Under the New Jersey Workers’ Compensation Act (the Act), employers are required to provide employees who suffer work-related harm with workers’ compensation benefits, including medical benefits. In some cases, though, even if an employer concedes that an employee is eligible to recover benefits, it may dispute what treatment is reasonable and necessary. The process for determining whether novel treatments are covered under the Act was recently discussed by a New Jersey court opinion in a case in which the employer denied the employee’s claim for the cost of stem cell therapy. If you were hurt at work, you should speak to a skillful New Jersey workers’ compensation attorney to discuss what medical treatment your employer may be required to provide for your injuries.

History of the Case

It is alleged that the plaintiff, who worked as a housekeeper for the defendant, injured her right bicep and shoulder while making a bed and required surgery for her injuries. She then injured her cervical spine and left shoulder a few months later and underwent a second surgery. She filed workers’ compensation claims for both sets of injuries, and an order was entered granting her disability and medical benefits that approved treatment with an orthopedist. Traditional treatment methods failed, and her treating doctors recommended that she undergo stem cell treatment for her shoulder.

Reportedly, the plaintiff filed a motion for medical benefits asking the court to order the defendant to pay for her stem cell therapy and attached a report from her doctor advising the treatment was the last option before surgery and therefore was medically necessary. The defendant opposed the motion arguing the treatment was not approved by the FDA. A discussion was held in chambers, and the court found in favor of the plaintiff, after which the defendant appealed.

Determining Whether Treatment is Reasonable and Necessary

On a motion for medical benefits, the plaintiff must show that he or she is temporarily disabled or in need of medical treatment. The motion must contain affidavits, medical reports, and certifications, which may provide a sufficient basis for an order compelling the defendant to provide the requested relief. The defendant can counter the plaintiff’s motion by opposing it on a legal or factual basis and can provide medical reports if there is a medical basis for the opposition.

A motion for medical benefits should only be granted without a hearing if the opposing documents are insufficient to meet the allegations of the documents in support of the motion. If the opposition is adequate, however, the court must conduct a full hearing. In the subject case, the court found that the lower court failed to conduct the hearing required due to the strength of the defendant’s evidence. Thus, the court reversed the trial court ruling.

Meet with a Seasoned New Jersey Workers’ Compensation Attorney

Sometimes newer treatments are more successful at providing relief for work-related injuries than traditional remedies, but such treatments may not always be covered by workers’ compensation benefits. If you were harmed while working, you should speak to an attorney as soon as possible regarding what benefits you may be owed. The seasoned New Jersey attorneys of The Law Offices of Jonathan F. Marshall can help pursue your workers’ compensation rights to medical treatment benefits and any other damages you may be owed. You can contact us at 800-999-0897 or through the form online to schedule a meeting.