The initial stages of a workers’ compensation case in New Jersey are comprised of three primary issues. Having the insurance company accept the claim, getting the injured employee the appropriate medical treatment and ensuring that the injured individual has temporary disability benefits while he or she is unable to return to work.
This stage must be initiated by filing a workers’ compensation claim and it typically ends when the injured worker’s physician writes a stationary and permanent report, indicating that the injured employee has achieved maximum medical improvement.
If you are not familiar with the term, you might not understand what this means for your case and your condition. Maximum medical improvement means that you have achieved the best possible healing and recovery for your workplace injury at this time.
This does not necessarily mean that you are fully recovered and eligible to return to work.When you achieve maximum medical improvement, this is when you might consider accepting a settlement for your injury claim. Your workers’ compensation attorney can help you determine your next steps once you reach MMI.
What Happens in A Typical Workers’ Compensation Case?
In some situations, the insurance company will accept click liability for your claim immediately. Other times they would want to conduct an investigation and delay accepting liability until that has been concluded.The investigation, for example, might include a formal interview under oath, known as a deposition or subpoenaing your medical records.
The case is not always put on hold until the insurance company accepts the claim because some doctors will agree to treat patients on a lien basis.Even in situations where the insurance company accepts liability for a claim, there may be disputes over what treatment is necessary and reasonable.
If the insurance company refuses to authorize diagnostic testing or treatments that are requested by the injured employee’s doctor, this dispute could initiate what’s called a utilization review. Disputes may also emerge over temporary disability.
One of the most common disputes having to do with temporary disability is whether or not the injured employee is capable of working at all.When these disputes emerge, the primary treating physician is usually responsible for writing a report. If either party objects to this report, a neutral doctor evaluates the materials and makes a decision.
When the insurance company requests that the injured employee goes to a neutral doctor, this physician is known as the agreed medical examiner.
What Happens Once I Have Achieved Maximum Medical Improvement?
The second stage of your New Jersey workers’ compensation claim has to do with job vouchers, future medical care and permanent disability.
When your primary treating doctor indicates that you have achieved maximum medical improvement, he or she may also recommend any future medical treatment necessary to protect your health and whether or not you are able to return to your old job or need to find a new line of work.
In the event that both parties agree with this physician’s conclusions then the case can be settled. However, if either party objects, then the issues are then resolved by the neutral doctor.
What About Future Medical Care?
The final stage of a workers’ compensation case involves providing the injured employee the medical care he or she needs and reopening the case if an injured employee’s condition gets worse. One of the most common disputes has to do with what future treatment is needed that is both necessary and reasonable.
It is handled much like it is in the initial stage of your workers’ compensation claim, ultimately going through a utilization review if necessary.
Maximum Medical Improvement: Working with a New Jersey Workers’ Compensation Attorney
Maximum medical improvement, as mentioned above does not necessarily mean that you have fully recovered from your injuries. It may be very likely that it’s impossible for you to return to your original job.
This is why you need to take your case seriously and consider working with a New Jersey workers’ compensation attorney if the insurance company is making it difficult for you to receive benefits, but you have clearly suffered serious issues as a result of your workplace injury.
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