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Your Right to Receive Medical Treatment When You’re Injured at Work

17 May 18
Jane Payne
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Until it happens to them, most individuals don’t give much idea about undergoing medical treatment should they maintain a serious workplace injury.

Once we have personal medical issues, those of us that are lucky enough to have private health insurance are all accustomed to being able to choose our primary physician and can go to experts whom we choose. If we receive poor excellent therapy from our doctor, are treated rudely by the doctor or his staff, we just move elsewhere for our therapy.

Unfortunately, an entirely different set of rules apply to medical care after a work-related injury. Underneath New Jersey Workers’ Compensation Law, an employee who sustains an injury on the job, regardless of fault, is eligible for all reasonable and necessary medical treatment related to that job injury. Every employer in this State is required to carry workers’ compensation insurance to pay for the price of the therapy. The workers’ compensation carrier is obliged to pay 100 percent of the price of this medical treatment, with no limit regarding the complete sum payable. There are not any co-pays or obligations; all associated medical costs are covered, including prescription medications and medical devices. There’s absolutely no time limitation on the length of time the workers’ compensation provider must continue providing medical therapy. If your work injury requires five years of treatment, that is what the company must supply. Talk to Teamsters 987 Union today.

Sounds great so far. Here’s the rub: New Jersey Workers’ Compensation Law offers, without exception, that the employees’ compensation provider has the right to ascertain the provider of your health care treatment. This usually means that the injured worker has absolutely no input in the decision as to the provider of his medical therapy. Therefore, should you sustain a workplace injury, you are obligated to visit the physician chosen by your employer or its workers’ compensation insurance carrier.

What Will Occur If You’ve Got A Work-Related Injury

This is what generally happens when you experience an injury at work. Your employer contacts that the workers’ compensation provider, that directs you to a medical provider. Normally, that physician is either the “company doctor” a doctor who is under contract with your employer or your insurance company, or to a medical health center, that is a practice type facility which relies exclusively on referrals from employers and employees’ compensation carriers. These health care providers, because most or all of their company is obtained from employees’ compensation carriers, often comply carefully with the principles and requirements imposed on them from the carriers. In most conditions, a competitive bidding process used to ascertain that medical providers are selected by the carriers.

See: How To Join A Union | Join A Union | Join TLU 987

Since the patient can’t decide to go to a supplier other than those chosen by the provider or company, lots of the physicians providing treatment to injured workers tend to produce patterns of behavior in the way they practice medicine. Due to pressures to keep prices down, the physicians have to determine as many patients as possible per day. Backlogs and delays getting into seeing the doctor is the standard. Diagnostic studies that a private physician might order without a second thought are simply not obtained in any respect. Referrals to specialists are delayed or denied. Patients have been treated in an assembly line manner and are given time to explore their injury and its consequences with the physician.

The injured worker frequently also has to deal with a doctor whose disposition toward them is unfavorable from day one. A number of these doctors, either by training or personal philosophy, tend to get an anti-injured worker mindset. They presume that the employee is feigning or exaggerating their symptoms, or seeking to get an excuse to remain out of work. If they could find some justification for determining the employee’s condition isn’t because of the work injury, they’re quick to blame the condition on something else, such as a pre-existing condition. This mentality is a byproduct of pressure from the insurance providers. If the doctor does not play by the provider’s principles, the patients have been directed elsewhere. If a doctor is too much of an urge for his patient and asserts with the insurance adjuster about the plan of recommended treatment, the provider simply won’t use that physician later on.

What Can You Do If You’re Denied Appropriate Medical Care?

So- what will you do if the doctor designated to cure you to your work injury is not treating you appropriately? The initial response of most injured employees that are at odds with the appointed doctor is to go to their doctor, using their personal medical insurance. Unfortunately, this may create more difficulties than it solves. Health insurance policies uniformly have a provision that treatment for work-related injuries is excluded from policy. Therefore, most personal doctors will not treat work-related accidents. Even if they do, then the price of their treatment is not covered by private medical insurance.

Fortunately, New Jersey Workers’ Compensation law will provide for a technique to contest the treatment (or absence thereof) being supplied by the workers’ compensation doctor. An injured employee has the right to file an Employees Claim Petition with the Department of Workers’ Compensation. This Division includes over 50 Employees’ Compensation Judges, with Courts throughout the State, whose job is to hear disputes involving injured workers. The Judges of Compensation possess the authority to order employees’ compensation carriers to provide appropriate medical care to employees who are needing that treatment.

Do I Need An Attorney If A Dispute Arises About My Medical Care?

Because of the complexities of proceeding with a claim in Workers’ Compensation Court, it is highly encouraged that you keep a Workers’ Compensation lawyer to help you in this process. Since this is a very specialized field, you should pick a lawyer with expertise in this area. The Supreme Court of New Jersey certifies lawyers with experience in the subject of workers’ compensation law. Your attorney won’t charge a fee for representing you in a workers’ compensation claim before the matter is finished. The Judge of Compensation who hears that the situation sets the attorney’s fee after the matter is noticed, and under no circumstances is that charge greater than 20 percent of the award.

What’s Going to Happen Once I have Filed My Workers’ Compensation Claim?

When your claim was filed, in case a dispute involving your medical treatment appears, your Workers’ Compensation attorney can file a Motion for Medical Therapy, which will be given priority from the Court, which will generally list the Motion for a hearing within 30 days of the date of filing. The Judge has the power to guide the insurer to offer medical therapy, offer an evaluation by a specialist, or guide that diagnostic studies be accomplished.

If you find yourself at odds with your employer or its workers’ compensation insurance carrier regarding the medical treatment being provided to you, it’s important to be aware that they do not always have the final word concerning your health care treatment. You’ve got the right to dispute a refusal of therapy. It’s possible for you to obtain legal representation without needing to incur any out of pocket expenses for that representation. An independent workers’ compensation judge will listen to your dispute and can direct the insurance provider to provide you with all reasonable and necessary therapy your state requires.