Can I Use My Own Doctor for Workers’ Comp in New York?

If you get hurt at work in New York, one of the first questions you ask is whether you can go to your own doctor — the one who knows your history, whose office you can get to, who you actually trust. For most workers the answer today is no. That changes on January 1, 2028.

Governor Hochul’s universal authorization legislation was enacted in the FY26-27 State Budget. It rewrites Workers’ Compensation Law § 13-b so that any eligible licensed provider in good standing can treat an injured worker, without first applying to the Workers’ Compensation Board. Until that date, the old rule still governs your claim.

Here is what the rule is right now, what it becomes, and — the part that gets left out of the press releases — what does not change at all.

The rule today: your doctor has to be Board-authorized

WCL § 13-b, in the version in force until January 1, 2028, is blunt about it: no person shall render medical care under the Workers’ Compensation Law without authorization by the Chair of the Board. A “provider” under that section means a licensed physician, chiropractor, podiatrist, nurse practitioner, physician assistant, physical therapist, occupational therapist, acupuncturist, psychologist, or licensed clinical social worker who is authorized by the Chair.

Being a licensed doctor in New York is not enough. The authorization is a separate step the doctor has to take, on their own time, for the privilege of treating comp patients at fee schedule rates.

There is one carve-out. Under the current § 13-b(2), any provider licensed in New York may render emergency care in an emergency hospital or urgent care setting without Board authorization, and if that provider is on staff there, they may keep treating you while you remain a patient in that facility. That is why nobody stops to check credentials in an emergency room. It is also why the problem shows up two weeks later, when you need a follow-up with an orthopedist.

Why so few doctors have bothered

The Board’s own numbers tell the story. There are roughly 24,500 Board-authorized providers in New York, and only about 18,000 of them are actively treating injured workers. That works out to about ten percent of the providers who are eligible to be authorized.

Ten percent. Nine out of ten eligible providers in this state cannot legally treat your work injury.

Part of the reason is built into the statute. Under § 13-b(3), a physician seeking authorization does not just apply to the Board — the application also goes to the medical society of the county where the office is located, or to a board designated by that society, for a recommendation. The statute gives the county society forty-five days; if it does not act, the Chair may finish the review without it. New York is one of only a handful of states that requires this kind of special authorization at all.

But the paperwork and the fee schedule are not what doctors complain about most. Ask a surgeon why they stopped taking comp cases and you will usually hear a version of the same thing: they got tired of asking permission.

Having to request treatment you already know the patient needs

An orthopedist examines a knee, reviews the MRI, and concludes the patient needs an arthroscopy. If that patient has private insurance, the surgery gets scheduled. If the same patient was hurt at work, the same surgeon with the same findings does not schedule anything. They file a prior authorization request in OnBoard and wait for an insurance company to agree.

Consider who does the agreeing. The first look comes from the claim administrator’s Level 1 reviewer — an insurance company employee, not necessarily a physician. That reviewer may deny the request for administrative reasons with no medical review at all. If the denial is on medical grounds or for burden of proof, it escalates to the Level 2 reviewer, the insurer’s physician, who weighs in on whether the surgery is necessary without ever having examined the patient. A doctor who has put hands on the knee is answerable to a doctor who has read a file, and before that, to somebody who is not a doctor.

Then there is the waiting. A request to confirm Guideline-consistent treatment gets eight business days. A variance gets fifteen calendar days, which the carrier can stretch to thirty by giving notice that it wants an examination or a records review. That is the clock on paper, and it runs while the patient sits in pain and out of work. See how workers’ comp treatment gets approved in New York.

The system is supposed to spare doctors most of this. A good deal of care that is consistent with the Medical Treatment Guidelines needs no request at all. In practice, doctors ask anyway — for almost everything, physical therapy included — because the consequence of guessing wrong lands entirely on them.

That is the part that drives providers out, and it is worth being precise about why. If a request is denied and the doctor treats anyway, they cannot bill the insurer, and under WCL § 13-f they cannot bill the patient either. The patient cannot put it through their private health coverage. So a denial is not a question of who pays instead. It is unpaid work, or no treatment. The Board’s own guidance frames it as a choice: the provider may treat the claimant according to the claim administrator’s decision, or request review from the Board. The Workers’ Compensation Law is written on the assumption that a physician who believes care is related to the injury will go ahead and provide it and be made whole later. In our experience that is not what happens. Surgeons will not operate on a denial, and they will not operate on an authorization granted without prejudice either.

And if the doctor does fight it, the fight costs clinical time. A contested request can mean the treating physician’s deposition, the insurer’s examiner’s deposition, summations, and then a decision — a process that can run for months. The Board has at least moved provider testimony to the telephone and taken steps to pay for it faster, but it is still a working physician spending an afternoon on litigation instead of patients. See what happens when workers’ comp denies your surgery.

Put it together and the decision most doctors made looks less like greed and more like arithmetic. Taking comp cases means accepting that your clinical judgment is reviewable by a claims examiner, that treatment you consider plainly necessary has to be requested and sometimes defended, and that the downside of being overruled is work you do not get paid for. Nine out of ten eligible providers in New York looked at that and said no.

Worth saying plainly: universal authorization does not fix any of this. It opens the door. What is on the other side of the door is the same prior authorization system.

What that costs you

The Board describes injured workers in suburban and rural parts of the state traveling an average of 35 miles to reach an authorized provider, with up to 40 percent having to go to a different county for treatment.

In Staten Island and Brooklyn the distance is usually not the issue. There is no shortage of doctors here. There is a shortage of authorized doctors, which is a different problem with the same result: your choice is limited to whoever is on the list, whether or not that person is the right specialist for your injury, and whether or not you can get an appointment this month. The Board makes this point itself — because only about ten percent of eligible providers are authorized, choice of provider can be severely limited even where there is no shortage of providers.

For an ordinary knee or back injury you will find somebody. For anything unusual — an occupational lung condition, a rare cancer, a complex hand reconstruction — the list of authorized specialists can be very short, and the waiting can do real damage to a recovery.

What changes on January 1, 2028

The amended § 13-b reverses the default. Instead of “no person shall render medical care without authorization,” the new subdivision 1 reads that any provider as defined in the section shall be authorized to render medical care or treatment under the chapter.

The definition does the work. Under the new § 13-b(1)(m), an “authorized provider” is a duly licensed acupuncturist, chiropractor, nurse practitioner, occupational therapist, physical therapist, physician, physician assistant, podiatrist, psychologist, or social worker who is not currently on the exclusion list. The Board has said authorization will be automatic as part of a provider’s licensing through the New York State Education Department.

The exclusion list is the other half. WCL § 13-d was rewritten in the same package and is now titled “Placement of providers on the exclusion list.” The Chair publishes and maintains a list of providers disqualified from treating comp patients or performing independent medical examinations — for professional misconduct or incompetency in connection with comp work, for exceeding the limits of their professional competence, for materially false statements about their qualifications, and other grounds.

So the model flips from opt in to opt out. Every licensed provider in the state is authorized unless the Board has affirmatively disqualified them.

Two limits are worth knowing now. Participation stays voluntary — no doctor is required to take comp cases, and the Board has been candid that it still has to make the system attractive enough that they will. And independent medical examinations are carved out: under the new § 13-b(3), a physician, podiatrist, chiropractor, or psychologist who wants to perform IMEs still has to file an application with the Chair. The carrier’s examiner remains a separately authorized category.

What does not change

This is the part worth reading twice, because the announcement sounds bigger than the change is for someone whose treatment is being fought over right now.

The Medical Treatment Guidelines still control what care you get. The new § 13-b(2) says so in the statute itself: any provider rendering care under the chapter must comply with all applicable laws, regulations and guidance, including the New York Medical Treatment Guidelines and the Official New York Medical Fee Schedule. Universal authorization changes who may treat you. It does not change what they are permitted to treat you with. See how workers’ comp treatment gets approved in New York.

Prior authorization requests still have to be filed and can still be denied. Your family doctor, newly authorized on January 1, 2028, will still have to submit a PAR through OnBoard for care outside the Guidelines or over the dollar thresholds, and the insurer can still deny it at Level 1, Level 2, or Level 3. If your surgery gets turned down, the process is the same as it is today — see what happens when workers’ comp denies your surgery.

The paperwork still decides your case. Authorization is about who may treat. It says nothing about whether the report gets written correctly, filed in OnBoard, and into your eCase file. In our experience that is where claims actually stall. See why your doctor’s paperwork decides your workers’ comp case.

You still cannot be billed. Under WCL § 13-f, a provider rendering care to a compensation claimant may not collect or receive a fee from the claimant within this state. That protection is unchanged.

The carrier can still steer some things. Diagnostic testing networks, pharmacy networks, and a preferred provider arrangement in the first thirty days operate on their own rules, and none of them are touched by universal authorization. See can the carrier make you use their doctor or pharmacy.

You will still go to the carrier’s IME. Attending an independent medical examination is a separate obligation, and the examiner still writes a report for the insurer.

The catch that nobody is advertising

Being authorized and being willing are two different things, and after January 1, 2028 the second one becomes the whole ballgame.

A provider who treats a comp case has to use OnBoard — the Board’s online system — to file the initial report, the progress reports, the prior authorization requests, and the CMS-1500 billing. They have to write reports that address causation, degree of disability, and work status in the specific way a workers’ compensation judge needs to see them. They may get deposed. None of that is difficult for a practice that does comp work every week. For a family medicine office that has never touched a comp claim, it is a new administrative system and a new vocabulary, for a fee schedule rate.

The Board is planning for this. It has moved prior authorization requests online, replaced twelve custom billing forms with the single CMS-1500, cleared the medical billing dispute backlog so administrative disputes now run two to three months and arbitration three to four, moved provider depositions to the telephone, and proposed fee schedule regulations to raise evaluation and management fees toward what private insurance pays. The gap between enactment and the effective date exists precisely so the Board can build training and run direct outreach to recruit providers.

Whether your own doctor says yes is a separate question from whether the law allows it. Our expectation, and it is only that, is that the change will help most in specialties where authorized providers are genuinely scarce, and help least where the real obstacle was never authorization but the paperwork and the fee.

Who can treat you, and whose report actually counts

One thing that survives the rewrite word for word, and that catches people out constantly: not every authorized provider’s report can do every job in your case.

Under § 13-b(2)(e), in both the current and the amended version:

• A record, report, or opinion of a physical therapist, occupational therapist, acupuncturist, or physician assistant is not evidence of causal relationship — it cannot establish that your condition came from the work accident.
• A record, report, or opinion of a physical therapist, occupational therapist, or acupuncturist is not evidence of disability at all.
• A record, report, or opinion of a physician assistant is not evidence of the presence or degree of a permanent or initial disability.

That last one matters more than it looks. If the only recent note in your file describing how disabled you are was written by a physician assistant, you may have a file full of treatment records and still no admissible opinion on degree of disability — which is the finding a judge needs before directing the carrier to pay you. Physical therapy notes will not fill that gap either.

Expanding the pool of people who may treat you does not expand the pool of people whose reports can carry the legal weight. After January 1, 2028 you will have far more choice, and the same need for a physician’s opinion, in writing, on the established body parts, for defined periods.

What to do between now and then

• Check before the first visit. Confirm the provider on the Board’s Health Care Provider and IME Search, and ask the office whether they handle comp.
• Do not assume your primary care doctor can take over. If they are not authorized, they cannot treat the work injury under the comp system today, and a practice that is not set up for comp will usually decline the case rather than treat it and argue about billing afterward.
• If you cannot find the specialist you need, say so on the record. Distance and availability are real issues, and there are ways to address them — including telehealth, and treating out of state if you have moved.
• Keep the reports coming. Continued lost-wage benefits depend on medical evidence being filed at least every ninety days. A gap in the file is a gap in your benefits.
• Do not stop treating because a bill showed up. Under § 13-f your treating provider cannot charge you for care of the work injury. Bring the bill to us.

Frequently asked questions

Can I use my own doctor for workers’ comp in New York?

Today, only if that doctor is authorized by the Workers’ Compensation Board. About ten percent of eligible providers in New York are. Starting January 1, 2028, when universal authorization takes effect, any licensed provider in good standing who is not on the Board’s exclusion list will be authorized automatically — but participation stays voluntary, so the doctor still has to be willing to take the case.

When does universal authorization take effect in New York?

January 1, 2028. The legislation was enacted in the FY26-27 State Budget. The amended WCL § 13-b and § 13-d carry an effective date of January 1, 2028, and the current versions remain in force until then. The Board has said the lead time is for training and provider outreach.

Does universal authorization mean my treatment will be approved?

No. It changes who may treat you, not what treatment is approved. The Medical Treatment Guidelines, the prior authorization request process, and the Official New York Medical Fee Schedule all continue to apply — the amended § 13-b(2) writes that obligation into the statute directly. An insurer can still deny a request for surgery after January 1, 2028 exactly as it can today.

How do I find out whether a doctor is Board-authorized?

Use the Board’s Health Care Provider and IME Search at wcb.ny.gov. Then call the office and ask whether they accept workers’ compensation cases, because a provider can be authorized and still decline comp work.

Will I be able to use my own doctor for the insurance company’s examination?

No. An independent medical examination is performed by an examiner the carrier selects, and under the amended § 13-b(3) a physician, podiatrist, chiropractor, or psychologist still has to apply to the Chair for authorization to perform IMEs. That requirement is not being removed. Your treating doctor and the carrier’s examiner remain two different people with two different jobs.

Can a doctor bill me for treating my work injury?

No. WCL § 13-f prohibits a provider rendering care to a compensation claimant from collecting a fee from the claimant in New York. If you receive a bill for treatment of your work injury, bring it to your attorney rather than paying it.

My doctor is not authorized and I have already been treating with them. What happens?

It depends on what was treated and when, and it is worth reviewing the file rather than guessing. Emergency care in a hospital or urgent care setting is treated differently under § 13-b(2). Ongoing treatment by an unauthorized provider is a problem to address early, because the reports may not be usable and the billing will be contested.

Does universal authorization apply to a claim I already have open?

The change is tied to an effective date rather than to a date of accident, so it is not limited to new claims. What it does not do is retroactively fix the authorization status of treatment already rendered. The practical effect on an open claim is forward-looking: from January 1, 2028 your options for who treats you get much wider, while everything already in the file is judged under the rules that applied when the care was given.

If you cannot find a doctor who will take your case

Being turned away because it is a comp case is not something you have to solve alone, and it is not a reason to treat outside the system and hope the billing sorts itself out. Whether there is an authorized provider for your injury within reach, and what to do if there is not, is answerable in one phone call. Call 718.701.2776 or 800.310.5520.

This page describes New York law in general terms and reflects the statutes and procedures published by the Workers’ Compensation Board. It is not legal advice about your claim, and reading it does not make us your attorneys.