In my Upstate New York Workers’ Compensation Law practice, it is not uncommon for the insurance carrier to refuse payment of a medical bill alleging that a “new accident” has occurred.
Almost always, the medical report that has been filed with the insurance company for payment indicates that a new incident, accident, or trauma has occurred. If the insurance carrier can successfully show that the medical care is not the result of a work related injury but some new episode or accident then they will not have to pay for the bill.
Insurance carriers routinely make ludicrous arguments that there has been a new accident when it is clear that the claimant’s need for treatment relates to the compensable work injury. The “but for” test is a good guideline for determining whether or not an insurance carrier should be liable to pay for a medical bill. Ask the question “but for” the work injury, would the treatment in question be needed? If it is clear that without the work injury the treatment would not be necessary than an argument could made that the insurance carrier is liable to make payment. However, if the treatment would have been needed regardless of whether or not the work injury had occurred, then it will be hard to prove that the carrier is liable for payment.
The question of new accident is a common one and often litigated in the New York State Workers’ Compensation system. Litigation usually includes testimony of the claimant as well as medical experts who will give detailed opinions regarding causality.
If you are having problems with your Workers’ Compensation claim in the Albany/Schenectady/Troy region of New York State, feel free to contact us for a consultation.