If you’ve been injured at work in New Jersey, you’re probably wondering what happens next. One of your biggest concerns may be how much your employer has to pay for your medical treatment. After all, medical bills can add up fast, especially if you need surgery, prescriptions, or hospital care. Fortunately, under New Jersey workers’ compensation law, your employer or their insurance company is required to cover all necessary and reasonable medical treatment related to your injury.
But understanding the details of what your employer must pay can get confusing. Below, JFM Law will break it down for you, explain your rights, and show you how our workers’ compensation lawyers can help.
Workers’ Compensation Lawyer in New Jersey
If you've been injured on the job in New Jersey, you might be feeling overwhelmed. Medical bills and lost wages can quickly pile up, and it’s common for employers and insurance companies to delay or deny benefits. You shouldn’t have to handle this on your own. We’re here to stand by your side, helping you pursue the benefits you deserve. Your health and financial well-being matter. Call us today at (732) 333-6621 or contact us online for a free consultation. JFM workers’ comp attorneys have offices in Freehold, Toms River, and New Brunswick, serving injured workers throughout New Jersey.
What Medical Treatment Does Your Employer Have to Pay For?
According to NJ Statutes § 34:15-15, your employer or their workers' compensation insurance must pay for all necessary and reasonable medical care related to your injury. This includes:
- Doctor visits
- Hospital stays
- Surgeries
- Physical therapy
- Prescriptions
- Any other treatment your doctor says is necessary to help you recover
The law specifically states that your employer is responsible for covering these costs until you’ve recovered enough to return to work, or until your condition is stable and won’t improve with further treatment (this is called “maximum medical improvement”).
Can You Choose Your Own Doctor?
One of the most important things to know is that, in New Jersey, your employer has the right to choose your treating physician (NJ Statutes § 34:15-15). This means you can’t go to just any doctor and expect your employer to pay the bills. Instead, your employer’s workers’ compensation insurance company will direct you to a specific doctor or medical provider for treatment.
If you want to see a different doctor or get a second opinion, you’ll generally have to pay for it yourself—unless you can show that the treatment your employer is offering is inadequate or inappropriate.
What If It’s an Emergency?
There are exceptions to the rule about your employer picking your doctor. If you need immediate care because of a medical emergency, you can go to the nearest hospital or urgent care center. In this case, New Jersey law allows you to seek emergency treatment without getting approval from your employer first (NJ Statutes § 34:15-15). However, you’ll need to inform your employer as soon as possible after receiving care.
What Happens If Your Employer Refuses Treatment?
There are times when employers or their insurance companies delay or deny necessary medical treatment. If your employer refuses to provide treatment, you can seek medical care on your own, but your employer will only be responsible for paying the bills if certain conditions are met. You or someone on your behalf must have requested the treatment from your employer, and the employer must have refused or neglected to provide it.
If your employer still refuses to authorize treatment, you can file a claim with the New Jersey Division of Workers' Compensation. In fact, you can file a motion for emergent medical treatment if you can show, through medical documentation, that you need urgent care (NJ Statutes § 34:15-15.3). If a doctor believes that delaying treatment will cause you irreparable harm, the court can order your employer to pay for the necessary care.
How Much Does Your Employer Have to Pay?
Your employer’s insurance must cover all the medical costs related to your work injury as long as the treatment is necessary and reasonable. The fees charged by doctors, hospitals, and other providers must be typical for your area and approved by the Division of Workers’ Compensation if there’s a dispute (NJ Statutes § 34:15-15).
For example, if your doctor charges more than what is normally charged for similar services in your community, your employer or their insurance company might refuse to pay the full amount. In such cases, the Division of Workers’ Compensation will decide if the charges are reasonable.
Are There Any Limits to What Your Employer Has to Pay?
There are limits on what your employer must pay, but these only apply to initial services if no formal claim has been made. For instance, New Jersey law once capped payments for medical treatment for both physician services and hospital services unless a petition was filed with the Division of Workers' Compensation (NJ Statutes § 34:15-15). However, this is no longer the case once you file a workers' compensation claim, and your employer is responsible for the full cost of necessary treatment.
In addition, employers are not allowed to pass any of the costs of your medical treatment onto you. They cannot deduct money from your wages to cover the cost of a medical examination or treatment that they require (NJ Statutes § 34:11-24.1).
What About Prescription Medications?
Your employer must cover prescription medications related to your injury as well. As with other types of medical treatment, you will need to use a pharmacy that’s approved by your employer’s insurance company. If you fill your prescription at a pharmacy that isn’t approved, your employer might not pay for it.
What If You Need Long-Term Care?
Sometimes, a work-related injury causes lasting damage that requires long-term care. In such cases, your employer must continue to pay for necessary treatments. If you need an artificial limb, prosthetic devices, or other medical appliances, your employer must provide these as well. This includes items like artificial teeth, a glass eye, or hearing aids if they’re needed to relieve the effects of your injury.
What Happens If You Disagree With Your Treatment?
If you believe the treatment your employer is offering isn’t sufficient, you have the right to challenge it. You can file a claim with the Division of Workers' Compensation and ask a judge to order better treatment. Your employer will have a chance to argue their case as well.
Additionally, if you refuse the treatment offered by your employer’s doctor, your employer can ask the Division to modify your compensation if they believe your refusal is unreasonable (NJ Statutes § 34:15-23). In other words, if you refuse necessary treatment, you could lose some or all of your workers' compensation benefits.
What Happens to Medical Bills if There’s a Dispute?
Sometimes, disputes arise between workers and their employers or between employers and healthcare providers about medical bills. If you find yourself in this situation, it’s important to know that providers cannot send unpaid bills to collections or report them to a credit agency until the workers' compensation judge has fully resolved the dispute. If a medical provider violates this rule, the judge can order them to retract the charges, impose fines, and award damages to you.
How a Workers’ Compensation Lawyer Can Help
Workers’ compensation laws can be tricky to understand, and getting the right medical care isn’t always as simple as it should be. A workers' compensation lawyer can help you in several ways:
- Help You Get the Right Treatment: If your employer is delaying or refusing to approve necessary treatment, a lawyer can file a claim on your behalf and work to get you the care you need as quickly as possible.
- Ensure All Medical Costs Are Covered: A lawyer can help ensure that your employer’s insurance company is paying for all the medical treatments they’re legally required to cover. This includes everything from doctor visits and surgeries to prescriptions and physical therapy.
- Challenge Denied Claims: If your claim for medical treatment is denied, a lawyer can represent you in front of the Division of Workers' Compensation and argue your case.
- File for Emergency Treatment: If you need immediate care and your employer is dragging their feet, your lawyer can file an emergent medical treatment motion to make sure you get the care you need without delay.
- Help With Long-Term Care: If your injury requires long-term care, a lawyer can make sure that your employer is paying for any necessary prosthetics, medical devices, or continued treatment.
- Handle Disputes: If there’s a dispute over medical bills or treatment, your lawyer will be able to resolve it in your favor, ensuring that no medical bills wrongfully affect your credit.
Frequently Asked Questions
What medical treatment must my employer cover?
Your employer must cover all necessary and reasonable medical treatments related to your work injury, including doctor visits, surgeries, and prescriptions.
Can I choose my own doctor for workers’ compensation?
No, in New Jersey, your employer or their insurance company chooses your treating doctor.
What if I need emergency medical care?
In emergencies, you can seek immediate treatment at the nearest hospital without prior approval from your employer.
What happens if my employer refuses to authorize treatment?
You can file a claim with the New Jersey Division of Workers’ Compensation and request a judge to order the necessary treatment.
How long does my employer have to pay for treatment?
Your employer must pay for treatment until you reach maximum medical improvement or can return to work.
What about prescription medications?
Your employer must cover prescriptions, but you need to use an approved pharmacy by their insurance company.
What if I need long-term care?
Your employer must cover necessary long-term care, including prosthetic devices or other medical appliances.
What can I do if I disagree with my treatment?
You can file a claim with the Division of Workers’ Compensation to request a judge to order better treatment.
Can medical providers send unpaid bills to collections?
No, medical providers cannot send bills to collections until disputes are resolved by a workers' compensation judge.
What if my treatment is delayed?
If delayed, you can file a motion for emergent medical treatment to get immediate care authorized by the court.
Hiring a Workers’ Comp Attorney in New Jersey
After a work-related injury, you shouldn’t have to worry about how you’re going to pay for your medical treatment. In New Jersey, your employer or their insurance company is required to cover all necessary and reasonable medical expenses related to your injury under workers' compensation law. Whether it’s doctor visits, hospital stays, surgeries, or prescriptions, the costs should be covered.
If you run into any problems with getting the treatment you need or if your employer is refusing to pay, a workers’ compensation lawyer at JFM Law can step in to make sure your rights are protected. They can help you get the care you need, challenge denied claims, and ensure that your employer is following the law. We’re ready to help you with that. Call (732) 333-6621 or reach out online for a free consultation. Let’s talk about your rights and how we can help protect them.