When you’re injured on the job, your health should be your first priority. When seeking medical care after a work injury, it’s important to understand the rules to ensure your treatment will be covered. At Nappa, Monterosso & Poznansky, LLP, we’ve helped injured workers in Staten Island and the greater New York City area navigate complex workers’ compensation claims for more than 30 years. Our workers’ compensation lawyers explain how to protect your rights when you choose a treating doctor.
Key Takeaways
- Board authorization is required— To ensure your medical bills are covered, your treating physician must be authorized by the New York State Workers’ Compensation Board (WCB).
- Proper documentation is key— It’s important to find an experienced provider who knows how to explicitly link your injury to your job and determine your level of disability.
- Independent Medical Exams (IMEs) — Our Staten Island workers’ compensation attorneys provide the guidance you need for insurance-mandated exams that can limit your medical care.
- Local NYC experience— As the largest workers’ compensation firm in Staten Island, our team has longstanding local connections and the experience to guide you toward qualified specialists.
Rules for Choosing a Treating Doctor in NY
Follow guidelines when you choose a treating doctor for your workers’ compensation claim helps to ensure your treatment is authorized and your medical benefits are protected.
NY Workers’ Compensation Board Authorization
In New York, your treating physician must be authorized by the WCB. This is a specific credential in addition to a standard medical license. If you seek treatment from a doctor who isn’t authorized for non-emergency care, the insurance carrier is not required to pay your bills. In addition, an unauthorized physician’s medical reports may not be recognized as valid evidence for your claim. You can search for an authorized health care provider on the WCB website.
Employer PPO
If your employer participates in a Preferred Provider Organization (PPO), you’re generally required to see a doctor in that network for the first 30 days of treatment. However, after 30 days, you have the right to switch to any Board-authorized doctor of your choice.
Medical Emergencies
If you need emergency medical care, go to the nearest hospital immediately. Under New York law, emergency care for a work injury is covered, regardless of a doctor’s workers’ compensation status. Once the emergency has passed, you must transition your care to an authorized provider.
Your Rights as a Patient
Unlike many other states where an employer dictates your medical treatment, the New York system is designed to give you some freedom of choice.
Choosing a Treating Doctor
You have the right to be treated by a doctor who understands the specific demands of your job and your physical and mental limitations. If you’re dissatisfied with the care you are receiving, believe your doctor isn’t properly addressing your symptoms, or disagree with their disability rating, you generally have the right to change physicians at any time. The only requirement is that the new doctor must be authorized by the Workers’ Compensation Board.
Independent Medical Exams
An independent medical exam (IME) is a medical evaluation requested and paid for by the insurance carrier. Despite the name, these exams are rarely objective. Insurers hire these physicians to provide opinions that often downplay the severity of your injuries or suggest a return-to-work timeline that contradicts your own treating doctor’s recommendations.
If an insurance carrier requires you to attend an IME, it’s important to know your legal rights.
- Advance notice— You must be notified of the IME location and time at least seven business days before the appointment.
- The right to a witness— You may bring a friend, family member, or even your own doctor to observe the IME.
- Nurse case managers— You are not required to allow an insurance-hired nurse case manager into the examination room.
- Recording the exam— You have the right to record the IME to ensure the doctor’s final report accurately reflects the physical exam that took place.
An unfavorable IME report can lead to a reduction or termination of your workers’ compensation benefits. Our legal team helps you prepare for the questions the IME doctor will ask and advises you on how to accurately describe your physical limitations without falling into common traps.
Your workers’ compensation attorney scrutinizes the IME report for inaccuracies, such as misquoted statements or findings that conflict with the actual length and nature of the exam. If necessary, we cross-examine the IME doctor and present expert medical testimony from your treating physician to challenge the report’s credibility before a judge.
How Our Workers’ Compensation Attorneys Help
- Coordinating with medical providers— We work with your treating physicians to ensure their reports use specific language document causation and your exact level of disability.
- Protecting your privacy— We ensure that nurse case managers and insurance adjusters do not interfere with your private medical care or influence your doctor’s treatment plan.
- Managing claim documentation— Our team collects and submits evidence and other required documentation to make sure you adhere to strict filing deadlines. These types of technical errors often lead to delayed treatment or denied payments.
- Handling insurance communications— Our team handles all communication and negotiations with insurers so you can focus on healing.
- Contesting disputed care— If an insurance carrier refuses to authorize a necessary surgery or diagnostic test, we represent you at appeal hearings to fight for the medical care you’re entitled to receive.
Tips for Selecting a Workers’ Compensation Doctor in NY
- Confirm board authorization— To ensure your medical bills are covered and doctors’ reports are valid in the eyes of the WCB, always verify that your treating doctor is authorized to treat workers’ compensation patients.
- Specialization matters— Whether you’ve suffered a back injury or occupational disease, it’s critical to find a WCB-approved specialist who understands your condition and how it impacts your health and ability to work.
- Ask your workers’ compensation lawyer —Our team has longstanding professional relationships with local healthcare providers who understand the complexities of the system. If you need help selecting a doctor, we’re happy to provide recommendations.
Why Choose Our Staten Island Workers’ Compensation Lawyers?
Navigating workers’ compensation and Social Security Disability claims in New York can be overwhelming. At Nappa, Monterosso & Poznansky, LLP, we provide the steady guidance you need during challenging times.
Decades of experience— For more than 30 years, we’ve helped workers in Staten Island and the greater NYC area get back on their feet after an injury.
Local knowledge— As native Staten Islanders, we care about our communities and know the challenges New Yorkers face when selecting a workers’ compensation doctor.
Personalized support you can trust— Partner and attorney Rolando Cubela is fluent in Spanish and provides direct service to ensure every client feels heard.
Relentless advocacy— From filing your initial claim to challenging unfavorable IME reports, we handle all aspects of your case with compassion and tenacity.
Contact a Workers’ Compensation Lawyer Near You in Staten Island
As the largest workers’ compensation law firm in Staten Island, Nappa, Monterosso & Poznansky, LLP, is committed to helping injured workers and their families protect their health and financial security. To schedule a free consultation with a worker’s comp lawyer near you in Staten Island, contact us or call 718-273-9000 today. We serve clients throughout the greater New York City area.
