Employee Exposed to Perfume at Work Allowed Workers' Compensation Benefits

A licensed practical nurse who suffered from preexisting pulmonary disability was permitted to recover benefits against her employer when a co-employee sprayed perfume at work. The NJ Appellate Division ruled that a licensed practical nurse was allowed to seek benefits when exposed to an employee's perfume even though the injured worker came to the employment with severe pre-existing obstructive lung disease.

The 64 year old nurse, who had smoked one pack of cigarettes daily for 43 years, had a severe reaction when a coworker sprayed herself with perfume on two occasions. The nurse subsequently became oxygen dependent and never returned to work.

The court reasoned in its opinion that the accident occurred in the course of her employment and arose out of her employment. The exposure at work was deemed a "neutral risk," one that was out of the control of the employee. The court determine that had she not been at work the nurse would not have had this exposure and reaction. The co-employee actions injured the nurse the court held and that the employee, "...had to breathe in order to fulfill her contract of service, contaminated by a co- employee, was a condition of the employment for Sexton and thus a risk of 'this' employment for her." The court reasoned that the injury was not self-inflicted and the employee takes their employees as they find them.

The Second Injury (SIF) was also held responsible for the pre-existing COPD condition since was the intent of the SIF to encourage employers to hire workers' with pre-exisiting conditions. In this case the pre-existing condition was not the sole cause of the injury; therefore, making the SIF liable also.

Sexton v. County of Cumberland/Culberland Manor, NJ App. Div., A-6414-06T1 Decided Januray 9, 2009).

Social Security Judges (ALJ) Productivity Report

Search SSA judges’ (SLJ's) decisions online.

In response to a Freedom of Information Act request by The Oregonian, the Social Security Administration released the production numbers and approval rates for all of its administrative law judges.

The agency released complete reports for 2005, 2006 and 2007. The table for 2008 covers most — but not all — of the year.To search the database, enter a judge’s name or select a year. You can sort the table by any of the categories by clicking on the category header.

Click here to access the database

http://bridge.caspio.net/dp.asp?AppKey=64ae0000d1i0d2c9f2d8i9a3f2h4

The Office of Inspector General released a report in April 2008 highlighting the deficiencies and the delay in the hearing process. As of that date there were 773,999 cases awaiting a decision and the average processing time was 505 days.

NJ Charges 11 Corporations for Massive Workers’ Compensation Insurance Fraud

The NJ Attorney General announced that seven people and 11 corporations were charged with a massive plan to commit workers’ compensation fraud that has allegedly netted the companies over $1.5 million. The indictments against the corporations and individuals were made available yesterday.

Anne Milgram, NJ Attorney General, and Deborah L. Gramiccioni, Criminal Justice Director, informed the public that, "The indictments allege that the defendants lied on insurance applications and failed to remit insurance premiums to the insurance companies, instead keeping the money for themselves. It is also charged that the defendants laundered money so that the scheme would go undetected. As a result, many people were allegedly left without workers’ compensation insurance."

"The indictment alleges that between June 2003 and September 2007, Sciarra, a former licensed insurance producer, and his co-defendants fraudulently avoided premium payments for workers’ compensation insurance they obtained for clients. The defendants allegedly submitted falsified applications for workers’ compensation insurance by misrepresenting and omitting information in the applications. These misrepresentations included understating the number of employees leased, the kind of work those employees did and the number of past injury claims involving the employers, all factors that are relevant to determining the cost of workers’ compensation insurance. The defendants also are charged with failing to turn over money that was provided by clients of the PEOs to pay for insurance premiums."

The State of New Jersey has recently enacted legislation expanding its insurance fraud program. In December 2008 the NJ legislature passed and the Governor signed Senate Bill No. 1918 which requires the Insurance Fraud Prosecutor to establish liaison with the Department of Labor and Workplace Development and authorizes its investigation of cases for failure to provide workers' compensation coverage.

Federal Court Rejects Review of Workers’ Compensation Judge’s Alleged Gross Judicial Misconduct

A complaint filed by an injured worker who sought Federal Court review of a NJ Workers’ Compensation Judge for alleged gross misconduct was dismissed. The Court held that it lacked the authority to review the matter.

The injured worker, who had filed an action for temporary and medical benefits before the NJ agency, was previously awarded by the Division of Workers’ Compensation 20% of the right wrist and 20% of permanent partial total for residuals of a “contusion, strain, tendonitis, and synovitis of the hand. "

In a complaint filed in the Federal Court, pro se, the injured worker alleged, “…Plaintiff asserts that the actions and inactions of the Department of Labor, the Division of Workers' Compensation, and specifically the Workers' Compensation judges violated her right to due process of law under the Constitution of the United States …..Plaintiff sought damages in the amount of $5 million.”

The complaint alleged, among other items, that, "....the Workers' Compensation hearing and trial judges engaged in gross judicial misconduct by: (1) conducting hearings in Plaintiff's absence, (2) adjourning hearings without good cause, (3) relying on fraudulent and factually inaccurate medical evidence to reach its determination, and (4) ordering an independent medical exam without Plaintiff's consent and without a court order."

Judge Greenway, rejected review of the matter based on the Rooker-Feldman doctrine. “The Rooker-Feldman doctrine, derived from Rooker v. Fidelity Trust Co., 263 U.S. 413, 44 S.Ct. 149, 68 L.Ed. 362 (1923), and District of Columbia Court of Appeals v. Feldman, 460 U.S. 462, 103 S.Ct. 1303, 75 L.Ed.2d 206 (1983), bars lower federal courts from exercising jurisdiction over an action that is “the functional equivalent of an appeal from a state court judgment.” Marran v. Marran, 376 F.3d 143, 149 (3d Cir.2004). The Supreme Court restated the Rooker-Feldman doctrine in Exxon Mobil Corp. v. Saudi Basic Indus. Corp., 544 U.S. 280, 125 S.Ct. 1517, 161 L.Ed.2d 454 (2005).”

The court reasoned , that “Whether the Workers' Compensation judges erred in holding a hearing in Plaintiff's absence, adjourning the hearings without notifying Plaintiff, or relying on “fraudulent” evidence at trial is an issue that must be decided by the New Jersey courts through the appeals process. In short, Plaintiff failed to avail herself of the proper appellate process.”

Hogg’s v. New Jersey, 2008 WL 5272372 (D.N.J. 2008) Decided December 16, 2008.

We are moving....January 1, 2009

JON L GELMAN LLC
Attorney at Law
1700 State Route 23 North Suite 120
Wayne, NJ 07470-7537
Phone:(973) 696-7900
Fax: (973) 696-7988
e-mail: jon@gelmans.com
Internet: http://www.gelmans.com/

DIRECTIONS TO OUR OFFICE
Directions by Google Maps – Click Here

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FROM ROUTE 23 NORTHBOUND:
At RT 23/I-80/RT 46 junction proceed north on RT 23 past two traffic lights (3.5) miles. Immediately after the 2nd traffic light, turn right into 1700 Route 23 North (Oak Hill Park), bear left to 1700 building.

FROM ROUTE 23 SOUTHBOUND:
1. Proceed past Ratzer Road exit in Wayne. 2. Proceed (0.6 miles south) past Fuddruckers on right and turn right to make a U-turn to go northbound. 3. Stay in right lane and cross straight over Rt 23 into 1700 Route 23 North (Oak Hill Park), bear left to 1700 building.

FROM ROUTE 46 WESTBOUND:
1 . Exit Route 46 at Route 23 North exit (bear right) just (0.5 miles) past the Fountains of Wayne on right.
2. Proceed north on RT 23 past two traffic lights (3.5) miles. Immediately after the 2nd traffic light, turn right into 1700 Route 23 North (Oak Hill Park), bear left to 1700 building.

FROM ROUTE 46 EASTBOUND:
Exit just past Willowbrook Mall in Wayne & bear left for State Hwy 23 N toward Butler (0.8 mile). Merge onto RT-23 N (0.8 mile). Then follow directions FROM ROUTE 23 Northbound above.

FROM ROUTE 80 WESTBOUND: EXIT #53, for State Hwy 23 N toward Butler (0.8 mile). Merge onto RT-23 N (0.8 mile). Then follow directions FROM ROUTE 46 Westbound above.

FROM ROUTE 80 EASTBOUND:
Take Exit 54 for Minnisink Rd toward Totowa/Little Falls. Turn LEFT at Minnisink Road (signs for Totowa) (0.1 miles). Turn left at Vreeland Ave (459 feet). Turn left to merge onto I-80 W (0.8 miles). The follow directions FROM ROUTE 80 Westbound above.

FROM ROUTE 287 NORTHBOUND or SOUTHBOUND:
Take Exit 48 toward Lincoln Park (0.2 miles). Turn left at Main Rd/US-202 (1.6 miles). Turn left at Main Rd/US-202/White Hall Rd. Continue to follow Main Rd (1.8 miles). Slight right at Boonton Turnpike/US-202. Continue to follow US-202 (2.5 miles). Take the ramp onto RT-23/US-202 N (2.1 miles). Slight right into 1700 Route 23 North (Oak Hill Park) (495 ft), bear left to 1700 building.

FROM GARDEN STATE PARKWAY SOUTHBOUND:
Take exit 159 to merge onto I-80 W. Then follow directions FROM ROUTE 80 Westbound above.

FROM GARDEN STATE PARKWAY NORTHBOUND:
Take exit 153 on the Left onto Rt 3 WEST, which will merge onto RT 46 West. Then follow directions FROM ROUTE 46 Westbound above.

CMS Regional Centers for Workers' Compensation Matters

CMS announces publishes State contact list for Workers'  Compensation matters. I its guide CMS has directed contact to 6 regional centers for all states and territories.

The contact list is now available on line.

Seeking a Waiver of CMS/MSP Overpayment Request

A formal process exits to obtain a waiver of an Overpayment Recovery request from The Center for Medicare and Medicaid Services [CMS]. If SSA advises you or your client that it has made an overpayment, ie. Medicare Secondary Payer Act [MSP] recovery request, then a waiver request maybe made. This is not to be confused with a Request for Reconsideration which should be used where the amount is disputed.

If you or your client agrees that the number is correct and the beneficiary is unable to make repayment, then a Request for Waiver of Overpayment Recovery should be filed. The form is 8 pages in length and requires the submission of a reason for the request including no fault of the beneficiary or unfairness of the request.

A financial statement is required to be submitted to CMS which requests information concerning: current rent; mortgage payments; pay stubs; tax returns; utility, medical, charge cards and insurance bills; cancelled checks; spouse and dependent(s) financial information.