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Josephine Lucciola appealed from an order denying her request to vacate a February 23, 2012 order establishing her social security offset.  She contended that the order contained the wrong offset calculation and that she was being shorted tens of thousands of dollars by her employer, Home Depot.  There was no dispute that Lucciola had been found totally and permanently disabled as a result of her eye injuries sustained in an accident in 2000.  She received an award in 2006 of total and permanent disability at $308.55 per week based on an average weekly wage of $440.79 per week.

When the total award was entered, the parties considered the fact that Lucciola also received social security disability benefits. The order said that Lucciola would have to reimburse Home Depot for any workers’ compensation benefits she received “in excess of the statutory offset rate during the period of time Petitioner has received Social Security Disability benefits.” For reasons unknown, the Social Security offset rate was not calculated for several years.  Home Depot withheld a portion of payments pending receipt of Social Security information and calculation of the offset.

Lucciola filed a motion in 2012 to enforce the terms of the order since her employer had been withholding part of her award.  The Judge of Compensation then entered an order setting petitioner’s offset rate at $125.43.  That meant that she would not receive $308.55 per week but would receive $125.43 per week.  The order also referred to petitioner’s average current monthly earnings (ACE) at $855.20.  It noted that her initial social security entitlement was $310.  Petitioner sought a penalty for Home Depot’s delay in making payments.

Sometime thereafter petitioner challenged the offset calculations.  She contended that there should be no offset at all, saying that the offset only applies to Second Injury Fund cases.  On that point she was incorrect.  She also argued that her prior lawyer had agreed to entry of the February 2012 order without her consent.

Following argument, the Judge of Compensation found that the $125.43 offset rate was correctly determined.  Petitioner appealed pro se and argued among other things that the offset calculation was incorrect.  The Appellate Division agreed with petitioner that the order setting the offset rate at $125.43 was incorrect.  First it noted that 42 U.S.C.A. 424a(a) states:  “If the total monthly benefits (i.e. the sum of the Social Security and workers’ compensation benefit) exceed eighty percent of the individual’s average current monthly earnings (ACE), then her Social Security benefit is to be reduced to the point where the combined monthly benefit does not exceed eighty percent of her average monthly earnings.”  The court also cited to Wood v. Jackson TP., 383 N.J. Super. 250, 254 (App. Div. 2006).

Importantly, the Act exempts certain states like New Jersey that adopted laws that require a reduction in workers’ compensation benefits to account for the Social Security benefits.  42 U.S.C.A. 424a(d).  New Jersey is such a state where employers can reduce in certain situations the workers’ compensation benefit rate under N.J.S.A. 34:15-95.5.  Instead of the Social Security Administration taking the offset, New Jersey employers get the offset in certain circumstances pertaining to total and permanent disability.  The Second Injury Fund need not be involved.  The New Jersey statute says:

Such compensation benefits shall be reduced by an amount equal to the [Social Security disability benefit}, not to exceed the amount of the reduction established pursuant to 42 U.S.C. 424a.  However, such reduction shall not apply when the combined [workers’ compensation benefit and Social Security disability benefit] is less than the total benefits to which the Federal reduction would apply, pursuant to 42 U.S.C. 424a.

The Court explained the main mistake that was made in this case. “As noted above, the weekly Social Security benefit may be subtracted from the weekly 80%-ACE only if the weekly 80%-ACE is greater than the initial workers’ compensation award.  In this case, the weekly 80%-ACE, which is $157.88 (not $196.82, as respondent asserts), is less than the $308.55 initial workers’ compensation award. Therefore, the effective workers’ compensation award should be calculated by subtracting the weekly Social Security benefit ($71.58) from the initial award ($308.55).  The result is a weekly benefit of $236.97.”

Another mistake that respondent’s counsel made in this case was arguing that the $855.20 figure was the 80% ACE.  The actual 80% ACE was $684.16 (80% of $855.20 equals $684.16), which is why the Court said above that the 80% ACE was $157.88, not $196.82.

What this means is that Home Depot was underpaying petitioner $111.54 per week for approximately 10 years.  The Appellate Division remanded the case to enter the correct offset rate and require respondent to pay petitioner the amount owed.  The Court also remanded for the Judge of Compensation to determine whether petitioner is entitled to a 25% penalty.

This case shows how complex calculating offsets can be when a claimant gets total and permanent disability in workers’ compensation and Social Security Disability benefits.  There is an offset worksheet available online.  Employers may contact the undersigned for the form.  The case may be found at Lucciola v. Home Depot, A-3055-14T2, (App. Div. July 22, 2016).

 

 

This Law Division case involved a novel question as to whether costs and expenses paid pursuant to an insured’s Extended Medical Expense Coverage (“Med-Pay”) are subject to the collateral source rule and, hence, not recoverable in a subsequent subrogation action. Although there is case law on whether Personal Injury Protection (“PIP”) benefits can be subrogated, no reported decision had yet addressed whether the collateral source rule in N.J.S.A. 2A:15-97 precludes recoupment of Med-Pay payments by way of subrogation. In Mid-Century Insurance Co. v. Freeman, 2016 N.J. Super. Unpub. LEXIS 1127 (Law Div. May 16, 2016), the court found that Med-Pay payments are subject to the collateral source rule and, accordingly, cannot be recovered by way of subrogation.

In Mid-Century, the carrier sought a declaratory ruling that a cause of action existed under New Jersey law for the recovery of Med-Pay benefits through subrogation against the tortfeasor. The defendant carrier, New Jersey Indemnity, opposed the application, contending that the Med-Pay payments were subject to the collateral source rule.

The underlying facts of this case involved an injury suffered by Tanya Alvarado, an insured of Mid-Century, who was a passenger in a vehicle owned by Shore Service Co. when it was struck in the rear by a vehicle owned and operated by John Freeman, an insured of New Jersey Indemnity. Ms. Alvarado was a passenger in a taxicab, not an automobile, and, thus, was not eligible for PIP benefits. However, she was eligible for medical payments under the Med-Pay provisions of her automobile policy. Mid-Century paid $5,206 in medical payments on her behalf.

Mid-Century then filed an arbitration petition against New Jersey Indemnity to recover the $5,206 that it paid. New Jersey Indemnity asserted as an affirmative defense that New Jersey law bars recovery of Med-Pay payments. The arbitrator upheld their position and found that New Jersey law barred the claim.

In this declaratory judgment action, the court examined the statutory provisions in AICRA (N.J.S.A. 39:6A-1, et. seq.), as well as the Supreme Court’s reasoning in Perreira v. Rediger, 169 N.J. 399 (2001), in which the Court found that a health insurer that paid benefits to an insured had neither a common law, nor statutory subrogation right against the tortfeasor. Against this background, the Court found that the collateral source rule barred such a recovery for Med-Pay payments made.

The Court based its decision on two grounds. First, the origin of the insurer’s Med-Pay obligation is not found within the express mandate of the auto statute, N.J.S.A. 39:6A-1, et seq., but stems from the regulation, N.J.A.C. 11:3-7.3(b) and, thus, cannot be considered an action brought pursuant to N.J.S.A. 39:6A-1. Hence, because they are not required under the auto statute, their payment would make them subject to the terms of the collateral source rule of N.J.S.A. 2A:15-97. Second, the Med-Pay expenses can neither be characterized as workers’ compensation benefits, nor life insurance proceeds (exceptions under N.J.S.A. 2A-15-97) but, rather, do qualify as benefits under N.J.S.A. 2A:15-97. Thus, they enjoy no exception from the collateral source rule’s application. The court found such application to be consistent with the Supreme Court’s Perreira v. Rediger, 169 N.J. 399 (2001), that these Med-Pay expenses are not recoverable by way of subrogation. Accordingly, the Court ruled that the collateral source rule of N.J.S.A. 2A:15-97 bars Med-Pay subrogation actions and cannot be recovered against the tortfeasor.

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