In her 2025 State of the State, Gov. Kathy Hochul outlined several proposals aimed at improving access to medical care within the New York State Workers’ Compensation system. These initiatives, detailed in her “Fighting for Your Family” agenda and elaborated upon in subsequent announcements, focus on removing barriers to treatment for injured workers and streamlining the system for healthcare providers. Below is a summary of what she said and the potential effects on the administration of Workers’ Compensation claims.
What Gov. Hochul Said
The governor emphasized the need to enhance healthcare access for injured workers as part of her broader healthcare and workforce agenda. Key points from her address and related policy documents include:
1. Universal Authorization for Providers:
Hochul proposed legislation to allow all eligible healthcare providers — such as physicians, nurse practitioners, and others licensed under state law — to treat Workers’ Compensation claimants without requiring prior authorization from the Workers’ Compensation Board (WCB). She stated, “New Yorkers who are injured or become ill on the job need more options for care,” highlighting that the current requirement for WCB authorization limits access, particularly in underserved areas like upstate New York.
This was further detailed in a February 25 press release, in which she noted that the reform would give injured workers “freedom to see the providers they want, including their own primary care providers whom they already know and trust.”
2. Expanding Provider Participation:
She proposed increasing reimbursement rates to make participation in the Workers’ Compensation system more attractive to providers. Hochul argued this would address the shortage of authorized providers, a barrier that delays care and prolongs workers’ recovery.
In her words, “These proposals enhance access for workers… as well as compensate our medical providers at a rate far more attuned to the reality of providing care.”
3. Legislative and Regulatory Changes:
Hochul introduced four legislative proposals and one regulatory change, including:
Amending the Workers’ Compensation law to allow insurers to pay for medical treatment for up to one year without accepting liability, with automatic claim acceptance after that period unless controverted. She said this would ensure “injured workers get timely medical care” while providing transparency.
Allowing fellows and resident physicians in teaching hospitals to treat workers under supervision, leveraging New York’s academic medical resources to expand care options.
4. Building on Recent Reforms:
She highlighted prior efforts by the WCB, such as eliminating custom forms, adopting a universal billing form, and implementing an online system for prior authorizations and billing disputes. These, she said, complement her new proposals to “ensure that New York’s injured workers can access the timely and high-quality care they deserve.”
These points were reiterated in her 2025 State of the State book and supported by stakeholders like NYS Workers’ Compensation Board Chair Clarissa Rodriguez, who called the proposals “a win-win-win — great for workers, great for providers, and great for employers.”
Potential Effects on Workers’ Compensation Claims Administration
Hochul’s proposals could significantly reshape the administration of Workers’ Compensation claims in New York, with both positive and challenging implications:
1. Improved Access and Faster Treatment:
Effect: Allowing all eligible providers to treat claimants without WCB authorization could drastically increase the pool of available healthcare professionals, reducing wait times for treatment. Workers could see their own doctors, fostering trust and continuity of care.
Administrative Impact: Claims processing might accelerate as injured workers receive care sooner, potentially reducing the duration of disability and associated costs. However, the WCB and insurers may need to adjust oversight to ensure quality and compliance across a broader provider network.
2. Increased Provider Participation:
Effect: Higher reimbursement rates could attract more providers, particularly in rural or underserved areas, addressing the current shortage (e.g., only about 20 percent of NYS physicians were WCB-authorized as of recent estimates).
Administrative Impact: This could streamline medical reporting and billing as more providers engage with the system, but it might also strain administrative resources initially as the WCB updates fee schedules and onboarding processes.
3. Pre-Liability Payment Flexibility:
Effect: Allowing insurers to pay for treatment up to one year without accepting liability could expedite care while giving insurers time to investigate claims. The automatic acceptance provision after one year (unless controverted) adds predictability.
Administrative Impact: This could reduce early-stage disputes and paperwork, but insurers might face pressure to investigate claims faster, potentially increasing administrative workloads. It may also lead to more contested claims at the one-year mark if liability remains unclear.
4. Leveraging Academic Resources:
Effect: Including fellows and residents expands capacity in teaching hospitals, potentially improving care quality and access in urban centers with major medical facilities.
Administrative Impact: This requires coordination between the WCB, hospitals, and insurers to ensure proper supervision and billing, possibly adding complexity to claims tracking and payment systems.
5. Operational and Cost Considerations:
Effect: Faster treatment and broader access could lower overall claim costs by reducing lost work time, but higher reimbursement rates and increased provider participation might raise medical expenses for insurers and employers.
Administrative Impact: The WCB and insurers may need to enhance IT systems, training, and compliance monitoring to handle a larger, more diverse provider base and ensure adherence to regulations. Employers could see premium adjustments reflecting these changes.
6. Potential Challenges:
Without clear implementation guidelines, the system risks inconsistency in care quality or fraudulent billing from newly authorized providers. The lack of an authorization filter might also complicate fraud detection, a persistent issue in workers’ compensation.
The interplay with the New York Health Information Privacy Act (NYHIPA), if signed, could add further complexity. NYHIPA’s strict data rules might conflict with the WCB’s need for fluid health data exchange, potentially slowing claims if consent or retention requirements aren’t aligned.
Conclusion
Gov. Hochul’s 2025 State of the State proposals aim to dismantle longstanding barriers in the NYS Workers’ Compensation system, prioritizing injured workers’ access to timely, trusted medical care. By broadening provider eligibility, boosting reimbursements, and allowing pre-liability payments, these changes could streamline claims administration, reduce delays, and improve outcomes. However, they also introduce administrative challenges — such as managing a larger provider network, adapting to cost shifts, and ensuring compliance — that the WCB, insurers, and employers must navigate. If implemented effectively, with clear regulations and robust oversight, these reforms could modernize the system; otherwise, they risk overwhelming existing processes. The WCB’s ongoing support suggests momentum, but success hinges on execution.
This article originally appeared on the website of Goldberg Segalla on April 16, 2025 and is republished with permission of the author.
Topics Legislation Workers' Compensation
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