Universal Authorization: Will It Change New York Workers’ Compensation for Carriers?

Having practiced on both the claimant and carrier sides of New York workers’ comp, I’ve had the opportunity to see the system from both perspectives. One thing that has become abundantly clear is that New York is widely recognized as a decidedly claimant-friendly jurisdiction. Carrier attorneys will say it openly. Claimant attorneys may be a bit more diplomatic about it, but many privately acknowledge the same reality. The practical realities of litigating claims have long favored claimants, often making it difficult for carriers to challenge questionable claims, questionable treatment, or questionable medical opinions as aggressively as they might in other areas of civil practice.

For that reason, whenever a significant legislative change comes along, the first question from the carrier side is usually the same: does this move the needle?

In my view, Universal Authorization probably doesn’t. Beginning Jan. 1, 2028, virtually any eligible licensed medical provider in good standing will be able to treat injured workers without first obtaining special authorization from the Workers’ Compensation Board. This is one of the most significant administrative reforms the system has seen in years, but it doesn’t alter the legal standards governing compensability, and most importantly doesn’t change the way Law Judges evaluate claims. If New York was claimant friendly on December 31, 2027, it will almost certainly still be claimant friendly on January 1, 2028.

That doesn’t mean the legislation is unimportant. It simply means its benefits are likely to be practical rather than philosophical. The obvious beneficiaries are injured workers, who should have access to a much larger pool of treating physicians, and medical providers, who no longer have to navigate a separate authorization process before deciding to participate in the system. The benefits to carriers, however, are less obvious.

Potential Benefits for Carriers

One area where carriers may see an indirect benefit is claim duration. Delays in obtaining medical treatment rarely help anyone. When claimants wait months to see specialists or establish care with an authorized provider, indemnity exposure often continues while very little happens on the file. If Universal Authorization succeeds in getting injured workers evaluated and treated more quickly, some claims may reach MMI sooner, return-to-work issues may be addressed earlier, and settlements may become possible sooner than they otherwise would have been.

The legislation may also provide carriers with access to more complete medical histories. One of the Board’s primary goals is to allow injured workers to continue treating with physicians they already know and trust. From the claimant’s perspective, that promotes continuity of care. From the carrier’s perspective, it may also mean that treating physicians have years of records documenting prior injuries, degenerative conditions, unrelated medical issues, and preexisting functional limitations. Those records may become valuable when evaluating causal relationship, disability, or apportionment. Continuity of care does not automatically strengthen a claimant’s case. Sometimes it provides a clearer picture of the claimant’s overall medical condition than has historically been available.

There is also the possibility that bringing new physicians into the system will produce more objective medical opinions. Many experienced workers’ compensation providers have practiced almost exclusively within this arena for years. Fairly or unfairly, some develop reputations for consistently favoring one side or the other. Physicians entering workers’ comp from general practice or specialty medicine may approach these cases with fewer preconceived notions and may simply evaluate the patient as they would any other patient in their practice. That will not necessarily favor carriers, but it may result in opinions that are viewed as more independent.

Potential Risks and Challenges

At the same time, carriers should be realistic about the potential drawbacks. Expanded access to physicians will almost certainly result in expanded utilization of medical care. More available providers are likely to mean more office visits, more referrals, more diagnostic testing, and more treatment requests. Some of that care may ultimately reduce indemnity costs by improving recovery and facilitating an earlier return to work. Some of it may simply increase medical exposure.

There is also the question of experience. Workers’ comp has its own terminology, reporting requirements, and legal standards. Physicians who are excellent clinicians may have little familiarity with concepts such as causal relationship, degree of disability, permanency, or the Medical Treatment Guidelines. During the transition, carrier attorneys may see more reports that fail to adequately address the legal issues in dispute. That may lead to additional hearings and/or more depositions while providers become familiar with the system. That possibility only reinforces the importance of expanding the available pool of IME physicians, however based on the current statutory and regulatory framework, IME authorization appears to remain a separate process from treating authorization, so any expansion of IME availability should not be assumed absent further guidance from the Board or legislative change.

One issue worth watching is whether the Board’s training and outreach efforts are sufficient to shorten this learning curve. The legislation gives the Board time to prepare for implementation, and it has emphasized education as a key component of the rollout. If that training is effective, the transition may be relatively smooth. If it is not, carriers may spend several years litigating issues that experienced workers’ compensation providers had long since learned to address. The success of this reform may depend as much on provider education as it does on provider participation.

Key Takeaways

Ultimately, I don’t believe Universal Authorization will make the system materially more defense friendly, nor will it alter the legal standards that have contributed to its longstanding claimant-friendly reputation. What it may do is improve the mechanics of the system. If injured workers receive appropriate treatment sooner, if claims move more efficiently, and if both sides have access to better and more complete medical information, there may be tangible benefits to be realized on the carrier’s behalf.

Whether those operational improvements ultimately reduce litigation or simply shift it into different areas remains to be seen. Like many significant reforms in workers’ comp, the success of Universal Authorization will depend less on the language of the legislation than on how it is implemented over the next several years. For carrier attorneys, the question is no longer whether the system has become more defense friendly (it likely hasn’t). The better question is whether a more efficient system can also become a more predictable one. If Universal Authorization accomplishes that, carriers may find ways to ultimately benefit, even if the playing field itself remains unchanged.