top of page

News

NJ Appellate Court Determines that “Ambulatory Surgical Center” Not Entitled to Reimbursement from Insurer (NJ)

February 7, 2020

Share to:

<p style="text-align: justify;">After a 2014 automobile accident, Claire Fiore underwent a lower back surgery at the Ambulatory Surgical Center (“ASC”) operated by Specialty Surgical Center of North Brunswick. Following the procedure, ASC sought reimbursement from Fiore’s automobile insurer, New Jersey Manufacturer’s Insurance Company (“NJM”). NJM denied payment. The dispute then went to arbitration, where a panel awarded ASC its $32,500 in reimbursement.  But NJM filed suit to vacate that award and the trial court did so.</p>
<p style="text-align: justify;">In <em><a href="https://www.wcmlaw.com/wp-content/uploads/2020/02/New-Jersey-Manufacturers-Ins-Co.-v.-Specialty-Surgery-Center-of-North-Brunswick.pdf">New Jersey Manufacturers Ins Co. v. Specialty Surgery Center of North Brunswick</a>, </em>NJM argued that it was not required to reimburse the insurer because the New Jersey personal injury protection (“PIP”) fee schedule did not specifically provide for a reimbursement value for ASCs.  The ASC disagreed, and argued it was entitled to reimbursement because lower back surgery (the procedure ASC performed) was listed as a reimbursable procedure.  The Court ruled that NJM was not entitled to reimbursement.  In doing so, the court reasoned that the plain language of the fee schedule applied.  The court also reasoned that the fee schedule provided for reimbursement only to “physicians.”</p>
<p style="text-align: justify;">The New Jersey Appellate Court’s decision is important because it lends support to a strict construction of regulatory language.</p>
<p style="text-align: justify;"><span>Thanks to John Lang for his contribution to this post.  Please email <a href="mailto:mgauvin@wcmlaw.com">Mike Gauvin </a></span><span>with any questions.</span></p>

Headshot of Staff Member
Button
Button
Button
Button

Contact

bottom of page