Under the New York workers’ compensation laws, when you have suffered a workplace injury or have contracted a disease related to your employment, you have the right to file a workers’ compensation claim and to get payment for certain medical expenses. What types of medical bills are covered?
You are entitled to payment or coverage of all expenses related to any necessary medical care directly related to or arising as a consequence of your work-related injury or illness. Workers’ compensation benefits also cover the costs of recovery, including physical therapy and rehabilitation.
As a general rule, any medical professional providing care to you must be preauthorized by the Workers’ Compensation Board, unless the treatment is an emergency. You have a right to payment of or reimbursement for such medical expenses, even if your injury has not resulted in any time lost at work and you have received no cash benefits for lost wages. If you have requested an authorization, but it has been withheld for more than 30 days, with no stated reason, the treating physician may provide care, if necessary to promote or protect you health or welfare.
If you require any x-rays, MRIs or other tests, or need a surgical procedure, physical therapy or special consultation, you must obtain prior authorization, if the costs exceed $1,000. If the workers’ compensation insurance carrier has notified you of a preferred provider of services, you must obtain services from that provider, unless the situation is an emergency or there is no preferred provider within a reasonable distance from where you live.
The cost of drugs to treat you condition are generally covered by workers’ compensation. The pharmacy may directly bill the workers’ compensation insurance company or you may seek reimbursement by sending the bill and a letter from your treating physician, indicating that the medication was a necessary part of your care.
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