Authorization for MG-2 Variance Requests
- The doctors must complete and submit the MG-2 to the insurance carrier and the Workers' Compensation
- Partial variances can be
- Variance requests must be submitted to the carrier and the workers' compensation board within two business days of the medical provider preparing and signing the
- Variance denials are resolved by a medical arbitrator, unless the claimant or insurer requests a hearing.
- Submission of duplicate variance requests is prohibited when:
- Time has not expired for the review of the initial request or
- New medical information to support the resubmission request has not been provided.
- Variance requests that are substantially similar to previously submitted requests can be denied by the carrier on that ground alone, without obtaining a new medical opinion on the need for such treatment. The Board may refuse to issue an order of the chair for a substantially similar request submitted while one is pending or without new medical information.
- If the carrier has not replied to a variance request within the allotted time, call the board and request an order of the
What makes an MG-2 Form Complete:
The Board won't take action on an MG-2 form, unless the following fields are completed:
- Patient's name, and
- Insurance Carrier's Name &
Please note that the Insurance Carrier's or TPA's name and address must match the information the Board has on file.
(1) Individual Provider's WCB Authorization Number for all providers authorized by the New York State Workers' Compensation Board
- Date Variance Request Submitted and Method of Transmission,
- Guideline Reference for the body part followed by the 2 to 4 character corresponding reference in the Medical Treatment Guidelines or followed by the four letters N-0-N-E ifthere is no listed procedure,
- Approval Requested For requires a written description of the treatment requested,
- Statement of Medical Necessity requires a description directly on the form and ifthere is a supporting medical report in the Board's case file, enter the date of service or if there is no supporting medical report in the case file, attach a medical report and enter "See attached medical report" on the form;
- A check box selected for how the carrier was contacted. Please note if you listed your fax number at the top of the form, do not select the second check box; and
- The Provider's signature or stamp. Please note that initials next to the signature or stamp are not
Denial of MG-2 Variance Requests
When an MG-2 is denied, a request for review of a variance denial is directed to medical arbitration unless the claimant or the insurer requests review by a workers' compensation law judge. The request for review by a medical arbitrator or a law judge may be made on a case-by case basis. The claimant or his/her legal representative must file a request for review of a denial of a variance within 21 business days of the receipt of the insurance carrier's denial.
**This information is based on New York State. Each state may be different. This blog post is for informational purposes. Your specific circumstances may vary from the information provided. Every case is different. Prior results do not guarantee future outcomes. The contents contained in this post do not establish an attorney-client relationship. Please contact us before sending confidential or time-sensitive material**