Court Opinion

ID: 9706809
Source: CourtListenerOpinion
Date Created: 2023-08-26 01:52:09.681721+00
Date Added: 2024-06-11T18:22:25.255397
License: Public Domain

POLLOCK, J.,
dissenting.
The Division of Workers’ Compensation (the Division) dismissed the petition of petitioner, Lodean Sheffield, because she had failed to file for workers’ compensation benefits within two years after she first “knew of the disability and its relation to the employment.” N.J.S.A. 34:15-34. In affirming the dismissal, the Appellate Division succinctly summarized the findings of the Division.
The Division judge held that petitioner sustained orthopedic and neurological disabilities arising out of her employment with Schering, but that her claims for such injuries and disabilities were barred by the two-year statute of limitations. N.J.S.A 84:16-41; N.J.S.A 34:15-51 and N.J.S.A 34:15-34. The judge found that petitioner had “sufficient awareness to have known or should have known that she had a compensable condition that may have arisen out of her employment” in 1983 and that since the claim petitions were not filed until February 1989, more than two years thereafter, they were time-barred. The judge further held that petitioner’s alleged gastrointestinal problems were not compensable because no real disability existed and that even if there were a gastrointestinal disability, it would not be compensable because it flowed from petitioner’s back injury, which was barred by the two-year statute of limitations. Finally, the judge held that petitioner’s hypertension was not related to her employment with Schering and that she failed to sustain her burden of proving that her pulmonary and internal *463conditions and disabilities were causally related to her employment. The judge, therefore, dismissed petitioner’s claim petitions against Schering and its workers’ compensation carriers, respondents Travelers Insurance Company (Travelers) and Liberty Mutual Insurance Company, and her petition for Second Injury Fund Benefits.
After carefully considering the record, the Appellate Division concluded that the judge’s findings were supported by substantial credible evidence in the record. Bradley v. Henry Townsend Moving & Storage Co., 78 N.J. 532, 534, 397 A.2d 323 (1979). I agree.
Because of the importance of the judge’s findings, I include the part that pertains to the timeliness of the filing of petitioner’s claim:
A very serious issue involved is the affirmative defense of Statute of Limitations. Petitioner has two years under the Workers’ Compensation Statute to file from when she knew or should have known she had a compensable accident related to her employment.
The files indicate that Petitioner had been treated for her lower back since 1979. The petitioner testified in around 1980 [that] she actively lifted and felt pain in her lower back. The petitioner testified that her back was aching and causing her problems when she was bending and lifting packages.
In the 1983 hospital record, the petitioner specifically stated or gave the history of her back problem caused by her work at Schering Plough. Petitioner also complained to Prudential Insurance Company, the company’s private plan, that her back condition was caused by her work. As a result of that, Prudential sent her a letter indicating that they were not going to pay any further benefits, and she would have to look to Workers’ Compensation. Mrs. Androtti, of the long-term disability department, told her that if she had intended to get benefits from Prudential, she should not push the idea to Prudential that she was hurt at work.
Now, all this showed a definite distinction between Workers’ Compensation and other benefits. This is not a situation where the company was paying long-term disability and medical benefits, and therefore lulling the petitioner into a false sense of security that she was receiving Workers’ Compensation Benefits.
Petitioner was aware she hurt herself at work. She took the position that she could not say that she hurt herself at work if she continued to receive her current benefits, she was thus made aware between the distinction of Workers’ Compensation Benefits and long-term disability benefits____
It is petitioner’s position that she was not aware of Workers’ Compensation and she was lulled in the false sense of security. Petitioner’s attorney alleges that respondent took a step to advise her on her right and did not inform her of Workers’ Compensation benefits.
*464The respondent has [a] long-term disability benefits department and the petitioner has been receiving long-term disability benefits to the present. The payment of her long-term disability benefits, which she would be entitled to under her employment contract, and by making sure she received the medical benefits she was entitled to, does not put the respondent in the position of being her legal advisor or her representative. It is clear from Ms. Androtti’s testimony that she advised [petitioner] as far as long-term disability, it was not her business to advise her of Workers’ Compensation.
The decision of whether [sic] petitioner is entitled to by the company of [sic] Workers’ Compensation resided in the Health Benefits Department. The decision made by the Health Benefits Department was that petitioner was not entitled to Workers’ Compensation. Her benefits fell under long-term disability.
Whether or not that turns out to be a correct assessment is really immaterial. They made a conscious effort to decide about Workers’ Compensation, they did not mislead petitioner. I do not think that they have an affirmative duty to sit her down and talk to her about the possibilities of Workers’ Compensation. They are not her lawyers and the fact that they sit her down and advise her of other benefits and private benefits she’s entitled to does not make them her overall Counselors for any possible suits against the company.
Furthermore, I don’t see any attempt to defraud the petitioner. The respondent, based on the information that [s]he had, could very well have come to the conclusion that there was no compensation case and there was no particular accident. Petitioner was complaining about her back at least since 1979 and had definite diagnosis of a lower back condition in 1980.
The petitioner did say, in her hospitalization in 1983, that it happened at work and they were aware that there were problems in bending and lifting. That, in and of itself, did not make clear that there was a Workers’ Compensation suit. An attorney [Jacob Balk] who saw her [regarding] Social Security and had a good percent of his practice dealing with Workers’ Compensation had all her medical records to send in to the Social Security Division. Apparently, based on his file, he did not see a connection of Workers’ Compensation Benefits or work-related injury.
Again, whether that was a correct assessment or incorrect assessment, it certainly could have been a reasonable assessment under the circumstances.
Based on the testimony of the petitioner in 1991, the court could take the position that her back condition was aggravated, accelerated and exacerbated by her work, this was after a trial with doctors testifying in which this assessment could be made. The company’s position was not, therefore, unreasonable.
Furthermore, it is really not what is in the company’s mind as to knowledge and notice of a possible work-connected accident. The statute of limitations begins to run when the petitioner knew or should have known of a work-related accident occurring or a compensable condition occurring out of her employment.
Petitioner gave a history in the hospital record of 1983 that the work was related to her back problems. She was told by the company that if she persisted in stating her back problems occurred out of the work, that she would not be able to receive money from Prudential Insurance Company. There was a distinction being made there.
*465It is clear to me that she had a sufficient awareness to have known or should have known that she had a compensable condition that may have risen out of the employment.
As the record reveals, petitioner elected to receive payments from respondent’s private-plan medical insurers, Prudential and John Hancock. Respondent’s long-term disability insurer, Travelers, paid her disability benefits. Respondent’s workers’ compensation carriers, originally Liberty Mutual and later Travelers, made no payments. The reason is that petitioner did not seek to recover workers’ compensation from respondent until after she had already received the medical and disability benefits under other policies.
On these facts, the majority holds “that the private-plan disability and medical benefits provided to Sheffield pursuant to Sehering’s scheme of compensation of disabled employees constituted payments of compensation within the meaning of N.J.S.A. 34:15-34.” Ante at 458, 680 A.2d at 758. To reach that result, the majority ignores the finding of the workers’ compensation judge that Sheffield knew the difference between workers’ compensation benefits and the private plan benefits. It also ignores the judge’s findings that Sheffield accepted payments under the latter plans and that Sehering did not mislead Sheffield regarding the availability of workers’ compensation benefits.
The essential facts are that the employer subscribed to private medical and disability plans, and that the employee knew the differences between recovery under those plans and under workers’ compensation. Further, the employee decided to pursue payments under the private plans, not under workers’ compensation. Nonetheless, the majority states that “the precise source of the payment is irrelevant. What is critical is that the payment to the injured employee could have been compelled under the Act to compensate that employee for the work-related injury.” Ante at 459, 680 A.2d at 759. In so finding, the majority has transformed payments under private health and disability plans into payments under a workers’ compensation plan, with the result that the payments under the private plans toll the time of an employee to *466file a workers’ compensation claim, notwithstanding the employee’s original decision not to seek workers’ compensation.
The majority relies on Dunay v. International Smelting and Refining Co., 60 N.J.Super. 546, 160 A.2d 80 (Law Div.1960), to support its broad ruling that payment of private medical benefits tolls the statute of limitations on a workers’ compensation claim. Dunay is distinguishable on its facts. The claimant in that case did not know whether his benefits came from the employer’s workers’ compensation insurance carrier or a private employee benefit association, “which appeared to the workman as a company project and not as an independent entity.” Id. at 551, 160 A.2d 80. The court found that “[t]his arrangement certainly has the effect of lulling the employee into a false assumption of security.” Id. at 552, 160 A.2d 80. Thus, Dunay stands as an exception to the two-year statute of limitations, because the employer misled the employee to believe he was receiving compensation. The case hardly supports such a broad ruling as the majority contends.
By contrast, in this case, petitioner knew that she was receiving medical benefits under respondent’s private plan to which she made co-payments, and not under respondent’s workers’ compensation plan.
To support its new rule, the majority also overreads our recent affirmance of the Appellate Division decision in Milos v. Exxon, Co., USA 143 N.J. 333, 671 A.2d 120 (1996), aff'g p.c.o.b. 281 N.J.Super. 194, 656 A.2d 1300 (App.Div.1995). In that case, Exxon instituted the Exxon Surveillance Program pursuant to a collective bargaining agreement with the employee’s union, 281 N.J.Super. at 197, 656 A.2d 1300, to counter the unique problems with diagnosing and tracking asbestos-related diseases, which often do not develop or progress until years after exposure. The employee previously had received payments under workers’ compensation for disability due to asbestos exposure. Id. To the extent that the employee was already diagnosed with a work-related pulmonary disability and had received benefits, his annual *467monitoring examinations under the program constituted continued compensation by the employer and tolled the statute of limitations on the employee’s application for a reopener. Id. at 200, 656 A.2d 1300.
The majority reads Milos to support its contention that any private benefits paid to an employee for an injury for which the employer has not conceded responsibility nevertheless tolls the limitations period on a workers’ compensation claim, even if the employee knew her injury was work-related and selected private insurance benefits. That interpretation expands the ruling in Milos far beyond the limits of that ease. Moreover, that interpretation unnecessarily extends the statute of limitations beyond the two years contemplated by the Legislature for ordinary cases such as Sheffield’s.
If respondent’s workers’ compensation carrier had paid petitioner medical expenses, the majority’s result would be correct. “The furnishing of medical benefits is held to extend the claim period on the theory that the furnishing of any kind of benefit required by compensation law indicates to the employee an acceptance by the employer of liability for the injury.” De Asio v. Bayonne, 62 N.J.Super. 232, 236, 162 A.2d 596 (App.Div.1960). To hold, however, that payments under a private medical or disability plan toll the time for filing a workers’ compensation petition is extraordinary. See 2B Larson, supra, § 78.43(1), at 15-279. I can find no case — and the majority cites none — tolling the period of limitations for filing a compensation claim on facts similar to this case. Those facts include an employee who, knowing the difference between workers’ compensation benefits and private medical and disability benefits, elected and accepted the private benefits. Those facts also include an employer who, in paying the private benefits, did not acknowledge liability in workers’ compensation.
In an era when the role of employers in the delivery of health care is increasingly important, the majority opinion gives employers a disincentive to provide their employees with medical and disability benefits. Under the majority holding, an employer, by *468directly or indirectly paying an employee private medical or disability benefits, tolls the running of the statute of limitations on a workers’ compensation claim. The practice could discourage employers from buying health insurance to pay medical and disability benefits for employees. It also extends the employer’s exposure for liability in workers’ compensation beyond the period contemplated by the Legislature. I would affirm.
For reversal in part; for affirmance in part — Justices HANDLER, O’HERN, STEIN and COLEMAN — 4..
For affirmance — Justice POLLOCK — 1.