When a New Jersey injured worker needs urgent care that has not been authorized, the petitioner can file a WC-383 Motion for Emergent Medical Treatment under N.J.S.A. 34:15-15.3. One required attachment is a physician's statement establishing the need for emergent care, that a delay in treatment will cause irreparable harm or damage, and the specific nature of that harm.
The treating or examining physician writes and signs the statement, and there is no state template. The petitioner or attorney completes the WC-383 motion, the statement of when and to whom treatment requests were made, and the service certification.
The issuer sets what the letter or report must contain; check its current rules before you write it.
Physician's statement supporting Motion for Emergent Medical Treatment
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.
A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.
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The WC-383 checklist requires a statement by a physician that includes the petitioner's need of emergent medical care, that a delay in treatment will result in irreparable harm or damage to the petitioner, and the specific nature of that irreparable harm or damage. All three elements need to be in the statement.
The form states the respondent shall file an answer within 5 calendar days from the date of service and may have an examination of the petitioner conducted within 15 calendar days from the date of service. The date of service is the latest of personal, electronic, fax or one-day delivery service.
The petitioner or petitioner's attorney. If an answer has been filed, service is by fax and one-day delivery on the respondent's attorney unless the Division serves electronically. If not, service goes to the employer and its insurance contact, or to the Uninsured Employer's Fund if the employer is uninsured.