Medical benefits are provided by your employer if your employer self-insures or by your employer’s workers’ compensation insurer. To ensure that an employer or insurer provides fair and full coverage for all medical costs, New Jersey law defines exactly what employers must pay and when they must pay it.
Unfortunately, not all employers live up to their obligations. Some employers try to deny or delay your claim for medical benefits. When this happens, an experienced New Jersey workers’ compensation attorney should be consulted in order to protect your rights.
Davis, Saperstein & Salomon, P.C., is committed to helping workers who have suffered job-related injuries or illnesses. We want to make sure that you get the medical benefits you need so that you can obtain care and treatment that is crucial to your health.
If you are running into obstacles in receiving medical benefits, contact us right away at (800) LAW-2000 or complete our online form. We can provide a free initial consultation.
Types of Medical Benefits
Under New Jersey law, the employer must “furnish to the injured worker such medical, surgical and other treatment and hospital service as shall be necessary to cure and relieve the worker of the effects of the injury and to restore the functions of the injured member or organ where such restoration is possible.”
In other words, the employer must pay for:
- Prescription costs
- Doctors’ visits
- Diagnostic testing
- Hospital services
- Physical therapy
- Pain management
- Any other medical treatment costs incurred due to the injury or illness.
The medical treatment must be necessary, reasonable and scientifically accepted as a customary form of medical care for your illness or injury. If your medical benefits claim meets these requirements, then your employer cannot deny you coverage for medical treatment that you need due to a workplace accident, injury or illness.
Who Chooses Your Doctor?
New Jersey workers’ compensation law gives employers the right to designate the doctor or physician that you visit for your treatment. Unless your situation is an emergency or your employer wrongfully refuses to provide medical care, you must go to the doctor that your employer chooses.
If you do seek treatment from a physician of your choosing in an emergency, then you must notify your employer as soon as possible.
Your employer must choose a doctor that is qualified and capable of providing you with reasonable care. If your employer is trying to send you to an unqualified doctor or to a doctor who refuses to recognize and treat your systems, you should call a New Jersey workers’ compensation lawyer immediately.
Obtaining Coverage for Medical Benefits
To obtain coverage for medical benefits, you must notify your employer right away when you suffer a work injury. You should notify your supervisor, the human resources (HR) or personnel office at your job or anyone in authority.
The initial notice that you give does not have to be in writing. However, putting it in writing is a good idea. When you notify your employer, you will need to specify that you need medical help.
Your employer will then refer you to a physician they have selected. Once your employer has received notice of the accident, they will also be responsible for notifying their insurance carrier and for filing a “First Report of Injury” with the Division of Workers’ Compensation (DWC). The insurer will then evaluate your claim and determine if you are covered. If so, you can be directed to a qualified medical professional for treatment.
Obtaining Additional Medical Service
Employers are required to pay only up to $50 in medical service until a petition is filed with the DWC. This petition will outline the need for additional medical service that exceeds this $50 amount. The petition is filed by the injured worker, a physician or other person on behalf of the worker such as a lawyer.
The DWC will:
- Examine the request for treatment
- Give the employer an opportunity to be heard
- Determine if the treatment and hospital services are necessary
- Determine whether the fees are reasonable.
What If Your Employer Doesn’t Want to Pay Medical Costs after a Work Injury?
If your employer doesn’t comply with their requirements regarding payment for medical treatment, you can get treatment yourself. The employer will then become liable for reimbursing you.
However, an employer will only be required to reimburse you if you met all the requirements, including notifying your employer of the injury and requesting treatment. This means that it is crucial that you get help from a lawyer to ensure you are fulfilling all of your obligations under the law to secure your right to payment.
If your employer generally complies with the law and provides you with medical coverage, there may still be a disagreement over whether a specific treatment should be covered. If this is the case, the dispute can be resolved with help from the DWC with the guidance of medical experts reviewing the request for treatment.
A New Jersey Workers’ Compensation Lawyer Can Help You Obtain Medical Benefits
At Davis, Saperstein & Salomon, P.C., our experienced New Jersey workers’ compensation lawyers know how important it is for you to obtain quality medical treatment after you have been hurt or become ill on the job. We will fight for your right to get all of the care you need in a timely manner so you can recover from your injury or illness.
Call us toll-free at (800) LAW-2000 or use our online form for a free initial consultation, including home and hospital consultations. We charge no fee unless we recover for you and your family.
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