It is you, the Health Care Provider
(HCP), that can make or break an injured workers' compensation claim. Without properly documented medical evidence, your patient will not be able to receive the compensation he/she is entitled under the law. But this post isn't just an attempt to get you to properly complete the appropriate forms and submit them timely by invoking your sympathy for the injured worker; as the laws have changed, you now have an obligation to do so, at the risk of otherwise losing your right to payment for your services, or worse, having the board issue a temporary suspension or revocation proceeding.
So it is not only in your patient's best interest, but also in yours, to follow these new rules carefully. The 2007 Workers Compensation Reforms (The Spitzer Reforms) made significant changes to the ninety year old system and have particularly made substantial changes for the health care providers.
The most significant changes are in the forms that the health care providers MUST use in order to treat patients under the Workers Compensation Law. In particular, as of April 1, 2009, if a medical provider does not use these forms, the provider will be subject to penalties!
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-4Auth C-4AMR (Ancillary Medical Report)- designed for providers of ancillary services (e.g. MRI's etc)EC-4NARR
SUMMARY OF HOW TO USE THESE FORMS C-4 FORM – Use this form to fill out information from the first examination/treatment of Claimant for the work-related injury. C-4.2 FORM – Use this form to fill out information from all subsequent examinations/treatment of the Claimant in connection with the work-related injury. C-4 AUTH FORM – Use this form to request approval for treatment from the insurance Carrier.
Where To Submit Forms Submit form to the Workers’ Compensation Board via: Mail: NYS Workers’ Compensation Board 20 Park St. Albany, NY 12207 Fax: 1-877-533-0337 Submit form to the Workers’ Compensation Insurance Carrier Submit copy of form to Claimant's attorneys Give a copy to the Claimant (Patient) at his/her request. You should also take notice and make sure to explain to your entire staff that neither the patients (Claimants), nor their attorneys can be charged for the reproduction of these documents. Since these forms are required by law, they do not come under the regulations set down in Public Health Law Sections 17 and 18, regarding a fee for duplicating written medical records, nor are they to be construed as a request for a narrative report.
In order to remain entitled to compensation, a patient who is out of work as a result of his/her work related injury must treat with a provider and submit the above mentioned forms to the Workers' Compensation Board and Insurance Carrier every 45 days. Doctors are supposed to submit the forms themselves within 48 hours of treating the Claimant.
Submitting the forms to the Claimant's attorney is crucial to ensure that you will be paid for your services. The Claimant's attorney needs the forms as supporting evidence of the ongoing compensation that entitles the Claimant to medical care and benefits, which in turn entitles the provider to payments for treatment.