Author: Jones Jones

Jones Jones LLC congratulates Associates Samantha Sharpe, Diandra Archbald and Diane Mandleur, and their team on securing a dismissal of a New York insurance claim under a New Jersey insurance policy.

In this case, the claimant alleged that while working for a car transport company, located in Englewood, NJ, they were involved in a motor vehicle accident in Brooklyn. As the claimant was employed in New Jersey, they were insured in New Jersey, however they filed the claim for New York.

The claimant testified that on the date of the injury, they were in Brooklyn after picking up a vehicle to bring back to New Jersey. When given the chance to cross-examine the claimant, the Jones Jones team dug deeper into the questions relative to the policy. This resulted in a testimony from the claimant that they were advised upon hire that they would be regularly sent out of New Jersey to pick up cars and would often be sent to different boroughs in New York to pick up cars.

Upon further research, our team discovered that the claimant only had New Jersey coverage on their policy. Further, the policy had very specific language dictating that if the insured had business in any other state, they were required to notify the underwriter within 30 days of the inception. The underwriter stated that for this case they were not notified of the New York relationship until after the injury was filed in 2023. As a result, this accident in New York was not covered under the New Jersey policy based on the insured’s failure to notify the underwriter of the true work being performed outside of New Jersey.

The Jones Jones team argued that between the claimant’s testimony and the underwriter’s testimony, there was in fact no coverage for New York based on the insured employer’s failure to disclose their business in New York. The Law Judge agreed with the Jones Jones team and found on behalf of the carrier that their New Jersey coverage did not extend to New York based on the insured’s failure to disclose their true dealings in New York and discharged the carrier.

Sharpe, Archbald and Mandleur showcased exemplary dedication to finding the right information for the client through their research and cross-examination skills in this case. Well done to the entire team. If you are in need of assistance with a workers’ compensation case, please contact our appellate team at clientservices@jonesjonesllc.com.

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Jones Jones LLC congratulates Associate Erica Francisco-Lau and her team on securing an out-of-state dismissal on behalf of an international airline in New Jersey. This dismissal comes amid a rise in filings of similar Pennsylvania workers’ compensation cases in the state of New Jersey.

In this case, the medical provider of a Pennsylvania worker for a major airline filed a claim to recover bills for surgery and appointments totaling over $61,000. The worker was injured in Pennsylvania while working as a baggage handler since 2012. As a New Jersey resident, the petitioner received some medical treatment in New Jersey where the claim was filed. In a trend we have seen applied in similar out-of-state cases, the claim was filed in New Jersey because the reasonable and customary standard is considerably higher than the Pennsylvania fee schedule prescribes.

After working closely with the airline, Erica and her team confirmed that the petitioner was hired in Pennsylvania and never worked for the airline in New Jersey. The team filed a motion to dismiss the claim in court on the basis that the medical provider’s counsel could not prove that New Jersey had any jurisdiction over this Pennsylvania worker’s compensation claim. The judge granted the motion and dismissed the case with prejudice, forcing the medical provider to consult the Pennsylvania’s Workers’ Compensation Board to dispute the bill amount paid.

Erica and her team produced an incredible outcome for our client, securing this dismissal thanks to her team’s keen understanding of workers’ compensation law, particularly across state lines. Please join us in congratulating Erica and her team. If you are in need of assistance with a workers’ compensation case, please contact our appellate team at clientservices@jonesjonesllc.com .

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