How Medical Bills Get Paid
New Jersey workers' compensation attorney, Manfred Ricciardelli, Jr., discusses how worker's comp insurance can help you pay for your medical bills after your at-work injury. Transcript listed below:
One of the biggest reasons people call my office are for questions regarding medical care. They are injured at work, they need care, they are not sure how the process operates and they are not sure how they are going to get that care. In New Jersey, when you are injured at work, the workers' compensation insurance carrier is responsible for providing you with any medical care that could cure or relieve your underlying condition. If there is care out there that can make you better, they have to provide it to you. When they provide it to you, they pay all of the medical bills associated with that care. It's not like private plan insurance where certain things are not covered or there are co pays. Any medical care designed to improve your condition is the responsibility of the insurance carrier. So if you need surgery, they have to pay for your surgery. If you need post surgery therapy, crutches, prescription medication, etc, all of that is supposed to be paid for by the carrier. Now, in New Jersey, since the carrier has the responsibility of providing all of your medical care, they do get the right to direct that care. That means they get to pick your doctors. So for example, if you are injured at work and need to go to the emergency room, that emergency room doctor may recommend you see an orthopedist. Someone from the carrier should contact you, take a statement to understand what the problem is, and then refer you to a doctor of their choice. If you want the carrier to pay for your care, you have to go to that doctor. If that doctor believes you need surgery, the carrier will provide that surgery to you. If you need post surgical care, the carrier will provide that care to you. Now, the carrier gets to make the first decision as to who you go to and what care you receive, but they don't get to make the final decision. If there is an issue and you disagree with the doctors they are sending you to, or if you disagree with the care they are providing you, or if they refuse to give you care and you think you need more care, the final decision maker in those circumstances is always the judge. So what my office does, if an issue with medical care arises, is we get whatever medical records already exist and we send you to an examination with my own doctor, not for treatment, but for an examination. We tell the doctor what happend in the accident. We provide the medical records and we summarize them. We send you to an appointment and you give the doctor your subjective complaints. The doctor is then going to perform an examination. He is going to give a report. The report is going to give a diagnosis and it's going to say whats wrong with you. It's going to say whether or not you need treatment and if so, it's gong to outline a treatment plan. The doctor will also say whether you are able to work or not. When I get that report and if our doctor believes you need more treatment and the carrier still wont provide it, then I file a motion with the court, I attach a copy of that report to the motion, and we go before the judge and try to have him sign a court order to provide you with the medical care our doctor says is necessary. Sometimes we win those motions and sometimes we lose. The carrier does have a right to defend that motion. The one thing to take from all this is that the judge gets to decide, and if the judge agrees with us, you are either going to get more care or different care and you are going to get to move on and get what you need.
For more information, visit our New Jersey workers'c compensation practice area page. To schedule a free consultation to discuss your case, call our office at 973-285-1100.
Download my book What the Injured Worker Needs to Know: Your Workers Comp Guide for even more insight into this legal area.