Home / Posts / Appellate Division Tosses Extraterritorial Medical Provider Claims

Search blog posts


Appellate Division Tosses Extraterritorial Medical Provider Claims

The Appellate Division examined the jurisdiction of out of state medical provider claims that had fee disputes due medical procedures performed in New Jersey in the consolidated matters of Anesthesia Associates of Morristown PA v. Weinstein Supply Corporation and Surgicore of Jersey City v. Waldbaums. A-5033-18T4 and A-5718-18T4. In recent years, the Division of Workers’ Compensation has seen an increase in claims arising out of the 2012 Amendments to the Workers’ Compensation Act (WCA) which gave the Division of Workers’ Compensation exclusive jurisdiction over medical provider applications. The Amendment to N.J.S.A. 34:15-15 was silent on whether an out of state worker who was directed by a treating physician would be bound to the New Jersey underlying claim would apply its fee schedule.

The Appellate Division began its analysis of jurisdiction of such claims by reviewing the 2012 amendment and providing “plain meaning” to the statute. The court explained that medical provider claims could be brought under the WCA when the underlying workers’ compensation claim would have had jurisdiction in New Jersey. The court examined several important workers’ compensation cases but placed emphasis on its recent decision in Marconi v. United Airlines, 406 N.J. Super 330 (App. Div. 2019). Marconi outlines Larson’s on Jurisdiction six-factor test for jurisdiction. The  factors 1) The place where the Injury occurred; 2) the place of the making of the contract; 3) the place where the employment relation exists ; 4) the place where the industry is localized; 5) place where the employee resides 6) the place whose statute the parties expressly adopted by contract. Applying this analysis, the Court determined that if an out of state workers’ compensation claim could not obtain jurisdiction within New Jersey, the contractual dispute for payment should also not be granted jurisdiction. The applicant would fail to have met personal jurisdiction in these matters.

The Court also declined the argument of both medical providers that these applications are contractual disputes. The court reasoned that the applicants failed to identify any contractual rate of reimbursement that existed between the medical provider and the employer, or the medical provider and the insurance carrier.

This decision is very important for defense practitioners as these claims have proven a challenge on the appropriate way to handle payment issues. Defense counsel should exercise caution when responding to medical provider applications and carefully examine any jurisdictional issues.