New Jersey Administrative Code
Title 11 - INSURANCE
Chapter 3 - AUTOMOBILE INSURANCE
Subchapter 5 - PERSONAL INJURY PROTECTION DISPUTE RESOLUTION
Section 11:3-5.8 - Medical review organizations
Universal Citation: NJ Admin Code 11:3-5.8
Current through Register Vol. 56, No. 24, December 18, 2024
(a) Medical review organizations shall be authorized to determine in connection with the PIP dispute resolution process set forth in this subchapter:
1. Whether the medical treatment or
diagnostic test is medically necessary;
2. Whether the treatment is in accordance
with medically recognized standard protocols including those protocols approved
by the Commissioner and set forth in N.J.A.C. 11:3-4;
3. Whether the treatment is consistent with
symptoms or diagnosis of the injury;
4. Whether the injury is causally related to
the accident ;
5. Whether the
treatment is of a palliative rather than a restorative nature; and
6. Whether medical procedures and tests that
have been repeated are medically necessary.
(b) The findings of a medical review organization shall be presumed to be correct, but may be rebutted by a preponderance of the evidence submitted to the dispute resolution professional.
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