New NY Rules Proposed To Cut Comp Dispute Time

New York State Insurance Superintendent Eric Dinallo announced proposed regulations yesterday aimed at cutting the time it takes to resolve disputed workers' compensation claims to 90 days instead of the hundreds it now takes.

According to his statement, the proposed new regulation, which follows landmark legislation mandating comp reform, would reduce the time to resolve disputed claims from over six-months to three.

Mr. Dinallo detailed the proposal in a letter sent on June 1, a deadline set by Gov. Eliot Spitzer. In his message, the superintendent outlined the reforms and their benefits, and submitted an accompanying set of regulations.

The regulations would:

o Set specific time benchmarks for each stage of the dispute proceedings.

o Accelerate the time when evidence must be submitted and testimony taken.

o Require professional representatives and medical providers to meet their responsibilities in a timely fashion, with consequences for not doing so.

Mr. Dinallo said a major improvement will require employers, claimants and doctors to submit complete information up front.

Early information substantially increases the opportunities for settling cases at an accelerated mediation session and at the pre-hearing conference, he noted.

His announcement said it also makes the trial-ready claim quicker and the initial evidentiary hearing follow within minutes of the pre-hearing conference.

The proposed regulations accelerate claim resolution through earlier factual disclosure and assist injured workers in filing claims with all necessary information.

Mr. Dinallo noted that resolving disputes faster is one portion of the comp reform legislation passed in March after business, labor and government reached an accord aimed at reducing system costs to employers while increasing benefits to injured workers and getting employees back to work faster.

In response to the new regulatory proposals, Gov. Spitzer issued a statement. “We are delivering on our promise to reform workers' compensation in ways that both reduce costs to employers and increase benefits,” he said. “This reform is an essential part of reviving the state's economy and encouraging businesses to create more jobs here.”

The superintendent issued a prediction that the changes “will significantly increase the efficiency and fairness of the system and accelerate the time it takes to get benefits to injured workers.”

Workers, he said, “will be able to return to work earlier, system costs will fall and premiums will become more affordable for business owners. This is truly a win-win for employees and employers.”

Under the comp reform legislation, the state's weekly payments to injured workers will be increased. By 2010, maximum benefits will rise to nearly $700 per week from only $400 today.

The announcement of the new claims resolution rules said it currently takes more than 200 days to resolve disputed claims.

During this period, it was noted, the injured worker may be receiving no cash payments or medical benefits, suffer financial hardship, delays in receiving medical benefits and treatment, and may have their long-term medical prognosis and the ability to return to work affected.

According to the State Insurance Department, under the current system, it is often not until the pre-hearing conference–an average of 75 days from the start of the claim–that the parties have sufficient information to evaluate their claims and defenses.

It takes almost three more hearings for a typical claimant to establish a disputed claim and start the flow of benefits. In the 20 percent of cases that take more than three hearings, the average number of hearings is five. It can take up to 90 days to schedule each additional hearing, according to Mr. Dinallo's department.

The reformed process was developed by the Workers' Compensation Task Force, led by Executive Director Bruce Topman, after consultation with advisors designated by the governor drawn from business, labor, the legislature and executive departments.