A medical provider may a claim petition on his or her own behalf in New Jersey Worker’s Compensation Court to recover denied or improperly reduced reimbursement for services rendered to workers injured in on-the-job accidents. You, the medical provider, are free to choose your own attorney to pursue your claim for payment of Worker’s Compensation benefits. You are no longer required to rely upon the patient’s attorney to collect payment on your behalf. This is significant, as a patient’s attorney may ask you to compromise your bills in an effort to maximize the amount of money that his or her client receives from a settlement. The primary interest of the patient’s attorney is making sure the client walks away with the most money in his or her pocket, a focus which doesn’t necessarily translate into your practice maximizing its recovery from Workers Compensation insurance.
The New Jersey Workers Compensation system has no “fee schedule” to govern reimbursement to medical providers for treatment and services provided to injured workers. Unless you have a contractual arrangement through a network or PPO that includes the Workers Compensation insurer as a designated payor, you are entitled to receive payment at your usual and customary rates. Even when a network agreement is applicable, the Workers Compensation carrier may apply the contract rates incorrectly, or cut out reimbursement through “cross-walking,” “downcoding” and other similar creative auditing techniques.