SUPERIOR COURT OF NEW JERSEY
APPELLATE DIVISION
A-6677-94T2
IN THE MATTER OF
DOUGLAS H. PATERSON
___________________________________________________________________
Submitted February 10, 1997 - Decided March 3,
1997.
Before Judges Petrella, Landau and Kimmelman.
On appeal from the Private Plan Hearing
Office, Department of Labor.
Pitman, Senesky, Nicola, Selitto & Oller,
attorneys for appellant Douglas H. Paterson
(Ronald D. Nicola, on the brief).
Chadbourne & Parke, attorneys for respondent
Sonoco Products Co. (Daniel E. Estrin, on the
brief).
The decision of the court was delivered by
LANDAU, J.A.D.
This is an appeal by Douglas H. Paterson from a final decision
of the Department of Labor, Private Plan Hearing Office, that
denied his request to enforce payment of temporary disability
benefits under an employer private plan.
After Paterson was injured in a motor vehicle accident on
February 12, 1993, he filed a claim for workers' compensation
benefits from his employer Sonoco Products Co. The claim was
contested, but Paterson received temporary compensation benefits
from April 17, 1993 through October 31, 1993.
GAB Business Services, Sonoco's compensation servicing agent
(Sonoco is self-insured), refused to continue benefits after
October 31, 1993 because Paterson, apparently on advice of counsel,
refused to submit to a further physical examination that it
requested. Subsequently, Paterson did agree to a GAB-requested
neurological and psychiatric examination which was conducted on
April 26, 1994. The temporary compensation benefits were promptly
resumed on a reservation of rights basis, effective April 25, 1994,
preserving Sonoco's ability to contest compensability.
Paterson sought temporary disability coverage under N.J.S.A.
43:21-29 and 21-30 for the period between November 1, 1993 and
April 25, 1994 when no compensation benefits were paid. These
statutes provide in pertinent part:
N.J.S.A. 43:21-29. Compensable Disability
Disability shall be compensable subject
to the limitations of this act, where a
covered individual suffers any accident or
sickness not arising out of and in the course
of the individual's employment or if so
arising not compensable under the workers'
compensation law (Title 34 of the Revised
Statutes), and resulting in the individual's
total inability to perform the duties of
employment.
N.J.S.A. 43:21-30. Nonduplication of benefits
...[W]here a claimant's claim for compensation for temporary disability, under the provisions of [the workers' compensation law], is contested, and thereby delayed, and such claimant is otherwise eligible for benefits under this chapter, said claimant shall be paid the benefits provided by this chapter until and unless said claimant receives compensation under the provisions of [the
workers' compensation law].
Critical to the present case is N.J.S.A. 34:15-19, part of the
Workers' Compensation Act, which formed the basis for GAB's
cessation of temporary compensation benefits during the period when
Paterson opted not to submit to re-examination. This section
provides:
After an injury, the employee, if so
requested by his employer, must submit himself
for physical examination and X-ray at some
reasonable time and place within this state,
and as often as may be reasonably requested,
to a physician or physicians authorized to
practice under the laws of this state. If the
employee requests, he shall be entitled to
have a physician or physicians of his own
selection present to participate in such
examination. The refusal of the employee to
submit to such examination shall deprive him
of the right to compensation during the
continuance of such refusal. When a right to
compensation is thus suspended no compensation
shall be payable in respect of the period of
suspension. On request, the workmen's
compensation bureau may examine the X-ray for
the purpose of determining the amount of
disability due, if any.
[N.J.S.A. 34:15-19.]
Because of the suspension of compensation benefits authorized by
N.J.S.A. 34:15-19, Paterson urged that as he was "otherwise
eligible," and workers compensation was being contested, he was
entitled to the temporary disability benefits available under
N.J.S.A. 43:21-30.
Sonoco's private plan insurer disagreed, contending that
Paterson's compensation benefits were not delayed because of the
contested nature of the workers' compensation case. Rather,
because he had refused to submit to a reasonably requested
reexamination, such refusal "deprive[d] him of the right to
compensation during the continuance of such refusal." See N.J.S.A.
34:15-19. They pointed out that as soon as Paterson rendered
himself eligible by submitting to the examination, temporary
compensation benefits were resumed.
The Private Plan Hearing Officer (PPHO) accepted this
analysis. He reasoned that while the temporary disability payments
to Paterson may be subject to reimbursement from a compensation
award, N.J.S.A. 34:15-19 provides that "no compensation is payable
in respect to the period of suspension" occasioned by refusal to
submit to a reasonable request for examination. The PPHO also held
that Paterson failed to meet a prerequisite for entitlement under
N.J.S.A. 43:21-30, in that compensation benefits were not "delayed
because the claim was contested", but were stopped because of the
"claimant's refusal to submit to physical examination as required
by law."
In consequence, Paterson's request that the PPHO order payment
of temporary disability benefits from November 1, 1993 to April 25,
1994 was denied.
Paterson urges on appeal that there has never been any
question that his workers' compensation claim is contested, or that
he was in fact disabled and unable to work during the period
between November 1, 1993 and April 25, 1994. Accordingly, he urges
that in light of the remedial nature of the temporary disability
statutesSee footnote 1, we should reverse the decision of the PPHO.
Sonoco argues that the statutory provision which denies
workers' compensation benefits during a period of suspension
occasioned by refusal to submit to examination would make no sense
if the employee could refuse, and simply turn to the Temporary
Disability Benefits Law for payments. Unlike cases such as
Janovsky v. American Motorists Ins. Co.,
11 N.J. 1 (1952) and
Brinkerhoff v. CNA Ins. Co.,
263 N.J. Super. 1, (App. Div. 1993),
Paterson was not waiting for resolution of compensation entitlement
or of a dispute as to his ability to return to work. Rather,
Sonoco points out, his benefits had been discontinued only because
he refused to submit to a medical examination. Further, Sonoco
urges, we should not credit Paterson's argument that he was in fact
disabled from November 1, 1993 to April 25, 1994, because he
"forfeited his claim" by refusing to submit to examination.
We believe that the arguments of each party inadequately
address provisions of the Workers' Compensation and Temporary
Disability Benefits statutes which affect resolution of this
appeal. N.J.S.A. 34:15-57.1 provides authority for reimbursement
of the Division of Employment Security or a private plan employer,
as the case may be, for the amount of disability benefits paid to
a disabled employee pursuant to the Temporary Disability Benefits
Law, but only if that employee "becomes entitled to or is awarded
compensation for temporary disability pursuant to chapter fifteen
of Title 34...for the same weeks or period with respect to which he
has received disability benefits pursuant to the Temporary
Disability Benefits Law." See also N.J.S.A. 43:21-30, which
provides for subrogation as to compensation benefits awarded for
the same weeks that temporary disability benefits were paid.
Thus, as Paterson's refusal to submit to a reasonably
requested re-examination barred him from entitlement to an award of
any workers' compensation benefit between November 1, 1993 and
April 25, 1994, that refusal effectively barred an entity which
would pay him Temporary Disability Benefits for that period from
being reimbursed for such payments.
We believe that the legislature did not intend to reward an
injured employee who refuses to comply with the provisions of the
compensation laws by affording an alternate method of securing
temporary benefits, while depriving its payer from reimbursement.
Read together, we are satisfied that N.J.S.A. 34:15-19; 15-57.1 and
N.J.S.A. 43:21-30 do not contemplate the award of temporary
disability benefits to an employee which have been necessitated
only because temporary compensation benefits were discontinued by
reason of the employee's refusal to submit to examination. The
delay or suspension of compensation payments in this case did not,
as required by the non-duplication provision, N.J.S.A. 43:21-30,
arise because Paterson's claim was contested.
We have not ignored the fact that when Paterson ultimately
submitted to examination, the report of GAB's physicians, Essex
Neurological Associates, opined and recommended as of April 30,
1994 that "he should continue to collect temporary disability
benefits" for the next two or three months. In short, apart from
the impact of his refusal, Paterson might have been medically
eligible for those benefits under N.J.S.A. 43:21-30, had
compensation benefits been delayed only because they were
contested.
The latter observation, however, prompts us to consider
whether there is any reason to deprive Paterson of temporary
disability benefits during the November 1993 - April 1994 hiatus if
it should be determined that, notwithstanding a finding of his
total inability to perform the duties of employment during that
period, his accident did not arise out of and in the course of
employment and is not compensable under the Workers' Compensation
Law. Under N.J.S.A. 43:21-29, such a disability would then be
compensable under the Temporary Disability Benefit Law. The
purpose of the Temporary Disability Benefit Law is to protect
workers against loss of income caused by non-employment-related
accident or sickness. Snedeker v. Bd. of Review, Div. of Emp.
Sec.,
139 N.J. Super. 394 (App. Div. 1976).
If the Workers' Compensation Law does not apply, the temporary
disability payer would have been deprived of no subrogation right
by reason of Paterson's refusal to be examined in the workers'
compensation proceeding. There would be no need to explore the
cause for delay or suspension of temporary workers' compensation
benefits, and no legislative policy to be served by denying
temporary disability benefits because of that refusal.
Accordingly, while we affirm the decision under review, we
expressly preserve Paterson's right to request temporary disability
benefits for the contested period in the event that it is
determined that his accident is not compensable under the Workers'
Compensation Law.
Affirmed.
Footnote: 1N.J.S.A. 43:21-26 calls for liberal construction of these statutes as remedial legislation.