When to See Your Own Doctor in a Workers Compensation Case

Don’t feel like you can trust your employer’s chosen doctor or the workers compensation insurance company doctor?

You’re smart to suspect there’s a conflict of interest. Yet New Jersey Law gives employers and insurance companies the right to choose the doctor who will evaluate you and offer medical treatment, if any. 

If you go to your own doctor while the workers compensation claim is still open, then the medical bills will become your responsibility.

However, there is a moment in a workers compensation case where going to your own doctor will be both appropriate and necessary. In the event the insurance company denies your claim, you now have the option to go to the doctor on your own. 

Going to Your Own Doctor After a Denied Claim

To make sure that doing so will strengthen your case rather than weakening it, you’re going to need to inform your employer and the insurance company in writing that you dispute the denial of their claim. You also need to inform them that you’re going to see your own doctor to get your own assessment.

At that point you’ll have the doctor submit the bill to your own private health insurance company. That company is immediately going to say wait, this was a workplace injury, we’re not responsible for this. They will try to kick it back to workers compensation and then will end up paying if workers compensation continues to deny your case.

At that point they can then seek compensation for their expenditure by putting a lien against your case. You do not actually lose anything when this happens, but it does keep you from “double dipping,” receiving two payouts from two insurance companies for the same expense.

Essentially they’ll be saying, we paid money you should have paid and now we want that money back. It would come out of your medical expense award which you normally would not need to receive directly because if they’d approved your claim all of your medical bills would have been reimbursed to begin with.

What if you have to go to the ER?

If your workplace injury is severe enough to require an ER visit you can go. You will just need to document the reasons why you needed to go to the ER and provide that information to your attorney.

It might be a good idea to get a referral to the ER from your doctor before you go in order to show the decision was medically necessary and not an overreaction. Your lawyer can then use this information to ensure one of the two insurance companies responsible covers the bill up to your policy limits.

Need help with your workers compensation case? Contact Talone Law today.

See also:

When Can a New Jersey Employer Deny Your Workers Compensation Claim?

Employers Commit Workmans Comp Fraud Too

What to Do if Workers Compensation Denies a Medical Procedure