a continuance.
Carrier/TPA, Rochester

WC is more expensive than if we were a torts system. Torts have statutory relationships between incidence and awards.
Carrier/TPA, Rochester

WC was designed to be a bridge, to provide benefits until the worker could return to work, not to be a retirement fund. It is supposed to tide them over. We need to get back to that.
Business, Rochester

We are supposed to be helping the injured worker to feed his family, get medical treatment and get back to some sort of work. Instead there are so many delays that he never gets back. Medical Treatment Guidelines should simplify, but instead of being a list of treatments already automatically authorized as per the original mandate, it is being treated as a list that by exclusion is NOT authorized. Claimant sits untreated and costs mount up.
Attorneys, Syracuse

We automatically appeal all cases where we do not get the outcome we tried to get.
Attorneys, Buffalo

We do lots of depositions for schedule loss of use, but it is with certain doctors that we know we need to take testimony.
Attorneys, Buffalo

We don't know where we are going, but we are on the fast track to get there. Board is pushing to get to permanent partial disability, to come up with C4.3 even when the claimant and the treating physician are not ready.
Attorneys, Rochester

We don't object to the Board throwing out doctors from the system when they are not living up to their oath.
Carrier/TPA, Rochester

We have a social worker in our practice that spends a great deal of time on WC follow up.
Providers, Syracuse

We hope this will be more open. At the end of a previous project we were allowed only to read the report in a district office under the watchful eye of a District Administrator.
Attorneys, Syracuse

We keep talking about costs to business. Elimination of physical therapy, occupational therapy & Chiro etc is driving up costs. There is no more palliative care - if it is not curative it is not allowed under Medical Treatment Guidelines.
Attorneys, Rochester

We need certainty, precision in the statutes, consistency, uniform standards that match those used in other states. Anything else builds in delay. When developing means of assessing cases, do not make the number and variety of factors to many or too complicated.
Business, Rochester

We need greater certainty. Too much unpredictability in what the carriers will do, what judges will decide. Even between Buffalo, Rochester and Syracuse the same question gets different answers.
Business, Rochester

We push to specialists because we are looking for too much objectivity.
Attorneys, Syracuse

We stipulate to scheduled loss of use (SLU) because the guidelines are clearer, the outcome more predictable, we have a longer history, more experience. SLU requires testimony in < 10% of cases, permanent partial disability is much more. This is anecdotal, but I could get stats.
Attorneys, Buffalo

We understand impairment but the Board gives zero guidance on functional capacity and the balancing of impairment, functional and vocational factors in Loss of wage earning capacity (LWEC) determinations. It is left to the judge. The decisions are inconsistent and yet they are usually upheld by the Board which makes no sense. There is no consistency so we cannot advise our clients and always need a hearing.
Attorneys, Rochester

We used to have the Chairman's advisory committee, bring it back
Attorneys, Buffalo

What do we do about narcotics? Long term users end up in rehab, suicides, this leads to full blown litigation.
Carrier/TPA, Syracuse

What has the Board done to reduce the cost, it is years since we did any sort of inventory (1990?) which showed that for every $1 4c goes to the injured worker, 16-18c goes to medical and rest???
Attorneys, Buffalo

What is the definition of temporary, permanent, total and Partial - this is not clear to anyone and gives inconsistent results. Other states have clear definitions.
Carrier/TPA, Syracuse

What's good for the injured worker is good for employers.
Business, Rochester

When rates were lower, doctors exaggerated the degree of injury and judges let them so they would get a living rate, but now the rates have doubled and doctors and judges are still letting this go on. This is driving costs higher across the board.
Carrier/TPA, Rochester

When the employer has a RTW program, injured worker still gets benefits when they turn down a job that the physician has said is manageable.
Carrier/TPA, Syracuse

With an aging workforce, it is hard to get the prior medical information when an injury occurs. Some doctors will not accept the WC HIPA forms. This causes delay.
Business, Rochester

With new caps, and average weekly wage calculations a 10% difference on an award is a significant amount - much more than it used to be. This creates incentives to litigate.
Attorneys, Buffalo

With the caps, claimants have no incentive to pursue permanency. This causes delays. Also the caps shifts the burden to the taxpayer because once the cap is reached they move into social security system.
Attorneys, Buffalo

With the new caps why haven't premiums gone down?
Attorneys, Buffalo

The combination of the ATF and the fact that payments will go on for 6-8 years for the worst affected claimants means that it will take a period of time for the caps to translate into premium reductions.
Attorneys, Buffalo