A
NJ Appellate Court allowed the assertion of a workers' compensation statutory lien against a liability award (NJSA 34:15-40), where the compensation insurance company paid the initial medical benefits without prejudice following a detailed
dismissal by the Compensation Court before trial. This decision has far reaching consequences in defining when, on the timeline, an
insurance carrier's actions should trigger responsibility.
Workers' Compensation was designed as a summary and expeditious system paying injured workers who suffer an injury or illness at work. The benefits of treatment and temporary disability benefits are triggered by the event or manifestation of injury, and should flow quickly to the injured worker without a long, burdensome, and litigious process.
The
payment of major medical benefits by an employer, in the past, under
The Sheffield Doctrine, has been considered to act as an estoppel, barring the denial of the compensation claim. The
NJ Legislature modified its Workers' Compensation Act several decades ago, and allowed for the payment of medical benefits, without prejudice. The consequence is that the injured worker is lulled into a sense of false security relying upon the implied acceptance of compensability. Albeit, the payment extends the statute of limitation for filing a formal claim.
The Court's dismissal, in the
Greene matter, barring the assertion of the lien by the workers' compensation insurance company, was reversed and the lien enforced from the liability award.
Interestingly, the Court did not note that the technique of ordinary settlement, by payment of unauthorized medical payments, and/or for waiver of the right to appeal, was a common practice before the legislative enactment of NJSA 34:15-20.
AIG in this case chose to "
have your cake and eat it too."
Historically, prior to the legislative enactment of lump sum payments, pursuant to NJSA 34:15-20, voluntary dismissals were utilized as vehicle to compromise dependency, and other claims, for settlement. In those instances, following the dismissal of the workers' compensation claim, the parties would enter into a settlement, albeit a fiction, to settlement of the right to appeal and a letter of payment would be exchanged and/or a Release would be executed. Any potential was extinguished.
Beside the increased necessity of reducing the dismissal terms to writing, and/or stipulation of dismissal, the issue is generated of far the insurance company can step into the deep water before it comes committed to a decision. The Legislature needs to revisit this issue, and redefine the timeline for irrevocable commitment of responsibility, otherwise the initial
Legislative intent for an expeditious, remedial administrative system will be defeated.
KELLY GREENE v
AIG CASUALTY COMPANY,
NJ App Div 2013 (Decided October 16, 2016) --- A.3d ----, 2013 WL 5629045 (N.J.Super.A.D.)
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This Committee Opinion was developed by the American College of Obstetricians and Gynecologists Committee on Health Care for Underserved Women and the American Society for Reproductive Medicine Practice Committee with the assistance of the University of California, San Francisco (UCSF) Program on Reproductive Health and the Environment. The Program on Reproductive Health and the Environment endorses this document. This document reflects emerging clinical and scientific advances as of the date issued and is subject to change. This information should not be construed as dictating an exclusive course of treatment or procedure to be followed.
