New York workers’ compensation insurance carriers and third-party administrators are learning the hard way that some New Jersey health care providers are taking “If at first you don’t succeed … sue!” to a new level. Recently, a number of New York carriers and/or their TPAs have been hauled into court by Garden State medical providers that have filed suit to recover the balance of unpaid medical bills. Of the handful of lawsuits filed thus far, the underlying workers’ compensation claim had previously been closed with a settlement or abandoned by the injured worker.

As is commonly known among workers’ compensation claims adjusters, there is no fee schedule for medical services administered in New Jersey. As a result, treatment that is provided to injured New Yorkers in New Jersey is billed at rates far in excess of those permitted by the New York fee schedule.

Notably, the New York State courts have previously held that resolution of disputed medical bills falls within the exclusive jurisdiction of the New York State Workers’ Compensation Board, which oversees an arbitration process in place for aggrieved medical providers seeking payment for outstanding bills. Perhaps more importantly, the Board has adopted the position that the New York fee schedule applies to bills submitted by New Jersey providers for treatment provided to residents of New York who cross state lines.

Nevertheless, a handful of New Jersey practitioners have turned to the New York City Civil Courts for recourse outside of the administrative agency. To commence these suits, the plaintiff providers typically serve a summons and complaint on the carrier or third-party administrator. Although there are generally several viable defenses to these complaints, failure to respond to the pleadings within the requisite time frame has the potential to result in the entry of a default judgment against the carrier. Therefore, an expeditious response is vitally important.

Should you receive a summons and complaint of this nature and require assistance, or if you have any questions on how this may impact you, please contact:

• Paul J. Kilminster (646.292.8741; pkilminster@goldbergsegalla.com)
• Or another member of Goldberg Segalla’s Workers’ Compensation Practice Group.