An intriguing decision was rendered by the New Jersey Superior Court Appellate Decision in October 2020: Anesthesia Associates v. Weinstein Supply, A-5033-18T4 and A-5718-18T4. The case consolidates for appeal two decisions of New Jersey workers' compensation judges regarding jurisdiction over medical billing disputes. It is intriguing for its analysis of jurisdiction, its reliance upon secondary authority, and for its defense of workers' compensation judges.
A side element of intrigue in many workers' compensation opinions is the volume of abbreviation engaged by the court; this is a great example. Essentially, the Court said:
the WCA is interpreted as regards the jurisdiction over AAM and SJC MPCs. There is involvement of the PABWC, as well as the PDOLI in one case and WCBNY in the other. Each MPC was instigated by an MPAP under the WCA.
In each of the two cases, an individual injured elsewhere (Pennsylvania and New York) received a minimal volume of medical service in New Jersey. The New Jersey medical providers (Anesthesia Associates - AAM and Surgicare of Jersey City - SJC) received reimbursement through those other jurisdictions: PDOLI (Pennsylvania Department of Labor and Industry) and WCBNY (Workers' Compensation Board of New York). Dissatisfied with the reimbursement, each filed a Medical Provider Claim (MPC) under the New Jersey Workers' Compensation Act (WCA) by submitting a Medical Provider Application for Payment (MPAP).
In neither instance had the injured worker invoked the jurisdiction of the New Jersey Division of Workers' Compensation by filing a claim. However, the medical providers contended that the Division nonetheless had subject matter jurisdiction independent of such a worker-filed claim. These medical providers essentially argued that the Medical Provider Claim is a "separate cause of action," which is "rooted in breach of contract" and subject to the jurisdiction of New Jersey's Division.
In the Anesthesia Associates claim, the Court noted that payment had been made pursuant to the Pennsylvania fee schedule, and the provider was seeking greater reimbursement in New Jersey. Notably, states continue to engage various methods for constraining medical costs, the court noted that "New Jersey bases payment on the 'usual and customary charges'" rather than a fixed fee schedule. Thus, it is practical to conclude that these providers envisioned greater reimbursement under New Jersey law.
A worthy discussion point as regards the Medical Provider Application for Payment (MPAP) forms is language pre-printed upon them. These forms state that:
"the Employee sustained an injury by an accident arising out of and in the course of his/her employment with Respondent, [that was] compensable under [the WCA]."Thus, the allegations include contention by the party seeking relief that there is, or could be, a New Jersey workers' compensation claim as regards that particular worker. One might wonder whether the filing of such a form in the absence of a worker-filed claim, or at least the opportunity for one, would amount to a misrepresentation of fact?
The jurisdictional issue in these two cases was one of "connection between New Jersey and the injured employee(s)." Clearly, the medical care providers had ties to, were located in, New Jersey. However, that was not the critical question. Rather than relying upon analysis of the New Jersey law, the Court instead turned to a secondary authority known in the workers' compensation community: Larsons. It explained that this author's "proper jurisdictional analysis" had been adopted by the New Jersey Supreme Court in 2003. Rather than rely upon the Court, this opinion quotes the secondary authority, which is curious. The Court concluded that the trial judges had properly engaged that six-element test in their conclusions that New Jersey lacked jurisdiction.
In the second claim, the medical provider alleged that, absent jurisdiction in New Jersey, it was "left without any forum to recover." Reaching back literally to the birth of our nation (the Constitution was ratified in June 1788), Surgicare asserted that Marbury v. Madison, 5 U.S. 137 (1803) compelled New Jersey to find jurisdiction to cure this alleged absence of any forum. That analysis does contain many references to jurisdiction but is most famous for its holding regarding judicial review and the role of the U.S. Supreme Court.
The New Jersey Court was unpersuaded by Marbury, however. It noted that New Jersey's declining jurisdiction did not leave Surgicenter without recourse entirely, but merely relegated it to the forum offered by the state of New York. Despite Surgicenter being dissatisfied by the outcome of proceeding in New York, that is application of the New York reimbursement constraints, the sound conclusion was that New York indeed offered a forum.
The Superior Court Appellate Decision affirmed both trial judge's declining of jurisdiction regarding these reimbursement disputes.
The Superior Court also noted that the disappointed medical providers' appellate statements were less than complimentary of the trial judges in these cases. One described the trial judge's decision as "an 'extraordinarily brazen, unsupportable misuse of authority.'" The other described the "decision in its case [w]as 'incoherent,' and 'preposterous.'"
The Court addressed these comments and accusations. It found those statements to be "pejorative attacks on the judges" and "to be totally unwarranted and disrespectful." The Court noted that
"the judges of the court of compensation, like other judges, are dedicated public servants who strive each day to properly assess the cases before them after giving due regard to the facts and the applicable law."
Litigants in all forums, regardless of the law being argued, might be well advised to remember that.
