Workers’ Compensation: The Perils of Treating on Your Own

One of the biggest sources of frustration among our clients, and injured workers’ in general, is that New Jersey Law allows the employer and the insurance company to direct medical treatment by selecting the doctor. An injured worker in New Jersey is not permitted to choose his own doctor by law.

The biggest problem with the insurance company directing medical treatment is that the claims adjusters who make these decisions often behave badly. hey think nothing of sending an injured worker 50 miles or more from their home to a doctor without any regard for the workers’ ability to get to the appointment. They also engage in a practice known as doctor shopping: ordering second or third opinions until they can find a doctor to say “no treatment is needed”.

This results in injured workers going through their personal medical physician and billing the treatment to their personal health insurance carrier. This is a bad idea. Unfortunately, over the years, the personal health insurance companies have gotten wise to this practice and the language of all of these policies specifically exclude paying for work related injuries. As a result, the personal health insurance carriers have become far more aggressive in recovering the monies they have been paying from the injured worker. In other words, if an injured worker tries to charge treatment for work related injuries to their private health insurance, they may very well be required by law to repay their private health insurance company for any monies paid to the doctors. This could add up to tens or even hundreds of thousands of dollars. Another reason this is a bad idea, is that should a worker who is treating on his own be told by their doctor not to work. In this case, there is no compensation available for lost time.

The Workers’ Compensation Courts do allow some remedies here. If medical treatment is not being given, a request can be filed with a Workers’ Compensation Court for medical treatment. It does have to be supported by a doctor describing the treatment that is needed. However, in an instance where an insurance authorized treating physician makes a treatment recommendation that the insurance company refuses to follow, the Court may grant an order compelling the insurance company to provide this treatment even without conducting a hearing.