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Workers' Compensation

What's Hot in Workers' Comp

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

What’s Hot in Workers’ Comp, Vol. 29, No. 3, March 2025

March 1, 2025

NEWS

On February 18, 2025, the New Jersey Law Journal published David Levine’s (Roseland, NJ) article “Navigating Preexisting Conditions in New Jersey Workers’ Compensation Claims.” Read his article here.

On February 12, 2025, Michele Punturi (Philadelphia, PA) participated in a panel at CLM 2025 Focus Conference: Work Comp, Casualty and Risk Management in Lake Buena Vista, FL. on “Workers’ Comp Risk Management Best Practices: Insights from High Risk Industries.”
 

RESULTS*

Linda Wagner Farrell (Jacksonville, FL)

  • successfully contested a claimant’s request for authorization for a van equipped with a wheelchair lift, arguing its medical necessity following a severe work-related injury. Testimony revealed the claimant’s significant mobility challenges were due to a work-related traumatic brain injury and spastic hemiplegia. However, the employer/carrier contested the request, asserting it was neither reasonable nor medically necessary based on the authorized treating physician’s assessment. Ultimately, the judge of compensation claims found the claimant did not meet the burden of proof to establish the necessity of the van, siding with the employer/carrier’s argument, and denied the authorization request along with the claims for attorney’s fees and costs.

Tony Natale (King of Prussia, PA)

  • successfully prosecuted a termination petition involving a Medicare beneficiary who sustained various traumatic injuries, including a knee tear, as a result of being struck and dragged by a golf cart. The carrier accepted the traumatic injuries at issue. The claimant argued he also sustained an aggravation of pre-existing degenerative osteoarthritis as part of his defense to the termination petition. This became a crucial issue in the case as the carrier did not accept the osteoarthritic condition and Medicare had been paying the medical expenses for that condition. A conditional lien from CMS would be the result of an unsuccessful termination petition. After extensive medical evidence was presented, the court ruled in favor of a full recovery and found no work-related osteoarthritis. This was a complete defense verdict. 
  • successfully defended a Medicare conditional lien request. The underlying claim involved an injury sustained in a motor vehicle accident with payments being made to the claimant under a New Jersey PIP Policy. The carrier exhausted the PIP policy following the injury. Medicare also paid significant medical bills for the claimant and demanded through CMS that the carrier reimburse all payments made as a conditional lien request. CMS, through their many contractors, threatened legal action with double damages if the lien was not satisfied. The carrier appealed the lien request through two levels of CMS contactors with no success. Tony formulated a third level appeal to an administrative law judge, arguing that CMS’s request for additional liens violated state PIP policy law and the carrier’s constitutional rights. Evidence presented showed the PIP policy had been exhausted and, thus, the carrier reverted back to a secondary payer, forcing Medicare/CMS as the primary payer under federal law. The court agreed, and a full defense verdict was issued. 
  • successfully defended a Claim Petition involving an alleged a low back injury with radiculopathy as a result of pushing a cart at work. The carrier accepted a strain injury with limited disability, leading to the claimant filing a Claim Petition for ongoing disability and medical benefits for an aggravation of a disc herniation. Tony presented a board certified orthopedic surgeon with a significant surgical practice who offered opinions that, at most, a strain injury occurred, which fully recovered. The court accepted the carrier’s expert witness, limited the work injury to a strain and found the claimant fully recovered. No additional medical or disability benefits were payable, resulting in a complete defense verdict on the issues. 
  • successfully defended a Fee Review involving PRP injection therapy. The claimant sustained a shoulder injury and the workers’ compensation claim was ultimately settled. After settlement, a provider alleged substantial medical bills related to the injury (generated prior to the date of settlement) were not paid. The bills first alluded to neck treatment, as opposed to shoulder treatment. The carrier produced evidence that any shoulder bills were already paid. The case continued on the issue of additional bills which appeared to be neck-related, not shoulder-related. After many hearings, Tony successfully had the provider’s application for fee review dismissed for failure to prosecute and/or produce evidence that could be used to support an award. 
  • successfully prosecuted a termination petition involving accepted contusion and strain injuries to various body parts, including the claimant’s knee. The claimant was a Medicare beneficiary and a Veterans Administration beneficiary. During the post-injury treatment process, the claimant underwent total knee replacement surgery. The bills were paid by the Veterans Administration (which has similar rights to Medicare in assessing conditional liens). Tony alleged that all work-related injuries had recovered and that the total knee replacement surgery was not work related. The crux of the medical presentation was predicated upon two years of VA Hospital records documenting the claimant’s need for (and the scheduling of) total knee replacement surgery before the date of the work injury. The court granted the employer’s termination petition and found the claimant submitted no evidence that would allow the court to expand the nature of injury to include the total knee replacement surgery costs. 

*Prior Results Do Not Guarantee a Similar Outcome 


 

What’s Hot in Workers’ Comp, Vol. 29, No. 3, March 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.

Firm Highlights

Event

CLM 2026 Focus Conference

Allison joins three insurance industry leaders to discuss how cyber coverage disputes, the growing impact of social inflation on bodily injury claim valuation, and the use of artificial intelligence are reshaping the bad faith landscape. The panel will examine emerging sources of extra-contractual exposure, including evolving cyber insurance coverage issues and the challenges of accurately valuing bodily injury claims. Practical approaches to claim evaluation using AI, along with defense strategies designed to help prevent or successfully defend against bad faith litigation, will also be addressed. 

Complete Victory Obtained in a Workers’ Compensation Matter

Result

Complete Victory Obtained in a Workers’ Compensation Matter

Defense Victory Obtained in Workers’ Compensation Case

Result

Defense Victory Obtained in Workers’ Compensation Case

business meeting photo

Result

Summary Judgment Obtained in Insurance Coverage Case

Bret E. Dubbert Joins Marshall Dennehey’s Orlando Office as Special Counsel in the Casualty Department

News

Bret E. Dubbert Joins Marshall Dennehey’s Orlando Office as Special Counsel in the Casualty Department

Thought Leadership

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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News

Marshall Dennehey Announces 2027 New Jersey Super Lawyers And Rising Stars

Thought Leadership

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.

Marshall Dennehey Named a Standout in Litigation by BTI Consulting Group

News

Marshall Dennehey Named a Standout in Litigation by BTI Consulting Group

Thought Leadership

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.