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.
