Notable Wins

Client: Midwestern Insurance Alliance 

Court: Appellate

Trial Attorney: Brian P. Berkoff, Esq.

Brief Attorney: Ashley T. Mollenthiel Fiore, Esq. and Brian P. Berkoff, Esq.

**Results may vary depending on your particular facts and legal circumstances**

Matter Caption: Avery v. Next Mile, LLC/DSP

WIN from April 11, 2023

Petitioner appealed the decision from the April 11, 2023 trial and argued that the Judge of Compensation should have placed the burden of proof on respondent to disprove that the shooting arose from employment.

The petitioner’s attorney cited cases in which the disputed issues were about the medical or physical cause of the injury, which was not in dispute for this case. This case was an issue of pure legal causation and whether the accident arose out of employment.

The Appellate Division affirmed the case based on the facts and found that the judge did not err in deciding the case based on the testimony at trial. They noted there is no precedent for burden-shifting in this case as it involved legal causation and not medical causation.

To learn how this matter progressed from Trial to Appellate Division ruling, click here.

Client: A national insurer

Court: Workers’ Compensation

Trial Attorney: Prudence Higbee, Esq. 

Brief Attorney: Prudence Higbee, Esq. and Jaclyn Terranova, Esq.

**Results may vary depending on your particular facts and legal circumstances**

Matter Caption: Schonewolf v. South Jersey Bakery

Following a trial that included the testimony of two factual witnesses and three medical experts Judge French granted a complete dismissal of a claim for dependency benefits.  On October 11, 2017, the decedent rolled his ankle while climbing off of a forklift.  Three days later he passed away. The diagnosis at the time of death included severe sepsis, community acquired pneumonia and cardiac arrest.  The petitioner demanded lifetime dependency benefits totaling more than $1,000,000.00. 

At trial, the attorney for the petitioner offered testimony by two different experts who submitted two different theories on causation. The first theory was that the decedent died from an acute pulmonary embolism that originated from a deep vein thrombosis (DVT) in the ankle, which developed because the decedent rolled his ankle at work.  The second theory was that after the decedent developed a DVT in his ankle due to rolling it at work, Staph aureus bacteremia entered the body through micro abrasions caused from the stretching of swelled skin from the ankle injury, the DVT propagated above the knee, and into the lungs, subsequently leading to sepsis and death, all within 72 hours of the work incident.

Prudence Higbee successfully defended this case by offering the testimony of an infectious disease expert, Dr. Stephen Smith, who opined that neither of the petitioner’s theories could have caused the decedent’s death. First, Dr. Smith confirmed there was no medical evidence to support a finding that petitioner sustained acute pulmonary embolism. Notwithstanding the fact that a DVT could not be caused by an ankle sprain or rolling of an ankle, Dr. Smith agreed with the petitioner’s second expert that petitioner died due to severe sepsis caused by Staph aureus bacteremia, but explained that the infection had to be present in petitioner’s body well before he sprained his ankle as he was in severe septic shock and acute renal failure when he presented to the hospital, within just 48 hours of the ankle injury.

The Honorable Ingrid L. French, A.S.J.W.C. found Dr. Smith’s testimony to be credible and supported by the medical records in evidence. Judge French found that although there was no evidence to confirm when the local seeding of Staph aureus bacteremia took place, when Mr. Schonewolf arrived to the hospital just two days after the work incident, the progression of the infection was so severe that it supports a finding that the seeding began prior to his ankle injury.  Based on the foregoing, Judge French found that the petitioner failed to sustain her burden of proof and dismissed with prejudice the claim for dependency benefits.

Client: Robert Wood Johnson Hospital

Court: Workers’ Compensation

Trial Attorney: Ashley M. Fiore, Esq.

Brief Attorney: Brian P. Berkoff, Esq. and Nicholas Stephens,Esq.

**Results may vary depending on your particular facts and legal circumstances**

Matter Caption: AnnaMarie Angelo v. Robert Wood Johnson Hospital

Petitioner filed two workers’ compensation claims for alleged injuries to the neck, shoulders, back, bilateral legs and right hip.  After many years of ongoing disputed causally related need for treatment requests, the petitioner filed a Motion for Medical and Temporary Disability Benefits wherein she certified to her restrictions, complaints and need for treatment for the lumbar spine. The petitioner sought additional medical treatment, temporary total disability benefits and permanency benefits.

The respondent was able to secure incredible surveillance which demonstrated that petitioner was in peak physical condition despite her allegations otherwise to the Court, respondent’s need for treatment expert and petitioner’s need for treatment expert. Based on this, all benefits were terminated and respondent pursued a Trial on its Motion to Dismiss for Alleged Violation of Fraud Act.

Our office proceeded with testimony and carefully went through all of petitioner’s alleged complaints and restrictions. The surveillance secured clearly contradicted her testimony. At the conclusion of her testimony, the surveillance was presented to the Judge and petitioner’s attorney. All parties agreed that Dismissals of both claims with prejudice were appropriate based on the multiple material misrepresentations made by petitioner. No further benefits were paid to petitioner and the petitioner was ordered to pay for stenographer fees associated with her testimony.

Client: ACE Solutions/Carrier: American European Insurance Group

Court: NY Supreme, Manhattan County

Brief Attorney: Nuo Jiang

**Results may vary depending on your particular facts and legal circumstances**

Matter Caption: J. Carey Smith  2019 Irrevocable Trust, et al. v. 11 West 12 Realty, LLC., et al.

Client is an HVAC contractor who installed an HVAC system inside a historic townhouse located in Manhattan.  The building was part of the Forbes Estate and last occupied by Malcolm Forbes.  Plaintiffs purchased the townhouse and began a full renovation.  The general contractor managed the renovation over a 2 year period which included multiple sub-contractors and various aspects of the renovation.  Client installed very complex HVAC system including ducts, HVAC units, and advanced thermal controls.  Plaintiffs Complaint alleged construction defects, negligence, Civil RICO, and intentional acts.  Court granted Summary Judgment in favor of client on the basis that, among other reasons – Insured lacked privity with the Plaintiffs and accordingly did not owe any duty to them.

Client: Costco Wholesale

Court: Superior Court of New Jersey Appellate Division

Trial Attorney: Jennifer A. Cottell, Esq. 

Brief Attorney: McKenna R. Parris, Esq.  

**Results may vary depending on your particular facts and legal circumstances**

The Appellate Division affirmed the trial court’s denial of the Petitioner’s Motion for Medical and Temporary Benefits.  The trial court found Costco’s two expert witnesses, both authorized treating doctors, more credible than the Petitioner’s medical expert who did not review significant medical records including an MRI of the lumbar spine and an EMG study.  He was also unaware of the Petitioner’s prior back injury.  Nevertheless, his treatment of one injection provided only 50% relief for one week, and he had no definitive future treatment plan for the Petitioner.  The trial judge concluded that the Petitioner did not sustain her burden of proving that she was in need of further causally related medical treatment.  The Appellate judges found that there was sufficient credible evidence in the record to support the trial court’s decision and affirmed.

Client: Liberty Mutual Insurance

Court: Philadelphia County Court of Common Pleas

Brief Attorney: Edward F. Kuhn, lll

**Results may vary depending on your particular facts and legal circumstances**

Liberty Mutual Insurance (“Liberty”) defended Dan Lepore and Sons in a Workers’ Compensation case filed by one of Lepore’s employees. The Philadelphia Workers’ Compensation Court found the claim compensable. Lepore felt the claims were fraudulent and was very upset with the outcome. The Workers’ Compensation decision was appealed and the matter was then settled pending the appeal.

Lepore then filed a Complaint alleging Liberty breached the insurance contract by failing to provide conflict-free counsel in the Workers’ Compensation case. Lepore also included a bad faith count for the handling of the Workers’ Compensation claim and for Liberty’s billing practices. We also filed a Counterclaim on Liberty’s behalf against Lepore for Lepore’s failure to pay its deductible.

We filed a motion for summary judgment on behalf of Liberty to dismiss Lepore’s Complaint and to enter judgment on Liberty’s Counterclaim. Lepore also filed a motion for summary judgment to dismiss Liberty’s Counterclaim. The court granted Liberty’s motion for summary judgment to dismiss Lepore’s Complaint and granted Liberty’s Counterclaim. Lepore’s motion was denied.

Client: Safeco Insurance Company of America

Court: Superior Court of New Jersey, Burlington County

Brief Attorney: Voris M. Tejada, Jr.  

**Results may vary depending on your particular facts and legal circumstances**

The plaintiffs sued Safeco, their homeowners’ insurance carrier, for breach of contract after Safeco partially denied plaintiffs’ claim for roof damage allegedly resulting from a hailstorm.

Safeco filed a Motion for Summary Judgment seeking to dismiss the suit based on plaintiffs’ failure to comply with the limitations provision contained in their insurance policy. While the statute of limitations for breach of contract claims is 6 years, insurance policies commonly contain provisions which require the insured to bring suit within one year of the date of loss. Under related case law, this 1-year period is “tolled,” or paused, between the time the insured reports the claim and the time the insurer issues its coverage or denial decision.

Here, the plaintiffs did not report the loss to Safeco until 306 days later. Thereafter, Safeco spent 40 days investigating the claim before issuing its partial denial letter. Critically, the plaintiffs did not file suit until 432 days after the loss. As such, even after accounting for the 40 days Safeco spent investigating the claim, plaintiffs still waited 392 days to file suit, exceeding the 1-year limitations period set forth in the policy. For these reasons, the Court granted Safeco’s Motion for Summary Judgment and denied plaintiffs’ subsequent Motion for Reconsideration.

Client: QMB Plumbing & Heating (AmeriTrust)

Court: New York Supreme Court, Queens County

Brief Attorney: Alyson L. Knipe, Esq. 

**Results may vary depending on your particular facts and legal circumstances**

This case involved a trip and fall on the sidewalk abutting a construction site.  A hose ran from underneath the construction fence across the sidewalk to the gutter.  Plaintiff alleges that she tripped on the hose.  QMB was a plumbing subcontractor hired by the building owner.  On November 3, 2023, QMB  was granted summary judgment dismissing the action as we demonstrated that QMB did not own the hose that was the subject of the accident.

Client: Borough of Freehold

Court: Superior Court of New Jersey, Law Division, Monmouth County

Trial Attorney: Betsy G. Ramos, Esq.

Brief Attorney: Patrick J. Graham, Esq. 

**Results may vary depending on your particular facts and legal circumstances**

Plaintiff sought to reinstate claims that she initially filed against the Borough of Freehold in March 2020 and voluntarily dismissed shortly thereafter in June 2020 via consent order. The Borough of Freehold filed an opposition to Plaintiff’s Motion to Vacate Dismissal and a cross-motion for Summary Judgment seeking dismissal of Plaintiff’s reinstated claims with prejudice. The Court ultimately found that reinstatement of Plaintiff’s March 2020 claims was barred by the statute of limitations, and even if those claims were reinstated, the Borough of Freehold was entitled to absolute immunity under several provisions of the New Jersey Tort Claims Act.

Client:  Durand, Inc. 

Court: New Jersey Division on Civil Rights

Attorney: Ralph R. Smith, 3rd

**Results may vary depending on your particular facts and legal circumstances**

The Complainant filed a charge of discrimination claiming a violation of the New Jersey Law Against Discrimination (LAD) by Durand alleging she was demoted and discharged due to her sex and pregnancy.

At the conclusion of the DCR’s investigation, the agency determined there was no factual support for the claim and rejected it as the evidence showed that the employee’s supervisory demotion occurred due to poor performance.

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