NY Workers’ Compensation Board Bans Spinal Surgeon
A New York court has upheld a decision by the New York State Workers’ Compensation Board to bar a spinal surgeon from treating injured workers under the state’s workers’ compensation system. The ruling confirms that the board acted within its authority when it denied the physician’s request to continue treating patients whose care is covered by workers’ compensation insurance.
The case centers on an orthopedic spinal surgeon who had previously been authorized to treat injured workers. In April 2025, however, the New York State Workers’ Compensation Board decided not to reauthorize him after reviewing concerns about his medical practices. The board cited multiple allegations of professional misconduct, including claims that he performed unnecessary or risky invasive surgeries, failed to follow established treatment guidelines, and maintained inadequate documentation.
According to the board’s review, the man’s treatment practices raised serious concerns when compared to other medical providers. Officials found that the rate of improper treatment associated with his cases was about twice the average for physicians treating workers’ compensation patients. The board also alleged problems involving improper pre-authorization requests and incorrect billing procedures. These findings led regulators to conclude that he should no longer be allowed to treat injured workers within the system.
The surgeon challenged the decision in court, arguing that the board’s action was unfair and improperly influenced by outside allegations. He claimed the board was biased against him because he had been named in a federal lawsuit accusing him and several other professionals of participating in a scheme to inflate workers’ compensation injury claims. The lawsuit, filed under the federal Racketeer Influenced and Corrupt Organizations (RICO) Act, alleged that certain medical providers and law firms worked together to generate fraudulent or exaggerated workplace injury claims in order to collect large insurance payouts.
The surgeon argued that the board relied too heavily on the allegations contained in the RICO lawsuit rather than conducting its own independent investigation. He asserted that regulators simply adopted the views of the plaintiffs in the federal case.
However, the New York State Workers’ Compensation Board disputed that claim. The board stated that it conducted its own detailed review of the surgeon’s treatment of injured workers, including evaluating patient records and consulting medical experts. Based on that review, the board concluded that its decision to deny reauthorization was justified.
A judge in Schenectady County Supreme Court ultimately agreed with the board’s position. In a ruling issued March 5, the court found no evidence to support the surgeon’s claim that the board had acted improperly or conspired against him. As a result of the ruling, the surgeon remains barred from treating patients within New York’s workers’ compensation system and cannot receive reimbursement for such services.
Contact Us for More Information About Workers’ Compensation Benefits
The court rulings show how insurance fraud and workers’ compensation intersect in New York. Doctors can engage in improper treatment practices and cause injured workers to suffer in the process.
A White Plains workers’ compensation lawyer from The Law Office of Michael Lawrence Varon can help you get appropriate treatment and compensation after a workplace accident. Schedule a consultation with our office by calling (914) 228-1770 or filling out the online form.
Source:
insurancejournal.com/news/east/2026/03/12/861428.htm
