Governor Kathy Hochul today announced growing support for a significant element of her 2025 State of the State proposals to markedly improve access to health care for injured workers. The four legislative proposals and one regulatory change are designed to give injured workers more options for timely, high-quality medical treatment.
“New Yorkers who are injured or become ill on the job need more options for care,” Governor Hochul said. “My proposals do just that, giving injured workers freedom to see the providers they want, including their own primary care providers whom they already know and trust. Injured workers will no longer need to travel long distances or seek treatment from an unfamiliar provider just because their medical issue is work-related.”
First among these proposals is universally authorizing all eligible licensed health care providers to treat workers’ compensation claimants. Currently, only providers who are authorized by the NYS Workers’ Compensation Board may treat injured workers. While there are thousands of eligible medical providers in New York State, only about 10 percent have taken the additional steps required to become Board-authorized. Now they wouldn’t have to; authorization would be automatic as part of their licensing.
A second proposal allows resident and fellow physicians to treat injured workers, under a supervising provider, the same way they do for regular health insurance. This expansion could significantly increase provider participation at academic hospitals and health care systems.
Today, 40 percent of injured workers travel to a different county to receive care from a Board-authorized provider. On average, those in rural or suburban counties travel 35 miles or more to their workers’ compensation-related medical appointment. This proposal would allow for more, and closer, options for care.
While the first two proposals make it so more providers can treat injured workers, a third is aimed at making it more compelling to do so, and the remaining proposals will reduce delays in getting injured workers prompt medical treatment. These include:
- A proposed increase to workers’ compensation fee schedules (the amounts paid to health care providers for services in treating injured workers), to ensure that high quality providers in our system are paid at rates comparable to private health insurance.
- Legislation amending the Insurance Law to direct health care insurers to pay for medical treatment for workers’ compensation claimants when and while a workers’ compensation claim is disputed. Providers will be prohibited from collecting copays or coinsurance from the patient while the claim is under dispute. This ensures workers are no longer caught in the crosshairs of a dispute and can get the timely treatment they need, while also ensuring providers will get paid.
- Legislation amending the workers’ compensation law to permit workers’ compensation insurers to pay for medical treatment, without accepting liability, for up to one year. In addition to helping injured workers get timely medical care, the provision provides more transparency, requiring insurers to notify injured workers that such payments are being made and that their claim will automatically be accepted by the insurer at the one-year mark, unless the claim is controverted.
Governor Hochul’s latest proposals complement the many recent actions the Board has taken to increase provider participation. This includes eliminating custom forms and transitioning to a universal billing form to reduce administrative burden, use of an online system for prior authorization and requests to review medical billing disputes, quicker resolution of billing disputes and a significantly reduced need for provider depositions, among other improvements.
New York State Workers’ Compensation Board Chair Clarissa Rodriguez said, “The proposals put forth by the Governor are a win-win-win -- great for workers, great for providers, and great for employers. Workers will have far more options for care, providers can expand their practices and provide continuity of care to their existing patients, and employers will benefit from injured workers getting timely treatment so they can recover and return to work.”
Board Certified Occupational Medicine Physician Dr. Marc Wilkenfeld said, “It’s critically important that injured and ill workers get prompt medical care by professionals who understand their needs. The universal authorization that Governor Hochul has proposed will drastically increase the number of health care providers who can treat injured and ill workers in the workers’ compensation system. Additionally, New York State has top-notch teaching hospitals, so the Governor’s proposal to allow fellow and resident physicians to treat, under the supervision of a faculty physician, will further enhance the quality of care. Combined, these proposals will enable workers to get treated faster, increasing the likelihood that they will recover sooner and more fully.”
Worker Justice Center of New York Executive Director Alaina Evelyn Varvaloucas said, “Hundreds of thousands of New Yorkers labor in the state’s most dangerous industries and then find it nearly impossible to access adequate care for workplace injuries. In many cases, left untreated, these injuries lead to lifetime problems and can limit workers’ ability to continue working and supporting their families. These proposals enhance access for workers, particularly those in our upstate communities, as well as compensate our medical providers at a rate far more attuned to the reality of providing care. They are a critical step on the road toward real access to Workers’ Compensation benefits for all injured workers in New York.”
Occupational Medicine and Workers’ Compensation Expert Warren Silverman, MD, FACOEM, FACPM said, “Having a worker remain out of work due to a lack of sufficient healthcare providers when they might otherwise be rehabilitated rapidly and return to work is an unnecessary burden on the patient, cost to the system and to all parties, and a disruption to commerce in general. Opening up workers’ compensation to all physicians and providing a better reimbursement rate will benefit the injured or ill employee, the employer, the provider, the carrier and in general New York State. It is most clearly a win-win situation for all.”
The new workers’ compensation proposals are detailed in Governor Hochul’s 2025 State of the State Book, as part of an ambitious agenda to make New York safer, healthier, cleaner and more affordable for New York families.