Workers’ Compensation Law
The New Jersey workers’ compensation statute facilitates the provision of medical benefits and lost work time compensation to employees for work-related injuries and illnesses.
The HCS staff includes claim professionals who administer and coordinate the management and processing of workers’ compensation claims. Physicians and other health care professionals are an integral part of the process.
When an employee experiences a work-related injury or illness, the employer must furnish reasonable medical, surgical, hospital services and other treatment at no cost to the employee. Medical care must be provided to the injured worker to the level of maximum medical improvement. A physician or health care professional may not collect a fee for service provided or balance bill the patient.
The employer or its representative (workers’ compensation insurer or approved New Jersey workers’ compensation managed care organization) has the right to choose the medical professionals and facilities for provision of treatment. Only in emergencies may the employee select the physician or health care professional.
Temporary Disability Benefits
When time off work exceeds seven days, whether consecutive or not, benefits are paid equal to 70 percent of gross weekly wages up to a state-specified maximum weekly amount for up to a state-specified maximum number of weeks.
Permanent Partial Disability Benefits
When an injury or illness results in permanent disability, benefits are paid based upon a percentage of “scheduled” losses involving specific body parts such as arms, hands, fingers, toes, eyes, ears, teeth, back, heart or lungs.
Permanent Total Disability Benefits
In cases of total disability, wage loss benefits are payable as long as the total disability persists.
The spouse and other dependents may be eligible for wage loss and funeral benefits in the case of death of a covered employee.
Network physicians should not perform disability evaluations for permanency unless specifically requested to do so by the employer, its agent (HCS) or the workers’ compensation insurance company.
Independent Medical Examinations (IMEs)
In select cases, network physicians will be asked to evaluate injured workers who receive care from other physicians. The assigned case manager will provide the physician with a case overview and medical information to facilitate the process. It is important that findings are accurately documented and final opinions are conclusive and definitive.
Causal Relationship Questions
The causal relationship of the injury or illness to the employee’s job must be addressed at the initial evaluation and when treatment is being recommended for a new diagnosis or new body part.
It is rare for a physician or other health care professional to be required to appear in court to testify about a workers’ compensation case. Normally, the medical record, or in some instances, deposition testimony is acceptable. Therefore, it is important that your medical records are legible, complete, current, factual and accurate. In short, medical records should speak for themselves. A judge may use your medical records to make a decision. In the rare case when in-person testimony is necessary, we appreciate your cooperation.