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The Need To See A Workers Compensation Doctor Right Away

Workers’ compensation law is very complicated in New York. In addition to needing an attorney who concentrates in Workers’ Compensation, it is also necessary to be treated by a doctor who understands the Workers’ Compensation treatment guidelines. 

Many injured workers prefer to go to their primary care physicians to treat an injury. This is okay, if the primary physician understands Workers Compensation guidelines. Unfortunately, most primary care doctors are unaware of the workers compensation process which can cause complications in the case. We have had countless conversations with injured workers who were having problems with their payments and medical treatment, but after investigation it turned out the doctor who was treating the injury, had no idea how to fill out Workers’ Compensation medical reports.

For example a recent confusion was caused by a law change in December 1, 2010, wherein all treatment involving the mid and low back, the knees, the shoulders, and the neck was now subject to the new Medical Treatment Guidelines (MTGs), regardless of the date of injury. On March 1, 2013, a new Carpel Tunnel Syndrome MTG and an updated version of the initial four MTGs became effective and cover treatment performed on or after March 1, 2013, regardless of the date of injury.

These changes drastically affect the treatment of injured workers. Prior to the Medical Treatment Guidelines, any treatment which cost under $1,000.00 was done by the doctor and if the carrier disputed the bills, it was sent for arbitration and usually resolved between the carrier and the treating physician. However, under the new rules, if a procedure or treatment that a doctor performs is not pre-authorized under the new MTG, and a proper variance is not secured by the treating physician, the doctor will never be paid and will have no recourse against the carrier. The new Medical Treatment Guidelines are convoluted and confusing; as such it has caused most doctors to not properly follow them and get frustrated with the new protocol. Therefore, numerous doctors have begun to reject workers’ compensation patients for fear of not being paid. In turn, this causes many injured workers to be aggravated, as they are unable to get the treatment they so desperately need. 

Under the new guidelines many procedures and treatments are pre-authorized. If the treatment is not covered, then the doctor must then request a variance in order to obtain authorization, while giving detail into how the extra treatment will benefit the injured worker. For example, if someone injures their neck, back, shoulders, knees or is diagnosed with Carpel Tunnel Syndrome, then a set amount of therapy is automatically authorized depending on the body part. Once the limit is reached, a variance will be needed for any further treatment. The doctor will need to meet the burden of proof in order for it to be granted. Typically, the carrier denies the variance, and then the only way to get it granted is to timely request a hearing or arbitration. If an arbitration is requested then no more evidence or testimony of the doctors will be produced, as such it’s not as desirable. However, the alternative choice of requesting a hearing also has its shortcomings. It could take several months for depositions of the doctors to be conducted and then for the hearing to be scheduled. Then, even if the Law Judge grants the request, the carrier will likely appeal, which could cause another delay of 12-18 months. All through this time if any treatment is rendered, the doctor won’t be paid. If someone has a chronic condition different rules and guidelines will apply.

This article is only the tip of the iceberg in reference to these new changes, as the new guidelines rules and procedures are hundreds of pages long. As you can see, the process for getting something as simple as additional therapy or chiropractic care is very complicated and longwinded. Therefore, it is very valuable to immediately obtain an attorney to ensure all your rights are properly protected from the inception of the case. 

Our office always monitors our client’s files, which includes requests and denials for medical treatment. Often when treating doctors are perplexed the by guideline rules, we guide them through the process of what needs to be done to obtain additional treatment for the injured worker. When appropriate, we request hearings and conduct depositions for medical treatment issues. This is followed by giving arguments in front of the Law Judge, filing appeals and rebuttals. It is always prudent to retain an attorney as soon as possible to ensure that your case has a proper work up from the beginning of the case. 

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What to do when in an Accident

When involved in an accident while working, there are many things that must be taken care of. First you need to ensure you are receiving proper medical care. Medical treatment must be covered free of change by the Workers’ Compensation insurance carrier. It is necessary for you to notify your employer of the accident within 30 days (preferably in writing), and file a C3 form with the Workers’ Compensation board immediately.  This is to ensure your entitlement to lost wages and medical treatment. 

While you are out of work you are entitled to receive weekly compensation payments from the Workers’ Compensation carrier. Carriers notoriously do not voluntarily pay injured workers while they are out of work. Instead, they wait until the injured worker or their attorney requests a hearing in front of a Workers’ Compensation Law Judge. On the rare occasions where the carrier voluntarily pays an injured worker before a hearing, the carrier frequently pays the claimant much less than they are entitled to. Therefore, even if the carrier is voluntarily paying, it is highly recommended for an attorney to be consulted to see how much more money you could be entitled to.

Additionally, once your condition becomes permanent, (ie. treatment is not helping you anymore) even if you return to work you may be entitled to a lump sum payment. 

Workers’ Compensation Law is a very specialized field as there are many intricate details, which only attorneys that regularly handle these cases, are aware of. You should also know that under Workers’ Compensation Law, no attorney fee is to be paid by the injured worker unless the attorney is able to recover money.

If you are hurt at work, it is highly recommend that you ensure all proper forms are filled out, submitted, and that you consult an experienced attorney in the field. 

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Difference between Workers’ Compensation and Personal Injury

When someone is in an accident their case can fall under one of 2 categories, Workers’ Compensation, personal injury or possibly both. 

If someone gets hurt while working, they will have a Workers’ Compensation case, and would need to hire an attorney who specializes in Workers’ Compensation. This claim would be filed against the employer’s insurance company. On the other hand, if someone gets into an accident off the job, they would need a personal injury attorney. This lawsuit would be filed against the person who was responsible for the accident. 

However, things are very different if someone was injured while working, AND the accident was caused by someone who was not under the control of their employer. For example if a taxi driver gets into a car accident, or a construction worker’s injury was caused by another company on the job, then they would need TWO attorneys for 2 separate cases. A Workers’ Compensation attorney will file a case against their employer’s insurance, while a personal injury attorney would file a lawsuit against the person who caused the accident. Many people are easily mistaken by this, and thus do not get the proper representation they need. Workers’ Compensation and Personal Injury are 2 completely different fields. Most personal injury attorneys do not know how to properly handle a Workers’ Compensation case since it is a different Court system, and the rules and laws are different. Therefore, if someone gets injured while working it is imperative to retain an attorney who specializes in Workers’ Compensation and not just hire a personal injury attorney.

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Answers to Common Questions

What is Workers’ Compensation and who is eligible?

Workers’ Compensation is a claim filed against the employers insurance. This entitles the injured individual to medical coverage, lost wages, and money for permanent damage. By law, anyone who is injured while working is covered by Workers’ Compensation.

I just got injured while at work, what do I do now? 

First ensure that you are seen by a proper medical professional right away. Next, make sure your employer is immediately notified about this accident. Different forms will also need to be filled out and submitted to Court in order to protect your rights. It is highly advisable you speak to a Workers’ Compensation attorney to ensure your rights are protected.

 Do I really need an attorney? 

Although, you are not required to obtain an attorney, retaining one is highly recommended. The attorney will ensure all required documents are properly filled out and submitted to Court in a timely manner. Furthermore, the attorney makes certain that you receive all the money you deserve.  Since the insurance company has hired attorneys in order to figure out a way to pay you the least amount of money as possible, it is highly advisable for you to retain an attorney to maximize the money due to you.

Who will cover my medical bills if I go to the doctor/emergency room for treatment? 

By law the Workers’ Compensation insurance carrier must cover all medical bills related to a work related injury.
 

I got injured last month, can I still file a Workers’ Compensation claim?

 Technically, you have 2 years to file a Workers’ Compensation claim. However, it is highly recommended to file the claim right away. The longer someone waits to file a claim, the more likely it will be that that claim will be denied. Furthermore, an employer must be notified of the accident within 30 days, otherwise the case will automatically be denied.

Can my employer fire me, or will I lose my job if I file a Workers’ Compensation claim? 

An employer is not allowed to fire an employee just because a Workers’ Compensation claim was filed. 

How often do I need to see the doctor? 

You are entitled to be seen by your doctor as often as is deemed necessary by your doctor. If you remain out of work, we advise that you be seen at least once every 45 days.
 

How soon can I go back to work?

As soon as your doctor clears you to go back to work.
 

Do I pay the attorney any money upfront? 

No. The attorney does not get paid unless he is able to recover money for you.
 

When will I get compensated for the time missed from work? 

If you miss time from work due to a work related accident, you could be entitled to money of lost wages. The amount of time it takes to recover this money varies depending on many factors. This could take a couple of months, if the insurance carrier isn’t disputing the claim. However, it can take as long as 1 to 2 years, if the case goes to trial and there is an appeal.

I already have an attorney, can I switch attorneys?
An injured person is allowed to choose the attorney of their choice. If not satisfied with their current attorney, you are entitled to change attorneys. 

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