Workers’ Compensation: Some Law Regarding Employers’ Responsibility For Medical And Hospital Treatment

November 22, 2014

Medical and hospital services and treatment are provided for in N.J.S.A. 34:15-15. The Act provides that the employer must furnish to the worker all medical and surgical treatment as well as hospital services as may be necessary to cure and relieve the worker of the effect of an injury and to restore the function of the injured member or organ where such restoration is possible. The courts have held that the Division of Workers’ Compensation is responsible for determining whether an employer is required to pay for the employee’s medical treatment and whether the cost of the treatment is therefore “authorized” and chargeable to the employer. See Kinley Physical Therapy Services, Inc. v. Kramer, 256 N.J.Super. 355 (Law Div. 1992).

Where the required treatment is emergent or so peculiar that it justifies the payment of medical benefits, the employer will be held responsible even if authorization prior to the rendering of the treatment was not granted. Chapman v. Valley Diner, 25 N.J.Misc. 438 (Dept. of Labor 1947). Furthermore, where a demand for medical treatment by the employee to the employer would have been futile, the employee is excused from requesting authorization. Benson v. Coca Cola Company, 120 N.J.Super. 60 (App. Div. 1972). The Benson court also noted its belief that the legislature had not intended to require an injured employee in need of medical treatment to submit to the “slow grinding mills of the judicial process in the Division of Workers’ Compensation” in order to obtain authorization for necessary medical care. Id.

If, for any reason medical or surgical treatment necessitated by an original compensable injury either directly or indirectly causes a new injury, there is no question as to its compensability. Randolph v. E.I. duPont de Nemours and Co., 130 N.J.L. 353 (S.Ct. 1943); see also Bisonic v. Halsey Packard, Inc., 58 N.J.Super. 166 (Law Div. 1959), aff’d 62 N.J.Super. 166 (App. Div. 1960). When there is a subsequent event that occurs as a direct result of an original compensable injury, that subsequent event is considered to be a natural consequence of the initial injury, and is also compensable. If the subsequent injury is not a superseding event that was caused by the employee’s conduct, then the employer is responsible for all medical complications that flow as a natural occurrence from the original accident. When the intervening event can be said to have innocently aggravated the original condition, the chain of causation is not disrupted and the employer is responsible for the consequences that ensue. Selak v. Murray Rubber Co., 8 N.J.Misc. 838 (1930), aff’d 108 N.J.L. 548 (E.& A. 1932); Randolph v. E.I. DuPont De Nemours & Co., supra, 130 N.J.L. 353 (1943).

In Randolph, an employee lost the use of his eye as a result of an admitted work-related accident. The Petitioner was then involved in a second accident unrelated to his employment in which he fell down some stairs. The court considered whether the second accident was a natural and proximate result of the first work-related accident. The court held, “It seems to me enough if it appears that the employment is one of the contributing causes without which the accident which actually happened would not have happened, and if the accident is one of the contributing causes without which the injury which actually followed would not have followed.” 130 N.J.L. at 356.

In Bisonic v. Halsey Packard, supra, 58 N.J.Super. 166 (Law Div. 1959), the plaintiff suffered a work-related hernia and eventually underwent surgical repair which resulted in a cardiac condition. The court determined that if it were not for the work accident, the plaintiff would not have been subjected to any surgical procedure, and therefore, the resulting cardiac condition was causally related to the hernia operation and is compensable by the employer. 58 N.J.Super. at 175. The court also noted that burden is on the plaintiff to prove a causal relationship, but that burden is in all probability, not certainty.

The Appellate Division affirmed the decision below and found that the surgery which plaintiff had was essential to cure the hernia resulting from a work accident and its sequelae precipitated the cardiac disability. Bisonic v. Halsey Packard, 62 N.J.Super. 365 (App. Div. 1960).

In Amey v. Friendly Ice Cream, 231 N.J.Super. 278 (App. Div. 1989), plaintiff injured his right hand at work and later re-injured the hand while using a wrench. Since the plaintiff had been warned not to put pressure on the hand, the court found this to be an independent intervening cause thereby relieving the employer of responsibility. “Compensability can be defeated by certain degree of employee misconduct, and … that degree is something beyond simple negligence, and can best be described as an intentional violation of an express or implied prohibition in the matter of performing the act.” 231 N.J.Super. at 284.

In (unpublished) Cuevas v. S&J Electric, 2005 WL 2665539, (N.J.Super.A.D. Oct. 20, 2005), the court held an employer liable for injuries triggered when plaintiff sneezed while recuperating from a back injury. The court recognized that the workers’ compensation laws are entitled to liberal construction so as to afford coverage to as many workers as possible. Since the sneeze that caused a herniated disc was an innocent, involuntary act, the employer is liable because the intervening cause was not attributable to plaintiff’s intentional conduct.

In Cucciniello v. Sports Authority, 2008 WL 4329874, (N.J.Super.A.D. Sept. 24, 2008), the plaintiff aggravated a hip injury while walking through the snow, and the Appellate Division affirmed the finding that the employer was responsible to pay medical and temporary disability benefits for injuries sustained while petitioner was working. The issue was whether the walking through the snow, subsequent to his original compensable injury, was an intervening, superseding event that would insulate respondent from further liability. Hoogen v. Ritz Carlton Hotel, 14 N.J.Misc. 555, 556 (Dep’t Labor 1936).

In holding the employer responsible, the court relied upon Kelly v. Fed. Shipbuilding & Dry Dock Co., 1 N.J.Super. 245, 247 (App. Div. 1949), wherein the petitioner fell and broke his wrist in part due to the cast he had on his leg due to a work-related injury. The court concluded that the second injury was directly connected to the first injury, finding that the petitioner had engaged in an “instinctive act” that “innocently” contributed to the second injury. Id. at 248. The court noted “[t]he fact that the second injury was a wholly independent injury and not merely an aggravation of a compensable injury makes no difference in the result if the second injury is directly connected in a chain of physical causation with the compensable injury.” Ibid. And see Hartman v. Fed. Shipbuilding & Dry Dock Co., 11 N.J.Super. 611, 615 (Cty. Ct. 1951)(the worsening of original compensable injury by subsequent “incidental daily occurrences … can hardly constitute independent intervening causes, sufficient to break the chain of causation running from the original [injury].”)

Interestingly, the Cucciniello opinion also addresses the relevance of active treatment to chain of causation. “It is irrelevant that petitioner re-injured his hip while he was not under active medical treatment or ‘subject to’ permanent work restrictions. So long as the second injury is directly connected in a chain of physical causation with the compensable injury, respondent remains liable. Kelly, supra, 1 N.J.Super. at 248. See also Selak, supra, 8 N.J.Misc. at 839; Randolph, supra, 130 N.J.L. at 355.

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