New York workers who are unable to work because of an employment-related injury, illness or condition need to know the details about filing for workers’ compensation benefits and what they are entitled to. While lost wages are often the focus of their claim, they also need to know about health care. This is paramount to making a full recovery and is frequently a source for discord between the insurer and the worker.
Injured workers can receive medical care for their issues through workers’ compensation. That includes any problem and need they might have. If they have an eye issue, they can get an optometrist’s care. The same is true for surgery, dental work and getting assistive devices like a walker, a wheelchair or a cane. They will also have the right to receive medications. Workers using workers’ compensation benefits for the medical care must go to a medical professional who is authorized under the Workers’ Compensation Board. The only exception is when it is an emergency.
As the treatment proceeds, the WCB and the workers’ compensation insurer will receive reports about the treatment and its progress. This is essential because workers who are unable to work because of their medical issue will not get lost wages without these reports. Workers who are off the job for an extended period will need to have these reports filed a minimum of every 90 days so they can maintain eligibility for wage benefits.
In some cases, there is a dispute over the claim. For example, the worker could say that their medical issues are so severe that they cannot work and the insurer disagrees. There could also be a dispute as to whether the injury is work-related. The medical reports are vital in these circumstances.
The reason for the dispute will dictate how it is settled. If it is relatively minor, then the WCB can address it informally and a hearing is not needed. If it is more complex, then it can be handled administratively, through conciliation, via an order or there can be a hearing.
An injured worker should not receive bills for their health care costs. The only exception is if the WCB declares the claim invalid. Any travel costs to receive medical care is also covered. The medical provider will adhere to Medical Treatment Guidelines. For many aspects of medical care, the provider does not need to get authorization. For expansive tests and possible procedures, they might need authorization.
When there is a dispute, an Independent Medical Examiner could be needed to make an objective assessment of the worker’s injuries and the insurer’s belief that there is a disparity between what the worker and their medical professional says and what the insurer believes.
Medical care is a fundamental part of a workers’ compensation claim
Medical treatment is a common source for dispute between a worker, the employer and the insurer if there is a workers’ compensation claim. For blue collar workers who work in labor-intensive jobs, there could be fear that filing for benefits and maximizing the amount they receive could lead to disfavor with the employer. They are reluctant to seek professional guidance in their claim. This can be a costly misstep.
When seeking workers’ compensation benefits, there are financial, physical, emotional and professional factors at stake. Having help with their claim can be one of the most important decisions they make and play a key role in making a full recovery in every way.