In a landmark decision the NJ Court of Appeals held that medical provider claims for expenses in workers’ compensation claims are subject to a contractual six-year statute of limitations. The ruling will have a major impact upon the overburdened state’s Division of Workers’ Compensation (NJDWC) system.
The NJDWC is already recognizing a soaring number of medical expense disputes and it lacks a standardized adjudication process. The Legislature should establish a medical fee schedule and create a separate alternate dispute resolution (ADR) system to adjudicate the medical provider claims.
The Court ruled that the delayed medical claims were valid even though they were filed over two years from the injured workers’ accident. In deciding the case the Court reasoned that even though the NJ DWC had been conferred with exclusive jurisdiction under N.J.S.A. 34:15-15 enacted in 2012, the Legislature was silent on the issue of the statute of limitations (SOL) for such matters. The Court held that, the triggering date for the time-bar in N.J.S.A. 34:15-51 is not the date of the employee’s accident, but the date of the action’s accrual under the law of contracts N.J.S.A. 2A:14-1.
Judge Fisher wrote, “…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 time-bar simply doesn’t fit. N.J.S.A. 34:15-51 requires that a petition for compensation must be filed within two years of ‘the accident.’ Because there can be no doubt that ‘the accident,’ as used in this statute, relates only to the date the employee's work-related injury occurred, the idea that the timeliness of a medical-provider's claim should be gauged by the passage of time from the employee's accident seems nonsensical. It's safe to say that there would be – if this shorter statute of limitations applied – numerous times in which the window within which medical providers would be required to assert their claims would expire before their claims accrued. Is it not likely that at times an employee might be treated by a medical provider for a period greater than the two-year period following the worker's accident or even not be treated by a particular medical provider until after two years elapsed from the work-related accident? In seeking a reasonably plausible interpretation of the Legislature's amendment, are we really to assume the Legislature intended to create a situation where a medical provider's right to pursue a legitimate claim 12 A-5597-16T1 might actually be extinguished before it even accrued? Absent greater evidence than its silence, we refuse to assume the Legislature intended to make such a significant and incongruous change to the time-bar applicable to medical provider claims.”
NJ is one of the very few states that has no medical fee schedule nor ADR process to handle medical fee disputes. See, “Guidelines for Medical Provider Claims-A Valuable Approach” 10-21-17 and “Fee Schedules: A Defense of Bureaucracy in Workers Compensation” 12-3-18.
Medical claims have become a growing albatross to the compensation adjudication process and a major distraction from the focus of the primary worker- employer disputes. The expense disputes continue to escalate in number and drain the summary adjudicatory process of delivery of workers’ compensation benefits of precious and limited judicial resources. While the Court's decision is rationale, it unfortunately administratively compounds a dire situation. Before medical provider claims emasculate the entire workers’ compensation system, legislative action is needed to finally establish a medical fee schedule and establish a separate mandatory and binding ADR process for medical provider disputes.
THE
PLASTIC SURGERY CENTER, PA VS. MALOUF CHEVROLET-CADILLAC, INC. THE PLASTIC
SURGERY CENTER, PA VS. LEONE INDUSTRIES THE WOODS O.R., INC. VS. LEONE
INDUSTRIES STEVEN J. PARAGIOUDAKIS, M.D. VS. CAFÉ BAYOU MARC MENKOWITZ, M.D.
VS. CAFÉ BAYOU (DIVISION OF WORKERS' COMPENSATION) (CONSOLIDATED)
A-5597-16T1/A-5603-16T1/A-5604-16T1/A-0151-17T1/A-0152-17T1
(Decided January 17, 2019) ___ N.J. Super. ___, ___A.3d___, 2019 WL 256698
[Approved for Publication]
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Jon L. Gelman of Wayne NJ is the author of NJ Workers’ Compensation Law (West-Thomson-Reuters) and co-author of the national treatise, Modern Workers’ Compensation Law (West-Thomson-Reuters). For over 4 decades the Law Offices of Jon L Gelman 1.973.696.7900 jon@gelmans.com has been representing injured workers and their families who have suffered occupational accidents and illnesses.
