Workers’ Compensation Claims: Back to the Basics Medical Benefits

Rispoli & Borneo P.C.

Workers Comp Attorney Asbury Park – Asbury Park Workers Compensation Attorney

Every employer in the State of New Jersey is required to purchase workers’ compensation insurance.  If you are injured at work, you are entitled to benefits under your employer’s New Jersey workers’ compensation insurance policy.  Those benefits include temporary disability benefits, medical benefits and a permanency award.  The purpose of this post is to discuss the medical benefits provided in a typical New Jersey workers’ compensation claim.

If an employee is injured at work, the employer’s Workers’ Compensation Insurance Company is required to provide medical treatment.  The cost of the treatment is paid 100% by the insurance company.  However, the insurance company has the authority to select the treating physician.  If the employee treats with an unauthorized physician (a physician not approved by the insurance company), the employee will most likely be responsible for the cost of treatment.

Once an authorized physician has been selected, that physician coordinates an injured employee’s medical care.  The authorized physician can prescribe medication, prescribe physical therapy, order testing, and refer the employee to a specialist.  The authorized physician also determines when an injured employee can return to work.  Finally, the authorized physician determines when an injured employee has reached “maximum medical improvement,” which allows the insurance company to discontinue treatment.

Frequently, the insurance company will seek to discontinue treatment and an injured employee will disagree with the decision.  In this instance, the Asbury Park workers compensation attorney must file a Motion for Medical and Temporary Benefits.  This motion puts the issue of continued medical treatment before a Workers’ Compensation Judge.  If the parties cannot resolve the issue, with the assistance of the Judge, a formal hearing will be held with testimony from the injured worker, the employee’s medical expert and the insurance company’s medical expert.  Ultimately, the Judge will make a decision as to the necessity of additional treatment.

Issues related to an injured employee’s medical treatment arise often in Workers’ Compensation cases.  Medical treatment can become an issue at any point in the life of a case.  To ensure an injured worker gets all of the medical treatment necessary to make the best recovery possible, it is important to retain an experienced workers’ compensation attorney who will not hesitate to challenge the insurance company’s position and is ready, willing and able to file the appropriate motions.