Estimated reading time: 11 minutes
Table of contents
- The General Rule: Your Employer Controls Initial Medical Care
- When You Can See Your Own Doctor
- The Risk of Treating Outside the System Without Guidance
- Can You Change Doctors in a Workers’ Compensation Case?
- Why the Authorized Treating Physician Can Affect Your Entire Workers’ Compensation Claim
- Local Context: Workers’ Comp in New Jersey’s Major Employment Corridors
- Workers’ Comp Attorney Spotlight: Gary E. Adams
- Frequently Asked Questions
- Talk to a New Jersey Workers’ Compensation Lawyer Today
Whether or not you can see your own doctor after being injured on the job in New Jersey is typically one of the first questions a newly injured worker asks. While this is typically an issue that is brought up in connection with a regular health insurance claim, in a workers’ compensation claim, the injured worker’s employer has significant control of the medical treatment of the injured worker, at least initially. It is therefore helpful to understand the process in place for workers’ compensation claims in New Jersey and where an injured worker can assert their rights regarding the medical treatment they are entitled to receive for their work-related injuries.
At Pellettieri Rabstein & Altman, our Supreme Court certified workers’ compensation lawyers have represented injured workers and their families in New Jersey workers’ compensation claims since 1929.
The General Rule: Your Employer Controls Initial Medical Care
Under New Jersey workers’ compensation law (N.J.S.A. 34:15-15), the employer or the employer’s workers’ compensation carrier has the right to direct your medical treatment following a work-related injury. The employer or carrier chooses the authorized treating physician (ATP) as well as any required specialists and physical therapy. All of your treatment, however, must be approved by the employer’s insurance carrier to be covered and provided to you at no cost to you.
This employer selected doctor is referred to as an authorized treating physician (ATP). All treatment rendered within the workers’ comp system must be approved by the employer’s insurance carrier in order to be provided at no cost to you.
Many injured workers are surprised to learn that they cannot simply continue treatment with their longtime primary care physician after a workplace injury.
When You Can See Your Own Doctor
While the employer controls authorized treatment, there are important exceptions and circumstances where you can, or should, see your own doctor:
1. Emergency Situations
In cases of medical emergencies related to work injuries, workers have the immediate right and ability to go to the nearest emergency room or other urgent care facility for treatment and the workers’ compensation carrier for the employer must pay for such emergency treatment, even if the facility is not on the employer’s approved list of providers.
2. The Employer Fails to Provide Timely Treatment
If your employer or their insurer fails to authorize and provide medical care in a timely manner, you can go out and get whatever treatment you need and try to collect for it. The laws and procedures for getting medical care when an employer or their insurer fail to provide it in a timely manner is very complex. It is always recommended that you have a good workers compensation attorney representing you to file a motion to compel (require) medical care when needed.
3. Second Opinions and Independent Medical Examinations (IMEs)
You have the right to obtain a second medical opinion from any physician of your choice at your own expense. Often the physician appointed by your employer will have a conflict of interest as they are paid by the same insurance carrier that is responsible for paying for your workers’ compensation claim.
Your attorney can obtain a second medical opinion for you to challenge the findings of your employer’s appointed physician, especially if the physician appointed by your employer downplays the severity of your injuries, fails to recommend required additional treatment, or fails to award sufficient permanent partial disability to you.
On workers’ compensation cases, both the employee and employer have the right to an independent medical examination or IMEs. Workers’ compensation lawyers often use IME’s of their own choosing to challenge the findings of the doctor selected by the employer to treat the employee’s work related injuries.
4. Treatment After the Case Is Settled or Closed
As part of your settlement for an award of medical benefits, you may be able to agree to continue treating with your own physician for any future medical needs.
The Risk of Treating Outside the System Without Guidance
In some instances, workers who are not satisfied with the employer-selected treating physician, or with the pace of treatment and recovery authorized by the workers’ compensation carrier, treat with their personal physicians without first consulting with an attorney. In these instances, the worker may be in for some unexpected problems, including:
- Payments for unauthorized medical care and treatment are not usually paid by the workers’ compensation carrier. However, an attorney may argue that authorized medical care and treatment were inadequate or unavailable.
- The injured worker’s claim for benefits could be impacted as the insurance carrier may argue that any treatment provided by the unauthorized physician was not related to the work-related injury.
- Your medical records could be used against you in your workers’ compensation claim when there are contradictions between your treating physician’s records and the records from your authorized workers’ compensation doctor.
And before you go for treatment outside of the workers’ comp system, make sure you talk with a workers’ compensation attorney first. There are ways to treat within the system that will protect your interests and health.
Can You Change Doctors in a Workers’ Compensation Case?
Most questions we receive regarding workers’ compensation claims and changing of authorized physicians center around the following main point: What are my options to change my authorized physician in my workers’ compensation claim?
Changing authorized treating physicians is possible. However, he or she can be changed by the insurance carrier, or by order of a Workers’ Compensation judge. You cannot change to a new doctor on your own and expect them to be covered.
There are circumstances under which a worker would be seeking a change of physician, such as:
- The authorized doctor is not adequately treating your injury
- You are experiencing a new or worsening condition that requires different expertise
- There is evidence of a conflict of interest or bias in the authorized doctor’s approach
- The authorized physician has ceased providing treatment or is unavailable
When a carrier refuses a reasonable request to change physicians, a skilled workers’ comp attorney can file a motion for medical treatment before a New Jersey Workers’ Compensation judge. Our attorneys at Pellettieri Rabstein & Altman have extensive experience filing and winning these motions on behalf of injured workers across the state.
Why the Authorized Treating Physician Can Affect Your Entire Workers’ Compensation Claim
The authorized treating physician plays a significant role in your workers’ compensation case. The medical reports, diagnosis and assessment by the authorized treating physician, regarding your work ability, will determine:
- What treatment you receive and for how long
- Whether you are eligible for temporary disability benefits and what percentage of your salary you will receive while on temporary disability status
- The extent of any permanent partial or total disability for which you can receive an award
- When you have reached Maximum Medical Improvement (MMI) – the end of temporary disability benefits
A physician employed by an employer can provide fine medical care and do a great job treating an employee’s workplace injury. But the fact that the carrier is paying for that care, and that the carrier typically uses the same doctors that they have used in prior years, can create a conflict of interest that must be addressed.
Our lawyers have extensive experience in the system of treating workplace injuries and the ways in which the authorized treating physician’s medical records, diagnosis and opinions can be used against an injured worker. We use independent medical examiners, expert witnesses, and litigation as needed to ensure that our client’s injuries are fully and fairly documented.
Local Context: Workers’ Comp in New Jersey’s Major Employment Corridors
New Jersey is home to some of the highest injury rate industries in the Northeast. Every day New Jersey workers are impacted by the employer-controlled treatment system. The following are some of the most common New Jersey industry types where our New Jersey injury at work attorneys represent workers who have suffered a work injury.
- Construction workers in Trenton, Camden, Newark, and across Mercer, Burlington, and Essex counties
- Healthcare workers at hospitals and long-term care facilities throughout Central and South Jersey
- Warehouse and logistics employees in the booming distribution hubs along the I-295, I-78, and I-95 corridors
- Public employees — including police officers, firefighters, and correctional officers — at municipal and county agencies statewide
- Manufacturing and industrial workers in Middlesex, Union, and Morris counties
Pellettieri Rabstein & Altman’s attorneys practice in all parts of New Jersey. With offices in Trenton/Lawrence Township, Cherry Hill, Morristown, and Nutley, we are able to meet with clients in person at a location of their choice. We also offer the option of phone or video conferencing for those clients who are unable to travel.
Workers’ Comp Attorney Spotlight: Gary E. Adams
Gary E. Adams is the Managing Partner of Pellettieri Rabstein & Altman and is the Chairman of the firm’s Workers’ Compensation department. He is a Certified Workers’ Compensation Trial Attorney by the Supreme Court of New Jersey. For the entirety of his law practice, Gary Adams has focused on representation of injured workers and union members in Workers’ Compensation matters throughout the State of New Jersey. He handles cases from the initial filing of a claim through trial before Workers’ Compensation Judges of the Superior Court (Appellate Division) and the Supreme Court of New Jersey on appeal.
In representing injured workers and union members for decades, Gary E. Adams has handled thousands of claims including those caused by a single traumatic work accident as well as those caused by occupational diseases, heart attacks, repetitive motion injuries and death claims. His experience includes trials in the Superior Court as well as appeals in the Appellate Division and Supreme Court of New Jersey.
Mr. Adams is past Chairman of the New Jersey State Bar Association’s Workers’ Compensation Section and testified on workers’ compensation reform before the New Jersey Legislature. He has played a significant role in the development of New Jersey’s Workers’ Compensation laws and continues to be involved in efforts to reform and protect the rights of workers.
Frequently Asked Questions
Q: Can my employer force me to see their doctor in a New Jersey workers’ comp case?
A: In most cases, yes. Under New Jersey workers’ compensation law, the employer or its insurance carrier generally has the right to select the authorized treating physician for a work-related injury. The insurance carrier selects the authorized treating physician for your work-related injury. In some cases, however, you have the right to emergency treatment from a doctor of your choice, a second opinion at your own expense, and to challenge the authorized treating physician’s inadequate care in the courts with the assistance of a workers’ compensation attorney.
Q: What happens if I see my own doctor without authorization?
A. If you see a provider who has not been authorized by the workers’ compensation carrier to treat you, the cost of such treatment is not reimbursable by the carrier. However, your attorney may be able to argue that such treatment was necessary due to the carrier’s failure to authorize adequate and timely medical care. It is always best to consult with a workers’ compensation attorney before receiving unauthorized treatment.
Q: Can I request a different workers’ compensation doctor in NJ?
A. Yes, you can request another doctor; however, the insurance carrier generally has to approve your request. However, if the authorized treating physician’s care is found to be inadequate, your attorney can file a motion with the Workers’ Compensation judge for a change of physician or for additional medical treatment.
Q: What is an independent medical examination (IME) in a workers’ comp case?
A: An Independent Medical Examination or “IME” is a medical examination performed by a doctor, not necessarily your treating physician. IME’s are utilized to provide an independent medical opinion regarding such matters as whether an employee has a work-related injury and its extent, as well as whether an employee is in need of certain treatment. In some cases, a worker and his or her attorney may also schedule an IME in order to counter the opinions of the doctor selected by the employer.
Q: Do I need a lawyer to dispute medical care decisions in my workers’ comp case?
A. No, you don’t need a lawyer. However, it is very difficult to deal with issues regarding the medical care that you need to get better from your work injury as well as issues regarding your benefits. The Workers’ Compensation carrier has a whole department of lawyers and adjusters who are trying to keep the benefits to a minimum. It would be wise to have a lawyer on your side as well.
Q: How does a workers’ comp attorney help with medical treatment issues?
A: Experienced workers compensation attorneys like those at Pellettieri Rabstein & Altman can file motions, challenge testimony of employer-selected physicians with their own independent medical evidence, negotiate with workers compensation insurance carriers, and present evidence before a Workers Compensation judge when necessary. Attorney’s fees in a workers compensation case are paid by the carrier as a percentage of the award granted to the injured worker by the court. In other words, there is no upfront fee to hire an attorney to handle your workers compensation claim.
Talk to a New Jersey Workers’ Compensation Lawyer Today
The rules with respect to choosing a doctor to treat a workplace injury in New Jersey are very complex and often involve great controversy. If you feel that you are not receiving the proper medical treatment, that you are being denied medical treatment that you need, or that your employer-selected doctor is not treating you fairly, you should contact the experienced workers’ compensation lawyers at Pellettieri Rabstein & Altman.
Our New Jersey work injury lawyers represent clients with work injuries throughout the State and have been doing so for nearly 100 years. Our certified workers’ compensation lawyers are involved in all aspects of workers’ compensation law. We have served on various committees for the workers’ compensation section of the New Jersey State Bar Association. We have achieved published precedent-setting opinions in workers’ compensation cases in New Jersey.
Free consultations available. We take workers’ compensation cases on a contingency fee basis, meaning that there is no charge for our services unless we are able to recover benefits for you. Contact us online or call to speak with a New Jersey workers’ compensation attorney today.
