In New Jersey, the employer's workers' compensation carrier generally chooses the doctors who treat your work injury, and it pays for that authorized treatment in full, with no copays or deductibles. If the carrier refuses or delays care you need, you don't have to accept that: a Motion for Medical and/or Temporary Disability Benefits asks a Judge of Compensation to order the treatment, and the Division hears these motions on an expedited basis.
Who chooses your doctor in a New Jersey comp case?
Under N.J.S.A. 34:15-15, the employer, through its carrier, has the right to select the authorized treating physicians. In practice, the carrier sends you to an occupational medicine clinic or an orthopedist or other physician in its network, and that doctor decides what testing, therapy, injections, or surgery to recommend. The carrier then authorizes, or doesn't authorize, each step.
Carriers often assign a nurse case manager to coordinate appointments. That person works for the carrier. Be polite and cooperative, and keep in mind that what you say can end up in the file.
Two things you can control:
- Give every doctor a full, consistent history. How the injury happened at work, every body part affected, and any prior problems with the same area. Omissions are what carriers later use to question causation.
- Report all symptoms, every visit. If your neck has hurt since the fall but you only ever mention your shoulder, the neck may never be treated or rated.
What if you see your own doctor?
You can always see a doctor of your choice, but the carrier generally does not have to pay for treatment it didn't authorize. Emergency care is the main exception. If you went to the emergency room right after the injury, that care should be covered.
The other exception matters when a carrier stalls. If the employer had notice of the injury and refused or neglected to provide necessary treatment, and a judge later finds the care you obtained was reasonable and necessary, the carrier can be ordered to pay for it. That is not a risk to take casually, so get advice before treating on your own while a claim is open.
Your own health insurance may cover care while a claim is disputed, though it may seek repayment if comp is later found responsible. If the carrier has denied the claim altogether, see what to do after a denial.
Can you get a second opinion?
New Jersey doesn't give injured workers an automatic right to a second opinion at the carrier's expense, but there are several routes:
- Ask the carrier. A request for a second opinion or a different authorized doctor, especially before surgery, is sometimes granted.
- Pay for a consultation yourself. You can see any doctor privately. If that doctor's opinion supports treatment the authorized doctor declined, it can become evidence in a motion.
- File a motion. When there is a real dispute about what care you need, the judge can decide it.
The examination your lawyer arranges for permanency purposes is different. That doctor rates lasting impairment after treatment ends; it isn't a treating relationship. Our page on permanent disability explains that stage.
How does a motion for medical benefits work?
The motion is filed with the Division, usually supported by a medical report showing the treatment you need and why it relates to the work injury. The same motion can ask for temporary disability benefits if those have been cut off or never started.
The carrier responds, often by sending you to its own examining doctor. The Division lists these motions on an expedited basis. Many are resolved at that stage, with the carrier agreeing to authorize the care. If not, the judge hears the medical evidence and decides whether to order the carrier to provide it.
A motion is a tool for now, not the end of the case. Permanency, and the case as a whole, is handled later; see the step-by-step guide.
Talking to a lawyer about your situation
When treatment stalls, timing matters. Delayed care can make an injury worse, and a long gap can complicate the rest of the case. A lawyer can tell you whether your situation calls for a request, a second opinion, or a motion.
Gray Law Group is in Jefferson, Morris County, and represents injured workers in Morris, Sussex, Warren and Passaic counties and throughout northern New Jersey. Bring your treatment records and any letters from the carrier to a consultation.
Frequently asked questions
Can I switch authorized doctors if I don't trust mine?
You can ask the carrier to authorize a different doctor, and some carriers agree, but there is no automatic right to switch. If the disagreement is about whether you need treatment the authorized doctor won't provide, a motion for medical benefits lets a judge decide.
Do I have to attend the insurance company's medical exam?
Generally, yes. The carrier is entitled to have you examined by a doctor it chooses, and refusing to attend can put your benefits at risk. Go, be accurate and consistent, and tell your lawyer afterward how the exam went.
Who pays if the carrier refuses treatment and I get it anyway?
It depends. Unauthorized treatment may not be reimbursed. But where the carrier had notice and refused or neglected to provide care that a judge later finds was reasonable and necessary, the carrier can be ordered to pay for it.
Does workers' comp pay for physical therapy and prescriptions?
Yes, when they are authorized and related to the work injury. Authorized care can include office visits, diagnostic testing, surgery, physical therapy, injections, and prescription medication, with no copay or deductible.
This website is for informational purposes only and does not constitute legal advice. Prior results do not guarantee a similar outcome.