O'BRIEN v. Two West Hanover Co.

795 A.2d 907, 350 N.J. Super. 441
CourtNew Jersey Superior Court Appellate Division
DecidedApril 30, 2002
StatusPublished
Cited by6 cases

This text of 795 A.2d 907 (O'BRIEN v. Two West Hanover Co.) is published on Counsel Stack Legal Research, covering New Jersey Superior Court Appellate Division primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
O'BRIEN v. Two West Hanover Co., 795 A.2d 907, 350 N.J. Super. 441 (N.J. Ct. App. 2002).

Opinion

795 A.2d 907 (2002)
350 N.J. Super. 441

Thomas O'BRIEN, Plaintiff-Appellant,
v.
TWO WEST HANOVER COMPANY and Lorraine Benkendorf d/b/a Benkendorf Electrolysis, Defendants, and
Local 464A UFCW Group Reimbursement Welfare Fund, Defendant/Intervenor-Respondent.

Superior Court of New Jersey, Appellate Division.

Submitted February 25, 2002.
Decided April 30, 2002.

*908 Kopelson & Westreich, attorneys for appellant (Robert Westreich, on the brief).

Mizzone, Filko & Mizzone, attorneys for respondent (Elissa Mizzone Testa, of counsel and on the brief).

Before Judges PETRELLA, KESTIN, and STEINBERG.

The opinion of the court was delivered by STEINBERG, J.A.D.

Plaintiff Thomas O'Brien appeals from an order granting the motion of intervenor Local 464A UFCW Group Reimbursement Welfare Fund (Fund) to enforce its claimed right of subrogation. Plaintiff initially sued defendants Two West Hanover Company and Lorraine Benkendorf, doing business as Benkendorf Electrolysis, for personal injuries. The Fund is a union benefits plan which provides medical, surgical, and hospital benefits to participants. After plaintiff's personal injury claim was settled, the Fund moved to intervene for the purpose of enforcing its claimed lien for medical payments it had expended on plaintiff's behalf. While plaintiff's procedural history does not provide a full explanation, it appears the parties agreed to enter into a stipulation of facts they believed relevant to allow the judge to make a legal determination of the Fund's claim.

The parties stipulated that the Fund's plan "is governed by ERISA." The stipulation also provided as follows:

The Plan provides that a member must first seek payment of medical expenses from "other sources," including the proceeds of any lawsuit, before payment is authorized by the Plan.

The Plan provides expressly that the payments from "other sources" include only payments intended as compensation for medical expenses[,] not injuries:

If you have been involved in any form of ... accident and can be paid for your medical and surgical expenses, you must seek reimbursement...[.]

If you have ... any other source from which you can receive ... damages which would include a claim for recovery of costs of medical hospital care... [you must pursue such source.]

So that the members will understand, this Plan has been adopted for the Protection of our Members to make *909 certain that they will be made whole and not be compelled to pay out of their own pockets, whenever possible, for medical and hospital care.

Plaintiff executed a subrogation agreement, which assigned "to Local 464A and United of Omaha the right to receive and collect" the proceeds of any funds received, or to be received, as a result of litigation. The agreement further provided that its purpose was to reimburse the Fund for any and all expenses incurred as a result of payment of hospital, medical, and related bills on plaintiff's behalf.

The Fund paid medical benefits of $38,840 for plaintiff and asserted that its "lien," less a one-third attorney fee, was $25,906.33. The eighth paragraph of the stipulation reads as follows:

The underlying case was settled for $275,000.00, an amount that constituted less than full compensation to the Plaintiff for his injuries, which include a $360,000 wage loss and significant loss of function in his lower back. Plaintiff compromised his claim because his need for back surgery did not appear until more than two years after his slip and fall and there were, consequently, doubts about Defendants' liability. Although the Plan stipulates to the statements in this paragraph, it has no independent information bearing on the facts stipulated.

Relying upon Werner v. Latham, 332 N.J.Super. 76, 752 A.2d 832 (App.Div. 2000), plaintiff's attorney later advised the Fund that he would not pay any portion of its claim on the ground that the settlement did not provide full compensation to plaintiff for his injuries.[1] The motion judge concluded that the Employee Retirement and Income Security Act (ERISA), 29 U.S.C. §§ 1001-1461 (1999), preempted New Jersey law and directed that the funds in dispute (which apparently had been placed in escrow) be paid to the Fund. Plaintiff appeals, contending that Werner required the judge to find that none of the funds received by him in settlement were subject to the Fund's claim for reimbursement. Because we conclude that the stipulation of facts was inadequate to allow the judge to make an informed decision, we are constrained to reverse and remand.

This case involves the interplay of ERISA, the collateral source rule, N.J.S.A. 2A: 15-97, and the impact, if any, of Werner upon those statutes.

N.J.S.A. 2A:15-97 provides as follows:

In any civil action brought for personal injury or death, ... if a plaintiff receives or is entitled to receive benefits for the injuries allegedly incurred from any other source other than a joint tortfeasor, the benefits, other than workers' compensation benefits or the proceeds from a life insurance policy, shall be disclosed to the court and the amount thereof which duplicates any benefit contained in the award shall be deducted from any award recovered by the plaintiff, less any premium paid to an insurer directly by the plaintiff or by any member of the plaintiff's family on behalf of the plaintiff for the policy period during which the benefits are payable. Any party to the action shall be permitted to introduce evidence regarding any of the matters described in this act.

N.J.S.A. 2A: 15-97 eliminates the possibility of double recovery by requiring a deduction "from any tort judgment the amount received by plaintiff from collateral sources (other than workers' compensation and life insurance) less any insurance *910 premiums plaintiff has paid." Perreira v. Rediger, 169 N.J. 399, 409, 778 A.2d 429 (2001). In reviewing the legislative history, the Court concluded that while the primary purpose of the statute was to disallow double recovery to plaintiffs, there was a secondary goal of containing spiraling automobile insurance costs. Id. at 409-410, 778 A.2d 429. In essence, the Legislature elected to benefit liability carriers by reducing the tort judgment by the amount of health care benefits received and left health insurers in the same position as they were prior to the enactment of the statute. Id. at 410-11, 778 A.2d 429. In other words, the burden of paying the medical expenses fell upon health insurers.

Notably, the statute is silent regarding a health insurer's rights to either subrogation or reimbursement. Id. at 409, 778 A.2d 429. Because the purpose of N.J.S.A. 2A:15-97 was to eliminate double recovery to plaintiffs and allocate "the benefit of what had previously been double recovery to the liability insurance industry," the Court further held that where the collateral source rule applies, the benefits provided by the health care insurer are subtracted from the judgment. Id. at 416, 778 A.2d 429. Thus, subrogation provisions in health care policies or plans "only apply to cases that do not involve the collateral source rule." Id. at 418, 778 A.2d 429. Hence, we must determine whether the collateral source rule applies.

In determining whether the collateral source rule applies, we must consider ERISA and its impact upon the collateral source rule.

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Bluebook (online)
795 A.2d 907, 350 N.J. Super. 441, Counsel Stack Legal Research, https://law.counselstack.com/opinion/obrien-v-two-west-hanover-co-njsuperctappdiv-2002.