When you’re in the middle of a worker’s compensation case it’s vital to know how to navigate your medical care. Certain missteps can cause you to take on medical bills worker’s compensation insurance would have paid.
In a New Jersey worker’s compensation case, your employer and your insurance company can dictate your medical care, including which doctor you see. If you wanted to use your own doctor, or a doctor from a different insurance network, then you’d have to seek prior authorization from the insurance company. Failing to do so can make you responsible for those bills.
The only exception is the ER doctor you receive when you take the initial injury. That doctor can be from any network or hospital and worker’s compensation would still generally be required to pick up that bill.
Thus, you should not see your own doctor for any procedures or tests related to your injury unless you seek prior authorization.
Of course, this may all strike you as a horrible conflict of interest. It often can be. Consider the story of AmCare, the on-site health provider for Amazon.com warehouses. They handle the worker’s on-site injuries, which should all be covered as worker’s compensation insurance. Instead, reports allege AmCare workers repeatedly put people back on the floor who should not have been there. Going to an AmCare clinic did not “count” as reporting an on-the-job industry according to the Amazon/AmCare set-up. AmCare mostly seemed to be engaged in limiting company costs.
Some of the doctors New Jersey residents encounter during the worker’s compensation process seem to have similar priorities. It’s not uncommon for such doctors to report Maximum Medical Improvement (MMI) well before you are physically capable of doing the work. This dirty trick puts an MMI on paper that requires you to return to your job even when you are too injured to do so. It also puts an end to your weekly benefits, though not your medical ones.
Suddenly, you’re being treated as though you’re faking an injury to get money instead of as someone who has worked hard for a company and who has suffered on the job. Numerous processes exist to cast doubt on your pain and to raise the question of whether you can really go back to work.
Fortunately, you still have legal rights, and the company-affiliated doctor isn’t your only recourse.
At that point, a second opinion can serve as useful legal evidence. Your worker’s compensation attorney can advise you on whether and when to seek one, and can help you push back, helping you retain your benefits.