Every year, tens of thousands of workers’ comp insurance claims are filed due to workplace injuries. Despite this prevalence, the NYC workers’ comp process is often confusing and poorly understood by those who need it most. That is why we have put together this physical therapy guide to navigating NYC workers’ comp. Here we cover the basic steps you should follow in order to get back to your job as quickly and easily as possible.
Understanding NYC Workers’ Comp
Before you begin the process of filing a workers’ comp claim for physical therapy, you should have a basic understanding of what workers’ comp is and how it can benefit you.
New York City’s well-established workers’ compensation system requires almost all businesses in the city to provide coverage for all employees, including those who work part-time. That means that if you work in the city, you are likely to be eligible for this insurance through your employer.
This insurance is not the same as your regular health insurance. Instead, it specifically covers injuries or illnesses sustained while you are working Examples of the types of conditions you could receive compensation for include the following:
- Sprains
- Strains
- Occupational arthritis
- Fractures
- Torn ligaments and tendons
- Back injuries such as herniated discs
- Dislocations
If you have questions about your eligibility or coverage under NYC workers’ comp, reach out to your employer. Knowing your situation before you get injured or immediately after can help you receive all of the benefits for which you qualify.
Navigating the NYC Workers’ Comp Process
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If you have the misfortune of becoming injured at work and require physical therapy to heal, you will need to follow certain steps to receive the help you need. Here is an overview of the most important steps involved in getting physical therapy through workers’ comp.
Report your injury promptly to your employer
The first step in navigating the NYC workers’ comp process is to report your injury to your employer as soon as possible. The claims process moves fairly rapidly in the state. On your end, you have no more than 30 days to inform your workplace of your illness or injury in New York State.
Timely reporting helps to connect your illness or injury with the workplace where it happened. Plus, not informing your employer quickly enough could make you ineligible to receive treatment under workers’ comp.
Once your employer learns of your workers’ comp claim, they have 10 days to inform the insurance carrier of your injury or illness. They are required to report any incident that results in either of the following:
- Medical care that goes beyond first aid
- Injury or illness that leads to at least 1 lost day of work after the day of the incident
From there, your insurance provider will be in communication with you to help you work through the remainder of the claims process.
Submit an Employee Claim Form
In addition to alerting your employer to your injury or illness, you will need to submit an Employee Claim Form to the Workers’ Compensation Board for New York State. You may also have an additional form to file if you have previously experienced an injury in the same location.
While you must inform your employer of your workplace injury within 30 days, you can take up to 2 years to submit this form. However, the faster you complete this paperwork, the faster your workers’ comp insurance can take effect. Try to do it about the same time you let your employer know about your claim.
Choose approved medical providers
In order to have your claim approved and receive your benefits, you must use medical providers who are authorized by the New York Workers’ Compensation Board. This includes the providers who conduct your medical evaluation and providers who offer treatment.
If you require physical therapy to heal, you will need to choose a physical therapist who is approved by the board. Choosing the right provider can ensure that your claim is approved and your reimbursement occurs without any issues. The good news is that you can choose ANY provider who is authorized by the Board, giving you some freedom of choice to select a PT who meets your needs.
Get authorization for physical therapy
Before you can begin physical therapy for your workplace-related injury or illness, you must get a referral from the primary medical provider who is overseeing your case. In addition, keep these considerations in mind:
- Your physical therapist must be authorized by the Board.
- Your physical therapist must be licensed.
- You may have a limit on the number of visits you receive.
Make sure you understand how your coverage applies and ensure that you are working through the right process to get your physical therapy expenses covered.
Attend treatments
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Once you have an authorized physical therapist, you will work with them to develop a treatment plan tailored to your specific injury. This plan will likely include an evaluation of your injury, a number of estimated visits, and an approach that includes the treatments considered most likely to get you back to health.
During this part of your workers’ comp journey, you should attend all of your treatment sessions and work with your provider to determine your needs. By doing so, you not only get the most out of your benefits but ensure that your treatment helps you heal as quickly and as fully as possible.
During this process, expect to engage in additional evaluations that track your progress, clear communication with your physical therapist, employer, and insurance provider, and benefits that make your treatments more affordable.
Additional Workers’ Comp Considerations
In addition to navigating this basic process, there are a few considerations you should keep in mind when navigating the NYC process for workers’ comp physical therapy. These tips can help you avoid losing your coverage and ensure that you successfully receive the treatment for which you qualify.
- Do not pay any medical bills on your own. These bills should be paid through your workers’ comp coverage.
- Always use authorized providers or you may be responsible for your bill yourself.
- Communicate clearly with all involved parties. You want to make sure that your health needs are met and that you understand exactly how the claims process works.
- Consider hiring a lawyer to avoid mistakes that could cost you your benefits.
- Fill out your claim form accurately since errors can affect your ability to access your benefits.
Have you been injured at work? In Touch NYC Physical Therapy works with workers’ comps claims to get you the tailored treatment you need to get back on the path to health. Let us help you heal and navigate the insurance process, with less stress and a personalized approach. Contact us today to get started!