Medical Care


One of the most important things for injured workers to understand is that the Workers’ Compensation system is driven by medical evidence.

Under New York State Workers’ Compensation Law, you are entitled to choose your own doctors as long as the medical provider is authorized by the New York State Workers’ Compensation Board. A list of authorized providers can be found at the New York State Workers’ Compensation Board website.

Prescriptions are also paid for by the Workers’ Compensation Carrier. Most Carriers use a third-party administrator to handle prescription issues. This often leads to delays that are not typically experienced with private health insurance. Additionally, you are entitled to be reimbursed for mileage to and from your doctor or physical therapy visits, as well as other medical expenses, such as bandages or crutches.

Can I Choose my Own Doctor?

While the law says that you are entitled to choose your own doctor, some Employers, particularly large Employers, have doctors on premises or have a relationship with a medical office that specializes in industrial injuries. While it may be a condition of your employment to attend an appointment with a physician chosen by your Employer, this does not generally preclude you from having your own, separate physician.

In certain communities in New York, many doctors do not accept Workers’ Compensation patients. The doctors who decline cite a variety of reasons, including availability, the fee schedules (how they are paid), and the paperwork requirements. The process continues to evolve in New York. Today, most injured workers are going directly to a specialist as opposed to a family doctor, where they otherwise would have started.

Typically at the outset, the injured worker is most concerned with getting better. The first doctor visit is usually accompanied with feelings of pain, fear, anxiety, and uncertainty. At MCV Law, we counsel our clients regarding their medical treatment, so as to educate them and provide insight into what they are learning during their medical visits and how the same impacts their case. We emphasize the importance of giving a concise, consistent history and developing trust with their medical providers.

What About Pre-Existing Conditions or Injuries?

It’s very important to let the medical providers know of prior conditions, especially if they involve the same body area. Some injured workers are afraid that if they tell their medical providers they have had a similar injury in the past, their claim will be ruined. This is not true and indeed may lead to further controversy and allegations of fraudulent conduct.

When thinking about past injuries, the relevant inquiry is whether or not the prior injuries resulted in a permanent impairment. Also, it is important whether the prior injury prevented or limited your work.

For example, you hurt your back when you were 25 years old while snowmobiling recovering quickly, allowing you to return to your job as a mechanic for 8-9 more years. Then, you hurt your back at work. It is important for the doctor to know you had a prior back injury that resolved and that your current problem is a result of the new injury and not the old snowmobile accident.

Fraud

If you fail to tell your doctor about the prior injury, the insurance company may think you are defrauding them by hiding your injury. This is called a “Section 114-a violation.” This often results in litigation and risks to your case. Thus, it’s best to be upfront with the doctor and the Carrier.

Additionally, allegations of a Section 114-a violation arise from exaggeration of your injury to a medical provider or IME. It is not unusual that the Carrier will conduct surveillance to determine whether your condition actually rises to the level you reported to your medical provider.

In addition, Section 114-a can be raised where you have not properly reported a return to work or are engaged in an activity that is similar to work.

At MCV Law, we see a lot of clients get tripped up over their failure to answer questions about past injuries, because they look at the questions too quickly and do not take care when completing the C-3 “Employee Claim”.

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