The medical coverage available through workers’ compensation is one of its most valuable benefits. Even workers who have decent health insurance typically still have to pay quite a bit for their care if they fail to file a workers’ comp claim. Many policies have large deductibles that people need to meet before getting treatment, and they may have co-pays or coinsurance do even after meeting that deductible.
Workers’ compensation medical coverage in New Jersey does not pass any care costs on to workers who suffer from job-acquired medical conditions. Those who qualify for benefits can obtain treatment ranging from surgery to physical therapy without paying for their care out of pocket. At least, up to a point.
When a worker fully recovers
The best-case scenario for an injured worker is that they respond well to treatment. Eventually, they will no longer have any significant physical limitations and will be able to return to work with only a few accommodations required. Once someone no longer has any lingering symptoms, workers’ compensation will cease paying for medical care. Workers who have returned to their job and who have a flare-up of their symptoms in the future may be able to start receiving benefits again if their condition worsens.
When they reach maximum medical improvement
Sometimes, workers have health issues that are serious enough that they will not fully heal. There will always be lingering symptoms or functional limitations. They can therefore only rely on workers’ compensation to cover treatment that is medically necessary and that will likely improve their condition. When the physician overseeing someone’s treatment determines that they will no longer respond to treatment, the worker will be ineligible for ongoing medical benefits to cover treatment costs. If someone has reached maximum medical improvement (MMI) for their condition, the coverage for ongoing treatment will typically end.
However, people can continue receiving benefits for symptom management even after achieving MMI. Occasionally, workers may disagree with the doctor who claims that they have fully recovered or achieved MMI. Sometimes, a second opinion may be necessary to ensure that someone can continue getting the care they require to manage a job-related health condition.
Learning about the rules that govern workers’ compensation benefits will often help those struggling with health issues after developing a medical issue related to their work to better understand what to expect and when to speak up if their rights aren’t being honored.