Tag Archives: Workers’ Comp claim

A Look at Treatment under a Workers’ Comp Claim

If you’re injured on the job in New Jersey, the NJ workers’ compensation system ensures that your employer or your employer’s workers’ compensation insurance company must pay for your reasonable and necessary medical treatment. In other words, if you are injured at work, the law provides that you don’t have to pay for the associated medical expenses. As with most legal provisions, however, a workers’ comp claim is not without its limitations.

Reasonable and Necessary Medical Treatment

It seems easy enough – if you are injured at work, workers’ comp has got you covered. It’s not, however, quite that simple. Workers’ comp insurance companies are only responsible for paying for those medical treatments shown to be directly related to the injury you sustained at work. Further, these companies need only pay for those medical treatments that are directly related and that are reasonable and necessary.

What’s Reasonable and What’s Necessary?

 It probably goes without saying that you and your workers’ compensation insurance provider may not always see eye-to-eye when it comes to what is reasonable and necessary regarding your medical treatment. There are some basics, however, that most insurance companies – once they’ve accepted your workers’ comp claim– will cover:

 

  • Medical appointments;
  • Diagnostic testing, including x-rays, MRIs, ultrasounds, and the like – but only if such tests are medically necessary to diagnose the exact nature of your work-related injury;
  • Some hospital services;
  • Some surgeries;
  • The administration and purchase of some prescription medications;
  • Some medical devices, including things like wheelchairs, splints, crutches, and hearing aids; and
  • Some physical therapy (for a prescribed period).

As this list reveals, workers’ compensation insurance companies are not only cynical but also have plenty of wiggle room when it comes to finding medical expenses unnecessary and unreasonable.

Unnecessary and Unreasonable

While reputable doctors rarely order treatments that they don’t believe are both medically necessary and reasonable, workers compensation insurance companies are in the business of making money and are not averse to taking on a few battles. For instance, these insurance companies have been known to deny experimental or cost-prohibitive treatments and drugs; alternative therapies like chiropractic and acupuncture (that many people find offer significant relief); more than three weeks of treatment for soft-tissue injuries; and specialized treatments ordered by non-specialized medical professionals.

 

Don’t despair; experienced workers’ compensation attorneys understand how important your claim is to you and know how to fight for the resolution you are entitled to.

 

If You Were Injured on the Job, Call 201-498-9768 Today for More Information

 

If you were injured on the job, don’t leave your recovery to chance or to your employer’s workers’ compensation insurance. Contact a skilled New Jersey workers’ comp lawyer who will help guide your claim toward the resolution you’re entitled to. At John L. Schettino law, we’re here to help. For a free phone consultation, contact or call me at (201) 498-9768.

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