When you suffer an injury at work, the first thing you may hear is that it doesn’t matter how it happened – workers’ comp will pay for everything. And, there is certainly some truth to that statement. But, not complete truth. In fact, New Jersey has what is known as a “no fault” workers’ compensation system. Essentially, employers pay their workers’ comp insurance premiums; when an employee suffers an injury on the job, the insurance company pays for the medical expenses, lost wages, etc. In exchange for workers receiving these benefits, they are precluded (almost always) from bringing a personal injury lawsuit against their employers. The state legislature (as is the case in all states) has determined that this balance of “powers” is fair to everyone. When workers are injured on the job, they do not have to prove negligence. On the flip side, injured workers cannot bring lawsuits based on negligence against their employers. No one is extraordinarily happy, but everyone benefits to some degree.
Back to the notion that workers’ comp will pay for “everything:” The truth is that workers’ comp will generally pay for all reasonably necessary, causally-related medical expenses incurred as a result of an injury suffered by an employee on the job. However, even if there is no question that an injury was in fact suffered at work, there may be a significant question as to how far that injury goes – and to what extent an insurance company must pay for that injury. For an injured worker, connecting the medical treatment to the injury is critical in order to receive payment for resulting medical expenses, lost wages, and possible disability ratings. If there is no causal relation between the injury and the medical treatment, the insurance company will stop paying benefits.
So, how does an injured worker sufficiently demonstrate that the medical treatment he or she receives is directly related to the injury he or she suffered at work? The short answer is this: medical evidence.
Every doctor’s appointment and rehabilitation therapy leaves a paper trail. An injured employee can be sure that the workers’ comp insurance company knows exactly what medical treatment is rendered and the stated reasons for that medical treatment. Once an insurance company gets a whiff that continuing medical treatment may no longer be related to the work injury, the denials for benefits will start to roll in.
Whether you suffer a traumatic injury or a WEAR and TEAR repetitive stress injury, the workers’ comp insurance company and your employer are concerned with a few different things:
- A medical diagnosis, usually supported by objective diagnostic studies (i.e.: X-ray, MRI, CT Scan, etc.);
- How quickly you can get back to work;
- The nature of your symptoms (and what the treatment of those symptoms will cost); and
- How long will it take for your symptoms to subside (and thus end the financial responsibility of the workers’ comp insurance company).
The answers to all of these concerns can be found in the medical evidence. Each of your healthcare providers report their observations and medical opinions regarding your injury and your prognosis moving forward.
It is also important to note that, in addition to receiving medical treatment from your own providers, the insurance company can and likely will request that you undergo an Independent Medical Examination (IME) by a physician of their choosing. Any report generated from this independent physician is grouped in with the medical evidence as a whole.
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The workers’ compensation team at Petro Cohen has more than 100 years of combined experience, and we have established ourselves as one of the leading law firms in New Jersey by successfully handling tens of thousands of Workers’ Compensation cases both in the Atlantic City area and throughout the state.
If you or someone you love would like to receive more information on workers’ compensation settlements, wage loss, workplace injuries, wage claims, and how to receive workers’ compensation benefits, contact our professional attorneys as soon as possible at (609) 677-1700 to schedule your free consultation. We can answer your questions and determine the most efficient way to proceed in order to help you and your family obtain the compensation that you deserve.