ASSEMBLY, No. 1455

STATE OF NEW JERSEY

INTRODUCED FEBRUARY 5, 1996

By Assemblyman IMPREVEDUTO

An Act regarding the selection by an employee of treatment and services under the workers' compensation law and amending R.S.34:15-15 and R.S.34:15-23.

    Be It Enacted by the Senate and General Assembly of the State of New Jersey:

    1. R.S. 34:15-15 is amended to read as follows:

    The employer shall furnish to the injured worker such medical, surgical and other treatment, and hospital service as shall be necessary to cure and relieve the worker of the effects of the injury and to restore the functions of the injured member or organ where such restoration is possible; provided, however, that the employer shall not be liable to furnish or pay for physicians' or surgeons' services in excess of $50.00 and in addition to furnish hospital service in excess of $50.00, unless the injured worker or the worker's physician who provides treatment, or any other person on the worker's behalf, shall file a petition with the Division of Workers' Compensation stating the need for physicians' or surgeons' services in excess of $50.00, as aforesaid, and such hospital service or appliances in excess of $50.00, as aforesaid, and the Division of Workers' Compensation after investigating the need of the same and giving the employer an opportunity to be heard, shall determine that such physicians' and surgeons' treatment and hospital services are or were necessary, and that the fees for the same are reasonable and shall make an order requiring the employer to pay for or furnish the same. The mere furnishing of medical treatment or the payment thereof by the employer shall not be construed to be an admission of liability.

    [If the employer shall refuse or neglect to comply with the foregoing provisions of this section, the] The employee may secure, on the employee's own initiative, such treatment and services as may be necessary and as may come within the terms of this section, and the employer shall be liable to pay therefor; provided, however, that the employer shall not be liable for any amount expended by the employee or by any third person on the employee's behalf for any such physicians' treatment and hospital services, unless such employee or any person on the employee's behalf shall have [requested the employer to furnish the same and the employer shall have refused or neglected so to do,]notified the employer of the employee's intent to secure treatment and services or unless the nature of the injury required such services, and the employer or the superintendent or foreman of the employer, [having] has knowledge of such injury [shall have neglected to provide the same], or unless the injury occurred under such conditions as make impossible the notification of the employer, or unless the circumstances are so peculiar as shall justify, in the opinion of the Division of Workers' Compensation, the expenditures assumed by the employee for such physicians' treatment and hospital services, apparatus and appliances.

    All fees and other charges for such physicians' and surgeons' treatment and hospital treatment shall be reasonable and based upon the usual fees and charges which prevail in the same community for similar physicians', surgeons' and hospital services.

    When an injured employee may be partially or wholly relieved of the effects of a permanent injury, by use of an artificial limb or other appliance, which phrase shall also include artificial teeth or glass eye, the Division of Workers' Compensation, acting under competent medical advice, is empowered to determine the character and nature of such limb or appliance, and to require the employer or the employer's insurance carrier to furnish the same.

(cf: P.L.1979, c.283, s.7)

    2. R.S.34:15-23 is amended to read as follows:

    Whenever it shall appear that an employer is being prejudiced by virtue of the refusal of an injured employee to accept proffered medical and surgical treatment deemed necessary by the physician selected by the employer or by the employee's own physician, or his failure or neglect to comply with the instructions of the physician in charge of the case, the employer is hereby authorized to file a petition with the [workmen's compensation bureau] Division of Workers' Compensation, which is hereby empowered to order proper medical and surgical treatment at the expense of the employer. In the event of refusal or neglect by the employee to comply with this order the bureau shall make such modification in the award contained in the schedule as the evidence produced shall justify.

(cf: R.S.34:15-23)

    3. This act shall take effect on the 180th day after enactment.

STATEMENT

    This bill allows an employee covered by workers' compensation to select the physician and medical services used for the treatment of workplace injuries.

    The bill would bring the provisions of New Jersey's workers' compensation law regarding who selects medical service providers into compliance with the provisions of the laws of the majority of states. Under current New Jersey law, an employee is required to visit the physician of his employer's choice, unless the employer refuses to provide treatment, in which case the employee may select the physician. New Jersey is among the 17 states that currently have laws permitting the employer to select the attending physician in workers' compensation cases. Of those state laws, four permit an employee to change physicians after a waiting period and five permit a State agency to change the selection. Of 32 states which permit the employee to choose the physician: three require the employee to select the physician from a list provided by a state agency; three require that the employee select a physician from a list provided by the employer; and the other 26 states, like this bill, give a free choice of physicians to the employee.

Allows employee selection of physician and medical services under workers' compensation.