N.J. Admin. Code § 12:18-2.4

Current through Register Vol. 56, No. 24, December 18, 2024

Section 12:18-2.4 - Choice of doctor

(a) An employee covered under a private plan shall have the right to choose his or her own attending licensed medical practitioner, but he or she may be required to submit, not more often than once a week, to an examination by a licensed medical practitioner designated by the employer, insurer or organization paying benefits.

(b) Where a covered employee has utilized a licensed medical practitioner, and that licensed medical practitioner has examined the covered employee and has diagnosed him or her with a disabling condition, and where the licensed medical practitioner has certified that the employee's condition renders him or her unable to perform the duties of his or her employment for a given period of time, the employer, insurer or organization paying benefits may only deny benefits to the covered employee during that period so certified where:

1. The employer, insurer or organization paying benefits has contacted the covered employee's personal licensed medical practitioner and has reached a mutual agreement therewith as to a change in the period of the covered employee's disability;

2. A licensed medical practitioner designated by the employer, insurer or organization paying benefits has examined the covered employee and has determined that the covered employee is no longer disabled. Where such a determination has been made, benefits shall not be paid beyond the date of the examination;

3. A covered employee refuses to submit to or fails to attend an examination conducted by a licensed medical practitioner designated by the employer, insurer or organization paying benefits, in which case the covered employee shall be disqualified from receiving all benefits for the period of disability in question, except as to benefits already paid; or

4. The employer, insurer or organization paying benefits has obtained credible factual evidence showing that the covered employee is performing activities that demonstrate that he or she is able to perform the duties of his or her regular employment. In such instances, benefits shall not be paid beyond the date that such factual evidence is obtained.

N.J. Admin. Code § 12:18-2.4

Amended by R.1994 d.241, effective 5/16/1994.
See: 26 New Jersey Register 1326(a), 26 New Jersey Register 2131(a).
Amended by R.1998 d.157, effective 4/6/1998.
See: 30 New Jersey Register 12(a), 30 New Jersey Register 1288(a).
Substituted references to medical practitioners for references to physicians, dentists, chiropractors, podiatrists, practicing psychologists, and optometrists throughout.
Amended by R.2000 d.327, effective 8/7/2000.
See: 32 New Jersey Register 169(a), 32 New Jersey Register 1700(a), 32 New Jersey Register 2908(a).
Designated existing paragraph as (a) and added new (b).