Choosing a Doctor & Getting Medical Treatment
You have been hurt on the job, or are showing symptoms of an occupational illness. Your first responsibility was to notify your employer of the accident or injury. Next, you need to submit a request to your employer to get medical treatment. Under New Jersey Workers’ Compensation law, your employer or your employer’s insurance company can select the health-care provider to treat your work-related injury or condition. Some employers will agree to let you see your own doctor or chiropractor. Be sure to have that written permission with you before visiting your own clinic.
You will not have to pay any co-pay or deductible—the entire cost of treatment, including physical therapy, chiropractic treatments, doctor’s visits and other expenses, is covered. The doctor chosen by your employer will typically be under contract with your employer’s insurance company. Unfortunately, some of those providers take advantage of the relationship and do not provide the customer service, quality of diagnostics, and referrals to specialists you would find at your regular clinic.
If you are not happy with the workers’ comp doctor
Your employer does have the right to choose your doctor. However, if that means you are not receiving reasonable and necessary treatment that will cure you, relieve pain, or restore function, you have options. DO NOT go to your regular clinic and try to use your regular health insurance—treatment for a work-related injury is probably excluded from the policy.
You can file a claim in Workers’ Compensation Court, a Motion for Medical and/or Temporary Disability Benefits. Your motion will be scheduled to be heard by a judge within 30 days of filing. The judge can order the insurance company to pay for the treatment, diagnostic studies, or an evaluation by a specialist. If a doctor provides a statement that you need medical care before the hearing, and that a delay will result in irreparable harm, you can file a Motion for Emergent Medical Care.
Should you represent yourself in workers’ compensation court?
The claim process is complex and it is recommended that you retain a workers’ compensation attorney to represent you. Your lawyer will not charge a fee in a workers’ compensation case until the matter is ended, at which time the fee is determined by the judge. That fee will never be more than 20% of the award.
What is maximum medical benefit?
The workers’ compensation authorized doctor will eventually declare you have reached “maximum medical benefit” and should return to work. You may not have completely recovered from your injury and still experience pain and other symptoms, but if you have reached maximum medical improvement, you will not benefit from further medical treatment.
For more than a century, Workers’ Compensation Law has provided New Jersey workers with a no-fault insurance plan for on-the-job injuries and occupational diseases. The system may be challenging at times, but protects workers and forces employers to provide employees with care and compensation in the event of injuries.