WORK INJURY TREATMENT PROGRAM
New York State requires all employers to carry insurance for their employees for medical treatment and replacement of lost wages in case they get injured at work. This insurance is called Workers’ Compensation. Our work injury treatment program focuses on the following four parts to ensure that our patients receive proper treatment, disability benefits and compensation for their work-related injuries.
Establishing Injured Body Parts
Medical Treatment Guidelines
Return the Worker to Pre-Injury Status
Permanent Impairment Rating
1. Establishing Injured Body Part
New York State Workers’ Compensation laws dictate that when a worker is injured, all injuries must be reported and accepted by the Workers’ Compensation Board. However, if the worker fails to report all injuries, or if the doctor fails to identify all injuries, the worker would not be able to receive medical treatment or benefits for the missed injuries. At our office, we conduct a very careful physical examination on the first visit to make sure we discover all injuries, and we make sure to report all of them to the Workers’ Compensation Board. This way, the worker is entitled to receive all of the medical treatment and benefit he or she is entitled to under the New York State Workers’ Compensation laws.
2. Medical Treatment Guideline
In diagnosing and treating work-related injuries, doctors must follow Medical Treatment Guidelines established by the Workers’ Compensation Board. The Medical Treatment Guidelines are very complicated and exhaustive clinical rules that outline exactly what kind of treatment and test are allowed for specific injuries. If a worker goes to a doctor who is not familiar with the Medical Treatment Guidelines, it is very likely that the worker will not get the full treatment and benefits he/she is entitled to, because the doctor will have a difficult time navigating the Medical Treatment Guidelines. Also, if the worker needs a test or treatment that is not part of the Medical Treatment Guidelines, the doctor would need to request for it in a very specific way. If the doctor is not familiar with the process, it will take hours for the doctor to read through the Medical Treatment Guidelines to figure what to do. The likely outcome is that the doctor would just give up on completing the request. Our is very familiar with the Medical Treatment Guidelines. Our patients can rest assured that they will receive the full treatment and the benefits they are entitled to according to the Medical Treatment Guidelines when they treat at our office.
3. Return the Worker to Pre-Injury Status
The goal of injured worker and the doctor is to return the worker to pre-injury status and have the worker return to work as soon as possible. At our office, it is our goal to have the worker not only return to work, but be able to continue working without getting injured again. We educate the returning workers on how to avoid new injury by avoiding potentially provocative movement and positions, and give recommendation on modifying the work environment. We also communicate with the employers to give suggestions on what kind of accommodation is needed for the returning worker.
4. Permanent Impairment Rating
Sometimes, a work injury can be so severe that the worker never fully recovers from the injury. The worker may not even be able to return to the original work. When an injury is treated as much as possible and enough time has passed, the doctor may decide that the injury has reached Maximum Medical Improvement, or MMI. MMI means that the worker’s injury is now permanent and it is not expected to significantly improve despite continued treatment. At that time, the doctor can determine the severity of the worker’s injury is by grading it according to a guideline established by the New York State Workers’ Compensation Board. The doctor’s familiarity with the impairment guideline is very important, because the impairment rating that the doctor assigns to the injury is used to calculate the compensation for the permanent injury. The insurance company responsible for paying the compensation will most likely challenge the doctor’s impairment rating. If the doctor cannot justify the impairment rating, the compensation would most likely be reduced. At our office, we are very familiar with the impairment rating process. We have performed many impairment ratings for our Workers’ Compensation patients successfully. Our patients can rest assured that their impairment ratings will be performed correctly according to the impairment guidelines.
FREQUENTLY ASKED QUESTIONS
Yes, you do. It does not matter if it was your fault or not. If you are injured during your employment, you qualify for medical treatment.
Not at all. Workers' Compensation laws do not allow an employee to sue an employer for being injured at work. Filing for Workers' Compensation benefits is much like filing a claim after a house fire or flood damage. However, if you were injured at work due to negligence of another party other than your employer, such as being rear-ended while working as a taxi driver or falling at a supermarket due to slippery floor while working as a Pepsi delivery man, you may be entitled to personal injury compensation. In these cases, you would need a personal injury attorney as well as a Workers' Compensation attorney to represent you.
First, you need to notify your injury to your employer as soon as possible, preferably immediately. Workers' Compensation laws require that you notify your employer about on-the-work injury in writing within 30 days of the incident. However, sometimes employees do not realize they were seriously injured until a few days to few weeks after the accident. If you later realize you were injured at work sometime after the accident, you should still notify your employer about your injury as soon as possible.
Your employer will want to know when, where, and how you were injured, so have this information on hand. Make sure you notify of all of your injured body parts to your employer. A Workers' Compensation case gets established based on specific injured body parts. An insurance company establishes your case and assign benefits based on the specific body parts that were injured. If you forget to notify your employer or your employer fails to report all injured body parts, you will not qualify to get treatment or benefits for the unreported body parts.
Once you report your injuries to your employer, your employer is legally required to report your injuries to the Workers' Compensation insurance company within 10 days. The insurance company or your employer should be able to provide you with a Carrier Case Number. You should also be assigned a Workers' Compensation Case Number. These two numbers will be the identifying numbers for your Workers' Compensation case. You can provide the healthcare providers you see with these two numbers to receive medical treatment.
Sometimes an employer is adversarial toward an employee for seeking Workers' Compensation benefits and refuses to file the Workers' Compensation claim. Sometimes an insurance company disputes that there had been a work-related injury. Or sometimes an employer does not have Workers' Compensation insurance and cannot provide an employee with Workers' Compensation benefits. In any case, if you were injured at work and you are not being provided with Workers’ Compensation insurance information, you need to seek out a Workers' Compensation attorney to receive benefits that you are entitled to.
Workers’ Compensation Board is a part of New York State regulatory agency that oversees the insurance companies that provides Workers’ Compensation insurances to employers and the doctors who treat the injured employees. Often there are conflicting opinions between the doctor and the insurance company about how seriously the employee is injured and what kind of treatment and benefit that the patient is entitled to. Usually, the injured employee has a Workers’ Compensation attorney to representing him/her. When there is disagreement, the employee’s attorney can request a hearing to the Workers’ Compensation Board. At the hearing, a Worker’s Compensation judge will make a decision about the disagreement.
Workers' Compensation Board has established a treatment guide called the Medical Treatment Guidelines for the most commonly injured body parts. These Medical Treatment Guidelines are meant to get the injured employee back to work as soon as possible while reducing costs. One of the complaints that the doctors have with these guidelines is that it does not take into account the physical differences between people. A 20 years old athlete and a 60 years old sedentary worker will respond differently to treatment for the same injury, and yet the guidelines do not take this simple fact into account. Therefore, if you need more treatment than what the guidelines allow for your injury, your doctor must request additional treatment to the insurance company. It has been our experience that it is difficult to get authorization for any additional treatment that is beyond the guidelines. When the doctor’s request for additional treatment for the injured employee is denied by the insurance company, the injured employee’s attorney can request a hearing to help approve the additional treatment.
Unfortunately, sometimes the injury is so severe that the injured worker cannot return to work for many months, or even permanently. The injured worker may also have exhausted all treatment options. When it becomes apparent that the worker’s injuries are permanent, the worker’s attorney can request a Permanent Impairment Rating evaluation from the worker’s doctor. There are established guidelines from the Workers’ Compensation Board that the doctor can follow to give a Permanent Impairment Rating to an injured worker. The attorney tries to get the maximum benefit that the worker is entitled to by applying the Permanent Impairment Rating determined by the doctor and the worker’s previous salary.
Often, the insurance company requests another doctor to evaluate the worker and form an opinion. Usually, there are conflicting opinions between the worker’s doctor and the insurance company’s doctor on how much the worker is permanently impaired. Both doctors will need to defend their positions at a deposition. Depositions can be unpleasant experiences for doctors, as the attorney from the opposite side will try to make each doctor appear less credible. How well the doctors perform at these depositions will have a direct impact on the worker’s compensation. Therefore, it is very important that the injured worker to be treating with a doctor who is familiar with the Workers’ Compensation regulations and comfortable with depositions.
If you have been injured recently and have your Workers' Compensation Case Number and a Carrier Case Number, and you know which body parts have been established, you can come in for treatment as long as one of the body parts are neck or back. In certain cases, if you are waiting to get these numbers, we may be able to treat you before you receive them. However, if you were injured at work many months ago and received many months of treatment, your treatment benefit most likely would have been exhausted by now. We will start try to get authorization for more treatment if needed. You are welcome to call our office at (718) 746-4919 and talk to us about your current situation.
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