Who chooses a patient’s doctor for a workers’ compensation case?

On Behalf of | Jun 20, 2024 | Workers' Compensation

A medical doctor or physician can play an important role in a workers’ compensation claim. They can help establish whether a condition is truly the result of someone’s employment. They may also recommend certain forms of treatment and on-the-job accommodations to help a worker recover as quickly as possible. A doctor can determine if someone has stopped responding to treatment or has failed to follow medical recommendations. Their input can lead to the end of a worker’s benefits or the conversion of temporary benefits to permanent ones.

Having a physician who listens to an injured worker and cares about their overall long-term recovery is highly beneficial for the affected worker. Does an injured employee get to choose the physician who provides their workers’ compensation care?

Workers do not pick their own doctors

The New Jersey workers’ compensation program has many protections for employees in place. The option of selecting one’s own physician is usually not among those protections. It is standard procedure for either the employer or their insurance provider to select the physician who oversees a worker’s care.

However, there are two exceptions to that general rule. The first is when an employee requires emergency treatment. Someone traveling via ambulance to a hospital probably doesn’t have time to check in with human resources and get the name of a physician from their employer.

The employee typically needs to inform the doctor treating them in the emergency room or at the hospital about the work origins of their medical issue. Workers’ compensation can pay for the emergency care needed to stabilize the patient. However, if the worker needs ongoing treatment, their employer determines who provides that care.

The second exception is for workers involved in a workers’ compensation appeal. If the company initially denies their claim, the worker may see their own doctor for treatment during the appeals process. Upon approval for benefits, that prior care provided by a physician of their choice is eligible for reimbursement from the workers’ compensation program.

Employees who need workers’ compensation coverage and those facing complex claims may benefit from seeking personalized support as they navigate the claims process and learn about their rights. Understanding who “chooses the doctor” is important for those in need of workers’ compensation benefits for medical care in New Jersey.