Does Workers’ Compensation Cover the Emergency Room? Posted on April 19, 2021April 19, 2021 Visits to the emergency room are notoriously expensive and can run in the thousands of dollars for a short visit for minor care. Someone injured in a work-related accident may naturally be anxious about who will pay for a trip to the emergency room. Emergencies can happen anytime of the day or night, and some people’s work requires them to be off-site or in locations other than their employer’s venue. They may not have anyone around to report their work-related accident but need immediate attention for their injuries. Fortunately, Workers’ Compensation covers medical treatment for work-related injuries, including treatment in the emergency room. Workers who have been injured on the job and go to the emergency room are urged to contact an experienced Workers’ Compensation lawyer for help. How Should I Handle My Emergency Room Visit? Anyone seriously injured at work should seek immediate care even if this means going to the nearest emergency room. In New Jersey, the law says that workers must use a medical provider stipulated by their employer or their employer’s insurance company; however, an exception is made for emergency treatment of work injuries. If possible and injuries permit, the worker should inform the emergency room staff that they are dealing with a work injury and possible Workers’ Compensation claim. Also, the injured worker should try to contact a work supervisor to let them know about the work accident and that it requires emergency treatment. If this is not possible at the time of treatment, this should be done as soon as possible afterward. What Else Does Workers’ Compensation Cover? Workers’ Compensation is a no-fault system of insurance that covers the cost of work-related injuries and illnesses for employees. Even if the employee was partially to blame for the work accident that caused their injuries, their medical treatment is covered. In return, employees are not allowed to sue their employers for work injuries. Workers’ Compensation benefits pay for medical treatment of work injuries and illnesses, including doctor visits, hospitalization, surgeries, blood test, X-rays and other imaging tests, prescription medication, and prosthetic devices. They also pay approximately two-thirds of a worker’s wages if they cannot return to work immediately because of injuries from a work accident. Those who are permanently disabled from a work-related injury can receive Workers’ Compensation disability payments. In addition, death benefits are available for the survivors of a worker who suffers a fatal work injury. Will I Have to Pay for Anything? The Workers’ Compensation system covers standard Western medical treatments. Insurance companies will not pay for alternative treatments and experimental treatments. Workers can certainly use alternative treatments such as acupuncture but will most likely have to pay out of pocket for them. Usually, private medical insurance will not pay for treatment related to a workplace injury or illness. According to New Jersey Workers’ Compensation law, workers must choose a doctor from a list of doctors approved by their employer. It is possible to seek treatment from a doctor not on the list, but treatment may not be covered and the worker is required to pay the bills out of pocket. Sometimes if a claim for Workers’ Compensation benefits has been denied, medical bills will have to be paid by the worker first until a settlement has been reached. How Do I File for Workers’ Compensation Benefits? Any injury from a work-related accident should be reported as soon as possible to a manager, supervisor, or other administrator. This begins the process of receiving Workers’ Compensation benefits. It is not required in New Jersey that notice be given in writing, but it is always best to keep written records of the claim process. The employer is responsible for notifying their insurance company, who will determine if an injury or illness is compensable. They may confer with the doctor who evaluated the injury and then decide to approve treatment. If this is the case, benefits should begin immediately and the employee does not usually get billed by the doctor. What Should I Do If My Claim is Denied? It is possible that an employer’s insurance provider will refuse to pay for treatment of a work injury or illness. This can be because the injury or illness is not considered work related, the type and extent of medical treatment is being disputed, or other reasons. However, there are also instances when a legitimate claim is denied because the insurance company is trying to avoid paying benefits. It is highly advisable to seek legal counsel when a claim is denied. Most Workers’ Compensation lawyers offer free consultations, so there is no cost involved to get some upfront legal advice. Workers have the right to dispute a denied claim by filing an application for an informal hearing or a formal claim petition. An informal hearing is similar to mediation. During the hearing, a judge reviews medical records and asks questions about the work injury before recommending a settlement. This is not a binding judicial decision and can be negotiated between the worker and the insurance company. Soon after signing an agreement, a worker can expect to receive payment. In contrast, the formal claim petition filed with the Division of Worker’s Compensation is a longer process that results in a binding decision from the judge who hears the case. Similar to a trial, the injured worker, medical doctors, and witnesses give testimony to be considered by the judge before he or she makes their decision. Appeals may be made to the Appellate Division of the Superior Court. Workers who have had their claim denied can benefit highly from the experience of a seasoned Workers’ Compensation lawyer who knows the steps of the claim process and the evidence needed to support a successful petition. An experienced lawyer will also know exactly what benefits for which the worker is eligible and how to maximize them and will not settle for less. Burlington County Workers Compensation Lawyers at Kotlar, Hernandez & Cohen, LLC Fight for the Rights of Injured Workers If you have been injured in a work accident, speak with one of the experienced Burlington County Workers Compensation lawyers at Kotlar, Hernandez & Cohen, LLC. We can help you navigate the system to prove that your injury is eligible for coverage under your employer’s Workers’ Compensation plan. We are ready to do what it takes to get you the benefits you deserve. Call us at 856-751-7676 or contact us online for a free consultation. Our offices are in Mount Laurel, Cherry Hill, Trenton, and Vineland, New Jersey; and Trevose, Pennsylvania. We serve clients throughout New Jersey and Pennsylvania.