In re Joosten

103 Misc. 2d 140, 425 N.Y.S.2d 718, 1980 N.Y. Misc. LEXIS 2088
CourtNew York Supreme Court
DecidedJanuary 15, 1980
StatusPublished
Cited by3 cases

This text of 103 Misc. 2d 140 (In re Joosten) is published on Counsel Stack Legal Research, covering New York Supreme Court primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
In re Joosten, 103 Misc. 2d 140, 425 N.Y.S.2d 718, 1980 N.Y. Misc. LEXIS 2088 (N.Y. Super. Ct. 1980).

Opinion

OPINION OF THE COURT

James F. Niehoff, J.

On February 24, 1976 the petitioner Joseph M. Joosten, while acting in the course of his employment, was operating his motor vehicle in the southbound lanes of Jerusalem Avenue in Hicksville, New York. At the same time, Joan Fagan was traveling in a northbound direction on Jerusalem Avenue when a vehicle owned by Carmine Annunziato and driven by Catherine Annunziato exited from a shopping center on the west side of the street, entered the northbound lanes of Jerusalem Avenue, and struck the Fagan vehicle. The Fagan vehicle then went out of control, continued north on Jerusalem Avenue, crossed a grassy median, entered the southbound lanes and ultimately struck the Joosten automobile.

Mr. Joosten, who was 35 years of age at the time of the accident and married to Barbara L. Joosten, sustained a massive closed head injury in the nature of a fracture and was unconscious for many weeks following the initial trauma as a result of which he sustained diffuse brain damage. Following his discharge from the Nassau County Medical Center, Mr. Joosten’s mental condition was such that his behavior could best be described as infantile, his general fund of information was severely reduced, and he has a barely functional left eye. There is no question but that his disability is total and permanent.

Inasmuch as the petitioner was injured during the course of [142]*142his employment, he was entitled to and did collect workers’ compensation benefits in the amount of $87,677.09, which payments are still continuing and which will in time result in a workers’ compensation deficiency. The lien of the compensation carrier, the St. Paul Fire and Marine Insurance Company (St. Paul), remains unpaid to date.

It should be noted that Mr. Joosten had purchased extra no-fault insurance coverage from Valley Forge Insurancé Company which provided for maximum potential benefits in the amount of $150,000.

An action was begun on behalf of Joseph M. Joosten and Barbara L. Joosten as plaintiffs against Catherine Annunziato, Carmine Annunziato and Joan Fagan, as defendants, which resulted in an offer of settlement from both of the liability insurance companies involved for the limits of their respective policies, namely, $100,000 each.

At the time the offer of settlement was made it was agreed before the Justice then sitting in Trial Term, Part 1, that $160,000 of the $200,000 settlement would be allocated to Joseph Joosten on his cause of action and that $40,000 would be allocated to Barbara Joosten on her cause of action for loss of services and that it would be the Joostens’ obligation to satisfy the existing workers’ compensation lien out of the settlement. At the same time, the parties agreed that a Justice of this court would decide the rights of the plaintiff, Joseph M. Joosten, under section 29 of the Workers’ Compensation Law, and his attorneys, Crowe, McCoy, Agoglia, Fogarty and Zweibel, P. C., for reasonable counsel fees in recovering the workers’ compensation lien heretofore asserted by St. Paul Fire and Marine Insurance Company.

Thereafter, the petitioners Joseph M. Joosten and Barbara L. Joosten, brought on a formal petition for an order (1) permitting the petitioners to compromise and settle this action and (2) fixing the amount of the liens, if any, due to the workers’ compensation carrier and/or the no-fault carrier.

By short form order dated September 11, 1979, Mr. Justice Howard E. Levitt referred this matter to Special Term, Part II, of this court for hearing and determination. Ultimately the matter was referred to this court for determination. In the papers submitted and by later stipulation, the parties agreed to the operative facts set forth above and requested that this court render a decision based thereon.

The petitioners contend that St. Paul, the workers’ [143]*143compensation carrier, must pay its equitable share of attorneys’ fees as provided in subdivision 1 of section 29 of the Workers’ Compensation Law.

The respondent St. Paul claims that it is entitled to full satisfaction of its lien out of the proceeds of the no-fault insurance policy without sharing in the expenses incurred by the petitioners in bringing about the settlement with the third-party tort-feasors. More specifically, the respondent claims that according to insurance regulations, the petitioner should be directed to execute an assignment to it so that as the workers’ compensation carrier it may seek direct reimbursement from the carrier liable for the first-party benefits under the no-fault law (Valley Forge Insurance Company). Under such a direct reimbursement procedure, there would be no apportionment of attorneys’ fees since no fees would be earned by the petitioners’ attorneys with respect to St. Paul’s lien.

The insurance regulations upon which the respondent relies are 11 NYCRR 65.6 (p) (5) and 11 NYCRR 65.15 (p) (5).

The latter section, 11 NYCRR 65.15, is entitled "Claims for personal injury protection benefits — accidents on and after December 1, 1977”. Inasmuch as the accident herein occurred on February 24, 1976 that section is not applicable to this matter and need not be considered.

The former section, 11 NYCRR 65.6, is entitled "Claims for personal injury protection benefits — accidents prior to December 1, 1977” and is applicable herein. Section 65.6 (p) thereof is entitled "Offsets” and paragraph (5) of that subdivision is entitled "Workers’ compensation liens — Reimbursement of section 671(2) (b) offset.”

Section 65.6 (p) (5) was enacted to implement the holding of the Court of Appeals in Grello v Daszykowski (44 NY2d 894) to the effect that the no-fault carrier must bear the loss once a compensation carrier executes on its lien. The insurance regulation sets forth two procedures for reimbursement of the workers’ compensation carrier by the no-fault carrier.

The first procedure applies to situations where there is a third-party action brought by a claimant or by his workers’ compensation carrier as assignee. Under that procedure, when the lien of the provider of workers’ compensation benefits has been satisfied out of the proceeds of any recovery obtained by or on behalf of a claimant against a third-party tort-feasor, upon the submission of proof of satisfaction of the lien, the no-[144]*144fault insurer must make the claimant whole with respect to first-party benefits for items of basic economic loss not recoverable in an action (11 NYCRR 65.6 [p] [5] [ii]) for which the no-fault carrier has received its deduction pursuant to section 671 (subd 2, par [b]) of the Insurance Law.

The second procedure applies to situations where the claimant assigns his payment right to the workers’ compensation provider and is set forth as follows: "(iii) In lieu of the procedure set forth in subparagraph (ii) of this paragraph, subject to acceptance by the workers’ compensation provider, the claimant may assign the payment right to the workers’ compensation provider as an alternative to the workers’ compensation provider obtaining satisfaction of its lien directly from the claimant’s recovery. The assignment shall be effective only if there has been a recovery made pursuant to section 673(1) of the Insurance Law.

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Bluebook (online)
103 Misc. 2d 140, 425 N.Y.S.2d 718, 1980 N.Y. Misc. LEXIS 2088, Counsel Stack Legal Research, https://law.counselstack.com/opinion/in-re-joosten-nysupct-1980.