SYLLABUS
(This syllabus is not part of the opinion of the Court. It has been prepared by the Office of the Clerk for the
convenience of the reader. It has been neither reviewed nor approved by the Supreme Court. Please note that, in the
interests of brevity, portions of any opinion may not have been summarized.)
Wade Stancil v. ACE USA (A-112-10) (067640)
Argued March 26, 2012 -- Decided August 1, 2012
HOENS, J., writing for a majority of the Court.
The Court considers whether an injured employee may sue
his employer’s compensation carrier for pain and suffering caused by the
carrier’s delay in paying for medical treatment, prescriptions, and other
services. Plaintiff Wade Stancil was injured in 1995
while employed by Orient Originals. He received workers’ compensation
benefits from his employer’s compensation carrier, defendant ACE USA (ACE).
In 2006, following a trial, the court of compensation determined that Stancil
was totally disabled. In 2007, Stancil filed a motion in the compensation
court seeking an order compelling ACE to pay outstanding medical bills.
During a hearing on the motion, the compensation
judge commented that ACE had a history of failing to make payments when ordered
to do so. On September 12, 2007, the compensation judge granted
Stancil’s motion, warned ACE against any further violation of the order to
pay, and awarded Stancil counsel fees. On October 29, 2007, the parties
returned to the compensation court for a further proceeding relating to
the disputed bills. After finding that the bills identified in the
September 12 order remained unpaid and that ACE’s failure to make payment was a
willful and intentional violation of the order, the court issued another
order compelling ACE to make immediate payment and again awarding counsel
fees.
The court commented on its limited ability to ensure that
carriers would comply with orders, noted that it lacked the authority to
enforce orders through contempt proceedings, found that Stancil had
exhausted his administrative remedies, and suggested that he seek further
relief in the Superior Court. In 2008, Stancil underwent additional
surgery and psychiatric treatment. Stancil’s physician attributed the
need for additional treatment to an earlier treatment delay caused by the
carrier’s delay in paying medical providers.
On April 15, 2009, Stancil filed this lawsuit
in the Superior Court. In his complaint, Stancil claimed that ACE required him to undergo medical examinations by physicians
of its own choosing and then rejected the recommendations of those
physicians and refused to authorize the recommended medical care. The
complaint stated further that Stancil obtained orders from the
compensation court, but ACE failed to comply. Stancil contended
that ACE’s failure to authorize needed treatment caused him unnecessary
pain and suffering, a worsening of his medical condition, and expenses
that should have been paid by ACE. ACE responded by filing a motion to
dismiss the complaint. ACE argued that the Workers’ Compensation
Act, N.J.S.A. 34:15-1 to -142 (the Act), is the exclusive remedy for the
claims pled in the complaint and therefore no damages could be awarded.
The trial court granted ACE’s motion. The court analyzed the
impact of then-recently adopted amendments to the Act and found that the Legislature
had foreclosed resort to the Superior Court for the kind of tort-based relief
demanded by Stancil.
The Appellate Division affirmed. 418 N.J.
Super. 79 (App. Div. 2011). The panel agreed with the trial court
that The Legislature’s amendments to the Act foreclosed Stancil’s claims.
The panel also rejected Stancil’s argument that ACE’s willful
disregard of compensation court orders met the Act’s intentional wrong exception
to the litigation bar. The Supreme Court granted certification limited to
determining whether an employee who suffered a work-related injury has a
common-law cause of action for damages against a workers’ compensation carrier
for its willful failure to comply with court orders compelling it to
provide medical treatment when the delay or denial of treatment causes a
worsening of the employee’s medical condition and/or pain and suffering.
207 N.J. 66 (2011).
HELD: An injured employee does not have a common law
right of action against a workers’ compensation carrier for pain and
suffering caused by the carrier’s delay in paying for or authorizing treatment
because 1) the workers’ compensation system was designed to provide
injured workers with a remedy outside of the ordinary tort or contract remedies
cognizable in the Superior Court; 2) in amending the Workers’ Compensation Act
in 2008, the Legislature rejected a provision that would have given the
compensation courts broader permission to authorize a resort to the Superior
Court and adopted a remedy that permits compensation courts to act through a
contempt power; and 3) 2allowing a direct common-law cause of action against a
carrier would undermine the workers’ compensation system by substituting a
cause of action that would become the preferred manner of securing
relief.
CHIEF JUSTICE RABNER, JUSTICE LaVECCHIA, and JUDGE WEFING (temporarily assigned) join in JUSTICE HOENS’s opinion. JUSTICE ALBIN filed a separate, dissenting opinion. JUSTICE PATTERSON did not participate.
