Does NJ Have Treatment Guidelines for Workers’ Compensation Injuries?

While some states have specific treatment guidelines that healthcare providers must follow with regard to workers’ comp patients, New Jersey has no such publications. For example, New York requires all medical care providers to treat every existing and new workers’ comp injury in accordance with New York’s Medical Treatment Guidelines (MTG). New Jersey, however, does not follow any type of similar structure.

The absence of such rigid guidelines means that New Jersey’s physicians have some latitude and leeway in how they medically treat their workers’ comp patients. It also means, however, that there is a huge variance of what may be considered “reasonable and necessary” treatment for a given classification of injury. For example, an employee who suffers a work-related broken leg may receive substantially different medical treatment from another employee with a similar injury.

Additionally, New Jersey is unlike many other states in that it does not require physicians to calculate permanent impairments according to a specific guide or measuring system. The good news for injured New Jersey workers is that permanency payments are based on a loss of function rather than just lost wages.

• For example, an injured employee tears his rotator cuff while on the job. He soon returns to work with no limited job duties. However, he can no longer play baseball or perform other certain activities. As a result, his permanency payment is based on his loss of function rather than just his lost wages.

What is the Duty of the Employer for Injured Employees?

Even though there are no specific medical treatment guidelines that workers’ comp physicians must follow, the underlying guiding principle is as follows:

• An employer/workers’ comp insurance company is only responsible for paying medical costs and expenses that are reasonable and necessary and that are comparable to the usual fees and expenses of similar services within the same community.

In New Jersey, the employer/workers’ comp insurance company has the right to choose the physicians who provide treatment to an injured employee. Additionally, the insurance company has the right to decide not to pay for certain types of medical treatment it did not authorize.

Regardless of these rights, it is important to note that an employer has an absolute duty to provide medical treatment to an injured employee.

Exceptions to This Rule

Effective May 16, 2017, New Jersey’s new Opioid Prescription Law went into effect that establishes strict guidelines that physicians must follow when prescribing opioid medications to patients. These guidelines especially apply to physicians treating workers’ comp patients, as pain management often accompanies work-related injuries.

Contact Us Today

At Petro Cohen, P.C., we have helped many employees obtain the medical treatment they need and deserve. We are well-versed in the nuances of New Jersey’s workers’ comp system, and we know when insurance companies try to take advantage of injured workers. Call or contact us for a free consultation. Talk to an experienced lawyer who can help you sort out your rights. We can be reached by phone at 888-675-7607, or you can complete our online form. We look forward to discussing your situation with you.