During his time in office, former Governor Chris Christie signed a bill giving the Division of Workers’ Compensation jurisdiction over disputes related to medical costs associated with work injury claims. Medical providers and facilities with disputes regarding Workers’ Compensation payments can file Medical Claim Petitions (MCP) with the Division of Workers’ Compensation to be heard by Workers’ Compensation judges.
In the immediate years following Christie’s legislation, only around one to two percent of all Workers’ Compensation claims involved MCPs. Fast forward six years and nearly one in every five claims is an MCP case. As of November 2018, more than 6,300 MCP claims had already been filed in the Division of Workers’ Compensation that year.
There are many reasons for the growing number of Workers’ Compensation MCPs in New Jersey. Some experts believe the increase in disputes is due to discrepancies in provider network coverage, as well as the ongoing debate over fair and reasonable customary charges for medical services.
Preventing Time-Consuming MCPs
A spokeswoman from Managed Care Operations for First MCO, a New Jersey medical repricing company in New Jersey, believes many MCPs can be prevented with:
- Extensive provider networks: Comprehensive networks give employees access to a wide variety of physicians and facilities. MCPs often occur in cases where employees require emergency treatment from a provider that may not be in network. Their employer may dispute fees that do not resonate with average rates in their own geographical area.
- Employers should do their homework: Knowing more about where their physicians operate may reduce disputes. For example, the worker’s provider may be in network, but the facility where they perform surgery or other procedures is not. When employers do the leg work to ensure doctors and their hospitals are in network, there is less room for discrepancies.
Reasonable and Customary Charges
Many MCP cases are decided based on what constitutes reasonable and customary charges for medical services. Surprisingly, these fees are not uniform. They vary depending upon which databases are used to determine pricing. In one significant New Jersey case, two co-surgeons disagreed with the reimbursement they received for medical care they provided. They argued they each deserved at least 87.5 percent of customary charges.
The Workers’ Compensation insurance provider disagreed, insisting their payment of 73.6 percent to each surgeon was reasonable based upon payments made by other commercial insurance carriers. Despite the surgeons’ arguments that the severity of the patient’s injuries justified additional fees, the judge ruled against them.
Because MCPs are becoming more common, physician and facilities seeking to dispute Workers’ Compensation payments should consult a Cherry Hill Workers’ Compensation lawyer with expertise in this area. Significant compensation may be at stake.
Cherry Hill Workers’ Compensation Lawyers at Pietras Saracino Smith & Meeks LLP Represent Physicians with Medical Claim Petitions
For injured or ill workers, a skilled physician’s expertise is crucial to their recovery and for their chances of regaining their quality of life. When employers or insurance carriers file an MCP, the Cherry Hill Workers’ Compensation lawyers at Pietras Saracino Smith & Meeks LLP will advocate for you. Call us today at 856-761-3773 or use the online form to get started today. Located in Cherry Hill, New Jersey, we represent clients from the City of Camden and throughout South Jersey.