Articles & Blogs

New Jersey Medical Provider Claims for Out-Of-State Injuries

New Jersey
November 17, 2021
February 14, 2020

There is a significant trend with medical providers in New Jersey bringing claims for reimbursement of their treatment, before the New Jersey Workers’ Compensation Division for cases involving out of state injuries.  As a result, judges are being asked to decide whether or not jurisdiction is appropriate on such claims.  Presently, there is no binding case law on the subject; however, we continue to monitor the various division decisions.  While some judges have allowed jurisdiction, others have not.  

Recently, in February 2019, Judge Roca did find that jurisdiction was appropriate on one of these Medical Provider Claims.  In that case, the parties had stipulated that the accident had occurred in New York; that the injured worker had been hired in New York; and that the employer was located in New York. However, two days after the injury, the injured worker appeared at the emergency room at Bayonne Medical Center in New Jersey.  Bayonne Medical Center had issued an invoice to the employer, which the employer paid pursuant to the New York Workers’ Compensation fee schedule.  Bayonne then brought a Medical Provider Claim before the New Jersey Division seeking additional monies and making a claim for the remaining balance of their bill.  Judge Roca considered jurisdiction to be appropriate by finding that the New Jersey Workers’ Compensation Statute does not require that the injured worker file a claim in New Jersey, as a prerequisite to the filing of a Medical Provider Claim. Judge Roca further opined that the state has a special interest in ensuring that the medical providers, who furnish medical treatment in New Jersey to an injured worker, are fairly compensated according to the usual and customary rates of the community where the services are rendered.  The judge went on to say that the purpose of the workers’ compensation system is to provide prompt benefits, competent medical treatment and limited litigation.  To this end, the judge said that it is important for the medical providers within New Jersey to be confident in the fact that in providing medical treatment to persons injured in the course of their employment, they will be compensated according to the laws of the state.  For these reasons, Judge Roca denied the respondent’s Motion to Dismiss and found that jurisdiction was appropriate in New Jersey, despite the facts of the underlying work injury and the stipulations that had made between the parties.

Fortunately, from a defense perspective, there are several other judges who disagree with Judge Roca’s Decision in that regard and position on the issue of jurisdiction.

In the case of Meadowlands Hospital v. M&I Pushcart Corp., CP 2018-9647, Judge Ferriero dismissed a Medical Provider Claim for lack of jurisdiction.  In that case, Meadowlands Hospital rendered care to the injured worker. The injured worker had an established claim in New York.  He had no employment contacts with New Jersey.  He did not live in New Jersey.  The accident did not occur in New Jersey.  There was no evidence that the injured worker was hired in New Jersey or had contracted to work in New Jersey.  The only connection to New Jersey was that he had a surgical procedure in New Jersey. In finding that jurisdiction was not appropriate in New Jersey, Judge Ferriero concluded that a Medical Provider Claim is a derivative claim of the Claim Petition and in order for a New Jersey Court to have jurisdiction over it, the Court must have jurisdiction over the underlying work accident.  

Both Judge Karch and Judge Dillon agree with Judge Ferriero’s Decision in the Meadowlands Hospital case.  

On August 13, 2019, Judge Dillon found that there must be sufficient contacts with the employment relationship to warrant New Jersey jurisdiction.  In the case of Specialty Surgery of Secaucus; Coastal Anesthesia Associates v. Minisink Valley School, CP 2018-16123 & CP 2019-16114, the only contact which the injured worker had with New Jersey was that he presented for treatment in New Jersey. The judge went through the factors for establishing whether a court has jurisdiction to hear a workers’ compensation claim as set forth in Professor Larson’s treatise.  These are: (1) place where the injury occurred; (2) place of making the contract; (3) place where the employment relation exists; (4) place where the industry is localized; (5) place where the employee resides; (6) or place whose statute the parties expressly adopted by contract.  13 Lex. K. Larson’s Workers’ Compensation, Section 142.01 (Matthew Bender, Rev. Ed. 2019).  The judge found that none of these factors were met by the injured worker and as such, there was no jurisdiction over the Medical Provider Claim.  

In another case, Mid-State Anesthesia, CP 2018-819, Judge Karch dismissed the Medical Provider Claim for lack of jurisdiction.  The injured worker had no contacts with the state of New Jersey as it pertains to the underlying injury claim itself.  The injured worker lived in New York, worked in New York, was employed by a New York employer, was injured in New York, and received medical treatment in New York.   He was then directed by his New York doctor to a surgical center in New Jersey twice, each time for a single one-day visit.  The injured worker’s same day surgery was performed by his New York doctor whose team included a doctor from Mid-State Anesthesia.  Mid-State Anesthesia even sought authorization from the New York’s Workers’ Compensation Board to provide their services.  The judge reasoned that the only contact with the State of New Jersey were the two days of treatment in New Jersey.  The Judge found that this did not rise to the standard of “sufficient purposeful minimal contacts” requisite to vest the court with personal jurisdiction. The judge further explained that there were not sufficient contacts with New Jersey referring to the Larson’s factors.  The judge even went on to say that while she feels that the provider is probably due more money, that the provider knowingly availed itself of the reimbursement rates of the New York Workers’ Compensation Statute when it obtained authorization from the New York Board to perform the surgery.

In light of these decisions, and the continued increase in Medical Provider Claims, knowing the view of the particular judge on your case is extremely important.  That information can be critical to a successful defense and dismissal of the claim, or it can help with avoiding a potentially high award which can then be resolved ahead of time, for the least amount possible under the circumstances.  For those judges who have not yet issued a decision on the jurisdictional issue for these Medical Provider Claims, we can argue in our defense the positions and decisions identified by Judges Ferriero, Karch & Dillon.