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PIP Carrier’s Claim Petition Is Rejected for Failure to Show Work Connection

By on April 22, 2015 in Compensability with 0 Comments

What can a PIP carrier do when it believes the bills it has paid arise from a workers’ compensation case but the injured party has never filed a claim?  In New Jersey, the PIP carrier has a right to file a workers’ compensation claim petition in the name of the injured worker, but there is a catch:  the PIP carrier is subject to the same defenses that the injured worker would be subject to.

In High Point Insurance Company (as subrogor of Kevin Smith) v. Drexel University, A-2030-13T4 (App. Div. April 17, 2015), High Point Insurance paid personal injury protection benefits for injuries suffered by Kevin Smith, a Ph.D. student and Teaching Assistant at Drexel University.  On September 2, 2011, Smith drove a Drexel University vehicle to a site in the Pine Barrens in New Jersey to conduct research for his graduate dissertation.  While driving back to Drexel University, Smith was injured in a car accident.

High Point sought reimbursement of the PIP benefits it paid to Smith by filing a claim petition in the Division of Workers’ Compensation.  Smith himself never filed a claim petition on his own behalf.  Drexel University answered the claim petition with a denial.

The Judge of Compensation observed that the Ph.D. program Smith was enrolled in at Drexel did not require that he work as a Teaching Assistant.  Smith decided to accept that position in an attempt to offset the cost of the Ph.D. program.  The Judge felt that Smith was using the Drexel vehicle to reach the Pine Barrens for his own personal research, not in his role as a Teaching Assistant.  The Judge also noted that there were no classes in session the week of the accident. Judge of Compensation dismissed the workers’ compensation claim petition commenting that High Point never proved any requirement that Smith travel to the Pine Barrens for his work.

On appeal, High Point argued that Drexel “entwined” Smith’s personal graduate studies and teaching assignments to a degree that traveling for his research became work related.  The Appellate Division rejected High Point’s reasoning and held that there was no connection between the accident and Smith’s employment.

The case illustrates a number of interesting procedural points.  The New Jersey Division of Workers’ Compensation is open to a variety of claims by PIP carriers.  A PIP carrier can intervene in an existing litigated claim in the Division of Workers’ Compensation for reimbursement of benefits the carrier has paid.  In addition, the carrier can also file a claim petition in the name of the injured party, even if there is no existing claim petition.  Getting cooperation from the injured party can sometimes prove difficult, but in this case Smith agreed to cooperate and testified.  The problem which High Point had was that it could not show that driving the Drexel vehicle was related to the Teaching Assistant job.  It was more of a personal mission related to Smith’s research for his Ph.D.

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About the Author

About the Author:

John H. Geaney, a shareholder and co-chair of Capehart Scatchard's Workers' Compensation department, began an email newsletter entitled Currents in Workers’ Compensation, ADA and FMLA in 2001 in order to keep clients and readers informed on leading developments in these three areas of law. Since that time he has written over 500 newsletter updates.

Mr. Geaney is the author of Geaney’s New Jersey Workers’ Compensation Manual for Practitioners, Adjusters & Employers. The manual is distributed by the New Jersey Institute for Continuing Legal Education (NJICLE). He also authored an ADA and FMLA manual as distributed by NJICLE. If you are interested in purchasing the manual, please contact NJICLE at 732-214-8500 or visit their website at www.njicle.com.

Mr. Geaney represents employers in the defense of workers’ compensation, ADA and FMLA matters. He is a Fellow of the College of Workers’ Compensation Lawyers of the American Bar Association and is certified by the Supreme Court of New Jersey as a workers’ compensation law attorney. He is one of two firm representatives to the National Workers’ Compensation Defense Network. He has served on the Executive Committee of Capehart Scatchard for over ten (10) years.

A graduate of Holy Cross College summa cum laude, Mr. Geaney obtained his law degree from Boston College Law School. He has been named a “Super Lawyer” by his peers and Law and Politics. He serves as Vice President of the Friends of MEND, the fundraising arm of a local charitable organization devoted to promoting affordable housing.

Capehart Scatchard is a full service law firm with offices in Mt. Laurel and Trenton, New Jersey. The firm represents employers and businesses in a wide variety of areas, including workers’ compensation, civil litigation, labor, environmental, business, estates and governmental affairs.

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