What if I Need Surgery Due to a Workplace Injury in New Jersey?

If you’ve sustained a workplace injury in New Jersey and your doctor recommends surgery, you may be worried about who will pay for the procedure, whether you can choose your own doctor, and how your benefits will be affected. Workers’ compensation laws are designed to protect injured employees, but the process can be confusing, especially when surgery is involved. Continue reading for more information and consult with an experienced Warren County workers’ compensation lawyer today.

What is Workers’ Compensation?

Workers’ compensation is a no-fault insurance system designed to provide benefits to employees who suffer job-related injuries or illnesses. Because it is no-fault, employees are entitled to benefits regardless of who was at fault for the injury, as long as the injury occurred while performing job duties or arising out of and in the course of employment. In exchange for these benefits, the employee generally gives up the right to sue their employer for negligence.

This system provides several benefits, including medical benefits, temporary total benefits, permanent partial benefits, permanent total benefits, and death benefits. Every employer in New Jersey, with very few exceptions, is legally required to carry workers’ compensation insurance to protect their employees in the event of an injury.

What if I Need Surgery Due to a Workplace Injury?

If a workplace injury in New Jersey requires surgery, the procedure, along with all associated medical costs, should generally be fully covered under your employer’s workers’ compensation insurance. New Jersey law mandates that employers must provide necessary medical treatment for work-related injuries, and surgery falls under this category.

However, coverage is not automatic. To ensure the procedure is covered, the surgery must be deemed medically necessary by an authorized medical provider. The insurance carrier or the employer typically has the right to select the treating physician. If the doctor chosen recommends surgery, the carrier will still review the recommendation.

Before scheduling a major procedure, the workers’ compensation insurance carrier must approve the surgery. This approval process involves reviewing the medical records, the doctor’s recommendation, and often includes an independent medical examination by a doctor hired by the insurance company. If the carrier denies the surgery, you have the right to challenge this decision by filing a motion with the Division of Workers’ Compensation. It is essential to have legal representation at this stage for help navigating the appeal and ensuring you receive the necessary treatment.

Will I Get Paid While Recovering From Surgery?

Yes, you are likely entitled to wage replacement benefits, known as Temporary Total Disability (TTD) benefits, while recovering from surgery for a work-related injury if you cannot work for more than 7 days. TTD benefits compensate you for lost wages while you are temporarily unable to work. In New Jersey, this benefit is calculated at 70% of your average weekly wage, subject to minimum and maximum limits set by state law. These payments continue until you are medically cleared to return to work, reach maximum medical improvement, or are able to return to light-duty work.