Key Takeaways:

• The NY Workers’ Compensation Board has announced new Medical Treatment Guidelines—including new Guidelines covering Complex Regional Pain Syndrome—become effective on May 2, 2022.

• The extensive Guidelines for Complex Regional Pain Syndrome are noted to be mostly associated with recent trauma or injury, and are broken down into two categories: CRPS-I and CRPS-II.

• These Guidelines will be particularly helpful to avoid misdiagnosis of the condition, along with specific management and treatment protocol recommendations for those injured workers who have been diagnosed.

The New York State Workers’ Compensation Board has announced new Medical Treatment Guidelines that become effective May 2, 2022. Today’s alert includes a breakdown of the section for Complex Regional Pain Syndrome (also commonly referred to as CRPS or RSD).

The Board has collaborated with physicians to produce a series of Guidelines that define the medical standard of care for certain published conditions, and allow for certain treatment to be covered without necessitating approval if defined within those Guidelines, leading to prompt treatment and a better defined liability for the carrier.

About the New Guidelines

The Complex Regional Pain Syndrome Guidelines, found here, encompass 320 pages of instructions, with the first section dedicated to diagnosing the two categories of the condition through use of motor, sensory, vascular, psychological, and neuropathic testing. The two categories include CRPS-I—which is also known as Reflex Sympathetic Disorder [RSD]—and CRPS-II—Causalgia, which involves a specific nerve and distribution. There is guidance for specific signs and categories that take this condition out of the diagnosis of exclusion category, which should assist in requiring specialized physicians in the best position to render the diagnosis.

Most of the Guidelines are dedicated to the Appendix, which provides questions to be posed to patients in order to reach a diagnosis. Additionally, there are management algorithms to guide on achieving functional improvement in the setting of the diagnosis. Last, it is noted that the diagnosis is generally reached by medical professions with specialization of Pain Management, Neurology, or Physical Medical and Rehabilitation.

Recommendations for New York Workers’ Compensation self-insureds, third party administrators and carriers

Insurers are recommended to review the new Guidelines for Complex Regional Pain Syndrome to ensure they are prepared when the diagnosis is being considered, or is already established, to confirm appropriate use treatment and medication modalities are being employed in the case. The New York State Workers’ Compensation Board will be offering training for all of the sections of the Medical Treatment Guidelines; further information is available here.

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

• Christina M. Hassler
• Serena David
• Damon M. Gruber
• Sean J. McKinley
• Or another member of the firm’s NYS Workers Compensation