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What is Workers' Compensation?

Ulster County Workers' Compensation Claims Attorney

Have you been injured in a work-related accident in Ulster County? If you or a loved one has sustained a workplace injury, you are facing frustration and difficulties that we understand. With injuries come steep medical bills, loss of mobility, emotional trauma, physical pain and suffering, and sometimes the inability to work and earn a living. In more severe cases, some injured workers suffer permanent disability and may not ever be able to return to their normal jobs. Under New York law, there are provisions that protect the rights of injured workers so that they do not suffer severe financial hardship after a workplace accident. Speak with an Ulster County workers' comp lawyer from our firm today about filing for benefits, so that you are fully reimbursed for any damages and loss of income.

How Workers' Compensation Could Help You

Workers' compensation is a special type of insurance that was designed to ensure that all employees are rightly reimbursed for any damages if they are ever injured in a work-related accident. Under New York law, all employers that operate a business in New York State must carry workers' compensation insurance coverage for their employees. When you reside and work in New York and you happen to suffer a work-related injury, you may be able to find support and relief through the workers' compensation system. Without this specialized insurance coverage, an injured worker could be responsible for covering the cost of medical bills, rehabilitation, and physical therapy. Without workers' compensation, an injured worker would not be reimbursed for lost wages or given any temporary benefits while unable to perform normal job duties. We want to make sure that you don't get hit twice! Our legal team can help you fight for your rights and seek the full benefits that you are legally entitled to.

Wage Loss Replacement

At Kirk & Teff, LLP, we assist our clients in obtaining wage loss replacement payments and awards for periods of temporary or permanent total disability, partial disability, and for periods of reduced earnings when injured workers are able to return to work, but with restrictions, and therefore making a lower wage than they were at the time of the injury.

Your rate of compensation is affected by various factors: whether past work was full-time, part-time, or seasonal, 4 days, 5 days, or 6 days or more per week, whether there was concurrent employment (more than one job at the time of the accident), as well as the age of the injured worker as of the date of accident.

Medical Care for Injured Workers

YOUR HEALTH SERVICE PROVIDERS

There are a number of issues to be aware of concerning the relationship between you and your doctor. First, you have a right to choose your treating medical providers. You also have the right to a second opinion and a right to change your medical provider if you are not happy with the standard of care you are receiving. However, all medical providers must be authorized by the Workers' Compensation Board to treat injured workers under New York State Board licensing and certification requirements. Treatment from a medical provider who does not have a WCB authorization number, most likely will not be paid by the insurance carrier.

It is equally important to make certain that the physician you treat with is appropriately trained in the specialty that relates to your work injury. You would not go to a foot doctor for a shoulder injury, or to a psychiatrist for a back injury. Make certain that when you choose a medical provider that they are properly trained in treating your specific type of injury.

Frequency of Visits to Your Treating Physician

It is necessary to see your treating medical provider(s) at least every 75 to 90 days in all cases where you are receiving monetary compensation for a temporary partial or total disability and not working, or where you are working with restrictions at reduced earnings. We advise our clients not to wait until the last minute to schedule and see your treating provider. If you have no timely medical report in your file and have a hearing coming up, you then rely on the hope that a medical appointment will immediately turn into a medical report in time for a hearing. This is often an unrealistic expectation. Many larger medical practices use billing services that fill out their reports. It can take two weeks or even longer from the date of your appointment until an actual report is produced. If there are problems with the report, extra time is needed to correct them prior to a hearing. Always err on the side of caution and try to have medical appointments made in plenty of time to cover all periods of lost time from work.

Relating the Facts of the Workplace Accident and Your Injuries to Your Treating Physician

An often overlooked part of your doctor's appointments, especially the initial one, is giving a proper history. It is critical to give your treating medical provider a comprehensive and detailed account of your work accident, and to clearly indicate to them all body sites that were injured in the accident, even if one or more of those sites may no longer be causing you difficulty when you see the doctor. The fact that body part that was initially injured is not currently causing problems is no guarantee that it will not do so in the future. It is much easier to establish your injury for all sites in the beginning of a claim than to try and add them later on.

The Medical Treatment Guidelines that Physicians Must Follow

The Workers' Compensation Board's Medical Treatment Guidelines set forth procedural requirements for health service providers to follow in connection with medical tests and treatment, as well as limitations with respect to long-term medical care. Most health service providers are familiar with the procedural requirements to ensure medical care is provided.

One of the most significant changes in workers' compensation over the past five years has been the institution of the Medical Treatment Guidelines for back, neck, shoulder, knee, and carpal tunnel injuries. Essentially, the guidelines as instituted severely restrict what is known as "palliative" or "maintenance care." This is particularly true with respect to continuing requests for physical therapy, acupuncture, and chiropractic care. A general rule is that these forms of treatment have a maximum duration of approximately three months once initiated. In the case of physical therapy, allowances are made for any required therapy following a surgery.

The thrust behind the guidelines is that they focus on care that restores a claimant's functional abilities to as close to pre-injury status as possible to enable a return to work. Thus, care which is designed to just maintain a claimant in their current condition is usually prohibited by the Medical Treatment Guidelines.

Finally, remember that in all cases the burden of proof for any proposed treatment that is not in the Medical Treatment Guidelines or is proposed for a period that runs beyond the maximum duration allowed in the Guidelines is on your treating medical provider. If your provider does not provide the necessary medical data, there is little chance that the treatment will be approved.

Acupuncture

Acupuncture treatment is now considered a legitimate method of treatment by the Workers' Compensation Board. However, there are restrictions in place as to the maximum duration of this course of treatment. There is also an additional consideration here. Many acupuncturists are not medical doctors. The Board Rules and Regulations require all acupuncture treatments to be administered by a licensed medical doctor. If you choose this method of treatment from the options offered by your medical provider, make certain that the acupuncturist is a medical doctor, or the bills will not be paid.

Diagnostic Testing

On diagnostic testing, the guidelines also severely restrict the number of diagnostic procedures a claimant can obtain once a diagnosis has been made. Thus it is more difficult now to obtain additional MRIs, CT Scans, and the like once a definitive diagnosis has been made and a course of treatment started.

While the Medical Treatment Guidelines allow for treatment outside of the guidelines, there are not only numerous procedural hurdles relative to making requests on the proper forms, but also the "burden of proof" of demonstrating that a claimant needs care which falls outside of the treatment guidelines falls upon the claimant's medical provider. In general, any proposed treatment that is not approved by the FDA or American Medical Association is prohibited under the Medical Treatment Guidelines.

Pain Management

It is also important to note that the Workers' Compensation Board has instituted Guidelines on Non-Acute Pain Management. These guidelines severely restrict the duration of prescription narcotic medications. If you have an older claim and have been prescribed opiates by your treating physician for an extended period of time, the "burden of proof" will fall on them to provide enough data to the Board to sustain a request for continuation of this type of medication outside the durational limits set by the Guidelines.

These issues and many others make for a steep learning curve for an injured worker. Contact our firm today if you feel that you can benefit from the experience and knowledge of a workers' compensation attorney!

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