NEW JERSEY
Employer or Carrier Selects
The employer has the right to choose the treating physician. If the employer refuses to provide medical treatment, the injured worker is free to choose the treating physician. However, in the case of an emergency, an injured worker may obtain medical or hospital treatment without specific
authorization from the employer, but the employer should be notified as soon as possible concerning
the treatment being received. (N.J. Stat. § 34:15-15, NJ Department of Labor & Workforce Development Website:
http://lwd.dol.state.nj.us/labor/forms_pdfs/wc/pdf//wc(g)-338.pdf
Panels
Not addressed
Panel Provisions
See Direction of Care law.
NEW JERSEY MCO
Employer or Carrier Selects
The WCMCO shall ensure that workers of employers covered by the WCMCO are able to receive, at a minimum, the following services:
4. Be directed to medical service providers within a reasonable distance from the worker's place of employment, considering the nature of care required and normal patterns of travel. To receive urgent care, the worker shall be assigned to a physician near the workplace. The assigned care coordinator physician will, in turn, arrange for necessary care through a provider closer to the worker's residence, if appropriate;
5. Receive treatment by a non-WCMCO medical service provider at the direction of the care coordinator physician when the worker resides outside the WCMCO's geographical service area. The care coordinator physician may only select a non-WCMCO provider who practices closer to the worker's residence than an WCMCO provider of the same category if that non-WCMCO provider agrees to terms and conditions of the WCMCO; 7. Emergency treatment in accordance with procedures that provide that in a potentially life threatening condition, the 911 emergency response system should be called or the worker should be taken to the nearest hospital emergency department. For fixed work sites, an WCMCO may instead submit alternative emergency treatment procedures that provide equivalent promptness of treatment and level of care. (N.J.A.C. 11:6-2.12(a))
Change of Provider
Not Addressed
Panels
Not addressed
Panel Provisions
See Direction of Care law for network access requirements.
In previous discussions with NJ regulators, the state advised that an application for WCMCO may include a sample panel as a methodology for direction of care. This sample panel must include information regarding emergency treatment (See 11:6-2.12 (a)(7).
The information on this website constitutes summary information only and does not constitute legal advice. Review of the full text of the referenced statutes and regulations may be necessary. Coventry Health Care Workers' Compensation, Inc. makes no representations or warranties about the accuracy of the information contained on this website.