If you suffer a work-related injury or illness in New Jersey, you are eligible for workers’ compensation benefits without having to prove fault. In fact, it doesn’t matter who caused the incident; whether it was your employer, a co-worker, an accident, or even yourself, you can still receive benefits. Despite this no-fault law, you may feel pitted against your employer at some point in the workers’ compensation process. Because of high cost of insurance or pressure from insurance companies, employers may not be the most supportive of your workers’ compensation claim. Fortunately, New Jersey state law does offer some protections to injured workers. The following will answer three frequently asked questions about employer actions during the workers’ compensation process.
My employer is telling me I need to go to the doctor chosen by their insurance company to treat my work-related injury, but I feel more comfortable seeing my own doctor. Do I have a choice?
Your employer is right. Under New Jersey state law, they have the authority to select the healthcare provider who treats injured employees pursuing workers’ compensation claims. Your employer should give you a few choices of doctors or practices, but this is not required by law. It is important that you see the doctor your employer refers you to after the initial injury and for any continuing care. Failure to do so can cause your claim to be denied.
The main reason the insurance company chooses your healthcare provider is for a fairness. The doctor that initially assesses your injury will be a key witness in your workers’ compensation case. The testimony provided by your doctor will directly determine the amount of continuing care, recovery time, and medical benefits you receive. If you have a previous relationship with the doctor that testifies, they may feel pressured to skew the medical report in your favor. A third party doctor who has no personal ties with the patient or insurance company will be most likely to give a fair and honest report.
Another reason the insurance company chooses the health care provider is because of the cost of services. The insurance company will choose a doctor based on how much they are willing to pay for services as you receive continuing care.
If you don’t like the doctor your employer chooses, there isn’t much you can do because your employer retains the right to choose the healthcare provider under New Jersey workers’ compensation law. However, if you feel that your employer refused or neglected to refer you to medical services that were reasonable and necessary to treat your injury and restore function where possible, you can take action. In other words, you didn’t just dislike the doctor, but you felt that the services were inadequate or they were not equipped to handle your situation. For example, you were referred to a general practice doctor, but you feel you need a specialist to fully assess and care for your injury. If this is the case, you should contact a skilled lawyer and file a formal claim with the state of New Jersey.
While I was recovering from my work-related injury, my employer terminated me. Is that legal?
It depends on the reason for your termination. New Jersey state law does not strictly prohibit the termination or laying off of an employee who is on leave while recovering from a work-related injury. However, it does prohibit the termination of an employee in retaliation for filing a workers’ compensation claim or for testifying at a co-workers’ hearing.
If you feel that you were fired because of one of these reasons, you should file a discrimination complaint against your employer with the Division of Workers’ Compensation.
If you were fired after returning to work because of a disability, you may be able to take further action. The Americans with Disabilities Act (ADA) requires that employers provide reasonable accommodation for a disability. If you feel that you were able to perform essential job duties with or without reasonable accommodation, but were fire because of your disability, you can claim a violation of the ADA.
If you were released by your doctor for light duty work only, make sure to check with your employer before returning to work. If you employer can not currently provide light duty work, you can. You can continue to receive medical care and and temporary disability benefits until your healthcare provider claims your injury has reached maximum medical improvement.
I’m recovering from a work-related injury and my employer has canceled my health insurance. Is this allowed?
Unfortunately, there is no New Jersey Workers’ Compensation law that prevents an employer from canceling an injured workers’ health insurance while they are recovering. However, some protection is provided by the Federal Family Medical Leave Act. This act allows for employees to take a leave of twelve work weeks per year for certain reasons, including a serious health condition. Your employer must continue your health care coverage during that time under law.
This is only general legal information and you should always contact a lawyer to discuss your specific situation. If you feel that you have been unfairly targeted by your employer during the workers’ compensation process, a skilled lawyer will be especially valuable in helping you choose your next course of action.