.

What's Hot in Workers' Comp

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

What’s Hot in Workers’ Comp, Vol. 25, No. 11, November 2021

November 1, 2021

NEWS

Ryan Hauck’s article “Raymour Decision Benefits Insurers and, Arguably, Claimants,” was published in the October 7, 2021, edition of The Legal Intelligencer

Tony Natale’s (Philadelphia, PA) article “The State of Pay-For-Play: College Athletes as Employees and the Implications for Workers’ Compensation,” was published in CLM Magazine, September 2021.

Congratulations to Katelynne Storey (Jacksonville) who was recently inducted into the E. Robert Williams American Inn of Court. The Inn is composed of lawyers, judges, mediators, and law students who are significantly involved in the workers’ compensation area of law in Jacksonville, Florida. 

 

RESULTS*

Angela DeMary and Kyle Byard (Mount Laurel, NJ) successfully obtained a complete dismissal with no payment on a medical provider petition. They argued lack of jurisdiction based on the recent Appellate Division’s consolidated decisions of Anesthesia Associates of Morristown v. Weinstein Supply and Surgicare of Jersey City v. Waldbaum’s, Nos. A-5033-18T4, A-5718-18T4 (App. Div. October 7, 2020)(cert denied, April 1, 2021). Despite opposing counsel’s attempts to distinguish the issues of the instant matter from the recent case law, the court rejected the arguments and granted the complete dismissal of the claim with prejudice.

Ashley Eldridge (Philadelphia, PA) obtained two successful appellate verdicts on challenges to defense opinions before the Workers’ Compensation Judge. 

In the first case, the judge denied a claim petition in which the claimant alleged a significant shoulder injury. Ashley successfully argued that an injury did not occur while at work and, secondarily, that any injury and surgery were the result of a pre-existing condition. The claimant attempted to argue that the decision was not supported by substantial, competent evidence, although the Appeal Board found the judge’s findings and conclusions to be legally sufficient.

The second case also involved a claim petition alleging injuries and disability beyond an acknowledged L2-3 transverse process fracture. After reviewing the substantial evidentiary record, the judge did not find the claimant or his evidence to be credible. The petition was denied beyond a limited period of disability. On appeal, the claimant attempted to argue that the judge failed to consider evidence, which the Appeal Board dismissed.

Adam Huber and Angela DeMary (Mount Laurel, NJ) were successful in obtaining an order for dismissal before Judge Gallagher in the Mount Holly workers’ compensation court. In his claim petition, the petitioner alleged permanent disability as a result of contracting COVID-19 while working for the insured. The petitioner alleged that while working an auto hauler he was exposed to COVID-19, which resulted in a permanent pulmonary disability. Adam and Angela successfully argued to the judge that the petitioner’s discovery failed to provide sufficient proofs supporting that the petitioner had COVID-19 or that, if he did, it was “related to his job.”

Tony Natale (Philadelphia, PA) successfully defended one of Pennsylvania’s largest turkey processing plants in a million dollar amputation claim. The claimant alleged that due to an alleged exposure to turkey blood and feces at the workplace, he developed an infection in his foot that led to amputation of his leg. The claimant alleged a specific loss of the leg, total disability due to injuries separate and apart from the loss, and disabling psychological injuries. Tony was able to prove through the use of an infectious disease expert that the claimant’s leg amputation was caused by an underlying venous insufficiency and infection stemming from years of uncontrolled diabetes. Tony was also able to force the claimant to admit on cross examination that he failed to provide proper notice of a work-related injury within the meaning of the Workers’ Compensation Act. The claimant was done in by his own execution of a fee agreement with counsel at or near the time of his injury, which wholly undermined his earlier testimony that he had no inkling of his condition being work-related until filing his claim petition nearly three years after the date of injury. 

Tony Natale also successfully defended a Berks County mushroom harvesting company in a case of relative first impression in Pennsylvania. The claimant sustained a work-related injury to the right shoulder. She underwent surgery and was released to modified duty. The employer offered her a modified job. The claimant returned to work and continued at restricted duty. She was ultimately found to be fully recovered by a renowned Philadelphia shoulder surgeon. Tony then filed a termination petition, alleging full recovery of the right shoulder. The claimant responded by filing a claim petition, alleging a new injury to the opposite shoulder that totally disabled her from employment. After cross examining the claimant, it was determined that she purposely exceeded her work release restrictions upon return to work, despite the employer’s directive to the contrary. The claimant alleged that her voluntary acts exceeding her restrictions caused her new injury. The judge ruled that the claimant was not in the course and scope of employment when she exceeded her restrictions and her alleged injuries to her left shoulder were degenerative, not work-related. The judge also found the claimant to be fully recovered from the previously accepted right shoulder injury.

Michele Punturi (Philadelphia, PA) and Audrey Copeland (King of Prussia, PA) obtained two successful appellate verdicts before the Commonwealth Court.

In the first case, they defended a well-known local hospital where the judge denied the employer’s termination petition. Michele and Audrey challenged the claimant’s medical expert, who could not establish through substantial competent evidence that the claimant was not fully recovered from a cervical spine injury.

In the second case, involving a medical only notice of compensation payable, the claimant filed a claim petition and the employer filed two termination petitions based upon an amended opinion of the defense medical expert, a board certified orthopedic surgeon. Michele and Audrey challenged the claimant’s evidentiary arguments and failure to establish that the judge was biased and that the second termination petition was barred by res judicata

Michael Sebastian (Scranton, PA) successfully handled a case where, prior to our representing the defendants, a third party case had been resolved on February 28, 2019, for $1,250,000. On June 2, 2020, the claimant filed a review petition requesting the judge to adjudicate the subrogation lien since the defendants did not resolve the lien via a third party settlement agreement. The defendants continued to pay full indemnity benefit to the claimant in the amount of $573.02 until the third party settlement agreement was finalized on August 19, 2020. The parties calculated that the claimant’s future indemnity payment would be $200.22 per week. Claimant’s counsel required that the third party settlement agreement be calculated as of the day of the settlement in February 2019. He would not agree that claimant was overpaid indemnity benefits from the date of the settlement through August 19, 2020. Claimant’s counsel alleged waiver of the overpayment by failing to timely resolve the issue. The judge opined the claimant was not overpaid and that we would actually recoup the overpayment in future payments, but 20 months later in time. The Workers’ Compensation Appeal Board reversed, finding that the employer overpaid the claimant, and remanded the case to the judge with instructions to calculate the subrogation lien as of the date of the parties entered into the third party agreement. The Board found no explanation in the record for the delay in finalizing the third party agreement. This increased the subrogation lien for not only the indemnity payment but any medical payment made after February 28, 2019, and before August 19, 2020. 

*Prior Results Do Not Guarantee A Similar Outcome

 

What’s Hot in Workers’ Comp is prepared by Marshall Dennehey Warner Coleman & Goggin 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. We would be pleased to provide such legal assistance as you require on these and other subjects when called upon. ATTORNEY ADVERTISING pursuant to New York RPC 7.1 Copyright © 2021 Marshall Dennehey Warner Coleman & Goggin, all rights reserved. No part of this publication may be reprinted without the express written permission of our firm. For reprints or inquiries, or if you wish to be removed from this mailing list, contact tamontemuro@mdwcg.com.

Firm Highlights

Thought Leadership

SIU Gets a Boost: NJ Supreme Court Affirms Insurers' Right to Litigate, Not Arbitrate, Fraud Claims

In a significant win for insurers' Special Investigation Units, the New Jersey Supreme Court clarified that statutory insurance fraud and racketeering claims may proceed in court rather than through PIP arbitration. At issue was whether insurance fraud claims brought under New Jersey's Insurance Fraud Prevention Act (IFPA) and the state's Anti-Racketeering Act (NJ RICO) are subject to mandatory arbitration under the Automobile Insurance Cost Reduction Act’s (AICRA) PIP dispute-resolution framework. Allstate had sued a network of medical practices, physicians, and related corporate entities, alleging a scheme to extract more than $1.7 million in PIP benefits through fraudulent and misleading billing. The trial court dismissed Allstate's complaint and compelled arbitration, reading AICRA's arbitration clause — which covers "any dispute regarding the recovery of... benefits" under PIP coverage, N.J.S.A. 39:6A-5.1(a) — as sweeping in fraud and racketeering claims along with routine benefit disputes. The Supreme Court affirmed the Appellate Division's reversal, adopting Judge Gilson's opinion below (480 N.J. Super. 566 (App. Div. 2025)) as its own reasoning. The Court held that IFPA and RICO claims fall outside the scope of AICRA's PIP arbitration mechanism because that "streamlined and specialized" process cannot grant the relief those statutes contemplate — treble damages, injunctive relief, broad discovery, and joinder of third parties — and because arbitrators lack authority to award compensatory or treble damages to an insurer. The Court also rejected the argument that Allstate's own Decision Point Review Plans independently compel arbitration, finding those plan provisions no broader than AICRA's own arbitration clause. Notably, the Court expressly disagreed with the Third Circuit's contrary holding in GEICO v. Mt. Prospect Chiropractic Center, 98 F.4th 463 (3d Cir. 2024), concluding it is not bound by that federal interpretation of New Jersey law. Insurers retain the right to pursue IFPA and RICO claims in the Law Division, with a jury trial. For SIU units and NJ insurance carriers, this decision is a significant win: it forecloses defense clinics' primary procedural tool for shunting fraud investigations into limited-scope PIP arbitration, where treble damages, RICO relief, and meaningful discovery were never realistically available. Carriers building cases against fraudulently structured clinics, straw-owned practices, or coordinated billing networks can now proceed with confidence that a well-pleaded IFPA/RICO complaint stays in the Law Division rather than being diverted to arbitration on a motion to compel. Practically, this strengthens SIU's leverage in settlement negotiations, preserves civil discovery tools (subpoenas, depositions, joinder of related corporate entities) critical to unwinding complex ownership and referral schemes, and resolves the split with the Third Circuit in favor of NJ insurers — at least as a matter of state law. Expect increased reliance on IFPA civil actions, rather than PIP arbitration demands, as SIU's primary enforcement vehicle going forward.

Thought Leadership

Congress Passes Financial Exploitation Prevention Act

On June 25, 2026, the House passed the Financial Exploitation Prevention Act of 2025 (“the Act”) by a vote of 414 to 2. The Act allows financial advisors and firms to delay suspicious transactions regarding the accounts of clients who are 65 or older, if they believe financial exploitation has occurred or is about to take place. With the advancement of technology and AI, the House’s overwhelming bipartisan passage of the Financial Exploitation Prevention Act represents an important step in strengthening the financial industry’s ability to combat the growing threat of elder financial exploitation. The Act recognizes what advisors have long known that financial professionals are often the first to detect suspicious behavior but have historically lacked clear legal authority to intervene before irreversible financial harm occurs. From the industry’s perspective, the bill accomplishes several important objectives, including the following: (1) Provides a practical “pause button” by allowing financial professionals to temporarily delay certain transaction requests when there is a reasonable belief that a senior or vulnerable adult is being financially exploited; (2) Empowers financial professionals to act by providing greater certainty that firms can act in good faith to protect clients without unnecessary legal risk; and (3) Strengthens investor protection without sacrificing client rights by allowing temporary delays based on a reasonable suspicion of exploitation, which is intended only to allow additional review and not to deny clients access to their money indefinitely. In sum, the Financial Exploitation Prevention Act will equip financial professionals with practical, carefully tailored tools to stop suspected financial exploitation before client assets are lost. By allowing firms to temporarily delay suspicious transactions under defined circumstances, Congress is recognizing the critical role advisors play as the first line of defense against increasingly sophisticated fraud schemes. The Act strikes an appropriate balance between protecting vulnerable investors and preserving individual financial autonomy, while reinforcing collaboration among advisors, families, and law enforcement to combat financial exploitation. The bill now awaits Senate action.

Thought Leadership

New Jersey Expands Family Leave Protections Effective July 17, 2026

On January 17, 2026, Governor Murphy signed into law legislation expanding the New Jersey Family Leave Act (NJFLA). Beginning July 17, 2026, significant amendments to the NJFLA will expand job-protected family leave to smaller businesses and more employees across the state. The new law broadens coverage by lowering the threshold for private employers from 30 employees to 15 employees, meaning many smaller businesses will now be subject to the NJFLA. Employees of state and local government agencies will continue to be covered regardless of the size of the employer. The amendments also make it easier for employees to qualify for leave. Under the revised law, an employee will be eligible after three months of employment and at least 250 hours worked during the preceding 12 months, replacing the previous requirement of 12 months of employment and 1,000 hours worked. Currently, New Jersey's Temporary Disability Insurance (TDI) and Family Leave Insurance (FLI) programs provide eligible employees with wage replacement while they are on leave but do not independently guarantee job protection. The recent amendments to the New Jersey Family Leave Act (NJFLA) expand these protections by extending job-protected leave to additional employees. Under the amended law, employees receiving TDI or FLI benefits may be entitled to return to the same position they held before taking leave, or to an equivalent position with the same seniority, status, pay, and benefits. Although the legislation also states that it does not expand or modify an employee's reinstatement rights under the NJFLA, the amendments appear to provide job protection to eligible employees receiving TDI or FLI benefits without requiring them to separately satisfy the eligibility requirements of the NJFLA or the federal Family and Medical Leave Act (FMLA). As a result, some employees may be entitled to longer periods of job-protected leave than were previously available under existing law. With these amendments, New Jersey continues to strengthen workplace protections by expanding access to job-protected family leave for eligible employees. These changes significantly expand access to job-protected family leave and may require employers to update their leave policies, employee handbooks, and HR practices. Notably, employers who were previously not required to administer NJFLA may need to amend their policies and/or create new protocols to come into compliance with the NJFLA. Failure to do so would prove costly, as the penalties for non-compliance are significant.

Result

No-Cause Jury Verdict Secured in Wrongful Death Trial

We successfully obtained a no-cause jury verdict in a 13-day wrongful death trial. The decedent, a 59-year-old man, was admitted to the emergency room on February 15, 2019, with complaints of abdominal pain, decreased appetite, and constipation, despite the use of laxatives. The patient did not complain of any nausea, vomiting, or diarrhea. He had a significant medical history including diabetes, hypertension, prior coronary artery stenting, morbid obesity (with past gastric bypass surgery), longstanding ventral hernia, and back pain. A CT scan revealed multiple hernias and a potential closed-loop bowel obstruction, leading to a surgery consultation. Our client, an emergency general surgeon, interpreted that the patient did not have a closed loop or any significant obstruction and recommended non-surgical management. The patient was approved to have clear liquids, and had a vomiting incident shortly after, but our client was not notified. The patient was returned to NPO status, and after improving overnight, he was returned to “clears” and additional medical and renal consults were ordered. Our client did not receive any communications from the residents/nurses of any changes in the patient’s condition. On February 18, 2019, two rapid responses were called due to increased heart rate and vomiting. It is believed that the vomiting resulted in aspiration, causing sepsis, ultimately leading to the patient’s death. During the trial, the plaintiff’s sole medical expert highlighted imaging on the wrong hernia, which called into question all of his opinions in the case. We made key objections related to the expert testimony, limiting what the allegations were, and preventing new allegations from being made. After approximately two and a half hours of deliberating, the jury returned a no-cause verdict.