Will New Jersey Workers Compensation Cover Prosthetics?
It’s tragic but true: many work injuries end in amputation. A prosthetic can help restore quality of life and even the ability to continue working, but they are costly. A low-end prosthetic can cost as much as $5000, whereas a high-end prosthetic can cost up to $70,000. A high end prosthetic such as a myoelectric prosthesis offers movable fingers and a considerable return to functionality.
New Jersey Law pays out an amount of loss of function equal to a number of weeks according to the workers compensation chart. If you lose 25% of your hand or foot function you will be compensated for three weeks of work in addition to what you’re paid while you’re out of work, and in addition to your medical bills.
The number of weeks varies by the amount of function loss. If you lose 50% of your hand function then you are paid for 150 weeks, an amount which can add up to over $43,000.
Theoretically the workers compensation company should pay for prosthetics too. Unfortunately they tend to want to pay for the cheapest and least functional prosthetic they can get away with. For example, they might want to fit you for a claw that won’t actually give you any real functionality. You might need to use the loss of functionality award to pay for that amount yourself. Workers compensation insurance will often try to claim that a better prosthetic is not “medically necessary.”
If you already had a prosthetic and the accident damages it then New Jersey law treats this situation quite a bit difficulty. Section 34:15-12.7 says:
“Whenever as the result of an accident for which compensation is payable to any employee of any employer under article 2 of chapter 15 of Title 34 of the Revised Statutes, to which this act is a supplement, such employee sustains damage to, or destruction of, a prosthetic device, hearing aid, artificial member, dental appliance or eyeglass, it shall be the obligation of the employer to repair or replace the same or to make payment of the cost or value thereof, upon claim made therefor, which obligation shall be in addition to the obligation for the payment of the compensation payable to said employee for injuries sustained as a result of such accident.”
Thus if you had a high-end, highly functional prosthetic that was damaged in the workplace then the workers compensation company will have no choice but to pay the replacement value for the very same prosthetic.
It is frustrating to realize that workers compensation companies really have no interest in actually helping you to return to a normal life after your accident. All they care about is getting out of your case after paying as little as possible.
If you’ve lost a limb you should go ahead and call a workers compensation attorney even if you haven’t been denied benefits or appropriate care yet. Our office can help you maximize your settlement, which may give you the resources you need to pursue the quality of life you deserve.
See also:
Does NJ Workers Compensation Cover Ambulance Costs?
How Do Scars and Disfigurement Impact a New Jersey Workers Comp Claim?
