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Defense Digest

Lack of Insurance Coverage Does Not Defeat Workers’ Compensation Bar for New Jersey Workers’ Compensation Intentional Injury Claim

Defense Digest, Vol. 30, No. 1, March 2024

March 1, 2024

by Robert J. Fitzgerald

Key Points:

  • The New Jersey Workers’ Compensation Act requires all employers to obtain workers’ compensation insurance coverage or be subject to both criminal and civil penalties. 
  • The New Jersey Uninsured Employer’s Fund provides injured employees both medical and disability benefits, but not permanency benefits. 
  • Claims for intentional injuries are very difficult to sustain as they require proof of that the employer’s conduct was substantially certain to result in the employee’s injuries.

In Glen and Donna Heuman, v. Wayne Heuman, et al., 2023 WL 8539709 (NJ Super. App. Div. Dec 11, 2023), the New Jersey Appellate Division addressed an intentional injury claim with a twist—lack of workers’ compensation insurance coverage. 

In December 2017, Deejon Builders LLC, a general contracting company, entered into an agreement to build a new home. Deejon retained Wayne Heuman Masonry—owned and operated by Glen Heuman’s cousin, Wayne Heuman—as a contractor to perform masonry work. Although Wayne primarily worked alone, he would occasionally hire Glen to assist with masonry jobs. Glen was paid in cash, and his employment was never “formally recorded.”

Wayne contacted Glen to work onsite on February 13 and 14, 2018. During those two days, Glen mixed mortar and grout for the foundation of the home using a mortar mixer, which Wayne modified due to a missing recoil spring. To start the mixer in its altered state, the operator had to remove the protective cover, wrap a pull cord with a handle around a pulley section of the machine, and tug, similar to a lawnmower.

Glen used the mixer without incident on February 13, 2018, and approximately 15-20 times before lunch the following day. After lunch, however, when Glen attempted to start the mixer using the modified system, the pull cord became caught in the machine’s rotating motor, and its handle struck him in the eye. Glen received emergency treatment for fractures in his right orbital lobe as well as the rupture of the globe of his right eye. He underwent two surgeries, ultimately resulting in the removal of the right eye and his permanent need for a prosthetic. 

Glen then filed both third-party negligence and intentional injury claims against Wayne. During discovery, Glen testified he had assisted Wayne at approximately five masonry jobs and most of them involved mixing mortar. He used Wayne’s modified mixer on those other occasions without incident. Glen conceded he was familiar with use of similarly modified machines from his prior experience in masonry. Additionally, Glen admitted he was not wearing safety glasses when he was operating the mixer, which was not proper protocol. 

Glen also testified Wayne indicated to him that he possessed insurance, although Glen did not request proof of insurance or inquire what specific insurance Wayne had purchased. However, Wayne testified that he was unaware of the statutory requirement to obtain workers’ compensation insurance. Specifically, Wayne explained, he “mostly worked by [himself]” and, therefore, did not understand “the sense of [him] having workman’s comp if [he was] only covering [himself].” Wayne also testified that wrapping the cord to start the machine in that manner was common practice in the industry, and he further stated he had seen this solution for similarly broken machines during his 30-year tenure in the business.

Both parties obtained contradictory expert reports disputing whether the modification of the mortar mixer and Glen’s injuries were attributable to an intentional act. Following discovery, Wayne moved for summary judgment, arguing that the actions did not give rise to an intentional injury claim. Glen opposed summary judgment, arguing that Wayne’s failure to maintain insurance coverage defeated the workers’ compensation bar. Additionally, Glen argued there was a genuine issue of fact as to whether Wayne’s modification of the mortar mixer was substantially certain to lead to Glen’s injuries. The trial court granted summary judgement to Wayne, and Glen appealed.

The Appellate Division first noted that the lack of insurance coverage does not preclude the employer from asserting the workers’ compensation bar. It specifically noted that the New Jersey Uninsured Employer’s Fund (UEF) was created to pay for the payment of awards against uninsured defaulting employers. The Appellate Division also noted there are both criminal and civil penalties for uninsured employers. In an interesting footnote, the Appellate Division noted that, whatever difficulties there were in obtaining benefits from the UEF, it can only be resolved by the legislature.

As to the intentional injury claim, the court stated Wayne’s actions did not satisfy the high bar to apply the intentional wrong exception. Specifically, the evidence did not show Wayne knew that the use of the modified mixer was substantially certain to result in injury. Wayne had not received any formal OSHA citation about the machine or any previous complaints from employees, including Glen. Further, Glen did not protest use of the modified mixer or request that it be repaired at any point. He testified to using it multiple times in the past and 15-20 times on the day of the incident. No evidence in the record demonstrated any prior injuries or “close calls” resulting from use of the mixer, or even similarly modified mixers. Finally, Wayne did not conceal the machine’s alteration from Glen or regulatory authorities.

The court also noted that Glenn failed to overcome the “high threshold” of the context prong, as there was no record evidence that the defendant’s actions were not “a simple fact of industrial life or are outside the purview of the conditions that the Legislature could have intended to immunize employers under the Workers’ Compensation bar.” The testimony of both Glen and Wayne reflected this type of modification of a mortar mixer was common practice among the industry. “At bottom, plaintiffs fail to establish defendant’s conduct qualified as an intentional wrong under the statute or the case law.”

This case illustrates once again the very high burden the petitioner has to meeting an intentional injury claim. Even in a case where the employer did not maintain the requisite workers’ compensation insurance, the court still required proof that the employer’s conduct was substantially certain to result in the employee’s injuries in order for the employee to prevail. Further, where the injury sustained is viewed as “a simple fact of industrial life,” the employee’s recovery will be limited to the benefits under the workers’ compensation scheme. 

If you have questions about your workers’ compensation insurance coverage, or whether you are protected against an unexpected intentional injury claim, contact your insurance professional immediately.

*Bob is a shareholder working in our Mount Laurel, New Jersey, office. He can be reached at (856) 414-6009 or rjfitzgerald@mdwcg.com. 


 

Defense Digest, Vol. 30, No. 1, March 2024, is prepared by Marshall Dennehey to provide information on recent legal developments of interest to our readers. This publication is not intended to provide legal advice for a specific situation or to create an attorney-client relationship. ATTORNEY ADVERTISING pursuant to New York RPC 7.1. © 2024 Marshall Dennehey. All Rights Reserved. This article may not be reprinted without the express written permission of our firm. For reprints, contact tamontemuro@mdwcg.com.

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Thought Leadership

NJ Workers' Compensation Legislation Update

A couple more bills were introduced for the 2026-27 session. Any updates since February have been highlighted in bold. A1023 | S3984 Medical use of cannabis under certain circumstances This requires workers’ compensation, PIP, and health insurance coverage for the medical use of cannabis under certain circumstances. It was introduced on January 13, 2026 and referred to the Assembly Financial Institutions and Insurance Committee. It was also introduced on March 19, 2026 and referred to the Senate Commerce Committee. A1045 Certain injuries to volunteer and professional public safety and law enforcement personnel This revises workers’ compensation coverage for certain injuries to volunteer and professional public safety and law enforcement personnel. It was introduced on January 13, 2026 and referred to the Assembly Labor Committee. A3724 Personal liability to employer officers for failure to pay for coverage This provides personal liability for owner, executive officer, or executive director of employer for failure to pay for workers' compensation coverage. It was introduced on January 13, 2026 and referred to the Assembly Labor Committee. On May 7, 2026, it was reported and referred to Assembly Judiciary Committee. A4617 Certain workers' compensation supplemental benefits and funding method This concerns certain workers' compensation supplemental benefits and funding method. For a permanently and totally disabled worker or surviving dependents after December 31, 1979, with some exceptions, this bill provides for an annual cost of living adjustment in the weekly workers’ compensation benefit rate. It was introduced on March 10, 2026, and referred to the Assembly Labor Committee. S241 Inclusion in database of appointed officials This requires that workers’ compensation judges and administrative law judges be included in database of appointed officials. It was introduced on January 13, 2026 to the Senate, Referred to Senate State Government, Wagering, Tourism & Historic Preservation Committee. A1870 | S1379 Workers' compensation benefits for certain workers due to September 11, 2001, terrorist attacks This provides workers’ compensation benefits for certain public safety workers who developed illness or injury as result of responding to September 11, 2001 terrorist attacks. It was introduced on January 13, 2026 and referred to the Assembly Labor Committee. It was also introduced on the same day and referred to the Senate Labor Committee. On February 5, 2026, it was reported from the Senate Committee, 2nd Reading, and referred to the Senate Budget and Appropriations Committee. A2779 | S1521 Excludes Certain Illegal Aliens This excludes certain illegal aliens from workers’ compensation and temporary disability benefits. It was introduced on January 13, 2026 and referred to the Senate Labor Committee. It was also introduced on the same day and referred to the Assembly Labor Committee. A2792 | S1555 Prevent Intoxicated Employees from Workers’ Compensation This prevents intoxicated employees from receiving workers’ compensation. It was introduced on January 13, 2026 and referred to the Senate Labor Committee. It was also introduced on the same day and referred to the Assembly Labor Committee. S2290 Increase Mandatory Retirement Age This increases statutory mandatory retirement age for Supreme Court Justices, Superior Court Judges, Tax Court Judges, Administrative Law Judges, and Workers’ Compensation Judges from 70 to 72. It was introduced on January 13, 2026, and referred to the Senate Judiciary Committee. A3167 | S2372 Workers’ compensation insurance requirements for certain corporations and partnerships. This concerns workers’ compensation insurance requirements for certain corporations and partnerships. It was introduced on January 13, 2026 and referred to the Senate Labor Committee. It was also introduced on the same day and referred to the Assembly Labor Committee. A1384 | S2757 Reduce Statute of Limitations in Medical Fee Disputes This reduces statute of limitations from six years to two years in medical fee disputes in workers’ compensation matters. It was introduced on January 13, 2026 and referred to the Senate Labor Committee. It was also introduced on the same day and referred to the Assembly Labor Committee. S3144 Testimony in Workers’ Compensation This concerns submission of testimony in workers’ compensation claims. It was introduced on January 13, 2026, and referred to the Senate Labor Committee. S3342 Increase Mandatory Retirement Age This increases statutory mandatory retirement age for Supreme Court Justices, Superior Court Judges, Tax Court Judges, Administrative Law Judges, and Workers’ Compensation Judges from 70 to 75. It was introduced on February 5, 2026, and referred to the Senate Judiciary Committee. A3548 | S3571 Maximum benefits for certain volunteers This provides certain volunteer and other workers with maximum compensation benefit for workers' compensation claim regardless of outside employment.. It was introduced on January 13, 2026 and referred to the Senate Labor Committee. On March 2, 2026, it was reported from the Senate Committee, 2nd Reading, and referred to the Senate Budget and Appropriations Committee. It was also introduced on the same day and referred to the Assembly Labor Committee. On May 7, 2026, it was reported and referred to Assembly State and Local Government Committee.

Thought Leadership

What’s Hot in Workers’ Comp - News and Results*

RESULTS* Ben Durstein (Wilmington) obtained a favorable decision involving a claimant who fractured his patella in a work accident requiring two surgeries. The IAB rejected the claimant’s medical expert’s opinion that he sustained a 25% permanent impairment to the right lower extremity. Instead, the board accepted the opinion of the employer’s medical expert that the appropriate permanency was 13% utilizing the 6th Edition of the AMA Guides to the Evaluation of Permanent Impairment. Tony Natale III (King of Prussia) successfully had a claim petition alleging new injuries and periods of disability dismissed based on full recovery. The claimant was injured when his skid loader was struck by another loader in the process of baling hay. Original injuries were accepted and the claimant returned to work. Thereafter, the claimant abandoned work and filed a claim petition to assert new injuries and extended disability. Cross examination of the claimant’s medical expert stunningly revealed his failure to review claimant testimony, his lack of awareness of a social security disability decision detailing the existence of claimant’s alleged work-related conditions prior to the date of work injury, and his failure to understand that the claimant admitted to full recovery of injuries for which he was continuing to treat. Tony Natale III (King of Prussia) successfully obtained a defense verdict in a Medicare conditional payment lien third level appeal. The United States government alleged a Medicare conditional lien payment was due and owing in the upper six-figure range based on an auto accident and PIP policy for which the government conditionally became the primary carrier. The government argued that our client, the PIP carrier, was the primary payer and, under federal law, must reimburse the government for its conditional lien payment. At the third-level appeal hearing, the government’s position was refuted by the revelation that the date of injury tied to the medical bills associated with the lien was glaringly and chronologically prior to the insurer’s PIP policy date. The court held that based on this evidence and argument, the government could not meet its requirements to assert a lien against our client. A. Judd Woytek (King of Prussia) and John Abda (Scranton) successfully had a workers’ compensation claim petition granted for medical benefits only for a closed period with no wage loss awarded. The claimant alleged multiple injuries as the result of a very minor motor vehicle incident where a co-worker’s delivery van rolled down an incline of approximately six feet, and bumped into the rear of the claimant’s delivery van. He claimed he was thrown forward and suffered head and neck injuries, along with aggravating a pre-existing ankle injury. The claimant was also terminated following the accident for having a large hunting knife in his van, which was against the employer’s workplace violence policy. The judge granted the claim for a mild concussion and an ankle contusion, but terminated medical benefits as of the date of our IME’s. The judge found that no wage loss benefits were payable as the claimant was terminated for cause and work remained available to him. The judge found our medical experts to be more credible than the claimant’s, along with finding our four employer witnesses to all be credible. The trial team was assisted by paralegal Bonnie Zemek (King of Prussia). Eric Scott Thompson (Wilmington) was successful in a workers’ compensation matter in Delaware. On October 15, 2024, the claimant was injured while performing fire training in a multistory building when he tripped over a fire line, injuring his right knee. The claimant received regular and consistent treatment for the right knee through August 29, 2025, when he presented with left knee complaints for the first time. His treating orthopedist diagnosed a hamstring strain. The claimant was next seen October 15, 2025, with continued left knee complaints, and was referred to a total knee doctor within the practice. He was then diagnosed with a posterior root tear of the medial meniscus. Our expert testified that it was not plausible for a lateral hamstring strain to progress to a meniscal tear in two months. The claimant required a total knee replacement that was ultimately performed in February 2026. In the six months between the time of initial presentation with left knee complaints and the total knee replacement, conservative care consisted of a single injection. Our expert testified that posterior root media meniscal tears can respond to conservative care, and it was not known if it would with the claimant because it was not adequately explored. The Industrial Accident Board agreed with our expert and determined that the claimant failed to meet the burden of establishing more likely than not that the left knee complaints were caused by overloading/overuse as a result of the compensable injury to the right knee. They also agreed that the claimant was able to return to work in a sedentary capacity as opined by his physicians and our expert prior to the left total knee replacement and that there were employment opportunities available within his restrictions and capabilities as presented by the vocational expert. As a result, the claimant was no longer entitled to total disability benefits and will receive partial disability benefits for which he is limited to 300 weeks. Michele Punturi (Philadelphia) and Alana Staniszewski (Pittsburgh) had a termination petition granted in a Pennsylvania workers’ compensation case. The petition involved an echocardiography technologist with long-term employment at a local hospital who sustained a right shoulder injury resulting in surgery in January 2024. Following surgery, the claimant was diagnosed with a frozen shoulder and underwent additional surgery in June 2024, with a recommendation for a third surgery. The opinions of the defense medical expert, a Board-certified orthopedic surgeon, were found credible, persuasive, and competent based upon the extensive history he obtained from the claimant, analysis of the mechanism of injury, and review of records, along with comparison of MRIs from October 2023, February 11, 2024, and January 6, 2025, which failed to reveal any causal relationship other than a strain/sprain of the right shoulder. This evidence supported that the claimant had fully recovered, and was not in need of any ongoing medical treatment and/or restrictions. In particular, despite allegations of injuries beyond a sprain/strain, the defense medical expert identified that those allegations were not consistent with what was found at the time of surgery, and elements of the surgery were to treat a chronic and degenerative condition. Additionally there were no ongoing issues or problems with the subscapularis, which was intact, consistent with the follow-up MRI of February 11, 2024, and the claimant did not have evidence of a frozen shoulder. In fact, the MRIs and mechanism of injury, he opined, did not support any injury causing tendonitis or inflammatory conditions within the bicep tendon. Furthermore, multiple days of surveillance footage demonstrated the claimant’s normal use, with the ability to sweep and shovel snow, operate her vehicle, raise her arms above shoulder level, and use a broom – all without any observable difficulty, which challenged the claimant’s credibility of a disability and further established a lack of causation. As a result of this favorable decision, supersedeas fund reimbursement will be obtained for both wage loss and medical benefits through the supersedeas fund recovery process. *Prior Results Do Not Guarantee a Similar Outcome NEWS Heather Carbone (Jacksonville) was a panelist for a webinar hosted by The Workers’ Compensation Claims Professionals (WCCP) Association. As part of the “Meet the Experts” Series, the speakers addressed “Afterthoughts that Undermine a Successful Mediation,” highlighting the pitfalls and challenges of underprepared or unprepared mediation participants. The discussion included appropriate pre-mediation communications, setting of expectations, management of expectations, and working through the unexpected or unprepared. Attendees gained ideas about how and when to prepare, best practices, and the potential for non-parties (spouse, significant other, risk owners-insurers) to have differing perspectives or concerns than the actual employee and employer. On May 21-22, 2026, A. Judd Woytek, (King of Prussia) joined a panel at the CLM Alliance (Claims and Litigation Management Alliance) Work Comp Conference in Nashville to present "We See You: How Employee Engagement Enhances Work Comp Outcomes." Judd and his fellow panelists discussed the positive impact of employee engagement on claim outcomes, return-to-work timelines, and overall claim costs.