Key Takeaways

• The NY Workers’ Compensation Board has announced that the new medical treatment guidelines—including new guidelines covering Traumatic Brain Injury (TBI)—become effective on May 2, 2022.

• The guidelines for diagnosing and treating TBI are extensive and highly patient specific.

• Insurers should closely monitor all TBI-related therapies to ensure the strict treatment guidelines are followed.

The New York State Workers’ Compensation Board has announced that the new medical treatment guidelines—including new guidelines covering Traumatic Brain Injury (TBI)—are scheduled to become effective on May 2, 2022. The New York State Medical Treatment Guidelines for Traumatic Brain Injury is a 627-page document, with 38 pages of that being the guidelines, followed by 557 pages of evidence tables.

About Traumatic Brain Injury

Traumatic Brain Injury (TBI) occurs by definition with sudden trauma, usually brought about by the head striking, or being struck by, an object. Alternatively, TBI may occur following a blast or explosion. TBI can involve categories ranging from mild (concussion) to moderate or severe (which involve loss of consciousness, amnesia, coma). Complications can range from headaches to behavior alterations, limited bodily function, and complications to ocular nerves, vascular, and endocrine systems.

About the New Guidelines

The treatment guidelines are highly patient specific, with the therapy and medication recommendations varying in great detail contingent upon each individual injury, the severity, and the related post-TBI complications. The diagnosis and treatment are based on evidence tables located in pages 46-602 of the New York State Medical Treatment Guidelines for Traumatic Brain Injuries.

The diagnosis of TBI is outlined in the guidelines and should coordinate with the evidence tables to confirm the condition and severity.

The symptoms for all TBI conditions can include physical, cognitive, and behavioral/emotional presentations—all of which should be detailed in the medical report to support the treatment recommendations.

The recommended therapies and rehabilitation covered under the guidelines are for select patients who meet very specific criteria for each treatment. Each individual’s injuries will coincide with a specific therapy recommendation, which is evidence-based depending on the diagnosis and severity category.

Recommendations for Insurers

Insurers are recommended to closely monitor all TBI-related therapies, specifically to ensure the strict treatment guidelines are followed. None of the relevant therapies should last more than 12 weeks without documented improvement and justification to continue in rare circumstances. The New York State Workers’ Compensation Board will be offering training for all of the sections of the Medical Treatment Guidelines; the training schedule is available here.

Home Based Therapies beyond 12 weeks should be the preferable method of continued care. Medication therapy is also closely monitored to determine both need, and duration with specific criteria for Botulinum Toxin Injections (Botox). Medication alone is unlikely to provide complete symptom relief, so any treatment plan providing medication only should be highly scrutinized, with tapering to occur as soon as practicable.

If you have any questions about these new guidelines or how they impact your business, please contact:

• Alexis A. Close
• Christina M. Hassler
• Damon M. Gruber
• Sean J. McKinley
• Esther F. Omoloyin
• Or another member of the firm’s Workers Compensation