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  1. #1
    Join Date
    Jun 2009

    Exclamation Does Workmans Comp Have to Cover Your Medical Bills for the Rest of Your Life

    hello everyone!

    Last aug I injured myself on the job...2 herniated discs, ddd, some disc space narrowing, and disc bulging. I'm 24 btw. now i was released back to work about 2 months ago, however was laid off of my job before i was even released due to company restructuring. i was feeling pretty good, not too much pain in my back once i was released, but these last 2 weeks my back has been killing me. well, i thought since this happened on my jobs dime that wc would have to cover my doc visits whenever i need them, for life, bc lets be 24 and once you hurt your back thats will always have on and off probs. so i call wc to tell them i need to see one of my docs and they tell me they will not pay for it. i have an apt to see thier doc at the end of june and they expect me to wait until thier doc says yes i need more treatment or no i dont. my lawyer says that the settlement from the lawsuit is compensation for everything and that is so they dont have to pay my bills forever. but seeing as im not going to trial yet or anything and not 2 months after im released i start getting pain again worries me. is this what i have to look foward to for the rest of my life?

    so can someone explain to me this...workmans comp does NOT have to pay for treatments on this injury, even if for the rest of my life it is a problem?

    please, please, please, someone help me.

    thank you all so much!

  2. #2
    Join Date
    Jun 2008

    Default Re: Does Workmans Comp Have to Cover Your Medical Bills for the Rest of Your Life

    Some interesting notes for people involved in legitimate worker's compensation claims in the state of New Jersey especially those which are defended by a "certain" insurer who we all know and love as the number one insurer of workmen's compensation in the state of New Jersey.

    1) Here's a nice link for your own personal information to keep in my mind when speaking to your attorney about potential "settlement" figures and what you believe to be "fair and accurate".

    Want to know how this is "possible" in today's day and age? It's possible because as a whole the population of the state of new jersey has allowed a statutory system which was originally structured to give industrialists who were building huge public works projects an effective means to accurately estimate costs into a system whereby now a mega insurer can collect millions , frankly billions in premiums, some state subsidized without having to pay out valid claims or provide proper treatment.

    2) The actual Table which determines your award for permanancy for the past 7 years at least has been PREPARED ... yes literally prepared by the "defendant" . Another interesting link .

    Take a gander at the Schedule of Disabilities table utilized by the STATE of New Jersey which serves as the definitive guideline for compensation rates for workplace injuries. Do you see who prepared the table?

    Oh and in regard to your question. It should have been explained to you at the time of settlement that when you settle a workmen's compensation claim in the state of New Jersey it is intended to act as a settlement of all future medical costs in connection with your claim.

    You have a legal right within 2 years of the date of settlement to petition the WC court to reopen the medical on your claim. I wouldn't waste time with the lawyers and such. I would simply go to the website I just gave you. Fill out the form on that website to reopen your medical and go to your local wc court and file it properly.

    Good Luck. You're in the WORST state in the nation when it comes to this stuff.
    Last edited by BuddyK; 06-05-2009 at 05:30 AM.

  3. #3
    Join Date
    Feb 2007

    Default Re: Does Workmans Comp Have to Cover Your Medical Bills for the Rest of Your Life

    so can someone explain to me this...workmans comp does NOT have to pay for treatments on this injury, even if for the rest of my life it is a problem?
    WC covers the ER for work injuries... you/IW are not the insured party, and comp is also not 'health insurance'.

    There are limitations on what benefits, and how long those are available.

    IF you have settled your claim, and accepted a lump sum cash payment,...a C&R/Compromise and Release, that pretty much closes out this claim.

    If there are provisions in the statute that allow for additional medical treatment, even after you have accepted money for 'future medical treatment'... that would one one hell of a great opportunity... I've never seen one.

    Time Limits for Filing Claims
    Important: There is a two year statute of limitations that applies to workers' compensation cases. A formal claim petition must be filed within two years of the date of injury or the date of last payment of compensation, whichever is later. Medical treatment authorized by the employer is considered a payment of compensation. In cases of occupational illness, such as asbestosis, lead poisoning or hearing loss, the claim petition must be filed within two years from the date the worker first became aware of the condition and its relationship to employment. Please note that the filing of an application for an informal hearing does not stop the two-year statute of limitations from running.
    Typically that means you must file for additional benefits within 2 years of the last payment of benefits... as provided above, medical treatment is considered 'payment' of a benefit. After that, even though you have an accepted claim... your case would be closed... even if you have a 'future medical' award in some cases.

  4. #4
    Join Date
    Jan 2007
    PA, but worked in NJ

    Default Re: Does Workmans Comp Have to Cover Your Medical Bills for the Rest of Your Life

    Hello Huneydip,

    I am sorry to hear the news of your continued suffering from your work injury.

    I see that was real convenient for your employer to lay you off, while out of work from a work injury. Sadly this is permitted under NJ law ???????

    OK simply put once you are released to go back to work, and given medical max improvement status at this point WC is no longer responsible for your care. I noticed that you did not mention any MMI status???? So my question is when you were released to return to work, was there any follow up Dr appointments scheduled??

    I imagine this upcoming exam @ the end of June IS NOT FOR CONTINUED CARE, but for a rating purpose to determine your impairment from this work injury.

    Without any doubt stress will exasperate your back pain symptoms. This just may be the case with your condition?? Unless you can get the treating WC Dr to say that more care will be curative then the only other option is for your lawyer to file a motion for medical care as well as TTD. During this care, if you are unable to work your job, which will be the case as you have been laid off, you should also get TTD.

    May I ask some questions?? What kind of medical care did you receive? Was it purely conservative such as pills and PT?? Was any study done such as MRI? Did you ever get the opportunity for epidural steroid injections??

    In general WC will cover all curative medical care and some limited pain management such as a series of injections. However once you are deemed MMI (Medical max improved) your temp. total disability benefits and medical care ends. Then you see the carrier's dr for rating and then your lawyers dr for rating and then you are ready to move forward to your settlement. That is it. I FULLY explain this is the link below. Please review and if you should have any questions I will be happy to explain in the greatest detail if you need.

    Once you are deemed MMI your condition is considered pre-existing if you should need more medical care after WC has fulfilled their obligation under NJWC law. If you say it is a work injury NO insurance will cover this, as they will tell you to contact your employer, which you will have already done and completed.

    Good luck

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