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Patry v. West Jersey Health Systems

January 8, 2010

KATHLEEN PATRY, PETITIONER,
v.
WEST JERSEY HEALTH SYSTEMS (AS SELF-INSURED), RESPONDENT-APPELLANT, AND WEST JERSEY HEALTH SYSTEMS (AS INSURED BY NEW JERSEY MANUFACTURERS INSURANCE COMPANY), RESPONDENT-RESPONDENT.



On appeal from the New Jersey Department of Labor and Workforce Development, Division of Workers' Compensation, C.P. Nos. 1992-048045 and 1993-009199.

Per curiam.

NOT FOR PUBLICATION WITHOUT THE APPROVAL OF THE APPELLATE DIVISION

Argued December 9, 2009

Before Judges Stern and Lyons.

Scibal Associates (Scibal) appeals from an "order to enforce" entered by the Workers' Compensation court on September 17, 2008. The order requires Scibal to reimburse New Jersey Manufacturers Insurance Company (NJM) fifty percent of the amount NJM has expended since the parties' 1999 settlement and to continue to regularly reimburse NJM for any further costs incurred thereafter under the settlement.

The facts giving rise to this case concern two work-related injuries suffered by Kathleen Patry (Patry) while employed by West Jersey Health Systems (West Jersey). At the time of the first injury, which occurred on November 4, 1991, West Jersey was insured by NJM. When Patry was injured a second time, on October 20, 1992, West Jersey was self-insured and its plan was administered by Scibal. As a result of these injuries, Patry filed a workers' compensation action.

On March 31, 1999, an order was entered by the Workers' Compensation court after the parties agreed upon a settlement regarding Patry's action. The order declared Patry was totally and permanently disabled under N.J.S.A. 34:15-12b. It described Patry's medical condition as follows:

[t]he permanent disability resulting from said accident is orthopedic, neurologic and psychiatric in nature involving left wrist strain and sprain; neuroma of radial sensory nerve left wrist requiring excision; DeQuervain's tenosynovitis release left wrist; ablation of radial and lateral antibrachial cutaneoeus nerves left elbow; post-traumatic arthritis left wrist requiring arthrodesis with local bone graph and dynamic compression plate; rotator cuff tendonopathy left shoulder secondary to subacromial impingement; C6-7 cervical radiculopathy confirmed via EMG/NCV testing; centralized neuropathic pain syndrome left forearm and hand; chronic pain syndrome with reflect [sic] sympathetic dystrophy (RSD); implantation of spinal cord stimulator; chronic depression.

The order acknowledged that the disability was not a result of the two injuries alone but by the combined effect of pre-existing conditions and the two injuries.

The provision pertinent to this appeal provided that NJM would manage Patry's continuing medical care, NJM would pay for Patry's continuing medical care, and Scibal would reimburse NJM for fifty percent of the costs of continuing medical care.

In a letter dated April 2, 1999, which was addressed to Scibal's counsel, NJM's counsel inquired as to "the name of the person that [NJM] should contact at [Scibal] in the event there is [sic] any questions or difficulties in obtaining reimbursements for [the] payments of temporary disability as well as medical costs."

The record reflects that communications ceased between NJM and Scibal until an April 10, 2007 letter from NJM's counsel to Scibal requested reimbursement in accordance with the 1999 order. It was accompanied with an itemization of the medical bills paid by NJM.*fn1 The letter also stated, "[i]f you need additional documentation regarding the actual bills please advise. If you would like to discuss this matter further please do not hesitate to contact me." Scibal did not respond to NJM's correspondence.

Thereafter, on January 18, 2008, NJM moved to enforce the 1999 order. Scibal filed a certification, dated February 21, 2008, in opposition to NJM's motion, claiming the defense of laches. On July 11 and September 12, 2008, the Workers' Compensation court heard oral argument on the motion.

The court granted NJM's motion, and on September 17, 2008, the court issued an order to enforce, directing Scibal to abide by the terms of the 1999 order. However, the court determined that NJM would not be entitled to any interest. It is from this order that Scibal appeals.

A November 10, 2008 letter from NJM to Scibal requested reimbursement of fifty percent of $1,141,258.06, which is $570,629.03. Enclosed with this letter were reports, bills, and an itemization for medical bills paid or medical costs incurred from March 31, 1999, until October 2, 2008.*fn2

On appeal, Scibal raises the following arguments:

POINT I

THE CLAIM FOR REIMBURSEMENT BY WEST JERSEY HEALTH SYSTEMS (NJM) SHOULD HAVE BEEN DENIED BY THE TRIAL COURT PURSUANT TO THE DOCTRINE OF EQUITABLE ESTOPPEL

POINT II

THE CLAIM FOR REIMBURSEMENT BY WEST JERSEY HEALTH SYSTEMS (NJM) SHOULD HAVE BEEN DENIED BY THE TRIAL COURT ...


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