Medical records are the foundation of a workers’ comp claim. Before your benefits can begin, an authorized provider must examine you and submit a report to your employer’s insurance carrier verifying your injuries. The duration of your benefits hinges on the doctor’s reports. To protect your claim, seek medical care immediately, follow your treatment plan, and report all symptoms to your doctor. We can help you select a doctor and advise you on what to know about health care after a work injury.
How Long Do I Have to See a Doctor After a Work Injury?
You generally have 30 days to report an injury to your employer in New York, but you should see a doctor and report the injury within 24 hours if possible. Your employer and the insurance company could view any delay as a sign that medical care is unnecessary.
Workers’ compensation lost time benefits are available when your injuries prevent you from working at full capacity. A medical opinion is essential to prove your injuries are disabling. The sooner you obtain care, the sooner you will receive solid evidence to substantiate your claim.
Your doctor must submit a preliminary report to your employer, the Workers’ Compensation Board, and the insurance carrier within 48 hours of your initial exam and provide a comprehensive report within 15 days. If requested, the doctor must submit ongoing reports documenting your progress. To prevent your benefits from being denied or stopping prematurely, attend all appointments and follow your treatment plan for as long as it takes to reach maximum medical improvement.
Can Workers' Comp Force You to See Their Doctor?
New York workers’ compensation law gives you the right to choose your own treating doctor, but the doctor must be on the Workers’ Compensation Board’s list of authorized providers. If your employer participates in a preferred provider organization (PPO) network, you must also choose a provider in that network for the beginning of your claim. If you do not comply with these requirements, workers’ compensation insurance may not cover the cost.
The insurance carrier also has the right to obtain their own medical opinion about your medical condition from one of their consultants, via what is known as an Independent Medical Examination (IME). If you receive a notice for an IME, it is important that you attend the examination, arrive on time, and cooperate with the doctor.
What Not To Say to a Workers’ Comp Doctor
Workers’ compensation doctors have a duty to remain unbiased in their reports to your employer and their insurance carrier. If you say the wrong thing, it could jeopardize your benefits. To avoid complicating your claim, limit your discussion to your objective medical condition and report new symptoms as they occur. You should not:
- Exaggerate symptoms. Test results may reveal if you are exaggerating, and the doctor’s observations may reflect this in your medical records.
- Minimize symptoms. There is no benefit to acting tough or reassuring the doctor that you are okay. Minimizing symptoms could cause the doctor to prematurely report that you can return to work.
- Admit fault. Although workers’ compensation is a no-fault insurance program, you should still avoid accepting blame for the accident. While you should relate the mechanism of injury and how the accident occurred, focus on treating your injuries rather than assigning fault to the cause of the accident.
- Omit facts about pre-existing conditions or prior injuries. Diagnostic tests and prior medical records can reveal how long ago injuries occurred. Having a pre-existing condition or prior injuries do not disqualify you from workers’ compensation benefits if your accident aggravated the injury or caused a reinjury. However, omitting information or denying prior injuries could undermine your credibility or lead to allegations of fraud.
Can You Change Your Workers' Comp Doctor?
If you are dissatisfied with the care you receive from your workers’ compensation doctor, you are entitled to choose a different doctor. You must still select your new doctor from the Workers’ Compensation Board’s list of authorized providers or your employer’s PPO network, as applicable. You should notify your attorneys about any change.
What Happens If Workers' Comp Orders an Independent Medical Examination?
An Independent Medical Examination (IME) is a medical exam the insurance carrier may order at any time during your claim. The carrier chooses the independent medical examiner. Despite their title, independent medical examiners are not neutral. They are consultants for the insurance carrier. If you miss or refuse to attend an ordered IME, it could be harmful to your claim or cause you to lose your benefits.
You should receive a notice at least seven business days before the exam with the date, time, and location. These guidelines can help you protect your benefits when an IME is required:
- Arrive on time.
- Answer the examiner’s questions without adding unnecessary information.
- Bring a witness.
- Videotape or record the exam, and notify the examiner of the same.
- Contact our experienced workers’ compensation attorneys immediately if you are summoned to an IME.
If you do not receive a copy of the IME report, we can obtain it for you. If the insurance carrier reduces or suspends your benefits, or requests to do so, because of the IME, our dedicated New York City workers’ compensation lawyers can request a hearing before the Workers’ Compensation Board and appear on your behalf to keep your benefits as high as possible.
What Medical Expenses Does Workers’ Comp Cover?
Workers’ comp pays for necessary health care you receive for your work-related injury or illness. In most cases, your providers must bill the insurance carrier directly, and you are not subject to co-pays or deductibles. While some treatment, procedures, testing, and devise may require authorization, covered health care can include:
- Doctor visits
- Dental services
- Surgery
- Optometric services
- Nursing care
- Hospitalization
- Crutches
- Eye-glasses
- False teeth
- Artificial eyes
- Orthotics
- Prosthetics
- Assistive devices
- Physical therapy
- Occupational therapy
- Podiatric services
- Psychological therapy
- Chiropractic care
- Diagnostic tests
- Medications
You are entitled to reimbursement for most medication and supplies prescribed by your doctor and for travel expenses incurred seeking health care as long as it is authorized. Use Form C-257 to request reimbursement for your pharmacy or transportation expenses. You also may be required to obtain medications through a pharmacy chosen by your employer.
Rely on Shulman & Hill for Your Workers’ Compensation Questions
Our dedicated workers’ compensation attorneys have decades of combined experience helping injured workers get the benefits they are entitled to under the law. We can answer your questions and provide the personalized legal representation you deserve. We have recovered over $500 million in case results for injured clients. If you were injured at work, contact us online or call (212) 221-1000 to schedule a free consultation.
