Q. Must I wait for medical care?
A. No .but physicians must request authorization for procedures that cost more than $1,000 each. This $1,000 pertains to each procedure, not the total cost of care. Insurers must respond to the request within 30 days. At°0ftatilorization is not necessary in case of an emergency.
Q. may a doctor treat me if the insurer does not answer a request for approval?
A. yes. Insurers have 30 days to reply to an authorization request. If tile insurer does not reply in 30 days, the provider may perform the services Diagnostics tests must be obtained from a network provider, services. if the carrier requires claimants to use its network.
Q. must I have lost time in regular employment for a disability to be covered?
A. Not necessarily. The disability is compensable if there is loss of earning capacity, or loss of use or partial use of a bodily member, eye or hearing.
Q. If l receive remuneration or a gratuity for performing a duty or activity covered under the law, can I still sustain a compensable injury in the line of duty?
A. No. The following items are not remuneration or a gratuity: reimbursed expenses for meals, lodging, necessary travel or a mileage allowance; and acceptance of transportation, food, drink, shelter, clothing and similar items while on duty.
Q. Does a notice of injury have to be provided in writing?
A. Yes. You or your representative must sign the notice. However, the Board may excuse the failure to give written notice on any of the following grounds: notice could not have been given for sufficient reason; a member of a body in charge of, or any officer of, the ambulance or fire company/district had knowledge within 90 days of the injury or death; the political subdivision, ambulance company or
Insurance Carrier was not prejudiced by a delay in giving such notice; the Cause of disablement or death was not known to be formed in the line of duty as a volunteer member in sufficient time to comply with the notice requirement.
Q. Will I be reimbursed for purchasing necessary medicine or prescribed drugs?
A. To be reimbursed, you must submit to the Board and your insurance carrier Claimant's Record of Medical and Travel Expenses and Request for Reimbursement (Form C-257) with receipts..
Q. What happens when an insurer contests a claim?
A. To contest a claim, an insurer must file a notice of controversy with the Board within 18 days after the disability begins or within 10 days of learning of the accident, whichever is later. It must give the reasons why the claim is not being paid. A law judge will resolve the issue at a pre-hearing conference or a hearing.
Q. Can a closed case be reopened?
A. Yes. The Board may reopen a closed case, subject to time limitations, upon application of any party. The application must state the basis of the request. The Board can reopen a case that has been completely settled by a Section 32 Waiver Agreement if all the parties agree to reopen it.
Q. Can I render emergency service with another district or company?
A. Yes. if you offer individual service to another Company in New York State outside the area regularly served by your company or district, and after such services are accepted by the officer in command at the scene, the responsibility for benefits resulting from an injury in the line of duty will fall to the fire or ambulance company (and its political subdivision) that accepted your voluntary service.
Q. What is the Penalty for making false claims for benefits?
A. Making false claims for benefits is workers' compensation fraud, a class E felony. It is punishable by up to four years imprisonment and a $5,000 individual or $10,000 corporate fine.
Did You Know?
If you choose to accept Workers’ Compensation Benefits you can not sue your employer. However . . . If you are involved in a motor vehicle accident with another car you might be able to file a lawsuit with the driver of the other car..