For practitioners unfamiliar with defending against workers’ compensation claims in New Jersey, there is more than meets the eye than an employee merely filing a claim against their employer alleging injuries sustained during the course and scope of employment. The fact that an employer/carrier directs care in New Jersey is one of the most poignant aspects of the practice. Historically, a dispute over treatment costs was handled generally as a contractual dispute through the Superior Court. After the passage of Assembly No. 2652 (L. 2012, c. 67) by Governor Christopher Christie on November 19, 2012, exclusive jurisdiction over medical fee disputes became vested with the New Jersey Division of Workers’ Compensation.
Unlike the workers’ compensation laws in neighboring jurisdictions, such as New York and Pennsylvania, New Jersey does not have a Fee Schedule for workers’ compensation claims. Instead, New Jersey applies the “usual and customary rate” standard set forth under N.J.S.A. 34:15-15, which provides in part:
- All fees and other charges for such physicians' and surgeons' treatment and hospital treatment shall be reasonable and based upon the usual fees and charges which prevail in the same community for similar physicians', surgeons' and hospital services.
The “usual and customary rate” standard in the absence of a more concrete Fee Schedule has given rise to additional litigation before the Division beyond the standard Claim Petition. Those of us in the industry are familiar with a recurring fact pattern. This pattern involves a New Jersey provider who files a Medical Provider Application for the payment/reimbursement for treatment arising from a workers’ compensation claim pursued under the jurisdiction of a different state. Since there is no Fee Schedule, filing “out-of-state” MPAs with the Division is more financially advantageous to providers who are located and provide treatment in New Jersey.
Providers would rely on the literal wording of N.J.S.A. 34:15-15, as it pertains to the Division’s vested jurisdiction over “any claim for compensation for a work-related injury or illness.” From a policy perspective, the argument was that New Jersey had an interest in protecting the rights of its providers practicing medicine in the State. However, this reasoning could imminently bestow greater rights on these providers under the Division than the injured workers who the Workers’ Compensation Act was designed to protect. This issue was brought before the Appellate Division in Anesthesia Associates of Morristown, PA v. Weinstein Supply Corp., Nos. A-5033-18T4, A-5718, 2020 N.J. Super. Unpub. LEXIS 1892, 2020 WL 4933009 (App. Div. 2020) certif. denied, 245 N.J. 587 (2021).
Anesthesia Associates was a consolidated decision arising from the appeal of two MPAs (Anesthesia Associates of Morristown PA v. Weinstein Supply Corp. and Surgicare of Jersey City v. Waldbaums) with similar fact patterns as described above. Anesthesia Associates involved services provided in New Jersey to a Pennsylvania resident, who worked in Pennsylvania and sustained an injury in Pennsylvania. Surgicare of Jersey City involved a New York resident, who worked in New York and received benefits through the New York Workers’ Compensation Board. The Appellate Division affirmed the standard to determine jurisdiction for a provider was essentially to “step into the shoes” of the injured worker. If the injured worker could hypothetically file a Claim Petition in New Jersey, then the provider could also claim standing for jurisdiction. The Appellate Division referenced six factors to be considered in determining jurisdiction as noted in Larson’s Workers’ Compensation Law, known as “the Larson factors”:
- Place where the injury occurred;
- Place of making the contract;
- Place where the employment relation exists or is carried out;
- Place where the industry is localized;
- Place where the employer resides; or
- Place whose statute the parties expressly adopted by contract
The amount of jurisdiction-disputed MPAs involving claimants residing outside of New Jersey being filed appeared to diminish in the aftermath of Anesthesia Associates. However, providers continue to file MPAs when the claimant was a New Jersey resident. Even before this decision, it had been a matter of law that residence alone is not a sufficient basis upon which to confer jurisdiction…” see Wenzel v. Zantop Air Transp., Inc., 94 N.J. Super. 326, 334 (Law Div. 1967); Marconi v. United Airlines, 460 N.J. Super. 360 (App. Div. 2019) (regarding “minimum contacts”). Despite these long-standing opinions, providers will continue to emphasize that the combination of an individual’s status as a New Jersey resident and the fact they received treatment for an out-of-state workers’ compensation claim at a facility located in New Jersey, that the provider has a standing to seek payment or reimbursement under the New Jersey Division of Workers’ Compensation. Presumably, the issue of whether Anesthesia Associates would have any impact on similar situations involving New Jersey residents was not explicitly addressed as the claimants in the latter opinion resided outside New Jersey.
On December 22, 2025, the Honorable Peter J. Koulikourdis, J.W.C. entered a Decision in the matter of Meta Surgical Associates v. Six Continents Hotel, Inc. (Christino Rojas), Claim Petition Number 2023-14775. The primary distinguishing factor between Meta Surgical Associates and Anesthesia Associates is that the Claimant, Mr. Rojas, is a New Jersey resident. However, he was hired out of and worked exclusively in New York, which was the location of his work injury. Claimant received workers’ compensation benefits and medical treatment under New York’s jurisdiction and pursuant to New York’s Fee Schedule. The provider disputed the amount it received for treatment rendered in New Jersey for two dates of service, which was paid pursuant to New York’s Fee Schedule. The provider filed an MPA with the New Jersey Division of Workers’ Compensation seeking payment/reimbursement for its services. The Judge of Compensation reaffirmed the long-standing precedent from Wenzel and its progeny, as well as the Larson factors in that Claimant’s residency was insufficient to confer jurisdiction to a facility providing limited treatment in New Jersey. The Judge of Compensation referenced an arbitration procedure/process under New York State Law for medical providers to follow if they believe the amount they received is insufficient. In New York, a provider may file a Form HP-1.0 (Request for a Decision on Unpaid Medical Bill(s) to initiate the process for the Workers’ Compensation Board’s assistance to address the dispute. The Judge of Compensation brings to light the repetitive scenario when a provider is “dissatisfied with the amount paid, and now seeks New Jersey as an avenue for additional financial compensation”. This pattern described was essentially akin to forum shopping.
Beyond the status of a claimant’s residence, the Judge of Compensation also addressed the issue of the provider’s location in New Jersey. The Judge points out that while the New Jersey Workers’ Compensation Act does not address the issue of jurisdiction for “extra territorial claims”, the Act and subsequent case and statutory law have established that “there still must be sufficient contacts with the employment relationship to warrant New Jersey jurisdiction” and there is currently no legal precedent permitting jurisdiction based exclusively on the location of treatment. The Judge of Compensation ultimately held that “the New Jersey Division of Workers’ Compensation does not have a substantial interest in unduly enriching treatment providers who have already been paid under a different state’s compensation statute.” In brief, residency and treatment location in New Jersey alone should not automatically establish jurisdiction.
It should be noted that this decision is an unpublished opinion from the Division of Workers’ Compensation and therefore not binding as legal precedent. It also remains to be seen whether the provider will file an appeal. That said, this is still a significant victory for New Jersey workers’ compensation carriers and defense attorneys alike. It is reassuring that many of the same arguments we have made in our own Motions to Dismiss for Lack of Jurisdictions were echoed by the Judge of Compensation in Meta Surgical Associates. Rest assured that this decision will undoubtedly hold persuasive weight as we aggressively defend against the voluminous amount of out-of-state MPAs we handle in New Jersey.
If you have any questions about this issue, please contact Nicolas Pedone, Esq. at NPedone@c-wlaw.com or (856) 761-3800.