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West Jersey Health System v. Cronenberger

August 9, 1994


The opinion of the court was delivered by: A. A. Rodriguez, J.S.C. (temporarily assigned).

Submitted May 4, 1994

On appeal from the Superior Court of New Jersey, Special Civil Part, Camden County.

The main issue presented is whether the Workers' Compensation Act (Act), N.J.S.A. 34:15-1 to -128, bars a medical provider from suing an employee for an unpaid bill resulting from a work-related injury where the employer failed to carry workers' compensation does not. However, public policy mandates that execution should not issue until the employee has made a claim to the Uninsured Employer's Fund (UEF) for payment of medical benefits pursuant to N.J.S.A. 34:15-120.2, and the UEF determines whether or not to make the payment.

Gary Croneberger was employed by Maple Aluminum Products, Inc. (Maple), which is no longer in business. On January 31, 1984, and again on May 4, 1984, he sustained injuries while working for Maple. He filed a petition with the Division of Workers' Compensation seeking compensation for his injury. Maple did not carry workers' compensation insurance as required by N.J.S.A. 34:15-71.

Four years after the filing of his petition, Croneberger was admitted to West Jersey Health System (West Jersey) for out-patient surgery to transplant the tendon in his left hand. He claimed that the treatment was necessary as the result of his May 1984 injury. At that time, he was no longer employed by Maple. He did not obtain authorization from Maple to have the surgery. On West Jersey's admission form Croneberger wrote that he was "self-employed and self-insured." West Jersey's bill for his surgery was $1,526.64.

Three years later a judge of compensation found that Croneberger had suffered a compensable injury and awarded temporary and permanent disability. The judge also ordered that Maple pay all treatment expenses, including the West Jersey bill. The record suggests that Maple's failure to carry insurance delayed the resolution of the claim in the Division and the award of compensation. The award was reduced to a Superior Court judgment and execution against Maple issued.

In September 1991, three years after the surgery, West Jersey filed an action against Croneberger to recover for the unpaid bill. Croneberger filed an answer and moved for summary judgment arguing that the workers' compensation law barred West Jersey's action. In the alternative, Croneberger moved for leave to amend the complaint to join Maple and Thomas Howey, its president and sole shareholder, as third party defendants. West Jersey cross-moved for summary judgment claiming that Croneberger was contractually liable to the hospital for services rendered and that the suit was not barred by the Act. The judge granted West Jersey's motion, ruling that the workers' compensation law had no effect on West Jersey's rights, and denied Croneberger's motion to join Maple and Howey in the action.

Croneberger argues that: (1) he cannot be held liable for a medical treatment bill which the Division of Workers' Compensation has found to be the responsibility of his employer; (2) there is no legal or factual basis for the conclusion that his representations upon admission to West Jersey waived his statutory right to workers' compensation medical benefits; and (3) the trial judge erred in failing to permit Croneberger to join Maple and Howey to the action. *fn1 We disagree with the first contention, but agree with the third. The second one is moot.


The motion judge correctly concluded that the provisions of the Act do not affect the contractual liability between an injured employee and a provider of medical services. The prohibition of N.J.S.A. 34:15-8, which bars employees and employers from pursuing any common law remedy, does not extend to the medical provider. Likewise, N.J.S.A. 34:15-15, which imposes upon the employer the obligations to pay for compensable hospital services, governs only the responsibilities between employer and employee.

However, our analysis cannot end there. The goal of the workers' compensation laws is "to relieve the injured employee of the burden of paying for his own medical care and to replace his lost wages. . . ." 38 Jon L. Gelman, New Jersey Practice, Workers' Compensation Law at 1, at 1 (1988). "The beneficent social purposes of workmen's compensation legislation are to be reflected by the benefits of liberal construction in the petitioner's favor." Benson v. Coca Cola Company, 120 N.J. Super. 60, 64-65, 293 A.2d 395 (App. Div. 1972).

In order to obtain medical treatment an injured employee must first demand treatment from the employer. N.J.S.A. 34:15-15. If the employer refuses or fails to provide medical treatment, then the employee may seek medical treatment. Ibid. The employee is not required to demand medical treatment if such a request would be futile. Benson, supra. 120 N. J. Super. at 64-65. If the employee obtains medical treatment on his own, the employerm ay be held liable to the medical provider for treatment costs. Stafford v. Pabco Products, Inc., 53 N.J. Super. 300, 304-05, 147 A.2d 286 (App. Div. 1958)( "parties who furnish medical or hospital services to employees were intended toh ave enforceable rights to reimbursement by the employers under R.S. 34:15-15 inw orkmen's compensation proceedings.").

The clear legislative intent of the Act is that an employee should not have to pay for medical treatment for injuries arising out of and in the course of employment unless there is no other available source of payment. Kinley Physical Therapy Services, Inc. v. Kramer, 256 N.J. Super. 355, 606 A.2d 1163 (Law Div. 1992), supports the proposition that the employee is the last source o f payment for work-connected medical expenses. While the employee's workers' compensation claim was pending, the health care provider filed suit against the employee seeking payment for medical services rendered. The judge concluded that a medical provider could assert a claim against the employee only after it is determined that the treatment is non-compensable. He said:

It follows that a medical provider may only press a claim against an employee after the Division of Worker's Compensation determines the treatment to be non-compensable. "While the compensation proceedings are in progress, if it turns out that the claim was not compensable, and that the employee is to be ultimately liable for the fees, the physician or hospital has been protected by a holding that the statute of limitations is tolled during the pendency of ...

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