201-880-7213

Proofs Required to Oppose Motion for Benefits In New Jersey

The New Jersey Appellate Division recently rendered a decision on October 10, 2019 dealing with the quality of proofs required when filing a Med/Temp Motion or the opposition to same.  While the decision is “unpublished” and therefore not binding precedent upon any court,  the takeaways from the Appellate Division’s decision are useful for claims professionals and attorneys when obtaining proofs, considering proofs and ultimately submitting proofs to the court in opposition to Motion for Medical and Temporary Disability benefits.

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New Jersey Appeals Court Limits Payments to Ambulatory Surgery Centers

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 an 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.

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Federal Employer’s Liability Act Claims Preempt New York Jurisdiction.

In general, the Federal Employers Liability Act preempts the New York Workers’ Compensation Law unless the parties waive their federal rights and claims. The Board lacks the authority to rule on jurisdictional issues regarding federal claims (such as whether or not the claimant is an employee of the interstate entity. This is because WCL § 113, states that “[t]he provisions of [the New York Workers’ Compensation Law] shall apply to employers and employees engaged in intrastate, and also interstate and foreign commerce for whom a rule of liability or method of compensation may be established by the congress of the United States . . . provided that awards according to the provisions of this chapter may be made by the board . . . in case the claimant, the employer and the insurance carrier waive their admiralty or interstate rights and remedies.”

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New Jersey Medical Provider Claims Have a Six-Year Statute of Limitations

On January 17, 2019 the New Jersey Appellate Division ruled that medical providers filing a “Medical Provider Application for Payment or Reimbursement of Medical Payment” seeking additional money from workers’ compensation insurance carriers have six years to file their claims. This is longer than the two year Statute of Limitations which applies to the underlying workers’ compensation claim. This decision will increase the number of Medical Provider Claims filed in New Jersey.

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Explainer: Appeals of New Jersey Workers’ Compensation Decisions

Decisions of a Workers’ Compensation Judge are appealable directly to the New Jersey Appellate Court. An appeal of the Workers’ Compensation Judge’s opinion must be made within 45 days of the entry of the final order. How does the appeals court rule where there was a disagreement between the doctors who testified in the workers’ compensation case?

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Explainer: The Standard of Review in a New Jersey Workers’ Compensation case

Appeals from workers’ compensation courts are directly to  the New Jersey Superior Court Appellate Division. R. 2:2-3.  The standard for review of a decision of a Judge of Compensation in most instances is governed by Close v. Kordulak Bros., 44 N.J. 589 (1965). In Kordulak, the Supreme Court held that the standard of review for decision rendered by the Division of Workers’ Compensation is:

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