When an employee is hurt on the job, a workers’ compensation claim is usually needed. However, while the monetary part of that claim is important, so to is the medical care part of the workers’ compensation claim. The term, medical care refers to medical services, including health, dental, surgical, optometry, assistance devices and prescription medication. And, there is more too it than simply going to one’s primary care physician.
Healthcare provider
Except in emergency circumstances, the healthcare provider that provides medical care must be authorized to do so by the New York Workers’ Compensation Board. Luckily, a list is maintained online. The healthcare provider themselves (or their office staff) should be able to tell potential patients whether they have been approved by the Board to provide medical care for work-related injuries.
Exceptions
Some employers participate in a Preferred Provider Organization program, where healthcare providers must be part of that PPO program. Other employers may participate in a non-Workers’ Compensation Board adjudication claim process called the Alternate Dispute Resolution system as part of a negotiated labor agreement, which may have yet another slate of healthcare providers. These providers may or may not be Board approved.
Reporting requirement
Whoever is selected as the healthcare provider must maintain written reports about the employee’s treatment. These reports must be sent to the Board and the workers compensation insurance carrier in most situations. For example, if one is unable to work because of the work-related injury or illness, a medical report is required to get lost wages. These reports are required every 90 days that an employee is unable to work. If one’s claim is disputed, the Board also requires a medical report to adjudicate and resolve the claim.
Healthcare expenses
Bills are not paid by the New York City metro area employee, regardless of which borough they reside in. The employer’s workers compensation insurance carrier must pay those bills directly. The approved healthcare provider must sign Form A-9 to this effect. If, for some reason, the insurer fails to pay, it must explain in writing what was not paid, why it was not paid and what information is needed to process the payment. Always keep receipts of anything paid, like travel expenses, parking, mileage, etc. All expenses incurred for treatment are reimbursable through Form C-257.