Extent of Medical Benefits

• The Department of Labor requires employers or an employer's insurer to cover all medical care and devices needed to treat an injury suffered on the job or an occupational illness. The state's workers' compensation laws protect employers that maintain proper workers compensation insurance from liability for workers' medical treatment, regardless of who was at fault in the accident. Required benefit coverage includes physicians' visits, prescriptions and other medical devices such as wheelchairs or crutches, and benefits extend until doctors determine a worker reaches maximum medical improvement, the point at which he recovered as much as possible.
  
  

Initial Claim and Doctor Choice

• In the case of an injury that requires immediate emergency care, a worker may seek treatment without prior approval from her employer or employer's insurance company. If the injury doesn't require immediate medical attention, the worker must report it to her employer, either verbally or in writing. Workers must provide notice within 90 days of the accident to receive coverage or their insurer chooses the physician from which the injured worker receives care. A worker may seek treatment at her choice of physician only if her employer neglects to provide treatment.
  
  

Disputed Claims

• In some cases, the insurance provider may refuse to pay the worker because it disagrees with a doctor's choice of medical treatment, doubts that the injury occurred in the workplace or questions that an illness has its roots in occupational factors. In this case, a worker may appeal to the Department of Labor's Division of Workers Compensation to adjudicate the claim. First, a judge hears both parties' cases at an informal hearing and makes a nonbinding suggestion on how to resolve the claim for treatment. If parties don't accept the settlement, they move to a formal hearing, at which case a judge issues a formal and binding decision regarding treatment.
  
  

Other Benefits

• In addition to medical coverage, New Jersey requires that employers provide disability benefits to workers who are injured and cannot return to work. After an employee misses seven days of work, the insurer must provide disability benefits equal to 70 percent of the worker's pre-injury earnings. Workers who are permanently disabled, such as those who lose a limb, eyes or ears, receive compensation at a rate determined by the state based on the type of injury.