New Jersey Administrative Code
Title 11 - INSURANCE
Chapter 6 - NEW JERSEY WORKERS' COMPENSATION MANAGED CARE ORGANIZATIONS
Subchapter 2 - NEW JERSEY WORKERS' COMPENSATION MANAGED CARE ORGANIZATIONS
Section 11:6-2.12 - Minimal WCMCO treatment standards and protocols

1. Initial treatment by a participating physician within 72 hours (depending on the nature of the injury or illness) of the WCMCO's knowledge of the necessity or request for treatment;

2. Initial treatment by a participating physician in the WCMCO within five working days or as soon thereafter as practicable, following treatment by a physician outside the WCMCO;

3. Screening and treatment, if necessary, by a WCMCO physician in cases requiring in-patient hospitalization;

4. Be directed to medical service providers within a reasonable distance from the worker's place of employment, considering the nature of care required and normal patterns of travel. To receive urgent care, the worker shall be assigned to a physician near the workplace. The assigned care coordinator physician will, in turn, arrange for necessary care through a provider closer to the worker's residence, if appropriate;

5. Treatment by a non-WCMCO medical service provider at the direction of the care coordinator physician when the worker resides outside the WCMCO's geographical service area. The care coordinator physician may only select a non-WCMCO provider who practices closer to the worker's residence than a WCMCO provider of the same category if that non-WCMCO provider agrees to the terms and conditions of the WCMCO;

6. Specialized medical services the WCMCO is not otherwise able to provide. The WCMCO's application shall include a description of the places and protocol of providing such specialized medical services; and

7. Emergency treatment in accordance with procedures that provide that in a potentially life threatening condition, the 911 emergency response system should be called or the worker should be taken to the nearest hospital emergency department.