• Payment for Petitioner’s Unauthorized Psychiatric Care Does Not constitute the “Last Payment of Compensation” For Purposes of Satisfying the Two-Year Statue of Limitations under N.J.S.A. 34:15-51
  • July 7, 2012 | Author: Dario J. Badalamenti
  • Law Firm: Marshall Dennehey Warner Coleman & Goggin, P.C. - Roseland Office
  • Toth v. Princeton Health Care, Docket No. A-4847-10T2, 2012 N.J. Super. Unpub. LEXIS 285 (App. Div., decided February 10, 2012)

    The petitioner was a social worker employed by the respondent. On July 23, 2004, she suffered a serious head injury as a result of hitting her head on her car door while bending down to retrieve her security badge. The compensability of the petitioner’s injury was undisputed, and she received approximately six months of authorized orthopedic and neurologic treatment, the costs of which were paid entirely by the respondent's workers' compensation carrier. The petitioner was discharged from care on January 28, 2005.

    In the months following the accident, the petitioner sought counseling with a psychiatrist for the psychological consequences of her injury. The petitioner testified that she deliberately withheld any information regarding this counseling from the workers' compensation carrier. The costs of her counseling were paid by her insurance carrier under a group health policy provided through her employer. The petitioner's psychiatric care continued until March of 2007.

    On November 6, 2008, the petitioner filed a claim with the Division of Workers' Compensation for permanent partial disability arising out of her July 2004 injury. The respondent moved to dismiss the claim on the grounds that it was filed beyond the two-year statute of limitations as set forth in N.J.S.A. 34:15-51 of the Workers’ Compensation Act, which provides, "Every claimant for compensation . . . shall . . . submit to the Division of Workers' Compensation a petition . . . within two years after the date on which the accident occurred . . . or in case a part of the compensation has been paid by the employer, then within two years after the last payment of compensation[.]"

    The Judge of Compensation found that the “last payment of compensation” was made by the respondent's workers' compensation carrier on January 28, 2005, the date on which the petitioner was discharged from authorized care and that the petitioner’s claim was therefore untimely. He accordingly granted the respondent's motion and dismissed the petitioner’s claim. On appeal, the petitioner argued that the last payment to her psychiatrist by her health insurer in March of 2007 should be considered the "last payment of compensation" for the purposes of determining the timeliness of her claim.

    In affirming the Judge of Compensation’s dismissal, the Appellate Division relied on Sheffield v. Schering Plough Corp., 146 N.J. 442 (1996), in which the Supreme Court concluded, "Where medical treatment which could have been required under the workers' compensation statute is actually furnished by the employer, such treatment is considered "payment of compensation" and a claim petition filed within two years of such payment is within the appropriate time frame. Conversely, where the employee obtains medical treatment in the absence of any authorization by the employer, the treatment generally will not constitute payment of compensation extending the limitations period. "

    The Appellate Division found that the petitioner was well aware that the manner in which to resolve any issue concerning medical treatment was to communicate with the workers’ compensation carrier’s representative with whom the record clearly demonstrated she had extensive previous direct dealings. Rather, the petitioner deliberately failed to disclose to the workers' compensation carrier that she was receiving psychiatric treatment which was being paid for by her health insurer. “As it was Petitioner herself who made the decision to continue receiving payments from that source," the Appellate Division concluded, "those payments did not extend the two-year statute of limitations period established by N.J.S.A. 34:15-51."