The 10 Most Common New York State Medical Treatment Guideline Forms Mistakes We See

New York has one of the most complex medical treatment processes in the U.S. When the claims process gets delayed, it’s most often because the necessary New York State Medical Treatment Guideline forms—including MG-2 and MG-1—were filed incorrectly.

With strict deadlines, steep penalties and a more formalized process than other states, it’s critical to the health of injured employees and the productivity of employers, providers and carriers that these forms are filled out correctly from the get-go.

We review thousands of NYS MTG forms a year for our clients. Here are the 10 most common form mistakes we see so you can avoid them:

1. No/incorrect date of injury (DOI) or claim number noted on the form
   This usually happens when a claimant has more than one claim and the provider's office mistakenly lists a request for treatment with the wrong claim. For example, a form with a request for right knee physical therapy with the claim number and date of injury for a worker's comp injury an employee sustained on his left elbow.

2. The doctor’s name and address are missing on the top of the forms
   This can cause delays as recipients try to track down the appropriate doctor.

3. The doctor’s WCB number is missing
   Doctors’ authorized to treat Worker's Compensation claims in NY State are given a WCB number that needs to be filled out at the top of the forms. Out of state providers submitting forms are still required to enter their NPI number even if they do not have a WCB number.

4. No guideline reference number
   This is the number that corresponds to the section of the Medical Treatment Guidelines that the requested treatment relates to. The form is a request to vary from the Medical Treatment Guidelines and including this section is critical to correct and timely filing.

5. No treatment specified
   Many times providers attach medical documents that mention the requested treatment but they neglect to fill out the treatment on the form itself.

6. No body part specified
   Similar to above, providers often note the injured body part in the medical documents they attach but not on the form itself. We also see requests for body parts that are not part of the Medical Treatment Guideline form, which covers knee, mid and low back, shoulder, neck, carpal tunnel and non-acute pain.

7. No duration or frequency listed for medication and/or physical therapy
   This can delay much needed prescriptions and treatment for injured employees and delay their return to work.

8. Missing signature
   When the provider neglects to sign the form it’s unable to be processed.

9. Missing or late date

   Often, we find providers neglect to date the form. We’ve also received forms where the date is beyond two days of the carrier's receipt of the form, which means the form is automatically denied and the process needs to start again.

10. No medical documents filed with the Board

    This constitutes a denial based on "no burden of proof." If there is no medical documentation supporting the request for treatment that varies from the guidelines, then the treatment cannot be approved.

 As experts on NYS MTG, we review close to 10,000 variance requests a year for our clients. Our medical professionals ensure the requesting provider is authorized by the Board to treat WC patients and that all forms are filled out correctly, body parts are compensable to WC injury and that the treatment requested is medically necessary. This creates faster, more straightforward claims processes and gets injured employees the care they need and back to work. Learn more about how we can help here.