Workers in New Jersey who are hurt while on the job may seek benefits under the state's workers' compensation program, but determining what are and what are not work-related injuries can sometimes be a contentious process. Research conducted by the Workers' Compensation Research Institute reveals that these decisions may sometimes be taken based upon financial rather than medical considerations, and the safety advocacy group says that the costs of treatment are more likely to be transferred from traditional health insurance coverage to workers' compensation when fee schedules are high.
Physicians are often responsible for determining whether an injury is work related. Speaking at the Massachusetts-based nonprofit organization's annual conference on issues and research in Boston, the president and CEO of the WCRI said that the decision of the attending physician is frequently the most important factor when determining if an injury is related to work. While causation may be clear when workers have suffered cuts, bruises or fractures after a workplace accident, the cause of soft tissue injuries, sprains and strains can be more difficult to identify.
According to research conducted by the WCRI, injuries are 6 percent more likely to be considered work-related when fees are 20 percent higher. Experts say that physicians may take this option because workers' compensation claims pay higher fees and usually remain open for longer. Workers' compensation income benefits are also generally higher that the disability payments available under health insurance plans.
Workers' compensation insurance premiums are often a major expense for employers in New Jersey, and fears of rate increases sometimes prompt them to contest the claims made by their injured or sick workers. Attorneys with experience in this area may be familiar with this tactic, and they could advocate on behalf of those who have suffered workplace injuries during workers' compensation hearings.