Opinion ID: 1436756
Heading Depth: 1
Heading Rank: 5

Heading: Stage III Disputes About Length of Coverage

Text: In January 1993, the Appellate Division dealt with the application of the one-year limitation on benefits. In re Naoma Dykas, 261 N.J. Super. 626, 619 A. 2d 660 (App.Div. 1993). At that time, N.J.A.C. 4A:6-1.6(b)(3) stated, Benefits are limited to a one year period from the initial date of the injury or illness. In Dykas, the worker suffered from CTS in both wrists. She first reported the affliction to her employer on approximately June 1, 1989. Dykas, supra, 261 N.J. Super. at 629, 619 A. 2d 660. The first surgery took place November 14, 1989, and the second on August 31, 1990. The worker received SLI benefits only for the recovery period following the first surgery. The Board upheld the denial of benefits on the grounds that the date of the second surgery, August 31, 1990, exceeded [the] one-year limitation established in N.J.A.C. 4A:6-1.6(b)3. Ibid. The issue was whether the initial date of the injury or illness was the first date her discomfort was brought to the employer's attention (notice), or the date when she was actually out of work due to the illness (disability). The Board applied the notice theory and limited SLI benefits to one year from June 1, 1989. The Appellate Division reversed and remanded the case, holding that the date the disability began, not the date when the injury or illness was suffered or became manifest, is the initial date from which the one-year period begins to accrue. Id. at 631, 619 A. 2d 660. As applied to the Dykas case, the one-year period began on November 14, 1989, which was the date of the disabling surgery. The second sick leave, resulting from the surgery on August 31, 1990, occurred within the one-year time limit and, therefore, qualified for SLI benefits. The Dykas court discussed the effect a hiatus in treatment should have on the one-year time limitation. The court found: If the Board chooses to establish a one-year maximum for the receipt of benefits, an employee whose injury or illness is reported in a timely fashion should not suffer a loss of benefits because there is a medical or practical necessity for a sufficiently long hiatus between stages of treatment so as to extend its entire course beyond one year; as long as the total of benefits received does not exceed a year's worth of salary continuation. [ Id. at 633, 619 A. 2d 660.]