The legislation will be the subject of consideration by the NJ Assembly Labor Committee on Monday, May 14, 2012.
Click here to read: Clearing the Workers' Compensation Benefit Highway of Medical Expense Land Mines
By John H. Geaney and Jon L. Gelman
"Medical expenses in contested workers’ compensation cases are now a significant and troublesome issue resulting in uncertainty, delay and potential future liability. Th 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."
Statement of the Bill
"This bill prohibits the charging of workers’ compensation
claimants for medical expenses that have been authorized by the
employer or its carrier or its third party administrator, that have
been paid by the employer, its carrier or third party administrator
pursuant to pursuant to the workers’ compensation law, or which
been determined by the Division of Workers’ Compensation to
be the responsibility of the employer, its carrier or third party
administrator. The bill gives the division sole jurisdiction over
disputed work-related medical claims, and directs the division to
provide procedures to resolve those disputes, including procedural
requirements for medical providers or any other party to the
dispute. Finally, the bill provides that the treatment of an injured
worker or dependent of an injured or deceased worker shall not be
delayed because of a claim by a medical provider. "
Further Reference:
NJ Task Force Report on Medical Provider Claims
"During our meetings, it came to the attention of the Task Force that “balance billing” is a
problem. This is the practice wherein authorized medical providers accept fees paid by the
carrier and then issue a bill to the petitioner for any remaining balance. In an effort to eradicate
this practice, the Task Force recommends an amendment to N.J.S.A. 34:15-15. Section 15 of the
Act requires that employers furnish and pay for physicians, surgeons and hospital services for the
injured worker. Having reviewed the statute and the case law, the Task Force believes that there
is a need to clarify that balance billing in the workers’ compensation setting is inappropriate.
Accordingly, the Task Force recommends the following amendment to N.J.S.A. 34:15-15 which
we would propose would appear as a paragraph between the final two paragraphs of that section.
This additional language would read as follows:
“Fees for treatments that have been authorized by the employer or
its carrier or its third party administrator, or which have been
determined by the court to be the responsibility of the employer, its
carrier or third party administrator, shall not be charged against or
collectible from the injured worker. Sole jurisdiction for any
disputed medical charge arising from a workers’ compensation
claim shall be vested in the Division of Workers’ Compensation.”
"Medical expenses in contested workers’ compensation cases are now a significant and troublesome issue resulting in uncertainty, delay and potential future liability. Th 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."
Statement of the Bill
"This bill prohibits the charging of workers’ compensation
claimants for medical expenses that have been authorized by the
employer or its carrier or its third party administrator, that have
been paid by the employer, its carrier or third party administrator
pursuant to pursuant to the workers’ compensation law, or which
been determined by the Division of Workers’ Compensation to
be the responsibility of the employer, its carrier or third party
administrator. The bill gives the division sole jurisdiction over
disputed work-related medical claims, and directs the division to
provide procedures to resolve those disputes, including procedural
requirements for medical providers or any other party to the
dispute. Finally, the bill provides that the treatment of an injured
worker or the payment of workers’ compensation to an injured
worker or dependent of an injured or deceased worker shall not be
delayed because of a claim by a medical provider. "
Further Reference:
NJ Task Force Report on Medical Provider Claims
"During our meetings, it came to the attention of the Task Force that “balance billing” is a
problem. This is the practice wherein authorized medical providers accept fees paid by the
carrier and then issue a bill to the petitioner for any remaining balance. In an effort to eradicate
this practice, the Task Force recommends an amendment to N.J.S.A. 34:15-15. Section 15 of the
Act requires that employers furnish and pay for physicians, surgeons and hospital services for the
injured worker. Having reviewed the statute and the case law, the Task Force believes that there
is a need to clarify that balance billing in the workers’ compensation setting is inappropriate.
Accordingly, the Task Force recommends the following amendment to N.J.S.A. 34:15-15 which
we would propose would appear as a paragraph between the final two paragraphs of that section.
This additional language would read as follows:
“Fees for treatments that have been authorized by the employer or
its carrier or its third party administrator, or which have been
determined by the court to be the responsibility of the employer, its
carrier or third party administrator, shall not be charged against or
collectible from the injured worker. Sole jurisdiction for any
disputed medical charge arising from a workers’ compensation
claim shall be vested in the Division of Workers’ Compensation.”
