Lois Law Firm obtained a Board Panel Decision on May 11, 2018 affirming the law judge’s decision to disallow a claim on the substantive merits of the claim, but the Board also (for the first time) specifically ruled that the employer’s Pre-hearing Conference Statement was sufficient on its face to assert and maintain all defenses. In addition, the Board also determined that the PH-16.2, as submitted, was sufficient to permit the production of an employer witness that was not specifically requested in the PH-16.2.
Download the full decision here:
Pabon v. Crown Energy (25 downloads)
For the first time in the show’s history, Third Fridays podcast host Christian Sison comes to you live and without any guests. The topic is #DefendFromDay1, and the show focuses on how the movement began, how it can be currently implemented, and how we can use it for the future.
Within the construct of #DFD1, Christian reviews a recent Appellate Division case involving conflicting medical testimony on the causal relationship of a requested surgery. In analyzing the Court’s decision, it becomes clear that #DFD1 strategies would have best been used to procure an IME report much sooner and with the benefit of the pre-accident records. As to the future, Christian projects an interesting possibility as to how the Board may use medical records and testimony, in light of its recent trend towards efficiency and expediency.
Continue reading #DFD1: Third Fridays Podcast
The Division Of Workers’ Compensation’s jurisdiction includes medical fee disputes arising from New Jersey workers’ compensation claims.N.J.S.A. 34:15-15 states:
“Exclusive jurisdiction for any disputed medical charge arising from any claim for compensation for a work-related injury or illness shall be vested in the division.”
As evidenced by its situation inside of the New Jersey Workers’ Compensation section of the New Jersey Labor Statute, this provision is meant to apply to all New Jersey Workers’ Compensation claims.
Prior to the November 19, 2012 amendment to the New Jersey Workers Compensation Act (N.J.S.A. 34:15-15), the statue of limitations for fee disputes was set by N.J.S.A. 2A:14-1 as per Medical Diagnostic Assocs. v. Hawryluk, 317 N.J. Super. 338, 349 (App. Div. 1998), cert. denied, 160 N.J. 89 (1999). Under N.J.S.A. 2A:14-1, recovery upon a contractual claim or liability, express or implied, not under seal, or upon an account other than one which concerns the trade or merchandise between merchant and merchant, their factors, agents and servants, shall be commenced within 6 years next after the cause of any such action shall have accrued.” Continue reading The Statute of Limitations in New Jersey Medical Provider Claims
Coverage under the Longshore and Harbor Workers’ Compensation Act requires a master-servant relationship between employer and an employee. Crowell v. Bensen, 285 U.S. 22, 54 (1932). The Act defines employee as “any person engaged in maritime employment, including any longshoreman or other person engaged in longshoring operations, and any harbor-worker including a ship repairman, shipbuilder, and ship-breaker.” 33 U.S.C. § 902(3). The Act also sets out a long list of potential employees who do not fit the criteria: clerical and secretarial workers, marina workers, fishermen, etc.
The issue of employment is usually reached int he context of an alleged independent contractor seeking benefits. Just because an employer has not secured LHWCA coverage for an employee does not mean that that worker is not covered under the Act as an employee. Tanis v. Rainbow Skylights, 19 BRBS 153 (DOL Ben. Rev. Bd. 1986). Continue reading Longshore Employment Defined.
Which workers’ compensation act applies: the Longshore and Harbor Workers’ Compensation Act or the Jones Act? The Jones Act and the LHWCA are mutually exclusive. Thus, when dealing with a “water-based” (as opposed to “land-based”) LHWCA claim, it must be determined if the claim falls within the criteria of LHWCA coverage, or belongs more properly under the Jones Act. Of course, the claim might not belong under either jurisdiction and should be decided under a state workers’ compensation act.
The Jones Act (The Merchant Marine Act, 1920, 46 U.S.C. § 688), in pertinent part, reads as follows:
Any seaman who shall suffer personal injury in the course of his employment may, at his election, maintain an action for damages at law, with the right of trial by jury, ... and in case of the death of any seaman as a result of any such personal injury the personal representative of such seaman may maintain an action for damages at law with the right of trial by jury. ... Jurisdiction in such actions shall be under the court of the district in which the defendant employer resides or in which his principal office is located.
Admiralty jurisdiction and the coverage of the Jones Act depends only on a finding that the injured was “an employee of the vessel, engaged in the course of his employment” at the time of his injury. The fact that a Jones Act petitioner’s injury occurred on land is not material. 46 U.S.C. § 740; Senko v. La Crosse Dredging Corp., 352 U.S. 370, 373 (1957). Continue reading The Jones Act v. Longshore
Workers’ Compensation benefits are analogous to no fault benefits because the employee will be entitled to benefits regardless of whether the employee was negligent in causing the injury or death. By the same token, an employer’s negligence is not considered. Comparative negligence, contributory negligence, or the act of God doctrines are not applicable in determining entitlement to workers’ compensation benefits in New York. Pierce v. Young, 252 N.Y. 520 (1929).
There are some exclusions from compensation. Keep these possible defenses handy when analyzing claims. Continue reading Defenses to New York Workers’ Compensation Claims