The COVID-19 pandemic has presented employers, workers’ compensation insurers, and third-party administrators with unprecedented challenges—both from a regulatory and statutory standpoint and from the incidence of novel claims for alleged coronavirus-related injuries. Goldberg Segalla’s Workers’ Compensation team will continue to provide our client community with weekly updates containing news and informed analysis on issues critical to their business.

Key Takeaways

• The New York State Workers’ Compensation Board has adopted on an emergency basis amendments to expand telemedicine options in response to COVID-19

• The Board has issued a three-page summary of its COVID-19 outbreak response, covering remote hearings and depositions, IMEs, C-4 AUTH responses, requirements for updated medical evidence, labor market attachment, and compliance requirements

• Board Chair Clarissa Rodriguez released a letter addressed to workers’ compensation carriers and payers with guidance and recommendations in light of COVID-19

New York State Workers’ Compensation Board Response to Telemedicine

The New York State Workers’ Compensation Board has adopted on an emergency basis amendments to 12 NYCRR 325-1.8, 329-1.3, 329-4.2, 333.2, and 348.2 to expand telemedicine options in response to COVID-19. This supersedes the previous emergency telemedicine adoption filed on March 16, 2020. A Notice of Emergency Adoption will be published in the May 6, 2020, edition of the State Register. This emergency rulemaking is effective for 90 days upon filing April 20, 2020.

• • Read the board’s bulletin here.

Applies to:

• Treatment involving emergency medical aid, authorized provider treatment, physical therapy/occupational therapy, psychologist/ licensed social workers, and chiropractic care to workers’ compensation patients.

Impact:  

• Provides a code method to allow for telemedicine by two-way audio and visual communication (g., Skype) as well as telephone visits.
• The coding for these procedures will be Common Procedural Technology (CPT) 99212 for Chiropractic/Physical Therapy, CPT codes 99212-99214 for Authorized Providers, and CPT 90832 for psychology/social worker care.
• This will allow for knowledge as to whether the visits were by phone or video.
• It also limits the care for PT/OT/acupuncture and chiropractic care to two times per week for 30 days, and one time per week thereafter.

Board Issues Summary to Outbreak Response

The New York State Workers’ Compensation Board has issued a three-page summary of its COVID-19 outbreak response. This covers remote hearings and depositions, IMEs, C-4 AUTH responses, requirements for updated medical evidence, labor market attachment, and compliance requirements.

Read the summary here.

Letter to Carriers and Payers Regarding COVID-19 from Chair Clarissa Rodriguez

On April 16, 2020, New York State Workers’ Compensation Board Chair Clarissa Rodriguez released a letter addressed to workers’ compensation carriers and payers.

Read the letter here.

Applies to:

• Employers, initial investigation teams for TPAs and insurance carriers who make determinations on whether to accept or deny a claim, as well as risk managers for whom that determination has a resulting impact.

Impact:

The letter urged New York employers, carriers and payers to:

• Send the CIP (claim information packet) inclusive of information on the New York State Workers’ Compensation Board process for potential injured workers.
• Be aware of Discrimination Law under Section 120 of the New York State Workers’ Compensation Law requiring that employers are directly adjudicated for claims that termination resulted solely because a worker filed a workers’ compensation claim.
• Be thoughtful during investigation of claims from front-line and essential workers.
• Ensure timely and prompt dissemination of facts, and the goal of all New Yorkers to mitigate and end the pandemic.

The decision to accept or deny a claim involves looking at the facts and applying them to the law (including knowledge of WCL Section 21-a, Section 120, and rules for prehearing conferences).   Goldberg Segalla’s Workers’ Compensation team is always available to help clients determine the merits of each individual claim and circumstance.

For a complete list of high-level guidance and updates from the New York State Workers’ Compensation Board, please see our New York State Workers’ Compensation Board COVID-19 Initiative Overview.

For more information or immediate guidance, contact:

• Christina M. Hassler
• Damon M. Gruber
• Sean J. McKinley
• Or another member of our Workers’ Compensation practice