NYS Workers' Compensation Board
Riverview Center
150 Broadway
Attn: WCB Medical Director's Office
Suite 195
Menands, NY 12204
(800) 781-2362
WCBMedicalDirectorsOffice@wcb.ny.gov
The regulations require insurance carriers to:
Note: When a variance request is denied, insurers are allowed to select a dispute forum preference (medical arbitrator or WCB adjudication) in each dispute. If either the insurer or injured worker selects resolution through adjudication, the case shall proceed for proposed decision and, if necessary, to a WCB Hearing. If neither selects adjudication, the dispute will be referred to the medical arbitrator. The resolution is binding and not appealable under WCL § 23.
Insurers are required to complete a registration to assign an administrator and designate contacts for Medical Treatment Guidelines. This includes insurers who contract with a Third Party Administrator (TPA) to administers their claims. A TPA is not permitted to register on an insurer's behalf.
The insurance carrier must designate an administrator from its organization during the registration process. Administrators will be responsible for submitting contact information to the Board and for keeping the contact information updated. If the insurance carrier uses a TPA, the administrator can add designated contacts for their third party administrator.
In addition, the administrator has the authority to opt the insurer out of the Optional Prior Approval process and certify that the insurer has implemented Medical Treatment Guidelines into its policies, practices and procedures.
An insurer may designate more than one administrator, including an administrator from its TPA. For more information, read Administrators Responsibilities.
Every insurance carrier is required to designate the name, telephone number, fax number and/or email address of at least one qualified employee as a point of contact for the Board and treating medical providers. Contacts will be responsible for the review of requests for variances, optional prior approval and authorization for special service(s) costing over $1,000 in a non-emergency situation or requiring pre-authorization pursuant to the Medical Treatment Guidelines (MTG). Changes in the designated contact must be reported to the Board within 10 business days of the change.
The health crisis facing the New York State continues to impact the ability of authorized health care providers to implement changes and comply with the newly adopted Medical Treatment Guidelines (MTGs) set to take effect January 1, 2021.
To prevent any negative impacts to injured workers, the Board has issued an Order of the Chair directing that the MTGs set to be effective January 1, 2021, will instead be effective on the launch date of OnBoard: Limited Release, to be announced in a future communication to stakeholders. Please watch for updates.
Training is available for the following new Medical Treatment Guidelines (MTGs).
Each new MTG has a corresponding training course that provides an overview of the General Guideline Principles, conditions associated with the body part or disease, and treatment recommendations. Continuing medical education (CME) credit is available for each course.
Non-CME training presentations are also available as PDF files for those who want to learn about the new MTGs but do not need CME credit.
* Post-Traumatic Stress Disorder and Major Depressive Disorder were posted on October 21, 2020 for a 60-day public comment period. Training for these MTGs will be adjusted if needed based on the feedback received.