N.J. Admin. Code § 12:235-7.4

Current through Register Vol. 56, No. 9, May 6, 2024

Section 12:235-7.4 - Medical bills; physician's examination

(a) Any medical bills or charges for which petitioner seeks payment from the UEF must be timely submitted by the petitioner to the UEF and be supported by the following:

1. Related treating records, itemized bills and a physician's report, which reflects that the bills and charges were reasonable, necessary and causally related to the work accident or occupational exposure alleged in the claim petition; and

2. Other necessary medical documentation or information required by the UEF.

(b) Any dispute under this section concerning the treating records, bills, physician's report or UEF request for other medical documentation or information shall be determined by the judge after a hearing upon oral or written motion by the UEF or another party.

(c) The UEF may order an independent medical examination of a petitioner by a physician at any time when the UEF is involved or when it appears the UEF may become involved in a case. The examining physician may be asked to offer an opinion on:

1. The causal relationship between the alleged accident or occupational exposure and the petitioner's current medical condition;

2. The necessity of petitioner's previous and current medical treatment and the reasonableness of charges for such treatment for the alleged accident or occupational exposure;

3. The prognosis for the petitioner;

4. Whether the petitioner is able to return to work;

5. Whether or not petitioner required further treatment to reach maximum medical improvement; and

6. Any other pertinent issues or information.

(d) Fees for the independent medical evaluation ordered by the UEF shall be paid by the UEF.

(e) If it appears that the petitioner may be entitled to benefits from the UEF, then the UEF may direct the petitioner to the appropriate authorized treating physician for treatment.

1. Treatment obtained by petitioner from any physician other than the one authorized by the UEF shall be deemed to be unauthorized treatment, and costs for such treatment shall not be payable by the UEF.

(f) The UEF may provide for medical care to assist the petitioner until he or she has reached maximum medical improvement.

N.J. Admin. Code § 12:235-7.4

Amended by R.1991 d.466, effective 9/3/1991.
See: 23 N.J.R. 1759(a), 23 N.J.R. 2642(a).
Text at (a)1 and 2, (e) deleted; physician's opinion specified at (b).
Amended by R.1997 d.110, effective 3/3/1997.
See: 28 N.J.R. 4067(a), 29 N.J.R. 799(a).
Recodified from N.J.A.C. 12:235-12.4 by R.2002 d.340, effective 10/21/2002.
See: 34 N.J.R. 2257(a), 34 N.J.R. 2549(a), 34 N.J.R. 3641(d).
Former N.J.A.C. 12:235-7.4, Filing, recodified to N.J.A.C. 12:235-5.3.
Amended by R.2004 d.263, effective 7/6/2004.
See: 36 N.J.R. 1350(a), 36 N.J.R. 3294(a).
Rewrote (b); in (c), inserted "ordered by the UEF" following "evaluation"; in (d)1, substituted "payable by" for "chargeable to" preceding "the UEF"; added (e).
Amended by R.2009 d.299, effective 10/5/2009.
See: 41 N.J.R. 1935(a), 41 N.J.R. 3807(a).
Rewrote (a); added new (b); and recodified former (b) through (e) as (c) through (f).