Under New York State’s workers’ compensation system, you have the right to any medical treatment needed for your work-related injury or illness, at your employer’s expense, as long as you and your doctor follow the rules. You also generally have the right to pick your own doctor. Read on to learn about the rules in New York for selecting your treating physician, switching doctors, seeing specialists, and being examined by other physicians to resolve medical disputes.
The treating doctor will make a number of important decisions in your workers’ comp case, including:
These decisions will not only play a critical role in your recovery, but they can affect how much you can receive in New York workers’ comp benefits.
Because of the treating doctor’s role, choosing a physician will be one of the most important decisions you’ll make in your workers’ comp case. So you might be wondering, what are the rules for selecting a doctor?
In general, New York lets you choose any doctor who’s on the list of authorized health care providers registered by the State Workers’ Compensation Board (WCB). Your employer’s insurance company may limit your options, at least at first, if it has a preferred provider organization (PPO). In that case, you must see a network physician for the first 30 days (the clock starts running when you go for the initial appointment). The PPO might also have a specific pharmacy you have to use.
Sometimes your initial doctor doesn’t work out. Maybe you don’t have a good relationship with the doctor, or your employer doesn’t think the treatment plan is helping. Both you and your employer may request a change.
Even if the insurance company has a PPO, you may switch to an out-of-network doctor 30 days after your initial visit with an in-network doctor. The new doctor must be on the WCB’s list of authorized medical providers.
Your employer may transfer your medical care to a different doctor if:
Your doctor may appeal a transfer when your employer claims that it’s in your interests.
If you need care or diagnostic tests that the treating physician can’t provide, your doctor may refer you to specialists for consultations, surgery or other procedures, physical therapy, and the like. The insurance company or the WCB will have to preapprove any specialist consultation, surgery, therapy procedure, or diagnostic procedure that costs more than $1,000, unless those services are needed on an emergency basis. If the insurer or the WCB doesn’t approve a referral request with reason or within 30 days, the request will be considered approved.
Your treating doctor will write regular reports about your diagnosis, treatment, progress, and ability to work. If you disagree with anything in one of those reports, you may request an independent medical examination (IME) to get an opinion from another doctor. Your employer and the insurance company may also request an IME. Either way, your doctor may be present during the exam. The examiner will write a report, which the workers’ comp judge will consider when making a decision about the dispute.
You won’t receive workers’ comp benefits during any time you refuse to cooperate with an IME requested by your employer or its insurer.
If you’re having trouble with your medical treatment, or the insurance company is balking at approving treatment or going along with your doctor’s opinion, you should speak to a workers’ comp lawyer. The workers’ comp system is complex, but you don’t have to navigate it alone. An experienced workers’ comp attorney can help you switch doctors, recommend a good doctor for your condition, get approval for necessary medical care, and get the benefits you deserve.