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Carbone v. Atlantic Yachting Co.

Decided: June 6, 1951.


McGeehan, Jayne and Wm. J. Brennan, Jr. The opinion of the court was delivered by William J. Brennan, Jr., J.A.D.


This appeal brings up for review the determination of facts and order of the hearing officer of the Department of Labor and Industry, Division of Employment Security, Disability Insurance Service, by which appellant, American Casualty Company of Reading, Pennsylvania, as carrier under a private insurance plan approved under the Temporary Disability Benefits Act (R.S. 43:21-25 et seq.), was ordered to pay disability benefits to the plaintiff, Joseph Carbone, Sr.

Plaintiff ceased active employment as a cook with defendant employer on June 27, 1950. He claimed he did so because of illness, "involutional melancholia." The order on appeal directed appellant to pay plaintiff disability benefits from August 2, 1950, to November 3, 1950.

Eligibility requirements for benefits under a private plan may be no more restrictive than as provided by the statute for benefits payable by the state plan. R.S. 43:21-32(b):

Bogda v. Chevrolet-Bloomfield Div. General Motors Corp. , 8 N.J. Super. 172 (App. Div. 1950). Under the terms of appellant's policy, qualifications for benefits are substantially the same as the qualifications prescribed by the statute for employees covered by the state plan. Plaintiff was not entitled to benefits unless his disability existed when his employment terminated on June 27, 1950, or occurred within two weeks thereafter (cf. R.S. 43:21-27 and 43:21-39(a)) and unless he gave written notice of his disability to appellant within 30 days of the date he first came under the care of a "legally qualified physician, surgeon or dentist" (cf. R.S. 43:21-49 and 43:21-29.1), although failure to furnish notice within the time provided would not invalidate his claim if it were shown not to have been reasonably possible to furnish such notice and that such notice was furnished as soon as was reasonably possible (cf. R.S. 43:21-49). However, even if these eligibility requirements were met, benefits were payable only for periods during which plaintiff was actually under the care of a legally licensed physician (cf. R.S. 43:21-39(b)), Bogda v. Chevrolet-Bloomfield Div. General Motors Corp., supra.

The determination of facts incorporates findings, (1) that plaintiff's termination was occasioned by illness, (2) that he first consulted his physician on August 2, 1950, (3) that within 30 days thereafter, namely, on August 30, 1950, he mailed a notice of disability to the Disability Insurance Service, and (4) that he was under the care of his physician for the disability from August 2, 1950, to November 3, 1950, the date of the hearing hereinafter mentioned. Upon these findings the payment of benefits for the period from August 2, 1950, to November 3, 1950, was ordered.

When a claimant for benefits under an approved private plan is unable to agree with his employer or the insurer as to benefits thereunder, R.S. 43:21-50 authorizes the claimant, within one year after the beginning of the period for which benefits are claimed, to file a complaint with the Division of Employment Security. The Division is empowered

to conduct such investigation, including informal hearings, as it deems proper, and, if the issues raised by the complaint are not settled, to conduct a formal hearing before a hearing officer upon due notice to all parties in interest under procedural rules and regulations promulgated by the Division "providing for a fair and impartial hearing" at which "any party in interest shall have the right to appear." The proceedings are to be recorded and "at such hearing evidence, exclusive of ex parte affidavits, may be produced by any party, but the hearing officer, in conducting the hearing, shall not be bound by the rules of evidence."

The hearing officer is required to make "a determination of facts, and an order disposing of the issue presented, which shall be final and binding on the claimant, the employer and the insurer," and a copy of which order is to be served by registered mail upon each of the interested parties. Any party aggrieved by the action of the hearing officer has a right of review in the Superior Court, which under Rule 3:81-8 is by appeal to the Appellate Division, and "in such event the record of the proceedings shall be transcribed and the entire record of the disputed claim shall be duly certified to the Superior Court."

It is plain that the function under the statute is not administrative or ministerial, but quasi-judicial. Penn. R.R. Co. v. N.J. State Aviation Commission , 2 N.J. 64 (1949).

Plaintiff and appellant were unable to agree that plaintiff was entitled to benefits, and on November 3, 1950, a hearing under the statute was held before the hearing officer. The gist of appellant's argument on this appeal is that the hearing officer's determination of facts was not made upon the evidence adduced at the hearing, but upon information extra such evidence collected ex parte after the hearing by the hearing officer and not spread upon the record or ...

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