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Workers’ Compensation Board

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Better for Workers. Better for Business.

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The New NYS Workers’ Compensation Board

After a historically productive 2017 and 2018, the New York State Workers’ Compensation Board is performing better than it has in decades. The Board has significantly improved the experience of injured workers and their employers by successfully delivering on key legislative reforms, implementing nation-leading initiatives, and instituting processes that speed payment of benefits and reduce costs.

injured workers’ benefits increased by 134%

The results are striking

Since 2006, maximum benefit levels for injured workers have more than doubled from $400 to $934, while employers’ workers’ compensation costs were reduced by 9.8%.

employer costs decreased by 9.8%

9 in 10 injured workers receive first lost wage benefit payment timely

illustration of injured worker with arm cast
Increase in timely initial payments to injured workers; From 35% in 2015 to 90% in 2018

Injured Workers Now Promptly Paid

Since the NYS Workers’ Compensation Board (Board) began educating payers, monitoring their performance against legal time frames, and systematically penalizing lapses, insurers are paying lost wage benefits to injured workers and reporting their injuries faster than they have in decades.

In 2018, 9 in 10 injured workers received their first benefit payment timely, meaning within 18 days of disability or 10 days from the worker giving the employer notice of an injury, whichever is later. Injury notices, an indispensable first step in timely benefits, saw similar improvement.

5.9% controverted claims 2018 rate

Lowest Dispute Rate in Decades

When insurers controvert (or initially deny) claims, the injured worker receives no benefits while the claim is litigated. This century’s first decade had an average controverted claim rate of 15%. To halt this disturbing trend, the Board improved the controversy rules as part of a systematic, concerted effort to stop unnecessary disputes. In 2018, the rate of controverted claims fell to 5.9%, the lowest level in decades.

Appealed claims pending less than six months; From 57% in 2014 to 94% in 2018

Appealed Claims Now Quickly Resolved

Terrific progress was made in accelerating decisions in appealed claims. In 2018, 94% of claims were pending less than six months. The Board significantly reduced the inventory of appeals awaiting a decision, as well. All this occurred while the quality of Board decisions improved.

illustration of injured worker with legal representation

Better Worker Protections

In response to the 2017 Reform, the Board promptly created new procedures to ensure injured workers get a hearing within 45 days when they are not receiving benefits and their claim is undisputed. The Board also created a new process for injured workers to apply for a financial hardship redetermination, meaning that injured workers who are close to exhausting their benefits and in serious financial need could potentially receive lifetime benefits.

Improving Health Care and Benefit Determinations

Attracting More Providers

The Board’s updated medical fee schedule, which significantly increases reimbursement to providers, and the adoption of the universal bill form (Form CMS-1500) to greatly simplify medical reporting, are designed to attract more health care providers into the system and make medical billing easier. The Board’s authorized provider list was also updated to reflect actively treating providers.

Revising Impairment Guidelines

The Board met a Jan. 1, 2018, deadline to compose new Permanent Impairment Guidelines for medical providers to use when giving opinions in benefit determinations. The development of the Guidelines involved an extensive revision process that included the consideration of more than 25,000 public comments. The new Guidelines provide more clarity and reflect advances in medical care and outcomes.

drug formulary

Adopting a Drug Formulary

The Board implemented a drug formulary that includes a list of high-quality, and cost-effective preferred medications that can be prescribed to injured workers without any prior approval.

Related to this, the Board is implementing a new process for providers to request prior authorization for a non-formulary drug.

Addressing Opioids

The Board created Non-Acute Pain Medical Treatment Guidelines, a significant response to the opioid crisis. Nationally, these Guidelines have been pointed to repeatedly as a best practice in the treatment of non-acute pain in injured workers.

illustration of three health care providers

Expanding Provider Types, Improving Access to Care

A new law included in New York’s Fiscal Year 2019-2020 Enacted Budget allows the Board to authorize more types of health care providers to treat workers’ compensation patients.

Starting January 1, 2020, licensed clinical social workers, nurse practitioners and acupuncturists (all three new to the system), plus physician assistants, occupational therapists and physical therapists will all be able apply for their own authorization.

Today, only physicians, chiropractors, podiatrists and psychologists can be authorized to treat injured workers.

Additional types of providers coming into the system means that injured workers will have faster access to the care they need.

Learn more about New Provider Legislation.

Slashing Workers’ Compensation System Costs

Assessments rate reduced by 33%; From 18.8% in 2013 to 12.6% in 2019

Employer Assessments Rate Cut by 33%

Employers pay an annual assessment to operate the workers’ compensation system. The assessment rate was greatly reduced since the Business Relief Act of 2013, declining 33%. In 2013, the rate stood at 18.8%; for 2019, it is 12.6%.

Insurance rates cut; From -11.7% in 2018 to -10% in 2019

Insurance Rates Declining

In New York, insurance rates have dropped significantly over the past three years, due to stronger trends in wages and efforts by the Board to create smarter, more efficient processes that cut administrative costs. A more progressive use of technology also contributed to the decrease — 2018 had the largest rate cut in more than a decade.

Outdated, Expensive Special Fund Closed

Ultimately, employers will save hundreds of millions of dollars because the Board successfully defended a lawsuit to close the Reopened Case Fund to new cases. This Depression-era entity no longer served its intended purpose and added unnecessary system costs.

Making a Real Difference with New Technology

Virtual Hearings initiative

Innovating with Virtual Hearings

This groundbreaking initiative allows all parties in a workers’ compensation hearing to participate remotely using their computer or mobile device. It is the first high-definition, all-access system for legal hearings in the nation, in which multiple users in different locations log in once and then move from one hearing to another. A new app (WCB VHC) that is currently available in the iOS App Store, and will soon be available for Android devices, makes participating in virtual hearings via a mobile device even easier! Virtual hearings are expected to reduce the number of missed and postponed hearings, get benefits to workers faster and lower claims resolution costs. They also eliminate the need to travel to hearings, especially beneficial to injured workers.

Learn more about Virtual Hearings.

statewide financial system with eBill feature

Accepting Online Payments

Stakeholders can now pay assessments, penalties, and other costs online. The Board transitioned to a statewide financial system that contains an eBill feature. The Board became the first state agency to employ this feature to receive payments.

Building a New Electronic Claims System

The Board is building a new and improved claims system, the Business Information System, which will replace the current legacy, paper-based systems with a single, web-based platform. It will offer new electronic self-service features for all stakeholders.

Launching the Nation’s Strongest Paid Family Leave Benefit

provides care for an organ or tissue donor

The nation’s most comprehensive Paid Family Leave benefit is successfully running in New York. Administered by the Board, New York’s Paid Family Leave benefit provides job-protected, paid time off to employees who need to care for their families in times of need.

10 weeks of paid time off in 2019

To launch this benefit, an entire statewide insurance system was designed and implemented in just 20 months. Large-scale, successful public education and outreach prepared both employers and employees, and millions of New Yorkers made use of our comprehensive website, Helpline, and other resources.

In 2019, New York Paid Family Leave has a number of enhancements as part of its four-year phase in. These include more time with loved ones, greater financial security and new support for organ and tissue donors, while retaining the same strong protections.

Learn more at PaidFamilyLeave.ny.gov.

More improvements Coming in 2019

  • Workers’ comp stakeholder trainings
  • Medical authorization portal
  • Additional medical treatment guidelines