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Medical Providers Have Six Years To File Claims in Division of Workers’ Compensation

By on January 24, 2019 in Claims with 0 Comments

The New Jersey Appellate Division decided an important case on January 17, 2019 entitled The Plastic Surgery Center, PA. v. Malouf Chevrolet-Cadillac, Inc,.  The case centered on how long a medical provider has to file a claim petition in the Division, namely whether providers have two years, like claimants, or six years.  The case has been reported.

The Court first noted that suits on contracts in New Jersey have a six-year statute of limitations under N.J.S.A. 2A:14-1.  When the New Jersey Legislature amended the New Jersey statute in 2012 granting exclusive jurisdiction over disputed medical charges to the Division of Workers’ Compensation, the Legislature never addressed which statute of limitations would apply.

New Jersey Manufacturers argued in this case that it should be two years because that is how long a claimant has under the statute, namely two years from the date of injury, or if compensation has been provided by the employer, then two years from the last payment of compensation.   Counsel for the Plastic Surgery Center argued that it should have six years like any other contract claim.

The Court gave several reasons for its conclusion that medical providers should have six years to file in the Division.   It began by noting that the Legislature could have expressed but did not express its intent to apply the two-year time bar to medical providers when it gave the Division exclusive jurisdiction over medical provider claims.  The Court also noted that the Legislature did not expand the two-year statute of limitations provision to specifically reference medical providers as falling with that rule.  Instead, the rule only mentions claimants.

Most importantly, the Court said that the rationale for two years does not fit N.J.S.A. 34:15-51, which is the statute of limitations provision in New Jersey.  “…We  are most persuaded that the Legislature intended to leave unaltered the time within which medical-provider claims must be commenced because the Act’s two-year-bar simply doesn’t fit.”   It said that such a rule would sometimes mean that the statute would run on the rights of the medical provider to file before the medical service is even provided because the medical provider might not render its service until after two years from the date of accident.

New Jersey Manufacturers argued that the Court should consider the alternative language of the statute, which provides “two years from the last payment of compensation.”  The Court said that language applies to claimants who receive compensation.  It does not fit the concept of a medical provider who renders a service to a claimant.  “By arguing that the time-bar operates differently for medical-provider claims – that the action accrues on the date of service instead of the employee’s accident – the respondents must concede that medical providers are different types of claimants than employees.”  The Court said that adopting this approach would “rewrite” the statute, something the Court said it does not have a right to do.

The issue is of great importance because one of every five claim petitions in New Jersey is a Medical Provider Claim, and that percentage is rising rapidly.   It is hard to say whether this ruling will increase the number of filings by true New Jersey medical providers because this practitioner does not believe that there were many New Jersey medical providers sitting on the sideline waiting for a ruling on the statute of limitations.  Many practitioners always thought that the six-year statute of limitations on contracts applied to medical providers.

But this decision will give great greater impetus to a noticeable trend: out-of-state medical providers are moving satellite offices to New Jersey and choosing to do medical procedures in New Jersey even though many of the workers they are treating were injured in and worked in New York and Pennsylvania.  In many cases the injured New York and Pennsylvania workers also live out of state.  The only connection with New Jersey is the fact that the procedure was scheduled in New Jersey for higher reimbursements.  This trend is directly traceable to the fact that New Jersey has no fee schedule and reimbursements are therefore much higher here. The next issue that the Appellate Division needs to address is jurisdiction where the only contact with our state is the location of the treatment.

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John H. Geaney

About the Author

About the Author:

John H. Geaney, an executive committee member and shareholder with Capehart Scatchard, began an email newsletter entitled Currents in Workers’ Compensation, ADA and FMLA in 2001 in order to keep clients and readers informed on leading developments in these three areas of law. Since that time he has written over 500 newsletter updates.

Mr. Geaney is the author of Geaney’s New Jersey Workers’ Compensation Manual for Practitioners, Adjusters & Employers. The manual is distributed by the New Jersey Institute for Continuing Legal Education (NJICLE). He also authored an ADA and FMLA manual as distributed by NJICLE. If you are interested in purchasing the manual, please contact NJICLE at 732-214-8500 or visit their website at www.njicle.com.

Mr. Geaney represents employers in the defense of workers’ compensation, ADA and FMLA matters. He is a Fellow of the College of Workers’ Compensation Lawyers of the American Bar Association and is certified by the Supreme Court of New Jersey as a workers’ compensation law attorney. He is one of two firm representatives to the National Workers’ Compensation Defense Network. He has served on the Executive Committee of Capehart Scatchard for over ten (10) years.

A graduate of Holy Cross College summa cum laude, Mr. Geaney obtained his law degree from Boston College Law School. He has been named a “Super Lawyer” by his peers and Law and Politics. He serves as Vice President of the Friends of MEND, the fundraising arm of a local charitable organization devoted to promoting affordable housing.

Capehart Scatchard is a full service law firm with offices in Mt. Laurel and Trenton, New Jersey. The firm represents employers and businesses in a wide variety of areas, including workers’ compensation, civil litigation, labor, environmental, business, estates and governmental affairs.

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