When a New York workers' compensation patient needs treatment or testing that varies from the Medical Treatment Guidelines, the provider requests a variance through an MTG Variance PAR in OnBoard. The request carries a statement of medical necessity with supporting records, and the claim administrator has 15 calendar days to respond, or 30 if it requests an IME or records review. It replaced Form MG-2.
The Board-authorized treating provider makes the request, and delegates with their own Board-assigned user IDs can draft it for the provider's review. The claim administrator responds in OnBoard.
Download the current version from the source each time; forms change without notice.
MTG Variance Prior Authorization Request (PAR)
New York State Workers' Compensation Board takes this form through its online services or your EMR, so there is no PDF to fill. Vero Scribe writes the visit note it draws on, so the details are ready when you complete it.
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Form MG-2, the Attending Doctor's Request for Approval of Variance and Carrier's Response. Since May 2, 2022, variance requests are made online through OnBoard: Limited Release, and the Board no longer accepts paper variance requests.
Fifteen calendar days, or 30 calendar days if the claim administrator requests an independent medical examination or records review. If no response arrives in time, an Order of the Chair may be issued. Weekend or holiday deadlines may extend under General Construction Law 25-a.
Yes, within OnBoard. A Level 1 partial grant or medical denial goes automatically to Level 2 review by the claim administrator's physician. After Level 2, the provider may request Level 3 review by the Medical Director's Office, whose decision on medical necessity is final but does not guarantee payment.