Why The Right Medical Reports Matter In New York Disability Claims

The Right Medical Reports Matter

As of January 2012, the State of New York released their updated Guidelines for Determining Permanent Impairment and Loss of Wage Earning Capacity. These will apply to any case without a medical opinion determining permanent impairment with a rating based on the 1996 Guidelines.

Getting the Right Paperwork

Each state has their own particular Guidelines when it comes to Workers’ Compensation and Disability claims, but what all states have in common is one thing: the need for proof that an injury is present, as well as the extent of the injury.

In the state of New York, the degree of disability is determined by a medical professional, rated according to the scale of mild, moderate, marked and total, and converted into a percentage as follows:

  • Mild – 25%
  • Mild to Moderate – 33%
  • Moderate – 50%
  • Moderate to Marked – 67%
  • Marked – 75%
  • Total – 100%

The percentage of the rate received is based on these numbers, until such time as a patient reaches Maximum Medical Improvement (MMI), after which a permanent wage loss earning capacity is determined. Should the insurance carrier or Workers’ Compensation carrier disagree with the opinion of the patient’s doctor, they may order an evaluation by an Independent Medical Examiner (IME). It is important to note that, in these cases, the Workers’ Compensation Board does not automatically rule in favor of either doctor, and a complex legal proceeding may result.

According to the New York State Workers’ Compensation Board, “If a treating provider or independent medical examiner (IME) is asked to provide a permanency evaluation and believes that the injured worker has not yet reached MMI, the provider must document the treatment the claimant is receiving, specific improvements that are expected, and a timeframe by which the claimant is expected to reach MMI.” In other words, medical professionals are required to have the proper documentation and data related to a specific patient, in terms of their treatment as well as projected recovery.

Accurate and objective data is the key to not only expediting a Workers’ Compensation or Disability claim in New York, but the foundation for successful treatment. When it comes to the medical field, opinions can vary greatly; objective data is much more effective as it does not rely on mere observation alone.

Understanding the need for providing accurate reports that demonstrate need for care and document improvement objectively, Kennebec’s P.R.O.O.F. Preferred system combines time-tested Range of Motion (ROM) and musculoskeletal testing (MT) technology with the cutting-edge software. The P.R.O.O.F. Preferred system’s tests and printable reports are designed to produce reliable assessments that can be used for impairment or disability as well as monitoring and documenting treatment effectiveness and medical necessity. These reports have been proven to be effective in reimbursement situations, Independent Medical Exams (IME) and Personal Injury and Worker’s comp cases, providing reliable and effective documentation that can prove medical necessity and allow for the proper treatment plan.

If you are looking for a state-of-the-art system that can prove medical necessity by providing tangible yet accurate information, P.R.O.O.F. Preferred’s Range of Motion and Muscle Testing devices are modular in nature, with options to customize your system so that it meets the needs of your practice and your patients. For more information on Kennebec’s cutting-edge products, contact them today to speak with one of their expert staff.