Until it happens to them, the majority of people don’t give much idea about getting medical care if they maintain a serious workplace injury.
When we have personal medical problems, those of us who are lucky enough to get private health insurance are accustomed to being able to pick our main doctor and can visit experts whom we select. If we receive inferior quality treatment from our doctor, are treated rudely by the doctor or his staff, we just move elsewhere for our therapy.
Unfortunately, an entirely different set of principles apply for medical treatment following a work-related injury. Under New Jersey Workers’ Compensation Law, an employee who sustains an accident on the job, irrespective of fault, is entitled to all reasonable and necessary medical care related to this job accident. Every company in this State is required to carry workers’ compensation insurance to pay the cost of the therapy. The workers’ compensation carrier is obliged to cover 100% of the cost of the medical treatment, without limitation as to the whole sum payable. There are not any co-pays or deductibles; all related medical expenses are covered, including prescription drugs and medical devices. There’s absolutely no time limitation regarding how long the employees’ compensation provider has to continue providing medical therapy. If your job injury requires five decades of therapy, that is what the provider has to provide.
Sounds great up to Now. Here is the rub: New Jersey Workers’ Compensation Law provides, with no exception, that the workers’ compensation company has the right to determine the provider of your medical therapy. This usually means that the injured worker has absolutely no input in the decision concerning the provider of healthcare treatment. As such, if you sustain a workplace injury, you’re obligated to go to the physician 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 generally occurs when you have an injury on the job. Your employer contacts the workers’ compensation provider, that directs you to a healthcare supplier. Commonly, that physician is the “company doctor”, a physician who’s under contract with your employer or your insurance company, or into a medical health center, that will be a practice type facility which relies solely on referrals from companies and workers’ compensation carriers. These health care providers, because most or all of their business is obtained from workers’ compensation carriers, tend to comply very carefully by the principles and requirements imposed upon them from the carriers. In many situations, a competitive bidding process used to ascertain that medical suppliers are selected by the carriers.
Since the patient can’t decide to go to a supplier other than those chosen by the provider or employer, lots of the physicians providing treatment to injured employees tend to create patterns of behavior in how they practice medicine. Due to pressures to keep costs down, the physicians have to view as many patients as you can per day. Backlogs and delays getting into seeing the physician is the standard. Diagnostic studies that a private doctor may order without a second thought are deferred or not acquired at all. Referrals to specialists will be delayed or refused. Patients have been treated in an assembly line fashion and are given time to go over their injury and its effects with the physician. Visit Teamsters 987 Union here.
The injured worker frequently also has to take care of a physician whose disposition toward them is unfavorable from day one. Many of these physicians, either by instruction or personal philosophy, are inclined to have an anti-injured worker mindset. They presume that the worker is feigning or exaggerating their symptoms, or even seeking to find an excuse to stay out of work. If they can get any justification for determining that the worker’s condition isn’t due to the work injury, they are quick to blame the status on something different, like a pre-existing illness. This mentality is really a byproduct of stress from the insurance providers. If the physician doesn’t play with the carrier’s rules, the sufferers have been directed elsewhere. If a physician is a lot of an advocate for his individual and asserts with the insurance adjuster regarding 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 will you do in case the physician designated to deal with you to your work injury isn’t treating you suitably? The initial response of most injured workers that are at odds with the appointed physician is to go to their doctor, using their personal health insurance. Sadly, this can create more problems than it solves. Health insurance policies uniformly contain a provision that treatment for work-related accidents is excluded from coverage. Therefore, most personal physicians won’t treat work-related injuries. Even when they do, the cost of their treatment isn’t covered by private medical insurance.
Luckily, New Jersey Workers’ Compensation law does provide for a method to competition the therapy (or lack thereof) being supplied from the employees’ compensation doctor. An injured employee has the right to file an Employees Claim together with the Division of Workers’ Compensation. This Division includes over 50 Employees’ Compensation Judges, with Courts throughout the State, whose function is to hear disputes between injured workers. The Judges of Compensation possess the authority to order workers’ compensation carriers to provide appropriate medical care to workers who are needing that therapy.
Do I Need An Attorney If A Dispute Arises About My Medical Care?
Because of the intricacies of moving with a claim in Workers’ Compensation Court, it’s highly recommended that you keep a Workers’ Compensation attorney to assist you in this procedure. As this is a very specialized area, you should choose a lawyer with expertise in this field. The Supreme Court of New Jersey educated lawyers with experience within the business of workers’ compensation law. Your lawyer will not charge a fee for representing you at a workers’ compensation claim before the issue is concluded. The Judge of Compensation who hears that the case sets the lawyer’s fee after the issue is heard, and under no circumstances is that fee greater than 20 percent of their award.
What’s Going to Happen Once I have Filed My Workers’ Compensation Claim?
When your claim has been filed, should a dispute regarding your medical treatment appears, your Workers’ Compensation lawyer can file a Motion to Medical Therapy, which is given priority by the Court, which may generally list the Motion for a hearing within 30 days of the date of submitting? The Judge has the authority to guide the insurance carrier to offer medical therapy, provide an assessment by an expert, or guide that diagnostic tests have been accomplished.
If you end up at odds with your employer or its workers’ compensation insurance carrier regarding the medical care being provided for you, it is essential to be mindful they do not necessarily have the final word about your health care therapy. You’ve got the right to dispute a denial of treatment. You’re able to get legal representation without having to incur any out of pocket expenses because of this representation. An independent workers’ compensation judge will hear your dispute and may direct the insurance carrier to supply you with all reasonable and necessary treatment your circumstance needs.