Worker can't sue insurer for willful refusal to pay medical expenses
Stancil v. ACE USA, No. A-1438-09T1 (N.J. Super. Ct. App. Div. 02/01/11).
Ruling: The New Jersey Superior Court, Appellate Division dismissed a worker's suit against an insurer seeking damages for the insurer's failure to timely comply with orders of the compensation court authorizing certain medical procedures.
What it means: In New Jersey, the remedies in the workers' compensation law constitute the sole relief available to a worker arising out of a willful noncompliance by an employer or its insurer with an order of the compensation court.
Summary: A worker suffered a work-related injury. The employer's insurer agreed that the injuries were compensable and paid benefits. A compensation judge ordered the insurer to pay certain outstanding medical expenses as required by prior orders. The insurer still refused to pay. The worker then sued the insurer, asserting that the insurer willfully refused to comply with the compensation judge's orders, resulting in a delay or denial of necessary medical treatment and causing him pain and suffering and a worsening of his medical condition. The New Jersey Superior Court, Appellate Division dismissed the worker's suit, holding that the workers' compensation law held the exclusive remedies for the worker.
Examining the legislative history of a new statute, the court said that the legislature amended the statute to address circumstances in which insurers flout judge's orders and refuse to pay for workers' medical expenses, as was the case here. The court explained that if authorization of a lawsuit was intended to remedy an insurer's willful noncompliance with a compensation court order, the legislature would have said so. Instead, the legislature authorized stricter sanctions and clarified authority for enforcement by the compensation judges.
The worker argued that the intentional wrong exception should apply. The court disagreed, stating that the exception only applies to conduct by an employer or coworker in the workplace.
The court also said that allowing a suit would run contrary to the foundational principle underlying the workers' compensation law, which gives employers immunity from lawsuits in exchange for adjudicating claims under a comprehensive regulatory framework. The court noted that the worker was not precluded from returning to the compensation court to seek the remedies authorized under the new law.
Read more at the WorkersComp Forum homepage.
February 24, 2011
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