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The Role of Medical Evaluations in New Jersey Workers’ Compensation Cases

If you’ve been injured at work, getting medical treatment is your top priority. But in New Jersey workers’ compensation cases, medical evaluations serve another vital purpose. They play a critical role in determining whether your claim is approved and how much compensation you may receive.

Understanding how medical assessments affect your claim can help you feel more prepared and confident throughout the process. Here’s what you should know.

Why Medical Evaluations Matter

Medical evaluations are a key part of every workers’ compensation claim. They help prove that your injury is work-related and provide documentation of the severity of your condition. Without a medical evaluation, the insurance company may question whether your injury happened at work or whether it is severe enough to justify benefits.

Your doctor’s report serves as evidence for your claim. It can influence decisions about medical treatment, temporary disability benefits, and permanent disability awards. A strong, well-documented evaluation can support your case. A vague or incomplete report can lead to delays or even a denial.

Who Performs the Medical Evaluation?

In New Jersey, your employer or their insurance carrier usually selects the doctor who will evaluate and treat you. You must attend these appointments if you want to continue receiving benefits. These doctors are sometimes called “authorized treating physicians.”

You may also seek a second opinion, but if your employer or their insurance company does not approve the doctor, the cost may not be covered under your claim.

In some cases, especially during disputes, the insurance company may request that you attend an Independent Medical Examination (IME) with a doctor of their choosing. This doctor is not involved in your treatment. Their job is to evaluate your condition and provide a report that may confirm or challenge your claim.

What to Expect During the Evaluation

Whether you’re seeing your treating physician or attending an IME, the medical evaluation is a formal part of your case. Be honest, detailed, and consistent about your symptoms and how the injury occurred.

During the evaluation, the doctor may:

Ask about how the injury happened
Review your medical history and prior injuries
Examine the affected area of your body
Ask you to describe your pain, limitations, or daily challenges
Order diagnostic tests like X-rays or MRIs

The doctor will then write a report that includes their findings. This report may include information about your diagnosis, treatment plan, ability to work, and whether your condition is temporary or permanent.

How Medical Evaluations Affect Your Benefits

The doctor’s findings can impact multiple parts of your claim:

Medical Treatment: The report can influence what type of care you receive and how long it lasts.
Time Off Work: If the doctor says you cannot return to work, you may be eligible for temporary disability benefits.
Permanent Disability: If your injury causes long-term impairment, the doctor’s evaluation helps determine if you qualify for permanent partial or total disability.

If there are disagreements between doctors, the case may need to go to a hearing where a judge will review the reports and decide which one is more credible.

Prepare and Protect Your Rights

Medical evaluations are not just about your health. They are also legal evidence. Keep a detailed record of your appointments, follow your doctor’s advice, and be consistent in your statements.

If you are asked to attend an IME, understand that the insurance company hires the doctor. Be respectful, but know that their goal is to evaluate the claim, not to treat you.

If you believe your condition is being misrepresented or that you’re not getting proper care, it may be time to speak with a workers’ compensation attorney.

At Workplace Lawyers, we help injured workers in New Jersey navigate the challenges of workers’ compensation claims, including medical evaluations. If you have questions about your case or need help preparing for an upcoming assessment, we’re here to guide you.