Court Opinion

ID: 9629830
Source: CourtListenerOpinion
Date Created: 2023-08-22 09:50:41.451003+00
Date Added: 2024-06-11T09:29:08.929559
License: Public Domain

Justice ALBIN,
concurring in part, and dissenting in part.
John Basil died because his employer’s workers’ compensation carrier did not furnish him with the necessary medical care to treat his workplace injuries. Under the workers’ compensation statute, N.J.S.A. 34:15-15, an employer is required to furnish medical care to an injured worker. In the circumstances of this case, it is reasonable to conclude that Basil’s employer delegated that responsibility to Transportation Insurance Company, the employer’s workers’ compensation carrier.
Basil died because the carrier sent him for evaluation and treatment to an “incompetent” physician — a physician who, while treating Basil, did not maintain the statutorily-required malpractice insurance necessary to practice medicine in this State; a physician who negligently failed to diagnose and treat a cancerous tumor related to Basil’s workplace injury; a physician who surrendered his independent, professional judgment for the care of his patient to the carrier’s cost-saving functionaries. Those are the facts viewed in the light most favorable to plaintiff, Bash’s widow. If believed by a jury, the evidence would support a finding that the carrier negligently retained the “incompetent” physician and improperly exercised control over Basil’s medical treatment, resulting in his wrongful death.
The majority has not given Mrs. Basil the benefit of her best case as required on a summary judgment motion, but has instead improperly weighed the evidence as though it were a jury. Because I believe that Mrs. Basil has presented sufficient evidence to have the carrier answer in court for the wrongful death of her husband, I respectfully dissent.
I.
Basil was employed as the Branch Manager at Jasper Engines and Transmission Company (Jasper) in Fairfield, New Jersey on *75September 27, 1996, when he fell while moving an engine in a Jasper warehouse. He suffered injuries to his abdomen, back, and right middle finger, and experienced an immediate “pulling” in his rib cage. A little more than a week later, he felt a “ball or knot” in his rib cage, which caused intense pain for brief periods when he sat in certain positions.
On the day of the accident, Basil went to see his chiropractor, who treated him over the course of five visits, ending on November 19, 1996. Jasper’s workers’ compensation carrier, defendant Transportation Insurance Company (the carrier), paid for those visits. Basil managed “sporadic episodes” of pain with ibuprofen.
A year later, in December 1997, when Basil experienced increased pain in his rib cage unrelated to any new injury, he resumed treatment with his chiropractor. However, the carrier refused to pay for chiropractic services, and its Claims Service Representative (CSR), Pamela Hudson, told the chiropractor’s office that “if [Basil] needs treatment I can set him up [with] an orthopedist.”1 (Emphasis added). The carrier then referred Basil to Frank Wolf, M.D., a New Jersey-licensed physician who had discontinued both his orthopedic surgery practice and his medical malpractice insurance in 1993. From that date until 2001, Dr. Wolf performed independent medical examinations for insurance companies and attorneys.
In a letter dated January 14, 1998, CSR Hudson instructed Dr. Wolf to examine “Basil for evaluation purposes only” and “to determine whether [he] has sustained any permanent disability as a result of [Basil’s workplace] injury.” Dr. Wolf also was told to “obtain a detailed medical and work history and comment on causal relationship, diagnosis, and need for additional treatment.” A week later, Dr. Wolf examined Basil and found “an area of fullness in the area between the lower rib cage and sternum.” Without any x-rays or “special studies,” Dr. Wolf diagnosed the problem as a “probable hematoma” caused by a “stretching and *76tearing” involving the abdominal muscle and muscles and tissues within and attached to the rib cage. In a letter to the carrier dated January 20, 1998, Dr. Wolf advised that Basil “should benefit from additional treatment in the form of physical therapy.” Dr. Wolf wrote a prescription for physical therapy, but forwarded it to the carrier rather than to Basil.
On February 3, 1998, CSR Hudson addressed a letter to Dr. Wolf, advising him that “the above captioned claimant [John Basil] has been referred to your office for treatment for injuries sustained as a result of a work related injury.” The letter requested “timely medical reports relating to the claimant’s progress, expected course of treatment” and instructed that “prior authorization” must be received from the carrier before undertaking “any special services” or “diagnostic tests.” That same day, CSR Hudson placed a note in Basil’s file memorializing that she had forwarded a “letter to Dr. Wolf authorizing any necessary takeover treatment.” Dr. Wolf did not respond to that letter characterizing him as the treating physician.
Basil had doubts about Dr. Wolfs recommendation of physical therapy. He informed the carrier that because he “[felt] a lump in his rib area,” he thought he first should have an x-ray or MRI to rule out a muscle tear. Remarkably, up to that point, neither Dr. Wolf nor any of the carrier’s representatives had authorized an x-ray or MRI to determine the exact nature of Basil’s medical problem.
On February 23, 1998, Basil’s claim was reassigned to Claim Representative (CR) Lorraine Crecco. On April 7, 1998, Basil’s attorney sent a letter to the carrier, urging that it “permit active medical treatment” of Basil. Not until a month later, on May 6, did the attorney receive a response in the form of a telephone call from CR Crecco, who told him that Basil had not gone for physical therapy as prescribed by Dr. Wolf. CR Crecco, apparently, did not appreciate the need for an x-ray or MRI or Basil’s overriding and understandable concern that physical therapy might worsen his condition.
*77At the attorney’s request, CR Creeeo scheduled a “reevalu-at[ion]” of Basil with Dr. Wolf. As a result of that examination on May 26, 1998, Dr. Wolf wrote the carrier that pain in Basil’s rib cage area continued and that “the area ‘jumped’ when touched.” He noted that Basil’s “right lower rib area feels ‘like a golf ball’ rolling and tingling.” Nevertheless, Dr. Wolfs diagnosis remained the same as in his first report: “probable hematoma.” He concluded that “further study ought to be completed for confirmation or modification of diagnosis.... A simple chest and rib x-ray series would be the logical first step and if necessary an MRI.” Moreover, Dr. Wolfs clinical notes from the examination indicated that Basil could not sit up from a lying-down position without assistance and that the “patient needs studies, x-rays, possible MRI to follow.” Dr. Wolf, however, documented in his report to the carrier that Basil “wishe[d] to continue with treatment in proximity to his home geographic area and; therefore, has been advised that this examination does not establish nor imply a patient-physician relationship.”
Despite Dr. Wolfs findings in May 1998, the carrier did not authorize chest and rib x-rays until September 11, 1998, and then only in response to a lawyer’s letter. It took yet another month for CR Crecco to direct Dr. Wolf to “give [Basil] a prescription to obtain a simple chest and x-ray series.” Two weeks later, Dr. Wolf called in a prescription to Poeono General Hospital to perform a “chest and right thoracic wall standard [x-ray]” on Basil. A hospital technician reported orally to Dr. Wolf that the results were negative and that an MRI of the “right lower chest wall” was recommended.
Dr. Wolf, however, did not report the x-ray result and MRI recommendation to the carrier until four months later in a letter dated February 26,1999. In that letter, Dr. Wolf noted a number of “diagnostic possibilities” to account for the lump in Basil’s chest, including that of a “tumor ... that may remain undetectable on physical examination or even standard tests.” Even so, Dr. Wolf did not advise the carrier that an MRI was necessary, only *78that one “be considered.” He also recommended “that [Basil] be referred to a thoraco-abdominal surgeon for further assessment and treatment of this nebulous mass.”
On March 3, 1999, Basil’s attorney requested that the carrier give its authorization for Basil to be treated by a thoracic-abdominal surgeon and to undergo an MRI, as recommended by Dr. Wolf. Three weeks later, CR Crecco referred Basil for treatment with Dr. Aaron H. Chevinsky, a thoracic surgeon. On October 26, 1999, imaging and biopsy of Basil’s abdominal wall revealed a “huge retroperitoneal tumor.”
Basil died of stage IV sarcoma on September 17, 2000 at the age of 56.
II.
Those are the facts most favorable to plaintiff. The majority should have referenced only those facts at this procedural stage of the case. Under our summary judgment jurisprudence, plaintiff also was entitled to the benefit of the most favorable inferences to be drawn from those facts. R. 4:46-2(c); see also R.A.C. v. P.J.S., 192 N.J. 81, 87 n. 2, 927 A.2d 97 (2007) (noting that in summary judgment motion “we must view the facts in the light most favorable to the non-moving party ... and give him the benefit of all favorable inferences in support of [his] claim” (internal quotation omitted)); Brill v. Guardian Life Ins. Co. of Am., 142 N.J. 520, 540, 666 A.2d 146 (1995).
The most favorable facts and inferences clearly would allow a jury to conclude that Dr. Wolf was Basil’s treating physician. When the carrier refused to pay for chiropractic services, CSR Hudson called Basil’s chiropractor’s office and stated that if he “needs treatment I can set him up [with] an orthopedist.” CSR Hudson then sent Basil to see Dr. Wolf, an orthopedist, who conducted a physical examination. Later, in a letter, CSR Hudson unambiguously informed Dr. Wolf that Basil was referred to him “for treatment for injuries sustained as a result of a work related injury.” In addition to examining and diagnosing Basil on two *79occasions, Dr. Wolf wrote a prescription for physical therapy for Basil in January 1998 and a prescription for an x-ray in October 1998. A hospital technician read to Dr. Wolf a report containing the results of the x-ray and a recommendation that an MRI be performed. Dr. Wolf, in turn, recommended that the carrier consider both authorizing an MRI and referring Basil to a specialist. Issuing prescriptions, directing tests, and conducting examinations, as Dr. Wolf did, is consistent with the actions of a treating physician. From the totality of his interactions with Dr. Wolf, Basil had reason to believe that he was Dr. Wolfs patient, not just a claimant undergoing an independent medical examination for the carrier.
It is true that a jury, accepting other facts and inferences, could reach a different conclusion. But a court should not accept the moving party’s storyline on a summary judgment motion. The majority has erred by adopting the facts and inferences that place the carrier in the best light by casting Dr. Wolf as an independent medical examiner. The majority has made the same error in concluding that the carrier did not exercise control over the course of Basil’s medical treatment. By giving the carrier, rather than plaintiff, the benefit of its best case, the majority has turned our summary judgment standard on its head.
Here, plaintiff’s best evidence suggests that the carrier not only interfered with Basil’s medical treatment, but delayed vital diagnostic testing that might have timely uncovered the metastasizing cancerous tumor that eventually killed Basil. As evidence of the control the carrier exercised, Dr. Wolf sent the physical therapy prescription to the carrier rather than the patient. Although Basil had “a lump in his rib area,” the carrier would not authorize a simple x-ray but instead expected Basil to pursue a physical therapy regimen, which might have exacerbated his condition. Only after being hounded by Basil’s attorney did the carrier move, and then at glacial speed, toward furnishing Basil the medical treatment to which he was entitled under the Workers Compensation Act, N.J.S.A. 34:15-1 to-142.
*80In May 1998, having detected a golf-ball-sized growth in Basil’s rib area, Dr. Wolf wrote to the carrier that “[a] simple chest and rib x-ray series would be the logical first step.” It took four months for the carrier to authorize the x-rays, and another month for it to direct Dr. Wolf to issue the x-ray prescription. Although the need for an MRI would have been obvious to a first-year medical student, Dr. Wolf only recommended that an MRI “be considered,” and then awaited instructions from the carrier. Dr. Wolf seemingly abandoned his own professional independence and judgment and left to insurance company claims representatives the ultimate decision of whether Basil should receive timely, and potentially life-saving, diagnostic testing.
In the light most favorable to plaintiff, the record reveals a dawdling physician, indifferent to his patient’s needs, and an insurance company in full control of the patient’s course of treatment, slowly dispensing authorization for medically-needed tests and treatment.
III.
Plaintiff contends that her husband’s treating physician, Dr. Wolf, was practicing medicine while not carrying malpractice insurance in violation of N.J.S.A 45:9-19.17. Plaintiff submits that Dr. Wolfs failure to cany statutorily-required malpractice insurance rendered him an “incompetent” physician — a physician who did not possess the essential qualifications to practice medicine. In other words, without maintaining malpractice insurance, Dr. Wolf should not have been treating patients or even conducting independent medical examinations. In that latter regard, it bears mentioning that a physician owes the same duty of care to a person who is being examined and diagnosed for specific complaints during an independent medical examination as would be owed to a “traditional” patient presenting those complaints. See Ranier v. Frieman, 294 N.J.Super. 182, 192, 682 A.2d 1220 (App.Div.1996).
*81Ordinarily, the negligence of an independent contractor, such as Dr. Wolf, would not be imputed vicariously to the entity that retained him. Majestic Realty Assocs. v. Toti Contracting Co., 30 N.J. 425, 430-31, 153 A.2d 321 (1959). That is so because, typically, a principal who hires an independent contractor has no right to control the contractor’s work. Baldasarre v. Butler, 132 N.J. 278, 291, 625 A.2d 458 (1993). Under those circumstances, the contractor, rather than the principal, is deemed solely responsible for any dangers and risks arising from his own work. Ibid. There are, however, exceptions to that general rule.
A.
One exception is when a principal hires an independent contractor who the principal knows or has reason to know is incompetent to perform the task. Mavrikidis v. Petullo, 153 N.J. 117, 137, 707 A.2d 977 (1998). The incompetent contractor exception is perfectly illustrated in Puckrein v. ATI Transport, Inc., 186 N.J. 563, 897 A.2d 1034 (2006). In that case, a waste disposal company hired an independent-contractor trucker to haul glass residue and solid waste over the highways. Id. at 570, 897 A.2d 1034. Because of the negligent maintenance and operation of the truck, a horrific roadway accident occurred, killing and maiming several people. Id. at 568, 897 A.2d 1034. The truck had no insurance identification card and an expired registration, and therefore the trucker had no right to be on the road. Id. at 569, 897 A.2d 1034. In short, the trucker was “incompetent” to haul the company’s waste.
We held that “a company whose core purpose is the collection and transportation of materials on the highways, has a duty to use reasonable care in the hiring of an independent trueker[,] including a duty to make an inquiry into that trucker’s ability to travel legally on the highways.” Id. at 579-80, 897 A.2d 1034. After hiring the trucker, the company had a continuing duty to make a reasonable inquiry into whether the trucker had liability insurance and a valid registration — the essential qualifications to be on the road. Id. at 580-81, 897 A.2d 1034. We concluded that if the *82company knew or should have known of the trucker’s incompetence, the company then would be vicariously liable for the trucker’s negligence. Id. at 580, 897 A.2d 1034.
Likewise, as of March 19, 1998, the effective date of the statute requiring physicians to carry medical malpractice insurance, Dr. Wolf was an incompetent contractor who no longer possessed an essential qualification to practice medicine. Although Dr. Wolf first saw Basil in January 1998, before the statute’s start date, he continued to treat Basil through February 1999. As in Puckrein, the carrier here had a continuing duty to inquire whether the physicians it retained to furnish treatment or to conduct independent medical examinations of injured workers maintained statutorily-mandated malpractice insurance in accordance with N.J.S.A 45:9-19.17. That statute provided:
A physician who maintains a professional medical practice in this State and has responsibility for patient care is required to be covered by medical malpractice liability insurance, or if such liability coverage is not available, by a letter of credit for the minimum amount required by the State Board of Medical Examiners. [N.J.S.A 45:9-19.17(a) (emphasis added).] 2
The statute was enacted on January 19, 1998 and went into effect on March 19, 1998. See L. 1997, c. 365, § 3. It mandated that the State Board of Medical Examiners notify all licensed physicians of the statute’s requirements within thirty days of the date of the statute’s enactment — by February 18, 1998. N.J.S.A. 45:9-19.17(d). Accordingly, on March 19, 1998, Dr. Wolf and all other licensed physicians in New Jersey were required to have medical malpractice insurance. By April 9, 1998, Dr. Wolf was required to advise the Board of Medical Examiners that he had acquired medical malpractice insurance. N.J.S.A. 45:9-19.7.3 3
*83The majority concedes that a physician who conducts an independent medical examination “maintains a professional medical practice” for purposes of N.J.S.A. 45:9-19.17 and therefore is required to carry malpractice insurance. On the other hand, the majority, astonishingly, claims that N.J.S.A. 45:9-19.17 did not become effective on March 19, 1998, as decreed by the Legislature, see L. 1997, c. 365, § 3, but rather on April 5,1999, when the State Board of Medical Examiners promulgated regulations defining certain terms of the statute, see 31 N.J.R. 881(a) (Apr. 5,1999) (codified at N.J.A.C. 13:35-6.18). There is no support for that claim in the legislation. The Legislature did not cede to the State Board of Medical Examiners, an executive branch agency, the power to undo the effective date of the statute.
Moreover, nothing in N.J.S.A 45:9-19.17 indicates the need for the promulgation of regulations to trigger the statute’s insurance coverage requirement or for the Medical Board to define the statute’s terms. The majority, nonetheless, suggests that before the Board’s adoption of its regulations, the statutory words, “maintains a professional medical practice in this State,” essentially had no meaning. I disagree. Had the Medical Board never promulgated a regulation, we would give those words their plain meaning, and if those words were susceptible to ambiguity, we would then attempt to divine the Legislature’s intent through other traditional methods of statutory interpretation. See DiProspero v. Penn, 183 N.J. 477, 492-93, 874 A.2d 1039 (2005). The suggestion that N.J.S.A. 45:9-19.17 was a nullity until the Board promulgated a regulation has no basis in the statute itself or our law in general. See Smith v. Dir., Div. of Taxation, 108 N.J. 19, 26, 527 A.2d 843 (1987) (noting that “administrative regulations are not binding on the courts and a regulation will fall if a court finds that the rule is inconsistent with the statute it purports to interpret”); Kingsley v. Hawthorne Fabrics, Inc., 41 *84N.J. 521, 528, 197 A.2d 673 (1964) (“An administrative agency may not ... give [a] statute any greater effect than its language allows.”).
B.
Another exception to the rule that a principal will not be held liable for the negligence of an independent contractor is when the principal exercises or retains control over the contractor’s performance. Majestic Realty, supra, 30 N.J. at 431, 153 A.2d 321. Generally, a principal “who hires an independent contractor ‘has no right of control over the manner in which the work is to be done,’ ” and therefore is not vicariously liable for the contractor’s negligence. Baldasarre, supra, 132 N.J. at 291, 625 A.2d 458 (quoting W. Page Keeton et al., Prosser and Keeton on the Law of Torts § 71 (5th ed. 1984)). However, when a principal directs or exercises control over the very manner in which the contractor performs his work, the principal loses any immunity from liability for the contractor’s negligence. See Mavrikidis, supra, 153 N.J. at 134-35, 707 A.2d 977 (noting that “the reservation of control of the manner and means of the contracted work by the principal permits the imposition of vicarious liability” (quotation omitted)). Although a principal may exercise broad supervisory power to ensure that the independent contractor is carrying out his responsibilities, the principal may not direct the means by which the contractor fulfils those responsibilities and still argue that it is not vicariously liable for the contractor’s negligence. See Majestic Realty, supra, 30 N.J. at 431, 153 A.2d 321.
Here, viewing the evidence in the light most favorable to plaintiff, Transportation Insurance Company not only exercised control over the means by which Dr. Wolf discharged his medical duties, but Dr. Wolf surrendered his independent medical judgment to the authority of the carrier. The extent of the carrier’s involvement in the treatment of Basil permits the inference that the carrier itself was practicing medicine. As noted earlier, Dr. Wolf sent the physical therapy prescription to the carrier. In*85stead of seeking approval from the carrier for the diagnostic tests that were necessary, Dr. Wolf consulted with the carrier as though he were seeking its input for medical decisions that fell within his exclusive province. So, for example, Dr. Wolf suggested that a chest x-ray “would be the logical first step” — he did not seek authorization for one. Consequently, months of foot-dragging passed before so simple but critical a test was performed. Additionally, instead of asking the carrier to authorize a medieally-necessary MRI after discovery of a golf-ball-sized growth in Basil’s chest, Dr. Wolf obligingly asked the carrier to “consider[ ]” an MRI. The carrier’s own imprudent micromanagement of and control over Basil’s medical care does not permit it to hide behind the immunity shield that ordinarily would protect a principal from the negligent acts of its independent contractor.
In light of the most favorable evidence and inferences supporting plaintiffs ease, the majority erred in affirming the dismissal of the claims of Basil’s widow.
IV.
In summary, Mrs. Basil’s case should proceed to a jury, which has the responsibility for deciding contested facts. At this stage, Mrs. Bash has presented sufficient evidence, if believed by a jury, to hold Transportation Insurance Company vicariously liable for the death of her husband. Dr. Wolfs failure to carry malpractice insurance made him an incompetent contractor, and the carrier had a continuing duty to inquire whether Dr. Wolf maintained medical malpractice insurance as required by N.J.S.A. 45:9-19.17. Moreover, the carrier controlled and directed the very manner in which Dr. Wolf provided medical services to Basil.
I concur with the majority that Mrs. Basil was not barred by the Workers Compensation Act from bringing a direct action against Dr. Wolf. For the reasons expressed, however, I would reverse the Appellate Division and reinstate Mrs. Basil’s claims against the carrier for the death of her husband. I therefore respectfully concur in part and dissent in part.
*86For affirmance — Justices LaVECCHIA, WALLACE, RIVERA-SOTO and HOENS — 4.
Concurring in part; dissenting in part — Justice ALBIN — 1.

 Basil continued his treatments with the chiropractor at his own expense.

 N.J.S.A. 45:9-19.17(b) states that "[a] physician who is in violation of this section is subject to disciplinary action and civil penalties.. . ” Presumably, the State Board of Medical Examiners would not permit a physician, who refused to comply with the statute by procuring malpractice insurance, to practice medicine.

 N.J.S.A. 45:9-19.7 requires all physicians to provide certain information in their biennial applications for relicensing, such as the name and address of their *83medical malpractice insurers. Physicians are also required to inform the Board of Medical Examiners of any change to that information within twenty-one days. Ibid.