After a workplace injury, your doctor may recommend medication, physical therapy or even surgery. You may wonder whether workers’ compensation will cover that treatment. In New Jersey, workers’ compensation generally covers necessary and reasonable medical treatment related to a work injury. However, the employer or carrier typically controls which provider treats you.
What medical treatment can workers’ comp cover?
Workers’ comp can cover medical care for a work-related injury. This may include doctor visits, prescriptions, hospitalization, physical therapy, diagnostic testing and surgery.
The treatment generally must relate to the work injury and qualify as necessary and reasonable under the workers’ compensation system. A doctor’s note alone does not mean the carrier must approve it.
Does your doctor decide what treatment workers’ comp covers?
New Jersey generally allows the employer or its insurance carrier to select the authorized treating physician. If your claim is accepted, the carrier will generally direct you to an authorized provider.
There are exceptions. You may be able to choose a treating physician if the employer improperly refuses to provide medical treatment or if you need emergency care.
What can you do if the carrier refuses necessary treatment?
A dispute can involve more than whether your injury is covered. It may also concern the type or extent of treatment you need. You may be able to seek relief through the New Jersey Division of Workers’ Compensation.
Depending on the circumstances, that may include an informal hearing, a Claim Petition or a motion seeking medical benefits or emergent medical treatment. Keep copies of medical records, treatment notes and communications with your employer or carrier. These records can help show what was recommended and whether it was provided or refused.
What if workers’ comp denies the treatment you need?
A treatment denial does not end the dispute. The carrier may question whether the treatment is related to the work injury, whether the treatment is necessary and reasonable or whether the claim is compensable. The carrier may also direct you to an authorized medical provider if your claim is accepted.
The right response depends on why treatment was denied. Addressing the dispute promptly may help protect your access to needed care. A New Jersey workers’ compensation attorney can review the facts and explain your options.