How to Get Emergent Medical Care Under Workers' Compensation Insurance
The NJ Division of Workers’ Compensation [NJ-DWC] has a streamlined procedure to obtain emergent medical care.
The NJ-DWC has approximately 95,000 cases open cases pending in the system each year. The program attempts to efficiently and effectively handle disputes as to medical benefits, temporary disability, and permanent disability issues.
EMERGENT MEDICAL CARE
Emergent medical care is a type of medical care that is needed in urgent or emergency situations. This type of care is provided to patients who have a medical condition that requires immediate attention, such as a heart attack or stroke. The goal of emergent medical care is to stabilize the patient and provide the necessary medical treatment as quickly as possible to prevent further complications or harm to the patient.
ORDINARY MOTIONS FOR MEDICAL TREATMENT
Two procedural motions are available to parties who seek medical care when a dispute arises. An ordinary motion for medical care, established by regulation, has been utilized for years, if not decades, as an avenue to seek redress. The ordinary motion addresses the needs of the parties who require medical care, but their condition is not emergent. These motions are handled at the local hearing office level, and their status is reported to the Director of the Division of Workers’ Compensation every 90 days if they remain pending. Approximately 2% of the pending claims statewide involve such ordinary medical motions.
EMERGENT MOTION FOR MEDICAL TREATMENT
As a result of concerns expressed in the media that alleged long delays in the handling of claims for emergent medical care, the NJ Legislature enacted a statutory mechanism to resolve disputes. That motion requires the observance of a stringent timetable for judicial action. In those cases where there is a need for emergent medical care, and the failure to provide it on a timely basis would result in irreparable harm, the new administrative procedures for an emergent medical motion may be invoked. See “Motions for emergent medical care—generally,’ 39 N.J. Prac., Workers' Compensation Law § 23.5.10 (3d ed.) Thomson-Reuters.
Immediately following the enactment of the statutory changes, the NJ-DWC promulgated Rules to be followed in processing emergent care motions that would conform with the Legislative mandate. The NJ-DWC operated in conformance with the proposed Rules until they were finally adopted on October 5, 2008, which followed a period for public comment, The rules set forth specific criteria and addressed procedural compliance issues. The Rules permit those injured workers who need urgent medical care to immediately access the NJ-DWC system for a speedy and efficient resolution of their claim.
The efforts and concerns of the NJ Legislature and the Division of Workers’ Compensation have improved the administrative process. While this favorable aspect of the NJ workers’ compensation system cannot be globally utilized to solve all the shortcomings of the national healthcare crisis, it is a step in the right direction. It may provide some guidance in the ongoing national healthcare debate.
The author, Jon L. Gelman, practices law in Wayne, NJ. He is the author of NJ Workers’ Compensation Law (Thomson-Reuters) and co-author of the national treatise Modern Workers’ Compensation Law (Thomson-Reuters). For over five decades, the Law Offices of Jon L Gelman 1.973.696.7900 email@example.com have represented injured workers and their families who have suffered occupational accidents and illnesses.
© 2009-2022 Jon L Gelman. All rights reserved.
Recommended Citation: Gelman, Jon L., How to Get Emergent Medical Care Under Workers' Compensation Insurance, www.gelmans.com (2020), https://www.gelmans.com/ReadingRoom/tabid/65/ArtMID/1482/ArticleID/980/preview/true/Default.aspx
New Fee Rules for Obtaining Medical RecordsA new law has been enacted that amends the current law concerning the fees that may be charged for copies of medical and billing records by hospitals and by health care professionals licensed by the Board of Medical Examiners. Obtaining medical records in Workers’ Compensation actions is a standard claim and litigation procedure.
Law Would Increase Transparency in the Workers’ Compensation Medical Delivery SystemSenator Troy Singleton (NJ D-7) has introduced legislation that would increase transparency in medical treatment arising from workers’ compensation claims.
Medical Providers Prohibited From Reporting to Credit AgenciesNJ Governor Murphy has signed legislation (S.3036) that prohibits a provider to an injured worker of medical, surgical, other treatment, or hospital service pursuant to the workers' compensation law, R.S.34:15-1 et seq., from reporting any portion of their charges which are alleged to be unpaid, to any collection or credit reporting agency, bureau, or data collection facility.
Medical Treatment is an Exclusive Remedy Not a Reasonable AccommodationThe NJ Supreme Court has held that the provision of medical treatment does not equate to a "reasonable accommodation", therefore an employee cannot claim under the Law Against Discrimination [LAD] that failure to provide medical care was actionable. The provision of medical treatment is an exclusive remedy of the Workers’ Compensation Act.
Should Workers' Compensation Be In The Wellness Business?A recent study indicate that wellness programs are exceptionally important. Employers and workers' compensation insurance companies would be wise to follow this initiative. One out of every four dollars employers pay for health care is tied to unhealthy lifestyle choices or conditions like smoking, stress and obesity, despite the fact that most large employers have workplace wellness programs.
When An Employer Should Not Deny Medical CareIt is always tricky slope for an employer to deny medical care based on a pre-existing medical condition. The employer must be absolutely certain that the proofs offered at trial will provide a credible basis for a ruling by the Court. Without that certainty, the employer could be subject to paying for uncontrolled medical care as well as for penalties.
Preventing Joint Replacement Surgery in Workers' Compensation Claims