The New York State Insurance Department has proposed medical treatment guidelines for those injured on the job, which regulators say are designed to hold down workers' compensation costs and ensure better care.

But the unit developing the evaluation scheme has yet to decide whether the proposals will have any teeth behind them.

The guidelines, the department said, focus on the treatment of injuries to the lower back, cervical spine, knee and shoulder--which account for nearly 60 percent of total medical costs in New York's workers' comp system, according to data reported by the Workers' Compensation Research Institute.

"Putting medical treatment guidelines in place will mean injured workers get faster and more effective medical care at a lower cost to employers," New York Insurance Superintendent Eric Dinallo said in a statement.

"These guidelines will standardize treatments so injured workers get quality and appropriate care for their condition. Without guidelines, disputes and inappropriate treatments can lead to higher cost, but not better care," he added.

The department's Workers' Compensation Reform Task Force--headed by Executive Director Bruce Topman and Project Manager Dr. Elain Sobol Berger--worked with representatives of labor, business and other state agencies to develop the guidelines. Physicians and other professionals also shared their expertise and advice, the department said.

Mr. Topman, speaking to National Underwriter, said the plan for establishing treatment guidelines grew out of the workers' comp reform legislation passed in March.

In a letter to the department, Mr. Topman noted, Gov. Eliot Spitzer, as required by the legislation, had designated the members of the advisory committee and asked the department to develop the guidelines.

Asked if these guidelines will be enforced in some way, or if they are intended to be only a reference point for involved parties, Mr. Topman said: "That is a topic for discussion that is on the immediate upcoming agenda of the advisory committee and the task force."

The department has sent the guidelines to the Workers' Compensation Board for its consideration in promulgating regulations.

A WCB representative, Jim Smith, said the board has no comment on the actual guidelines, but he noted WCB is confident it will work quickly with the task force to implement them.

While the WCB has no specific deadline, Mr. Smith said, "the timetable around here, when it comes to workers' comp reform initiatives, is always 'as soon as possible.'"

Responding to the guidelines announcement, David Dickson, past president of the Professional Insurance Agents of New York, highlighted the need for consensus with respect to treating injured workers.

"There were 120,000-plus [dispute] hearings last year in New York for workers' compensation," noted Mr. Dickson--a lot of which, he said, involved injuries covered under the guidelines.

Establishing guidelines, Mr. Dickson added, could reduce the number of hearings, but he cautioned that much will depend on how the guidelines are implemented.

Michael Barrett, legislative representative for the Independent Insurance Agents and Brokers of New York, said he expects the guidelines will have the "force of law" behind them as they are implemented through the WCB.

"Everyone will be on the same page with the same rules," he said.

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Will Proposed Medical Care Guidelines In N.Y. Have Teeth?

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