On December 19, 2013, the Appellate Division, in a published decision, Natalie Bellino, Petitioner-Respondent v. Verizon Wireless, Respondent-Appellant, set for the most current interpretation of the workers’ compensation anti-fraud statute under N.J.S.A. 34:15-57.4.
The statute permits Workers’ Compensation Judge the ability to dismiss a claim if there is “false or misleading statement, representation or submission concerning any fact that is material to that claim for the purposes of wrongfully obtaining benefits”. Insurance companies use that provision when claimants fail to indicate to treating doctors or examining doctors prior medical conditions that are relevant to the workers’ compensation jury.
The Bellino case stands for the proposition that in order for that statute to be invoked and to have the remedy to dismiss the claim, the respondent or insurance company must prove that the fraudulent statement was made with a conscious objective to obtain benefits to which one knows that he/she is not entitled to or an awareness that the intentional falsehood would cause a desire to result to fraudulently obtaining benefits.
The Appellate Division has put the burden on the insurance company to show that the worker knew that the statement was false, was material to obtaining the benefit and made the statement falsely to obtain benefits for which the worker was not entitled to.
This case goes a long way in clarifying what happens when the workers’ compensation claimant forgets to tell an evaluating doctor of an old injury or old condition. The insurance company cannot use that to deny benefits to the claimant.
The Supreme Court of New Jersey in a case decided on April 11, 2014, in the matter of Cheryl Hersh v. County of Morris, modified the current law as it relates to accidents which occur off of the work premises.
The Supreme Court held that where the employer provided parking in a parking garage, some two blocks from the workplace and an injury occurs on a public street to the claimant who was walking those two blocks to the office, that is not compensable nor does it arise out of the course of employment because the workers’ compensation claimant was told to park in a designated lot, off premises.
The Supreme Court modified the existing law that was in existence since 1989 where a designated parking lot which was provided to the employee, was deemed to be part of the employer’s premises for the purposes of workers’ compensation. That has now changed. If an employee is injured off of the workplace site, the test is whether or not the employer had control of the property on which the accident occurred. In the Hersh case it was a public street and the employer had no control and therefore it was not compensable.
Compensation claims have generally been recognized when the employee arrives at the employer’s place of employment and reports to work. There are certain exceptions and in 1989 an exception was created by the Appellate Division where an employee parked in the mall parking lot in a designated spot directed by his employer and was struck by another car as he walked to the employer’s store in the mall while in the garage. In the 1989 Livingstone v. Abraham & Strauss, Inc., the Appellate Division allowed workers’ compensation and deemed the site of the injury to be on the employer’s premises because the employee was directed to park in that particular area by the employer. That has changed to some degree and the issue is not going to be one of control over the premises.