Lessons from Daniel

On August 2, 2016, the Appellate Division upheld a Judge of Compensation’s denial of a petitioner’s motion for medical treatment and temporary disability benefits. In upholding the Division’s decision, the Appellate Division agreed that the petitioner had not met his burden of proof that the need for surgery arose from and was causally connected with the same trauma complained of in the original claim petition. Daniel v. United Arlines, No. A-1252-14T3 (App. Div. August 2016).

The petitioner in Daniel sustained a compensable accident in November of 2006, resulting in an initial award of 22.5 percent of partial total for residuals of sprain and strain of the cervical spine with herniation, radiculopathy and multiple bulges in the cervical spine on December 6, 2007. On November 22, 2010, the petitioner received an award of 30 percent of partial total less 22.5 percent of partial total for sprain and strain with labral tear of the right shoulder, and sprain and strain of the neck.

On October 12, 2012, the petitioner filed a second reopener claim petition. Thereafter, a motion for medical and temporary benefits was filed for treatment to the shoulder. Both experts agreed the petitioner required surgical repair, but respondent argued that the need for surgery was related to a new condition, bursitis, not the underlying compensable shoulder injury. The Judge of Compensation agreed with respondent because it found no credible evidence relating to petitioner’s current complaint and the need for surgery to the original accident. The judge also found that the majority of petitioner’s current complaint would not be relieved by the treatment requested. In reaching this conclusion, the Judge of Compensation relied on the defense’s expert, whom the judge deemed more credible, as the defense’s expert provided sound basis for his diagnosis by utilizing diagnostic testing, while petitioner’s expert relied on petitioner’s subjective complaints and the treating doctor’s reports. The Appellate Division found that the Judge of Compensation did not err in her findings.

However, aside from reiterating that a petitioner has the burden of proving requested treatment is causally related to an underlying compensable injury and showing that the requested treatment would provide relief, the Appellate Division also discussed the more wrinkled issue of whether the denial of a motion for medical and temporary benefits is tantamount to the denial of a reopener claim petition.

The Appellate Division indicated that the denial of a motion in a reopener claim does not obviate respondent’s liability of the overall claim. Rather, the court distinguished between the motion for treatment specifically for the petitioner’s shoulder and the reopener claim petition, based on an increased incapacity caused by compensable injuries to the petitioner’s cervical spine and shoulder. This point, briefly addressed by the court, suggests that a Judge of Compensation must undertake an additional analysis to dispose of a reopener claim petition in situations when a motion for medical and temporary benefit, is denied because the denial of one does not automatically dispose the other.

This additional analysis was autonomously undertaken by the Judge of Compensation in Crawley v. Kazi Foods, (Claim Petition No. 2009-11649, September 15, 2015). Here, the petitioner sustained a compensable injury to the right knee on April 30, 2009. The petitioner received an initial award of 22.5 percent of the statutory leg on December 14, 2011 for post right knee arthroscopy, resection hypertrophic medial plica and partial medial mensiscus, as well as residual of a contusion, strain and surgical intervention of the right knee. On August 16, 2013, the petitioner filed a reopener claim petition. On August 11, 2014, the petitioner filed a motion for medical and temporary benefits. Eventually, the petitioner was indicated for additional treatment to the right knee by way of surgery. The authorized treating physician and petitioner’s expert agreed that the petitioner required surgery. The experts also agreed that the need for surgery was related to the petitioner’s pre-existing arthritic condition, which had progressed since the entry of the initial award. However, the treating physician specifically indicated that the progression of the petitioner’s arthritis was unrelated to the compensable injury.

Deciding that the authorized physician was more credible, the judge denied petitioner’s motion because she failed to establish a causal connection between the work related injury and increase in symptoms. The judge further held that respondent proved that the increase in symptoms was related to the natural progression of age, and other factors, and not an exacerbation, aggravation or acceleration of the pre-existing condition. Concluding that the petitioner failed to establish the causal connection to the pre-existing condition and that there was no other objective medical evidence to show an increase of the work related injury, the judge dismissed the case in its entirety, with prejudice.

The noticeable differences in the Daniel and Crawley are that Daniel involved injuries to multiple body parts while Crawley involved injury to one body part. Additionally, Daniel involved a development of a new condition or an “intervening accident or condition,” as described by the Appellate Division, while Crawley involved a progression of a pre-existing condition. Further, the judge in Daniel limited her analysis to the motion before her while the judge in Crawley continued his analysis to consider whether the reopener claim petition remains viable even with the denial of the motion. Finding no other objective medical evidence to show an increase of the work related injury other than the progressed pre-existing arthritis, the Crawley judge dismissed the case in its entirety.

The lesson, thus, here for respondents is to be on the lookout for cases where it would be appropriate for a judge of compensation to undertake the additional analysis discussed by the Appellate Division in Daniel. Going this extra step may result in an outright dismissal of a pending claim petition, which will of course translate into victories for clients in courtrooms and boardrooms.

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