The Workers’ Comp Doctor Is Ending My Treatment & I’m Still in Pain!

If you’ve been injured in the course of employment, the workers’ compensation system is designed to cover the medical costs and some lost wages that result. Unfortunately, however, many workers are denied the benefits they deserve. In this article, we’ll explore steps you can take if you believe your treatment has been stopped too soon or if you continue to experience pain or other long-term effects after your medical treatment is complete.

The Company's Workers Compensation Doctor sent me back to work too soon.

When the Company's workers’ compensation doctor releases you to work, they may either release you to perform your full duties or stipulate a period of light-duty work, during which you’re relieved of responsibility for performing tasks that the doctor believes could exacerbate your condition.  Often you will be told that you are MMI, or have reached Maximum Medical Improvements, which means that there is no more treatment that you will be given.  It’s important to make the physician aware of all the duties you normally perform at work and how they impact your condition and to perform only the duties for which the doctor has cleared you.

If you return to work and find that specific tasks cause pain or otherwise aggravate your condition, make another appointment with the insurance company for the workers’ compensation doctor to discuss your experience.  The doctor may add light-duty restrictions to your return-to-work plan, allowing you to avoid these tasks until your recovery allows you to perform them safely.  Remember, workers’ compensation doctors are retained by insurance companies and are not considered your’ treating physician.  Be sure to document your experience of the appointment, including how long the doctor spent with you, details of the physical examination, the questions they ask you, and your responses.

Don't be shocked if your request for additional treatment is denied, even if the doctor says you could us more treatment.  In the absence of updated restrictions from the workers’ compensation doctor, your employer may expect you to continue performing all tasks for which you’ve been cleared. Be sure to let your employer know how the work is affecting you, however, as they may decide to scale back your duties to prevent the risk of further injury or prolonged disability, which can result in additional workers’ compensation costs as well as diminished productivity.

The workers’ comp doctor says I’ve reached maximum medical improvement.

If you’ve been notified by your worker’s compensation doctor or insurance company that you’ve reached maximum medical improvement (MMI), workers’ compensation will not cover further treatment. MMI doesn’t mean that you’ve attained the physical condition you were in prior to the accident. Rather, it’s a determination that continued medical treatment will not improve your condition. Once you’ve reached MMI, you can begin to seek permanent disability benefits.

Permanent Disability

If you still aren’t back to normal after any temporary disability benefits are terminated because you’ve reached MMI, you may be entitled to either partial or total permanent disability benefits. Some types of injuries have predetermined benefit amounts; these can be found on the state labor department’s schedule of disabilities. This schedule sets benefit durations and weekly compensation rates based on the treating physician’s assessment of the percentage of function lost in specified body parts, including ears, eyes, arms, legs, hands, feet, fingers, and toes. Other types of disabilities are non-scheduled, and compensation for these is determined on a case-by-case basis.

Unlike many states, New Jersey bases permanent disability compensation on the loss of functionality in all aspects of a worker’s life, not just their ability to do their job. So, even if your job doesn’t require you to do any lifting or bending, for example, an on-the-job back injury that prevents you from lifting your child or working in your garden will still entitle you to benefits.

What if I disagree with the doctor’s determination?

If you disagree with the workers’ compensation doctor’s assessment of your condition, your attorney can file a formal claim petition and then an application for an informal hearing with the Division of Workers' Compensation.  Whether you believe you’re not yet ready to return to work, that you need light-duty restrictions, or that you could benefit from further medical treatment, this allows you the opportunity to have your concerns heard. Before filing such an application, however, you will want to have a 2^nd opinion from a treating doctor, not a workers compensation doctor, of your choice for a second opinion, which can be used as evidence to support your position. once you file your Motion for Medical and Temporary Benefits, with supporting medical documentation, the judge may decide to order your employer’s insurer to cover the costs of visits to outside doctors, but this is not guaranteed. While it’s possible for workers to complete the hearing or claim process on their own, it’s highly advisable to consult with an experienced workers’ compensation attorney to ensure your interests are adequately represented and obtain the best possible outcome.

Informal Hearings

Informal hearings are typically scheduled within a few weeks after the application is filed. Claims addressed through this process are frequently decided after one or two hearings. The judge’s findings are non-binding, and you can move ahead with a formal claim petition if you disagree. Be aware, however, that even if you go through the informal hearing process, you will have a maximum of two years after becoming aware of your injury to file a formal claim petition.

Formal Claims

A claim petition is the starting point for your work-related injury to proceed through the Court.  After filing your Claim Petition, the company, known as the Respondent, will file an Answer to the Claim Petition.  After that, you will request a copy of all your medical records from the company.   Then, you will provide those medical records to a medical expert, who will review your records, conduct an in-person evaluation, and then write a report assessing your "permanency." 

You will also have to respond to a medical evaluation that is conducted by the Company's doctor, who will also review the medical records, and perform an in-person evaluation and then write a report. 

Once these reports have been written, they will be exchanged, and your attorney will make a "demand" of permanency to try to settle the case. If the case cannot be settled, then a trial will be scheduled. 

At trial, both sides will present evidence, including witnesses, exam results, and expert medical testimony. To ensure your case is presented in the best possible light, it is important to have competent legal representation at this proceeding. The trial judge’s determination is binding, but if it appears that the judge made legal errors, you can appeal your case to the Appellate Division of the Superior Court. Appellate cases, however, are expensive and time consuming; the appellate process often takes more than a year.

Legal Representation for Your Workers’ Compensation Claim

The workers’ compensation process can be complicated and confusing and is always a very long process. An experienced attorney can help you understand your rights and access the compensation you deserve. At the Mark Law Firm, we have access to a network of medical experts who can assist with your workers’ compensation claim without the need to incur additional costs.

Discover how the Mark Law Firm can assist with your workers’ compensation case or learn more about workers’ compensation in New Jersey on our blog.