Medical Treatment Guidelines for PTSD and Depression: Why Now?

By Dr. Howard Rombom | November 23, 2020

The New York State Workers’ Compensation Board has proposed medical treatment guidelines for PTSD and depression. There is no reason given.

In the middle of a global pandemic which has severely impacted New York, putting forth new guidelines to treat depression and PTSD is irresponsible. Providers need to cope with a uniquely changing health care delivery system that is adapting to the rigors of telemedicine. The NYS Workers’ Compensation Board is in the middle of a vast overhaul of its administrative system requiring providers to change entire practice management software, systems and procedures.

And yet, despite all of the demands on medical providers, the Board has chosen to totally “revamp” behavioral healthcare for injured workers.

Why…and why now?

The New School Center for New York City Affairs published a report entitled Time for a Real Look at How the New York State Workers’ Compensation System Treats Workers.

New York State was the first state to adopt Workers’ Compensation regulations; New York was once “a national leader in safeguarding the interest of workers injured on the job.” The report continues:

“However, worker protections under New York’s Workers’ Comp System have seriously eroded over the years as legislative and administrative changes have focused on curtailing benefits rather than minimizing injuries, adequately compensating injured workers, or fostering the return to work. Fairly compensating injured workers used to be the guiding principle for Workers’ Compensation; for the last several years, changes have reduced employer costs and boosted insurance company profits.”

The report describes in detail the changes and deficiencies of the New York State Workers’ Compensation System including the continuing reduction in benefits and treatment availability for injured workers in New York State.

“Profits have soared for New York’s Workers’ Compensation insurance companies while payments to or on behalf of workers for indemnity and medical costs have fallen in absolute and relative terms.

The total dollar amount of workers’ benefits fell 28% from 2014 to 2018 while insurance profits tripled.

“New York workers’ comp profits topped 1 billion dollars for the first time in 2017, then jumped more than 50% to nearly 1.6 billion in 2018. Benefits paid to or on behalf of injured workers were only 47% of premiums in 2018, while Workers’ Comp insurance profits were an unbelievable 27% of every premium dollar.”

In its review of the New York State Medical Treatment Guidelines, the report concluded that: “New York State’s Medical Treatment Guidelines, adopted in late 2010, are another source of friction for workers attempting to access Workers’ Compensation benefits. Physicians must strictly adhere to the new Medical Treatment Guidelines or request a variance from the Board. According to the Workers’ Compensation Research Institute, the Medical Treatment Guidelines have not generated any significant medical cost savings but have created millions of dollars in cost due to the tens of thousands of variance hearings, while also preventing workers from receiving medical care in a timely fashion.”

“Immigrants, some of whom may experience language-access problems navigating the Workers’ Comp System, hold over one-third of all jobs in higher-than-average injury-prone industries, including construction, transportation and warehousing, hotels and restaurants. Immigrants account for 28% of all New York workers.”

The new proposed medical guidelines do not provide for cultural sensitivity or awareness, the impact of these new guidelines will profoundly affect the immigrant population and workers of color throughout New York State.

Workers in New York State have struck a “bad bargain when evaluated against the indemnity benefits, they were provided under the state laws.” It has been a “bad bargain” because benefits paid to workers were far from adequate. This includes the ability of injured workers to receive the medical care they require.

“Over the past five years, 2014 to 2018, the profitability of New York’s Workers’ Comp insurance companies greatly exceeded that of other insurance lines in New York and slightly surpassed the average performance of Workers’ Comp insurers in other states.”

Since the “reforms,” payments to or on behalf of workers have fallen relative to Workers’ Comp premiums while insurance company profits have soared; Workers’ Comp profits skyrocketed to 1.6 billion in 2018 and rather than improving the benefit structure for injured workers, premium rates are being slashed. The State Insurance Fund had net income over 1 billion in 2018 and now has a surplus of over 7 billion dollars.”

Why has the Workers’ Compensation Board determined at this time to severely limit the treatment injured workers can receive when facing a psychological/behavioral/emotional injury?

It is time to let the New York State Workers’ Compensation Board know that these Medical Treatment Guidelines are an anathema to injured workers in New York State and the obvious, although unstated goal of these new guidelines is to limit care, thereby limiting costs and further increasing profits. The resulting impact on workers will be increased suffering, ongoing disability as well as disruption to their families and their lives.

The proposed new Medical Treatment Guidelines for PTSD and Major Depressive Disorder demonstrate that the Workers’ Compensation Board in New York is abandoning injured workers, telling them they are not important enough to receive necessary care, that their problems are not really that serious, and that they can only receive minimal treatment.

Let the NYS Workers’ Compensation Board know that these proposed guidelines should be abandoned and the New York’s injured workers deserve better than this.

Send your comments to: [email protected]

Don’t let profits override the care injured workers require and deserve.


Howard M. Rombom, Ph.D. is Owner and Clinical Director, Behavioral Medicine Associates. Behavioral Medicine Associates is the leading provider of psychological care to injured workers in New York State.