Sometimes, injured workers have questions regarding authorized or unauthorized medical care. N.J.S.A. 34:15-15 of the New Jersey Workers’ Compensation Act provides that, “The employer shall furnish to the injured worker such medical, surgical, and other treatment, and hospital service as shall be necessary to cure and relieve the worker of the effects of the injury.” The case of Benson vs. Coca Cola Co. addresses the issue of unauthorized medical care.
In the Benson case, the employee was examined by the workers’ compensation carrier’s physician. The employee subsequently sought out medical treatment from another physician, without the workers’ compensation carrier’s authorization, and then sought reimbursement from the carrier for the medical expenses. The workers’ compensation court found against the employee, holding that N.J. Stat. Ann. § 34:15-15 did not give discretion to the injured employee to seek independent medical assistance, thus the outside medical treatment and hospitalization was unauthorized.
The Appellate court held that the statute provided that upon refusal or neglect of the workers’ compensation carrier to provide adequate and proper medical treatment, the employee could either file a claim petition or, after a request to the carrier, seek his own treatment at the employer’s expense; however, where such request would be futile, it was unnecessary that the formality be accomplished. The Appellate court held that the trial court lacked findings with respect to whether a further demand would have been futile and unnecessary and sent the case back for further findings of fact to determine if the workers’ compensation carrier had to pay for the unauthorized medical care.
The moral of this story is to always ask the workers’ compensation carrier or your employer for treatment before going to get it on your own. If they deny treatment or it seems that it might be futile to ask for the treatment, they may be responsible for payment of same.
Meanwhile, the case of Hanrahan vs. Township of Sparta addresses the issue of palliative care versus curative care in workers’ compensation cases. In the Hanrahan case, the employee was a police officer for Sparta Township. He suffered neck and back injuries as a result of an automobile accident during the course of his employment. He continued to suffer neck and pack pain and his doctors suggested a continued course of physical therapy to relieve the pain as much as possible and to restore flexibility. The workers’ compensation carrier did not want to authorize the continued physical therapy and contended that this medical treatment was not authorized by the Workers’ Compensation Act, N.J. Stat. Ann. §34:15-15, because it was palliative, and not curative.
The Appellate court disagreed and affirmed the decision of the Division of Workers’ Compensation that the physical therapy should be provided. The Court held that the act provided for continued treatment, whether or not labeled as palliative so long as there was a showing by competent medical testimony that the treatment was reasonably necessary to cure or relieve the effects of the injury.
The Court held that provisions of the workers’ Compensation Act were to be liberally construed. The Court stated the following, “We hold that even in non-total disability cases, N.J.S.A. 34:15-15 provides for continued treatment, whether or not labeled as “palliative,” as long as there is a showing by competent medical testimony that the treatment is reasonably necessary to cure or relieve the effects of the injury.”
If you have any questions regarding your workers’ compensation coverage, it is strongly recommended that you seek experienced counsel immediately.