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NY Partial Permanent, Need Medical Treatment in FL
08-03-2011, 01:54 PM
Post: #1
NY Partial Permanent, Need Medical Treatment in FL
New Member with questions, here is some background:

Sustained on the job back injury ca. 22 yrs ago in NY resulting in 'Permanent partial disability', continued to work and sustained additional back injury about 15 yrs ago which resulted in forced retirement, bi weekly Workers comp compensation, and SS Disability (which has recently been converted to regular SS payments).
Moved to FL thereafter.

Have not submitted any medical claims through State Insurance Fund, instead just used pain medication throughout the years for the back pains that had been prescribed for other medical condition.

I am now experiencing a significant increase in back problems, which I have reason to believe are related to the previous on the job backinjuries.

My regular Dr. here in FL wants me to have an MRI to establish what is going on.
He states that he will accept Workers Comp., but he does not have any forms that may be required to submit a claim with NY.
I contacted WC and was told that they did not know how this should be handled, and that I should contact the State Insurance Fund... which I did.
There I was told that the Dr. should just submit billings to the State Insurance Fund...No Forms (!), and that they than would make a decision on whether or not any treatment/tests would be approved/covered or controverted.
Was also told that IF the doctor has any questions, that he should call the State Insurance Fund........(?)

Does any of this sound 'kosher'. Should there not be some kind of form available to be filled out by the doctor and submitted to WC ? instead of going through the State Insurance Fund ?
I am almost tempted to submit this 'ball of wax' to my 'regular' insurance, though of course I know that's a 'no,no' (verbalized this idea to the State Ins. rep. and was told: 'can't comment on that'.....

I am also wondering which claim number should be used, the number attached to the 1st injury, the 2nd injury or both ?

ANY AND ALL ADVISE, OR INPUT WILL BE MUCH APPRECIATED !!!
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08-03-2011, 03:29 PM
Post: #2
RE: NY Partial Permanent, Need Medical Treatment in FL
what/who do you mean by "WC"?
what would they have to do with your treatment?

i doubt you can make a strong enough connection to treatment now for what happened 15 or 22 yrs ago.
WC treatment is limited to only the prior injury not anything that has happened since.
but, of course, you and you doctor can try.
her are NY forms:
http://www.wcb.state.ny.us/content/main/Forms.jsp
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08-03-2011, 04:04 PM
Post: #3
RE: NY Partial Permanent, Need Medical Treatment in FL
(08-03-2011 03:29 PM)1171 Wrote:  what/who do you mean by "WC"?
what would they have to do with your treatment?

i doubt you can make a strong enough connection to treatment now for what happened 15 or 22 yrs ago.
WC treatment is limited to only the prior injury not anything that has happened since.
but, of course, you and you doctor can try.
her are NY forms:
http://www.wcb.state.ny.us/content/main/Forms.jsp

THANKS FOR YOUR REPLY & OPINION !

By 'WC' I made reference to 'Workers Compensation/ Board'

I thought that medical payments are part of receiving Workers Comp Benefits (note that I am still receiving bi- weekly compensation for the dates listed ....)
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08-03-2011, 04:09 PM
Post: #4
RE: NY Partial Permanent, Need Medical Treatment in FL
the board handles litigation; are you wanting a judge to make a decision?
I'm not sure you are ready for a board hearing on the issue.
---the comp board makes no payments; just handles administration and litigation.
benefits are paid by the carrier.
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08-03-2011, 06:27 PM
Post: #5
RE: NY Partial Permanent, Need Medical Treatment in FL
(08-03-2011 04:09 PM)1171 Wrote:  the board handles litigation; are you wanting a judge to make a decision?
I'm not sure you are ready for a board hearing on the issue.
---the comp board makes no payments; just handles administration and litigation.
benefits are paid by the carrier.

Ok...what prompted me to try to find out about getting a medical charge for (i.e.) an MRI on my back approved by the carrier (or through WC..) is the fact that a couple of years ago they sent me an Express Script card for use for prescription drugs related to my prior injuries, however I never recieved instructions as to how to bill, or who to approach for medical reimbursements other than prescription drugs.
A-N-D... this I DO find important: periodically I receive notifications & questionnaires from my regular (private ) insurance carrier that emphasis that any workrelated injury treatments should NOT be submitted to them...hence my digging into trying to find out what is the correct form to use for my doctor to submit approval for medical treatment related to prior injury.

But, there is a new development... I have contacted the WC injured workers advocate and was told to have Dr. submit request for medical treatment authorization via Fax to NY State Insurance Fund.... sooo, my questions have been answered.
THANKS FOR YOUR EFFORTS !
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08-03-2011, 06:30 PM (This post was last modified: 08-03-2011 06:33 PM by 1171.)
Post: #6
RE: NY Partial Permanent, Need Medical Treatment in FL
yes, if your employer had insurance thru the State Insurance Fund then as your former employer's work comp carrier you should contact them.
It won't help to contact the Comp board at this point.
State Fund Insurance company forms are here
http://ww3.nysif.com/EyebrowPages/Forms.aspx
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