When Can Doctors Charge for Workers Compensation Reports in New York

Can I charge for that report? — Sometimes, if is Workers’ Compensation in New York

No medical services delivery system is more time consuming, for fewer dollars, than New York workers’ compensation. It comes as a surprise, therefore, to many that there are exceptions. Evidentiary reports are one of them.

The Workers’ Compensation Law requires treating physicians to keep adequate records and file periodic reports. Therefore, payment for these is in the medical fee schedule, however inadequate it may be. However, some reports are necessary but are not the responsibility of the carrier. For these, a party can, and indeed must, pay directly.

Casual Relationship (death claim) The most common is a causal relationship report for a death claim. In most cases, the claim is made months, or even years, after death and the records make no reference to work, much less causal relationship. In those cases, a qualified physician is asked to review the records and provide a written opinion. A fee is charged directly to the claimant, usually a surviving spouse.

Therapeutic Report Another type of report, the “therapeutic report,” is no longer used but was necessary for closing a claim on a lump-sum settlement. The claimant was required to pay for the report. Many resisted and insisted their lawyers, who would be collecting a sizable fee, pay. The Board side-stepped the dispute by automatically adding $100 to the lawyers fee to cover the cost of the report prevailing in the 1960s. The lump sum legal fee was 10% plus $100. Few people remembered why the $100 was added and when the therapeutic report was abolished in the late 1970s the Board continued to award the $100, although it no longer knew why it was doing so.

Scheduled Loss Impairment A third type of report is now in a sort of limbo. When maximum medical improvement is reached, a patient may be examined for “schedule loss impairment.” Formerly, that was not asked of the treating physician or surgeon and claimants paid a non-treating doctor for the report. Currently, the question is asked on the C-4.3 form and the charge may now be subject to medical fee schedule.

Causal Relationship (occupational disease) A fourth type of report is a “causal relationship” report needed for occupational disease claims, since many diseases have no obvious connection to work. The report is similar to the report filed in death claims. However, a physician or surgeon is cautioned to avoid a type of abuse associated with occupational disease claims.

A few years ago, certain doctors would write the initial report and charge for it. If they were called to testify, the claimant had to pay for the doctor’s appearance directly. To get around this, the doctor would then begin minor treatment and claim to be a treating physician so that the testimony fee would have to be paid by the carrier. Such practices no longer work. The abuses were dealt with ten years ago and the memory is still fresh at the Board.

Another situation is where a worker has a work comp injury which is also the subject of a negligence claim. If a doctor is treating on both, the doctor may charge for reports which are needed for the negligence case even though the report can be used in the comp claim as well. Similarly, a doctor can be paid for reports necessary for a private insurance claim although the report can also be used in a work comp claim.

I want to emphasize the importance of communication among the workers, the employer and the medical community BEFORE the first hearing. Ground up claims “management” is the approach that works. I put “”management” in quotation marks because I don’t think of this as management but sensible cooperation and communication.
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Attorney Theodore Ronca is a practicing lawyer from Aquebogue, NY. He is a frequent writer and speaker, and has represented employers in the areas of workers’ compensation, Social Security disability, employee disability plans and subrogation for over 30 years. Attorney Ronca can be reached at 631-722-2100.
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WC Cost Calculator www.ReduceYourWorkersComp.com/calculator.php REAL COST of work comp.
WC 101 www.ReduceYourWorkersComp.com/workers_comp.php for the basics about workers comp.

Do not use this information without independent verification. All state laws are different. Consult with your corporate legal counsel before implementing any cost containment programs.