What’s Hot in Workers’ Comp - News and Results*

NEWS

On February 18, 2025, the New Jersey Law Journal published David Levine’s (Roseland, NJ) article “Navigating Preexisting Conditions in New Jersey Workers’ Compensation Claims.” Read his article here.

On February 12, 2025, Michele Punturi (Philadelphia, PA) participated in a panel at CLM 2025 Focus Conference: Work Comp, Casualty and Risk Management in Lake Buena Vista, FL. on “Workers’ Comp Risk Management Best Practices: Insights from High Risk Industries.”
 

RESULTS*

Linda Wagner Farrell (Jacksonville, FL)

• successfully contested a claimant’s request for authorization for a van equipped with a wheelchair lift, arguing its medical necessity following a severe work-related injury. Testimony revealed the claimant’s significant mobility challenges were due to a work-related traumatic brain injury and spastic hemiplegia. However, the employer/carrier contested the request, asserting it was neither reasonable nor medically necessary based on the authorized treating physician’s assessment. Ultimately, the judge of compensation claims found the claimant did not meet the burden of proof to establish the necessity of the van, siding with the employer/carrier’s argument, and denied the authorization request along with the claims for attorney’s fees and costs.

Tony Natale (King of Prussia, PA)

• successfully prosecuted a termination petition involving a Medicare beneficiary who sustained various traumatic injuries, including a knee tear, as a result of being struck and dragged by a golf cart. The carrier accepted the traumatic injuries at issue. The claimant argued he also sustained an aggravation of pre-existing degenerative osteoarthritis as part of his defense to the termination petition. This became a crucial issue in the case as the carrier did not accept the osteoarthritic condition and Medicare had been paying the medical expenses for that condition. A conditional lien from CMS would be the result of an unsuccessful termination petition. After extensive medical evidence was presented, the court ruled in favor of a full recovery and found no work-related osteoarthritis. This was a complete defense verdict. 
• successfully defended a Medicare conditional lien request. The underlying claim involved an injury sustained in a motor vehicle accident with payments being made to the claimant under a New Jersey PIP Policy. The carrier exhausted the PIP policy following the injury. Medicare also paid significant medical bills for the claimant and demanded through CMS that the carrier reimburse all payments made as a conditional lien request. CMS, through their many contractors, threatened legal action with double damages if the lien was not satisfied. The carrier appealed the lien request through two levels of CMS contactors with no success. Tony formulated a third level appeal to an administrative law judge, arguing that CMS’s request for additional liens violated state PIP policy law and the carrier’s constitutional rights. Evidence presented showed the PIP policy had been exhausted and, thus, the carrier reverted back to a secondary payer, forcing Medicare/CMS as the primary payer under federal law. The court agreed, and a full defense verdict was issued. 
• successfully defended a Claim Petition involving an alleged a low back injury with radiculopathy as a result of pushing a cart at work. The carrier accepted a strain injury with limited disability, leading to the claimant filing a Claim Petition for ongoing disability and medical benefits for an aggravation of a disc herniation. Tony presented a board certified orthopedic surgeon with a significant surgical practice who offered opinions that, at most, a strain injury occurred, which fully recovered. The court accepted the carrier’s expert witness, limited the work injury to a strain and found the claimant fully recovered. No additional medical or disability benefits were payable, resulting in a complete defense verdict on the issues. 
• successfully defended a Fee Review involving PRP injection therapy. The claimant sustained a shoulder injury and the workers’ compensation claim was ultimately settled. After settlement, a provider alleged substantial medical bills related to the injury (generated prior to the date of settlement) were not paid. The bills first alluded to neck treatment, as opposed to shoulder treatment. The carrier produced evidence that any shoulder bills were already paid. The case continued on the issue of additional bills which appeared to be neck-related, not shoulder-related. After many hearings, Tony successfully had the provider’s application for fee review dismissed for failure to prosecute and/or produce evidence that could be used to support an award. 
• successfully prosecuted a termination petition involving accepted contusion and strain injuries to various body parts, including the claimant’s knee. The claimant was a Medicare beneficiary and a Veterans Administration beneficiary. During the post-injury treatment process, the claimant underwent total knee replacement surgery. The bills were paid by the Veterans Administration (which has similar rights to Medicare in assessing conditional liens). Tony alleged that all work-related injuries had recovered and that the total knee replacement surgery was not work related. The crux of the medical presentation was predicated upon two years of VA Hospital records documenting the claimant’s need for (and the scheduling of) total knee replacement surgery before the date of the work injury. The court granted the employer’s termination petition and found the claimant submitted no evidence that would allow the court to expand the nature of injury to include the total knee replacement surgery costs. 

*Prior Results Do Not Guarantee a Similar Outcome 

_{What’s Hot in Workers’ Comp, Vol. 29, No. 3, March 2025, is prepared by Marshall Dennehey to provide information on recent legal developments of interest to our readers. This publication is not intended to provide legal advice for a specific situation or to create an attorney-client relationship. We would be pleased to provide such legal assistance as you require on these and other subjects when called upon. ATTORNEY ADVERTISING pursuant to New York RPC 7.1 Copyright © 2025 Marshall Dennehey, all rights reserved. No part of this publication may be reprinted without the express written permission of our firm. For reprints or inquiries, or if you wish to be removed from this mailing list, contact tamontemuro@mdwcg.com.}