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Considering workers’ compensation medical care coverage rules

According to recent research by the Workers Compensation Research Institute, injured workers from New York are increasing costs to employers by coming to New Jersey for treatment at ambulatory centers. The number of workers travelling to New Jersey for treatment is on the increase.

Why would injured New York workers come to New Jersey for medical treatment? According to the institute, it is because New York’s workers’ compensation system allows out-of-state providers to bill at the going rate in their geographical area. The costs can be significantly greater out-of-state, sometimes by thousands of dollars.

Contrast New York’s system with Pennsylvania’s, which caps medical fees based on a provider’s place of business in state and which caps medical fees for out-of-state providers at the rates prevailing in Harrisburg, Pennsylvania.

It isn’t surprising that, given a window of opportunity, the medical industry is taking advantage of the situation. Commentators have noted that surgeons may be taking advantage of it by accommodating injured workers for earlier surgeries in order to bring in high-profit business.

For injured workers, of course, the main concern is to obtain the medical care needed to recovery from a workplace accident rather than worry about the details of the workers’ compensation billing system. Injured workers do, however, need to be aware of the rules governing workers’ compensation coverage of medical care. Failure to follow the rules can result in medical care not being covered by the workers’ compensation insurer, which is one reason it is beneficial to work with an experienced workers’ compensation attorney when pursuing a claim. 

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