Can You Choose Your Own Doctor in a New Jersey Workers’ Compensation Case?
By the Law Offices of Michael S. Williams – Injury attorney
After suffering an injury at work, getting appropriate medical treatment is often one of an injured employee’s most immediate concerns. A common question is whether an injured worker can choose his or her own doctor.
In most New Jersey workers’ compensation cases, the employer or its workers’ compensation insurance carrier has the right to select the medical providers who treat the injured employee. However, that does not mean an injured worker is without options when treatment is delayed, denied, or fails to adequately address the work-related injuries.
Understanding how medical treatment works under New Jersey workers’ compensation law can help injured employees protect their rights and avoid problems with their claims.
Who Chooses the Workers’ Compensation Doctor in New Jersey?
Under New Jersey workers’ compensation law, the employer generally has the right to select and authorize the physicians who provide treatment for a work-related injury.
N.J.S.A. 34:15-15 generally requires an employer to furnish an injured employee with medical, surgical and other treatment that is necessary to cure and relieve the worker from the effects of the work-related injury.
In practice, the employer’s workers’ compensation insurance carrier will often select the initial treating physician and determine whether referrals to specialists, diagnostic testing, physical therapy, injections, surgery, or other treatment will be authorized.
This is different from using private health insurance, where a patient may have greater freedom to select a physician within an insurance network.
Can You See Your Own Doctor After a Work Injury?
An injured worker can seek an evaluation from a physician of his or her own choosing. However, that does not necessarily mean the employer or workers’ compensation insurance carrier will be responsible for the cost of that treatment.
Because the employer generally has the right to direct medical treatment, obtaining unauthorized treatment can create a dispute over responsibility for the medical bills.
There are circumstances in which unauthorized treatment may become an issue, particularly when an employer has failed or refused to provide necessary treatment. However, an injured employee should generally speak with a New Jersey workers’ compensation attorney before independently arranging significant medical treatment and assuming the workers’ compensation carrier will pay for it.
What If the Workers’ Compensation Doctor Is Not Helping?
An injured worker does not necessarily have to accept inadequate medical care simply because the physician was selected by the employer or insurance company.
Problems may arise when an authorized physician:
- fails to investigate continuing complaints;
- refuses to order appropriate diagnostic testing;
- does not address complaints involving another injured body part;
- prematurely releases the employee to work;
- recommends treatment that the insurance carrier refuses to authorize; or
- discharges the employee from treatment despite continuing symptoms.
When there is a legitimate dispute concerning necessary medical treatment, an injured worker may be able to seek assistance from the New Jersey Division of Workers’ Compensation.
Can You Get a Second Opinion?
An injured employee may want a second opinion when there is disagreement with an authorized physician’s diagnosis, treatment recommendations, work status, or decision to discharge the employee from care.
There is an important distinction, however, between obtaining another medical evaluation and having the workers’ compensation carrier authorize treatment with a doctor selected by the injured worker.
Depending on the circumstances, a workers’ compensation attorney may request another authorized physician, obtain medical evidence addressing the disputed treatment, or ask the Workers’ Compensation Court to determine whether additional treatment should be provided.
What Happens When the Insurance Company Refuses Treatment?
When an employer or its workers’ compensation insurance carrier denies, delays, or refuses necessary medical treatment, an injured worker does not simply have to accept that decision. The worker can seek intervention from the New Jersey Workers’ Compensation Court by filing a Motion for Medical and Temporary Benefits.
This is where having an experienced workers’ compensation attorney who regulary practices in the county where the employee lives is essential.
Through this motion, the injured worker can ask the Court to compel the employer or insurance carrier to authorize and provide medically necessary treatment, including diagnostic testing, specialist evaluations, physical therapy, injections, surgery, or other treatment required for the work-related injury.
Depending on the circumstances, the dispute may involve:
- an MRI or other diagnostic testing;
- evaluation or treatment by a specialist;
- physical therapy;
- injections;
- surgery;
- treatment of an additional injured body part;
- an additional medical evaluation or second opinion; or
- continued treatment after an authorized doctor has discharged the injured worker from care.
In some disputed cases, the Workers’ Compensation Court may require an examination by an independent physician of its choosing to assist the court in determining whether additional medical treatment is necessary. The medical evidence and opinions of the physicians involved can be important in determining whether further treatment should be authorized.
These disputes can be particularly important when an injured employee continues to experience significant symptoms but the insurance carrier takes the position that no additional treatment is necessary.
What If the Doctor Sends You Back to Work but You Are Still Hurt?
A return-to-work determination does not necessarily mean that a workers’ compensation case is over.
There is an important difference between being released to full duty, being released with work restrictions, and reaching maximum medical improvement (MMI).
An injured worker who is released to work but believes the job cannot be performed safely should promptly discuss the situation with a workers’ compensation attorney. Simply refusing to return to work can potentially affect entitlement to temporary disability benefits.
The physician’s restrictions, the type of work offered by the employer, the employee’s ability to perform that work, and whether additional medical treatment remains necessary can all become important issues.
What If the Employer Does Not Send You to a Doctor?
After a workplace injury, the employer should be notified as soon as possible. If the employer or its insurance carrier fails to provide necessary medical treatment after receiving notice of the injury, the injured worker may have legal options to obtain treatment.
An injured worker is not required to wait indefinitely for the insurance company to act.
A New Jersey workers’ compensation attorney can communicate with the employer and insurance carrier, request authorization for necessary treatment and, when appropriate, file a motion seeking relief from the Workers’ Compensation Court.
Do You Have to Pay the Workers’ Compensation Doctor?
Authorized medical treatment for a compensable workplace injury is paid through workers’ compensation rather than by the injured employee.
An injured worker should not have to pay deductibles or copayments for authorized workers’ compensation medical treatment.
This is another reason injured employees should be cautious before arranging treatment independently without first determining whether the treatment has been authorized and who will be responsible for the medical bills.
What Should You Do If Your Workers’ Compensation Treatment Is Being Delayed?
If medical treatment is being delayed, denied, or discontinued, it is important to document what is happening and address the problem promptly.
Keep track of appointments, treatment recommendations, work restrictions, referrals, and requests for authorization. If a doctor recommends an MRI, specialist evaluation, injection, surgery, or other treatment that is not being authorized, advise your attorney. Assuming the employee wants the recommended treatment, a demand for the treatment should be made and motion be filed if not approved.
Similarly, if you have consistently reported an injury to a particular body part but that body part is not being evaluated or treated, that issue should be addressed rather than ignored.
Waiting can potentially delay your recovery and complicate disputes over medical treatment and temporary disability benefits.
Speak With a New Jersey Workers’ Compensation Lawyer
Disputes over medical treatment can have a significant impact on a workers’ compensation claim. Delayed treatment may prolong an employee’s symptoms, interfere with the ability to return to work, and create disputes over temporary disability benefits.
The Law Offices of Michael S. Williams, LLC represents injured workers in Freehold, throughout Monmouth County, and across New Jersey in workers’ compensation matters involving medical treatment, temporary disability benefits, permanent disability benefits, and other workplace injury issues.
If you were injured at work and are having difficulty obtaining medical treatment through workers’ compensation, contact our office at 732-351-2800 to discuss your rights.
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Legal Disclaimer
This blog is provided by the Law Offices of Michael S. Williams for informational purposes only and does not constitute legal advice. Reading this article does not create an attorney-client relationship. Every personal injury case is unique, and outcomes depend on the specific facts and applicable law. You should not act or refrain from acting based on the information contained in this blog without first consulting a qualified attorney licensed in New Jersey.
