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Reasonable and Necessary

New Jersey law provides protections for you as an employee. The workers compensation system in New Jersey allows that, if you’re injured at work or while working, you are owed reasonable and necessary medical treatment. In other words, if you’re injured on the job, the law protects you from having to pay your medical expenses out of pocket.


While these protections sound easy enough, there are limitations. The first is that workers compensation is responsible only for those medical treatments that are directly related to the injury you incurred at work. The second is that workers comp is responsible only for those medical treatments that are reasonable and necessary. These limitations provide insurance companies with ample opportunities to contest workers compensation claims.

Reasonable and Necessary

Reasonable and necessary sounds straightforward enough, but wiggle room is built into the process. Once your workers’ comp claim is allowed, there are some categories of treatment that are generally accepted as reasonable and necessary:

  • Diagnostic testing – including x-rays, MRIs, ultrasounds – when determined medically necessary to accurately diagnose the nature of your injury;
  • Designated hospital services;
  • The prescription and administration of designated medications;
  • Doctor and specialist appointments;
  • Designated surgeries;
  • Physical therapy for a designated interval; and
  • Designated medical devices, including wheelchairs, splints, and crutches.

What about Unnecessary and Unreasonable?

Insurance companies are in the business of turning a profit, and there are certain medical treatments that they routinely determine to be both unnecessary and unreasonable:

  • Any treatments related to your injury that your doctor finds unnecessary;
  • Alternative medical therapies – such as acupuncture and chiropractic care;
  • Prescription drugs and treatments that are new, experimental, or cost prohibitive;
  • Treatment that isn’t consistent with the injury you’ve incurred or with your diagnosis;
  • Treatments that duplicate themselves – such as the same treatment ordered by more than one doctor;
  • Designated treatments ordered by non-specialists;
  • Ongoing treatment for a minor or subjective injury; and
  • Any medical treatment of more than three weeks for a soft-tissue injury.

Medical professionals naturally prioritize improving your health. Insurance companies, however, are invested in keeping medical expenses down. This clash can lead to complications for workers compensation claims.

Your Workers Compensation Claim

If you’ve been injured on the job, you know just how difficult that can be. If the insurance company is contesting payment for the medical treatment that you need, it can be more difficult still. Your health is too important to leave to chance. An experienced workers compensation lawyer will guide your claim toward the just compensation to which you’re entitled.

If You Have a Workers Comp Claim, Call 201-498-9768 Today for More Information 

If you were injured on the job, make full recovery your priority. Don’t let workers compensation insurance dictate the kind of medical care you receive. A skilled New Jersey workers comp attorney will advocate for your rights and for your rightful compensation. At John L. Schettino law, we’re here to help. For a free phone consultation, contact or call me at (201) 498-9768 today.