When an Emergency Room doctor performs an operation that saves a life in New Jersey due to a work accident, the doctor usually ends up fighting an insurance carrier over how much is a reasonable fee for his or her professional services. In a published decision, an Appellate Division Three-Judge Panel just rebuked arguments made by the Insurance Council of New Jersey, whose members are 16 Insurance Companies who do business in New Jersey, by holding that doctors have six years to file a claim in the New Jersey Workers Compensation Court for unpaid or partially paid medical bills rather than two years as advocated by the Insurance Council of New Jersey and the insurance companies involved in the appeal.
The 2012 Amendment
In 2012, the New Jersey State Legislature amended the Workers Compensation law to provide that disputes over unpaid medical bills matters involving work accidents had to be filed in the Workers Compensation Court. The amendment to the law codified case law which had stated that medical bills related to Workers Compensation should be resolved in the Workers Compensation Court rather than the Superior Court of New Jersey.
Time Periods to File Claims
The time to seek a Superior Court Judge’s assistance in getting the outstanding medical bill paid was six years. An injured workers time to file a claim in the Workers Compensation court is two years. The arguments made by the Insurance Companies was that the time to bring an action was two years because the matter was now in the Workers Compensation Court and subject to its statute of limitations but the Appellate Division stated that the two year period was for injured workers and did not extend to medical providers. Medical providers have six years to bring a claim pursuant to long settled law in the Superior Court of New Jersey. Their dispute is one based on “contract law” thus the contract statute of limitations would apply. Versus, a work injury is a personal injury governed by the specific statute of limitations clause in the Workers Compensation statute which mimics the statute of limitations for personal injury including automobile, fall down and other injury cases in New Jersey namely two years from the date of the accident.
Appellate Division Uses Surgery Analogies
The Appellate Division made some strong statements and even couched its opinion in terms of a medical procedure:
“Although courts may at times engage in “statutory surgery” to preserve a legislative enactment from some unconstitutional taint, State v. Natale, 184 N.J. 458, 485-86 (2005); Town Tobacconist v. Kimmelman, 94 N.J. 85, 104 (1983), our holding does not implicate constitutional concerns; so we may not utilize that scalpel. Even so, judicial surgery is undertaken to reshape the Legislature’s language only to preserve what the Legislature meant. That is not what respondents [insurance carriers] seek. They do not ask that we remove some part of the statute to avoid a constitutional infirmity; they seek instead to have us transplant into the statutory body a method for ascertaining the timeliness of a medical-provider claim never expressed nor likely contemplated by the Legislature. We decline the invitation. The relief respondents are after must be pursued in the legislative branch, not here. Absent some clearer expression from the Legislature, the timeliness of medical-provider claims is to be assessed by resort to N.J.S.A. 2A:14-1.[the
The Plastic Surgery Center PA v. Malouf Chevrolet-Cadillac, Inc. , Approved for Publication, January 17, 2019.six year statute of limitations]”.
No Medical Fee Schedule for Workers Compensation
Disputes over outstanding medical bills arise not only in work accident cases but also in automobile cases. The State of New Jersey with respect to automobile accident cases has a fee schedule but no such fee schedule exists in work accident cases. A fee schedule sets forth what is an acceptable charge for a particular medical procedure and is periodically updated. Without a fee schedule, Workers Compensation judges are left to make decisions based upon their own opinion as to the correct payment amount. Workers Compensation Judges could take the fee schedule set established for automobile accident cases and make their decision based upon that fee payment schedule. Most of the doctors who file claims in the Workers Compensation Court seeking payment of medical bills, commonly known as Medical Provider Applications, are initial treatment doctors from Emergency Rooms throughout New Jersey including trauma centers where there are substantial bills in question. The Workers Compensation Insurance Carriers make a partial payment of those bills but not for the full amount billed by the doctors. Without a fee schedule, it becomes difficult to bring consistency in payment of those bills. For sure, it is important to maintain the Emergency Rooms and Trauma Center Hospitals open and the doctors who perform many times medical miracles by practicing their profession with the assistance of other medical professionals who work as a team. So the timely payment of those bills, with agreed pricing is important to the public good.
Where Do The Parties Go From Here
The decision by the Appellate Division can be appealed by the Insurance Carriers involved in the consolidated cases to the New Jersey Supreme Court. Since it was a unanimous decision, there is no direct right of appeal. The New Jersey Supreme Court would have to grant the application to have the decision reviewed. Although the New Jersey Supreme Court recently took up a workers compensation case to review the rights of Volunteer Firefighters to temporary disability benefits, it is unlikely that the New Jersey Supreme Court will go out of its way to disturb such a strong Appellate Court decision dealing with a well-settled six-year statute of limitations (time to sue) with respect to payment of medical bill disputes. If the State Legislature did not explicitly say it was changing the statute of limitations then the New Jersey Supreme Court should not overturn a decision by an Appellate Division that the existing six-year statute of limitations should remain.
Resources:
The Plastic Surgery Center, PA v. Malouf Chevrolet-Cadillac, Inc. A-5597-16T1