New York lawmakers are proposing changes to guidelines used for medical treatment of injured workers in workers’ compensation claims.
Senate Bill 3550, introduced Tuesday, would prohibit insurance companies from paying for fees that exceed the state’s medical fee schedule or that are not included in the current fee schedule and are reimbursable under Medicare.
The language of the bill states that insurers shall never pay any fee for professional health services in excess of the fees allowed under the schedule established by the Chairman of the Workers’ Compensation Board.
Deviations from medical treatment guidelines would be permitted only upon written request to insurers prior to commencing treatment of injured workers.
The bill states that treating physicians will bear the burden of proof for the necessary treatment if it deviates from the guidelines, and that failure to submit the request would result in maximum reimbursement of 50% of the treatment guidelines.
The bill would also allow insurers to order independent medical examinations of injured workers at any time during the course of treatment.
The measure also states that services not covered by the Treatment Guidelines or the Worker̵7;s Fee Schedule will be determined as non-reimbursable.