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.

Workers’ compensation is insurance that provides cash or medical care benefits for workers who are injured or become ill as a direct result of their job. Employers must pay for this insurance, and may not require the employee to contribute to any cost necessary for  compensation. Weekly benefits such as monetary payments and medical care are given by the employer’s insurance carrier, as directed by the Workers’ Compensation Board, a state agency that processes the claims.

It is not enough to just have insurance as an employer. It is the employer’s responsibility to also provide immediate emergency medical treatment for employees who are injured on the job. They must complete a full report of the injury, with the injured worker’s review and mail it to the nearest workers’ compensation board office within a timely manner.

A claim is paid if the employer or insurance carrier agrees that the injury or illness is work-related. If the employer or insurance carrier disputes the claim, no cash benefits are paid until the workers’ compensation law judge decides who is right. If a worker is not receiving benefits because the employer or insurance carrier is arguing that the injury is not job-related, he or she may be eligible for disability benefits in the meantime. Any payments made under the Disability Program, however, will be deducted from future workers’ compensation awards.

In a workers’ compensation case, neither party is determined to be “at fault”. The amount that a worker receives is not decreased by perceived carelessness, nor increased by an employer’s fault. Although workers’ compensation laws provide treatment to injured employees, they are also meant to protect employers, as they are designed to be the only remedy that injured employees may seek from their employers. One may find that an employer frowns upon employees who file workers’ compensation benefit claims, and some blatantly discriminate against such employees.

Most states prohibit employers from punishing, discriminating against, or discharging employees who exercise their rights under workers’ compensation laws, and allow employees to bring civil actions against their employers for the tort of “retaliatory discharge.”

It is of the business owners best interest to comply with the rules and regulations set forth by the Workers’ Compensation Board. Failure to do so could easily result in further fees, punishments or even lawsuits.

If you or someone you know has been injured at work or is dealing with a workers’ compensation case, call Losi & Gangi at 716-854-1446 and speak with one of our experienced attorneys.

This article has been adapted from information gathered from other sources including http://www.wcb.ny.gov/.

If you have become permanently disabled from a workplace injury, you may be able to receive permanent disability benefits. Before receiving these benefits, you will have go through lengthy legal and medical steps required by New York State to show that your medical condition isn’t likely to change and that it either prevents you from working at all or limits your ability to work and earn your former wages. If you have completely recovered from your injury, you will not be eligible for further indemnity benefits, but you remain eligible for medical treatment.

To qualify for any workers’ comp benefits you must show that you meet all of the basic eligibility requirements such as

• Your employer must have workers’ comp insurance

• You must be an eligible employee at that company

• You must have an injury or illness that’s covered by workers’ comp and is work related

• You must file a workers’ comp claim under the procedures and deadlines in New York State

• You must follow New York State’s rules for getting medical treatment from a workers’ comp treating doctor

To even be considered for permanent disability benefits, your workers’ comp treating doctor needs to prove that you’ve reached a plateau in your recovery. This means that your condition isn’t expected to improve any further with more treatment. This is known as maximum medical improvement (MMI).

It may take you a few months to a few years to reach MMI after you were first hurt on the job. The degree of severity of your injury will have the biggest impact on how long it takes. A broken bone will differ from exposure to toxic chemicals resulting in cancer or other occupational illness.Other factors such as the medical treatments available for your injury or if your insurance company has been dragging their feet on approving any procedures or surgeries may come into play.

Once your doctor has determined you’ve reached MMI, the process starts to determine whether you have any and if so, how much permanent disability. This is the time when you stop receiving temporarily disability payments if you have been out of work and they haven’t run out yet. Typically, your treating doctor will say whether you have a lasting medical condition or lost function otherwise known as an impairment, that resulted from your work-related injury or illness. An impairment can be anything from a bad back to a missing limb to a painkiller dependency from medication you had to take for your injury.

Your insurance company may request an independent medical examination (IME) to determine what your permanent impairments are.  States have different criteria for using the medical information about impairments to decide whether injured employees have permanent disabilities that affect their ability to perform certain tasks at work or to even work at all. The result of this process is called your “loss of wage earning capacity”, (LOWEC)  and is expressed in a percentage.

There are times you don’t have to prove that you can’t work at all in order to receive permanent disability benefits. If you lost your eyes or an appendage you may already be considered permanently disabled. If you have a combination of permanent impairments that add up to a 100% disability rating, you may also qualify for permanent disability benefits. If your disability rating is less than 100%, you may be able to receive some kind of  permanent partial disability benefits.

Once the Worker’s Compensation Board hears from a doctor that you have a permanent disability, they will begin the process of establishing your level of disability. If there is any sort of dispute,  whether it is over the amount of permanent disability to if you have any lasting impairments, you should contact a workers’ compensation lawyer as soon as possible. Since the process is complicated, insurance companies and their lawyers do everything in their power to keep their costs down by minimizing or denying permanent disability benefits. This is when you need an experienced attorney representing you and helping protect your rights.

Unfortunately, permanent disability benefits may not necessarily last the rest of your life. If you are classified  totally and permanently disabled, you’ll usually receive  lifetime  benefits,  but if you only have permanent partial disability you may be limited to how long the benefits will last. Whether your benefits are for partial or total permanent disability, you may be able to opt for a lump sum payment in a workers’ comp settlement. Losi & Gangi Attorneys are here to help answer any of your workers’ compensation  questions and ensure you are fairly represented in your worker’s compensation claim.. Give us a call today at 716-854-1446 and one of our attorneys will assist you in receiving the compensation you deserve.

If you were injured on the job or developed a medical condition because of your work (cumulative trauma like a repetitive strain injury (RSI) you are probably hoping to receive workers’ compensation benefits.  Workplace injuries are generally covered by your employer’s workers’ compensation insurance.  Many states require employers to be covered in accordance with the average level of risk for that particular industry.  What can you do if your claim has been denied?  You may be able to appeal your denial through your state’s board of workers’ compensation. 

Employers or their insurance companies sometimes look for any possible reason to deny workers’ comp claims.  The first thing you need to do is determine the reason why your claim was denied.  The details should be explained in your denial letter.  In New York State that form is called a SRO 1-04.  If you believe your denial was done in error you can appeal. 

Common Reasons for Denial of Workers’ Comp Claims

Your employer may say that you weren’t working when you were injured, or that you were involved in some sort of horseplay or misconduct, or that your current medical condition is not a direct result of an accident at the workplace.  Whatever your reason for filing the workplace injury claim, you will need to gather sufficient evidence to support the claim.  Some examples include, witness testimonials, or medical evidence and records.  If the doctor that is treating you has already stated that your current condition was due to an injury at work, but your insurance company disagrees, you may need to get schedule another medical evaluation to get an additional doctor’s opinion.

The law in your state may have special restrictions on workers’ comp claims for increasing trauma or psychological conditions.  Some states rule out workers’ comp benefits for illnesses caused by long-term stress at work.

In most cases, you must receive medical treatment in order to receive workers’ comp benefits.  If you deny or do not seek out medical treatment your claim may be denied.  When you discuss the extent of your injury with your employer, they should pull out the employee handbook to review their policies and procedures.  Employees that initially report the injury but refuse treatment may see that their workers’ compensation benefits are suspended.  Your employer may not allow you back at work until you pass a medical clearance test to determine if you can perform your everyday duties. 

Timing is everything when it comes to filing a workers’ comp claim.  You should immediately report your injury with human resources and make it clear that you were hurt on the job.  Check with state laws to see what your timeframe is to file your workers’ comp claim. If you did not adhere to the state laws, your claim could be denied.  This goes for both reporting your injury and filing your claim in time.  Many states include limited exceptions for when the injured employee couldn’t file a claim right away because they were in a coma, severe injuries that required immediate and prolonged treatment or surgery (burns) or the employee had to remain quarantined.  Don’t hesitate to file a claim even if your injury seems minor.  It could get worse as time goes on especially if you have neck or back injuries.  If you happen to file a claim and the injury gets better on its own, the claim will be closed but if you wait to file you could lose the chance to get benefits or risk the claim being denied. 

Have you recently quit, been laid off or fired from the job where you filed your workers’ comp claim?  Insurance agencies usually deny claims that were filed after you left the company.  Did you report the injury while you were still employed there or during the time that you gave your notice?  Some states have special rules for workers’ comp claims that were filed after you left your job.  If you qualify for one of these exceptions you may be able to receive workers comp. 

So Your Claim Was Denied, Whats Next?

Don’t feel like you won’t be receiving workers’ comp benefits just because your claim was initially denied.  Double check and reread the letter that was sent to you saying that your claim was denied.  The reasons should be listed but if you feel that it had to do with paperwork or a similar mistake, you should contact your claims adjuster and employer to explain your situation.  In most cases you will have to consider appealing the denial.  Your letter should give a deadline for filing your appeal, which is determined by state law.  The first level of the appeal will be a hearing where you will have to provide medical and any other type of evidence that supports your claim in front of an administrative law judge.  The hearing can be done through your state labor department or state board of workers’ compensation. 

If you still want to appeal the decision, you should look into getting a workers’ comp lawyer as soon as possible.  A lawyer will help you determine whether or not an appeal would be the best route.  Since the deadlines for workers’ comp are short you don’t want to miss out on receiving your benefits because you we’re late.  You will want to bring any documentation, medical records and reports that state your case to your court date. 

If you have any questions about your workers’ compensation claim or would like more information, call Losi & Gangi at 716-854-1446.