Workers’ compensation lawyer Scott Schulman explains who pays for your medical bills if you have suffered a work injury.
Petrillo: If I get hurt on the job at work, who pays for my doctor bills?
Schulman: One of the three benefits besides the lost wages is the medical expense, and your employer and/or worker’s comp is responsible for any medical expenses, medical treatment. So generally if someone is significantly hurt at the job site or off job site, they may go to the emergency room, and that poses the problems more often than not, because the emergency room is there to treat you and fix your injury. And the injured worker and the emergency room workers don’t know who the worker’s compensation insurance company is.
Schulman: So they will just generally bill you or your employer, and then we will process and turn those bills over to the insurance company. But thereafter the insurance company will designate a doctor or medical provider for you, sometimes or many times you’ll start out at an occupational health clinic.
Petrillo: Well, let’s talk about that. What if I don’t want to go to the company doctor? Do I have to see them?
Schulman: Well, this is America. You don’t have to do anything, as I tell my clients. You have a right to do whatever you want. However, the caveat is, in New Jersey the bargain that workers’ compensation law is, is your employer will provide medical treatment and medical benefits for you, and you are supposed to cooperate with what they provide to you, at least initially. And so they may send you to an occupational health clinic. And if you don’t want to go there, then the employer is not responsible to provide any further treatment to you. So I encourage my clients to go and follow along with the medical treatment that the insurance company is providing.
Petrillo: Well, how about if I want to see a specialist?
Schulman: It’s a very good question, which I hear a lot. And what I tell the injured worker, what I tell my client is, look, let’s just go and follow their protocol. Because the insurance companies have a protocol, and the first day you’re injured or first week you’re injured, their motivation is to control expenses and save money. And so they’re not going to immediately send you to an orthopedic doctor. Sometimes they should, and they can actually save themself money by sending you immediately to an orthopedic doctor, but they generally will make you ride out and go to the occupational health clinic for at least a couple visits. And after those couple of visits that doctor weeds out the significant injuries versus the not significant injuries or the injuries that resolve within a few weeks. The ones that don’t resolve and that are significant, that doctor will make the appropriate referral at the appropriate time generally for a person to see a specialist such as an orthopedic doctor.
Petrillo: Okay. Now how about if they send me to a specialist, but he’s really more loyal to the worker’s comp and to the employer than he is to me? How do I know if the specialist or the doctor is for the company, for the worker’s comp carrier, or if he’s for the patient, the injured worker? How do I know?
Schulman: And that’s another good question and I see that all the time. A lot of times, many times these doctors are the same specialists that the insurance companies use, whether they’re orthopedic doctors, neurologists, or spine surgeons. And the doctors may be motivated by their allegiance and loyalty to the insurance company to get other patients to treat as opposed to the individual that’s in front of them. But more often than not, the doctors can generally recognize, and even though they may be motivated by money and loyalty to the insurance company, I find that most of the times when someone does have a significant injury, they will do whatever is appropriate. They may wait a little longer, they may wait a few more weeks to get an MRI referral or another type of test, but they will eventually get that done based on the patient’s complaints and findings. Sometimes-
Petrillo: How about, I’ve heard these stories about nurse case managers that are hired by the workers’ comp carrier. Is that for the benefit of the patient?
Schulman: I can conclusively say absolutely not.
Petrillo: Well, why not?
Schulman: Well, because the nurse case manager-
Petrillo: Would they pay for a nurse to go to the doctor’s appointments with the patient to go talk to the doctor on the patient’s behalf? Aren’t they to benefit the patient?
Schulman: Well, the nurse, first of all, this nurse doesn’t treat the patient. The nurse is hired by the insurance company …
Schulman: … To control costs, to control medical treatment, and many times, or in fact I could probably say close to 100% of the time, the nurse case manager is not on the same side as the injured worker.
Petrillo: Is she allowed to follow me around and go to the appointments with the patient?
Schulman: Well, many times the nurse case manager will be the one scheduling the appointments, notifying the injured worker to attend such and such evaluation with the doctor. And the nurse case manager will be there in the waiting room and then go into the office or attempt to go into the office for the evaluation with the specialist.
Petrillo: Well, isn’t that a violation of the patient’s rights?
Schulman: You would think. The insurance company will have you believe that since they pay for your medical treatment, that they essentially can do whatever they want. But the patient does have some rights to assert. The injured worker can say, “No, I don’t want the nurse case manager to come in the evaluation room with me and the doctor.” And oftentimes I will tell my client that they can assert that right and the nurse case manager will have to stay out of the evaluation room so it’s just the patient and the doctor. However, that doesn’t prevent the nurse case manager from sticking her nose into the business where she doesn’t belong. Because once the patient leaves the office, the nurse case manager will then go in and talk to the doctor.
And I have it both ways. The nurse case manager sometimes will be in the appointment room and will kind of nudge the doctor along to say, “Well, this person can really go back to work. You’re keeping them out of work. There’s no reason they can’t go back and do their job.” And the doctor will get the hint from the nurse case manager and say, “Yeah.” Suddenly the person can go back to work.
Petrillo: All right.
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