what happen if i get treatment for a work related injury with my health insurance in new york

The fact of the matter is that if you require treatment for a work-related injury, only workers’ compensation insurance can be used. If you use your personal health insurance when you’re still injured from your workplace injury, you will have to lie to the doctor and tell them your injury is not work-related.

Full Answer

Should I use health insurance to treat my work injuries?

But your employer and its workers’ compensation insurance carrier refuse to provide a panel of physicians or to pay for medical treatment. Should you use health insurance to treat for your work injuries until the Commission makes a decision at your workers’ compensation hearing? Yes.

Can private health insurance companies refuse to pay for work-related injuries?

Because workers’ compensation exists, many private health insurance companies will refuse payment for any treatment they believe is related to a work accident. In fact, private health insurance companies often include exclusionary language in their policies.

What happens to my medical bills if I get injured at work?

Your employer will still be required to pay all of your medical bills for treatment related to this new work-related injury. Similarly, if you are unable to work, your employer will pay you temporary disability benefits (a.k.a time loss compensation benefits).

Do you need treatment time after a workplace injury?

These treatments take time, which is a valuable commodity when recovering from a workplace injury. You may feel treatment time could be better spent on other activities, such as attending physical therapy or pursuing your workers’ comp benefit. You may even wonder whether the treatment the doctor recommends will be effective.

Who pays for my health insurance while on workers comp in New York?

Workers comp benefits apply to any worker who suffers a qualifying work injury. They guarantee that the worker's health insurance (which includes medical bills, lost wages, and disability benefits) will be paid by his employer's workers compensation insurance.

Can you be terminated while on workers comp in NY?

According to New York State law, being fired while on Workers' Compensation is not discrimination. This is because NY law allows employers to replace you if you're unable to perform your work. However, you cannot be fired while on Workers' Comp. just for filing a NY Workers' Compensation claim.

How long can a workers comp claim stay open in NY?

Two yearsSpecifically the rules offered by the New York State Workers' Compensation Board state: Two years from the date of the disabled worker's disability; or. Two years from the time the disabled worker knew or should have known that the disease was due to the nature of employment.

What is the employee's responsibility if they get injured?

An employee's responsibilities include: Promptly reporting to their employer the details of any accident, injury or disease that might be related to their work. Co-operating with their employer, case manager, claims manager and rehabilitation provider to achieve a full return to work (if this is medically appropriate).

What happens if I can return to work after an injury?

Can I Be Forced Back to Work After Injury? No. After you have received a Notice of Ability to Return to Work you cannot be forced to return to your job while you are still injured. For instance, you and your physician can protest the medical information that's been cited in the notice.

Does my employer have to hold my job while on workers comp in NY?

Employers are not required to hold positions. Workers' Compensation Law does not require your employer to keep your job open for you. However, most employers do take injured workers back. Stay connected with your employer about your job status.

What does NYS workers Comp pay?

Compensation Rates An injured employee is entitled to a compensation rate equal to two-thirds of the average weekly wage (AWW) in New York State for the 52-week period immediately prior to the date of accident. The rate is subject to prescribed maximums and degree of disability.

What is the maximum workers compensation in NYS?

Accordingly, the maximum weekly benefit rate is $1,063.05 for compensable lost time for workers' compensation claims with dates of injury during the period from July 1, 2021, through June 30, 2022.

How long does it take to get a workers comp hearing in NY?

Your hearing should typically take place within 1-3 months from the date in which the insurance company notified the Board of the contest of claim. The court is encouraging the hearings to take place within 45 days.

Do I get paid if I have an accident at work?

Do I get paid if I'm injured in a work accident? While you do have some rights after being injured at work, there is no obligation on any employer to pay a staff member their full standard salary if they are off work due to illness or injury – even if it was caused by an accident at work, or materials used at work.

How do you deal with work-related injuries?

As soon as an accident or injury happens, business owners should follow these steps:Get workers to a safe place. Move any injured workers away from an area if it is dangerous and make sure other employees stay clear.Assess the situation. ... Assist the injured. ... Gather information and keep evidence.

What happens if you have an accident at work?

If you are injured at work it is important to report the incident to your employer as soon as possible. Your employer's initial concern should be to ensure that you are free from immediate danger and to seek medical attention as soon as possible. This could be from a first aider or through calling an ambulance.

When Should You Seek Treatment?

You should seek treatment right away for any injury, even if it seems minor. This means seeing a doctor immediately after a work-related accident o...

Where Should You Go For Treatment?

If you need immediate medical attention, you should go to the nearest emergency room. If it’s not an emergency, however, you’ll need to follow your...

Why Your Choice of Doctor Is Important

Although doctors hired by employers or insurance companies are supposed to be objective, they often have close and financially rewarding relationsh...

What Should You Tell Your Doctor?

Even with the advancement of medical technology, doctors still rely on patients to report symptoms, severity of pain, and activities that are diffi...

Who Pays For Your Medical Bills?

In most states, your employer is required to pay for your medical bills until a decision has been made to accept or deny your claim, at least up to...

What is the role of a treating physician in workers compensation?

Your treating physician will play an essential role in your workers' compensation case. In addition to making decisions about your diagnosis and the treatment you should receive, the doctor will often have to write reports (and sometimes give testimony) that will affect when you can return to work and the benefits you'll receive, ...

How to communicate with your doctor about your injuries?

In doing so, you should follow these guidelines: Be honest and accurate. Describe your symptoms to your doctor truthfully.

What to do if you are not in an emergency?

If it's not an emergency, however, you'll need to follow your state's rules for getting medical care. Some states give you the right to choose the doctor who will treat you for your injuries (called your "treating doctor" in workers' comp lingo), while others give that right to your employer or its insurer.

Who pays for medical bills?

Who Pays for Your Medical Bills? In most states, your employer is required to pay for your medical bills until a decision has been made to accept or deny your claim, at least up to a certain amount. If your claim is approved, your employer will continue to pay for your medical bills for approved treatment.

How to tell your doctor about your symptoms?

Describe your symptoms to your doctor truthfully. Don't exaggerate, but don't downplay your symptoms either. An experienced doctor will know when you're not telling the truth, and you'll lose credibility. Err on the side of inclusion. Tell your doctor about all of your symptoms, even ones that seem minor or fleeting.

What happens if you lie to your doctor about your injury?

If you tell a doctor your injury is not from work, you are only hurting yourself and any potential your case has for filing a third-party injury claim.

Do companies have to pay workers compensation?

Most companies are required to carry workers’ compensation insurance, which means they have to pay for it . Every time one of their employees files a workers’ compensation claim, it has a negative effect on the premiums they will have to pay next year for their insurance.

Do workers compensation companies cut you off?

Their premiums are also based on how far the workers’ compensation claims go, so many times, they will try to cut you off as soon as possible and encourage you to pay for the rest of your expenses with your health insurance.

What to do if you have a workers compensation injury?

If the medical treatment you need for a work-related injury requires anything more than a few stitches to close a cut or a bag of ice to reduce swelling, take a deep breath and settle in. You might be in for a long process to get a final (and fair) resolution to your workers compensation case.

How to get medical benefits while off?

First Steps: Meet with a Physician. The initial treatment is done either by the employee’s physician of choice ( in 29 states) or by a physician chosen by your employer or their insurance carrier (in 21 states). If all goes well, the employee heals properly, his medical bills are paid, he has received two-thirds of his wages while off ...

What happens if you have a 50% impairment rating?

If the impairment rating assigned says that more than 50% (in most states, check your state’s laws to be sure) of the workers’ body is impaired, the worker could receive Permanent Total Disability benefits for the rest of his/her life.

Why is an independent medical exam considered neutral?

The reason “neutral” is in quotes is because an IME is paid for by one side or the other in a dispute over benefits.

What is impairment in workers compensation?

In practical terms for workers compensation, an impairment would be the loss of a specific body part or function such as eyes, a hand, a leg, or perhaps memory because of a work-related injury.

Why is impairment rating evaluation the most difficult examination in a workers compensation case?

The Impairment Rating Evaluation (IRE) is the most difficult examination in a workers compensation case because so much is riding on it and so much of the test is subjective.

What happens if you get hurt on the job but aren't hurt?

If you get hurt on the job, but aren’t hurt so badly you can’t do some work, temporary partial disability could be the category you fall into. In TPD, the treating physician believes you can spend at least part of the day doing your job and you’ll get paid for that. If it’s less than eight hours, workers compensation kicks in to make up for some of the lost wages.

Policy Overview

The University of Health Sciences and Pharmacy in St. Louis complies with workers’ compensation laws and provides workers’ compensation benefits to employees injured in the course and scope of their employment with the University.

Details

All employees (faculty, staff and student workers) are covered by Worker’s Compensation insurance and will receive benefits in accordance with Missouri Worker’s Compensation Law for work-related injuries or illnesses.

Procedures

Following are the procedures to be followed in the event of a work-related injury or illness.

Resources

Drug and Alcohol Testing policy in Faculty Handbook and Staff Handbook

Dan R. Denton

When meeting with your attorney as suggested in the other answers, make sure you get assurance that your private insurance will pay for future medical treatment if you settle the workers comp case.

Kenneth W Harrell

I agree with Ryan's assessment. It sounds as if your claim is denied. I'd get a meeting set up with your attorney as there may be legal (or factual) issues which lead him or her to believe that a settlement on a "doubtful and disputed" basis is in your best interests.

How long after injury do you have to seek treatment?

Don’t immediately agree to anything you feel uncertain about while you are at the appointment. Within the first 90 days after an injury, you must seek treatment with the panel providers approved by your employer’s insurance company.

What to do if you feel uncomfortable after a workplace injury?

Once you do meet with a doctor, may recommend treatment options you feel uncomfortable with, such as injections or even surgery. These treatments take time, which is a valuable commodity when recovering from a workplace injury.

What to do if you feel a treatment is unreasonable?

If you feel a treatment is unreasonable, such as surgery, the workers’ comp carrier can appeal to the judge in your workers’ comp case and present evidence why you should not have to undergo surgery.

What happens if you reject treatment?

If you immediately reject treatment, your employer and their insurance company can use this refusal to claim you are not trying to get better and attempt to terminate your benefits. If you accept the recommendation but do not act immediately on it, your employer has a tougher case to prove.

Can you wonder if a doctor recommends a treatment?

You may even wonder whether the treatment the doctor recommends will be effective. If the potential outcomes seem extensive or intrusive, you may feel you don’t want to pursue a recommended treatment.

Can you refuse treatment for an injury?

You cannot refuse reasonable treatment for an injury received on the job without facing the risk that the insurance company could try to use your refusal as a basis to request that a Judge stop your checks. You should consider the recommended noninvasive treatment options such as medication or physical therapy.

Why do pre-existing conditions end up in litigation?

Many claims involving pre-existing conditions end up in litigation due to the liability exposure involved for your employer. The earlier you hire an attorney, the more benefits you are likely to receive, and you may be able to avoid litigation. Read more on Tips for Workers Compensation Claims. Talk to a Lawyer.

What to do if you have a pre-existing condition?

If you have a pre-existing condition that you believe was worsened due to an industrial injury, you should strongly consider seeking a doctor that regularly treats injured workers. These doctors know the exact phrases and terminology necessary to describe your condition for purposes of your workers' compensation claim.

Can you get partial disability if your condition worsens?

Of course, if your condition did not permanently worsen due to the most recent industrial injury, you will not receive any permanent partial disability award. It is important to note the distinction between an aggravation of a previous work-related injury and a new work-related injury involving the same body parts.

Does health insurance pay for pre-existing conditions?

Your regular health insurance, if you have private insurance, will continue to pay for any treatment you need for the pre-existing condition. This may require you to see multiple providers – some for your pre-existing condition, and others for your workers' compensation claim.

Is an employer responsible for the worsening of your physical condition?

The reason for this is that your employer, in most states, is responsible only for the worsening of your physical condition caused by the industrial injury. Your employer will try to gather evidence to show that any permanent impairment you have now is a result of your pre-existing condition, and not the industrial injury.

How many off-the-job injuries were there in 2015?

According to NSC Injury Facts, there were over three times (3.5 to 1) as many off-the-job injuries that required medical attention as on-the-job injuries in 2015. That means employees were still missing time from work due to injuries which inevitably has an impact on the company’s bottom line. When an employee is unable to perform their duties, ...

What happens if you replace an employee?

If the replacement is an existing employee at the company, this will take away from their regular tasks. If a temporary worker is brought in, it will not only cost the company more but productivity will decline since the temp will not be able to perform the duties as well as the employee they are replacing.

Why do employers fear workers compensation?

Employers have a responsibility to provide a safe workplace.

Why is it important to have a conversation with an employee about their health?

It’s important that the conversation stays focused on their health and their return to work as well as things that could help the process. This should in no way make them feel pressure to return to work before they’re ready. Provide alternate duties to ensure the employee transitions back to a healthy work pace.

Does an employer have responsibility for an injury?

A common misconception is that because the injury is not specifically work-related (or goes unreported), the employer has no responsibility following the injury. Out of sight, out of mind, so to speak. While legally there are more implications for the employer if the injury happens on the job, employers are not completely off ...

Do employers have to provide alternate duties?

There are also some human rights and disability stipulations that the employer will need to pay attention to. Legally, the employer is not required to provide alternate duties when an employee returns after sustaining a non-work related injury but it greatly benefits them to do so.

The Benefits of Using The Ohio Workers’ Compensation System

Private Insurance Is Not Required to Cover Work-Related Injuries

• The workers’ compensation system exists specifically to address the unique needs and challenges associated with work-related injuries. The existence of these benefits effectively relieves private health insurance companies from their responsibility to those they insure when the injury or illness occurs on the job. Insurance companies do not have to...

See more on monastlaw.com

How An Ohio Workers’ Compensation Attorney Can Help