Court of Appeals of New York

In this case, claimant was injured on the job and entitled to worker's compensation, but upon receipt of acupuncture treatment, a Workers' Compensation Law Judge determined that claimant's medical provider failed to show that the additional acupuncture treatments were medically necessary. The Workers' Compensation Board affirmed the Judge's determination, arguing that the treatments were not medically necessary within the "Medical Treatment Guidelines." Order of the Appellate Division affirming the Board's decision is affirmed, where: 1) the establishment of the variance procedure was within the Board's broad regulatory powers; 2) it was reasonable for the Board to promulgate uniform guidelines for defining the nature and scope of treatment considered medically necessary; 3) nothing in the Workers' Compensation law precludes the Board from requiring proof of medical necessity from claimant's health care provider; 4) the carrier bears the burden of proffering "substantial evidence"; and 5) the Guidelines provide claimants with a meaningful opportunity to be heard on the denial of any variance request.

Appellate Information

• Decided 11/20/2014
• Published 11/20/2014

Judges

• Pigott

Court

• Court of Appeals of New York

Counsel