What may happen if I am a medical provider that treats in multiple States.

As of October 7th, 2020, the Appellate Court has rendered a decision regarding claims that are filed by medical providers seeking reimbursement for patients with out-of-state injuries. This Division of Workers’ Compensation has ruled against the medical providers and now hundreds of similar, pending cases in New Jersey Workers Compensation could be affected.

The court has concluded that under the New Jersey Workers’ Compensation Act, a medical provider is unable to receive payments from a patient’s employer when the patient lived and worked outside of the State of New Jersey, and lastly, if the patient has already filed workers’ compensation claims in the State in which they do reside.

In their decision they focused on claims from mostly Pennsylvania and New York.  New Jersey’s reimbursement rates are usually much higher than New York and Pennsylvania, which explains why providers are taking this decision so seriously.

The argument presented to the Appellate Court by the medical providers is that the Division is granted broad exclusive jurisdiction regarding claims under the New Jersey Workers’ Compensation Act. Furthermore, a medical provider claim petitions are an entirely separate cause of action, mainly as being a breach of contract, which would be covered by the Act. The Appellate Court, however, deemed that these claims hold no sufficient argument and thus ruled against the providers.

For reference, the Appellate Court heard two cases back to back regarding this issue. The first case was brought by the Anesthesia Associates of Morristown (AAM), the other was brought by Surgicare of Jersey City (SJC). In both of these cases, the court decided that the Workers’ Compensation Division has no jurisdiction over a medical provider claim for payment unless it has jurisdiction over the underlying claim for a compensable work-related injury.

In the case brought by AAM, the injured worker treated in New Jersey, but only for one day. AAM received a payment for $1,070.30 but filed its claim in the New Jersey Division of Workers Compensation with an attempt to receive the balance of charges that remain outstanding in the amount of $12,992.00. In the AMM case the worker suffered a compensable work-related accident Pennsylvania. Not only did was the worker get hurt in Pennsylvania, they also reside in the State, the employer is also based in that State, and the worker had already established a workers’ compensation claim in Pennsylvania. Therefore, the courts ruled against the medical provider.

The case brought by SJC was very similar. The injured worker here also spent one day of treatment in New Jersey for a surgery based upon the recommendation of his New York doctor. The surgery was completed by the New York doctor with all equipment and deceives ordered by that specific doctor. The injured employee was also injured in New York, they were a New York resident, and they were hired to work in New York.

The medical providers above both lost their cases but do have the opportunity to seek Certification from the Supreme Court of New Jersey, however no action in that regard has been taken yet.

Overall, this ruling should benefit New Jersey employers greatly by disposing of large amounts of litigation that are solely coming into the state with goals of a higher reimbursement.

If you have any further questions, please contact Goldberg & Wolf, LLC, at 856-651-1600.