Normally, you would go to your regular doctor or clinic for treatment of an injury or medical condition. But when you are injured on the job, you may not have that choice.
Under New Jersey workers’ compensation law, employers can force you to seek treatment with their “preferred providers” for a work-related accident. This can create problems if doctors are not qualified to treat your injury or if they are too quick to send you back to work.
You don’t choose your workers’ comp doctor, but you do have rights
New Jersey statute requires employers to cover all medical expenses “necessary to cure and relieve” your job-related injury or illness. However, the employer can dictate that you seek treatment with certain medical providers. Some employers will require you to go to a specific hospital, clinic or individual doctor. Other employers may allow you to choose from a list of several “preferred” providers who have been pre-approved.
In many cases, these providers are hand-picked by the workers’ compensation insurance carrier. While they are licensed professionals, these doctors may not be specialists or may not be as familiar with your medical history as your personal physician would be. Sometimes they are biased toward the employer or insurance company, especially when it comes to authorizing expensive treatments or declaring you fit to resume duty.
Exceptions and appeals under your medical benefits claim
There are some exceptions to the mandated provider rule:
- Your employer must cover emergency room treatment, even if it was not a preferred hospital or pre-authorized.
- You can request to see a specialist, and you can appeal if the request is denied.
- You are entitled to a second opinion from an outside physician. (But the employer does not have to cover this expense.)
- If your employer refuses to cover a specific course of treatment, you can seek an expedited hearing before the Divison of Workers’ Compensation.
- You have the right to appeal a treatment plan, a disability rating or a “clean bill” sending you back to work.
Beware of independent medical exams
At any point during your treatment, the employer or insurer can request that you to submit to a medical exam by a doctor of their choosing. The purpose of an independent medical exam (IME) may be to challenge the degree of injury or the duration of your disability leave. Remember, these doctors are not necessarily on your side. However, if you refuse an IME, your employer can legally terminate your workers’ compensation benefits. You are allowed to have your own doctor or a trusted person attend the exam with you.
You should report any workplace injury to your supervisor or employer in a timely manner. You should seek medical treatment even if you think the injury is minor. You should contact a workers’ compensation attorney if there is any delay or denial of benefits, or if your employer tries to terminate your claim or force you back to work.