FAQs About Medical Treatment Under Workers Compensation

How Does Workers Comp Cover Medical Treatment?

Workers compensation covers medical expenses for work related injuries of valid claims. It reimburses the injured worker for all medical treatment that was “reasonable and necessary.” Typically, this includes doctor visits, prescription drugs, surgery, hospitalization, urgent care treatment and rehabilitation. Injured workers must abide by workers comp guidelines when notifying medical professionals about their work related injury. It is common for questions to arise about this process and how it works. The following are a few frequently asked questions.

What Are New York Workers Compensation Medical Treatment Guidelines (MTGs)?

According to the New York State Workers Compensation Board, Medical Treatment Guidelines are standards that the Board legislatively mandated that govern the delivery of health care to injured workers. Mandatory standards of care exist for a variety of injuries, including the following types:

These guidelines have the purpose of establishing a single standard of care so workers can get appropriate treatment and improved medical outcomes within a timely manner.

Must medical treatment for workers compensation be authorized prior to receiving the care?

It is not necessary to receive pre-authorized approval when the provider is following the MTGs. Reasonable and necessary treatment fall into the category of pre-authorized treatment. That said, medical providers can also obtain approval prior to rendering services.

Do Medical Treatment Guidelines apply to long-term medical care?

Generally speaking, long-term medical care applies when the worker has reached maximum medical improvement but has a permanent disability. Workers compensation refers to the treatment as Ongoing Maintenance Care (OMC). The worker would be in a state of chronic pain and would need ongoing maintenance care to offset a decline in the condition. MTGs apply for this type of long-term medical care as well.

Do you have further questions about medical care under New York workers compensation?

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