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Defense Digest

Waiting on a Workers' Compensation Lien Reimbursement in New Jersey? You May Have to Wait a Little Longer. Section 40 and the Timeline for Satisfaction

Defense Digest, Vol. 30, No. 2, June 2024

June 1, 2024

Key Points:

  • The New Jersey workers’ compensation statute and applicable case law protects employers’ worker’s compensation lien rights against an injured worker’s third-party recovery. 
  • An employer can perfect its lien by providing notice to the third party that there is a worker’s compensation action; Perfecting the lien obligates the third party to inquire about and satisfy the statutory portion of the employer’s lien prior to paying the third-party proceeds to the injured party. 
  • The statute does not require either the third party or the injured worker to make payment on its lien immediately following payment of third-party proceeds, rather, this obligation waits until the lien amount is set. 

In New Jersey Transit Corp. v. Darshelle Joseph, 2024 WL 1172784 (NJ Super. App. Div. Mar 19, 2024), the New Jersey Appellate Division addressed a court order denying an employer’s application for satisfaction of a workers’ compensation lien. The Division found that an employer cannot recover on its workers’ compensation lien until that amount is set. The Appellate Division’s decision impacts an employer’s timely right to compensation of their lien under Section 40 of the New Jersey workers’ compensation statute.

Darshelle Joseph was involved in a compensable work injury on October 23, 2019. Mr. Joseph later filed a workers’ compensation, claim alleging permanent disability. Mr. Joseph also filed a third-party action against the alleged responsible party in the underlying incident. 

New Jersey Transit’s carrier sent a letter to Mr. Joseph dated November 11, 2019, informing him of its right to recover on money paid as a result his workers’ compensation claim. The carrier also requested that Mr. Joseph notify them whether he retained counsel to represent him in his third-party action.

The carrier ultimately paid a total of $7,112.90 in workers’ compensation benefits as a result of Mr. Joseph’s work injury. Mr. Joseph resolved his third-party claim in December 2021 for $14,000. Mr. Joseph’s attorney in the third-party action disbursed the settlement minus the attorney fee of $4,661.63 and $15.10 for costs. Mr. Joseph’s net was $4,676.73. The workers’ compensation case remains unresolved.

Following the third-party resolution, New Jersey Transit filed a verified complaint and order to show cause seeking reimbursement of its worker’s compensation lien. The parties argued their respective points, and the court subsequently denied New Jersey Transit’s request as premature. New Jersey Transit appealed that decision, and the Appellate Division took the appeal. 

The Appellate Division recited the relevant parts of Section 40 of the New Jersey workers’ compensation statute. It noted that in the event of an injured worker’s third-party recovery, the employer shall be entitled to recover if the amount the injured worker obtains from the third-party action is equivalent to or greater than the workers’ compensation lien and on the amount that exceeds the attorney fee on the third-party action and the costs associated with that action. The Division also noted that the statute provided that, if the employer provides notice of its workers’ compensation lien to the third party prior to third-party payment on a suit, the third party then has the duty to inquire prior to making any payment of the amount of the workers’ compensation lien and the obligation for payment. 

New Jersey Transit argued that it was entitled to reimbursement on its statutory workers’ compensation lien immediately upon the third-party action being resolved. It further argued that this is required regardless of the status of the workers’ compensation action in question. 

The Division noted that Section 40 of the statute, which covers third-party recovery, was enacted to guard against double-recovery. Section 40 provides a statutory lien in favor of an employer that attaches against an injured worker’s third-party recovery. This right to reimbursement depends on an injured worker realizing recovery on a third-party action. The Division also noted that while the statute outlines when and under what conditions an employer can recover on its lien, the statute does not provide a specific timeline on when this recovery takes place. However, it notes that the amount of the employer’s lien cannot be determined until the workers’ compensation benefits paid is finalized. 

The Division went on to discuss that, if the employer perfected its lien and notified the third party regarding the workers’ compensation lien, then the third party, as outlined above, would be obligated to satisfy this portion of the lien prior to making payment on the third-party action. The Division reinforced the section of the statute wherein workers’ compensation liens attach the third-party recovery. However, the Division cited case law supporting that notice of and perfection of the lien is not required in order to attach Section 40 lien rights to a injured worker’s third-party recovery. Perfecting the lien obligates the third party to consider the employer’s lien and make payment on that lien prior to making third-party payment to the injured party. 

However, none of this requires either the third party or the injured worker to satisfy the employer’s Section 40 lien rights immediately following recovery on its third-party action. In fact, the parties are unable to know the extent of the employer’s lien amount until that amount is finalized. Regardless, the Division reinforced that the employer’s right to third-party recovery enjoys great protection. The Division, therefore, remanded the case back the trial court so steps could be taken to reinforce the employer’s lien rights either via a third-party fund being held by the court or deposited into an attorney trust account until such time that the workers’ compensation action is resolved. 

This case reinforces the employer’s right to recovery on its workers’ compensation lien against an injured worker’s third-party recovery if that recovery is equal to or greater than the workers’ compensation lien. This decision also provides guidance to an employer regarding its right to recovery in the event the lien is perfected or not. 


 

Defense Digest, Vol. 30, No. 2, June 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.

Firm Highlights

Thought Leadership

First DCA Reverses Excessive Jury Award Unsupported by the Evidence

In December 2019, the plaintiffs filed a claim with Universal for damages caused by a water and sewage back up through the plumbing system and existing through multiple fixtures including the washing machine drain, kitchen sink, dishwasher, bathtub and toilet. Universal investigated the claim, issued payment for resulting water damage totaling $7,000.00 in actual cash value ($12,000.00 in replacement cost value). The plaintiffs sought additional benefits for work needed to access the below-slab cast iron plumbing system due to the failure of the system from rust, deterioration, corrosion and breaks in the line. Universal denied any additional benefits for access. In 2021, the plaintiffs filed suit. During litigation, Universal sent a plumber to inspect the home and the plumber concluded the pipes were clogged but could be cleaned. The plaintiffs’ plumber testified that the plumbing system needed to be replaced due to holes and openings in the pipes. The plaintiffs introduced two estimates prepared by Triad Restoration services totaling $79,680.22 in replacement cost value and $50,219.97 in actual cash value and an executed contract with another company for repairs with the amounts of repair redacted. Since the insurance policy did not provide coverage for repair or replacement of the plumbing system, the jury only had to decide whether the plumbing system needed to be replaced, and if it did, Universal would owe for the access costs; the jury verdict form required the jury to determine both the replacement cost value and actual cash value amounts. The jury asked if it had to rely on the Triad estimates for their amounts. The trial court advised the amount awarded had to be based on the evidence presented at trial and the law given by the trial court. The jury awarded $335,000.00 in replacement cost value or $305,000.00 in actual cash value. Universal motioned for a new trial arguing the amount awarded was unsupported by the evidence and then moved for remittitur. The trial court denied both motions and this appeal followed. The court found that while a jury’s verdict should only be disturbed with caution and discretion, the trial court must give the properly challenged award close scrutiny and determine whether it bears a reasonable relation to the damaged provided, is supported by the evidence, and could have been reached in a logical manner by reasonable means §768.74(3), (5)(d)-(e), Fla. Stat. The court found the trial court did consider the statutory requirements at the hearing on Universal’s remittitur motion and was concerned about a reasonable relation to the amount of damages proved and injury suffered and whether the award was supported by the evidence, but ultimately denied the motion, reasoning that the jury had been properly instructed to fairly and adequately compensate the plaintiffs. The court noted the only evidence providing the basis for the jury verdict was Triad’s estimates and those valued the plaintiffs' claimed loss at $79,680.22 in replacement cost value and $50,219.97 in actual cash value; no valuation evidence reasonably supported the jury verdict. The plaintiffs argued that the jury was entitled to consider more than the estimates, but the court conveyed the evidence provided did not give the jury a way to reach the amounts they awarded. The court was also not swayed by the plaintiffs’ argument regarding inflation and later price increases, but the court noted that no evidence via the contract, nor testimony regarding increase in labor, material, fuel or construction costs were entered into the record.  The court concluded the jury may draw reasonable inferences from the evidence, but it may not supply a damages number by speculation. The court did not find any of the plaintiffs’ remaining argument persuasive either. The court reversed the denial of Universal’s remittitur motion and motion for new trial as to damaged and remanded the case. The court ended its opinion with advising the trial court must determine whether replacement cost value or actual cash value is the property measure of damages under the policy and order remittitur in an amount consistent with that determination and the evidence.

Thought Leadership

United State District Court for the Middle District of Florida finds Evidence of Replacement Cost Value is Admissible and Recoverable Even When Repairs Have Not Been Made

The plaintiff filed a claim for damage as a result of Hurricane Ian. It claimed damages were over $24 million, but the carrier accepted partial coverage and paid $8,307.49 for secondary components. The carrier found hurricane damage to the building, but it was below the insurance policy’s $3.6 million deductible. The plaintiff sued for breach of the insurance policy. The carrier argued in a motion for summary judgment that plaintiff could not recover replacement cost value (RCV) because the property repairs had not been effectuated. The policy provided for RCV, but only after the repairs were completed. The carrier argued that because the repairs were not completed, the plaintiff was not entitled to RCV damages. The plaintiff argued the carrier could not withhold the actual cost value (ACV) due, which was the main allegation of the lawsuit, then fault it for not making the repairs to unlock the RCV. The United States District Court for the Middle District of Florida rejected the carrier’s argument, finding that when an insurer allegedly breached the policy by withholding coverage, it could not hide behind a repair-contingent provision to block the insured from RCV damages at trial. The court found the issue to be whether the contractual language designed to preclude certain coverage until after repairs are completed barred an insured from seeking those damages at trial when repairs were not complete. The court noted the Eleventh Circuit had not resolved this issue and neither side pointed to a definitive answer from the Florida Supreme Court. The court reasoned that it must look to the Sixth District Court of Appeal (6th DCA), which is the court which would have heard this case if it was in state court. The court noted the 6th DCA recently addressed this issue in Universal Prop. & Cas. Ins. Co. v. Rodriguez, 427 So. 3d 676 (Fla. 6th DCA 2026). The Rodriguez Court found that a breach of contract action is designed to adjudicate not only whether the contract was breached, but also evaluate the damages incurred had the breach not occurred, which the Rodriguez court found to be recovery of the RCV. This court also noted basic Florida contract principles compelled the same result, as a material breach frees the nonbreaching party to suspend its own performance and can demand the full benefit of its bargain, including RCV damages. Finally, the court found the distinction between a full denial and partial denial did not compel a different result. It found the policy required the carrier to acknowledge coverage and pay ACV for all covered damages, and the failure to do that is a material breach, entitling the insured to all of the damages available under the contract, which included the RCV.

Thought Leadership

Appeals Court Reverses Trial Court Order Awarding Attorney’s Fees Due to Lack of Evidence to Support Fee Awarded

The Fourth District Court of Appeal reversed the trial court’s order awarding appellate fees to People’s Trust Insurance Company based upon a lack of evidence to support the attorney’s fee award in RM & Assocs. Consulting, Inc. v. People's Trust Ins. Co., 2026 Fla. App. LEXIS 4654 (Fla. 4th DCA 2026). People’s Trust was the insurer of a residential property that had sustained water damage. RM & Associates Consulting was hired by the homeowner to perform mitigation services at the property. The homeowner assigned post-loss benefits to RM and RM subsequently filed suit against People’s Trust alleging that it had not been paid the money it was owed for the mitigation services. People’s Trust defended the lawsuit on the ground that the policy required the insured to notify the insurer before authorizing repairs so People's Trust could elect to use its preferred contractor. Because the owner did not comply with that provision, People's Trust asserted its liability was limited to the amount that its preferred contractor would have charged for the work, which People's Trust contended was $2,000. People's Trust paid that amount to RM before RM filed suit. People’s Trust filed a motion for summary judgment which was granted. RM appealed the summary judgment ruling and the ruling was upheld by the Fourth District Court of Appeal. The appellate court also granted People’s Trust’s entitlement to appellate attorney’s fees, subject to the trial court’s determination of the amount of fees, based upon an offer of judgment made by People's Trust. On remand, the trial court held an evidentiary hearing to determine the amount of attorney’s fees People’s Trust was entitled to. At the hearing, People’s Trust presented testimony from it’s fee expert, supervising trial counsel and appellate counsel. People’s Trust sought recovery of $24,866.17 for work performed by appellate counsel. The request primarily consisted of work performed in preparation of the answer brief. The fee expert testified that more than ninety hours spent preparing the answer brief was reasonable given the complexity and significance of the underlying issue. The appellate court found that the fee expert’s testimony fell short of meeting the necessary standard of demonstrating that the hours expended were necessary. The appellate court found that the billing records did not serve to cure the deficient testimony, as the billing records did not contain adequate details regarding the specific tasks performed. Rather the records contained entries such as “answer brief” which the appellate court found to be insufficient. The appellate court noted that neither the fee expert or counsel addressed how the prior research and briefing in the parallel litigation informed the work in the instant matter. The appellate court noted this was significant in that a court's attorney's fees award must exclude excessive, redundant, or otherwise unnecessary hours, citing Florida Patient's Compensation Fund v. Rowe, 472 So. 2d 1145 (Fla. 1985). Based upon the record failing to support the finding of the trial court, the 4th DCA remanded the case to the trial court for a reconsideration and redetermination of reasonable appellate attorney’s fees supported by competent substantial evidence. The 4th DCA reiterated that the fee expert’s focus on the quality of the work and the importance of the work to People’s Trust did not make up for the perceived deficiencies in the position that spending over ninety hours on a single answer brief was reasonable. Whether moving for attorney’s fees or challenging the amount of fees being sought by an opposing party, practitioners should be mindful of the evidence being used to support the claims being made. Parties should pay close attention to whether the hours being sought may be impacted by prior litigation either party may have engaged in. A party must be prepared to address how prior litigation efforts did or did not impact the amount of hours being claimed in current litigation. Lastly, billing records must be sufficiently detailed so as to support any potential future fee claim.