Today we're going to talk about finding the right doctor for you in the New York State Workers Compensation System. You should have a good lawyer and you should have a good doctor and it's as simple as that.
Having the right doctor is super important in your worker compensation case. Proper medical evidence is what drives your case. The example I always give my clients: if your case was a car, your medical records are the gas in the tank. If we don't have gas in the tank or if we don't have the right gas in the tank, we're not going anywhere. It's super important that you have a good doctor who knows how to supply the medical records and the evidence that you need to drive your case forward. Your medical record is the foundation of your entire claim, and treating with a doctor who understands this and understands the workers' compensation system as a whole and knows how to properly submit documents is vitally important to your case.
I've seen it too many times where you have a great case and the medical documentation is just not submitted properly or doesn't document the true nature of the injury in such a way to display how bad somebody really is hurt and the case suffers because of it. So having the right doctor who's not only a great doctor but also knows how the system works is super important. More importantly than documenting your file, having the right doctor is going to get you better quicker, your health is your number one concern and getting better and getting back to work is the goal here.
Having a good doctor who knows how to get the testing and the treatment that you require so you can get better is super important and under the worker compensation system, it's a very technical way that doctors have to request and obtain authorization for treatment and testing. It's important to have one that knows the system.
Under New York State law, you are free to choose any provider that you want who accepts workers compensation insurance, and you're going to want somebody who is really well versed in the system. So yes, you can choose any doctor you want. Within some parameters, they have to accept workers comp, but it is very, very important.
There are numerous online resources that can help you research the various doctors in the field to help you find one that's right for you. You could do a simple Google search which will pop up a million different websites where these doctors are found. But really in my experience, it comes down to a simple matter of comfort and trust. And that's not something you're going to find on a search engine or in a particular website. Do your research. Find the doctors that look good on paper. It really comes down to who you're comfortable with and who you trust.
I find that my clients who treat with doctors that they are comfortable with get better, get better sooner and have better results. You want to treat with somebody that you really do trust and somebody that you're comfortable with. I think that's the most important thing.
The other way you can find a doctor that's good for you and good for your case is talk to your lawyer. As a worker's compensation lawyer, myself and the other comp lawyers out there work within the system. We've been doing it for years. We know which doctors are the ones that really understand, how the system works, how to get the treatment, the testing that you need, and why it's so important. So, if you're at a loss for finding the right doctor, talk to your lawyer, they'll help you find a doctor who's good for you.
Question, popped up here, "I have a pain management doctor for my CRPS," For those of you who don't know, C is Chronic regional pain syndrome also known as RSD, which is reflex sympathetic dystrophy. A lot of big words, but it's a really horrible illness. I'm sorry you're suffering with that. It's a terrible thing to be going through.
"I have pain management doctor for my CRPS, and he recommends that I see a neurologist will workers compensation cover that doctor?" Generally speaking, the answer is yes, they will if it's related, if there's a causal relationship and that necessity for that doctor of the neurologist is part of that causal relationship, they absolutely should pay for it. And if they're not, you really need to get your lawyer involved there because they should be able to help get that authorized and get that paid for. But generally speaking, chronic regional pain syndrome is something that a neurologist generally diagnoses and treats, so you should not have too much of a problem getting that authorization and getting that treatment that you need. That's a great question. I appreciate the question.
There's a whole bunch of questions and you really should thinking about each person's individual specific circumstance. You're going to want to ask questions certainly tailored to your circumstances, but generally speaking, you want to ask your doctor if they've handled and are familiar with New York State Workers compensation cases. As we said earlier, the method for obtaining for requesting and obtaining authorization for testing and treatment is very technical. The doctors have to use an online portal set up by the Workers Compensation Board. You want to make sure that they have knowledge of that and they're comfortable with it so you can get the testing and the treatment that you need. And you want to find a doctor who's familiar with the New York State Workers Compensation system.
You might want to ask what type of treatment they recommend for your particular disability, injury or illness. You might want to ask what alternatives they recommend to the treatment that they initially recommend because you might not be comfortable or satisfied and it's certainly worth having that discussion. You don't want to jump right into a surgery. You want to have a discussion with your doctor about what the options are for your treatment and it's certainly a good conversation to have with your doctor.
You might want to discuss whether or not you need to see other doctors or specialists. Sometimes you need to see specialists and sometimes you need to see other doctors. If you do need to see other specialists, you might want to ask your doctor your initial doctor if those specialists are part of his same practice. Perhaps you might not have to go elsewhere. Maybe you're speaking to an orthopedist and you might need a neurologist and he might have a neurologist in his practice. Or you might need physical therapy and his practice might offer physical therapy. So you know it's helpful, it makes it a little easier for you. You're only going to one place and you're getting all the treatment that you need without having the different doctors in different locations. So certainly a very important question to ask.
But most importantly, regardless of what questions you ask and these are just some examples, you want to make sure you feel comfortable with the answers that you're getting and you want to feel comfortable with the fact that there's an open line of communication between you and your doctor. I think having open communication, being comfortable with your doctor is the most important thing. Again I find with my clients, they get better medical results, they get better, they achieve a higher level of health and they do it quicker with doctors that they're comfortable with so it's important that you're comfortable and confident with your doctor.
There's a lot of pitfalls that you could run into here and it's super important for your doctor to be familiar with workers compensation. For instance, your awards for temporary disability while you're out of work following an accident are directly tied to your medical records. We have something known as a 90 day rule. A medical report which shows that you are disabled from work is good for 90 days of awards, which is three months. So if I go see the doctor on January one, that medical report that shows that I'm disabled from work will carry me for 90 days of awards if you don't see the doctor within that ninety-day period. Once that time expires, the insurance company might ask to suspend your awards. Or if they're voluntarily paying you, they might just suspend them. So you need to be seeing a doctor who understands this and understands the system in general as a whole. In this circumstance, we've heard from clients who tell us, well, my doctor set my next visit for six months because he says there's nothing much he could do for me. Well, if you're out of work and you're disabled during that period of time, a Simon Turnaround is not going to help you. It's going to get your benefit suspended. So clearly that doctor doesn't understand the 90 - day rule doesn't understand how benefits are rewarded and you need to make sure you see somebody from the inception that understands this. It's so difficult that it just looks bad when you go and switch doctors halfway through your case for reasons like this. And you don't know what else that there that they're unfamiliar with.
We've heard of clients who tell us their doctors will take them off the schedule until the PT gets authorized or until a MRI is authorized or until surgery gets authorized. Well, you know, surgical the authorization process takes time. You could take up to 90 days if not a little more and you know if your doctors going to tell you that they don't want to see you until something gets authorized, they're jeopardizing your benefits with this 90 day role. So very, very important that they understand how things work in the workers comp system so that they're not jeopardizing your benefits.
I don't mean to talk down about doctors because most of them do know what they're doing. There are a lot of very, very good, competent doctors out there and we're happy to work with all of them, but I just want to make sure that you as the injured worker are aware of these issues. So you know who to look for and who not to look for. Similarly, the like we said earlier, the medical treatment portal. It's pretty technical and the attorneys can't and do not play a role in treatment authorization. It's for your doctor to do based upon his examination or her examination of you and your doctor has to understand how the medical portal works and this way they can request authorization for treatment and testing and things of that nature of physical therapy.
You need to be confident that your doctor is well versed in the system, so you can get the treatment and the testing that you need.
Generally the nature of the injury, you'll know it's one of those things. If you break your foot, you're going to want to see a podiatrist. If you get hit in the face and you knock all your teeth out, you're probably going to want to see a dentist, but for certain injuries you might not know if you need a specialist. If you have discs in your spine and you're seeing orthopedist, you might want to send you to a neurologist or a spine surgeon. Generally those types of specialists you're going to get that referral from your doctor, the doctor you're initially treating with and they'll make those referrals.
If you're unsure, your lawyer could also help you out in those circumstances, but you can see specialists. The board maintains lists of all the different doctors in the different areas of specialty. And if you don't know who to see off the bat, your general doctor could probably make that referral for you.
Yes, red flags. These constitute so many phone calls to and from our office on a daily basis. What type a red flag should you be looking for? One of the bigger ones is cop-payments. I usually see this when we get a new client that walks in with a case at six month or a year old and they've been trying to kind of go do it on their own and they come in and they say, "Well, I've been treating with this doctor and this doctor and here's all the receipts I paid for my 20 co-payments..." And under the workers' compensation system, doctors should not be charging you as their patient as an injured worker co-payment at all in New York State. So when you see a co-payment pop up, that's a red flag for me that this doctor doesn't understand the worker compensation system and he's charging co-payment, which he should not be doing. Another big red flag that we see sometimes is charging for medical records now.
There is a little bit of gray area here but at the very least a doctor treating an injured worker under New York State worker compensation should be sending those medical records to the Workers' Compensation Board and it goes into what's known as ECF. The ECF, or the Electronic Case folder where all the parties of the case can review those medicals. Maybe they're not going to send them to me because they want to charge me, but they can certainly send them to The Compensation Board to be scanned in so all the parties to your case can review them. And when you hear doctors say them charging you or sending you a bill for medical records, it's usually a red flag that they don't understand how the system works and you might want to talk to your lawyer about that which brings me to another red flag when the client comes in and says I need treatment and the doctor told me call your lawyer well, I'm not a doctor.
I can't request treatment, I can't recommend treatment. I don't know what you need. Your doctor knows what you need, which is why the doctors are tasked with the responsibility of requesting authorization for treatment. It's on the doctor to do that when they say call the lawyer, that means that they don't know the system. They don't know the medical portal system, they don't understand what's going on and they need to to educate themselves. Or you need to find another doctor.
The burden is with the doctor to get treatment and testing authorized, not the attorney. Now those requests might be denied and they might have run some roadblocks there and they might be asking you to call the lawyer for an explanation. But the remedy still lies with the doctor and when I hear that it, that's a red flag for me and the last one is poor communication.
Like I said earlier, comfort with your doctor is of the utmost importance and when a client comes into me and you could tell before they even bring it up that oh, the doctor rushed in and rushed out and he was in the room for 30 seconds and he never listened to me and he just wrote a bunch of stuff on a piece of paper. Clearly you're not comfortable with your doctor and you need to find a doctor that you're comfortable with because you're going to get better quicker and if you need help finding a doctor, talk to your lawyer. Super super important.
As I said earlier, if you're having trouble finding a doctor, that's going to help you with your particular needs. Talk to your lawyer. Your lawyer can help you there. The Workers Compensation Board website also does have a database. You can find it through their webpage, and there's a database where you put in your zip code and the type of doctor that you need and they'll generate a list of doctors in your area. I'm pretty sure that was updated not too long ago. There were some issues with some of those names being incorrect or out of practice, but certainly gives you a a pretty extensive list of doctors who can help you out. So it's worth looking there as well.
Question, "Is it true if your claim is denied for a good amount of time and the insurance company is not taking liability? Can you get the judge to let you continue to treat with your doctor instead of their docs?" I'm not quite sure what you mean by that, because you should never be treating with anybody's doctor but your own. I don't know if this is a question regarding a case outside of New York State, because I know in other states the insurance companies assign you a doctor and assign you a doctor for treatment that not the case in New York. So this might be a New Jersey question.
Certainly the laws are different state by state, and every state has a workers' compensation system. But they're all different in their own little weird ways. So I don't know about what happens with an insurance company taking too long of a period of time if a case is denied.
I'm certainly here to help and I love helping you guys.
If anybody has any questions, please, anytime you want call us at 212-406-8989. I hope you found this informational.
Finding the right doctor. It's a super important thing.
It's also as important as finding the right lawyer. Find a doctor that's going to get you better. Get you back to work quickly.
We're going to coming back to you soon with with another informational video. If there's any questions in the meantime, please folks, give me a call at 212-406-8989.
Have a wonderful day. Everybody thank you.