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May 2019

Finding a Treating Doctor In Your Workers’ Compensation Case

By | Workers Compensation

Workers’ compensation covers all reasonable and necessary medical treatment for an injury or illness that happens at work.  This includes doctors’ appointment, surgeries, Physical Therapy, medications and other treatments.  The doctor who treats your work injury will play a key role in your case by being the one who oversees all of your medical care and giving you opinions that will affect how much you receive in workers’ compensation benefits.  It is very important to find a treating doctor that you can trust.

In 2010, New York State promulgated medical treatment guidelines which provide detailed criteria doctors must follow in order to obtain treatment.  The attorneys and staff at Losi & Gangi are very well versed in working with your doctor to help Injured Workers obtain medical treatment in the most efficient matter.

Being able to choose a doctor usually falls under one of these categories (1) choosing a doctor from a list or medical Network provided by your employer, (2) you choose any authorized doctor or (3) your employer chooses the treating doctor for you.  Losi and Gangi can help you find a doctor who provides treatment under the New York state workers’ compensation law.

In many states, employers have the option of Contracting with a preferred-provider plan, not work, or Managed Care Organization to treat their employees work injuries.  This is a way for employers and insurance companies to reduce costs and control the medical care for workers’ compensation cases.  If your employer has a similar plan to this, you must use a treating doctor for their Network and follow their rules for getting care.  In New York State such a plan only lasts for a short period of time.

In New York you have the right to choose your own treating doctor as long as your employer doesn’t have her provider plan or Managed Care arrangement.  You will need to choose from a list of healthcare providers that the state is approved for treating workers’ comp injuries.  Your employer’s insurance company may limit your options if they have a preferred provider organization (PPO).  If this is the case, you must see a network physician for the first 30 days and may have a specific Pharmacy you have to use.  If you happen to change your treating doctor, the new doctor must be in the workers’ compensation boards list of authorized medical providers.  Your employer may transfer your medical care to a different doctor if the initial physician you choose isn’t authorized by the WCB to treat any workers comp injuries.

In other states, you first have to go to a treating doctor picked by your employer.  Some of these states only require you to see the company doctor for your initial visit or for a certain length of time.  Some workers worried that a company selected doctor may have a conflict of interest and might minimize the extent of their injuries.  If this is true, you may be able to switch doctors if you believe you aren’t getting an adequate care but must follow the rules in your state for changing workers’ compensation doctors.

Here are some tips you should consider while finding the right treating doctor:

  1. Consider their experience and understanding of your medical condition
  2. Willingness to accept the workers’ comp medical fee schedule
  3. Have knowledge of the workers’ comp claim process
  4. Willingness to support your workers’ comp claim with detailed reports and
  5. Availability for medical appointments

Losi & Gangi can help you with all considerations necessary to find the right treating doctor.

Bottom line – you should choose a doctor you can trust and feel comfortable around.  If you have questions call us today at 716-854-1446 and one of your experienced workers’ comp lawyers can explain the rules in New York state covering workers’ compensation and Medical Care.