It’s common knowledge in New York that, in the event of a work-related injury, you have a right to seek medical attention and have the costs covered by the workers’ compensation insurance provider. You will likely be required to undergo a physical examination by a physician chosen by the insurer, but you can also get care from your own doctor. However, your physician must follow certain guidelines established in 2010 by the state of New York.
The New York Workers’ Compensation Medical Treatment Guidelines
The guidelines set forth in 2010 address treatment of the most common types of work-related injuries, such as neck, back, shoulder and knee trauma. Additional guidelines covering carpal tunnel syndrome and ongoing maintenance for physical therapy, occupational therapy and certain types of chiropractic care were issued in 2013.
Though you are generally entitled to reimbursement or payment of all “reasonable and necessary” medical expenses, certain types of procedures require specific authorization from the insurer. If you undergo treatment without appropriate authorizations, you may be personally responsible for the costs. As a general rule, pre-authorization is not necessary, but must be obtained in specific situations, including the use of certain types of stimulators, grafts, implantations, transplants and replacements.
It’s important to understand, though, that the medical guidelines are generally not applicable in situations where an injured worker needs emergency medical care. They only apply to ongoing types of care.
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