Applying for workers’ compensation is often a fairly straightforward process. But certain bumps in the road, such as inadequate medical documentation, can complicate your claim and delay the payment of benefits, raising questions about your rights and responsibilities.
Having a strong doctor’s report to support with your claim can make it easier to prove that your injuries are work-related and that you qualify for compensation. A workers’ compensation lawyer in New York can help you understand the necessary documentation required to support your claim and guide you through the process from start to finish.
Understanding New York’s Workers’ Compensation System
New York requires the majority of employers to offer workers’ compensation benefits to their employees. Understanding how workers’ compensation works helps you determine the correct evidence to provide with your claim.
This is an insurance benefit that pays for necessary medical treatment expenses and a portion of lost wages after an on-the-job injury. It is a no-fault system, meaning workers do not need to prove that their employer was at fault; they simply need to show that the accident happened in the course of their job duties.
Across the U.S., around 2.4 million total recordable nonfatal injuries and illnesses occur annually in the private industry, according to the BLS. In New York, approximately 160,000 people apply for workers’ compensation benefits every year.
A survey found that between 2013 and 2017, nearly 7% of workers’ compensation claims were initially denied. While this number may seem insignificant, it represents thousands of workers who faced difficulties seeking compensation for workplace injuries.
Common Reasons for Workers’ Compensation Claim Denials
Submitting a workers’ compensation claim correctly is important to reliably securing reimbursement for necessary medical expenses. A doctor’s report is just one element of a successful claim.
A few common reasons a workers’ compensation claim might be denied include:
- Lack of medical documentation: The Workers’ Compensation Board requires receipts of medical documentation reflecting the treatment you received for the workplace injury. If you do not seek treatment right away, it might be difficult to tie the injury to a specific work related incident.
- Failure to report the injury promptly: You generally need to report your work related injury to your employer within 30 days to have a valid workers’ compensation claim.
- Failure to file the application on time: The New York Workers’ Compensation Board gives you two years to file an application for workers’ comp for the majority of work-related accidents. This is plenty of time for many workers, but you may be at risk of missing the deadline if you do not realize you qualify for workers’ comp until down the road.
- Disputes over the accident or injury: The insurer may allege that you were under the influence of drugs or alcohol when the accident occurred, that you intentionally injured yourself, or that you were not on the job when the injury happened. Any of these reasons could prevent you from securing workers’ compensation.
Your workers’ comp lawyer in New York can help you understand the strength of your potential claim and reasons it may be denied.
How a Workers’ Compensation Doctor’s Report Affects Your Claim
Serious workplace injuries often give rise to hundreds of thousands of dollars in medical bills and extended time off work. In these cases, you may need to provide substantial evidence showing the necessity of ongoing workers’ compensation benefits. Doctor’s reports can help support your case and serve as the foundation for your claim.
The treating physician is the doctor who describes the history of your work accident, provides the initial diagnosis, creates a treatment plan, and documents your degree of disability. While your accident will likely produce a significant amount of medical documentation, a “doctor’s report” is a formal document that connects your injury to your job and sets your work restrictions.
A doctor’s report serves several purposes in a workers’ compensation claim:
- Ties your injury directly to your work duties
- Outlines the physical restrictions and limitations that would prevent you from returning to your job at full capacity
- Establishes whether or not you can return to work and, if so, under what conditions
- Tracks your recovery through medical updates and progress notes
The doctor’s report is important evidence the insurance carrier will use to potentially approve your claim and calculate your benefits. Your workers’ comp lawyer in New York can help you understand what other evidence may be necessary or helpful in your claim.
How To Obtain a Doctor’s Report in Connection With a Workers’ Compensation Claim
Without proper medical evidence, you will have trouble proving your entitlement to workers’ compensation benefits.
Any medical documentation created in conjunction with your job-related accident can be helpful, but requesting a formal doctor’s report is very important. You should follow these steps:
- Visit a Board-approved medical provider (for non-emergency care). You can search on the NYWCB’s official directory to find an approved provider. While you may initially visit the nearest ER or urgent care to treat your injury, finding an approved provider for ongoing follow-up treatment is important to meet the criteria under the workers’ compensation system.
- Notify your doctor that this is a workplace injury. When you attend your first appointment with the Board-approved doctor, be sure to tell them that this is a workplace injury. They will know the types of documentation should submit as part of your claim.
- Request a detailed narrative report. Your doctor can provide a narrative report that outlines your work related accident diagnosis, medical causation, impairments and work restrictions, treatment plan and the degree of your disability.
As a Board-approved provider, your doctor will also know where to submit workers’ compensation documentation throughout your accident case and handle much of this process for you. If you need help with this process, don’t hesitate to contact a lawyer for workplace injuries.
Speak With a Workers’ Compensation Lawyer in New York
Providing a doctor’s report with your workers’ compensation claim increases the likelihood of it being approved. This report should be detailed and include relevant information regarding your restrictions and treatment plan.
At Pyrros, Serres & Rupwani, we provide legal representation for workers navigating the workers’ compensation system. Whether you need help understanding common workplace injuries that lead to workers’ comp claims or appealing a denied claim, we offer professional guidance and support.
Contact us today at 718-626-7730 for a free consultation with a workers’ comp lawyer in New York.
Frequently Asked Questions
Can you switch doctors midway through a workers’ compensation claim in New York?
Yes, you can switch doctors midway through your workers’ compensation claim, as long as your new physician is also authorized by the Workers’ Compensation Board. You have the legal right to choose your own medical provider as part of your claim. Speak with a workers’ compensation attorney in New York to learn more about this process.
How quickly do you need to submit a doctor’s report with your workers’ compensation claim?
Your treating physician should promptly submit the doctor’s report for you as part of your claim. As an injured worker, you generally do not need to personally submit the doctor’s report yourself, but you are responsible for notifying your provider that your injury is work-related.
What happens if your workers’ compensation claim is denied?
If your claim is denied, you may be able to appeal the denial by submitting additional evidence. A workers’ compensation lawyer in New York can review your claim denial and help you determine how to best proceed.
