Sroczynski v. John Milek
197 N.J. 36 (2008)
Decided December 17, 2008
The NJ Supreme Court affirmed the Appellate Division in holding that there is no legally effective policy cancellation where a carrier fails to prove that it strictly complied with all of the requirements for cancelling a workers’ compensation insurance policy. The NJ Legislature established clear and unambiguous requirements in the cancellation statute, which include the requirement that a carrier file with the Compensation Rating and Inspection Bureau the certified statement required in N.J.S.A. 34:15-81(b). However, the Court also held that only parties that have raised this particular filing issue can be granted relief from improper cancellations - past cancellations that were never challenged on this ground will stand because the policyholders waived their right to challenge them.
Charles Beseler Company v. O’Gorman & Young, Inc. 188 N.J. 542 (2006)
and companion caseNew Jersey Manufacturers Ins. Co. v. Delta Plastics Corp. 188 N.J. 582 (2006)
Decided December 4, 2006
The New Jersey Supreme Court affirmed the decisions of the Appellate Division and held that insurance carriers for employers will not be relieved of their duty to defend an employer in a common law action filed by an injured employee under the “intentional wrong” exception created in N.J.S.A. 34:15-8 where exclusions in their standard Workers’ Compensation and Employers Liability Insurance Policy do not expressly exclude coverage for unintended injuries caused by intentional wrongs.
Fitzgerald v. Tom Coddington Stables
186 N.J. 21 (2006)
Decided January 25, 2006
Reversing the Appellate Division, the New Jersey Supreme Court held that Tom Coddington Stables, rather than the Horse Racing Injury Compensation Board, was responsible for paying workers’ compensation benefits due to the petitioner. The Court held that the petitioner does not fall within the statutory definition of a “horse racing industry employee” and the New Jersey Legislature never intended that the Board provide blanket coverage for every person employed in the horse racing industry.
University of Massachusetts Memorial Medical Ctr., Inc. v. Christodoulou
180 N.J. 334 (2004)
Decided July 13, 2004
The New Jersey Supreme Court reversed the decision of the Appellate Division and held that settlements made pursuant to N.J.S.A. 34:15-20 only resolve issues between those who were parties to that agreement. Hence, where a medical provider was not a party to the Section 20 settlement, it is not bound by that agreement and may pursue an action in the Law Division to enforce its contractual rights to payment for the medical services it provided to the petitioner.
NJ Superior Court – Appellate Division
Bellino v. Verizon Wireless
435 N.J. Super. 85 (App. Div. 2014)
Decided March 19, 2014
Respondent appealed from an order granting temporary disability and medical benefits to petitioner by arguing that the judge of compensation erred in finding: (1) testimony of petitioner and her physicians credible; (2) petitioner was entitled to such benefits; and (3) petitioners statements and omissions did not amount to fraud in violation of N.J.S.A. 34:15–57.4. The Appellate Division, however, disagreed with respondent and affirmed the decision of the judge of compensation essentially because the respondent failed to prove that the petitioner possessed the state of mind or intent necessary to commit fraud as that offense is defined in N.J.S.A. 34: 15–57.4 where petitioner only omitted/misstated certain information in her statements to doctors when she went to them for evaluation and treatment.
Greene v. AIG Casualty Co.
433 N.J. Super. 59 (App. Div. 2013)
Decided October 16, 2013
The Appellate Division reversed a determination of law made by the workers’ compensation judge and held that where a respondent has paid workers’ compensation benefits it becomes entitled under N.J.S.A. 34:15-40 to a lien against the petitioner’s third-party proceeds even where that petitioner’s injuries are ultimately deemed to be noncompensable. The appellate court concluded that there is nothing in the workers’ compensation statutes which conditions such reimbursement on whether the benefits paid were actually owed in the first place: Section 40 applies regardless of compensability to prevent double-recoveries and allow recovery of voluntary benefit payments.
Alvarado v. J & J Snack Foods Corp.
397 N.J. Super. 418 (App. Div. 2008)
Decided January 8, 2008
The Appellate Division reversed and remanded for reconsideration that part of a workers’ compensation judge’s order that set only a $50.00 counsel fee where a tender had been made. In order for a tender to be bona fide and thus not subject to a petitioner attorney counsel fee, the court found that under N.J.S.A. 34:15-64 (c ) there must be: (1) an unconditional and unqualified offer to pay compensation; (2) express terms that leave no room for misunderstanding; and (3) the offer must be made within a reasonable time after notice of the injury and extent of disability, prior to any hearing and prior to the expiration of the twenty-six week period allowed in statute.
Menichetti v. Palermo Supply Co.
396 N.J. Super. 118 (App. Div. 2007)
Decided October 10, 2007
The Appellate Division reversed the decision of the workers’ compensation judge and held that, pursuant to N.J.S.A. 34:15-64(c), an employer is entitled to benefit from a statutory reduction in the attorney’s fee even if it offers to pay compensation benefits before its medical expert examines the petitioner. The employer is entitled to such reduction as long as: (1) its offer was made within a reasonable time prior to any hearing and was stated in clear, specific, unconditional and unqualified terms; and (2) it voluntarily tendered the amount then due to the petitioner within the twenty-six week period allowed by the statute.
Carreon v. Hospitality Linen Services of NJ
386 N.J. Super. 504 (App. Div. 2006)
Decided July 18, 2006
The Appellate Division reversed the decision of the workers’ compensation judge and held that if an employer/insured enters into a contract that expressly empowers a premium finance company to act as its attorney-in-fact, and subsequently, that premium finance company acts in accord with N.J.S.A. 17:16D-13 to request that the employer’s workers’ compensation insurance carrier cancel the employer’s policy, then such carrier is not required to send the employer/insured the notice of cancellation required by N.J.S.A. 34:15-81(a) to effect cancellation of the workers’ compensation insurance policy. Under such circumstances, the provisions of N.J.S.A. 17:16D-13 are controlling in regard to the procedural requirements for an effective cancellation of a workers’ compensation insurance policy.
Ongaro v. Country Flooring Enterprises
382 N.J. Super. 359 (App. Div. 2006)
Decided January 17, 2006
The workers’ compensation judge found that an alleged cancellation of a workers’ compensation insurance policy was not effective because of errors concerning the effective cancellation date in the notice was filed by the carrier with the Compensation Rating and Inspection Bureau. In reversing the workers’ compensation judge’s decision and in holding that there was an effective policy cancellation, the Appellate Division found that the carrier’s errors were merely clerical in nature and the dates provided were still sufficiently prior to the date of the accident at issue such that the cancellation was effective.
Warnig v. Prudential Property & Casualty Ins. Co.
363 N.J. Super. 563 (App. Div. 2003)
Decided October 27, 2003
The Appellate Division affirmed the decision of the workers’ compensation judge and held that N.J.S.A. 39:6A-6 does not apply to the Med-Pay portion of an automobile insurance policy. Hence, the insurance carrier that paid Med-Pay benefits as a result of a vehicular accident injuring the petitioner was not entitled to assert a statutory right of reimbursement against the workers’ compensation benefits the petitioner received from the same accident.
Daniel Avila v. Retailers & Manufacturers Distribution
355 N.J. Super. 350 (App. Div. 2002)
Decided November 27, 2002
The Appellate Division affirmed the judge of compensation's decision not to stay her opinion and order pending appeal since the grant or denial of a stay was within the judge's discretion. The court also upheld the judge's permanent disability award.
Francesca Lombardo v. Revlon, Inc.
328 N.J. Super 484 (App. Div. 2000)
Decided February 25, 2000
The appellate court reversed the workers' compensation judge who applied N.J.S.A. 34:15-57.4, an act concerning workers' compensation fraud, retroactively to the case and dismissed petitioner's workers' compensation claim. The appellate court determined that all of the evidence relied upon by the workers' compensation judge occurred prior to the effective date of the statute and therefore, the statute was not to be applied under these circumstances.
Division Reserved Decision
Pitts v. Leone Industries, Inc.
12-10853; decided September 23, 2014 by the Hon. E. Elaine Voyles, J.W.C.
The judge of compensation had to deal with numerous issues after the respondent engaged in prolonged denial of liability based upon an intoxication defense (N.J.S.A. 34:15-7) and a fraud defense (N.J.S.A. 34:15-57.4). These defenses were maintained until the last day of trial when they were voluntarily abandoned and liability was conceded by the respondent. Afterward, the judge found the respondent liable for temporary disability, medical, and permanency benefits, as well as most attorney fees and costs. Penalties were also assessed against the respondent pursuant to N.J.S.A. 34:15-28.1.
Neglia v. Craft Carpentry & Drywall
12-1172 decided June 10, 2014 by the Honorable Philip A. Tornetta, J.W.C.
Petitioner filed motion for reconsideration of an earlier order that: (1) denied his motion for medical and temporary benefits; (2) dismissed his claim petition with prejudice; and (3) directed him to reimburse respondent for payments made for medical treatment. The Court entered this order pursuant to the Workers’ Compensation Fraud Act (N.J.S.A. 34:15-57.4). Here the Court denied the petitioner’s motion for reconsideration of its finding that the petitioner purposely or knowingly made false or misleading statements in claiming compensation benefits and failed to prove any causal relationship between the alleged work-related accident and his need for medical treatment.
Johnson v. State of New Jersey
04-29233 decided October 18, 2010 by the Honorable Emille R. Cox, J.W.C.
This case was remanded by the Appellate Division for a conflict of laws analysis on the issue of whether the petitioner’s recovery of uninsured motorist benefits from his personal Pennsylvania auto insurance policy (i.e., for injuries sustained in a motor vehicle accident while in the course of employment with the State of NJ) should be subject to a workers’ compensation lien pursuant to N.J.S.A. 34:15-40. On remand, the compensation judge found that the petitioner’s recovery constituted a double recovery, hence the State would be entitled to exercise subrogation lien rights pursuant to the statute.
Piskorz v. Beno Stucco Systems Corp.
06-6559 decided August 15, 2008 by the Honorable Philip A. Tornetta, J.W.C.
Petitioner filed a motion for commutation of his workers’ compensation award, pursuant to N.J.S.A. 34:15-25, alleging he intended to leave the U.S. to open a business in Poland. The Judge of Compensation, however, denied the motion because the petitioner failed to prove: (1) he planned to actually remove from the U.S., and (2) his particular circumstances warranted a departure from the usual method paying a workers’ compensation award.
Perry v. New Jersey Horse Racing Compensation Board
05-2948; 21819 decided April 20, 2006 by the Honorable Diana Ferriero, J.W.C.
Distinguishing the facts presented by these claims from the facts in Fitzgerald v. Tom Coddington Stables, 186 N.J. 21 (2006), the judge found that the petitioner was entitled to worker’s compensation benefits from the New Jersey Horse Racing Industry Compensation Board pursuant to N.J.S.A. 34:15-134 because he was acting as an employee of racehorse owners at the time of his work-related accident.
DeJesus v. Joffe Lumber and Supply Co. (excerpts)
00-32442; 00-32475; 01-18060; decided March 16, 2006
by the Honorable Robert F. Butler, J.W.C.
Based on two consolidated cases, the petitioner was awarded benefits subject to a child support lien. In deciding the amount that could be deducted from the petitioner’s awards to satisfy this child support lien, the Judge of Compensation found that: (1) petitioner’s temporary disability award was subject to federal law that restricts the amount that can be garnished from wages because a temporary disability award constitutes a replacement for lost wages; but (2) petitioner’s permanent disability awards and Section 20 lump-sum payments were not subject to that federal statutory restriction because such awards or payments do not constitute replacements for lost wages. Hence, the petitioner’s permanent disability awards and Section 20 payments were subject only to the provisions of the New Jersey statute and formula for determining the amount that can be deducted to reimburse a child support lien.
Anderson v. Hill Refrigeration
95-36279 decided on March 15, 2006 by the Honorable Renee C. Ricciardelli, J.W.C.
The law firm that originally filed this case in 1995, in which the petitioner later received an award (in December of 2000) when represented by a different attorney, filed a motion for attorney’s fees in January of 2004 after the petitioner had timely filed a re-opener. However, the case had already been dismissed in June of 2003 for lack of prosecution under N.J.S.A. 34:15-54. In March of 2005, petitioner filed a motion to restore. The Judge of Compensation denied both motions because: (1) the petitioner failed to show any good cause for the court to extend the statutory time-limit of one year for restoration; and (2) to allow the petitioner’s original law firm to use the motion for attorney’s fees at such a late date would inflict an injustice upon the respondent.
Aros v. USA Home Improvements, Inc.
2001-21344 decided June 16, 2005 by the Honorable Diana Ferriero, J.W.C.
Because respondent unnecessarily prolonged proceedings and continually used questionable tactics to deny petitioner’s claim and Motion for Medical and Temporary Disability Benefits, the judge found that respondent: (1) was not entitled to an exemption from counsel fees for its tardy “voluntary” tender of permanency benefits (pursuant to N.J.S.A. 34:15-64); and (2) was subject to penalties for unreasonable delay in the payment of temporary disability benefits due petitioner (pursuant to N.J.S.A. 34:15-28.1).
Rosales v. State of New Jersey
99-7099; decided April 13, 2005 by the Honorable Richard E. Hickey, III, J.W.C.
In accordance with the opinion of the Appellate Division entered on November, 8, 2004, the judge calculated the offset against workers’ compensation benefits that the State of New Jersey can receive based on the ordinary disability benefits it pays the petitioner. The judge applied the provisions of N.J.S.A. 43:15A-25.1, which sets forth specific provisions for determining the portion of the disability pension that can be offset against the workers’ compensation award. The judge also held that the Second Injury Fund can receive an offset based on either N.J.S.A. 34:15-40 or the ordinary disability pension payments made to the petitioner.