What does the petitioner have to pay back when a settlement is reached in a New Jersey workers’ compensation case?
Has to be paid back: State Disability
Any petitioner’s award is offset by any amounts paid to the petitioner by State Disability as provided by N.J.S.A. 34:15-57.1. Temporary disability paid by the state for injuries later deemed compensable or settled via Section 20 must be reimbursed to the state. Before settling a case, counsel should be expected to investigate all outstanding liens. The New Jersey workers’ compensation law judge can provide the parties with the amount of the State temporary disability lien at the time of settlement.
Has to be paid back: Health Insurance
By the very terms of the Act, workers’ compensation insurance is primary to medical insurance. Therefore, any amounts paid on behalf of the petitioner for treatment deemed by a judge “reasonable and necessary” to cure the petitioner of the effects of the work-related accident, can be collected by the health insurer at the time of settlement, or later. Recent case law instructs that even matters disposed of pursuant to Section 20 may not extinguish a health insurer’s lien.
The New Jersey Supreme Court has 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. See Christodoulo v. University of Mass. Memorial Medical Center, Inc., 180 N.J. 334 (2004).
Gets an Offset: Pensions
Workers’ Compensation benefits should be offset by the petitioner’s ordinary disability retirement benefits, where the disability income is provided secondary to the same injury. Rosales v. State of New Jersey, 373 N.J. Super. 29 (App. Div. 2004), cert. denied, 182 N.J. 630 (2005).
Has to be paid back or set aside: Medicare.
As per the Medicare Secondary Payer Act, workers’ compensation is always primary to Medicare.
Has to be paid: Child Support
In reviewing the term “net proceeds” in N.J.S.A. 2A:17-56.23b concerning child support liens, the Appellate Division found that the first $2,000.00 of recovery by an individual, after allowances and litigation expenses, is not subject to the statutory automatic lien provisions of this statute. A child support lien does not apply to the first $2,000.00 of the net proceeds from a settlement. See Simpkins v. Adolfo Saiani, 356 N.J. Super. 26 (App. Div. 2002).
Has to be paid back: Motor Vehicle Medical Payments.
By the terms of the New Jersey Workers’ Compensation Act, workers’ compensation benefits are primary to New Jersey “PIP” (Personal Injury Protection) benefits.