Can I Choose My Own Workers’ Compensation Doctor?

Can I Choose My Own Workers’ Compensation Doctor?

If you’ve been injured at work, then you may be eligible to file a workers’ compensation claim. As part of the claim process, you are asked to seek medical treatment after obtaining necessary first aid and care.

Workers’ compensation is a type of insurance that will pay injured workers with cash benefits, while also providing medical care, if an injury or illness occurs because of their job responsibilities.

Employers are responsible to pay for this insurance. Employees do not contribute to the cost of this type of insurance policy. When authorized by the Workers’ Compensation Board, weekly cash benefits and medical care are paid by the insurance carrier which holds the policy for the affected employer.

The amount you receive is not decreased because of personal carelessness or increased because of employer issues.

Many workers want to know if they can choose their own doctor if they have a workers’ compensation incident at work. In many cases, employees can choose a doctor that has been authorized by the Workers’ Compensation Board, such as the specialists on our team.

There are notable exceptions to this capability. If your circumstances meet these exceptions, then your choice of doctor may be limited.

#1. Your injury is a medical emergency.

The Workers’ Compensation Board puts the health and welfare of the worker above anything else. If your injury qualifies as a medical emergency, then you can seek treatment from any doctor. Immediate treatment may require a visit to an emergency room, which would be covered.

What qualifies as an emergency can sometimes be difficult to define. Everyone has different medical needs. The bottom line is this: if you feel like you need to go to the emergency room, then go.

#2. Your employer is a PPO or ADR participant.

In the State of New York, some employers are authorized to participate in an Alternate Dispute Resolution program or a Preferred Provider Organization. Workers that are injured on the job, with a non-emergency injury, may be required to obtain their medical treatment from a provider that participates in these programs.

You will know if your employer is a participant. The State of New York requires participating employers to notify all employees, in writing, of the details that pertain to the program and what they should do if they suffer a work-related injury.

#3. You have specific tests or medicine that is required.

Some work-related injuries may qualify as a non-emergency, requiring specific treatment options to promote wellness. In this situation, the insurance carrier may require you to obtain your tests from a diagnostic network or a designated pharmacy.

Our clinic is a diagnostic and treatment center.

Some employers may have the ability to require injured employees to obtain tests or medicine from designated providers because of authorized contracts they have negotiated.

The guidelines in this area should be provided by your employer. In many instances, they are visibly displayed in a high-traffic area at your workplace. These requirements should also be available through your human resources representatives.

The amount you receive is not decreased because of personal carelessness or increased because of employer issues.

Section 32 Waiver Agreements occur when an injured worker and the insurance provider settle on a lump-sum benefit payment. This is a decision that is between you and the provider – not your workers’ compensation doctor. Agreements must be approved by the Workers’ Compensation Board before they will be treated as a valid and binding document.

Once the agreement is approved, no ongoing or future benefits are paid. Any future visits or treatments become the responsibility of the individual.

What to Do if You Suspect Employer Discrimination

If you have been injured at work, for any reason, then employers are not permitted to discriminate against you. They may not fire you or discriminate against applicants who have attempted to claim workers’ compensation. Workers who may testify in proceedings or who have testified are also protected by this provision.

If you believe your employer may have discriminated against you because of a claim, you have up to two years to file Form DC-120. Send the completed for to the Workers’ Compensation Board.

Workers are also protected by the Americans with Disabilities Act of 1990.

Most employees who suffer a work-related injury are permitted to choose their own authorized doctor to treat their condition. Workers are also protected from discrimination while pursuing a workers’ compensation claim.

If you’ve been hurt at work, then follow the necessary procedures and then schedule your appointment right away. That way, you will have access to all your potential rights and benefits.

Workers’ Comp Doctor Choice FAQ (New York & Queens, NY)

1. Can I choose my own workers’ compensation doctor in New York?

Yes—generally you may select any health care provider who is authorized by the New York Workers’ Compensation Board (WCB) to treat injured workers. The key requirement is that the provider be WCB‑authorized (or that you are within allowable exceptions noted below, such as emergency care). After initial treatment, you remain free to continue or transfer care among authorized providers. [See also the 30‑day PPO rule in the next FAQ.]

2. When do I have to use a PPO or ADR network doctor?

Some NY employers participate in a Preferred Provider Organization (PPO) or Alternative Dispute Resolution (ADR) program for workers’ comp. If you receive proper written notice that your employer is in one of these programs, you must obtain initial (non‑emergency) treatment from a provider in that network. After 30 days from your first visit, you may switch to any WCB‑authorized provider outside the PPO/ADR if you wish—just notify the insurer in writing when you opt out.

3. What if my injury is an emergency?

In a medical emergency you can go to any emergency room or doctor immediately. Stabilize first—network or authorization status does not matter in a true emergency. Once the emergency phase passes, follow workers’ comp rules for ongoing care (PPO/ADR, authorized provider, etc.).

4. How do I check if a doctor is authorized by the NY Workers’ Compensation Board?

Use the WCB Health Care Provider & IME Search tool to look up doctors by name, specialty, or location and confirm authorization status. You can also verify by NPI/license number. When you call to book, ask the office if they are currently WCB‑authorized and accepting workers’ comp cases. Medex can confirm this for you when you schedule.

5. Can I see my regular primary care doctor for a work injury?

Yes—if your primary care doctor is WCB‑authorized (and, if applicable, in your employer’s PPO for the first 30 days). If your PCP is not authorized or not in the required network, you can request referral to an authorized provider, or transfer your care after the 30‑day period. Many patients prefer a clinic (like Medex) that handles workers’ comp paperwork daily.

6. Can I change my workers’ comp doctor?

Absolutely. You may transfer your care to another WCB‑authorized provider at any time; if you are still within a mandatory PPO period, switch to another doctor within that PPO, then move outside the network after 30 days if desired. New York law specifically protects an injured employee’s right to change authorized physicians. No special board permission is usually required, but let the insurer and your attorney know so records follow you.

7. Do I need referrals to specialists (orthopedics, PT, imaging)?

Your treating workers’ comp doctor directs care—diagnoses, work status, and referrals. Insurers may require that diagnostic tests (MRI, CT, EMG) go through an approved diagnostic network, and prescriptions may have to be filled through a designated pharmacy/PBM. Your treating doctor (or Medex care coordinator) will route you appropriately so services are covered.

8. What is an Independent Medical Examination (IME) and do I have to go?

An IME is an exam requested by the insurer (or sometimes employer) with a doctor who does not treat you; it’s used to obtain an opinion about diagnosis, causation, disability level, or further care. You generally must attend a scheduled IME; refusing or missing it can jeopardize benefits. You are allowed to bring a witness and should be honest and consistent in what you report. The IME doctor’s report can affect your case, especially if it conflicts with your treating doctor’s findings.

9. What paperwork must my treating doctor file (C‑4 reports, deadlines)?

Your doctor must submit an initial report of treatment to the employer, WCB, and insurer—within 48 hours of first treatment—followed by a more detailed report within 15 days and periodic progress reports thereafter (often on Form C‑4 or electronic equivalent). Timely reports help keep your medical and lost‑time benefits flowing; missed reporting can delay or disrupt payments.

10. What if my employer pressures me to see their doctor or prevents me from changing doctors?

Interfering with an injured worker’s lawful choice of an authorized physician is prohibited under New York Workers’ Compensation Law §13‑a. Employers, carriers, and TPAs may not direct or coerce you to treat with a specific provider (outside permitted PPO/ADR rules). If you feel pressured, document it and contact the WCB, your attorney, or Medex for help.

11. Will workers’ comp cover tests, imaging & prescriptions if I treat at Medex?

Generally yes, provided services are medically necessary, related to the covered injury, and routed through any required insurer diagnostic or pharmacy networks. Medex is an Article 28 Diagnostic & Treatment Center with on‑site and referred specialty services; our workers’ comp team coordinates required authorizations so your care is billed correctly.

12. How soon must I report my injury & get care

Report the injury to your employer as soon as possible (within 30 days under NY law)—but do not wait on care. Seek medical attention promptly (ideally within 24 hours) so your condition is documented and required reports can be filed on time. Early documentation supports both your health and your claim.

13. Can I get reimbursed for travel to medical appointments

Yes. Reasonable travel expenses—mileage, public transit, parking—related to authorized treatment are reimbursable by the workers’ compensation insurer when properly documented. Save receipts and submit them with the appropriate reimbursement form.

14. Does Medex accept workers’ compensation cases?

Yes. Medex Diagnostic & Treatment Center in Forest Hills, Queens evaluates and treats work‑related injuries across multiple specialties and assists with workers’ comp paperwork, authorizations, diagnostic scheduling, and follow‑up. We’re transit‑accessible (subway & bus) and provide validated parking. Call (718) 275‑8900 or book online for a workers’ comp visit.

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