Under New York Workers’ Compensation Law, the Carrier has 30 business days to respond to an official request for treatment costing over $1000. An official request for treatment must be made by your doctor with the submission of a C-4Auth form to the Insurance Carrier requesting such treatment. Your doctor does not require authorization for treatments or tests costing less than $1000. If the Carrier does not reply within 30 business days from the date of the C-4Auth request, the treatment being requested is deemed authorized. If the Carrier denies the treatment on the basis of it not being medically necessary or being rendered to a site not established to the claim (meaning a body part that the Carrier is not convinced you injured in the work accident), a Hearing will have to be requested and that issue will have to be litigated. Remember, it can take up to 120 days to get a Hearing date If your doctor believes that the treatment being requested is an emergency and must be rendered, the doctor may render the treatment without authorization and later fight the insurance company to be compensated on the basis of the emergency of the situation. Under no circumstances should you pay for any medical treatment related to your workers’ compensation claim.
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