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Workers' Compensation Managed Care Organizations Regulatory Requirements

In order to qualify to offer the reduced premium to employers, a worker's compensation insurer must utilize a WCMCO that the Department has approved as capable of providing the kinds of care required to treat workplace-related injuries and diseases.

Once the WCMCO has met the approval criteria set forth in the rules, it may enter into a written agreement with an insurer to provide medical services under a workers' compensation insurance policy. An insurer willing to offer a premium reduction, after contracting with a WCMCO that has obtained Department approval, or after obtaining its own WCMCO approval, is then required to file certain information with the Compensation Rating and Inspection Bureau (CRIB). These insurer filing requirements are set forth in the CRIB Manual. At the completion of both these steps, the worker's compensation insurer may then implement the managed care program by offering employers a managed care program policy endorsement developed by CRIB that will reduce the employer's premium by at least five percent.

Organizations that want to be approved as WCMCOs must submit an application to the New Jersey Department of Banking and Insurance, complying with all of the rules applicable to WCMCOs.

 
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New Jersey Department of Banking and Insurance