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Work Comp Medical Care seems to win out over Medial Forms!

Form over Substance Hurts Workers Injured on the Job!

In order to make the system more user friendly, collect needed information and speed up the process the NY Workers Compensation Board and our friends in Albany undertook to create these positives through the 2007 workers compensation law reform and subsequent administrative mandates and changes.(Please note, the goal is worthy but the result, hmmm) The new Chair of the Workers Compensation Board Robert Beloten, has been handed a difficult task and has begun to try and  correct “the best intentions” of his predecessors and the ingrained psyche of the bureaucrats at  the WCB!

Simple situation – in a workers compensation case  doctors need to provide useful information about injured workers, doctors need to get paid, and the parties (claimant, insurance, wcb, attorneys) need to know some basic  “medical things” from the doctor   to continue with the case…not too bad. Ye Olde C-4 form was great for this. Instead the former administration spent over $150,000 to have the single medical form redesigned into one of  at least six forms, and from one page to multiple pages! (so much for user friendly)

RESULT – in the Rochester NY area the largest orthopeadic medical practice STOPPED treating  workers compensation claimants. Doctors around state have scrambled to fill out forms, modify computer systems and figure out how to fill out these new forms. And because of this, forms are not being filled out properly (but how can you when you need to site medical guidelines that don’t yet exist!) and many carriers are denying  payments to doctors due to these “technical” issues. And I personally have seen treatment denied to my clients for the very same reasons. YIKES!
A bright light?   Recently there seems to be some brighter light at the tunnels end. I applaud Chairman Beloten for his recent directive (Subject Matter 0476-398)

In sum he has directed the Workers Compensation Board to suspend the requirement of doctors in the counties of Monroe…form having to use the new C-4 forms, and allowing them to use the standard insurance form HF-1500 as long as it is submitted with appropriate evidence (an unfortunate problem that the use of the C-4 form would alleviate, but you can’t have your cake and eat it too, ask Mr. Madoff!). Secondly, some  Law Judges and Workers Compensation Board Employees, along with some carriers were using the various forms as a sword against doctors who mistakenly filled out the forms by denying medical payment even though the form was submitted – this course of action has been suspended Statewide! ( but this also has its own problems) so take your pick of the C4, C4.2, C4.3, C4-Auth, C-4AMR and so on!

It’s a start, and I again applaud the common sense approach aimed at helping  the most important person in the world of Workers Compensation – the injured worker! Quality medical care is a start, and requires quality doctors!– Stay tuned

0 Response

  1. Jim Sams

    Mr. Mittman, I am senior editor of a national news service. I would like permission to reprint your column in our professional columns section, which is available to all website visitors, including nonsubscribers. Please contact me if that would be ok.