Results
Successfully Defended a Claim for Permanent/Total Disability Benefits Where the Potential Exposure Exceeded Half a Million Dollars
We successfully defended a claim for permanent/total disability benefits and significantly lowered our client’s exposure. Given the petitioner’s age and the exposure of the case, our client faced a potential indemnity exposure of more than $500,000. Prior to trial, the petitioner refused to accept any settlement offer below permanent/total disability benefits. Following the petitioner’s testimony at trial, the judge dismissed the claim for permanent/total disability benefits and recommended a partial disability settlement, which equated to approximately $57,000 (only 10% of the potential cost) in total exposure, which was accepted by the petitioner.
Medical provider claim petition dismissed, with prejudice.
The parties were litigating a motion for medical treatment in which a physician was recommending an additional spinal surgery. The physician moved forward without authorization and performed spinal surgery on the petitioner. In order to complete the surgery, the physician brought in several ancillary services, including a vendor to perform diagnostic monitoring during the surgery. Following the surgery, the medical provider submitted its bills to the carrier, which were rejected based upon the lack of authorization. After a medical provider claim petition was filed, the respondent filed a motion to dismiss the matter for failure to obtain the requisite statutory authorization. The medical provider argued that it was only providing ancillary services and, therefore, did not require the authorization of the carrier under the New Jersey Workers’ Compensation Statute. The medical provider also argued that they were the “victim” since they were advised by the physician that the procedure was authorized. The judge rejected both arguments, holding that all medical providers including providers that provide ancillary services for surgical procedures, are required to obtain the same authorization for their treatment, or risk not receiving financial reimbursement.
Favorable decision in New Jersey workers’ compensation matter.
The case involved a compensable claim for right hip and shoulder fractures sustained in a fall. At issue was the level of permanent disability for the compensable injuries and the relatedness of a subsequent hip replacement surgery. The petitioner’s demand before trial was more than $450,000, plus almost $78,000 for medical expenses. The employer’s final offer was $180,000. After a three-day trial in Ocean County, the judge awarded permanency benefits totaling less than $153,000. Further, the judge determined that the hip replacement surgery was not related and denied the entire $78,000 medical bill claim.
Workers’ compensation defense verdict for a prominent health care system.
The petitioner filed a motion for additional medical and temporary disability benefits, essentially alleging she was permanently and totally disabled from prior compensable shoulder and leg injuries. After a three-day trial and extensive briefing, the judge dismissed the motion. He determined that, despite the compensable injuries, the petitioner had plateaued medically and was not entitled to any further benefits.
