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Workers' Compensation Board

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Medical Treatment Guideline Optional Prior Approval

The treating medical provider has the option to request prior approval from a participating insurance carrier to confirm that the proposed medical care is consistent with the Medical Treatment Guidelines. For additional information on optional prior approvals, please refer to Part 324 Medical Treatment Guidelines Regulations.

How to Request Optional Prior Approval

  1. Complete:
  2. Search for participating insurance carrier's designated contact.
    • Note: Failure to submit the request to the designated contact identified on the Workers' Compensation Board website may result in your request being denied.
    • Typing the Insurer's ID (W#) or name in the search box directly above the table will help to narrow the list.

    • Search for Contacts
  3. Fax or email the form to the designated fax/email address. If the Claim Administrator (Insurer or Third Party Administrator) asks that an alternate contact be used, identify the alternate contact on the form and send the request to both the designated and alternate contact.
  4. Send a copy to the Workers' Compensation Board on the same day using one of the prescribed methods of same day transmission (fax, email or Web Upload).

Insurance carriers are not required to participate in the Optional Prior Approval Process. The Board provides a list of insurance carriers who are not participating.

View List

Determining the Insurance Carrier

You can use Does Employer Have Coverage? to find the name of the employer's insurance carrier. If several insurers are listed for that employer, choose the one who provided coverage during the injured worker's date of accident. Occasionally, the system will identify the insurer for the date of accident as "SELFINS". If this occurs, please call (518) 402-0247 to identify the actual insurer.

Contact Us

Please email general_information@wcb.ny.gov or call (877) 632-4996 if you have questions regarding this form.