Pain Management & ESI

An epidural steroid injection (ESI) delivers corticosteroid medication directly into the epidural space — the area surrounding the spinal cord and nerve roots — to reduce inflammation around compressed or irritated nerve roots. In personal injury cases, ESI is typically indicated when radiculopathy from cervical or lumbar disc herniation does not adequately respond to conservative care (physical therapy, medications). ESI can provide significant relief from radicular pain and may allow patients to participate more effectively in rehabilitation. In some cases, ESI serves as a bridge to avoid surgery; in others, inadequate response to ESI supports the case for surgical intervention.

The NYS No-Fault Medical Treatment Guidelines (MTG) set specific criteria that must be met before interventional pain procedures like ESI will be authorized under No-Fault or No-Fault insurance. For lumbar ESI, for example, the MTG requires documented radicular symptoms, an adequate trial of conservative treatment, and objective imaging evidence of the targeted pathology. MAIC's treating physicians document each MTG criterion explicitly throughout the treatment course, ensuring that the clinical record supports authorization when the injection is requested. This proactive approach minimizes denials and authorization delays.

Trigger point injections involve inserting a needle into a myofascial trigger point — a hyperirritable spot in a muscle — and injecting a small amount of local anesthetic (with or without corticosteroid) to disrupt the trigger point and relieve associated pain. Trigger point injections are a covered service under New York State No-Fault insurance when medically indicated for myofascial pain syndrome documented to be accident-related. MAIC's pain management physicians provide these procedures with appropriate documentation of the clinical indication and treatment response.

When a pain management procedure is denied by a No-Fault carrier, MAIC's team manages the appeal process. Our physicians produce structured prior authorization appeal letters that specifically address each gateway criterion cited in the denial, reference the supporting clinical documentation, and cite the applicable MTG chapter and section. We track appeal deadlines and coordinate with the referring attorney's office on the status of authorization disputes. This comprehensive authorization management is part of MAIC's standard service to referring attorneys.

Yes. MAIC accepts New York State No-Fault insurance and No-Fault for pain management procedures including ESI, nerve blocks, and trigger point injections. All procedures require appropriate prior authorization, which MAIC's coordination team manages. We also accept medical liens for patients without active coverage. Our pain management division works closely with MAIC's billing team to ensure that all procedures are properly authorized and billed in compliance with NYS No-Fault and WCB fee schedules.