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What's Hot in Workers' Comp

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

What’s Hot in Workers’ Comp, Vol. 28, No. 1, January 2024

January 1, 2024

NEWS

Kiara Hartwell’s (Mount Laurel, NJ) article “A Workers’ Compensation Judge’s Approval of a Section 20 Settlement Can Be Contingent on a Petitioner’s Live Testimony” appeared in the December 2023 issue of Defense Digest. You can read her article here
 

RESULTS*

Kristopher Starr (Wilmington, DE) received a favorable decision from the Industrial Accident Board. The claimant had been injured in a compensable, accepted work accident where he sustained an injury to his lumbar spine (ligamentous). However, he had pre-existing degenerative pathology in the spine. We filed a Petition for Review to end temporary total disability benefits, alleging the claimant could work within restrictions. The claimant filed a petition for additional compensation, demanding approval of a lumbar discogram and ongoing total temporary disability benefits. The Board held that conservative treatment was appropriate, including TFESI injections, and that the lumbar discogram was not reasonable. Two MRI studies evidenced resolving soft tissue injury to the lumbar spine ligaments, and the claimant did not present as a surgical candidate. The employer’s doctor was found persuasive as to the issue of lumbar discography. The claimant’s doctor conceded, under cross-examination, there were no neurologic deficits evidencing radiculopathy on successive exams. Considering the evidence and the Health Care Practice Guidelines, the Board determined discography was not reasonable. A DACD Petition was granted in part and denied in part. As to indemnity, Kris presented vocational evidence and a Labor Market Survey showing no wage loss for positions within the claimant’s work restrictions. Kris indicated that Hoey v. Chrysler did not apply as the claimant was advised he could no longer be accommodated and was obligated to look for work. The claimant’s physician agreed, under cross-examination, that the claimant could work the Labor Market Survey jobs (all sedentary positions) and that the claimant was not totally disabled. Ongoing indemnity benefits were denied and our petition for review was granted. No appeal is anticipated by the claimant.

Frank Wickersham (King of Prussia, PA) successfully defended a Claim Petition on behalf of a national trucking company where the answer was late without a reasonable excuse. Frank persuaded the workers’ compensation judge that the Claim Petition was not well-pled as to the main allegation, which was that the claimant suffered a disabling aggravation of a pre-existing cervical condition from a fall at work. Frank further convinced the judge that the claimant did not meet his burden of showing that he aggravated a pre-existing cervical condition from his fall. The claimant’s expert admitted on cross-examination that when he first saw the claimant about one month after the work incident, he already had a head droop from a cervical fusion that was done five months before the date of injury. According to this expert, surgery “unrelated” to the work injury would be needed to correct it. This was inconsistent with the expert’s direct examination testimony, which was that the work incident had caused the head droop.

Kacey Wiedt (Harrisburg, PA) achieved the following successful results:
•    Successfully prosecuted a Modification Petition where the workers’ compensation judge found that the claimant’s benefits are to be reduced based upon an earning power assessment. The judge found our medical and vocational experts more credible than the claimant’s experts that the claimant had an earning power of $610.00 per week.
•    Successfully defended a Claim Petition where the workers’ compensation judge found that the claimant did not sustain a work-related wrist injury due to repetitively lifting cardboard boxes at work. The judge found our employer’s witnesses more credible and persuasive than the claimant, who testified that he was performing this task for a short period of time and that his medical issues are related to his diabetes, not an overuse injury in accordance with our medical expert opinion.
•    Successfully prosecuted a Termination Petition where the workers’ compensation judge found that the claimant was fully recovered from his back injury, which was previously accepted as a “lumbar sprain, L4-5 disc herniation with aggravation of degenerative spondylosis and spinal stenosis at L4 causing radiculopathy.” The judge found our medical expert more credible than the claimant’s medical expert.

Judd Woytek (King of Prussia, PA) achieved the following successful results:
•    Successfully defended a survivor’s claim for Federal Black Lung benefits. The miner had worked 11 years in the coal mine industry, and the parties stipulated that he had simple coal workers’ pneumoconiosis at the time of his death. Judd presented credible medical evidence to show that the miner’s pneumoconiosis did not cause or contribute his death, and benefits were denied. 
•    Successfully defended a claim for a right shoulder sprain/strain, impingement and SLAP tear. Based upon the fact witness and medical expert testimony that Judd presented, the workers’ compensation judge limited the injury to a right shoulder sprain/strain, limited disability benefits to a closed period of four months and terminated benefits as of the date of our IME. 
•    Along with Audrey Copeland (King of Prussia, PA), successfully defended the claimant’s appeal from a workers’ compensation judge’s decision (that had been affirmed by the Workers’ Compensation Appeal Board), which found that the claimant’s temporary total disability benefits should be reinstated as of the date he filed his Reinstatement Petition based upon Protz following a pre-Protz IRE. 

*Prior Results Do Not Guarantee a Similar Outcome
 


 

What’s Hot in Workers’ Comp, Vol. 28, No. 1, January 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. 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 © 2024 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

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.

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.