Who Chooses Medical Treatment in New York Workers' Compensation Cases

Decision‑makers in New York workers' compensation treatment

In New York, the party who selects the treating physician is typically the employer's workers' compensation insurer, but the employee retains the right to request a change if the provider is unsuitable or the care is inadequate. The insurer must use an authorized medical provider (AMP) from the state‑approved network, and any dispute triggers a formal review by the Workers' Compensation Board.

Role of the employer and insurer

The employer purchases workers' compensation insurance, and the insurer administers medical benefits. Under New York Labor Law § 190, the insurer is obligated to provide a qualified physician from the AMP list within five days of the injury report. The insurer's medical director reviews the case and assigns a provider based on injury type, geographic proximity, and provider availability.

Employee's right to change providers

If the employee believes the assigned physician is incompetent, has a conflict of interest, or fails to deliver appropriate care, they may submit a written request for a new provider. The insurer must consider the request and, if justified, reassign a different AMP. If the insurer denies the request, the employee can appeal to the Workers' Compensation Board, which will evaluate the medical justification and may order a change.

When a non‑AMP is used

In emergencies or when an AMP is unavailable within a reasonable time, the employee may seek treatment from any qualified physician. The insurer must then reimburse the costs, provided the employee submits appropriate documentation and the care is deemed reasonable and necessary.

Dispute resolution and oversight

All disagreements over provider selection are handled through the Workers' Compensation Board's formal dispute process. The Board reviews medical records, provider credentials, and the employee's statements before issuing a binding decision. Both parties must comply with the Board's order, and failure to do so can result in penalties or loss of benefits.

Key takeaways

• Insurer selects the initial treating physician from the AMP network.
• Employee can request a change if care is unsatisfactory.
• Board adjudicates disputes and can mandate provider changes.
• Non‑AMP care is reimbursable in emergencies or when no AMP is reasonably available.

Comparison of provider selection mechanisms