Your recovery comes first—let’s make the system work for you
After a work injury, the most important question is simple: How do I get the right medical care, right now? In New Jersey workers’ compensation, the employer (through its insurer) usually controls medical treatment—choosing the initial providers and authorizing tests, specialists, therapy, and surgery. That control is not unlimited. The law gives injured workers clear rights to prompt, appropriate care, second opinions when treatment stalls, and court orders when the carrier delays or denies authorizations. If temporary wage checks (TTD) are due while you’re out under care, the court can order those too.
At Shebell & Shebell, we move quickly: we secure authorizations, force approvals through Motions for Medical & Temporary Benefits, and, when necessary, seek a change of physician so you’re treated by the right specialist—not by a gatekeeper clinic that keeps you in an unhelpful loop. Your recovery is the mission. We build the record with honest testimony and clear medical evidence so judges can act fast.
New Jersey Workers’ Comp Medical Treatment 101: What’s Covered and Who Decides?
The carrier chooses—but must provide reasonable, necessary care
New Jersey’s system is built around authorized treatment. The insurer directs care, but it also has a legal duty to provide treatment that is reasonable, necessary, and causally related to the work injury. That includes:
- Emergency care the day of the accident
- Diagnostics (X-ray, MRI/CT, EMG/NCV, PFTs, etc.)
- Specialists (orthopedics, neurology, pain management, hand/shoulder, spine, ENT, pulmonology, psych)
- Therapy (PT/OT, vestibular, cognitive rehab)
- Procedures and surgery when indicated
- Medications/DME (prescriptions, braces, TENS, cane/rollator when medically necessary)
- Follow-up and referrals tied to the work condition
You should not be balance-billed for authorized care. Providers submit bills to the carrier under comp.
Temporary Total Disability (TTD) while treating
If the authorized physician keeps you out of work, you’re generally entitled to TTD checks (typically 70% of Average Weekly Wage, subject to caps) while you receive active treatment. If the employer can’t offer bona fide light duty within restrictions, TTD continues.
Can I Choose My Own Doctor in a NJ Workers’ Comp Case?
Short answer: not at first—then sometimes, yes (with a court order)
At the outset, the carrier typically picks the provider. But if care is inadequate, delayed, or not addressing the actual problem, we can push for:
- Targeted diagnostics that the treating doctor requested
- A specialist referral the case truly needs
- A court-ordered change of physician when the carrier won’t provide appropriate care
- Second opinions to break logjams and establish medical necessity
If you see an outside doctor without authorization, the carrier may refuse to pay. The safer path is to build the medical need and ask the court to order the right care.
How to Force Authorizations: Motions for Medical & Temporary Benefits (MMTB)
The fast lane when the carrier stalls
When an insurer delays or denies testing, referrals, procedures, or wage checks, we file an MMTB supported by persuasive proof:
- Treating notes or an expert report explaining diagnosis, medical necessity, and relation to work
- A clear request for specific care (e.g., “left shoulder MRI with/without contrast” or “lumbar epidural steroid injection at L4-5”)
- Evidence of denial or non-response
- Proof you’re out of work on doctor’s order (for TTD)
Judges can order concrete authorizations with deadlines (e.g., “MRI within 10 business days”) and set effective dates for TTD.
What If Treatment Stalls? Requesting Referrals, Second Opinions, and Change of Doctor
Signs your case needs escalation
- You’ve done weeks of PT with no meaningful improvement
- Primary clinic refuses to order the MRI/EMG the symptoms demand
- The provider minimizes objective signs (e.g., true weakness, positive orthopedic tests)
- A specialist is clearly indicated (hand/shoulder, spine, neurology, pain) but no referral is issued
- You’re worse, but notes don’t reflect your functional reality
The playbook we use
- Document symptoms and function (walking, sitting, lifting, overhead reach, sleep, neuro signs).
- Get the treating doctor to request diagnostics/referrals in writing.
- If blocked, obtain a concise expert affidavit/report explaining why the next step is medically necessary.
- File an MMTB requesting the specific test/referral or a change of physician.
- Set follow-up to ensure compliance; return to court if the carrier drags its feet.
Independent Medical Exams (IMEs) in NJ Workers’ Comp: What to Expect and How to Prepare
What an IME is—and isn’t
An IME is the carrier’s evaluation by a doctor who doesn’t treat you. It’s often used to question causation, necessity of care, or work status. Judges understand that IMEs are opinions, not gospel. Your preparation and the quality of your treating records matter more than theatrics.
How to prepare (and protect credibility)
- Tell the same clear story you tell your treating doctor and the court.
- Describe mechanics of injury and current function (sitting/standing tolerance, stairs, overhead reach, fine motor, driving, flare patterns).
- Don’t exaggerate. Honesty about good and bad days builds trust.
- Bring a med list and be ready to describe side effects (sedation, fog, GI issues, dizziness).
- If testing provokes pain, say so in real time.
We rebut weak IMEs with evidence-based reports from the right specialists and the objective tests your case requires.
Nurse Case Managers, Privacy, and Your Rights in Treatment
You have a right to private doctor-patient time
Nurse case managers can facilitate logistics, but they don’t direct care and should not sit in on your private clinical exam unless you consent. You control who’s in the room. If you feel pressured, say you’d like private time with the doctor first. We set boundaries and keep the focus on medicine—not on minimizing your file.
Diagnostics That Win Motions (and the Words That Matter)
Specific requests beat vague wish lists
Courts and carriers act faster when requests are precise and medically grounded:
- MRI/CT specifying region/level and “with/without contrast” when appropriate
- EMG/NCV to document radiculopathy/neuropathy
- Ultrasound for rotator cuff/biceps pathology when MRI is contraindicated
- PFTs when respiratory symptoms follow a chemical/exposure event
- Neuropsych testing for persistent post-concussion or cognitive issues
- Pain management consult listing failed conservative modalities and targeted next steps
We connect mechanism → pathology → indicated test in a few clean sentences so judges can sign orders with confidence.
Light Duty, Restrictions, and Safe Return-to-Work During Treatment
Light duty must match written restrictions
If the authorized doctor gives restrictions (no lifting over X lbs, no overhead work, sit/stand option, limited walking/standing, no ladders, environmental limits), the employer must offer real tasks within those limits. Red flags:
- “Make-work” assignments that agitate your injury
- Repeated pressures to exceed restrictions “just this once”
- Schedule changes that undermine necessary treatment
- Being sent home without tasks (then blamed for “refusing work”)
If light duty aggravates your condition or isn’t real, we document it, communicate with the doctor, and seek restored TTD via motion.
Pain Management, Medications, and Evidence-Based Care
Balance relief with safety and function
Adjusters often push back on injections or neuromodulation, and they frequently scrutinize opioid prescriptions. We keep care evidence-based:
- Demonstrate failed conservative care (PT, NSAIDs, activity modification)
- Show functional goals (improved therapy tolerance, ADLs, sleep)
- Document side effects and why an alternative is indicated
- Request stepwise plans: diagnostic block → therapeutic series → surgical consult if warranted
Good pain care is about function, not just a pain score. We help your treating team frame it that way.
Psychological Care When Pain and Injury Change Your Life
Mind and body are connected—and compensable
Work injuries often lead to depression, anxiety, or PTSD, particularly after trauma or prolonged pain. Psychological treatment can be part of authorized comp care when clinically connected. We request:
- Behavioral health evaluation (psychology/psychiatry)
- Evidence-based therapy (CBT, pain coping strategies)
- Medication management if indicated
Document sleep disruption, concentration limits, irritability, panic, and adjustment struggles—judges understand these realities.
Maximum Medical Improvement (MMI) and What Comes Next
When active care ends, benefits don’t have to
When you reach MMI (further significant improvement isn’t expected), we assess:
- Permanent Partial Disability (PPD)—the lasting loss of function
- Permanent Total Disability (PTD)—when you cannot reliably sustain competitive work
- Second Injury Fund coordination if pre-existing impairments combine with the new injury to cause total disability
If your condition later worsens, New Jersey allows reopening within specific timeframes. We calendar those windows and guide you on warning signs.
Transportation, Language Access, and Practical Barriers to Care
The basics matter
- If driving is unsafe, request transport assistance to authorized visits.
- Ask for interpretation services if English is not your first language—accuracy in medical records matters.
- Keep appointment logs; missed visits can be weaponized against you—reschedule promptly with a documented reason.
Third-Party Claims and Medical Coordination
When someone outside your employer contributed
If a driver, property owner, subcontractor, or product manufacturer helped cause your injury, we pursue a civil claim for pain and suffering and full damages while we keep comp care moving. We also manage the workers’ comp lien/credit to maximize your net when the third-party case resolves.
Documentation That Strengthens Medical Motions
- Accident mechanism in simple, concrete terms (what you lifted, which hand, direction of twist, fall surface)
- Symptom chronology (onset, radiation, numbness/tingling, weakness)
- Function limits (sitting/standing, stairs, overhead reach, fine motor, driving, sleep)
- Prior baseline vs. now (we’re not hiding history—we’re proving change)
- Treating notes requesting specific tests/referrals
- Denial emails/letters or non-responses from adjusters
The cleaner the record, the faster the order.
Common Carrier Tactics—and Our Answers
“We need more PT first.”
If therapy failed, we present objective findings and clinical guidelines supporting the next step.
“We’ll send you to our IME.”
Fine—meanwhile, we file a motion with treating proof. Judges will not let IME scheduling delay necessary care.
“Use our clinic for everything.”
Gatekeeper clinics aren’t specialists. When subspecialty care is indicated, we request it and move the court if blocked.
“Light duty available—no checks.”
Only if it fits restrictions. If it doesn’t, we restore TTD through motion.
“It’s degenerative.”
We prove aggravation/exacerbation with before-and-after evidence and objective tests; treatment proceeds either way.
How We Prepare You for Medical Hearings
Judges want authenticity. We help you communicate:
- The mechanics of injury and the day-to-day impact on function
- Treatment journey—what helped, what didn’t, and why the next step is reasonable
- Work reality—why proposed light duty does or doesn’t fit your restrictions
- Medication effects—relief window and side effects that affect safety and reliability
No dramatics. Just specific truth.
If You’re Waiting on Care, Don’t Wait on Us
Delays make injuries harder to treat and reduce leverage. Early motions get diagnostics, referrals, and wage checks moving. You shouldn’t have to fight alone to see a specialist or get an MRI that everyone knows is necessary.
Treatment Delayed or Denied? We’ll Get the Authorizations and the Right Specialist on Calendar
If your NJ workers’ comp care is stalled—no MRI, no specialist, injections denied, surgery ignored—we’ll file a Motion for Medical & Temporary Benefits with the precise diagnostics and referrals your case needs and get TTD checks restored if you’re out of work. We push for subspecialists (shoulder/hand, spine, neurology, pain), set deadlines in court orders, and request a change of physician when gatekeepers won’t treat what’s actually wrong.
Contact us for a free treatment-plan session today—we’ll map the exact tests to request, the evidence to gather, and the motion to file so your recovery stops waiting on an adjuster.
FAQs: Medical Treatment Rights in New Jersey Workers’ Comp
Can I pick my own doctor in a NJ comp case?
The carrier usually designates providers. If care is inadequate or delayed, we can seek a second opinion, targeted diagnostics, or a court-ordered change of physician.
What if the insurer won’t authorize an MRI or specialist?
We file a Motion for Medical & Temporary Benefits with treating or expert reports explaining medical necessity and work causation. Judges can order specific diagnostics and referrals with deadlines.
Do I have to let the nurse case manager into the exam room?
No. You’re entitled to private time with your doctor. The nurse can coordinate logistics but shouldn’t direct treatment or interfere with your exam.
The IME doctor says I’m fine—am I stuck?
No. IMEs are opinions. We counter with evidence-based reports from appropriate specialists and objective testing. Courts routinely side with credible treating evidence.
What if light duty hurts or exceeds restrictions?
Get written restrictions from the authorized doctor. If tasks exceed them or aggravate your condition, we document and seek restored TTD and a corrected plan.
Can psychological treatment be part of my comp care?
Yes, when clinically linked to the work injury or chronic pain. We request evaluation and therapy and coordinate with your medical team.
