Workers in New York are entitled by law to have all "medically necessary" treatments, procedures, and medications stemming from a work-related injury covered to 100% of permitted costs under published fee schedules. Thus, a doctor's office may not even ask for a co-payment if that office is aware that you are seeking medical treatment specifically for a Workers' Compensation injury or illness.
In fact, under Section 13 of the Workers' Compensation Law, it is improper for anyone other than the employer's insurance carrier to pay for anything that is "medically necessary" due to a Workers' Compensation claim. If the claimant is able to prove the "medical necessity" of a requested treatment or medical device, the Workers' Compensation Board holds wide discretion. For instance, even experimental procedures not yet approved by the FDA have been ordered by the Workers' Compensation Board. Below we've placed examples of claims in which the courts have ordered such medical necessities as breast reduction therapy, fertility treatment, and hot tub installation, where appropriate.
However, insurance companies and their lawyers don't just buy everyone a Hot Tub under the Workers' Compensation Law, to be sure. These insurance carriers often hire consultant physicians to dispute the medical necessity of even seemingly small items or procedures. Insurance companies will often fight just as hard as claimants, and so will insurance company lawyers!
Because insurance companies seldom "just pay" if they think they can avoid or even delay a liability to another day, every claimant in need of serious medical attention should likely retain experienced legal counsel as soon as possible.
Please Contact Us if you have been denied medical treatment for a Workers' Compensation injury. We'll make sure the question of "medical necessity" is either negotiated to a successful resolution, or litigated and judicially determined, in as little time as is possible.
See What the Courts Say:
Document One
The Matter of Denise Bolds v.
Precision Health, Inc. and Uninsured Employers' Fund
Document Two
The Matter of Stephen Spyhalsky v.
Cross Construction
Document Three
The Matter of Mitchell A. Young v.
Ceramic Tile Contractors
If You Need to Confirm Whether a Physician, Podiatrist or Chiropractor is Authorized to Treat Workers' Compensation Claimant's Check the Board's Listings for the Providers in the Various Counties Listed Below:
