142 A.3d 757
N.J. Super. Ct. App. Div.2016Background
- While working, plaintiff Tina Talmadge was injured in an automobile accident caused by a third-party, Connie Burns; she underwent anterior cervical fusion.
- The Hartford, employer’s workers’ compensation carrier, paid over $127,000 in medical, wage, and indemnity benefits to Talmadge.
- Talmadge sued the tortfeasor and settled for the tortfeasor’s policy limit of $250,000.
- The Hartford asserted a statutory workers’ compensation lien under N.J.S.A. 34:15-40 for $84,510.78 against the third-party recovery, including reimbursement for medical benefits paid.
- Plaintiff moved in the Law Division to declare the medical portion of the lien unenforceable, arguing PIP/no-fault limits prevent recovery of medical benefits from the tortfeasor; the motion was denied.
- On appeal the Appellate Division affirmed, holding section 40 permits reimbursement to the workers’ compensation carrier for benefits paid, including medical expenses, from the third-party recovery.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether a workers’ compensation carrier may be reimbursed from a third-party tort recovery for medical benefits paid when plaintiff also had PIP/no-fault coverage | Talmadge: Because no-fault/PIP prevents an insured from recovering medical benefits from a tortfeasor, the compensation carrier (subrogee) cannot claim reimbursement for medical payments | The Hartford: Section 40 authorizes reimbursement of all workers’ compensation benefits paid, including medical expenses, from third-party recoveries to prevent double recovery | The Appellate Division: Section 40 entitles the workers’ compensation carrier to reimbursement from the third-party recovery, including medical benefits paid; plaintiff’s PIP status does not bar the carrier’s lien |
Key Cases Cited
- Estate of Kotsovska v. Liebman, 221 N.J. 568 (2015) (discusses remedial, no-fault purpose of Workers’ Compensation Act)
- Utica Mut. Ins. Co. v. Maran & Maran, 142 N.J. 609 (1995) (section 40 permits carrier reimbursement from third-party recovery)
- Tlumac v. High Bridge Stone, 187 N.J. 567 (2006) (Workers’ Compensation Act’s remedial purpose and broad availability of benefits)
- Caviglia v. Royal Tours of Am., 178 N.J. 460 (2004) (No-Fault Act intended as exclusive remedy for out-of-pocket medical expenses)
- Bardis v. First Trenton Ins. Co., 199 N.J. 265 (2009) (no-fault insured cannot recover medical losses already reimbursed via PIP)
- Roig v. Kelsey, 135 N.J. 500 (1994) (legislative intent to preclude fault-based suits for PIP-covered losses)
- Frazier v. New Jersey Mfrs. Ins. Co., 142 N.J. 590 (1995) (section 40 prevents double recovery to injured employee)
- Greene v. AIG Cas. Co., 433 N.J. Super. 59 (App. Div. 2013) (section 40 requires repayment of workers’ compensation carrier from third-party recovery)
- United States Cas. Co. v. Hercules Powder Co., 4 N.J. 157 (1950) (historic support for preventing dual recovery of workers’ compensation benefits and tort damages)