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In one of the most puzzling decisions in decades dealing with N.J.S.A. 34:15-40, the court inDever v. New Jersey Manufacturers Insurance Company, 2013 N.J. Super. Unpub. LEXIS 2553, (App. Div. October 23, 2013) ruled that respondent has no lien on the medical portion of a third party claim against a UM or UIM carrier.
The case involved a motor vehicle accident which took place on January 3, 2000. Plaintiff, John Dever, was an on-duty Atlantic City police officer who suffered injuries when his vehicle was struck by a vehicle driven by Alice Turner. Plaintiff’s injuries were severe enough that he was granted an accidental disability pension effective January 1, 2001 granting him two thirds of his pay for life free of state and federal taxes.
Dever settled his claim against Turner, who only had a $25,000 policy limit and then filed a claim under his underinsured motorist policy issued by NJM. At trial the parties stipulated liability based on an agreement to cap damages within the $500,000 policy limits as reduced by the $25,000 payment from Turner.
Notwithstanding the extent of Dever’s injuries, the jury determined that he had not proven a permanent injury and awarded Dever $275,000 as compensation for his economic loss. He was not awarded pain and suffering damages. Both parties then challenged the verdict. NJM argued that the jury overcompensated Dever for what it contended were temporary injuries because most of the treatment ended in May 2000. The trial judge and the Appellate Division both rejected that contention and noted that Dever’s depression disrupted his ability to obtain and retain employment and therefore the jury verdict was supportable.
NJM also challenged the reimbursement of plaintiff’s medical expenses. The workers’ compensation carrier paid all the medical bills. Following the verdict, Dever moved for NJM to pay $8,482.11 arguing that he should not be forced to absorb his own medical expenses. The trial judge agreed with Dever in a post-verdict motion but the Appellate Division reversed. The court noted that it was missing key information at the time it issued its decision. “The workers’ compensation carrier paid all medical bills and we are told placed a lien on plaintiff’s recovery from the tortfeasor. The record does not disclose whether the workers’ compensation carrier was paid $8,482.11 from plaintiff’s settlement with Turner.”
First, the Appellate Division noted that every automobile insurance policy must provide PIP benefits for the payment of medical expenses to the insured. The court further observed case law stating that an “injured person who was the beneficiary of the PIP payments could not and should not recover from the tortfeasor the medical, hospital and other losses for which he had already been reimbursed.” (citations omitted). Therefore, the court said, a plaintiff in this situation cannot offer evidence of the amounts collectible or paid under a standard automobile insurance policy of PIP benefits. The court added that when an accident victim is not compensated for medical expenses, the accident victim may recover medical expenses.
Next the court examined what happens when an accident victim incurs medical expenses arising from work. It noted that workers’ compensation coverage is primary, as in this case, meaning that Dever’s medical bills were appropriately paid under workers’ compensation. PIP carriers need not make payments which are covered by workers’ compensation. In fact, had NJM paid the medical bills under PIP, the carrier would have had a right to recover those payments from the workers’ compensation carrier.
The court then discussed the subrogation rights of the workers’ compensation carrier underN.J.S.A. 34:15-40. It said, “Section 40 has been found to require reimbursement when an employee obtains a recovery from his or her UIM carrier as a result of third-party liability.”Midland Ins. Co. v. Colatrella, 102 N.J. 612, 616-618 (1986). This furthers the policy goal of workers’ compensation to avoid double recovery.
The court seemed to believe that there was tension between the automobile law and workers’ compensation law. It said in a far-reaching opinion:
The record is not clear as to whether the workers’ compensation carrier invoked its lien against the $25,000 recovery from Turner. We conclude such action would be inappropriate. Under these facts, plaintiff’s medical expenses are the responsibility of the workers’ compensation carrier and are not reimbursable by defendant. The trial court’s decision is reversed and the order for defendant to pay $8,482.11 representing plaintiff’s medical bills is vacated.
The court’s reasoning is hard to follow since it does not focus on the concept of double recovery so much as it does the concept of permitted recoveries.
Also, the Legislature has decreed workers’ compensation insurance must be the primary source of payment for work-related automobile injuries, and the cost of the employee’s medical expenses is born (sic) by the worker’s (sic) compensation carrier not the PIP insurance carrier. Therefore, a section 40 lien, which attaches only topermitted recoveries, cannot include medical expenses from a New Jersey no-fault insured; there is no right to recover such expenses.Patterson v. Adventure Trails, 364 N.J. Super. 444, 448-49, 836 A.2d 856 (Law Div. 2003). Allowing reimbursement to a workers’ compensation carrier from an employee’s UIM carrier is counter to the legislative intent of this express statutory reimbursement scheme.
It is important for practitioners to understand the limitations in this decision. First, there was no workers’ compensation carrier involved in this case. The compensation carrier’s identify is not disclosed, and there is no evidence that the compensation carrier appeared or made any argument. NJM was the UIM carrier, not the workers’ compensation carrier. It appears that counsel for NJM was arguing that the UIM carrier did not owe plaintiff the sum of $8,482.11 because that sum had been paid by the workers’ compensation carrier. The court took this a step further and went on to address the subrogation rights of the workers’ compensation carrier, which was not even involved in the proceeding. As such, respondents can argue that the court’s holding in this case is what is called “dictum,” or irrelevant to the facts of the case.
The reverberations of this case will be felt by employers until further clarification is given in future litigation. Claimants’ attorneys will seize on this case to argue that in a work-related car accident case, employers have no rights to subrogation of medical benefits. The Dever case is already being widely discussed by practitioners throughout the state, and employers need to seek a published decision clarifying theDever decision since it seems contrary to the established rule against double recoveries.