Can I See My Own Doctor For Workers Comp?
Under the New Jersey Workers’ Compensation Act, the workers’ compensation insurance carrier has the right and obligation to provide proper and appropriate medical treatment for a work related injury. After an injury the workers’ compensation carrier is to provide treatment including medical, surgical and other treatment and/ or hospital services in an effort to have the injured worker restored as much as possible to their pre-injury status. If medical treatment is provided, and the bills are not paid by the workers’ compensation carrier, there is a procedure by which the medical provider can bring action against the workers’ compensation carrier directly for failing to satisfy work related bills of an injured worker. The biller shall not seek payment directly from the injured worker. Disputes regarding the reasonable nature of the treatment and the reasonableness of the costs of treatment should be negotiated between the carrier and the biller. The injured worker should not have to worry about how bills for work related treatment will be satisfied. It is common in New Jersey for the workers’ compensation carrier to inform the injured worker that the carrier has the right to control their treatment. However, this right is not without limits. If a workers’ compensation carrier provides inadequate and/ or improper medical treatment they may forsake their right to exercise unbridled control over treatment.
WHEN CAN A WORKER OBTAIN TREATMENT INDEPENDENTLY OF THE WORKERS’ COMPENSATION CARRIER
If the workers’ compensation carrier does not provide treatment to the injured worker, or if the treatment provided by the workers’ compensation carrier is inadequate or improper, the injured worker can seek treatment on their own. Thereafter the injured worker can seek payment of bills and/ or satisfaction of any private medical lien by the workers’ compensation carrier. However, before an injured worker can seek treatment on their own the injured worker must first put the workers’ compensation carrier on notice of the injury, request treatment, and the request for treatment must be refused by the carrier. The only exception to this is if the accident or injury results in an emergent need for treatment. If there is an urgent need for treatment the injured worker can obtain emergent treatment, thereafter, as soon as capable the injured worker shall notify the employer/ workers’ compensation carrier of the treatment obtained and the need for additional treatment and payment of work related bills.
If an injured worker obtains their own treatment independently and does not put the workers’ compensation carrier on notice of the need for treatment and the bills related to the same (absent an emergency), they will be held responsible for the costs of the treatment they obtain on their own. An injured worker can’t go for treatment on their own for a work related injury without putting the employer on notice and then expect the workers’ compensation carrier to be responsible for the bills or medical liens resulting from that unauthorized treatment. It is highly recommended that an injured worker consult with an attorney in order to arrange for proper notice of an injury and a request for treatment be provided to the workers’ compensation carrier. As explained below, there are procedures an attorney can take to obtain appropriate and proper care by a workers’ compensation medical provider.
INADEQUATE OR IMPROPER TREATMENT BY THE WORKERS’ COMPENSATION CARRIER
Two common situations occur which can lead to a petitioner (injured worker) becoming entitled to seek treatment on their own. First, after putting their employer on notice of their injury and documenting their request for treatment, no treatment is provided. In this situation, an injured worker has the right to seek proper medical treatment to cure or relieve the effects of a work related accident or occupational exposure. Secondly, the workers’ compensation carrier may provide treatment after a work related accident or occupational exposure that is inadequate, improper, in error or incomplete. Practically speaking, some workers’ compensation carriers will employ providers who are not qualified in the specialty for which an injured worker needs assessment. Moreover, the carrier may send petitioner (injured worker) to a medical provider who quickly discharges them from care without thorough evaluation, diagnosis or treatment. In these instances, the injured worker shall document the request that sufficient additional treatment be required by a qualified medical professional in light of the type of injury suffered. If denied or ignored, the injured worker can seek treatment on their own and request reimbursement of bills and/ or medical liens by the workers’ compensation provider.
The authorized workers’ compensation doctors have primary responsibility to the injured worker, their patients. As a patient, the injured worker should avoid being defensive with a workers’ compensation doctor and avoid directing them on how to treat them. The injured worker has the right to politely ask questions about their care and ask whether certain modalities/ treatment methods can be employed in a respectful manner. However, the employee should not show their distrust/ distain for a provider if they feel they are getting the shaft as the doctor may place a note regarding non-compliance in their report which hinders their cause.
As a practical matter the medical providers may be left feeling they are at the whim of two masters, the insurance company and the injured worker. At times, the insurance company imposes pressure upon the doctor to cut treatment short and return an injured worker to employment too quickly. In this instance, the petitioner may feel that the ‘tail is wagging the dog’; the insurance company rather than the doctor controls the treatment. However, the doctor not the insurance company has the right to dictate what treatment is required. If a doctor recommends treatment and the insurance company refuses to provide it, per the below motion practice can be instituted to right that wrong. Alternatively, if the doctor is swayed by the insurance company and prematurely ends treatment, motion practice can be employed so that appropriate, proper, and complete treatment is provided.
MOTIONS FOR MEDICAL TREATMENT
Legal representation is important when no treatment or inadequate, improper, insufficient, erroneous and/ or incomplete treatment is provided by the workers’ compensation carrier. There is a procedure under the New Jersey Rules of Court that allows for petitioners attorney to file a motion for medical treatment when the workers’ compensation carrier forsakes their duty to provide appropriate care. An attorney can use the medical records from the treatment petitioner obtains on their own or from a doctor the attorney sends petitioner to in order to file a motion in the Division of Workers’ Compensation to request that treatment/ additional treatment be paid for by the workers’ compensation carrier. Motions for treatment are listed in the Division of Workers’ Compensation within 30 days of their filing. Many times filing a motion is the best way to ensure that proper treatment is provided and this requires proper representation.
Moreover, often times adequate treatment entails a determination by a treating provider relating to the ability of the injured party to work. Medical benefits and monetary benefits can go hand in hand. If an authorized medical provider from the insurance company indicates petitioner can work while an unauthorized provider indicates a petitioner is unable to work during the continued need for treatment it is important for the issue to be considered by a Tribunal. Otherwise, the injured worker would need to obtain monies through either the State of New Jersey Division of temporary disability Insurance for which a lien will be attached to the client’s file or from a private temporary disability carrier. Particularly for serious injuries wherein an absence from work can continue for more than the 6 month allotted period for state disability benefits, it is of utmost importance to present the issue before the court before the situation gets out of hand.
Thank you for your consideration of the above. Our firm remains ready, willing, and able to help you if the workers’ compensation carrier refuses you treatment or provides treatment that is inadequate, improper, insufficient or wrong.