Red Flags To Watch For In Your Workers Compensation Case

  • December 14, 2022

Whenever you are injured at work, you are entitled to receive workers compensation benefits. Those benefits are: 1) Medical Benefits; 2) Temporary Disability Benefits; and, 3) Permanent Disability Benefits.

When you are injured on the job, it is your employer’s worker’s compensation insurance company that is responsible for the payment of your medical bills, not your private health insurance carrier. Under the rules governing worker’s compensation law, you must go to the medical provider designated for you by the workers compensation insurance company.

The first red flag to watch for is when you are reporting the accident to your employer. Under New Jersey law you have an obligation to report the accident to your employer and make a request for medical treatment. Sometimes your employer will seem disinterested in your report of the accident and injury and tell you to “go to whatever doctor you want”. This is not your employer delegating to you the authority to designate the worker’s compensation treating physician. This is a sign that your employer does not want to report your accident to its worker’s compensation insurance company and wants you to go to your own doctors and have your private health insurance pay the medical bills. When this happens, you need to alert your attorney to discuss your options and get your case back on the worker’s compensation track as soon as possible. In this situation, your attorney will often be the first one who reports the accident to your employer’s workers compensation insurance company by filing a claim for you. 

In most cases, your employer will report your accident to its worker’s compensation insurance company and you will thereafter come under the care of the medical provider that was designated for you. When that medical care begins to go on for longer than the insurance company would like, you may find that you have been scheduled to submit to an examination by a different doctor. Usually the purpose of this examination is to terminate your medical treatment. The worker’s compensation insurance carrier cannot legally terminate the medical treatment being prescribed by the designated physician unless they have a medical opinion to the contrary. The insurance company has scheduled for you this examination with a doctor that they can count on to say that further treatment is not required. If you are receiving authorized Worker’s Compensation medical treatment, and you find that you have been scheduled to be examined by another doctor, you should immediately contact your attorney and alert him to what potentially will transpire.

Other times, the worker’s compensation insurance carrier will assign a nurse case manager to your case. The nurse case manager will attempt to accompany you to all of your doctor’s appointments in an attempt to influence the doctor to provide less, rather than more, medical treatment. Nurse case managers are not allowed to enter the examination room with you. Although the worker’s compensation insurance company is paying the doctor’s bill, there still exists between you and the medical provider a confidential doctor-patient relationship. If you have a nurse case manager who insists on coming into the examination room during your doctor’s visits, you should refuse, let the doctor know that you object to this person’s presence in the room, and contact your attorney to help you deal with the situation.

If you are under the care of a doctor who is of the opinion that you should remain out of work for 7 days or more as part of your medical treatment, then you are entitled to receive temporary disability benefits from the worker’s compensation insurance company. The amount you receive should be 70% of your gross weekly wages, or the maximum rate for the year, whichever is less. In 2022 the maximum rate is $1065. If you routinely work overtime, you may be getting short-changed. Many workers compensation insurance carriers will compute your temporary disability benefits based on straight time only. The average amount of your overtime needs to be used in these computations and could result in a significantly higher amount of temporary disability benefits.

Sometimes your designated treating doctor will return you to light-duty employment, but your employer does not have a light-duty job for you. Sometimes your employer will give you a light-duty job but claim that it pays much less money than your regular job, even less than the amount you would be receiving under temporary disability. If you have been placed in this situation you should contact your attorney and discuss your options in dealing with the situation.

In most cases, the workers compensation insurance company will close your case after medical treatment has ended and you are no longer eligible for temporary disability benefits. You usually need an attorney to file a formal claim on your behalf in order to obtain permanent disability benefits, i.e., money to compensate you for the amount of your injury that the doctors could not repair. However, even in cases where the insurance company does voluntarily pay you permanent disability benefits, it is almost always far less than what you would be entitled to if you pursue your case in court.

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