New Jersey Workers' Compensation Medical Benefits

Medical benefits are provided by your employer if your employer self-insures or by your employer’s workers’ compensation insurer. To ensure that employers provide legally mandated benefits to injured workers, New Jersey law defines exactly what they 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, you should consult with an experienced New Jersey workers’ compensation attorney 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 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 provide free initial consultations.

Types of Medical Benefits

Under New Jersey law, employers 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 things like:

  • Prescription costs
  • Doctors’ visits
  • Diagnostic testing
  • Hospital services
  • Physical therapy
  • Pain management
  • Surgery
  • Any other medical treatment costs incurred due to the injury or illness

Importantly, all 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.

Other Benefits You Can Get Through Workers’ Compensation in New Jersey

In addition to covering the cost of your medical treatment, workers’ compensation in New Jersey provides a wide range of other benefits. These include:

  • Lost wages during rehabilitation
  • Temporary total disability benefits
  • Permanent partial disability benefits
  • Permanent total disability benefits
  • Death benefits

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.

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 symptoms, you should call a New Jersey workers’ compensation lawyer immediately.

If you do seek treatment from a physician of your choosing in an emergency, then you must notify your employer as soon as possible.

Obtaining Coverage for Medical Benefits

To obtain coverage for medical benefits, you must notify your employer right away when you suffer a workplace injury. You should notify your supervisor or the human resources department at your job.

The initial notice that you give does not have to be in writing. However, putting it in writing is a good idea, as this creates a paper trail evidencing your timely notice. 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 additional medical services until a petition for more is filed with the DWC. This petition will outline the need for additional medical service that exceeds this $50 amount. The petition should be filed by the injured worker, a physician, or another 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

Who Is Eligible to Receive Workers’ Compensation in New Jersey?

Workers’ compensation is a “no-fault” insurance system, meaning that eligible employees are covered regardless of who was responsible for their workplace injury or illness. Employers are responsible for obtaining and maintaining coverage. When an employee becomes injured, they can seek benefits through their employer’s insurer.

Who Is Considered an Employee Under New Jersey Law

Employees injured on the job or while conducting job-related activities may be eligible to receive workers’ compensation. However, not everyone at a company may be entitled to seek benefits. Those exempt from workers’ compensation coverage may include:

  • Freelance or contract workers
  • Unpaid interns
  • Unpaid volunteers
  • Sole proprietors with no employees

Many employers try to avoid having their insurance premiums go up by misclassifying their employees as independent contractors. To be appropriately classified as an independent contractor, workers must satisfy a number of legal requirements. If you believe your employer has misclassified you — intentionally or by accident — you should consult with an experienced attorney as soon as possible.

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 meet 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 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.

What Penalties Can My Employer Face for Not Providing Appropriate Workers’ Compensation Insurance?

By law, almost all employers must carry workers’ compensation insurance. Failing to maintain valid coverage is a significant violation of the law. Noncompliant employers may be penalized $5,000 for the first ten days and up to $5,000 for each additional ten-day period they remain uninsured. These penalties cannot be discharged through bankruptcy.

As explained by the Department of Labor and Workforce Development (NJDLWD), “where a work-related injury or death has occurred, the employer, including individual corporate officers, partners, or members of an LLC, is directly liable for medical expenses, temporary disability, and permanent disability or dependency benefits.”

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 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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