An injury can affect all aspects of your life, from finances and career to your family and overall well-being. When you are injured on the job in New Jersey due to your job duties, you have the right to receive medical care and treatment. Despite employees’ and employers’ best efforts work place injuries still occur. Your employer can pay for your medical expenses, from an emergency room visit to physical therapy. Workers’ compensation is the insurance program that provides various benefits to employees who sustain injuries while working, including medical, disability and death benefits.
Seeing the Right Doctor for Worker’s Compensation Injuries
Specific rules dictate the process you must follow if you want workers’ compensation benefits to cover your medical expenses.
The first step is notifying your employer of your injury. This should be done as soon as possible after you are hurt. You can tell the personnel office, your supervisor, foreman or anyone in a position of authority. Notification to the organization does not need to be in writing.
Your employer may advise you to go to a particular occupational doctor or urgent care clinic, stating that this is the doctor or facility used for employee treatment.
Even if you don’t think you need to see a doctor right away, notifying your employer and having workers comp doctors check you out can avoid questions later on about whether or not the injuries occurred at work.
If at all possible it is very important you see a doctor your employer prefers. If you go to your own doctor without your employer’s permission it is likely workers’ comp will not cover the appointment fee or related costs. When you are hurt, you want to see a good doctor, so going to someone unfamiliar can be uncomfortable. However, in workers’ compensation cases, the doctor your employer uses serves two essential roles: they might provide treatment for your injury or perform an independent medical evaluation only.
Employers’ Preferred Providers
In a workers’ compensation case, doctors decide what medical treatment you need, whether you can return to work and if duty modification is required. In New Jersey, your employer or insurance company can dictate a specific doctor you have to go to for treatment. However, they often have a designated facility or provide you with a list of preferred physicians that meet their needs.
As a general rule, the insurer must approve all treatment concerning your injury. Without the authorization for care, the insurer does not have to pay for any medical expenses over $50. If you go to your doctor or another medical professional not approved by your employer, you could forfeit your workers’ compensation benefits.
Typically you worker’s compensation benefits will provide coverage for the following expenses or costs:
Medical costs related to your work injuries are paid either by your employer’s insurance carrier or the employer directly if they are self-insured. Expenses that are covered include necessary and reasonable medical treatment, hospitalization expenses and prescriptions.
If you are unable to work for more than seven days, workers’ compensation pays for temporary disability. These benefits cover approximately 70% of your average weekly wage. It cannot exceed 75% of the Statewide Average Weekly Wage or fall below 20% of the SAWW.
Permanent Total Disability
If you have a severe injury that prevents you from being able to return to work of any kind, you may be entitled to permanent total disability benefits. They are initially available weekly for 450 weeks and may continue beyond that time if you can show that you are still unable to work due to the injuries from your previous work injury.
Permanent Partial Disability
When an injury results in a permanent partial disability, you may receive benefits, paid weekly after the temporary disability period ends. Injuries may include losing mobility in a limb, fingers, eyes, toes, ears or teeth. However, it could also involve the heart, lungs, back or other areas of the body. The type of injury and severity dictates whether it qualifies as a disability.
If a spouse or parent died due to work-related illness or injury, you might be eligible for death benefits. Those who were part of the employee’s household at the time of his or her death are presumed independents. If a disabled child is mentally or physically disabled, he or she may qualify for additional benefits. Other members of a decedent’s family that are not part of the household may also receive benefits if they can prove dependency. After a judge determines eligible family members, the death benefits are divided among them. Funeral expenses up to a certain amount are the responsibility of the insurance carrier or employer.
Resolving Worker’s Compensation Medical Claims
If your employer or employer’s insurance company doesn’t authorize the medical treatment you require, you can file a motion with the Department of Workers’ Compensation. You must complete a form and provide a doctor’s written statement confirming that a delay in treatment can cause you specific harm and all relevant medical records that can prove the point.
Statute of Limitations for Worker’s Compensation Claims
All civil claims in New Jersey have statue of limitations and it is very important you are aware of when any relevant to your claim will expire. You must file a formal claim for workers’ compensation within two years of the date of your injury. If your case is a result of occupational illness, such as hearing loss, lead poisoning or asbestos, you must file a claim within two years of becoming aware of your condition and its relationship to your work.
Workers’ compensation laws in New Jersey are complex. They typically favor the employer, especially regarding control over medical care. A lawyer experienced in handling workers’ compensation cases can evaluate your case and fight for your right to get the care and benefits you need.
Contact our worker’s compensation attorneys to make an appointment to have one of our experienced attorneys review your claim!
Chris Costello, ESQ.
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