Jacobs, Schwalbe & Petruzzelli, P.C.
Assisting New Jersey Clients Since 1977
856-375-1028 Toll Free : 1-800-273-2471

Workers' Compensation Medical Benefits

NJSA 34:15-15 controls the provision of medical benefits available to an injured worker under the New Jersey Workers' Compensation Act. This section of the statute provides that an injured employee is entitled to such medical treatment as is necessary to "cure and relieve" the injured worker from the compensable injuries. There is no definite time limit set for the medical treatment. The treatment is required to restore the function of the injured worker as completely as possible. When the authorized treating physicians determine that the injured worker has reached "maximum medical improvement" treatment generally ends. 

Many employees are advised that, in the event of an injury, there are certain protocols that have to be followed with respect to reporting the accident and pursuing medical care. These provisions are often provided to the worker in the employee handbook or orally conveyed to the worker upon hiring or upon the occurrence of the accident. Workers are told, correctly, that the employer or their workers' compensation insurance carrier has the right to direct the medical care. This is referred to a "authorized medical care". Unfortunately, sometimes, employers and/or representatives of the insurance carrier who are handling the injured worker's claim are not sufficiently diligent in their responsibilities to provide this curative and remedial medical care. Under these circumstances, if the or carrier fail in their responsibilities to expeditiously provide treatment, I often advise my clients that we will utilize the portion of Section 15 that allows the injured worker to seek "reasonable and necessary" medical treatment on their own initiative. The treatment must be due to conditions causally related to the accident, the bills for this treatment can then be asserted against the employer and/or their workers' compensation carrier and, if not voluntarily paid, can be an issue that may be brought before the Judge of Compensation for resolution.

In my experience the judges will often order the employer/workers' compensation insurance carrier to pay these medical bills if it does appear that there was a failure on the part of the responsible parties to provide the necessary medical treatment provided under this statute. Judges will look at the nature of the injury, the type of medical treatment that is being sought or recommended, and make a determination as to whether the injured employee waited a sufficient amount of time before seeking medical treatment on their own. If there is not an emergency need for treatment you should always consult with a Workers' Compensation attorney first so that you are not going to be responsible for the bills.

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Jacobs, Schwalbe & Petruzzelli, P.C.
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