I-Team: NY Refers Injured Workers to Doctors Who Don't Accept Workers' Comp

Dozens of doctors who once accepted workers' compensation insurance have effectively dropped out of the program, but New York state continues to list them as participants, the I-Team has learned, leaving injured workers in the lurch as they try to find a provider.

In one case, the state Workers' Compensation Board sent an injured worker a list of 64 ophthalmologists, but after calling all of them, the patient still couldn’t find an eye specialist.

"The doctors said they don't accept workers' comp," said George Akturk, an injured supermarket worker who suffered bleeding in his left eye after falling off a ladder in 2011.

More than four years after the accident, Akturk says he still cannot find an eye surgeon to perform the procedure needed to scrape blood off of his retina.

"I have a pain like somebody is drilling a hole in my head," said Akturk.

The I-Team also called 64 eye specialists listed as serving Brooklyn on the state's Workers' Compensation Health Provider Search.

The results show the state's list of authorized practitioners is severely outdated.

Although each doctor was listed as a workers' comp participant, two-thirds of the offices reported they do not participate in the program. Thirteen doctors' offices reported they do accept workers' comp, but most of them do not perform the kind of retinal surgery prescribed for Akturk.

"These people are between a rock and a hard place," said Robert Grey, an attorney who represents injured workers.

He said it is an open secret in the workers' comp world that specialists are dropping out of New York's system.

"Ophthalmology, oncology, pulmonology, cardiology: these are all areas where if you're an injured worker with a workers' compensation case you're very likely to have a problem finding a doctor who is willing to treat you," he said.

Brian Keegan, a spokesman for the New York Workers' Compensation Board, said the state's list of participating doctors is updated each week, but did not explain why so many specialists are incorrectly listed as participants.

"The doctors found through the 'health provider search' are authorized providers and as such may not discriminate against workers’ compensation patients by refusing to accept workers’ compensation insurance," Keegan wrote in response to an I-Team inquiry.

Keegan said Governor Cuomo's proposed budget has a provision to increase the number of specialists participating in Workers' Compensation by streamlining the process to become an authorized provider.

But Dr Michael Lax, director of the SUNY Upstate Occupational Health Clinic, said the real reason doctors are dropping out of the system is that insurance companies and state regulators increasingly control medical decisions.

In 2010, New York adopted medical treatment guidelines that restrict the medical discretion of specialists.

"You get challenged at every step. You get challenged when you make the diagnosis. You get challenged when you try and prescribe a medication. You get challenged when you want to do a test," Lax said.

Last year, Pro Publica and NPR published an expansive investigation, concluding two-thirds of the states, including New York, have passed workers' comp laws that either reduce benefits or make it more difficult to qualify for care.

The reforms have often been justified by the notion that workers' comp costs are rising, but the report by Pro Publica and NPR found employers nationwide are paying the lowest rates for workers' comp insurance since the 1970s.

Despite those findings, Lev Ginsburg, director of government affairs for the Business Council of New York, said medical treatment guidelines are necessary to rein in specialists who may prescribe unnecessary treatments that keep employees from going back to work and increase the workers' comp insurance premiums employers must pay.

"It is excessively expensive. The results are perhaps not what they should be. There is an incredible disincentive for returning to work," Ginsburg said.

George Akturk says he cannot consider going back to work until he finds an eye surgeon. Last summer, Akturk says he did make an appointment with a retinal surgeon who agreed to accept workers' comp. But at the last minute, that appointment was canceled.

Since then, the I-Team has identified two eye clinics that have agreed to see Akturk. He has scheduled new appointments later this month.

Akturk has also filed complaints with the state about the surgeon who canceled his surgery appointment. Doctors who are authorized to accept Workers' Comp but deny treatment to an injured worker can be charged with misconduct, according to state labor law.

According to the Workers' Compensation Board, injured workers who have trouble finding an authorized doctor are directed to contact the Board's Medical Director's Office at (800) 781-2362 or WCBMedicalDirectorsOffice@wcb.ny.gov

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