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When a Level 1 PAR decision results in a denial or partial approval for medical reasons, it automatically escalates to Level 2 physician review. No additional provider action is required for most PAR types. The exception is Medication PARs, where the provider must initiate the Level 2 escalation request through OnBoard.

Level 2 introduces a peer-to-peer clinical review to uphold or overturn the initial decision. If the provider disagrees with the Level 2 outcome, they may escalate to the New York Workers' Compensation Board's Medical Director's Office for a final, binding determination. Knowing how each level works helps claims teams manage timelines, set expectations, and respond appropriately when decisions are challenged.

Learn more here: Navigating NYS Medical Treatment Guidelines and PARs: 2026 Compliance Update