New York's Workers' Compensation Board (NY WCB) recently issued a bulletin touting its accomplishments over the last several years. While it’s hard not to be skeptical of a government agency patting itself on the back, in the NY WCB’s case, it’s entirely deserved.

New York and the NY WCB have taken meaningful action to improve the workers’ comp system by prioritizing physicians, taking drastic steps to remove barriers to physician participation and give employers and injured workers better access to qualified physicians.

As daisyNews has argued before, the treating physician is the single most consequential variable in a workers’ comp claim, directly impacting matters of medical treatment, duration of disability, and liability, i.e., the three biggest factors in employer costs. With the right treating physician, an injured worker returns to full employment faster, disability payments end sooner, and the employer enjoys the protection of strong documentation in the event of a dispute.

Clearly, New York and the NY WCB understand this. Their recent reforms reflect a thoughtful, proactive effort to bring more qualified physicians into the system and connect them with employers and injured workers with minimal friction.

California has taken the opposite approach.

Rather than expanding access to the right physicians, California’s Medical Provider Network (MPN) system restricts injured workers to a dwindling pool of providers, arguably selected not on clinical criteria but primarily for their willingness to accept reimbursement cuts. Lost in a tangle of opaque, mismanaged, discount-driven MPNs, California’s injured workers also face needless authorization treatment delays and remain injured longer.

The result has been more cost creation than cost control, with California employers’ premiums increasing last year and set to increase even more this year.

Under its new leadership, the California Division of Workers’ Compensation (CA DWC) should read the NY WCB’s bulletin closely, take notes, and start making its own changes.

NY WCB Prioritizes Physician Access

Collectively, the initiatives on the NY WCB's list of accomplishments serve one overarching purpose: making it easier for providers to say “yes” to treating injured workers (and by extension, making it easier for injured workers to access care).

Among the most impactful changes, New York instituted mandatory e-billing statewide in August 2025, a move that pays providers faster, reduces practice’s administrative burden, and simultaneously gives the NY WCB reliable data on every claim in the state. That data allows New York to monitor the system in real time, identify problems, and measure whether reforms are actually working.

The NY WCB also reduced administrative lag time and expedited dispute resolution. Wait times for hearings are down from 76 days to 35, and pending work items for the Claims Operations Division are down by 30%. Medical billing disputes arising from providers' submissions of Form HP-1.0 are resulting in administrative awards within 2-3 months (that’s with the NY WCB recently announcing that providers can file HP-1s to dispute payer denials of CPT 99080, which providers use to offset electronic billing costs).

New York has also expanded the pool of eligible providers by allowing resident and fellow physicians to treat injured workers under supervision, and is actively pushing to increase reimbursement rates under the state's Medical Fee Schedule. Governor Hochul, with the NY WCB’s support, is pushing to universalize provider authorization to treat injured workers statewide.

More physicians willing to treat injured workers means more injured workers reaching the right physician faster, and faster returns to work.

When treatment authorization is required, New York providers submit requests through a state portal that gives the NY WCB direct visibility into every authorization decision statewide. This gives the agency a reliable, real-time mechanism to monitor for abuse, track denial patterns, and hold bad actors accountable.

New York is not just attempting to expand access to care. It’s watching to make sure that access really happens.

CA DWC: Impeding Care, Ignoring Data

By contrast, California has built a system that works against employers at every turn.

Rather than connecting injured workers with the best available physicians, MPNs block access, restricting care to networks that are arguably defined not by demonstrable measures of physician quality but by providers’ willingness to accept sub-fee-schedule reimbursements.

As a result, specialists opt out rather than accept rates that can fall below Medicare and injured workers wait months or longer for appropriate care. Employers pay disability benefits the entire time, while many physicians who are capable of quickly returning an injured worker to full employment stick to the relative stability of treating group health and Medicare patients.

The CA DWC has compounded the problem by refusing to collect the data needed to expose just how poorly the state’s system is performing.

In 2016, California legislators passed Senate Bill 1160 requiring the CA DWC to develop a system for mandatory electronic reporting of every Utilization Review (UR) document issued by a claims administrator, giving the state the same kind of visibility into treatment authorization that New York now has. Nearly a decade later, the CA DWC still has not implemented the UR tracking system.

The consequences are real and damaging. daisyBill data for 2024 show treatment denial rates ranging widely between payers, from as low as 3% to as high as 46%. California regulators cannot explain these disparities because they refused to collect the data that would illuminate them. Without a state portal or mandatory UR reporting, there is no mechanism to determine whether treatment is appropriately authorized or systematically denied to cut costs.

The CA DWC also declared mandatory reporting to the state's Workers' Compensation Information System “voluntary” for payers and blew past a 2024 deadline to publicize UR data.

Instead of gathering data as state law mandates, California relies almost entirely on the insurer-funded Workers’ Compensation Insurance Rating Bureau (WCIRB) for system analysis, based on data that are not publicly or independently verified. When Governor Newsom vetoed legislation that would have required UR physicians to be California-licensed and accountable to the state Medical Board, he cited a lack of evidence that UR is broken, a claim that is only plausible because the CA DWC has refused to collect the evidence.

New York’s tech-forward approach is building a comprehensive, transparent dataset on every claim. California is deliberately looking away, and employers are paying for that willful blindness every time their premiums go up.

Time to Look East

California will soon have a new Governor, along with leadership changes at the Department of Industrial Relations and the CA DWC. New York has proven that prioritizing access to the right physicians (and collecting the data to prove it's working) is the foundation of a better-functioning workers' comp system.

Better access to the right physician means faster returns to work, lower disability costs, and fewer legal disputes. New York is doing the work to make the system more efficient. California is raising premiums to further fund inefficiency.

California's new leadership should look East, take notes, and start making changes that drive better metrics for workers’ recovery instead of driving up employers’ costs.

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