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The Workers’ Compensation Board has just recently issued new Guidelines clarifying and codifying the procedures if and when an injured worker has to use their employers or insurance company’s diagnostic network. Under the 2007 amendment to the Workers’ Compensation Law insurance company’s and self-insured’s were given the authority to contract with diagnostic testing network’s to have certain tests performed such as MRI’s and EMG’s. The Workers’ Compensation Board has issued formal rules on what this all means.
Your employer or the workers’ compensation carrier must notify you at the time they send you the Statements of Rights that if your doctor is requesting testing that you must use their diagnostic testing facility.
If your workers’ compensation insurance company or employer have contracted with a diagnostic testing network they must provide you, the injured worker, with contact information such as a listing on the web and also provide details on how to schedule the necessary testing.
There are a number of technicalities under the regulations. One being that the insurance company’s or self-insured’s must notify doctors who accept workers’ compensation in New York that they must use these networks.
In addition, there are also exceptions when your doctor does not have to refer you to the diagnostic testing network. Specifically, if there is a medical emergency and the test is required within twelve hours. Also, if the prescribed test cannot be done within five business days. Another example is if the doctor needs x-rays as part of an integral office visit or treatment. Such as treating a fracture or dislocations. Most importantly if the carrier or employer have not notified you or your doctor that there is a diagnostic testing network you don’t have to use the network. We must advise you that it is likely the employer or insurance company will allege they did notify you and your doctor and that issue will have to be resolved at the Workers’ Compensation Board.
The Workers’ Compensation Board is in the process of adding to their website a medical network lookup to see which carrier’s and self-insured’s are using these diagnostic testing networks. As of now we do know that the City of New York in their workers’ compensation cases uses a company called Atlantic Imaging. Accordingly, if you have a case with the City of New York Law Department it is necessary that your doctor refer you to Atlantic Imaging. For those parties who want further information the actual rule is under 12NYCRR 325-7 which interprets Section 13-a(7) of the Workers’ Compensation Law.