First, you figure you’ll try to make it the rest of the day. After all, you don’t want to get docked for lost time. You refrain from telling anyone that you are in excruciating pain. Your attendance record is perfect, and you have no intention of taking off time. Although your co-worker heard you groan when you picked up the box, you don’t bother to report the incident.
Your shift ends early, so you quickly head over to your family doctor. The receptionist hands you paperwork that asks the usual questions. Without hesitation, you check the box that says your injury is work-related. You are ready to turn over your health insurance co-payment. And, then, you learn your mistake.
Under New Jersey workers compensation laws, employees receive benefits regardless of who was at fault. (There are limited exceptions to this rule, but your accident is not one of them.) The tradeoff is that the employer or their insurance company selects your medical provider. More than likely your regular doctor’s office understands that they will not get paid unless the workers’ compensation company approves them to treat them. This is called authorized medical treatment.
Be that as it may, you are in shock. Your regular physician’s office tells you they cannot even examine you. You cannot decide if you are more angry than in pain.
Authorized Medical Treatment
So, what happens next? Although you were initially hesitant to make a report regarding your work injury, you should do so immediately. Hopefully, since you are such a trusted and credible worker, your employer will understand the slight delay in making the report. The next step should be a referral to a company doctor to evaluate your injuries.
Your company’s personnel department is run very efficiently. Nevertheless, it seems like hours before you are finally referred for medical treatment. In fact, your company even provides you with transportation to a local clinic.
Like a good employee, you are happy to play by rules. Ultimately, you feel like the doctors at the clinic are doing absolutely nothing for you. You are ready to try anything. And, at this point, you don’t care how it gets paid.
For starters, you need to understand the concept of authorized medical treatment. Again, your company must authorize and approve the doctor, therapists, or other medical providers. If you disagree with their findings, you should speak with an attorney with experience in workers compensation law. A motion for medical benefits may be made to the courts on your behalf.
Reasonable and Necessary Treatment
According to New Jersey workers’ compensation law, the employer is responsible for “all necessary and reasonable medical treatment, prescriptions and hospitalization services related to the work injury.” Of course, one might wonder what is considered necessary and reasonable.
If you’re in pain, you more than likely think everything is reasonable and necessary. Actually, you may be happy to know that it’s up to the workers’ compensation carrier to actually prove that care is unnecessary or unreasonable. However, that may be ultimately decided in court.
The bottom line is that you should not attempt to reason with the insurance company on your own. Rather, you should seek counsel from an experienced workers’ compensation attorney if you are not getting the treatment you need.
Contact Us
The Law Offices of Anthony Carbone has represented injured workers for more than two decades. We are happy to meet with you and provide you with experienced legal advice. Contact us.