The Doctors Corner – Compensation and Social Security Information for Doctors

Medical Evidence – doctor reports, statements, diagnostic tests (MRI, X-Ray, CT Scan…) and opinions make the legal world go round. Without Medical Evidence – the proof of an injury and a disability – absolutely nothing will happen in your patient’s legal case, workers compensation case, or their social security case.

Being able to provide quality medical care, provide properly completed forms and understand what your patient expects and needs, and what you expect and need from your patient is vastly important. The follow information will help you, the Medical Practitioner understand some of the concepts, ideas and everyday necessities of dealing with disabled individuals who are making their way, often slowly and painfully, through the legal system – whether a civil (negligence/personal injury) lawsuit, a workers compensation claim, a disability claim or a Social Security Disability claim.

New York State Workers Compensation:
What exactly is Workers Compensation – the concept is simple. An individual injured while working is entitled to collect certain benefits (workers compensation) from an insurance policy purchased by that injured workers employer. In exchange for speedy medical care and monetary benefits, the injured worker has given up his or her right to sue the employer. The idea is to promote safety of the workplace, provide medical care that will get an injured worker back to work sooner rather than later, and allow an employer who provides a safe work environment a way to contain costs and help his/her workers.

THE REALITY: It is a BUREAUCRACY of immense proportions that often bogs down the very system intended to help move things along.

The 2007 Workers Compensation Reforms (The Spitzer Reforms) made significant changes to the ninety year old system and have particularly made extensive changes for the medical community.

The most significant changes are in the forms that the medical community MUST use in order to treat patients under the Workers Compensation Law. In particular, if a medical provider does not use these forms by April 1, 2009 then the provider will be subject to penalties!

“As of April 1, 2009, doctors must use the new forms. Doctors who do not use the new C-4 family of forms on and after April 1, 2009, will be penalized. The Board will not enforce payment for any examinations, services and/or treatments provided that are not reported and billed using the correct new C-4 form. In other words, if the doctor does not submit the correct Board prescribed form, the liable self-insured employer, insurance carrier, third-party administrator, Re-opened Case Fund, or the State Insurance Fund is not required to pay the doctor for any examinations, services and/or treatments included in the documentation submitted. In addition, the Board will investigate why the doctor is not using the correct new form and if warranted issue an administrative warning or commence temporary suspension or revocation proceedings.”

The Current Revised Forms are:

C-4 Attending Doctors Report
C-4.2 Doctor’s Progress Report
C-4.3 Doctor’s Report of MMI/Permanent Impairment
C-4Autz
C-4AMR (Ancillary Medical Report)- not yet available – will be designed for providers of ancillary services (e.g. MRI’s etc)
EC-4NARR

These forms are far more complex in the past and require a lot of input from the provider. In fact, the electronic narrative requires a pre-registration and special filing rules for addendums and so forth to the electronic form.

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