Under the New York Workers’ Compensation system , injured employees causally related medical care is controlled by various sections of the New York Workers’ Compensation Law , ( WCL). Generally speaking, such care is not the responsibility of the injured worker but rather the responsibility of the employers’ workers’ compensation insurance provider. If the employer fails to obtain or maintain such coverage, the WCL created a fund to cover such treatment responsibilities as well as indemnity issues. This Fund is known as the Uninsured Employers Fund.
There are no deductibles nor co-payments by workers nor anyone else. If the procedure or treatment has been properly provided or properly requested and complies with the WCL the injured worker is exempt from any financial obligation in respect to such care. If the provision of such causally related healthcare fails to meet the standards and procedures for obtaining payment to the health care provider; such care is not the responsibility of the injured worker. The claimant /worker is exempt from any financial responsibly for same. It is illegal for a provider of such causally related care to request or compel payment from the patient.
The real issue has become more vexing since the creation of the newest Medical Treatment Guidelines effective 12/1/2010. These regulation and practices have been promulgated with the stated intent to quicken the process for obtaining medical care under the WCL. At the present time, delays seem to have been created and questions remain regarding these Guidelines and their interpretation as well as authority. The New York State Legislature is presently, reviewing laws on these issues. We’ll see what develops. Further commentary will follow in later blogs.
As always, note my disclaimer, these discussions are merely just that, a discussion and not formal legal advise which should be conducted in a face to face retainer relationship with an attorney or legal representative and would be fact and law sensitive to each separate case presented.