Shapiro v. Middlesex County Municipal Joint Insurance Fund

704 A.2d 1316, 307 N.J. Super. 453, 1998 N.J. Super. LEXIS 21
CourtNew Jersey Superior Court Appellate Division
DecidedJanuary 20, 1998
StatusPublished
Cited by3 cases

This text of 704 A.2d 1316 (Shapiro v. Middlesex County Municipal Joint Insurance Fund) is published on Counsel Stack Legal Research, covering New Jersey Superior Court Appellate Division primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Shapiro v. Middlesex County Municipal Joint Insurance Fund, 704 A.2d 1316, 307 N.J. Super. 453, 1998 N.J. Super. LEXIS 21 (N.J. Ct. App. 1998).

Opinion

The opinion of the court was delivered by

LANDAU, J.A.D.

Plaintiffs Ira A. Shapiro, D.C., (Shapiro), John Alen, D.C., (Allen), and New Jersey Chiropractic Society (Society), appeal from an October 28, 1996 Chancery Division order, and the November 22, 1996 denial of its reconsideration, dismissing their complaint for failure to state a claim, R. 4:6-2(e), and simultaneously denying standing to the Society. The complaint alleged a number of antitrust claims under the New Jersey Antitrust Act (N.J.S.A 56:9-1 to -19), as well as claims for tortious interference with contractual and business relations. It was removed from the Federal District Court to the Chancery Division.

Plaintiffs Shapiro and Alen are practicing chiropractors in the Township of Old Bridge (Old Bridge). The Society is a statewide organization of chiropractors. Defendant Middlesex County Joint Insurance Fund (JIF), is a municipal insurance pool, established pursuant to N.J.SA 40A:10-36, providing insurance coverage, including workers’ compensation coverage, for a number of New Jersey municipalities, including the Township of Old Bridge in Middlesex County. Defendant William Kurtz (Kurtz) is the Executive Director of JIF. Defendant Insurance Claims Solutions [456]*456(ICS) has been the workers’ compensation claims administrator for Old Bridge since 1995. Defendant Scibal Associates (Scibal) was the workers’ compensation claims administrator for Old Bridge from 1986 to 1995. Defendant Old Bridge/Sayreville Medical Group (Medical Group) is a group of medical practitioners with offices located in Old Bridge and Sayreville. Defendant Allan F. Crane (Crane) was the Risk Manager for Old Bridge, and Terrence G. Blackwell (Blackwell) was its Director of Human Resources.

From 1978 to 1986 Old Bridge maintained a list of doctors authorized to render care to its employees for work-related injuries. Allen was appointed by Old Bridge in 1978 as a treating chiropractor for work-related injuries sustained by Old Bridge employees. In 1982, Shapiro joined him in that practice, which treated between thirty and fifty Old Bridge employees for work-related injuries each year. Shapiro opened his own practice in 1987 and was subsequently appointed as a chiropractic physician to whom referrals of Old Bridge employees could be made by a primary physician.

Old Bridge joined JIF in 1986 and Scibal was designated its claims administrator. After 1986, JIF named Medical Group as one of its approved primary physicians for treatment of workers’ compensation injuries, and Medical Group was designated as the primary care provider for Old Bridge employees. Pursuant to the arrangement entered into with JIF, chiropractic treatment for employees’ work-related injuries required a referral from an approved primary treating physician at Medical Group. Thus, chiropractors were approved by JIF for referral, but not as primary treating physicians. Chiropractic treatment for a compensation injury that was not the result of a referral from an approved primary treating physician was eligible for payment under the employee’s Blue Cross/Blue Shield Major Medical coverage. However, non-referred chiropractic treatment for work connected injury would not be covered by JIF.

Old Bridge’s Township Council passed a resolution in March 1992 memorializing its opposition to JIF’s refusal to authorize [457]*457chiropractic treatment of its work-injured employees which was presented to JIF at its March 1992 meeting. Executive Director Kurtz had noted that any referral to a specialist, including a chiropractor, would be honored, and an employee who desired to see a specialist would be allowed to do so as “authorize[d] ... on a controlled basis.” However, a motion to allow some specialists (including Allen and Shapiro) to be primary care providers for workers’ compensation injuries was voted upon and defeated at that time.

Plaintiffs allege that after 1986, they did not receive any referrals from JIF or Medical Group, despite the fact that Medical Group has no musculoskeletal experts on staff. Shapiro contends, through his experience, that most workers’ compensation claims are musculoskeletal in nature. Allen claims that although patients have requested chiropractic services, Scibal and Medical Group have denied their requests for referrals other than to physicians.

After careful examination of the record, we affirm the dismissal of the complaint, substantially for the reasons stated by the judge in his letter opinion dated October 17,1996. We add these limited comments.

With respect to plaintiffs’ claims for tortious interference with their contractual and business relations, our searching review of plaintiffs’ allegations does not confirm that they state “legally or ethically improper” actions. See Raul Intern’l Corp. v. Sealed Power Corp., 586 F.Supp. 349, 358 (D.N.J.1984); accord Ideal Dairy Farms, Inc. v. Farmland Dairy Farms, Inc., 282 N.J.Super. 140, 198-201, 659 A.2d 904 (App.Div.), certif. denied, 141 N.J. 99, 660 A.2d 1197 (1995). JIF, as the workers’ compensation providing entity for Old Bridge, may lawfully and ethically choose those physicians who it deems qualified to make the full range of professional judgments necessary to conform with the requirements of the workers’ compensation statute. Choosing Medical Group, rather than a licensee in a more narrow branch of the medical arts as the primary care provider for injured employees of Old Bridge, and requiring that all visits to specialists be subject to [458]*458referrals by the primary care physicians is a permissible employer decision under N.J.S.A 34:15-15. See Benson v. Coca Cola Co., 115 N.J.Super. 585, 590, 280 A.2d 515 (Cty.Ct.1971), remanded on other grounds, 120 N.J.Super. 60, 293 A.2d 395 (App.Div.l972)(employer has right to make initial choice of physician or hospital for injured employee).

As to plaintiffs’ claims that JIF is not immune from antitrust liability under N.J.S.A 56:9-5b(4), we note that whether an entity is an insurer pursuant to the N.J.S.A 56:9 — 5b(4) exemption “must be determined in light of the purpose of the exemption,” which, as noted by the motion judge, was “designed to avoid the situation whereby a state regulatory agency acting pursuant to one statute (the insurance laws) requires conduct which might be held to violate another statute (the Anti-trust Act).” Borland v. Bayonne Hospital, 122 N.J.Super. 387, 406, 300 A.2d 584 (Ch.Div.1973), aff'd, 136 N.J.Super. 60, 344 A.2d 331 (App.Div.1975), aff'd, 72 N.J. 152, 369 A.2d 1, cert. denied, 434 U.S. 817, 98 S.Ct. 56, 54 L.Ed.2d 73 (1977).

While N.J.SA 40A:10-48 states that a joint insurance fund is not technically an insurance company or insurer under State law, the fund’s activities are subject to like regulation by the Commissioner of Insurance1

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704 A.2d 1316, 307 N.J. Super. 453, 1998 N.J. Super. LEXIS 21, Counsel Stack Legal Research, https://law.counselstack.com/opinion/shapiro-v-middlesex-county-municipal-joint-insurance-fund-njsuperctappdiv-1998.