.

Defense Digest

New Jersey Medical Provider Claims Are Contingent Upon Jurisdiction Over Underlying Claim

Defense Digest, Vol. 27, No. 1, January 2021

January 29, 2021

by Kiara K. Hartwell

Key Points:

  • For a New Jersey workers’ compensation court to have jurisdiction over Medical Provider claims, there must be jurisdiction over an underlying claim.
  • Jurisdiction can be determined by place of injury, place of contract, place of employment, place where industry is localized, place of residency, place decided on by a contract or place of sufficient contacts.
  • The Appellate Division cautions litigants against disrespectful characterizations of unfavorable decisions by workers’ compensation judges.

In a recently consolidated appeal, the New Jersey Appellate Division clarified the scope of jurisdiction granted to workers’ compensation courts in medical provider claims. The New Jersey Workers’ Compensation Act provides “[e]xclusive jurisdiction” to the courts over disputed medical charges “arising from any claim for compensation for a work-related injury or illness.” Although the jurisdiction inquiry is fact-sensitive, the Appellate Division went further to explain that a single day of treatment in New Jersey was insufficient without any other contacts.

In the first of the two consolidated cases, Anesthesia Assoc. of Morristown, PA v. Weinstein Supply Corp., 2020 WL 5944009 (N.J. Super. App. Div. Oct. 7, 2020), Anesthesia Assoc. of Morristown, PA provided services to an injured worker at a New Jersey hospital on March 22, 2018. The underlying workers’ compensation claim was filed in Pennsylvania because the accident occurred in Pennsylvania, the injured worker was a resident of Pennsylvania, and Weinstein Supply Corp. was based in Pennsylvania. Anesthesia Assoc. submitted a claim to the Pennsylvania Department of Labor and Industry and received a payment per the applicable fee schedule. It subsequently sought payment of the balance from Weinstein’s insurance carrier.

When Weinstein’s insurer failed to make payment on the balance, Anesthesia Assoc. filed a Medical Provider claim in New Jersey. Weinstein filed a motion to dismiss for lack of jurisdiction, which the New Jersey workers’ compensation court ultimately granted. In doing so, the court concluded it did not have personal jurisdiction over the underlying workers’ compensation claim because none of the “Larson factors” (found in Williams v. Port Auth. of N.Y. & N.J., 175 N.J. 82, 87-88 (2003)) applied:

[the employee] lived in [Pennsylvania], worked in [Pennsylvania], and the accident occurred in [Pennsylvania]. The contract of hire occurred in [Pennsylvania]. No contract exists between [Anesthesia Assoc.] and Weinstein. The only connection to New Jersey is that [the employee] underwent one day of medical treatment with [Anesthesia Assoc.] in New Jersey.

The court explained that, just as the courts have found an injured worker’s New Jersey residence alone was insufficient for jurisdiction, “one day of treatment in New Jersey” was also insufficient.

In the second case, Surgicare of Jersey City v. Waldbaums, 2020 WL 5944009 (N.J. Super. App. Div. Oct. 7, 2020), the injured worker, a resident of New York, was injured in New York while working for his New York employer, Stop & Shop. The worker filed a claim in New York and, on August 11, 2017, underwent surgery at Surgicare of Jersey City. Surgicare submitted a claim for payment in New York and subsequently filed a Medical Provider claim in New Jersey. Similar to Weinstein, Waldbaums filed a motion to dismiss for lack of jurisdiction. Surgicare argued that Waldbaums did business in New Jersey and that treatment was rendered in New Jersey, establishing jurisdiction there. However, the New Jersey workers’ compensation court granted Waldbaums’ motion, noting that the injured worker “was directed by his New York doctor to a surgical center in New Jersey for a single, one-day visit. The patient’s same-day surgery was performed by a New York doctor using equipment and devices ordered by the New York doctor.” The judge ruled that this single day of treatment was insufficient to “rise to the standard of sufficient purposeful minimal contacts” for personal jurisdiction.

In reviewing the consolidated appeals, the Appellate Division concluded that “[u]nless the Division [of Workers’ Compensation] has jurisdiction over the underlying claim for a compensable work-related injury, it does not have jurisdiction over a [Medical Provider claim] for payment.” After applying the six “Larson factors” to both cases, the Appellate Division agreed with the workers’ compensation courts in finding that no jurisdiction existed for either claim and held that both were appropriately dismissed.

Finally, feeling compelled to comment on various hyperbolic and inflammatory remarks in the appellants’ briefs, the Appellate Division cautioned against baseless, future attacks accusing the workers’ compensation judges of either abusing their authority or rendering incoherent or preposterous decisions. It was noted that such comments were unwarranted and did little to advance a client’s position, while, on the other hand, eroding the public’s trust in the judiciary.

As these cases illustrate, medical providers seeking reimbursement must establish jurisdiction over the underlying workers’ compensation claim. Although this is a fact-sensitive inquiry, these cases confirm that New Jersey workers’ compensation courts require, at the very least, more than a single day of treatment in New Jersey. The inquiry going forward will be whether two days of treatment or other similar examples will be sufficient bases for jurisdiction. In order to avoid any possibility of paying under the New Jersey payment scheme, where there is no set fee schedule, employers and carriers handling non-New Jersey claims should strive to direct care within their respective states as much as possible. This is not only because whether New Jersey has jurisdiction is fact-sensitive to each case, but also because New Jersey has no fee schedule and only pays the “usual and customary charges” for services.

*Kiara is an associate in our Mount Laurel, New Jersey office. She can be reached at (856) 414-6404 or kkhartwell@mdwcg.com.

Defense Digest, Vol. 27, No. 1, January 2021 is prepared by Marshall Dennehey Warner Coleman & Goggin to provide information on recent legal developments of interest to our readers. This publication is not intended to provide legal advice for a specific situation or to create an attorney-client relationship. ATTORNEY ADVERTISING pursuant to New York RPC 7.1. © 2021 Marshall Dennehey Warner Coleman & Goggin. All Rights Reserved. This article may not be reprinted without the express written permission of our firm. For reprints, contact tamontemuro@mdwcg.com.

In a recently consolidated appeal, the New Jersey Appellate Division clarified the scope of jurisdiction granted to workers’ compensation courts in medical provider claims. The New Jersey Workers’ Compensation Act provides “[e]xclusive jurisdiction” to the courts over disputed medical charges “arising from any claim for compensation for a work-related injury or illness.” Although the jurisdiction inquiry is fact-sensitive, the Appellate Division went further to explain that a single day of treatment in New Jersey was insufficient without any other contacts.

In the first of the two consolidated cases, Anesthesia Assoc. of Morristown, PA v. Weinstein Supply Corp., 2020 WL 5944009 (N.J. Super. App. Div. Oct. 7, 2020), Anesthesia Assoc. of Morristown, PA provided services to an injured worker at a New Jersey hospital on March 22, 2018. The underlying workers’ compensation claim was filed in Pennsylvania because the accident occurred in Pennsylvania, the injured worker was a resident of Pennsylvania, and Weinstein Supply Corp. was based in Pennsylvania. Anesthesia Assoc. submitted a claim to the Pennsylvania Department of Labor and Industry and received a payment per the applicable fee schedule. It subsequently sought payment of the balance from Weinstein’s insurance carrier.

When Weinstein’s insurer failed to make payment on the balance, Anesthesia Assoc. filed a Medical Provider claim in New Jersey. Weinstein filed a motion to dismiss for lack of jurisdiction, which the New Jersey workers’ compensation court ultimately granted. In doing so, the court concluded it did not have personal jurisdiction over the underlying workers’ compensation claim because none of the “Larson factors” (found in Williams v. Port Auth. of N.Y. & N.J., 175 N.J. 82, 87-88 (2003)) applied:

[the employee] lived in [Pennsylvania], worked in [Pennsylvania], and the accident occurred in [Pennsylvania]. The contract of hire occurred in [Pennsylvania]. No contract exists between [Anesthesia Assoc.] and Weinstein. The only connection to New Jersey is that [the employee] underwent one day of medical treatment with [Anesthesia Assoc.] in New Jersey.

The court explained that, just as the courts have found an injured worker’s New Jersey residence alone was insufficient for jurisdiction, “one day of treatment in New Jersey” was also insufficient.

In the second case, Surgicare of Jersey City v. Waldbaums, 2020 WL 5944009 (N.J. Super. App. Div. Oct. 7, 2020), the injured worker, a resident of New York, was injured in New York while working for his New York employer, Stop & Shop. The worker filed a claim in New York and, on August 11, 2017, underwent surgery at Surgicare of Jersey City. Surgicare submitted a claim for payment in New York and subsequently filed a Medical Provider claim in New Jersey. Similar to Weinstein, Waldbaums filed a motion to dismiss for lack of jurisdiction. Surgicare argued that Waldbaums did business in New Jersey and that treatment was rendered in New Jersey, establishing jurisdiction there. However, the New Jersey workers’ compensation court granted Waldbaums’ motion, noting that the injured worker “was directed by his New York doctor to a surgical center in New Jersey for a single, one-day visit. The patient’s same-day surgery was performed by a New York doctor using equipment and devices ordered by the New York doctor.” The judge ruled that this single day of treatment was insufficient to “rise to the standard of sufficient purposeful minimal contacts” for personal jurisdiction.

In reviewing the consolidated appeals, the Appellate Division concluded that “[u]nless the Division [of Workers’ Compensation] has jurisdiction over the underlying claim for a compensable work-related injury, it does not have jurisdiction over a [Medical Provider claim] for payment.” After applying the six “Larson factors” to both cases, the Appellate Division agreed with the workers’ compensation courts in finding that no jurisdiction existed for either claim and held that both were appropriately dismissed.

Finally, feeling compelled to comment on various hyperbolic and inflammatory remarks in the appellants’ briefs, the Appellate Division cautioned against baseless, future attacks accusing the workers’ compensation judges of either abusing their authority or rendering incoherent or preposterous decisions. It was noted that such comments were unwarranted and did little to advance a client’s position, while, on the other hand, eroding the public’s trust in the judiciary.

As these cases illustrate, medical providers seeking reimbursement must establish jurisdiction over the underlying workers’ compensation claim. Although this is a fact-sensitive inquiry, these cases confirm that New Jersey workers’ compensation courts require, at the very least, more than a single day of treatment in New Jersey. The inquiry going forward will be whether two days of treatment or other similar examples will be sufficient bases for jurisdiction. In order to avoid any possibility of paying under the New Jersey payment scheme, where there is no set fee schedule, employers and carriers handling non-New Jersey claims should strive to direct care within their respective states as much as possible. This is not only because whether New Jersey has jurisdiction is fact-sensitive to each case, but also because New Jersey has no fee schedule and only pays the “usual and customary charges” for services.

*Kiara is an associate in our Mount Laurel, New Jersey office. She can be reached at (856) 414-6404 or kkhartwell@mdwcg.com.

Defense Digest, Vol. 27, No. 1, January 2021 is prepared by Marshall Dennehey Warner Coleman & Goggin to provide information on recent legal developments of interest to our readers. This publication is not intended to provide legal advice for a specific situation or to create an attorney-client relationship. ATTORNEY ADVERTISING pursuant to New York RPC 7.1. © 2021 Marshall Dennehey Warner Coleman & Goggin. All Rights Reserved. This article may not be reprinted without the express written permission of our firm. For reprints, contact tamontemuro@mdwcg.com.

Firm Highlights

Thought Leadership

PA Middle District Dismisses Claims Against School District and its Superintendent, Principal, Special Education Director, and Classroom Teacher

A five-year-old special education student was enrolled in the Wyoming Valley West School District and attended the State Street Elementary School during the 2024-2025 school year. The student refused to clean up classroom toys at dismissal. When his teacher allegedly grabbed him by the wrist to walk him back to his seat, the student dropped to the floor and began crying. The teacher then allegedly grabbed the student by the ankle and dragged him across the floor. Following an investigation, criminal charges were not advanced by the county DA, and the school permitted the teacher to return to the classroom. The student’s parents sued, lodging thirteen legal counts under both state and federal law, which sought monetary damages from the teacher, the school district, the superintendent, the principal, and the director of special education. The plaintiff’s 42 USC 1983 claims were dismissed as to the school district for failure to allege a policy or custom violation, and the failure to alleged deliberate indifference in the failure-to-train context. As to the superintendent, building principal, and special education director, the Section 1983 claims were also dismissed for failure to allege personal involvement on the part of the individuals. Regarding an equal protection claim asserted against all defendants, the motion to dismiss was also granted for a failure to advance a plausible equal protection claim, holding that “plaintiffs' single-act allegations do not include a factual basis to even infer that the act was motivated by discriminatory animus rather than some other non-discriminatory impulse.” The court further dismissed the plaintiff’s negligence-based claims including negligence against the teacher and district administrators, NIED, and vicarious liability under the Political Subdivision Tort Claims Act (PSTCA). The federal claims under the IDEA, Section 504, and the ADA were also dismissed in various respects. The IDEA claim was dismissed against all defendants with prejudice for failure to exhaust administrative remedies. The Section 504 claims against the individual defendants were also dismissed with prejudice, as districts, not individuals, are the recipients of federal funds under Section 504. However, the Section 504 and ADA claims were dismissed without prejudice as to defendant Wyoming Valley West, and the plaintiff was permitted leave to amend.

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Result

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29th Annual FDLA Florida Liability Claims Conference

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