Attorney Joe Jones leads a presentation on New Jersey’s mandatory e-Filing program now in place for all workers’ compensation cases. Jones discusses the system, how to set it up, and how it can benefit respondents litigating in New Jersey’s Division of Workers’ Compensation. The video (below) is from the live presentation provided to the Firm’s clients on March 25, 2019.
This was an accepted claim with authorized treatment. Permanency reports were exchanged, the case was conferenced and the Judge of Compensation gave her opinion as to value. The client granted authority as per the Judge’s recommendation and we presented an offer to the Petitioner’s counsel in November of 2018. The attorney delayed for months with various excuses, including “my client didn’t call me back”, and “I haven’t had the chance to speak to him yet”, etc. We filed a Motion to Dismiss after hearing one too many excuses. LOIS attorney Joe Jones aggressively pursued the dismissal Motion and was able to argue that the case should be dismissed as the petitioner and/or the attorney had no interest in moving the case forward.
The Judge agreed enough was enough and dismissed the case.
Case: DC v CCI
Lois Attorney: Joseph Jones, Esq.
In a decision issued January 29, 2019 a New Jersey Appellate Court has ruled that even though Medicare includes a CPT code and pays for specific treatment rendered in a ambulatory surgery center this does not obligate a New Jersey auto insurer to make payment for medical treatment billed under such code. At issue were bills submitted to an auto insurance carrier for treatment allegedly rendered in an out-patient facility to the claimant’s low back. The medical fees in dispute involved invoices from the facility not the doctor.
In this case, the facility, Specialty Surgery Center of North Brunswick, sough $32,500 in reimbursement from an automobile insurer for CPT code 63030, which refers to “lower back disc surgery.” The New Jersey Appeals Court ruled that the CPT code provided for reimbursement of physicians only, and not to ambulatory surgery centers. The court further found that despite Medicare’s position on reimbursement for that code, the surgery center was not entitled to payment under New Jersey’s personal injury protection (“PIP”) fee schedule promulgated by the New Jersey Department of Banking and Insurance for automobile claims.
While not mentioning the implications for medical provider claims in New Jersey workers’ compensation cases, this case stands for the proposition that where an ambulatory surgery center is seeking payment for fees that greatly exceed the normal reimbursement and justify those claims by referring to Medicare or other jurisdictional rules, the workers’ compensation carrier can argue that New Jersey’s PIP fee schedule should be relied upon by the workers’ compensation judge as a reasonable estimate of costs (where the surgery center accepts PIP payments). Case discussed: New Jersey Manufacturers Ins. Co. v. Specialty Surgical Center of North Brunswick, A-0319-17T1, A -0388-17T1 (N.J. App. Div. Jan. 29, 2019).
Attorney Greg Lois Attorney Gregory Lois leads a discussion on the challenges facing parties seeking to resolve disputes via New Jersey’s Section 20 lump-sum dismissal process where Medicare has an interest. This video is taken from the January 28, 2019 webinar provided by the Firm.
LOIS successfully defended an employer directly against a workers’ compensation claim and got them dismissed from the claim. The employer hired us directly to defend their interests in a workers’ compensation claim filed against them. An employee leasing entity provided the employee along with worker’s compensation coverage. The employer leasing company argued that they had terminated their contract of services with the employer and were therefore not responsible. We successfully argued that the statute for termination of insurance coverage was applicable and that they had not complied. First, the employer leasing company only provided a copy of the termination letter, but had not shown any proof of mailing or proof of service. Second, the accident occurred 2 days later (on a Sunday). The Judge entered an order against the employer leasing company and dismissed our client from the claim.
Case: RP v. IG;
Lois Attorney: Karen Vincent, Esq.
Effective January 1, 2019, the maximum temporary disability compensation benefit rate for New Jersey claims rises to $921.00 per week and the minimum rate is $246 per week. These rates take effect for new injuries occurring on or after January 1, 2019. Benefit rates in cases with dates of loss prior to January 1, 2019 do not get this higher rate – New Jersey does not have a cost of living increase for established claims. Continue reading New Jersey’s Maximum Benefit Rate Increase in Effect Now for New Claims