From the Desk of Attorney David L. Niefer
PRACTICE TIP: Even though an injured worker might reside out of state, the New York State fee schedule can apply to treatment provided out of state as long as it would not be a “hardship” if the claimant were limited to treatment in New York State.
As a general rule, injured workers who reside outside of New York State and receive treatment outside of New York State are entitled to have medical bills paid for at the prevailing rates in the state where they reside and are receiving care. This rule is intended to preserve an injured worker’s ability to receive medical care in the community where they reside. Thus, the provider will be receiving the same rates whether treating a New York State claimant or a claimant injured in the jurisdiction in question.
Recently, however, the WCB has carved out an exception to the general rule. In L and L Painting Co., Inc., WCB G2817338 (3/3/22), a Board Panel reviewed medical bills of a Newark, New Jersey resident injured in New York State and obtaining physical therapy from a provider in Newark, New Jersey. The WCLJ ruled that the provider was entitled to be compensated at New Jersey rates based upon the claimant’s residency in New Jersey. On review, the Board Panel took note of the claimant’s residency in Newark “which is a relatively short distance to New York”. The Board Panel determined that if the claimant were confined to only treatment in New York State, such confinement would not be a “hardship.” The Board Panel therefore chose to compensate the Newark, New Jersey provider at the New York State fee schedule rates and modified the ruling below.
Before assuming that an out of state provider treating a claimant who resides out of state is to be compensated at the out of state rates, evaluate whether the claimant resides sufficiently close to New York such that obtaining treatment in New York State would not be a hardship. If an argument can be made that there would be no hardship, then a C-8.1 requesting application of the New York State fee schedule should be filed to the out-of-state provider’s bills.
If you have any questions about this or any other issue, contact David L. Niefer at firstname.lastname@example.org or (607) 723-0600 or any of the attorneys in our office. If you would like a training session on this or any area of the Workers’ Compensation Law, please do not hesitate to contact our firm.
This information is provided for general guidance only. This information should not be used as a substitute for consultation with legal counsel. Each case presents unique facts requiring individual analysis.