Experience

• Prevailed in a carrier versus carrier case where Review and Joinder Petitions were filed by the Claimant’s employer, a subcontractor, and its insurance carrier. The subcontractor sought reimbursement from, and a shifting of all or a pro-rata share of future liability to the general contractor and its insurance carrier pursuant to a “wrap-up” workers’ compensation insurance policy. Under the policy, the general contractor agreed to provide workers’ compensation benefits to employees of subcontractors, but only when injured on the project site. Any injuries occurring off the project site were to be covered by the subcontractor’s workers’ compensation policy. The case was complicated by the fact that both carriers utilized the same TPA, raising questions as to how coverage decisions were made. The subcontractor did not dispute that the Claimant’s injury occurred off-site, but argued there may have been other instances in which general contractor paid for an injury that occurred off-site, thereby precluding the general contractor’s denial of liability based on past practice. The subcontractor subpoenaed records from the general contractor, seeking a review of any and all claims paid. We objected to the subpoena as overly broad and unduly burdensome given the scale of the project at issue, and asserted that the subcontractor was estopped from denying liability based on the clear and unambiguous language of the underlying policies. The WCJ sustained our objection to the subpoena of general contractor’s file and denied the subcontractor’s Review and Joinder Petitions on the merits.

• Successfully defeated a claim petition for psychological injuries. The Claimant, a third-shift cashier at a convenience store, alleged that she sustained PTSD and anxiety following two armed robberies. While the medical experts in the case acknowledged that Claimant had evidence of work-related PTSD, the WCJ found that Claimant failed to provide timely and adequate notice of the work injury, and so denied the Claim Petition. Claimant appealed and the WCAB affirmed the WCJ’s Decision.  

• Successfully prosecuted a termination petition and obtained a termination of benefits. In that matter, the claimant sustained a groin injury and underwent surgery, although, continued to have ongoing complaints and pursued medical treatment. The WCJ opted to terminate compensation in accordance with an IME opinion of full recovery. In this regard, the WCJ found the IME physician to be more knowledgeable and informed in terms of claimant’s condition as compared to claimant’s medical expert, who recently commenced treatment. The WCJ specifically took note that IME physician reviewed more of claimant’s medical records, was more familiar with the medical history, treatment and details regarding claimant’s work injury and employment history. Most crucial was the fact the WCJ was persuaded by IME physician’s explanation for the claimant’s ongoing complaints, which he attributed to an unrelated urological condition, something discounted by claimant’s treating physiatrist. As a result of the decision, the client is able to avoid liability for claimant’s ongoing medical treatment, including medications, and is not responsible for reimbursement of counsel’s litigation costs which total nearly $3,000. Once the decision is final, the client will be able to pursue a sizable supersedeas reimbursement sum for medical benefits paid out over the last year.