Until it happens to them, the majority of individuals don’t give much thought about undergoing medical treatment should they sustain a serious workplace injury.
Once we own personal medical issues, those people who are fortunate enough to have private health insurance are all accustomed to being able to pick our principal physician and can visit specialists whom we select. If we receive poor excellent therapy from our physician, are treated rudely by the physician or his staff, we just go elsewhere for our treatment.
Regrettably, a completely different set of rules apply for medical treatment after a work-related accident. Beneath New Jersey Workers’ Compensation Law, an employee who sustains an injury at work, regardless of fault, is entitled to all reasonable and necessary medical treatment associated with this work injury. Every company in this State must carry workers’ compensation insurance coverage to cover the cost of this treatment. The workers’ compensation carrier is obliged to pay 100 percent of the price of this medical treatment, with no limitation regarding the entire sum payable. There are no co-pays or obligations; all related medical expenses are covered, such as prescription medications and medical devices. There’s absolutely no time limitation on the length of time the employees’ compensation provider has to keep on providing medical treatment. If your work injury requires five decades of therapy, that is what the provider has to provide. Talk to Teamsters 987 Union here.
Sounds good so far. Here’s the rub: New Jersey Workers’ Compensation Law offers, without exception, that the workers’ compensation company has the right to determine the provider of your health care treatment. This usually means that the injured employee has zero input in the choice concerning the supplier of his health care therapy. Therefore, if you maintain a workplace injury, you’re obligated to go to the doctor selected by your employer or its workers’ compensation insurance carrier.
What’s Going to Happen If You Have A Work-Related Injury
This is what typically occurs when you have an injury on the job. Your employer contacts that the workers’ compensation provider, that directs you to a medical supplier. Typically, that physician is either the “company doctor” a physician who is under contract with your employer or your insurance carrier, or into an occupational health center, and it is a clinic type facility that relies exclusively on referrals from employers and workers’ compensation carriers. These healthcare providers, since most or all of their business, is obtained from workers’ compensation carriers, often abide carefully by the rules and requirements imposed upon them by the carriers. In many scenarios, a competitive bidding process used to ascertain which medical providers are selected by the carriers.
Since the patient cannot decide to go to a provider other than those chosen by the carrier or employer, many of the doctors providing treatment for injured employees tend to produce patterns of behavior in the way they practice medicine. Due to pressures to keep prices down, the doctors must see as many patients as you can per day. Backlogs and delays getting to see the doctor are the standards. Diagnostic studies a personal physician might order without another thought are deferred or not obtained at all. Referrals to specialists will be postponed or denied. Patients are treated in an assembly line fashion and are given little time to discuss their injury and its effects on the doctor.
The injured employee often also has to deal with a physician whose disposition toward them is damaging in day one. Many of these doctors, either by training or personal doctrine, tend to have an anti-injured worker mindset. They presume that the employee is feigning or exaggerating their symptoms, or seeking to get an excuse to stay out of job. If they could get any justification for determining the employee’s condition is not due to the work injury, they’re quick to blame the status on something different, like a pre-existing illness. This mentality is really a byproduct of pressure from the insurance carriers. If the doctor doesn’t play by the carrier’s rules, the patients are directed elsewhere. If a physician is too much of an advocate for his patient and asserts with the insurance adjuster about the plan of recommended treatment, the carrier simply will not use that physician later on.
What Can You Do If You’re Denied Appropriate Medical Care?
So- what could you do in case the physician designated to cure you of your work injury is not treating you appropriately? The first response of most injured workers who are at odds with all the appointed physician is to visit their doctor, with their private medical insurance. Sadly, this may create more problems than it solves. Health insurance policies have a provision that remedy for work-related injuries is excluded from coverage. Therefore, most private physicians will not treat work-related injuries. Even when they do, then the price of their treatment isn’t covered by personal health insurance.
Fortunately, New Jersey Workers’ Compensation law does provide a technique to contest the therapy (or absence thereof) being supplied by the employees’ compensation physician. An injured employee has the right to file an Employees Claim together with the Department of Workers’ Compensation. This Division has 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 ability to dictate workers’ compensation carriers to give appropriate medical treatment to employees who are being denied that therapy.
Would I Need An Attorney Should A Dispute Arise About My Medical Care?
Due to the complexities of moving with a claim in Employees’ Compensation Court, it’s strongly advised that you retain a Workers’ Compensation attorney to assist you in this procedure. As this is a highly specialized field, you need to select an attorney with experience in this region. The Supreme Court of New Jersey certifies lawyers with experience within the area of workers’ compensation legislation. Your lawyer will not charge a fee for representing you at a workers’ compensation claim until the matter is finished. The Judge of Compensation who hears that the situation sets the attorney’s fee after the problem is heard, and under no circumstances is that fee higher than 20% of their award. click here to learn more
What Will Happen Once I have Filed My Workers’ Compensation Claim?
Once your claim was filed, if a dispute regarding your medical treatment appears, your Workers’ Compensation attorney can file a Motion to Medical Treatment, which will be given priority by the Court, which may generally list the Motion for a hearing within 30 days of their date of submitting. The Judge has the power to guide the insurance carrier to give medical treatment, give an assessment by a specialist, or direct that diagnostic tests have been accomplished.
If you end up in danger with your company or its workers’ compensation insurance carrier about the medical treatment being provided for you, it is essential to be aware that they don’t necessarily have the last word concerning your healthcare treatment. You’ve got the right to dispute a denial of therapy. It is possible to acquire legal representation without having to incur any out of pocket expenses for that representation. A different workers’ compensation judge will listen to your dispute and can direct the insurance carrier to provide you with all reasonable and necessary treatment your condition needs.