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Medical Treatment for your Work-Related Injuries: Why you need a Certified Workers’ Compensation Law Attorney

• May 04, 2022

If you need medical treatment for a work-related injury, you’ll also need a Certified Workers’ Compensation Lawyer at your side in order to get the best possible medical care.

Here’s why:

Healthcare Overview

You might intuitively think that when a person requires medical treatment, the medical bills should be submitted to that person’s medical insurance company for payment. That certainly makes a lot of sense, but that is not the way our healthcare system here in New Jersey works. Which insurance company is responsible for the payment of your medical bills depends upon the underlying reason why you needed the medical treatment. If you needed medical treatment because of a work-related injury, it is your employer’s workers compensation insurance carrier that is responsible for the payment of your medical bills under the laws that govern Worker’s Compensation claims. If you need medical treatment because of an automobile accident, it is your automobile insurance carrier that is responsible for the payment of your medical bills pursuant to our state’s no-fault auto insurance laws. Your health insurance company is responsible for the payment of all medical bills not related to a work injury and not related to an automobile accident.

Therefore, you have no choice but to pursue a Worker’s Compensation claim if you require medical treatment because of a work-related injury unless, of course, you wish to pay for medical treatment yourself, out-of-pocket.

Workers’ Compensation Medical Benefits

Under New Jersey Worker’s Compensation Law, your employer’s workers compensation insurance company is responsible for the payment of 100% of all of your medical bills. There are no deductibles and there are no copayments. Hospitalizations, doctor’s visits, diagnostic testing, prescription drugs, canes, walkers, hospital beds, wheelchairs, etc. are all paid for 100% by the employer’s workers compensation insurance company. However, you must go to the doctors and other medical providers that the insurance company authorizes you to go to. You are not allowed to select your own physician or other medical providers when you are receiving medical treatment for work-related injuries unless, of course, you wish to pay for it yourself without the assistance of other insurance.

Frequent Problems That Arise

In an otherwise free market economy such as ours, the removal of patients' choice of treating physician has several unintended and undesirable consequences. The doctors and other medical providers are no longer concerned with providing quality service and satisfying the needs of their patients with the hope that they will then in turn refer their friends and relatives to their medical practices. Instead, this system encourages medical providers to pledge their allegiance to insurance companies. This system encourages doctors to provide only a minimal amount of low-cost treatment so that they in turn will be rewarded by the insurance company - who will send them an endless stream of injured workers who have no choice but to submit to their medical care.

This often leads to underdiagnosis of the injury. It is all too common for a worker with a back injury to be told by the insurance company’s authorized treating physician that the pain radiating down into the legs is just a back sprain. The injured worker will be discharged by the authorized treating physician after only a minimal amount of physical therapy and without an expensive MRI examination conducted. Of course, without this MRI examination, there will conveniently be no objective medical evidence of any injury other than the simple sprain that the authorized treating physician has diagnosed. Worse yet, the medical records of the authorized treating physician will frequently indicate that the injured worker states that his back problems have been resolved when the worker was actually complaining about increasing pain radiating into both legs.

Even when the authorized treating physician does prescribe treatment or testing, the scheduling can become so difficult and delayed that it rises to the level of a de facto denial of medical benefits. The company doctor may prescribe physical therapy, but you find that you are unable to attend because the worker’s compensation insurance carrier is not providing your physical therapist with authorization “until they have completed their review”. The same occurs when scheduling diagnostic testing such as an MRI, EMG, or ultrasound. I’ve had cases where an injured worker was being denied life-saving medications prescribed by the workers compensation insurance company’s own authorized treating physician because an insurance adjuster refused to provide the pharmacy with authorization until she “was provided with additional medical records for review”.

Your employer’s workers compensation insurance company will often assign to you a nurse case manager. The nurse case manager will lead you to believe that there is no doctor-patient privilege or right of privacy between you and your authorized treating physician because “the insurance company is paying for it”. The nurse case manager will even attempt to come into the examination room with you while you are being examined by the doctor. The purpose, of course, is to unashamedly exert influence over the authorized treating doctor on medical decisions such as when you are able to return to work, what types of treatment or testing should be prescribed and, if needed, raise questions about it being related to something other than this work injury so that a different insurance company would be responsible to pay instead of workers compensation.

Conclusion

You do not enter the NJ Workers Compensation system of healthcare voluntarily. You are forced into it, usually by the occurrence of a work-related accident. Due to the nature of this system, the quality of medical care that you receive can often be inferior to the care you would receive under your health or auto insurance, where you have a right to change doctors if you feel the medical treatment is being rendered is inadequate. You need an attorney in your corner who understands the NJ Workers Compensation Laws better than the insurance adjusters who are trying to provide you with the least amount of benefits possible. When disputes arise over the adequacy of the medical treatment that you are receiving, only a Workers’ Compensation Judge can decide if you are getting all of the medical benefits to which you are entitled. Given the arrogant tenacity of many adjusters who handle these workers compensation claims, our law firm frequently goes before the same Judge for the same injured worker on multiple occasions, litigating each step of the injured workers medical treatment, and asking for the imposition of sanctions and penalties against the insurance company.