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What's Hot in Workers' Comp

The Appellate Division Affirms Dismissal of Petitioner’s Three Claim Petitions for Failure to Sustain Burden of Proof.

Lindell v. W.H. Indus., Inc., No. A-1815-20 (App. Div. June 1, 2022)

July 1, 2022

by Kiara K. Hartwell

The petitioner began working for the respondent in 1999. In 2001, she was struck by a car and her right hand went through the windshield. She underwent surgery to repair her hand and another later to remove a neuroma. She also underwent pain management treatment, therapy and medication. She was diagnosed with right hand reflex sympathetic dystrophy (RSD)/complex regional pain syndrome (CRPS).

In 2009, the petitioner filed two claim petitions—for June 27, 2007, and September 14, 2007, incidents—in which she allegedly injured her right hand. She was still receiving treatment at the time of the June 27, 2007, incident. She then filed a third claim petition for a right hand injury on August 12, 2009. The petitioner stopped working then and alleged her pre-existing RSD/CPRS was aggravated by these incidents. The respondent filed its answers for the June 27, 2007, and August 12, 2009, incidents, confirming the incidents arose out of and in the course of employment and paying all benefits.

After the 2007 incidents, the petitioner was authorized to continue treatment with Dr. Schlifstein until care was transferred to Dr. E. Freeman in 2013. Dr. Freeman treated the RSD/CPRS diagnosis, but he never made a causation determination as the petitioner had come to him with that condition. He relied on the petitioner’s subjective complaints, noting she had a “very mild case” of RSD/CPRS “if you believe her subjective complaints.”

On September 21, 2015, the petitioner was riding her bicycle when she was hit by a car. Eight days after, she saw Dr. Freeman, claiming she had a flare-up of pain due to weather, but she never told him about the car accident. She did not disclose it to him as she was “fuzzy” due to the loss of a family member. In 2016, she underwent cervical and lumbar surgeries and failed to disclose them to Dr. Freeman, even though she saw him shortly before or after the surgeries. Dr. Freeman found out about the 2015 incident after being advised by the respondent in 2017. The petitioner also saw Dr. Schlifstein after the 2015 incident, but allegedly only for her left side, and he prescribed various medications. Dr. Freeman noted he was unaware the petitioner was getting treatment and prescribed medication by other doctors. Dr. Freeman noted the petitioner filled prescriptions from other providers while under his care after a review of pharmacy records.

Dr. Freeman was called as a witness by the petitioner. He testified that there was no evidence the 2009 work incident caused RSD or that it became worse. He confirmed that after the 2015 incident, the petitioner had pain flare-ups, which could have been related to the surgeries after the 2015 incident. Dr. S. Dane, the petitioner’s expert neurologist, then testified that the RSD/CPRS was aggravated by the 2009 incident, but no subsequent aggravation. He confirmed the petitioner did not tell him about the 2015 incident or surgeries when he initially examined her in 2017. He noted that many of her complaints could have been the result of cervical radiculitis due to the surgery, that the RSD diagnosis was based on her subjective complaints, and he only had one progress note from Dr. Schlifstein prior to the 2009 incident.

The respondent’s expert, Dr. C. Effron, testified, noting no objective findings of RSD and that there was no permanent disability to her right hand. 

The Workers’ Compensation Judge dismissed all three claim petitions for failure to sustain her burden of proof. The judge found the petitioner intentionally did not tell Dr. Freeman about the 2015 incident, that her assertion she only saw Dr. Schlifstein for her left side to be “blatantly absurd,” and “incredible” that Dr. Freeman did not ask her about changes in her medical history. She found Dr. Freeman to be credible and believed Dr. Effron’s testimony that the petitioner failed to disclose the 2015 incident. Overall, the judge found the nondisclosure of the 2015 incident, coupled with her lying about filling multiple doctors’ prescriptions, damaged the petitioner’s credibility. The judge also noted the petitioner stopped working after the 2009 incident, but provided no expert opinion that she was 100% disabled or that she was unable to work.

The petitioner appealed, arguing she met her burden of proof and the judge erred in various aspects. The Appellate Division disagreed, noting the judge’s assessment of credibility was crucial and found no error with the Judge’s admission of the pharmacy records. Even ignoring the pharmacy records, the Appellate Division pointed out that the judge found the petitioner lied about filling prescriptions from other doctors and there was no error in considering evidence regarding the 2015 incident. 

Although the petitioner argued the judge ignored the stipulations, which were to focus on the issue of the nature and extent of permanent disability, the Appellate Division disagreed. The judge found no objective medical evidence or material lessening due to the 2007 incidents and the petitioner’s credibility impacted any finding of permanency for the 2009 incident. The Appellate Division confirmed that providing medical treatment did not necessarily mean a finding of any partial permanent disability.
 

 

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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

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. 

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.