Legal Question in Workers Comp in New Jersey

Job Related Injury

Does an employer have the right to refuse to pay medical bills that an employee submitted, over injuries that the employee got from falling in a hole on a construction job site and the employee fractured their ribs.


Asked on 12/14/01, 1:11 pm

3 Answers from Attorneys

Evan Levow Lutz, Levow & Costello, P.A.

Re: Job Related Injury

Under the New Jersey Workers' Compensation Statute, there are three basic benefits to which you may be entitled:

1. Medical Benefits

2. Temporary Disability Benefits

3. Permanent Disability Benefits

With reference to MEDICAL BENEFITS, the employer/insurance company is obligated to provide the employee with, and pay for all reasonable, necessary, curative medical treatment which the employee may need because of the injuries sustained in the work-related accident.

You must remember that the employer/insurance carrier is permitted by law to choose the doctor or doctors who will treat you. These are known as authorized doctors. In other words, whichever doctor the insurance company authorizes will be paid for by them, including any specialist the authorized doctor may refer you to. If you see a doctor who is NOT authorized, it will be your responsibility to pay the doctor.

The insurance company is obligated to pay for your authorized medical treatment until such time as your medical condition has plateaued. Plateaued means that the authorized doctors have given you all the curative treatment they know will cure your medical condition and your condition will not get any better through further treatment. When you have reached a plateau, the insurance company's obligation to provide you with medical treatment ends. Any treatments after your condition has plateaued is known as palliative treatment, which may make you feel better temporarily, but will not help cure your medical condition. Workers' Compensation Law does not require authorized doctors to provide palliative treatment. The law only requires curative treatment.

An authorized doctor may release you to return to "light duty" work, with restrictions provided by the doctor. If the employer has such a "light duty" job available, you must accept it if it is offered to you. If the employer has no such "light duty" job, you are entitled to continue to receive temporary disability benefits until the doctor releases you to return to full duty. Hopefully, you will return to work with your employer, even though you may do so with a permanent disability. Since disability awards in New Jersey are measured by loss of your body function, and not loss of income, clients are encouraged to return to work as soon as they can do so.

If you have any other questions, please contact me.

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Answered on 12/14/01, 3:09 pm
John Pinho John Pinho

Re: Job Related Injury

The employer must make payment of the medical bills

incurred as a result of the accident.

Visit my website for more information on the 10 Most

Frequently Asked Questions in New Jersey Workers Compensation

http://www.njlawonline.com/workersquest.htm

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Answered on 12/14/01, 3:28 pm
Brian Lucianna Brian V. Lucianna, Esquire

Re: Job Related Injury

In NJ, an employer has the right to direct medical treatment. Without knowing more details, it is impossible to answer this question. However, t6he employer has the right to refuse treatment if it was not authorized. I suggest you seek counsel immediately. If you already have counsel and are asking this question to us, then perhaps you are not being well-served.

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Answered on 12/14/01, 10:51 pm


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