As an attorney who has practiced in the field of Workers’ Compensation for more than 28 years, I have seen many changes in how the system treats injured workers. During this age of progressiveness in New York, when the minimum wage has increased and the requirement for paid sick leave has been implemented, it only stands to reason that injured workers would be treated with dignity during their quest to obtain monetary benefits for their lost time and obtain the medical treatment necessary during their recovery.
Unfortunately, however, there has been a nationwide focus on Workers’ Compensation reform with the emphasis on cost savings, often at the expense of the injured worker. New York State has followed along in this national trend; therefore, it is even more imperative to know what to do in the event of a work-related injury or illness. Injured workers must notify their employer immediately – preferably in writing if possible – within 30 days and file their claim with the New York State Workers’ Compensation Board within two years of the date of an accident or onset of an illness.
Additionally, finding the right doctor is one of the most important decisions you can make during this particularly rough time. After you are injured, you obviously must seek immediate medical attention before you do anything else. Don’t wait or assume your injury is going to heal, because if you are unable to work, benefits will not be payable until the date of the first medical treatment. You might need to go to the hospital if your injury is an emergency or life threatening, but in most cases you should be able to visit your physician. Either way, be sure you notify the medical professional that you are being treated for a work-related injury as any treatment should be billed through Workers’ Compensation. It is important that your treating physician be coded to practice before the New York State Workers’ Compensation Board because of the medical evidence necessary to proceed with a claim, the myriad of forms they are required to file, and the possibility of their testimony in the future.
The New York State Workers’ Compensation Board has implemented medical treatment guidelines for injuries to the back, neck, shoulder, knees, and bilateral carpal tunnel syndrome. Medical providers must comply with these guidelines in their treatment of injured workers, which have a number of treatments or tests that are preauthorized based upon certain findings. If the modality of treatment is not included in the guidelines, a variance may be requested. There are different forms for different requests and different timelines in which to file. A doctor not coded in Workers’ Compensation or inexperienced in this procedure could prevent you from receiving proper or timely treatment.
Payments made for lost time are based upon the earnings of the injured worker, as well as the overall degree of disability. The degree of disability is based upon the medical evidence submitted by the injured worker’s treating doctor, as well as the opinion of the insurance company’s consultant. Many times these opinions are at odds and medical testimony is necessary so the law judge can make an informed decision. Doctors who are coded understand the procedure and the necessity of being available to testify on your behalf at these medical depositions. The insurance carrier will question the doctor on whether he or she is coded, which may impact the judge’s perception as to a doctor’s credibility regarding treatment guidelines, degree of disability, or earning capacity. Ultimately, the length of time and the amount of weekly benefits an injured worker is entitled to receive benefits once permanency is determined by a law judge is based on a finding of loss of earning capacity. In many cases, there can be a difference in years.
Nothing is better than finding a doctor who is competent, empathetic, and an expert in his area of specialty, but finding one with all of these qualities who is also knowledgeable in Workers’ Compensation is invaluable.
Catherine M. Stanton is a senior partner in the law firm of Pasternack Tilker Ziegler Walsh Stanton & Romano, LLP. She focuses on the area of Workers’ Compensation, having helped thousands of injured workers navigate a highly complex system and obtain all the benefits to which they were entitled. Ms. Stanton has been honored as a New York Super Lawyer, is the past president of the New York Workers’ Compensation Bar Association, the immediate past president of the Workers’ Injury Law and Advocacy Group, and is an officer in several organizations dedicated to injured workers and their families. She can be reached at 800.692.3717.
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