The New NYS Workers’ Compensation Board
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.
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 have decreased by 9.8%.
Vastly Improving the Injured Worker’s Experience
9 in 10 injured workers receive first lost wage benefit payment timely
Injured Workers Now Promptly Paid
Since the 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 2019, 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.
Dramatically Reduced Dispute Rate
When insurers controvert (or initially deny) claims, the injured worker receives no benefits while the claim is litigated. At the beginning of this century, the controverted claims rate was 15%. To reduce the rate, the Board improved the controversy rules as part of a systematic, concerted effort to stop unnecessary disputes. In 2019, the rate of controverted claims fell to 5.6%, the lowest level in decades.
Appealed Claims Now Quickly Resolved
Terrific progress has been made in accelerating decisions in appealed claims. As of January 1, 2020, 97% of these 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.
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 has taken steps to draw more providers into the system by increasing their reimbursement and reducing their paperwork. New medical fee schedules, which significantly increase reimbursement to providers, took effect in 2019. Adoption of the universal bill form (Form CMS-1500) greatly simplifies billing and reporting. The Board’s authorized provider list was also updated to reflect actively treating providers.
Revising Impairment Guidelines
The Board met a January 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.
Adopting a Drug Formulary
The New York Workers’ State Compensation Drug Formulary (Drug Formulary) took effect in June 2019. It includes a list of preferred medications that can be prescribed without any prior approval. New prescriptions had to comply as of December 5, 2019; refills must comply as of June 5, 2020.
Addressing Opioids
Published in 2014 in response to the opioid crisis, the Board’s Non-Acute Pain Medical Treatment Guidelines have been pointed to repeatedly as a best practice in the treatment of non-acute pain in injured workers – at both the state and national levels.
Expanding Provider Types, Improving Access to Care
A new law included in New York’s Fiscal Year 2019-2020 Enacted Budget now allows the Board to authorize more types of health care providers to treat workers’ compensation patients.
As of 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 are able to apply for their own authorization.
Previously, only physicians, chiropractors, podiatrists and psychologists could be authorized to treat injured workers.
Additional types of providers coming into the system means that injured workers have more options and better access to the care they need.
Slashing Workers’ Compensation System Costs
Employer Assessment Rate Cut by 35%
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 35%. In 2013, the rate stood at 18.8%; for 2020, it is 12.2%.
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
Building a New Electronic Claims System
The Board is replacing our multiple legacy, paper-based claims systems with a single, web-based platform.
The new system will be user-friendly, offering improved and expanded access to real-time claim data for all parties of interest, new electronic self-service features for interacting with the Board, and an overall reduction in the number of paper forms to improve system responsiveness to stakeholder needs. Stay informed on the project at wcb.ny.gov/BIS.
Innovating with Virtual Hearings
This groundbreaking initiative allows all parties in a workers’ compensation hearing to participate remotely using their computer or mobile device. Virtual hearings 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), available in the Google Play and iOS App Stores, makes participating in virtual hearings via a mobile device even easier! After a full year of running virtual hearings, the Board is seeing positive trends in usage as well as other benefits. From 2017 to 2019, the total number of hearings needing to be rescheduled due to the injured worker not appearing was reduced by 53%.
Launching an Electronic Medical Portal
The Board launched an electronic Medical Portal at the end of 2019 that has key features for providers. They are successfully using the Medical Portal to apply online for Board authorization to treat injured workers and take mandatory training. Providers are also using the Medical Portal to request authorization to prescribe drugs that are not on the Drug Formulary.
Additionally, the Medical Portal will eventually include a lookup tool for providers to verify if they are following the Medical Treatment Guidelines for treatment of an injured worker.
Administering the Nation’s Strongest Paid Family Leave Benefit
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.
New York Paid Family Leave gains significant enhancements in 2020 as part of its four-year benefit phase-in period.
This year, eligible employees have greater financial security. They can take up to 10 weeks of job protected, paid time off at 60% of their average weekly wage, up to a cap of 60% of the current Statewide Average Weekly Wage. The maximum weekly benefit for 2020 is $840.70.
Also new for 2020 is that more employees now have access to Paid Family Leave because the Farm Laborers Fair Labor Practices Act extends coverage to farm laborers (read below for more information on that legislation).
Paid Family Leave continues to provide strong employee protections, guaranteeing workers job protection, continued health insurance and protection from discrimination or retaliation.
Expanding Coverage
With the passing of the Farm Laborers Fair Labor Practices Act, coverage for workers’ compensation, disability benefits and Paid Family Leave has been extended to all farm laborers. The Board created an online toolkit to help farm employers, owners and operators understand and comply with the new coverage requirements.