What If I Receive a Medical Bill from My Workers’ Comp Doctor?

Worker’s Compensation in New York

Workplace accidents can result in injuries that put a strain on both your professional and personal life. Fortunately, if you have suffered from an accident at work in New York, the laws entitle you to help from your employer with covering all medical expenses related to your recovery.

In New York, the Worker’s Compensation Board (WCB) safeguard and enforce the Worker’s Compensation Law (WCL). With that said, they require your employer to cover any costs associated with medical treatment that result from workplace accidents. However, there is a small window of time to report your claim in order to receive compensation. We will talk more on this in a moment; let us first take a look at what you can expect worker’s compensation to cover in relation to your workplace injuries.

Coverage According to the WCL

In New York, workers’ compensation, also referred to as workers compensation, may cover more than you realize. In regards to your medical expenses, this includes, but is not limited to:

Ambulance rides to the emergency room;

• Emergency room visits;
• Emergency room or hospital stays;
• Appointment fees;
• Diagnostic testing;
• Surgeries;
• Rehabilitation; and
• Visits to specialists.

In fact, almost all medical expenses related to your workplace accident are to be covered by your employer under New York’s WCL. However, compensation is not limited to medical expenses alone. Attorney fees and court costs will also be provided for by your employer should your worker’s compensation claim result in a lawsuit.

The WCL also entitles you to certain cash benefits as well. For example, if your injury results in a disability that exceeds 14 days, you may be entitled to compensation for missed payments. You should note that claimants will not receive compensation during the first 7 days. However, they will receive back pay for this time period at the 14-day mark. Furthermore, some injuries may result in you being unable to perform the same type or level of work you had previously been expected to provide. This may result in a pay decrease. New York’s WCL has you covered here too. Your employer will be required to pay two-thirds of the difference between your previous pay and your reduced salary.

It is unfortunate, but in some situations, workplace accidents may result in fatalities. If this occurs, the WCL also helps protect the family of the deceased employee. This includes:

• Up to $12,500 for funeral expenses for Metropolitan New York counties;
• Up to $10,500 for funeral expenses for all over areas in New York;
• Weekly cash benefits for the deceased employee’s family that equates to two-thirds of the employee’s lost income.

Some states require you to “prove” your injury occurred at work. However, New York’s WCL is considered a “no-fault” law. This means that you are in no way accountable for an injury that occurred at work. In other words, the WCB cannot fault you for being careless while working and deny your claim.

Speaking with a qualified and experienced worker’s compensation lawyer can help you determine which of your expenses fall under the WCL. These individuals know what fees and schedules fall under the WCL and can give you a more tailored estimate based on the specifics of your case.

What Happens with The Bill?

While the WCL does protect your right to compensation after sustaining workplace injuries, occasional issues may arise. For many, this typically occurs when a medical bill is sent to you instead of your employer or their insurance company. So what do you do if this occurs?

First, you must report the injury to your employer within 30 days of the incident, preferably in writing. (In the case of an occupational disease, you have 2 years after you receive your diagnosis to report this to your employer.) This will kick off your worker’s compensation claim. During this time, certain steps will need to be taken. These include:

1. Your employer will provide you with Form C-3; you are required to fill out this form and submit it to your local WCB.
2. Your employer will need to fill out and file Form C-2 within 10 days of your notification of the workplace injury with both the WCB and their insurance provider.

When your employer files Form C-2 with their insurance provider, they will review the case. If the insurance provider approves the incident as a workplace accident that resulted in injury, they should notify the treating doctor or hospital and redirect all bills to their office.

If you receive the bill instead, you will need to contact the healthcare billing company and redirect all associated bills to your employer’s insurance provider. (In most cases, the billing company’s contact information should be clearly available on the bill. If this is not the case, you may need to contact the hospital or doctor’s office where you received your care in order to have your file updated.)

If your employer’s insurance provider denies your claim, you will likely need to file an appeal with the WCB. (We highly encourage you to seek legal assistance throughout the entire worker’s compensation claim process!)

Your employer may direct you to “pay the bill” and promise to reimburse you. Do NOT do this! This may make it harder for you to receive compensation for the bill after the fact. (This is yet another instance where a worker’s compensation lawyer can provide invaluable insight and legal advice regarding your case.)

All Workplace Accidents Are Serious

Workplace injuries may range in severity. However, any accident that occurs in the workplace is serious. Why? Even if your injury was minor, the next individual who suffers from the same accident may not be as lucky. Reporting workplace accidents is essential to protecting yourself and your fellow co-workers.

Some of the most common workplace accidents sound relatively harmless: the slip and fall. A slip and fall accident, however, can result in injuries far more serious than you may realize. For example, if you slip and land on your bottom, you may laugh it off with your co-workers and chalk it up to wounded pride. However, landing in this fashion may actually lead to spinal injuries that can fester as time goes on. What may start as a simple backache can, over time, worsen and become a debilitating spinal injury if left untreated. The injuries from a slip and fall accident may take a day or more to start showing up, which can delay your worker’s compensation case.

There are many different types of injuries that may occur at work. The WCB does not disregard a claim based on the type of injury. Some examples of the most common types of injuries you may suffer at work include:

Reaction Injuries: Slip and fall accidents are considered “reaction” injuries. The injuries occur as the result of a clear incident. These injuries can include sprains, broken bones, cuts, and more.

Repetitive Stress Injuries: Carpal tunnel syndrome is one example of a repetitive stress injury. These injuries result from prolonged exposure to unsafe conditions, including hunching over a desk all day.

Overextension Injuries: Most common among stocking, construction and moving employees, overextension injuries result from improper lifting, carrying, pushing, holding and pulling techniques.

Transportation/Vehicle-Related injuries: These injuries do not relate to your typical commute to and from work. However, for workplaces that require the use of vehicles, being struck or run over by a vehicle is likely to result in injuries covered by the WCL. Often among the most fatal injuries, these incidents typically occur in the agricultural industry but are also commonly found in industrial and manufacturing environments as well.

Fire and Explosion Injuries: Faulty gas lines, ill-fitting pipes and improper storage of combustible materials can result in fires or explosions in the workplace. Damages to the respiratory system, as well as burns and disfigurement, are common in the event of a fire or explosion at work.

Protect Yourself – Seek Help Immediately

Workplace accidents can result in expensive medical treatments. It is in both you and your employer’s best interest to keep the workplace safe. Promoting a healthy working environment is the first step in your employer’s ability to decrease the likelihood of workplace injuries. Encouraging regular breaks, providing clear training, and abiding by proper safety protocols are essential.

If you or a loved one has suffered from a workplace accident, it is very important that you seek help immediately. Not only can you help increase the chances of a full recovery and decrease your exposure to pain, but you can also help keep your fellow co-workers safe from a similar fate.

It is highly advised that you seek help from a competent, experienced legal professional if you believe you need to file a worker’s compensation claim. These individuals can provide invaluable legal assistance throughout the entire process. As practiced experts, a worker’s compensation lawyer can help you collect and main all necessary documents should your case need to go through a WCB hearing. They can help you prepare for providing testimony, identify potential treating doctors and specialists from the list of authorized healthcare professionals who may help you recover, and will act as your advocate on all things related to your workplace accident.

Even if you feel that your injury was minor, it is important that you seek help immediately. Spinal injuries, in particular, may take a few days to show up. Risking prolonged or lifelong disabilities is not something to ignore. The longer you wait to report your injury, the more likely your case will be dismissed. This may result in you having to foot the bill for all of your medical expenses related to your workplace injuries.