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The Issues Surrounding Managed Health Care in the New Jersey Workers' Compensation System

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Worker’s Compensation is the insurance that provides medical care and/or cash benefits for workers who are injured while they are on the job. However, when it comes to finding health care providers who will see, treat, and cover individuals who have been injured because of a workplace incident, it seems these facilities are far and few between.


What is WCMCO?

Through the State of New Jersey Department of Banking and Insurance, the Worker’s Compensation Managed Care Organization (WCMCO) was established. The Worker's Compensation Managed Care Organization is any entity that manages the utilization of care and costs associated with claims covered by workers' compensation insurance (“NJDOBI Workers Compensation, 2021”). It is through this organization and New Jersey’s Workers Compensation Law that permits employers to select providers of medical services for their injured employees (“NJDOBI Workers Compensation, 2021”).


Who Can Treat Your Injuries?

When you are injured on the job, your first reaction is to go to a doctor or facility that you are most comfortable with or have treated at before. However, when it comes to making sure your treatment is covered by insurance, you have to treat with a facility that has been pre-approved by your employer or Workers’ Compensation insurer. This limitation can be seen as problematic if the network lacks specific specialists or if the employee has established a relationship with another facility and wishes to continue treatment with them instead of who is approved.


Are There Personalized Care Issues that Come with Using an Insurance Doctor?

Another issue that surrounds the managed health care is the lack of personalized care that comes with employees seeing doctors they are unfamiliar with. In some instances, providers may have predetermined guidelines they are required to follow and abide by, making sure that every injured employee fits the predetermined guidelines. However, in cases where the employee does not fit into those guidelines and may require additional or special treatment, they might not receive that treatment from the pre-approved doctors. This lack of personalized care could end up having a negative impact on the employee’s treatment journey and ability to return to work within a reasonable time.

While the system of Managed Health Care in New Jersey’s Workers’ Compensation System is not perfect, it should be something that can be easily navigated for the employees. Despite this, there are some things that you may need to consider and consult with an attorney on. At Scura, Wigfield, Heyer, Stevens & Cammarota, LLP, we are dedicated to ensuring that you receive the best possible treatment for your work-related injury. Contact our firm to schedule a consultation.

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