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Choosing Your Doctor for a Work Injury in New York

Offered by Island Musculoskeletal Care MD, PC

After you’re hurt on the job, you need to get immediate medical attention. Seeing a doctor right away is the safest option for your health, of course: a doctor can diagnose and treat your injuries before they become worse. It also makes the workers’ compensation process smoother by creating documentation of your injuries.

Choosing the right doctor is critical to both your health and your legal rights. Fortunately, New York law puts injured workers largely in control of their choice of doctor.

In general, you can choose any doctor authorized by the workers’ compensation board

In New York, your employer is not allowed to pick a specific doctor or list of doctors that you must see after a work injury. For non-emergency treatment, workers’ compensation insurance will pay for you to see any doctor authorized by the Workers’ Compensation Board. (Note that you can go to any hospital or provider for emergency treatment, whether they’re authorized or not.) Authorized providers have gone through a screening and training process to ensure they are qualified to treat work injuries and navigate the workers’ compensation system.

There is one caveat: if your employer’s insurance company has a preferred provider organization (PPO), then you must choose a doctor who is in the PPO for the first 30 days after the work injury. However, you are still free to choose any doctor within the PPO, and you can change doctors within the PPO at any time; neither your employer nor the insurance company can require you to see a specific doctor. After 30 days, you are free to switch to any authorized physician, whether they’re in the PPO or not.

This legal protection is important because your doctor’s job after a work injury is not just to provide medical treatment. Your doctor is also a key advocate as your workers’ compensation claim moves forward.

You need a doctor who will advocate for the treatment you need

If you’ve never been hurt on the job before, you may be surprised by the way workers’ compensation works. When you get medical treatment through your regular health insurance, there are usually out-of-pocket expenses – co-pays, deductibles, and so on. Workers’ compensation is different: it pays for the full cost of all “reasonable and necessary” medical treatment for your work injury at no out-of-pocket cost to the injured worker. Your employer (and their insurance company) is responsible for everything.

The caveat is that the definition of “reasonable and necessary” is often contentious. Workers’ compensation insurance companies are notorious for disputing whether a particular procedure or medication is reasonable and necessary. Moreover, while they can’t control your choice of treating physician, they can require you to attend an independent medical examination (IME) with a doctor of their choosing. The IME doctor is hired by the insurance company – making the word “independent” a bit of a misnomer – and brings a certain degree of bias when determining whether your injuries require particular treatment.

This is one of the reasons why your choice of treating doctor is so important. A doctor who knows the workers’ compensation system can complete the documentation and fill out the forms needed to make the case for the compensation you need. If you’re required to attend an IME, your treating doctor can prepare the medical records that the IME doctor will review in order to put you in the best position to get your treatment approved. If you also have a workers’ compensation lawyer handling your case, then your doctor and your lawyer will work together to advocate for your medical treatment.

Your doctor also plays an important role in other workers’ compensation benefits

In addition to paying for your medical treatment, workers’ compensation pays certain disability benefits. If your injuries make you unable to work for a time, then workers’ comp pays two-thirds of your average weekly wage (AWW), up to a state maximum, to replace that lost income. If you are able to return to work but on a reduced basis (for example, you can’t work as many hours, or you have to take on lighter duties for reduced pay), then workers’ comp likewise pays two-thirds of the difference between your pre-injury and post-injury wages.

Again, the insurance company may dispute whether you are able to return to work or whether your injuries require work restrictions. Your doctor’s job is to document the extent of your injuries and identify the applicable work restrictions so that you can get the disability benefits you deserve under New York law.

Permanent injuries to certain parts of the body, including injuries to the extremities, can qualify you for schedule loss of use (SLU) benefits – meaning you can get financial compensation even if the injury doesn’t affect your ability to do your job. SLU compensation is based on a state formula and your percentage of disability.

For example, an injury to the leg is worth 288 weeks of compensation; if you sustain a knee injury that causes you to lose 25% of the overall function of that leg, then you would get 25% of 288, or 72 weeks of compensation. Your treating doctor’s job is to determine when you have reached maximum medical improvement (MMI) and assess the extent of impairment to each part of your body so that you can get all the benefits you are entitled to receive.

Choose a doctor with experience treating work injuries

Again, most doctors in New York can treat work injuries – but not all doctors are familiar with the intricacies and idiosyncrasies of the state workers’ compensation system. You need a doctor who can thoroughly diagnose your injuries, including diagnostic tests such as MRIs and EMGs, prescribe the appropriate treatment, and document your injuries in a manner that helps your workers’ compensation claim.

An experienced workers’ comp doctor understands how to assess claims, conduct comprehensive evaluations, and fill out the forms and documentation needed to move your case forward. Workers’ compensation doctors also understand the link between certain jobs and certain types of injuries, including shoulder, neck, and back injuries, and can help prove that your injury really was sustained at work. They also understand the urgency of work injury claims; ideally, you want to make an immediate appointment.

The sooner you see a doctor after a work injury, the better. Getting medical treatment is not only the best option for your health but also helps protect your legal rights by giving the insurance company less room to dispute or downplay your injuries. If you’ve been hurt on the job in New York, make an appointment with an experienced workers’ compensation doctor as soon as possible.

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