Medical Providers Prohibited From Reporting to Credit Agencies
Workers' Compensation
NJ Governor Murphy has signed legislation (S.3036) that prohibits a provider to an injured worker of medical, surgical, other treatment, or hospital service according 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.
I. Background
A. NJ Medical Fees
The NJ workers’ compensation does not have a medical fee payment schedule. The employer or insurance carrier may negotiate and contract with a provider for medical fees. If a dispute arises, the medical fee is determined by a judge of compensation.
B. NJ No Choice of Physician
NJ injured workers are not permitted a free choice of their medical provider. All medical treatment incurred due to a work-related accident or occupational illness must be authorized and furnished by the employer or insurance company, which selects the medical provider and authorizes payment for medical treatment.
II. What the New Law Mandates
A. Prerequisites to Credit Reporting
As a result of the new law, a provider may only report such charges when:
1. A judge of compensation within the Division of Workers’ Compensation has fully adjudicated the rights and liabilities of all parties, including the rights of the claimant regarding the payment of these charges, or
2. When a notice of a stipulation settlement or an order approving settlement regarding the payment of these charges has been filed with the court.
B. Penalties
Upon a finding of non-compliance with the provisions of the bill, a judge of compensation within the Division of Workers’ Compensation, in addition to other provisions under the workers' compensation law, may:
a. Order the non-compliant provider to retract the medical, surgical, other treatment, or hospital service charges reported to the collection or credit reporting agency, bureau, or data collection facility;
b. Impose a fine on the non-compliant provider, not to exceed $5,000, payable to the Second Injury Fund;
c. Order the non-compliant provider to pay a reasonable counsel fee in connection with a claimant for payments who has suffered damage to credit rating due to the reporting of unpaid medical, surgical, other treatment, or hospital service charges to a collection or credit reporting agency, bureau, or data collection facility;
d. Order the non-compliant provider to take such steps as are necessary, within 30 days of the order, to rehabilitate the credit record of a claimant, with a showing made to the court of the efforts made in that regard; and
e. Order a non-compliant provider to pay an award of damages to the claimant not to exceed 25 percent of the medical, surgical, other treatment, or hospital service reported by the non-compliant provider to the collection or credit reporting agency, bureau, or data collection facility, the minimum award being $350.
III. Unintended Consequences
While the initial intent of the legislation is to protect injured workers and their credit ratings, it remains to be seen whether fewer medical providers will offer medical care without employer or insurance company approval. The law has the potential to shift the cost to other revenue sources, including private healthcare systems and government programs funded by taxpayers at-large.
IV. Free Choice of Physician
To encourage greater medical participation, this legislation may ultimately encourage further legislation allowing injured workers the right to choose their physician to provide medical care for work-related accidents and injuries.
See: S3030 P.L.2019, c. 416, eff. 1/21/2020.
….
Jon L. Gelman of Wayne, NJ, is the author of NJ Workers’ Compensation Law (West-Thomson-Reuters) and co-author of the national treatise, Modern Workers’ Compensation Law (West-Thomson-Reuters). For over five decades, the Law Offices of Jon L Gelman 1.973.696.7900 jon@gelmans.com have represented injured workers and their families who have suffered occupational accidents and illnesses.
© 2023 Jon L Gelman. All rights reserved.
Recommended Citation: Gelman, Jon L., Medical Providers Prohibited From Reporting to Credit Agencies, www.gelmans.com (2023), https://www.gelmans.com/ReadingRoom/tabid/65/ArtMID/1482/ArticleID/1078/preview/true/Default.aspx
© 2001-2023 Jon L Gelman. All rights reserved.
Attorney Advertising
Prior results do not guarantee a similar outcome.
Disclaimer
Download Adobe Reader
More links
-
Medical Fees: Does One Price Fit All?The Federal government has proposed a simplified medical billing process that may impact workers' compensation billing practices going forward. Most workers' compensation fee medical fee schedules are linked either directly and indirectly the to Federal Medicare model and a proposed Rule published last week in the Federal Register proposes a single fee for all office visits.
-
NJ Expands Access to Medical Marijuana to Include Common Work-Related ConditionsGovernor Phil Murphy announced major reforms to New Jersey’s Medicinal Marijuana Program. The permitted medical conditions now include many common work-related medical conditions.
-
Is Medicare-For-All a Prescription for Infectious Diseases in the Workplace?The workers’ compensation system nationally has been challenged over the last two plus years of the COVID Pandemic. The multi-state administered workers’ compensation program is based on a litigious patchwork of state programs with varying degrees of eligibility, procedures, and benefits.
-
Federal Preemption of State Medical Billing SchedulesMedical benefits are a significant factor in the overall costs of of most state workers compensation programs. The ability to contain those costs is at the very heart of the viability of most workers’ compensation systems. Federal preemption of state medical fee schedules and regulations are a prevailing challenge to the patchwork of non-uniform state benefit programs.
-
The Right to Choose Your DoctorSelecting your own treating physician in a workers’ compensation claim may soon become permitted nationally. A movement in Iowa has now sparked national interest to permit employees the right to choose their medical provider.
-
Building A Workers’ Compensation System That WorksState workers’ compensation systems are beginning to suffer from the impact of the national economic downturn. Economically induced factors are compounding the underlying issues that previously generated a growing level of critical stagnation. The combination of this dynamic now threatens the very core of the workers' compensation system and endangers its extinction.