Articles & Blogs

Medical Provider Claims: Jurisdiction

New Jersey
November 17, 2021
May 4, 2018

A major trend that we have been seeing in New Jersey workers’ compensation is Medical Provider Claims being filed for out-of-state injuries, particularly New York or Pennsylvania, given the close proximity with New Jersey. This case arises in many different scenarios. For example, the injured worker is working exclusively in New York; the injury occurs in New York; but the injured worker seeks medical attention in New Jersey because that is where he resides. Or, the injured worker is working for a New York company and happens to be injured on a job site in New Jersey and therefore, seeks medical attention in New Jersey. Because the injured workers in these cases seek New York benefits, the medical bills are paid pursuant to New York state laws. Typically, the allowable reimbursements for New York and Pennsylvania are less than what is allowed in New Jersey because it is statutorily governed. The New Jersey Workers’ Compensation Act provides that 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. N.J.S.A. 34:15-15. This typically results in the provider receiving a higher reimbursement than what is allowed in other states. This has created an influx in Medical Provider Claims being filed in New Jersey seeking additional payments. Because these claims are tied to other states, it is essential to remember that one of the best tools that we have is the jurisdictional defense.  

Determining whether there is jurisdiction in New Jersey is not well settled in this area yet. There are two cases in which the Judges are referring to in order to find that subject matter jurisdiction is appropriate in New Jersey. In an unpublished opinion, Progressive Spine & Orthopedics v. Krasdale Foods, Inc., 215 N.J. Super. Unpub. LEXIS 1145, the Appellate Division found that where there is New Jersey jurisdiction for the underlying Claim Petition, there is jurisdiction for the Medical Provider Claim. Therefore, if the injured worker is able to establish jurisdiction with New Jersey, i.e. (1) did the accident occur in New Jersey; (2) did the contract of employment occur in New Jersey; and/or (3) does the petitioner have sufficient employment contacts with New Jersey, then the judges are finding that jurisdiction is appropriate in New Jersey. A recent case, Williams v. Raymour & Flanigan, has added a new layer to making it much easier to find jurisdiction in New Jersey. In that case, Williams worked exclusively in New York and was injured in New York. His only contact with New Jersey was that he resided here. In reversing the workers’ compensation judge’s opinion, the Appellate Division found that jurisdiction was proper in New Jersey because when petitioner was hired, he picked up the telephone to accept his job position at his residence in New Jersey thereby formalizing his contract of hire in New Jersey. It is important to note that Progressive Spine & Orthopedics is unpublished and therefore, not binding on the New Jersey Workers’ Compensation Court.  

The other leading case on jurisdiction is a New Jersey workers’ compensation decision, Spiros v. Atlantic Ambulatory Anesthesia Associates & Shrewsbury Surg. Center, CP# 2012-22032 & CP# 2013-1069. Here, the injured worker was employed in Tennessee and his accident occurred in Tennessee. He also sought benefits in Tennessee. Through his ongoing treatment for the Tennessee claim, he received medical services in New Jersey. The New Jersey providers were paid pursuant to the Tennessee statutory fee schedule and sought additional payments pursuant to New Jersey law. The judge held that because the provider is localized in the State of New Jersey, that New Jersey has subject matter jurisdiction over the claim. The judge reasoned that New Jersey has a special interest as the medical providers’ services are localized in New Jersey and, therefore, the burdens and costs of work related injuries fall most directly upon employers and consumers in the area where the industry is centered.

The burden of proof is on the applicant to prove that jurisdiction in New Jersey is proper. Therefore, until the applicant has satisfied its burden of proof, a denial on these particular claims should be maintained.