Authorized treating physician

What is an authorized treating physician?

The authorized treating physician is the doctor designated by the employer or its compensation carrier to treat your work injury.

In New Jersey the employer directs medical care for compensation claims. That is a significant difference from most other injury situations, where you choose your own provider.

Treating outside the authorized network generally means the treatment is not covered, even if the care is appropriate.

For many workers it is the most frustrating feature of the compensation system.

Why does this arrangement cause problems?

The physician's relationship with the payer creates a structural tension.

None of this means the physician is providing poor care, only that the arrangement creates pressures worth understanding.

• The physician is selected and paid by the party that benefits from a quick release
• Referrals to specialists may require carrier authorization
• Diagnostic testing can be delayed or denied
• Release to work may come earlier than you feel ready
• Your own physician's opinion carries no authority over treatment

What options exist?

You can seek treatment from your own physician at your own expense, and that opinion becomes relevant evidence even though the treatment is not covered.

Where authorized care is inadequate or delayed, a motion for medical treatment can be filed with the Division of Workers' Compensation.

In genuine emergencies treatment obtained without prior authorization is generally covered, though the circumstances matter.

Requesting a change of physician is possible in some circumstances, though it requires carrier agreement or an order.

How does this interact with a lawsuit?

Where a third party action exists, you have considerably more freedom over treatment because the compensation restrictions do not govern that claim.

The authorized physician's records still form part of the medical evidence in both proceedings, which is why what is documented there matters.

Consistency across both sets of records is important, since inconsistencies between what you told each physician will be raised.

Keeping your own notes of symptoms and appointments is worthwhile, since the authorized record may be sparse.

Common questions

Can I see my own doctor?

You can, generally at your own expense, since the employer directs authorized care. That opinion still carries evidentiary weight.

What if the authorized doctor will not order a test?

A motion for medical treatment can be filed with the Division of Workers' Compensation to compel appropriate care.

What if I need emergency treatment?

Emergency care obtained without prior authorization is generally covered, though the circumstances are examined.

Can I get a second opinion at my own expense?

Yes, and that opinion is relevant evidence even though the treatment itself is not covered. Where authorized care appears inadequate, a motion for medical treatment can be filed to compel appropriate care through the Division. Keeping your own notes of symptoms and appointments is worthwhile, since the authorized record is sometimes sparse and does not capture everything you reported. Dates and names matter most.