Workers' Compensation Claims Reporting

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NJM Insurance Group provides a comprehensive, seamless approach to claims management and quality, cost-effective medical treatment of injured workers. Our own employees are responsible for adjusting a loss, arranging for therapy, helping the injured worker return to work as soon as possible and, if necessary, defending any legal action in Workers' Compensation court.

In 1996, NJM became the first Workers' Compensation carrier in New Jersey to become state-certified as its own Managed Care Organization (MCO). While many other insurers utilize outside medical peer review groups and nursing agencies, NJM offers a full complement of managed care services through its own salaried staff. Our MCO network includes physicians, acute-care hospitals, rehabilitation hospitals, imaging facilities, physical therapy centers, and other providers that are contracted either directly with NJM or with our PPO partner, Procura Management, Inc. See links under NJM Managed Care Organization.

A licensed physical therapist oversees NJM's own physical therapy precertification program, which has significantly reduced the number of unnecessary treatments.

Additionally, we have an agreement with a major pharmaceutical chain to provide prescription medications to injured workers – NJM is billed directly. Employees receive their medications promptly while avoiding out-of-pocket expenses.

Our in-house Medical Utilization Department, which is staffed by registered nurses and other certified health care professionals, provides the following managed care services: medical case management, utilization review, physician bill review and quality assurance/continuing quality improvement. These health care professionals provide expanded support and medical expertise to the claims and legal staffs, ensuring that health care services are utilized responsibly and medical treatment is appropriate for the work-related injury. They also help injured employees return to work as quickly as possible and consult with NJM's attorneys and claims adjusters on a daily basis. This team approach is unique to NJM.