Your Doctor's Role in a Workers' Compensation Claim

Physical injury at work of construction worker

Make sure you get the right treatment if you're hurt on the job

New York workers put their health on the line every day, and some of the most common work injuries are musculoskeletal injuries that require orthopedic treatment. The good news when you're hurt on the job is that your treatment is covered by workers' compensation. The bad news is that you have to navigate the workers' compensation system, which can be complex and challenging even for seasoned professionals, let alone for injured workers who are just trying to get better.

Your choice of doctor can make all the difference when you're hurt on the job, not just in the quality of treatment you receive, but also in how smoothly your claim progresses. Here's why you need a doctor who has experience treating injured workers.

Your doctor is involved at nearly every stage of the workers' compensation process

Workers' compensation pays for the full cost of all reasonable and necessary medical treatment for a work-related injury or illness. That includes office visits, medical procedures, surgery, medication, medical devices, physical therapy, rehabilitation, and any other treatment you may need. Unlike most health insurance policies, there are no co-pays, deductibles, or other out-of-pocket expenses for medical treatment; it's all covered by the workers' compensation insurance company.

The key phrase there is "reasonable and necessary." It's unfortunately common for insurance companies to dispute whether a particular procedure or medication is "reasonable and necessary" to treat a work injury. They may also argue that a particular condition is pre-existing or otherwise unrelated to your work injury. As such, in addition to actually providing treatment, part of your doctor's job is to diagnose and evaluate your injuries, prescribe treatment, fill out paperwork and make the case that the treatment you need is indeed reasonable, necessary, and covered by workers' comp.

In addition, your doctor needs to provide documentation and medical evidence for other aspects of your workers' compensation claim, such as temporary or permanent disability, work restrictions, and schedule loss of use (SLU) benefits for permanent injuries to certain parts of the body. If you are represented by a workers' compensation attorney, then your doctor and your lawyer will work hand-in-hand to advocate for the treatment you need and the benefits you deserve under New York law.

In New York, you're free to choose your workers' comp doctor

While some states give employers a greater degree of control over the choice of doctor, in New York, patients are generally free to choose any physician authorized by the Workers' Compensation Board to treat their work injuries (with some caveats in the first 30 days depending on the insurance policy).

While most doctors are capable of treating work injuries, it's in your interest to choose a doctor who has experience dealing with the workers' compensation system and understands how the claims process works. We have the experience and expertise to fill out the forms, provide the necessary documentation, and help move your claim forward while you focus on healing. We also have the range of medical specialties needed to treat a wide range of musculoskeletal work injuries, including rehabilitation physicians who treat musculoskeletal problems in a conservative manner and a pain physician who can help if your symptoms become prolonged pain.

If you were hurt at work, contact us to schedule an appointment at one of our seven locations in NYC and Long Island. Visit us online to see our available times and book an appointment. We often have same-day appointments available.

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