The Interstate Medical Provider Claim: Unsettled Jurisdictional Questions Open the Floodgates in New Jersey
As overall filings in the New Jersey Workers’ Compensation Courts have been falling, one particular type of claim is on the rise: the Medical Provider Application for Payment or Reimbursement of Medical Payment. The statutory authority for these “Medical Provider Claim Petitions” (MCPs) is found in a single sentence in the depths of New Jersey Statutes Annotated 34:15-15: “[e]xclusive jurisdiction for any disputed medical charge arising from any claim for compensation for a work-related injury or illness shall be vested in the division.” The precise scope of jurisdiction established by this provision is currently unclear.
With nearly 300,000 New Jersey residents commuting into New York and over 75,000 commuting into Philadelphia, it’s no surprise that there are a large number of cases where no single state is in an obvious position to take the lead when a worker gets injured. Compounding the potential for jurisdictional confusion is that, in addition to the injured worker and the employer, the MCP tacks on a third wheel: the medical provider. Enterprising medical providers’ attorneys have not been perturbed by the complex domiciliary interplay. Instead, they quote that New Jersey claims “exclusive jurisdiction for any disputed medical charge arising from any claim…,” and file their applications.
The broad language of the provision invites a broad variety of interpretation. Judges of compensation differ on the scope of the provision. Some judges find that New Jersey has jurisdiction over the MCP only if it would have had jurisdiction over the underlying compensation claim, describing the MCP as a “derivative” claim. Others undertake an independent analysis as to whether New Jersey has a substantial interest in the matter. While the test for jurisdiction over the underlying claim is somewhat restrictive, the substantial interest test leaves significant discretion to the judges of compensation to decide what constitutes a substantial interest. For some, the fact that the medical provider is based in New Jersey may be enough.
Such a low bar can be problematic, though, as an injured worker who is a New York resident and is injured in New York while working for a New York-based employer may obtain treatment from a New Jersey provider. In this situation, a New York workers’ compensation claim may have been tried to completion before the New Jersey MCP is even filed. Yet, if a New Jersey judge of compensation finds that there is a substantial interest in the matter because a New Jersey provider’s bill has been underpaid, jurisdiction in New Jersey may result.
The scheme, as it stands, fails to provide litigants with a predictable means to determine where their disputes will be heard. It further threatens to undermine the compensation systems in neighboring states. For instance, where New Jersey mandates medical providers are paid according to the Usual, Customary, and Reasonable (UCR) rates, New York employs a fee schedule. Without further guidance on jurisdiction, providers can accept payment according to the New York fee schedule, and then seek further payment in the New Jersey Compensation Courts if the UCR rate happens to be higher than the New York schedule. Obviously, this frustrates the purpose of both states in codifying the method by which providers are paid.
With any luck, practitioners can look forward to a clarifying opinion from the Appellate Division in the near future (although, it’s worth noting that the Appellate Division recently declined to hear a case involving the issue). Until then, be prepared to see more MCPs with interstate trappings and be ready to argue within the framework of both the derivative claim and the substantial interest tests.
 Based on 2009-2013 census data. See, https://www.nj.com/data/2018/04/explore_the_ebb_and_flow_of_new_jersey_commutes_wi_1.html