Jennifer Lambert and Gary Lambert v. Travelers Indemnity
145 A.3d 1095
| N.J. Super. Ct. App. Div. | 2016Background
- Three plaintiffs were injured in work-related motor vehicle accidents; their medical expenses and indemnity benefits were paid by their employers' workers' compensation insurers (Travelers or MMJIF).
- Each plaintiff later recovered more than the workers' compensation payments from third-party tortfeasors (settlements or UIM recoveries).
- Plaintiffs reimbursed the insurers for a pro rata share of indemnity/compensation benefits but refused to reimburse medical expenses, claiming those were not recoverable from tortfeasors under the no-fault statute.
- Motion judge extinguished the portion of the workers’ compensation liens seeking reimbursement of medical expenses, reasoning N.J.S.A. 39:6A-12 (AICRA) barred recovery/introduction of evidence of medical amounts paid by insurers.
- Workers’ compensation carriers appealed; the Appellate Division consolidated the matters and reviewed whether AICRA or the Workers’ Compensation Act (WCA) governs the right to recover and the carrier’s reimbursement lien.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether an employee injured in a work-related auto accident may recover medical expenses from a third-party tortfeasor when those expenses were paid by workers' compensation | Plaintiffs: AICRA (N.J.S.A. 39:6A-12) bars recovery/introduction of paid medical expense evidence; thus plaintiffs did not recover medicals from tortfeasor | Carriers: WCA governs; workers may recover medical expenses from third-party and carriers may assert lien under Section 40 | Held for carriers: WCA governs; employees can recover medical expenses from tortfeasors and AICRA’s evidentiary bar does not apply |
| Whether a workers' compensation insurer may obtain reimbursement from the employee's third-party recovery for medical expenses it paid | Plaintiffs: Because plaintiffs did not recover medicals from tortfeasor (AICRA), carriers have no right to reimbursement for medicals | Carriers: Section 40 of WCA entitles carriers to reimbursement of medical expenses paid, less fees/costs | Held for carriers: Section 40 lien applies to medical expenses paid; carriers entitled to reimbursement |
| Whether workers' compensation insurance is to be treated as PIP (no-fault) insurance for evidentiary/recoupment purposes | Plaintiffs: Collateral-source language in AICRA/39:6A-6 effectively incorporates workers' compensation into the PIP/no-fault scheme | Carriers: 39:6A-6 shifts payment obligation to WCA but does not convert WCA or carriers into PIP insurers | Held for carriers: 39:6A-6 shifts payment responsibility but does not merge WCA into AICRA; carriers are not treated as PIP insurers |
| Whether AICRA displaced the WCA reimbursement scheme for work-related auto accidents | Plaintiffs: AICRA’s no-fault policy and N.J.S.A. 39:6A-12 preclude admission/recovery of paid medicals, displacing WCA reimbursement to that extent | Carriers: Legislature did not expressly displace WCA; existing WCA lien framework remains applicable | Held for carriers: AICRA did not displace WCA; WCA reimbursement scheme controls when workers' comp benefits are paid |
Key Cases Cited
- Lefkin v. Venturini, 229 N.J. Super. 1 (App. Div. 1988) (worker who received workers' compensation medicals could recover from tortfeasor; carrier entitled to reimbursement)
- Frazier v. N.J. Mfrs. Ins. Co., 142 N.J. 590 (1995) (UIM recovery treated as equivalent to recovery from tortfeasor for lien purposes)
- Cirelli v. Ohio Cas. Ins. Co., 72 N.J. 380 (1977) (PIP beneficiaries may not recover from tortfeasor amounts already reimbursed by PIP)
- DiProspero v. Penn, 183 N.J. 477 (2005) (context on legislative efforts to limit auto litigation and AICRA's objectives)
- Perrelli v. Pastorelle, 206 N.J. 193 (2011) (describing PIP benefits and no-fault framework under AICRA)
- U.S. Cas. Co. v. Hercules Powder Co., 4 N.J. 157 (1950) (origins and purpose of WCA Section 40 reimbursement scheme)
- Primus v. Alfred Sanzari Enters., 372 N.J. Super. 392 (App. Div. 2004) (compensation lien attaches to any sum recovered from third party)