The Division Of Workers’ Compensation’s jurisdiction includes medical fee disputes arising from New Jersey workers’ compensation claims.N.J.S.A. 34:15-15 states: “Exclusive 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.”
As evidenced by its situation inside of the New Jersey Workers’ Compensation section of the New Jersey Labor Statute, this provision is meant to apply to all New Jersey Workers’ Compensation claims.
Prior to the November 19, 2012 amendment to the New Jersey Workers Compensation Act (N.J.S.A. 34:15-15), the statue of limitations for fee disputes was set by N.J.S.A. 2A:14-1 as per Medical Diagnostic Assocs. v. Hawryluk, 317 N.J. Super. 338, 349 (App. Div. 1998), cert. denied, 160 N.J. 89 (1999). Under N.J.S.A. 2A:14-1, recovery upon a contractual claim or liability, express or implied, not under seal, or upon an account other than one which concerns the trade or merchandise between merchant and merchant, their factors, agents and servants, shall be commenced within 6 years next after the cause of any such action shall have accrued.” Continue reading The Statute of Limitations in New Jersey Medical Provider Claims→
Attorneys Karen Vincent and Greg Lois of the Lois Law Firm explain how New Jersey’s Second Injury Fund works, when relief can be obtained from the Fund, and strategies for maximizing the contribution of the Second Injury Fund. The presentation includes a practical step-by-step illustration of the impact of Fund contribution in a total disability case with pre-existing conditions.
A recent decision serves as a reminder that when cases are bifurcated for trial, the ruling may only be limited to the issue before the Court. In Moran v. Cosmetic Essence, the Judge of Compensation issued a ruling on temporary disability following a bifurcated trial regarding the compensability of an alleged work-related injury. On March 14, 2018, the Appellate Division of the Superior Court of New Jersey remanded the matter finding that the workers’ compensation judge should not have ruled to award temporary disability benefits following a bifurcated trial on compensability.
The facts in Moran.
The petitioner, Nestor Moran, filed a Claim Petition alleging that he was injured on January 28, 2016 while lifting a heavy box. Respondent filed an Answer denying compensability and alleging that no accident occurred while working. Petitioner then filed a Motion for Temporary and Medical Benefits. However, due to the fact that the Respondent denied a work-related accident occurred, it was agreed that they would bifurcate the trial limited to whether a work-related injury occurred and if such an injury did not occur, whether the petitioner committed fraud by pursuing the matter. Continue reading Practical Advice for Bifurcated Trials in New Jersey→
The New Jersey Appellate Division just handed down a decision in Larry D. Batts v. Flag House, a case that although not precedent for other courts to follow (the decision was an unpublished decision under Docket No. A-5616-15T4, January 16, 2018), discusses two important things:
A decision by a workers’ compensation Judge supported by substantial credible evidence will be generally upheld as substantial deference is given to their decisions as the trier of fact. This is a common theme in many Appellate decisions but an important one to note when you are making a record in a trial.
When an original case settles under an Order Approving Settlement involving more than one body part (arm and back, neck and psych, etc.) and the first re-opener is filed and settled with an increase to one of the original body parts but remains silent as to the other body parts, the second re-opener may include an increase in disability to the other body part that was not increased in the prior re-opener OAS (of course the petitioner still has to prove an increase in permanency!).
In Larry D. Batts v. Flag Ship, petitioner claimed injury to his right foot as well as psychiatric disability for chronic depression and anxiety disorder as a result of an accident that occurred on April 2, 1998 while at work when a forklift ran over his right ankle. The original case settled under an Order Approving Settlement awarding the petitioner 50% of the right foot for orthopedic disability and 10% of partial total for psychiatric disability. Continue reading New Jersey: No Modification to Award 18 Years After Loss→
“PIP” is short for “Personal Injury Injury Protection.” Personal Injury Protection is a mandatory coverage in New Jersey automobile insurance policies. that provides medical expense, income continuation, essential services, an funeral expense benefits for persons injured in automobile accidents. The coverage is available to the insured regardless of who was at fault in the accident. Personal Injury Protection is provided for “private passenger automobiles” as that term is defined in N.J.S.A. 39:6A-2. The definition covers both the type of vehicle and the ownership of the vehicle.
Disputes regarding medical care provided under the Personal Injury Protection coverage are resolved by way of Internal Appeal Procedure mandated by law or, where that fails to resolve the issue, by way of appeal to arbitration forum (Forthright, a provide company providing alternative dispute resolution services). This guide provides a background on PIP and a primer on resolving disputes for lawyers handling these cases. Continue reading Practical Guide: Understanding “PIP” and Winning Appeals in New Jersey→