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October 08, 2020

NJ Appellate Division Holds Out-Of-State Medical Providers Cannot Pursue Claims for Payment When No Underlying Jurisdiction Exists

On October 7, 2020, the New Jersey Appellate Division came down with the first decision involving a long-running dispute of jurisdictional application when out-of-state medical providers seek to file Formal Applications for Payment in the NJ Workers Compensation system.

In the matter of Anesthesia Associates of Morristown, P.A. v. Weinstein Supply Corp., two (2) MPA claims involving similar facts were heard consecutively by the NJ Appellate Division.  One matter involved an application filed by Anesthesia Associates of Morristown, Pennsylvania, which involved an employee who was injured in 1998 in the State of Pennsylvania.  Petitioner was a resident of Pennsylvania, his employer was based in Pennsylvania, and he had filed an underlying WC claim with the PA bureau accordingly.  The only connection to NJ was the location upon which the subject treatment was rendered.  The presiding WC Judge dismissed the MPA application and ruled that the underlying workers’ compensation case needs to be compensable under New Jersey law for jurisdiction over the MCP application.  In this case, the Judge concluded there were insufficient contacts in the State of New Jersey with respect to the underlying compensation claim.

The companion matter also presented for argument was that of Surgicare of Jersey City v. Waldbaum’s.  In this case, the facts were identical to the matter above, except that virtually all contacts were in the State of New York, rather than Pennsylvania.

In affirming the WC Courts’ decisions, the Appellate division acknowledged the 2012 statutory amendments at N.J.S.A. 34:15-15, et seq. granting exclusive jurisdiction to the NJ Division of Workers Compensation for any disputed medical charge arising from any claim for compensation for work related accident or illness.  The court went on to note the six (6) elements that must be considered in establishing jurisdiction, including:  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 employee resides; or place whose statute the parties expressly adopted by contract.

The Appellate Division concluded that the WC Judges were correct in that the 2012 amendment does not apply to MPA claims in matters where the NJ Division did not have underlying jurisdiction over an employee’s own underlying compensation claim.  In essence, if the Court didn’t have the ability to hear the claim giving rise to the treatment, it therefore couldn’t get involved with litigating a derivative MPA claim.

What It Means to You

This unreported, albeit sound, decision from the Appellate Division further confirms the ongoing consensus defense strategy of blanket denials of such out-of-state MPA claims, supported by Motions to Dismiss for lack of jurisdiction/failure to sustain burden of proof.  Unless and until this ruling is disturbed by higher court or legislative action more squarely addressing the issue, this course of action in handling like matters should remain in place.