NWCDN Members regularly post articles and summary judgements in workers’ compensations law in your state.
Select a state from the dropdown menu below to scroll through the state specific archives for updates and opinions on various workers’ compensation laws in your state.
Contact information for NWCDN members is also located on the state specific links in the event you have additional questions or your company is seeking a workers’ compensation lawyer in your state.
As practitioners well know, many ADA law suits begin with a workers’ compensation injury. But where is the line between an issue that must be handled in workers’ compensation and one that can be brought in civil court? That was the issue that the New Jersey Supreme Court decided on March 25, 2019 in Caraballo v. City of Jersey City Police Department (A-71-17) (080467).
Caraballo joined the Jersey City Police Department (hereinafter JCPD) as a police officer in February 1973. He injured his hands, back, and legs in August 1999 during a motor vehicle accident and filed a workers’ compensation claim. He underwent anterior cruciate ligament reconstruction surgery on his left knee.
Two city-appointed physicians gave opinions that Caraballo would eventually need bilateral knee replacement surgery. Caraballo’s workers’ compensation attorney contacted defense counsel for JCPD in 2008 and requested approval for the knee replacement surgery. Caraballo’s attorney also requested a specific physician to perform the surgery, noting that Risk Management had approved that physician.
Surgery did not take place for reasons that are not clear in the opinion. In August 2010, Caraballo put in his retirement papers with the New Jersey Division of Pensions and Benefits effective March 1, 2011. Lieutenant John McLellan of the JCPD Medical Bureau was of the impression that Caraballo did not intend to pursue the surgery. McLellan also noted that Caraballo refused to see a certain doctor “who would be able to determine unequivocally whether or not he should have the surgery.”
Caraballo retired on March 1, 2011. Thereafter Risk Management authorized an orthopedic surgeon to evaluate Caraballo for bilateral knee replacement surgery. The doctor told Caraballo to contact the office to pick a date for surgery pending medical and cardiac clearance. However, Caraballo never called the doctor’s office to schedule a date for surgery.
On March 4, 2013, Caraballo finally settled his workers’ compensation claim. A short time later, he brought a civil suit alleging that the City violated his rights under the New Jersey Law Against Discrimination for failing to authorized the knee replacement surgery and failing to make reasonable accommodations to his disability.
The trial court ruled against Caraballo because he failed to enforce his rights to have knee surgery in workers’ compensation court. Apparently, he never filed a motion for medical and temporary disability benefits. The Appellate Division reversed in favor of Caraballo. The Appellate Division observed that Caraballo may have been able to perform the essential functions of his job had he obtained a reasonable accommodation of knee surgery.
The New Jersey Supreme Court accepted certification and reversed the Appellate Division. The Court relied on prior case law to the effect that an employee must first exhaust all administrative remedies under workers’ compensation before seeking enforcement in the Law Division. The Court said:
Here, Caraballo filed his workers’ compensation claim in 2001, retired in 2011, and settled his claim with the JCPD in 2013. In the interim, Caraballo contacted Risk Management several times to obtain authorization for double knee replacement surgery but never sought to enforce his right to the surgery in the workers’ compensation court. Caraballo’s failure to utilize the Act’s administrative remedies to obtain knee replacement surgery precludes his failure-to-accommodate claim under the LAD.
The court next went on to consider whether surgery can be considered a reasonable accommodation in New Jersey. The court first cited to the language in the LAD and ADA for specific examples of reasonable accommodation: (i) making facilities used by employees readily accessible and usable by people with disabilities; (ii) job restructuring, part-time or modified work schedules or leaves of absence; (iii) acquisition or modification of equipment or devices; and (iv) job reassignment and other similar actions.
The Court observed that no New Jersey case prior to Caraballo had ever addressed the question of whether medical treatment qualifies as a reasonable accommodation under the LAD. A case in Connecticut was instructive to the Court, Desmond v. Yale-New Haven Hosp., Inc., 738 F. Supp. 2d 331, 350 (D. Conn. 2010). In that case the Connecticut District Court ruled against a workers’ compensation plaintiff who argued that in order to continue working she would need medical treatment, including pain management and physical therapy. The Connecticut Court held that a reasonable accommodation must relate to workplace barriers. There was no responsibility under the ADA or state civil rights law to make sure an injured employee is receiving appropriate medical treatment.
The New Jersey Supreme Court agreed with the ruling in Desmond:
The medical procedure sought by Caraballo – his double knee replacement surgery – is neither a modification to the work environment nor a removal of workplace barriers. Rather, it is a means to treat or mitigate the effects of his injuries, like the treatments at issue in Desmond. We therefore find it consistent with the LAD, the ADA, and their regulations that Caraballo’s total knee replacement surgery cannot qualify as a reasonable accommodation under the LAD.
This case is truly significant for practitioners, carriers, third party administrators and workers’ compensation professionals. Had the ruling gone the other way, employees would have been able to pursue civil action against employers for potential denial of benefits in workers’ compensation. The Court is undoubtedly correct that this would violate the basic rule that workers’ compensation is the exclusive remedy for injured workers regarding medical benefits.
Thanks to Rick Rubenstein, Esq. for bringing this case to our attention.
John H. Geaney, Esq., is an Executive Committee Member and a Shareholder in Capehart Scatchard's Workers’ Compensation Group. Mr. Geaney concentrates his practice in the representation of employers, self-insured companies, third-party administrators, and insurance carriers in workers’ compensation, the Americans with Disabilities Act and Family and Medical Leave Act. Should you have any questions or would like more information, please contact Mr. Geaney at 856.914.2063 or by e‑mail at email@example.com.