MOUNTAINSIDE, N.J., July 8, 2013 /PRNewswire/ — Constraints and controls imposed by health insurers outrage both doctors and patients[i]. Medical trade organizations, such as the American Psychological Association, resist cuts in insurance and managed care rates. The NJ Commissioner of Banking and Insurance new medical reimbursement schedule and dispute process went into effect this year on Jan. 4, 2013, raising similar concerns regarding the State of NJ's intrusion into the practice of medicine. The regulations promise to penalize those injured in auto accidents, and the doctors who treat their injuries.
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According to Mountainside, NJ personal injury attorney Francis M. Smith, Esq., "NJ's process for handling medical expenses for automobile accident injuries has been frustrating and exhausting for injured victims of car accidents, and their doctors." He explains: "Although the insurance industry has the clout to influence regulation changes, consumers do not."
The new Personal Injury Protection (PIP) regulations impact injured parties, health care providers and/or insurers in five ways:
Dispute Resolution Process. A PIP dispute between the medical provider and insurer can now be adjudicated (when both sides consent) with a "documentary review," (a/k/a an "on-the-papers" proceeding) when no further treatment is proposed and the amount in issue is under $1,000. (N.J.A.C. 11:3-5.2)
Assignment of Benefits. The State of NJ may restrict the choice of medical providers to those who agree to: (1) the insurer's review plan, (2) holds the insured harmless for co-payment penalties, and (3) agrees to submit disputes to PIP arbitrations, currently administered by Forthright. (N.J.A.C. 11:3-4.9(a))
Counsel Fees. The definition of what constituted reasonable counsel fees has changed (N.J.A.C. 11:3-5(e)). The idea is to try to lower attorney's fees. Some think this is an effort to dissuade attorneys from filing for arbitration for their clients.
Standard Professional Treatment Protocols. All treatment, diagnostic tests and services are to be rendered according to common standards and practices. Standard Professional Treatment Protocols now mean "evidence-based clinical guidelines/practice/treatment published in peer-reviewed journals." (N.J.S.A. 39:6A-4(a))
Internal Appeal Procedure: All insurance companies now must use the same appeal process for medical decision-point plans. That is, when a physician and insurer do not agree on whether a medical treatment or test is required, the physician now has only one appeal process to manage, rather than different appeal processes for every insurance company. (N.J.A.C. 11:3-4.7B)
"To attorneys who represent accident victims, these changes signal a significant shift, altering the playing field in favor of insurance companies who can now deny benefits without fear of significant consequences (and certainly none in the arbitration process)," observes Mr. Smith. "If allowed to stand, the changes instituted will prove that New Jersey is a state that is anti-consumer and pro-insurer with regard to auto insurance and medical benefits provided by auto insurance policies," he adds. Legal proceedings have been commenced intended to force reconsideration of the new Personal Injury Protection regulations.
[i] http://www.who.int/bulletin/archives/78(6)830.pdf
About Francis M. Smith, Esq., a New Jersey Personal Injury Lawyer
NJ Personal Injury Lawyer Francis M. Smith, Esq. civil approach has yielded outstanding results recovering more than $33,000,000 since 1996 for seriously injured clients in auto accidents, slip and fall accidents, dog bites, falls in super markets, work place and industrial accidents, and in dangerous premises. He offers free consultation and "no fee if no recovery" representation. He is a Life Member of the Multi-Million Dollar Advocates Forum®, The Top Trial Lawyers in America®, Court-appointed arbitrator, mediator and guardian. Mr. Smith handles all types of personal injury cases throughout northern NJ. More information on Francis M. Smith is available at http://www.FrankSmithLaw.com.
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