Help Wanted: Restoring Workers' Comp case

To restore coverage and treatment such as acupuncture,

To restore coverage and treatment such as acupuncture, the patient can ask the doctor for help and appeal the case. (Credit: iStock)

Carrie Mason-Draffen

Newsday columnist Carrie Mason Draffen Carrie Mason-Draffen

Mason-Draffen, a business reporter, writes a column about workplace issues.

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DEAR CARRIE: Since 1992, I had been receiving treatment for chronic neck pain after some heavy boxes fell on me at work. I received weekly acupuncture treatments initially and then got treatments every five to six weeks. And my Workers' Comp benefits paid for them for 14 years through the same doctor. In about 2006, the Workers' Compensation Board determined that the acupuncture doctor was not suitable because he didn't have a medical license from this country, even though my treatments with him were successful and I was able to return to work. So I started with another doctor chosen from a list that Workers' Comp gave me. The treatment with that doctor was once every two weeks for about three years. After that practice I went to another one. The point is that even with unforeseen difficulties such as having to change doctors, I was able to continue treatment until 2010, when the board's medical treatment guidelines changed. At that point it determined that I was no longer eligible for treatment because I didn't "show functional improvement," and that my doctors didn't fill out the complicated medical forms to the board's satisfaction. I have tried giving myself treatments, but I continue in so much pain. I want to get my treatments restored. How do I go about that?

-- Painful Saga

DEAR PAINFUL SAGA: You may have options for resuming treatments, according to a board spokesman. Your doctor can request more time for your treatments, and he or she can go to the Workers' Compensation Board's website to get help filling out special-request forms. And you can appeal the board's decision, said board spokesman Joseph Cavalcante.

When your doctor requests treatment outside of the medical guidelines, such as acupuncture treatments for a longer period than recommended, the physician can ask the insurer for a variance, with form MG-2, Cavalcante said.

"The doctor answers two important questions: What is the proposed treatment and why is this treatment medically necessary?" Cavalcante said. "The doctor explains how the treatment will improve your pain and function."

If the variance request is denied, the worker can either appeal to the board's medical director's office, where medical professionals will review his case, or he can request a hearing before a law judge, and the judge will decide, Cavalcante said.

The guidelines recommend treatments such as acupuncture if the care helps you get better, he said.

"That means the treatment should improve the worker's health, a reasonable expectation for medical care," he said. "If you experience an exacerbation of your condition, your doctor can provide treatment that will bring your pain and function back to your baseline before the exacerbation."

Treatment that follows the medical-treatment guidelines is preapproved; so prior clearance is unnecessary, he said.

Doctors can learn about medical-treatment guidelines and variances by taking free online training programs. Doctors interested in online training in worker's comp medical-treatment guidelines and special-request forms should go to www.wcb.ny.gov.

DEAR CARRIE: Our small office is closing down. We were not offered a transfer to the corporate office in another city. Instead the company has decided to hire new people and leave its loyal employees jobless. Is this legal?

-- Out in Cold

DEAR OUT: The move, though seemingly heartless, is legal as long as it isn't discriminatory -- that is, the company isn't moving so that it can unload older workers in favor of hiring younger ones elsewhere, for example.