The Importance of Investigating a Petitioner’s Medical History and How It Can Help Employers Save Money

Upon the filing of a New Jersey workers’ compensation claim petition, it is extremely important to thoroughly investigate the history of the alleged injured worker to ensure you attain the best possible outcome and to prevent unnecessary expenses. This is a relatively well-known strategy.  However, in a rush to close or settle a matter, this strategy can sometimes be overlooked, which can result in significant costs to an employer.

In a recent unpublished opinion by the New Jersey Appellate Division, the appellate court affirmed the decision of the New Jersey Workers’ Compensation Court, which dismissed a petitioner’s Application for Review or Modification of Formal Award (or reopener claim), alleging a worsening of symptoms and increase in disability, and also dismissed the Second Injury Fund. See Camarena v. Sprint PCS, A-2205-17T2 (App. Div. June 24, 2019). In its analysis of the case, the appellate court relied heavily on medical records acquired by the respondent to support its affirmation of the lower court’s decision, which ultimately saved the employer a substantial amount of money.

In the Camerena matter, the petitioner suffered injuries to her lumbar and cervical spine after she was involved in a work-related automobile accident in 1999. On March 21, 2003, an Order Approving Settlement was entered and awarded the petitioner 30 percent of partial total. In 2005, the petitioner filed a reopener claim alleging that her injuries had worsened since the initial award. Specifically, the petitioner complained of pain and discomfort to the right side of her body and attempted to seek total and permanent disability benefits by bringing in the Second Injury Fund.

This matter was tried in the workers’ compensation court before the Honorable George H. Gangloff, Jr. To help bolster its position that the petitioner’s increased disability was not related to the 1999 work accident, the respondent obtained voluminous records, which revealed that the petitioner was involved in subsequent accidents since her 1999 work accident, including a 2002 motor vehicle accident. While the petitioner testified that her 2002 accident only involved injuries to her right knee, the records contradicted her testimony and uncovered that she also complained of and subsequently received treatment to her lower back and neck. Additional records also revealed that the petitioner had fallen 28 times between the 1999 accident and May 2015, resulting in increased neck and back pain.  Moreover, the records revealed that the petitioner underwent surgery and received epidural injections to her lower back. Although the petitioner’s expert testified that he believed the petitioner to be totally disabled and unable to work after examining her, he admitted that he was unaware that the petitioner’s 2002 motor vehicle accident resulted in injuries to other body parts. In the end, Judge Gangloff relied on the medical evidence and dismissed the petitioner’s reopener claim against the respondent and the Second Injury Fund.

Following the dismissal, the petitioner filed an appeal. Neither the petitioner nor the respondent disputed the fact that the petitioner suffered an increased disability. Instead, the crux of the appeal concerned the actual cause of the petitioner’s worsened condition.

Ultimately, the appellate court affirmed the decision of the lower court. In its opinion, the appellate court held that Judge Gangloff “made detailed findings of fact after his careful and thorough review of the medical records [and] [r]elying on his own knowledge of the petitioner’s medical history . . . rejected the testimony of petitioner’s orthopedic expert because that individual knew so little about the 2002 accident and the 2004 fall.” It also held that the petitioner’s 2002 motor vehicle accidents and numerous falls were clearly intervening independent causes, which broke the chain of causation from the petitioner’s 1999 work accident to present.

This case is a prime example of why it is so important to thoroughly investigate the medical history of any petitioner who files a workers’ compensation claim. While doing so can oftentimes be tedious and time consuming, it can help save employers a great deal of money and, in some matters, help obtain dismissals of meritless cases.

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