After suffering a serious work injury, employees frequently head to the emergency room. However, after the initial visit, they receive ongoing treatment by a different doctor. Not all states allow those who have been hurt on the job to choose their treating physicians. Instead, the Workers’ Compensation provider or employer gets to pick which treating doctor will handle the diagnosis and recovery for the employee. This may seem like a harsh reality, especially to workers who would prefer to go to their own physician. Nevertheless, in the wide majority of circumstances, injured workers in New Jersey must be taken care of by a doctor who has been pre-approved by their company or Workers’ Compensation insurer.
New Jersey State Rules
New Jersey state rules explain that although an injured worker has the right to seek emergency or urgent care treatment by any medical professional, he or she must use a company doctor for continued care. The company doctor may be a local physician or a doctor who works as part of a neighborhood clinic or an onsite corporate-run clinic.
It is easy to understand why a team member who has been hurt at work would want to be seen by a family physician instead of a stranger. The physician already has a rapport with the patient, as well as a collection of their medical records. A doctor hired by an insurance carrier might not have an understanding of the patient’s past, such as a family doctor or general practitioner would.
Workers Who Refuse to Use a Company Doctor
Sometimes, employees feel that they should not have to use a physician named by the Workers’ Compensation insurer or employer. Consequently, they set up appointments with their own physician. Unfortunately, in those circumstances, they will likely have to pay out of pocket for their medical treatment. Additionally, if they have to take off from work to heal, they may not be eligible for Workers’ Compensation benefits.
Are There Circumstances Where Workers Choose Their Own Doctors?
As mentioned previously, injured workers have the right to seek emergency care from any doctor they choose. Normally, injured employees who need to head to the emergency room will be seen by on-call physicians. Those physicians will take care of the most pressing issues and diagnoses but will not offer continuing treatment.
New Jersey allows workers to receive Workers’ Compensation if they see a doctor of their choosing when an insurance company initially denies the claim, but the denial is later reversed. In the meantime, the hurt employee may want to partner with a Workers’ Compensation lawyer to appeal the denial. If the injured employee successfully overturns the denial, the insurance carrier should cover any medical costs already incurred. However, any future treatment will need to be decided upon by the insurer’s preferred treating physician.
Successfully Working with a New Doctor
In order to make the best of this situation and ensure they get the feedback, advice, and treatment they deserve, injured workers should take certain steps after being assigned a new doctor. Taking a few precautionary measures will improve employees’ chances of having a better experience, even if the doctor is unfamiliar to them.
Workers should be assertive and honest. The treating physician should be willing to answer any questions and explain why certain treatment may be recommended. The only way for a doctor to know how best to proceed is if a patient is being truthful. Even if the worker feels little personal rapport with the physician, the worker should always aim to be genuine. Workers also need to attend all scheduled appointments. If the insurance company hears that the injured employee missed any appointments, they will likely stop paying for care and assume the injured worker can return to their normal duties.
What If the Treating Physician is Not Satisfactory?
Treating doctors should perform their medical responsibilities as expected. This does not always happen, though. Workers who feel they are not receiving adequate medical care may want to work with a lawyer to appeal to the Workers’ Compensation courts. The goal of an appeal is for the worker to switch physicians. The worker would likely need to provide extensive documentation that the doctor did not make expected or adequate treatment suggestions or was otherwise unavailable or unresponsive to the patient’s needs. This burden of proof can be quite high, so it may be difficult for an injured worker to make a case without the help of a lawyer.
When Should I Consider Working with a Workers’ Compensation Lawyer?
Employees who feel they are not receiving appropriate medical care from a treating physician may want to consult a lawyer right away to evaluate the worker’s individual case and advise on whether an appeal is warranted. Like all legal cases, it can be very challenging, time-consuming, and potentially expensive for employees to navigate the courts and fight insurance companies alone.
Mount Laurel Workers’ Compensation Lawyers at Kotlar, Hernandez & Cohen, LLC Help Injured Employees Receive the Treatment They Deserve
If your New Jersey employer set you up with a physician who is not providing proper care, or you were denied benefits, contact one of our Mount Laurel Workers’ Compensation lawyers at Kotlar, Hernandez & Cohen, LLC. For a free consultation, call us at 856-751-7676 or contact us online today. Located in Mount Laurel, Cherry Hill, Trenton, and Vineland, New Jersey, as well as Trevose, Pennsylvania, we serve clients throughout New Jersey and Pennsylvania.