April 30, 2007
State Superintendent of Insurance reviews progress towards administrative workers' comp reforms
The state Department of Insurance has made "substantial progress" in its efforts to put administrative policies in place that are considered key components of the landmark workers' compensation reform agreement announced earlier this year.
Eric R. Dinallo, superintendent of insurance, outlined the department's progress in an April 27 letter to Governor Spitzer. The Governor had requested the update earlier this year.
The status report outlines progress in designing a data-collection system for workers' compensation, streamlining the adjudication process for resolving disputed claims, and developing objective medical guidelines to be used in determining the degree of disability in workers' comp cases.
Dinallo said the department has developed a plan to gather indemnity and medical data, labor market data, and rate data, which would be used to establish benchmarks, monitor how elapsed time long it fast injured workers return to work, and evaluate the "affordability and fairness of rates."
He said the Insurance Department plans to ask insurance carriers to provide information on the costs of drugs, medical procedures, and equipment provided to claimants. The department will work with the state Department of Labor and the Workers' Compensation Board (WCB) to develop ways to collect relevant data from the WCB and insurance carriers.
The best way to determine how fast workers return to work is to compare data kept by the WCB and insurance carriers with data maintained by the state's unemployment insurance system, Dinallo wrote. A comparison of this data and data maintained by carriers and the WCB "would provide a good statistical picture of the rate at which injured employees return to work." The Insurance Department plans to develop a method for making this comparison.
Dinallo also noted that the state Department of Labor is doing research "to determine the best practices for facilitating an injured employee's return to his or her previous job, to a modified job, or to new employment following vocational rehabilitation training."
Data to be used to evaluate rates should include data on insurance carriers' losses and costs, unemployment insurance and wage data from the state Department of Labor, the letter added.
Streamlined adjudication procedures
Dinallo said the Insurance Department will send proposals to the chair of the WCB on how to reduce needless delays in disputed cases by June 1.
Noting that many workers' comp claims are contested, and that it takes about 240 days to resolve disputed claims, Dinallo said the department is considering several administrative rules and regulations to let judges rule on cases "where legal and factual issues are straightforward."
The department is also considering steps to minimize hearings in cases in which the facts are undisputed, new regulations to require the completion of discovery before scheduled hearings, and steps to discourage repeated adjournments of hearing dates due to unavailable witnesses.
And the department is considering streamlining adjudication procedures to improve the rate at which injured workers return to work, the letter added.
The Insurance Department also said it was working to develop objective impairment and treatment medical guidelines. The guidelines are aimed at reducing the need for “factual conflicts” and “battles of experts” before the Workers' Compensation Board.
The Insurance Department acknowledged that the need for impairment guidelines “has become even more pressing in light of the new legislation, which requires judges to make precise disability findings along a much broader range of disability percentages than under the previous law.”
The department said its treatment guidelines will develop a system for “evaluating and treating common occupational injuries,” and reduce disputes that may delay medical care. The guidelines will also provide the basis for more successful return-to-work outcomes, the letter said.
“Since the issuance of your letter, the Department has been collecting both impairment and treatment guidelines used in other states and assessing whether any of them would be appropriate models for New York,” the letter said. “In order to understand the strengths and weaknesses of various guidelines used in other states and the effects of these guidelines in practice, we have had extensive discussions with individuals who have both drafted and evaluated them. We are also continuing to reach out to representatives of the medical community in New York to solicit their input and suggestions."
Dinallo said he expects that final guidelines will be produced by December 1 of this year.