Bill Text: NJ S3152 | 2014-2015 | Regular Session | Introduced
Bill Title: Revises workers' compensation law concerning fraud and evaluating physicians.
Spectrum: Partisan Bill (Republican 1-0)
Status: (Introduced - Dead) 2015-09-24 - Introduced in the Senate, Referred to Senate Labor Committee [S3152 Detail]
Download: New_Jersey-2014-S3152-Introduced.html
Sponsored by:
Senator ROBERT W. SINGER
District 30 (Monmouth and Ocean)
SYNOPSIS
Revises workers' compensation law concerning fraud and evaluating physicians.
CURRENT VERSION OF TEXT
As introduced.
An Act concerning workers' compensation, amending P.L.1998, c.74 and R.S.34:15-64, and supplementing chapter 15 of Title 34 of the Revised Statutes.
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. Section 1 of P.L.1998, c.74 (C.34:15-57.4) is amended to read as follows:
1. a. A person shall be guilty of a crime of the fourth degree if the person purposely or knowingly:
(1) Makes, when making a claim for benefits pursuant to R.S.34:15-1 et seq., a false or misleading statement, representation or submission concerning any fact that is material to that claim for the purpose of wrongfully obtaining the benefits;
(2) Makes a false or misleading statement, representation or submission, including a misclassification of employees, or engages in a deceptive leasing practice, for the purpose of evading the full payment of benefits or premiums pursuant to R.S.34:15-1 et seq.; or
(3) Coerces, solicits or encourages, or employs or contracts with a person to coerce, solicit or encourage, any individual to make a false or misleading statement, representation or submission concerning any fact that is material to a claim for benefits, or the payment of benefits or premiums, pursuant to R.S.34:15-1 et seq. for the purpose of wrongfully obtaining the benefits or of evading the full payment of the benefits or premiums.
b. Any person who wrongfully obtains benefits or evades the full payment of benefits or premiums by means of a violation of the provisions of subsection a. of this section shall be civilly liable to any person injured by the violation for damages and all reasonable costs and attorney fees of the injured person, if that violation is established by a preponderance of the evidence.
c. (1) If a person purposely or knowingly makes, when making a claim for benefits pursuant to R.S.34:15-1 et seq., a false or misleading statement, representation or submission concerning any fact which is material to that claim for the purpose of obtaining the benefits, the division may order the immediate termination or denial of benefits with respect to that claim and a forfeiture of all rights of compensation or payments sought with respect to the claim.
(2) Notwithstanding any other provision of law, and in addition to any other remedy available under law, if that person has received benefits pursuant to R.S.34:15-1 et seq. to which the person is not entitled, he is liable to repay that sum plus simple interest to the employer or the carrier or have the sum plus simple interest deducted from future benefits payable to that person, and the division shall issue an order providing for the repayment or deduction.
(3) Notwithstanding any other provision of law, and in addition to any other remedy available under law, a person who evades the full payment of premiums pursuant to R.S.34:15-1 et seq. or improperly denies or delays benefits pursuant to R.S.34:15-1 et seq. is liable to pay the sum due and owing plus simple interest.
d. Nothing in this section shall preclude, if the evidence so warrants, indictment and conviction for a violation of any provision of chapter 20, 21 or 28 of Title 2C of the New Jersey Statutes or any other law. For the purpose of this section, "purposely," "knowingly" and "purposely or knowingly" have the same meaning as is provided in chapter 2 of Title 2C of the New Jersey Statutes.
(cf: P.L.1998, c.74, s.1.)
2. R.S.34:15-64 is amended to read as follows:
34:15-64. a. The commissioner, director and the judges of compensation may make such rules and regulations for the conduct of the hearing not inconsistent with the provisions of this chapter as may, in the commissioner's judgment, be necessary. The official conducting any hearing under this chapter may allow to the party in whose favor judgment is entered, costs of witness fees and a reasonable attorney fee, not exceeding 20% of the judgment; and a reasonable fee not exceeding $400 for any one witness, except that the following fees may be allowed for a medical witness:
(1) (a) A fee of not more than $400 paid to an evaluating physician for an opinion regarding the need for medical treatment or for an estimation of permanent disability, if the physician provides the opinion or estimation in a written report; and
(b) An additional fee of not more than $400 paid to the evaluating physician who makes a court appearance to give testimony; or
(2) (a) A fee of not more than $450 paid to a treating physician for the preparation and submission of a report including the entire record of treatment, medical history, opinions regarding diagnosis, prognosis, causal relationships between the treated condition and the claim, the claimant's ability to return to work with or without restrictions, what, if any, restrictions are appropriate, and the anticipated date of return to work, and any recommendations for further treatment; and
(b) (i) An additional fee of not more than $300 per hour, with the total amount not to exceed $2,500, paid to the treating physician who gives testimony concerning causal relationship, ability to work or the need for treatment; or
(ii) An additional fee of not more than $300 per hour, with the total amount not to exceed $1,500, paid to the treating physician who gives a deposition concerning causal relationship, ability to work or the need for treatment.
b. (1) No fee for an evaluating physician pursuant to this section shall be contingent on whether a judgment or award is or is not made in favor of the petitioner.
(2) No evaluating or treating physician shall charge any fee for a report, testimony or deposition in excess of the amount permitted pursuant to the provisions of this section.
(3) If a claimant is found to have made a false or misleading statement, representation or submission concerning any fact which is material to a claim for obtaining benefits pursuant to subsection a. or b. of section 1 of P.L.1998, c.74 (C.34:15-57.4), and the judge of compensation makes a finding that the evaluating or treating physician was complicit in that statement, representation or submission, the physician shall forfeit any fees allowed pursuant to this section.
c. A fee shall be allowed at the discretion of the judge of compensation when, in the official's judgment, the services of an attorney and medical witnesses are necessary for the proper presentation of the case. In determining a reasonable fee for medical witnesses, the official shall consider (1) the time, personnel, and other cost factors required to conduct the examination; (2) the extent, adequacy and completeness of the medical evaluation; (3) the objective measurement of bodily function and the avoidance of the use of subjective complaints; and (4) the necessity of a court appearance of the medical witness. When, however, at a reasonable time, prior to any hearing compensation has been offered and the amount then due has been tendered in good faith or paid within 26 weeks from the date of the notification to the employer of an accident or an occupational disease or the employee's final active medical treatment or within 26 weeks after the employee's return to work whichever is later or within 26 weeks after employer's notification of the employee's death, the reasonable allowance for attorney fee shall be based upon only that part of the judgment or award in excess of the amount of compensation, theretofore offered, tendered in good faith or paid. When the amount of the judgment, or when that part of the judgment or award in excess of compensation, offered, tendered in good faith or paid as aforesaid, is less than $200, an attorney fee may be allowed not in excess of $50.
d. All counsel fees of claimants' attorneys for services performed in matters before the Division of Workers' Compensation, whether or not allowed as part of a judgment, shall be first approved by the judge of compensation before payment. Whenever a judgment or award is made in favor of a petitioner, the judges of compensation or referees of formal hearings shall direct amounts to be deducted for the petitioner's expenses and to be paid directly to the persons entitled to the same, the remainder to be paid
directly to the petitioner.
(cf: P.L.2002, c.112.)
3. (New section) No judge of compensation shall order, refer, or recommend a claimant to be evaluated by a specific physician or group of physicians. If a judge of compensation is found to have ordered, referred, or recommended a claimant to a specific physician or group of physicians, the director shall suspend that judge without pay for a period of not less than two weeks.
4. This act shall take effect immediately.
STATEMENT
This bill revises the laws concerning workers' compensation fraud and the evaluations of physicians in workers' compensation cases.
Specifically, the bill establishes the evidentiary standard for civil violations of the workers' compensation law as a preponderance of the evidence, for individuals who wrongfully obtain benefits or evade the full payment of benefits or premiums. While this standard has typically been used in workers' compensation proceedings, this change clarifies any ambiguity as to the appropriate evidentiary standard.
The bill also provides that, if a claimant is found to have made a false or misleading statement, representation or submission concerning any fact which is material to a claim for obtaining benefits, and the judge of compensation makes a finding that the evaluating or treating physician was complicit in that statement, representation or submission, the physician shall forfeit any fees allowed pursuant to current law.
The bill also provides that no judge of compensation may order, refer, or recommend a claimant to be evaluated by a specific physician or group of physicians. Under the bill, if a judge of compensation is found to have ordered, referred, or recommended a claimant to a specific physician or group of physicians, the Director of the Division of Workers' Compensation must suspend that judge without pay for a period of not less than two weeks.
