Are you wondering whether workers’ comp lets you choose your doctor after getting hurt at work in New York? The rules can change depending on your job, your employer’s insurance while at work, and how long it’s been since your first appointment. Making the wrong move when navigating workers’ comp choose doctor options could put your medical care or benefits at risk.
A workers’ comp lawyer can explain your options, help you find a Board-approved doctor, and push back if the insurance company tries to limit your care.
Your Medical Rights After a Workplace Injury in New York
Workers’ compensation is employer-provided insurance that covers medical care and wage replacement for employees who get hurt or sick on the job. In New York, most workers qualify as long as they are employees (not independent contractors) and their injuries or illnesses are work-related.
If you get hurt at work as an eligible employee in New York, you have the right to medical care under workers’ comp. Your benefits will cover doctor visits, surgeries, prescriptions, therapy, and assistive devices like crutches or braces. You do not need to pay out of pocket.
The workers’ compensation insurance carrier should cover all your bills, especially if you follow the proper workers’ comp choose doctor guidelines, unless the Board later rejects your claim.
You can go to any doctor approved by the Workers’ Compensation Board for treatment. However, if your employer uses a network of approved doctors (a PPO), you must start treatment with one of those doctors. After 30 days, you can switch to another Board-authorized treating physician outside of that network.
You also have the right to get reimbursed for travel to and from medical appointments related to your work injury report. Be sure to save your travel expense receipts so you can submit them with a request form.
If the insurance company delays or denies your coverage, it must explain why. You have the right to fight their decision. You can ask the Board to review it, and your doctor can back you up with medical records and reports.
Can You Choose Your Own Doctor for Workers’ Compensation?
In many cases, yes. New York law lets you choose your own doctor for a work-related injury. You can select any doctor with approval from the Workers’ Compensation Board. You can search the Board’s website to see who qualifies or ask your doctor’s office if they can treat workers’ compensation cases. Understanding why choosing a doctor matters for workers’ comp can impact your care and benefits.
However, it’s worth noting that your choice might be limited at first. If your employer uses a Preferred Provider Organization (PPO), you must begin treatment with one of the doctors in that network. After 30 days, you can switch to any Board-approved provider. To do so, you must write a letter to your insurance carrier or employer stating that you want to switch doctors.
The rules differ if your workplace has a union agreement under the Alternate Dispute Resolution (ADR) system. You may only seek treatment from that program’s workers’ comp doctors list.
In emergencies, you can go to any available provider. However, once the emergency ends, you must return to an authorized workers’ compensation attorney and medical provider to qualify for benefits after medical improvement.
NY State Rules on Doctor Choice in Workers’ Comp Cases
New York law gives you the right to choose your treating doctor, but only if that doctor has approval from the Workers’ Compensation Board. The doctor you see for treatment must also have the right specialty. For example, a dentist couldn’t treat your back injury, even if you’re an injured worker or injured on the job, needing health care for a specific condition.
Employers can’t pressure you to pick a certain doctor. They also can’t block you from seeing a qualified provider. If they do, they could face legal penalties.
If your employer joins a PPO, you must start with a doctor in that network. But after 30 days, you can change doctors. You must send a written notice to your insurer or employer to make the switch. The same rule applies if your employer uses a pharmacy network or diagnostic testing network.
If your current doctor doesn’t provide the right care or you don’t feel comfortable with them, you can ask to switch. You may also get a second opinion.
New York also allows workers’ compensation insurers to schedule independent medical exams (IMEs) that you must attend. A doctor who did not treat you will perform the exam to assess your injury, working ability, and treatment needs. This exam could affect your benefits, so consider bringing someone with you to ensure the exam is fair and accurate. They can take notes and confirm what the doctor said or did during the exam in case any questions arise later.
What Happens If You Refuse to See the Approved Doctor?
If your employer uses a PPO or is part of an ADR program, you must at least see a doctor from their approved provider list to start. If you refuse to see an employer-selected doctor, the insurance company could delay or stop your benefits.
The same rule applies to IMEs. If your insurer schedules an IME and you skip it without a good reason, the Board could suspend your benefits. The insurer might claim they can’t confirm your condition without that report.
If you feel unsure about which doctor to see, you can talk to a lawyer or file a complaint.
When Can You Request a New Doctor?
You can request a new doctor at any time if the doctor has approval from the Workers’ Compensation Board. If your employer uses a PPO, you must wait 30 days from your first visit before switching to a provider outside the network and notify your insurer or employer in writing.
You might want to switch if your current doctor doesn’t listen to you, doesn’t help you improve, or isn’t treating your injury, especially if you’re unsure how to express your concerns; consider learning some tips to talk to the doctor. You can also ask for a second opinion before changing doctors.
While you usually don’t need to fill out a doctor change request form, you should keep a copy of your request for your records. If your claim is under an ADR system, check your agreement first. Some programs have their own rules for switching providers.
Contact a New York Workers’ Compensation Lawyer Now
Are you ready to get help with your New York workers’ comp claim? Contact Fusco, Brandenstein & Rada, P.C. today at 516-496-0400 for your free consultation. Our team is here to help you understand your rights and take the first step toward securing the necessary benefits. We’ll listen to your story, explain your rights, and answer your questions, all at no cost to you.