New Jersey Medical Direction of Care
The employer has the right to choose the medical provider. If an employer refuses to provide treatment the injured employee may seek treatment on his/her own, conditioned on a demand on the employer except:
- In an emergency,
- Where the employer has knowledge of the injury and fails to act,
- “Circumstances are so peculiar,”
- The request for treatment would be futile.
With a Workers' Compensation Managed Care Organization (MCO) there are no significant changes, providing the MCO has an adequate number of providers within the service areas.
"Gatekeeper" primary treaters serve to refer additional treatment within the MCO.
Workers' Compensation Managed Care Organizations
A Workers' Compensation Managed Care Organization (MCO) is any entity that manages the utilization of care and costs associated with claims covered by workers' compensation insurance, which must be approved by the Department of Banking & Insurance (DOBI) in accordance with N.J.A.C. 11.6-1 et seq. New Jersey's Workers' Compensation Law (N.J.S.A. 34:15-1 et seq.) permits employers to select providers of medical services for injured workers. As an alternative to the traditional approach to workers' compensation coverage, employers may opt to utilize a managed care system for the delivery of quality medical care to injured employees at a reduced premium. Thus, employers will be eligible to receive at least a five percent reduction in policyholder standard premium by selecting the managed care option offered by the employer's workers' compensation insurer if the insurer uses a Department approved MCO.
To view the New Jersey MCO Regulations and the list of approved MCOs, please click on this URL link http://www.state.nj.us/dobi/division_insurance/managedcare/wcmco.htm .
For additional information regarding Gallagher Bassett's New Jersey Managed Care Organization offering, please contact your Gallagher Bassett Account Executive.
DISCLAIMER. The content of this Web site is provided for informational purposes only, from a general insurance/risk management perspective, with the understanding that Gallagher Bassett Services, Inc. (GB) is not rendering legal, accounting or other professional advice on specific matters. Accordingly, GB assumes no liability whatsoever in connection with the use of such content. GB recommends that you consult your legal counsel or other professional advisor with respect to your individual situation.
The information provided throughout this Web site is provided from a general insurance/risk management perspective and is NOT legal advice. Gallagher Bassett Services, Inc. (GB) does not provide legal advice as it is not qualified to do so. GB recommends that you seek the advice of legal counsel in order to become fully apprised of the legal implications related to the information provided above as such implications are highly dependent on the unique facts and circumstances applicable to an individual situation.