Workers must seek remedy for delay in treatment through comp system

In New Jersey, an injured worker cannot sue his employer's insurer for pain and suffering caused by the insurer's delay in providing medical treatment.

Case name: Stancil v. ACE USA, No. A-112 September Term 2010, 067640 (N.J. 08/01/12).

Ruling: The New Jersey Supreme Court held that an injured worker could not sue his employer's insurer for pain and suffering caused by the insurer's delay in paying for medical treatment.

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What it means: In New Jersey, an injured worker cannot sue his employer's insurer for pain and suffering caused by the insurer's delay in providing medical treatment.

Summary: A worker suffered a work-related injury and received workers' compensation benefits from his employer's insurer. The worker sought payment for medical, prescription, and transportation services. After the workers' compensation court ordered the insurer to pay, it failed to do so. The worker underwent more treatment that his physician attributed to an earlier delay in treatment and payment to providers. The worker sued the insurer, arguing that its failure to authorize treatment caused him to sustain pain and suffering and a worsening of his condition. The New Jersey Supreme Court held that the worker could not sue the insurer.

The court pointed out that the legislature preferred claims for work-related injuries to be resolved in the workers' compensation system. The workers' compensation court had a contempt remedy for carriers who refused to follow court orders.

The court also explained that to allow the worker to sue could "threaten to obliterate" the workers' compensation system. Every injured worker would prefer to sue to secure relief. The court said that the worker's essential argument was that his condition worsened and he was required to undergo further treatment because of the insurer's delay. The workers' compensation system had the authority to address his complaint. The court found it "unnecessary and inappropriate" to create an alternative venue for the worker to seek redress.

A dissenting judge stated that the remedies available under workers' compensation fell short of making the worker "whole" for the damages he suffered. The judge noted that several other states allow workers to sue insurers for the bad-faith failure to provide medical treatment and benefits, reasoning that the carrier's bad faith is separate and distinct from the workplace injury.

Read more at the WorkersComp Forum homepage.

September 24, 2012

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