In New Jersey, an injured worker who wants the Division of Workers' Compensation to order medical treatment or temporary disability benefits files a WC-101 motion. There is no state physician form. Instead, the motion is supported by the treating physician's medical report, which must state the medical diagnosis and show that the petitioner currently needs medical treatment, diagnostic studies, or referral to a specialist.
The treating physician writes the report in the practice's own format. The petitioner's attorney completes and signs the WC-101, and the petitioner or attorney supplies the supporting affidavits or certifications.
The issuer sets what the letter or report must contain; check its current rules before you write it.
Medical report supporting Notice of Motion for Temporary and/or Medical Benefits
There is no form to fill: the program asks for a letter or report with the content it sets. Vero Scribe writes the visit note it draws on, so the details are ready when you write it.
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No. The Division publishes the WC-101 motion itself but no numbered clinician form. The treating physician supplies a medical report, in the practice's usual format, that states the diagnosis and the patient's current need for medical treatment, diagnostic studies or referral to a specialist.
At minimum, the medical diagnosis, which the motion form marks as required. It should also identify the treatment, diagnostic studies or specialist referral the petitioner needs now, since the motion asks the Division to order those benefits, and any temporary disability when temporary benefits are claimed.
The WC-101 addresses this: if the petitioner received treatment but cannot secure a report from the medical provider authorized by the respondent, that fact may be set forth in the affidavit in lieu of the physician's report. Other evidence supporting the motion can be listed or attached under item D.