NJ Proposes Informal Process for Medical Bill Disputes

The number of disputes concerning the payment/reimbursement of medical bills have increased in workers’ compensation claims in New Jersey. The State has proposed converting the Informal Hearing procedure into a new Informal Process to hear such disputes and other matters previously consider as an Informal Hearing.

In a published article, “ Clearing the Workers’ Compensation Benefit Highway of Medical Expense Land Mines ,” the difficulties of the issue were previously identified. “Medical expenses in contested workers’ compensation cases are now a significant and troublesome issue resulting in uncertainty, delay and potential future liability. The recent NJ Supreme Court decision, University of Mass. Memorial Hospital v. Christodoulou, 180 N.J. 334 (2004) has left the question of how to adjudicate medical benefits that were conditionally paid or paid in error. Presently there is no exclusively defined procedure to determine the allocation, apportionment of primary responsibility for unauthorized medical expenses and reimbursement.” “The new benefit highway that embraces a new paradigm which extends to a new
safety net and the existence of these collateral programs require a modification of the
Workers’ Compensation Act and/or Rules to safeguard the interests of the parties, while
remaining consistent with the social remedial intent of the legislation.”

Previously legislation was proposed that would have given the NJ Division of Workers Compensation exclusive jurisdiction over medical bills. A-2501 That legislation was never enacted.

The proposed process would allow medical providers, or their representatives, to appear, without the need of an attorney, to informally discuss their disputes with the parties in an effort to seek a consent agreement for resolution. The proposed rule also repeals the need for registration of party representative.

The proposed rules were published on Monday, July 20, 2009 (41 N.J.R. 2768(a) and a public hearing is scheduled on Monday, August 17, 2009 from 9:00 to 12:00 noon NJ Department of Labor and Workforce Development, Trenton, NJ.