Legal Question in Workers Comp in New Jersey

Injury at work

My husband works for a hospital as security. He was injured

at work and having a lot of problems with his back. The

hospital said that he had to see their doctors as they cover

workman comp. Their doctors say there is nothing wrong with

his back and he wants a second opionion but they said that

if he goes to a doctor out of their network for a second

opinion, then he will have to pay the full cost of all the

therapy, tests and doctors costs from the beginning of his

injury.

they also told him that they wouldnt pay anything toward

the cost of his seeing another doctor out of network.

Can they do this?


Asked on 6/07/03, 9:21 am

1 Answer from Attorneys

John Pinho John Pinho

Re: Injury at work

In New Jersey the Workers Compensation Carrier has full control of medical care. If you go to an unauthorized doctor, the insurance carrier will not pay that doctor's bill. HOWEVER, i recommend to all my client's in your husband's situation that they go for a second opinion with a qualified orthapaedic doctor to determine whether the non-workers compensation doctor feels that there is some therapy, surgery or other treatment that could help. If the second-opinion doctor recommends some treatment, a Motion for Medical and Temporary Benefits can be filed and a Workers Compensation Judge can order the treatment and the payment of temporary disability benefits (weekly benefits) until your husband returns to work. If you cannot afford the Doctor's consultation fee and the pain is great, go to your local emergency room and see if they have a orthapaedic clinic and a doctor who will determine what the problem is and you can attempt to get that doctor to give you an opinion that differs from the workers compensation doctor. You will need (at a minimum) a doctor who is willing to complete a fill in the blank certification stating what his diagnosis, prognosis and recommendation for treatment is otherwise you cannot file the Motion for Medical and Temporary Benefits. On occasion it is necessary to bring in the doctor to testify in court. It is not an easy process but not an impossible one. Once you get into the Workers Compensation Court with a motion, most judges look at the case and try to get the Insurance Carrier to provide the appropriate treatment. Good Luck.

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Answered on 6/07/03, 12:08 pm


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