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Workers' Compensation

What's Hot in Workers' Comp

Disputed Claims and Credibility Challenges: Workers’ Compensation Case Dismissed After Bifurcated Trial

Makins v. Palace Rehab & Care Ctr. and Premier Cadbury, LLC, No. A-2263-23 & A-2276-23 (April 24, 2025)

May 1, 2025

by Kiara K. Hartwell

The petitioner’s legal dispute arose from a series of workers’ compensation claims related to injuries sustained during her employment at separate employers. While a 2013 back injury at one facility resulted in a settled claim, subsequent incidents at a second employer led to new claims, all of which were contested. Following a bifurcated trial focused on compensability, the judge dismissed the claims against one employer, citing credibility concerns, a decision later upheld by the Appellate Division.

The petitioner worked as a licensed certified nursing assistant at Palace Rehab & Care Center (Palace) from 2008 to 2016. She began employment with Premier Cadbury, LLC (Cadbury) in 2015, initially working shifts for both employers. She resigned from Palace in 2016 and worked for Cadbury full-time until she was terminated in June 2018.

In 2013, while working for Palace, she filed a workers’ compensation claim for a low back injury that occurred on June 5, 2013, as she helped a patient out of bed. On August 22, 2017, a judge issued an order approving settlement on that claim. 

In June 2018, the petitioner re-opened her case against Palace and, shortly thereafter, filed two additional claims against Cadbury. One was for an alleged incident on February 11, 2018, an aggravation to her low back injury, and another was for a June 8, 2018, injury to her left hip, left knee, and low back while picking up a resident. Cadbury denied the claims.

It was noted in the pre-trial memorandum for all of these cases that there was to be bifurcation of certain issues and nothing indicated the petitioner objected to same. The petitioner testified—but noted she was taking oxycodone and muscle relaxers which affected her memory—that she had memory issues as a result of “long COVID.” In the written decision, the judge noted the petitioner’s demeanor and response when questioned by the respondent’s attorney regarding the incidents at Cadbury. The judge specifically observed that she did not make eye contact, became agitated, and blamed it on her memory. The petitioner also denied all descriptions of the mechanisms of injury as stated in incident reports and medical records regarding her June 8, 2018, injury. 

After the petitioner’s testimony, Cadbury presented Carole Tate, the director of nursing in 2018, and Susan Duban, executive assistant in 2018 and HR coordinator, at trial. The petitioner’s and Palace’s attorneys objected to these witnesses, claiming they could not lay a foundation for the documents to which they would be testifying. The judge noted they could testify if they could lay a proper foundation. While Duban testified about the reporting procedures, Tate testified that she had first-hand knowledge of any work-related incidents as she would help prepare incident reports. She confirmed she created the February 11, 2018, incident report based on the information provided by the petitioner. While someone else created the June 8, 2018, report, she had reviewed and signed it. The judge then entered the incident reports into evidence. 

Cadbury’s attorney indicated he wanted to present medical experts to testify as to the authenticity of the records and the history taken from the petitioner in order to have those records admitted into evidence. On the third day of trial, the parties agreed to admit certain documents into evidence. 

In February 2024, the judge issued an order and written decision dismissing the petitioner’s claims against Cadbury, stating the trial was bifurcated on the issue of compensability. He pointed out the inconsistencies in the petitioner’s testimony and documents in evidence. He found she was not credible, dismissed the claims against Cadbury with prejudice, and held that the claim against Palace would proceed as he, the judge, had not made a finding on causal relationship yet.

The petitioner and Palace appealed, arguing the judge confused legal and medical causation, improperly relied on the petitioner’s testimony to determine credibility, and improperly relied on hearsay documents. The Appellate Division affirmed the judge’s decision, stating there was no abuse of discretion or a plain error on the bifurcation decision and no confusion between legal and medical causation. While the petitioner asked the court to disregard the judge’s assessment of her credibility, the Appellate Division noted the deferential standard given to the judge who had the opportunity to hear the witness. 

 

What’s Hot in Workers’ Comp, Vol. 29, No. 5, May 2025, 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. 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 © 2025 Marshall Dennehey, 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.

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Florida Supreme Court Rules Florida Statute §627.70152 Does not Apply Retroactively

In a decision that resolves years of appellate uncertainty and confirms that insurers and insureds alike can rely on the legal framework in place when a policy is issued, the Supreme Court of Florida last week found that Florida Statute §627.70152, which involves an insured’s requirement to provide an insurer with pre-suit notice before filing a suit, cannot be applied retroactively. In Universal Property & Casualty Insurance Company v. Hughes, the Court was presented with the issue of whether the statutory pre-suit notice requirement applied retroactively and whether it would apply to a breach of contract of an insurance policy that was issued before the statute went into effect. Before the Court was an appeal from a homeowner, Ms. Hughes, who sued her insurance carrier, Universal Property & Casualty Insurance Company (Universal) for breach of contract under an insurance policy that was in effect from April 24, 2019 through April 24, 2020. During the policy period, Ms. Hughes suffered a loss and, on May 29, 2019, made a claim for water damage. The carrier investigated the loss and issued payment; Ms. Hughes disputed the payment, finding the amount insufficient for repairs. On July 1, 2021, Florida Statute §627.70152 went into effect, which required insureds to provide notice of intent to initiate litigation against the carrier prior to filing a lawsuit; if an insured filed the lawsuit without complying with §627.70152, a court must dismiss the case without prejudice. On August 4, 2021, Ms. Hughes filed her lawsuit against Universal for breach of contract. Universal moved to dismiss based on her failure to comply with §627.70152. Ms. Hughes contended the notice requirement could not be applied retroactively. The trial court disagreed and dismissed the lawsuit without prejudice, and Ms. Hughes appealed. During the appeal, the Fourth District Court of Appeal, in Cole v. Universal Property & Casualty, 363 So. 3d 1089 (Fla. 4th DCA 2023), ruled that Florida Statute §627.70152 did apply retroactively to policies issued before the effective date of §627.70152. However, the Sixth District Court agreed with Ms. Hughes and overturned the trial court’s ruling, finding the statute could not retroactively apply to policies issued prior to the statute effective date. Thereafter, the other district courts weighed in, with the Third District Court agreeing with the Fourth District Court, and the First, Second and Fifth District Courts agreeing with the Sixth District Court. In resolving the conflict amongst the district courts, the Supreme Court advised “as a general rule, ‘the statute in effect at the time an insurance contract is executed governs substantive issues arising in connection with that contract.’ Hassen v. State Farm Mut. Auto. Ins. Co., 674 So. 2d 106, 108 (Fla. 1996). The Court applied the two-step test when deciding whether a statute has retroactive application: “First, the Court must ascertain whether the Legislature intended for the statute to apply retroactively. Second, if such an intent is clearly expressed, the Court must determine whether retroactive application would violate any constitutional principles.” Menendez v. Progressive Exp. Ins. Co., 35 So. 3d 873, 877 (Fla. 2010). In analyzing the Legislature’s intent, the Court must determine whether the Legislature has manifested a clear command for retroactivity in the statutory text.  In review of the statutory text, the Court found nothing in the language of the statute to indicate that the phrase “all suits” was serving another purpose of expanding its reach to suits based on policies that both predate and postdate the enactment of the statute. Buis v. Universal Prop. & Cas. Ins. Co., 394 So. 3d 738, 741 (Fla. 2d DCA 2024). Further, the Court noted the statute has an effective date, which has long been considered to be evidence against retroactive application of a statute. The Court concluded that, on its face, no provision of §627.70152 speaks to application of the statute to insurance policies issued before the statute’s effective date and therefore, the Legislature did not clearly command retroactivity of the statute to include insurance policies issued prior to the enactment of the statute. The Court briefly reviewed Universal’s argument that the presuit notice requirement was procedural, not substantive, and therefore should be applied retroactively; however, the Court agreed with the Sixth District Court’s finding that, in its entirety, §627.70152 transformed an insured’s ability to sue an insurance company under a property insurance policy and an insurer’s obligations to respond to and pay insurance claims, thus making the requirement a substantive change. The Court thereby upheld the decision of the Sixth District and disapproved the decision of the Fourth District in Cole.

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WCJ Improperly Refused to Conduct C&R Hearing and Erroneously Required Settlement of All Pending Petitions

In this case, the claimant sustained injuries in the course and scope of her employment as a registered nurse. The employer acknowledged the injury by a Notice of Compensation Payable (NCP).  Subsequently, a Workers’ Compensation Judge (WCJ) expanded the description of injury. The employer then filed a Termination Petition, alleging the claimant was fully recovered from the injuries. Providers filed Utilization Review (UR) Petitions, challenging UR determinations finding their chiropractic treatment to be not reasonable and necessary. A settlement of the claim was eventually reached, and the employer filed a Petition to Seek Approval of a Compromise and Release (C&R) Agreement. The C&R outlined that the agreement fully resolved all future workers’ compensation claims except for the termination and UR Petitions. Briefs were filed and one day later, the WCJ issued an Interlocutory Order which stated if instructions were not followed regarding filing of a C&R, a settlement hearing date would not be given. The employer complied with the order, and filed the C&R. Subsequently, the WCJ notified the parties that the C&R must resolve all issues in the petitions, or would not be entertained. A settlement hearing was never held, and the WCJ then issued a decision, granting the Termination Petition and dismissing the UR Petitions. The WCJ also said that the Petition for Approval of a C&R was dismissed without prejudice, as the issues in the Termination and UR Petitions went to a decision. The claimant appealed to the Workers’ Compensation Appeal Board (Board). The Board granted the claimant’s appeal, finding that the WCJ violated the requirement of Section 449 that an expedited hearing be held when a Petition for Approval of a C&R is filed.  The Board further held that it was legally incorrect for the WCJ to insist that the C&R resolve all issues raised by the pending Petitions. The Board remanded the case to a new WCJ, and Employer appealed to the Commonwealth Court. The court affirmed the Board and held that the WCJ erred, as a matter of law, by refusing to hold an expedited hearing within 30 days, once the Petition for Approval of a C&R was filed.  The court noted that the language of Section 449(b) is mandatory, and a settlement hearing is not discretionary or dependent on a party’s separate request for a stay, or whether the record has been closed. The court further rejected Employer’s argument that the case should not be remanded to a new WCJ for a new decision on the termination and and UR Petitions, as the Board passed no judgment on whether the C&R Agreement resolved the termination and UR Petitions, and left it for the WCJ to decide in connection with the Petition for Approval of a C&R.

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Commonwealth Court Reaffirms the Constitutionality of Act 111's IRE Provisions

In this case, the claimant sustained a work injury of January 6, 1994, which was acknowledged by Notice of Compensation Payable (NCP). After the claimant’s receipt of 104 weeks of temporary total disability benefits, the employer filed a Request for an Impairment Rating Examination (IRE). The IRE was performed in May 2023 and the IRE physician found that the claimant had a 5% whole person impairment, under the AMA Guides. The employer filed a Petition based on the IRE results, and the Petition was granted by the WCJ. During litigation, the claimant argued that the IRE provisions of Act 111 (Section 306(a.3) of the Act) were not applicable to her injury, since it predated June 24, 1996, the date Act 57 went into effect, and that the IRE provisions were unconstitutional. The Workers’ Compensation Judge (WCJ)) granted the Petition and the Board affirmed. On appeal to the Commonwealth Court, the claimant argued that Act 111 violated the nondelegation doctrine and that its retroactive application to the claimant’s injury was unconstitutional. The court rejected the arguments on the basis that they had already found the same arguments without merit in multiple, prior cases. The court also addressed an argument made by the claimant that Act 111 was procedurally defective under the Pennsylvania Constitution because it was only considered on two days in each House after having undergone amendments and reassignments. The court noted that the Pennsylvania Constitution requires every bill to be considered on three different days in each House. The claimant maintained that, according to the legislative history, the bill did not receive three separate days of consideration from each House when it was assigned a new bill number. The court pointed out, however, that the bill number, H.B. 1840 remained constant and was considered on three occasions by the House. Further, the court concluded that minor amendments to the bill were germane to its original subject, which was to modify the Act’s IRE process, in accordance with Protz II.

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