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  1. #1
    Join Date
    Apr 2012
    Posts
    2

    Default Can I Choose My Own Surgeon or Am I Stuck with Worker's Comp Insurance

    My workers compensation claim was made in the State of: New York
    I am a TV producer for History Channel. I was filming in Guyana, South America and was thrown from a boat, evacuated to Venezuela and ended up in a "clinic" where I was diagnosed with a separated shoulder and possibly a torn ligament. They had no capability to do an MRI. I went back to work to finish the shoot and have returned to NYC to begin editing. Now that I have seen a "real" doctor (from the network of crappy doctors selected for me by Chartis Insurance) I am finding out that I may have a torn rotator cuff that will require surgery.

    I am from California and this is a temporary assignment which ends in August. I do NOT trust the doctors chosen for me by the insurance company. Of the 40 names they sent to me, none were actually based in Manhattan and they were telling me I needed to travel to Jersey to be seen. Then they sent over cardio specialists, mental health specialists, and all manner of people who have no bearing on my injury.

    I have never considered a settlement until now but if this takes me out of work, disability cannot possibly compensate my weekly salary and what I need to earn. All I want is to be able to choose my own surgeon, probably from Blue Cross (which is my personal insurance) so that I can trust any follow up care for the years to follow.

    Can anyone give me some advice on what my rights are to choose doctors whom I trust?

  2. #2
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    18,011

    Default Re: Newbie: Can I Choose My Own Surgeon in NYC or Am I Stuck with Through WC Insuranc

    All I want is to be able to choose my own surgeon, probably from Blue Cross (which is my personal insurance) so that I can trust any follow up care for the years to follow.
    You may have to treat in the carriers network...
    IF you were to take a cash settlement, and there is no guarantee there will be one... you cannot use your own Blue Cross ins to pay for treatment to your injury...not even in the future. You'd be paying out of pocket for any additional treatment.

    You should consult with a NY WC attorney...there is no fee.
    Wage replacement/TTD is 2/3's of your AWW/Average Weekly Wage.

  3. #3
    Join Date
    Feb 2007
    Location
    Charlotte, NC
    Posts
    3,036

    Default Re: Newbie: Can I Choose My Own Surgeon in NYC or Am I Stuck with Through WC Insuranc

    Mmmartino-- you still have a lot to learn about how this works. The easiest thing for you to do would be to sit down with a workers' comp lawyer----someone with lots of work comp experience representing injured workers, in the correct jurisdiction (NY?) and let that person educate you about the process. Only then can you make rational decisions about it.

    But in choosing a lawyer, do your homework. Good internet sources to use are AVVO.com, Martindale.com, and the "find a lawyer" button on the home page at www.WILG.org.

    Good luck.
    The North Carolina Court of Appeals has held that "In contested Workers' Compensation cases today, access to competent legal counsel is a virtual necessity." Church v. Baxter Travenol Labs, Inc., and American Motorists Insurance Company, 104 N.C. App. 411, 416 (1991).

    Bob Bollinger, Attorney at Law

  4. #4
    Join Date
    Apr 2012
    Posts
    2

    Default Re: Newbie: Can I Choose My Own Surgeon in NYC or Am I Stuck with Through WC Insuranc

    Thank you so much BVia and complyr. It's true I am just beginning this process and I'm frustrated and feeling lost already. I did not know I would be able to consult with a lawyer without paying, so I will start there. I truly appreciate the advice and direction for these initial steps.

    I thought I had read that disability in NY is 50% of weekly wage but is capped at $1700/week. I currently earn $5000/week in my role as an Executive Producer so this is significantly less than my wages. Hence my hesitation at accepting workman's comp and giving up my right to sue for the negligence that caused the accident.

  5. #5
    Join Date
    Mar 2012
    Posts
    37

    Default Re: Newbie: Can I Choose My Own Surgeon in NYC or Am I Stuck with Through WC Insuranc

    You've given a lot of personal info here....I was able to find out your first name. You may want to ask a moderator (Tony) to take out some of the info for you. p.s. I'm not a weirdo --just have a lot of time on my hands! LOL

  6. #6
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    18,011

    Default Re: Newbie: Can I Choose My Own Surgeon in NYC or Am I Stuck with Through WC Insuranc

    Hence my hesitation at accepting workman's comp and giving up my right to sue for the negligence that caused the accident.
    That's not generally an option. Work injury/workers compensation is a no fault program... you don't have to prove injury, only to what extent your ER is liable for treatment, wage loss, and indemnity in the event of permanent disability. WC is not an option, but the exclusive remedy.
    Your ER didn't "cause" the injury, you didn't either. That's not the issue. However, if there is a 3rd party holding liability here, you should pursue that case, if you don't your ER will, and you would be compelled to cooperate in that recovery.

    Talk to a competant WC attorney. It would also be important to know if you were actually an "employee" or an "independant contractor"... if EE you are covered by your ER WC policy, if IC...no, but responsible for your own cost of treatment and no wage replacement would be due by your ER.

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