Like the broader U.S. system, workers' compensation in New Jersey promises to protect employees injured on the job by ensuring timely and adequate medical care.

Jon L. Gelman

However, this promise often feels broken when navigating the system's realities, particularly concerning medical benefits. Injured workers frequently encounter significant hurdles, especially when seeking medical treatment for both routine conditions and those requiring immediate attention.

Navigating New Jersey's medical maze

Obtaining necessary medical care under New Jersey's workers' compensation can be a frustrating and complex journey. While the system aims to provide treatment for work-related injuries, bureaucratic obstacles and limitations frequently impede access. A primary concern is the significant control employers and insurance carriers exert over selecting medical providers. Injured employees in New Jersey may find themselves restricted to a panel of pre-approved doctors, limiting their ability to choose specialists or physicians they trust. Unfortunately, this emphasis on cost containment can overshadow the need for the most comprehensive care tailored to the worker’s specific injury.

Furthermore, securing authorization for medical procedures, diagnostic tests and treatments can be lengthy and cumbersome. Delays in obtaining approval can significantly prolong an injured worker's recovery. This impacts their ability to return to work and diminishes their overall quality of life. The administrative burden adds unnecessary stress and financial strain on individuals already grappling with the physical and emotional consequences of a workplace injury.

Urgent needs, delayed care

The difficulties are amplified when workers require immediate diagnostic tests and urgent care. Prompt treatment is crucial for optimal recovery, yet the authorization process in New Jersey's system can create unacceptable delays. For conditions that necessitate immediate magnetic resonance images, specialized consultations or urgent procedures, the time taken to gain approval can lead to worsening conditions and prolonged disability. This is a critical failing of a system intended to support injured workers swiftly.

The double blow: occupational exposure

As with the national landscape, the denial of treatment in New Jersey is particularly concerning in cases of occupational exposure. When New Jersey workers develop illnesses due to workplace toxins or conditions, establishing a direct link to their employment can be a formidable challenge. Insurance companies may contest the causal connection between the exposure and the resulting health issue, leading to denials of essential medical care. This struggle is especially pronounced with latent illnesses that may not manifest for years after the initial exposure. 

Workers suffering from conditions like mesothelioma, asbestosis or other diseases linked to past workplace environments in New Jersey can face considerable resistance when trying to secure the medical treatment and compensation they deserve. The burden of proof often rests heavily on the employee, requiring him to navigate intricate medical and legal processes to prove the work-related nature of their illness.

The price of delay

The consequences of inadequate and untimely medical care within New Jersey’s workers’ compensation system mirror the national trends, leading to:

• Prolonged recovery. Delays in treatment impede healing, potentially leading to chronic pain and long-term disability.
• Financial strain. Without timely access to medical care and temporary disability benefits, New Jersey workers may face severe economic hardship.
• Mental health impact. The frustration and pain of delayed or denied care can significantly impact an injured worker's mental well-being.
• Reduced productivity. When New Jersey workers cannot access necessary medical care, their ability to return to work is hindered, affecting their lives and the state’s economy.

Moving forward

Addressing these critical issues within the New Jersey workers' compensation system requires focused attention and reform. Improvements could include the following:

• Streamlining authorization. Implementing more efficient and transparent pre-authorization processes to minimize delays.
• Expanding provider choice. Allowing injured workers greater flexibility in selecting their health care providers.
• Strengthening independent review. Ensuring unbiased, independent medical reviews focused on the best care for workers.
• Improving occupational exposure processes. Developing clearer protocols for evaluating and approving claims related to occupational exposures, considering the latency of such illnesses.
• Enhancing transparency. Improving data collection and transparency regarding treatment denials and outcomes within the system.

The promise of New Jersey’s workers’ compensation system must be upheld. By prioritizing patient-centered care, streamlining processes and addressing the unique challenges of work-related illnesses, especially in New Jersey, we can strive toward a system that genuinely supports the health and well-being of the state’s workforce.

Claimants' attorney Jon L. Gelman is the author of "New Jersey Workers’ Compensation Law" and co-author of the national treatise "Modern Workers’ Compensation Law." He is based in Wayne, New Jersey. This blog post is republished with permission.