Argued: September 10, 2013.
On appeal from the Department of Labor and Workforce Development, Division of Workers' Compensation, Claim Petition No. 2010-5720.
Ian G. Zolty argued the cause for appellant ( Capehart & Scatchard, P.A., attorneys; Mr. Zolty, on the brief).
D. Gayle Loftis argued the cause for respondent.
Pablo N. Blanco argued the cause for amicus curiae New Jersey Advisory Council on Safety and Health ( The Blanco Law Firm, LLC, attorneys; Mr. Blanco, on the brief).
Before Judges MESSANO, SABATINO, and HAYDEN. The opinion of the Court was delivered by HAYDEN, J.A.D.
[435 N.J.Super. 88] OPINION
[435 N.J.Super. 89] HAYDEN, J.A.D.
This case concerns an injured worker's eligibility for temporary disability benefits and medical treatment under the Workers' Compensation Act, N.J.S.A. 34:15-1 to -142 (the Act) and the essential elements required for the Act's anti-fraud provision, N.J.S.A. 34:15-57.4, to negate a claimant's eligibility for benefits. In particular, we consider the state of mind that a respondent must prove to disqualify a claimant who makes misstatements about his or her medical history when applying for benefits.
Respondent Verizon Wireless appeals from the October 15, 2012 order of the workers' compensation court, which granted temporary disability and medical benefits to petitioner Natalie Bellino. Respondent argues that the workers' compensation court erred in finding the testimony of petitioner and her physicians credible; in finding petitioner was entitled to curative medical treatment and temporary disability benefits due to a work-related injury; and in permitting her to receive workers' compensation benefits despite petitioner's statements and omissions that respondent alleges amount to fraud in violation of N.J.S.A. 34:15-57.4. Having considered respondent's arguments in light of the record and the applicable legal principles, we affirm.
The record reflects that in February 2010, petitioner worked for respondent as a customer service and sales representative at respondent's store in Secaucus. On February 23, 2010, petitioner tripped over some boxes, fell forward over the cartons onto the ground, and experienced immediate pain in her right hand and arm, right knee, left ankle, and lower back. After her co-workers helped her up, petitioner called her father, who took her to an urgent care doctor's office. Respondent instructed her a few days later to go to its authorized medical provider, Concentra Medical Centers.
On March 2, 2010, petitioner began receiving medical care from several doctors at Concentra, including Dr. Armondo Martinez, an orthopedic surgeon. In April 2010, Dr. Martinez, after observing swelling of petitioner's right hand and fingers, referred petitioner [435 N.J.Super. 90] to another Concerta physician, Dr. Jonathan Lester, a specialist in physical rehabilitative medicine and pain management.
During the course of his authorized treatment of petitioner from April 28, 2010 to July 20, 2011, Dr. Lester diagnosed her back complaints as a lumbar strain and her right hand and arm complaints as Complex Regional Pain Syndrome (CRPS), also known as Reflex Sympathetic Dystrophy. He found that she had significant edema of the right hand, increased temperature in the right hand compared to the left, significant tenderness or pain from light palpitation or squeezing, and " exquisite" pain from light touch of the right hand. Dr. Lester recommended several treatments, which respondent's insurer would not approve, including a series of nerve blocks, which he opined were often effective for treating CRPS.
Respondent referred petitioner to Dr. Gallick in July 2010 for an evaluation. Dr. Gallick determined, after examining petitioner, that she could return to work and no longer needed any treatment. Respondent ceased providing medical treatment and temporary benefits, and petitioner filed a motion for their resumption.
On October 15, 2010, the judge of compensation ordered respondent to resume providing petitioner with medical treatment until the receipt of the reports of respondent's medical evaluators. Respondent scheduled evaluations with Dr. Eric L. Fremed, a neurologist, on November 1, 2010, and with Dr. David J. Gallina, a psychiatrist, on November 30, 2010. Respondent also referred petitioner for treatment to Dr. Nilaya Bhawsar, a neurologist, who diagnosed her with CRPS, prescribed medication, and recommended that she be treated " aggressively" with nerve blocks. Respondent did not follow Dr. Bhawsar's recommendation because its two ...