# Gina Parascandolo v. Department of Labor, Board of Review, Brick Township Board of Education and Vinny's King Pizza

> New Jersey Superior Court Appellate Division · May 22, 2014 · 435 N.J. Super. 617

URL: https://www.frixlaw.com/law-library/cases/2675365

## Case

- **Court:** New Jersey Superior Court Appellate Division
- **Decided:** May 22, 2014
- **Citations:** 435 N.J. Super. 617; 90 A.3d 669; 2014 N.J. Super. LEXIS 73; 2014 WL 2117514
- **Precedential status:** Published
- **Opinion:** Opinion
- **Cited by:** 3 later opinions in the Frix Law Library

## Citator (automated)

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## Opinion text

NOT FOR PUBLICATION WITHOUT THE
APPROVAL OF THE APPELLATE DIVISION

SUPERIOR COURT OF NEW JERSEY
APPELLATE DIVISION
DOCKET NO. A-3209-11T1

GINA PARASCANDOLO,

Appellant, APPROVED FOR PUBLICATION

v. May 22, 2014

DEPARTMENT OF LABOR, APPELLATE DIVISION
BOARD OF REVIEW, BRICK
TOWNSHIP BOARD OF
EDUCATION and VINNY'S
KING PIZZA,

Respondents.
________________________________________________________________

Submitted October 16, 2013 – Decided May 22, 2014

Before Judges Fisher, Espinosa and Koblitz.

On appeal from the Board of Review,
Department of Labor, Docket No. 333,049.

Pezzano Mickey & Bornstein LLP, attorneys
for appellant (Lisa Pezzano Mickey, on the
brief).

John J. Hoffman, Acting Attorney General,
attorney for respondent Board of Review
(Lewis A. Scheindlin, Assistant Attorney
General, of counsel; Alan C. Stephens,
Deputy Attorney General, on the brief).

Berry, Sahradnik, Kotzas & Benson, attorneys
for respondent Brick Township Board of
Education, join in the brief of respondent
Board of Review.

Respondent Vinny's King Pizza has not filed
a brief.
The opinion of the court was delivered by

ESPINOSA, J.A.D.

In enacting the Temporary Disability Benefits Law (TDBL),

N.J.S.A. 43:21-25 to -66, the Legislature sought to provide

relief to workers who suffered involuntary unemployment and loss

of wages due to illness or injury that was not covered by the

Workers' Compensation Act (WCA), N.J.S.A. 34:15-1 to -128.5.

The TDBL was to "fill the gap" in existing employee welfare

legislation and expressly provided that its benefits should not

duplicate benefits provided under the WCA. See N.J.S.A. 43:21-

26, -30. Because the TDBL was generally applied to situations

involving one employer, the legal issue that typically arose

thereafter involved an "either/or" analysis; the injury was

either covered by the WCA or the TDBL but not both.

We first considered the interplay of the two statutes in a

case where the worker had two employers in In re Scott, 321 N.J.

Super. 60 (App. Div. 1999), aff'd, 162 N.J. 571 (2000). The

worker was injured at his part-time job and we determined that

the receipt of temporary workers compensation benefits (TWCB)

from that employer did not bar the receipt of temporary

disability benefits (TDB) for the loss of wages from his primary

employer. Id. at 65-66. This appeal requires us to examine the

interplay of the two statutes once again to determine their

2 A-3209-11T1
application when only one of two employers is a "covered

employer" under the TDBL and whether the right to subrogation

applies under such circumstances even though there was no

duplication of benefits.

Appellant Gina Parascandolo held two part-time jobs when

she was injured in the course of her employment at one of the

jobs. She received TWCB from the employer where she was

injured, a public employer that did not participate in the State

Disability Benefits Fund, and TDB through her other employment.

Although she received both forms of benefits, she did not

receive duplicate benefits. She appeals from a final agency

decision of the Department of Labor, Board of Review (the

Board), that held appellant was obligated to reimburse the

Division of Temporary Disability Insurance (the Division)

because she received both TDB and TWCB for the same injury. For

the reasons that follow, we reverse.

I

We begin by briefly reviewing the history of employee

welfare legislation, which began with the enactment of the WCA.

Originally enacted in 1911, the WCA represented a "'historic

trade-off whereby employees relinquished their right to pursue

common-law remedies in exchange for automatic entitlement to

certain, but reduced, benefits whenever they suffered injuries

3 A-3209-11T1
by accident arising out of and in the course of employment.'"

Van Dunk v. Reckson Assoc. Realty Corp., 210 N.J. 449, 458-59

(2012) (quoting Millison v. E.I. du Pont de Nemours & Co., 101

N.J. 161, 174 (1985)). Compensation under the WCA is limited to

injuries suffered "in the course of employment when the employee

is engaged in the direct performance of duties assigned or

directed by the employer." N.J.S.A. 34:15-36; see Hersh v.

Cnty. of Morris, 217 N.J. 236, 249-50 (2014).

The next development came in 1936 with the passage of the

Unemployment Compensation Law (UCL), N.J.S.A. 43:21-1 to -24.30.

See Butler v. Bakelite Co., 32 N.J. 154, 160 (1960). From the

outset, the UCL was recognized as remedial legislation, its

"primary objective" being "to provide a cushion for the workers

of New Jersey 'against the shocks and rigors' of unemployment."

Philadelphia Newspapers, Inc. v. Bd. of Review, 397 N.J. Super.

309, 318 (App. Div. 2007) (internal citation omitted), certif.

denied, 195 N.J. 420 (2008). Accordingly, the provisions of the

UCL are liberally construed, even permitting a statutory

employer-employee relationship, the "center of the UCL," to be

found when the facts might not satisfy common law principles.

Id. at 318-19.

However, the worker who suffered involuntary unemployment

as the result of a disabling accident or illness that did not

4 A-3209-11T1
arise in the course of employment received no relief from these

statutes. See Butler, supra, 32 N.J. at 160-62; Janovsky v. Am.

Motorists Ins. Co., 11 N.J. 1, 4 (1952). In enacting the TDBL

in 1948, the Legislature recognized the need

to fill the gap in existing provisions for
protection against the loss of earnings
caused by involuntary unemployment, by
extending such protection to meet the hazard
of earnings loss due to inability to work
caused by nonoccupational sickness,
accidents, or other disabilities of workers.

[N.J.S.A. 43:21-26 (emphasis added).]

The Legislature declared that the TDBL was remedial

legislation to be liberally construed. Ibid. The Legislature

also clearly expressed its intent that, while the TDBL was to

fill a gap in the protections afforded by the WCA and the UCL,

it would not duplicate the benefits provided by those statutes.

The TDBL thus allows "the payment of reasonable cash benefits to

eligible individuals who are subject to accident or illness

which is not compensable under the workers' compensation law."

Ibid. (emphasis added). With certain specified exceptions,

N.J.S.A. 43:21-30(b) explicitly bars the duplication of benefits

paid under the WCA:

No benefits shall be required or paid under
this act for any period with respect to
which benefits . . . are paid or payable on
account of the disability of the covered
individual under any workers' compensation
law . . . .

5 A-3209-11T1
Thereafter, the legal issue that was typically raised was

which of the statutes applied to provide relief to the worker

who suffered a loss of wages due to involuntary unemployment.

See, e.g., Janovsky, supra, 11 N.J. at 3-5; see also Butler,

supra, 32 N.J. at 157. As the Court explained,

Where an employee is disabled by accident or
illness he will generally be entitled to
benefits under either the compensation law
or the benefits law, but not under both. If
liability under the compensation law is
clear, payment will be made thereunder, and
if absence of liability under that statute
is clear, payment will be made under the
benefits law.

[Janovsky, supra, 11 N.J. at 5 (emphasis
added).]

A "twilight zone" was recognized for cases when "liability

under the compensation law [is] doubtful and dependent on the

outcome of contested proceedings." Ibid. In such cases, the

TDBL provides benefits "to help tide the worker over during his

inability to work . . . with full reimbursement from any award

subsequently rendered in the compensation proceeding." Ibid.;

N.J.S.A. 43:21-30(b)(1), (2).

The application of this nonduplication requirement is

straightforward in cases where the employee holds one job. See

Sperling v. Bd. of Review, 301 N.J. Super. 1, 5 (App. Div.

1997), aff’d, 156 N.J. 466 (1998). When an employee has only

6 A-3209-11T1
one job and suffers an injury "arising out of and in the course

of his employment," Janovsky, supra, 11 N.J. at 4, it is clear

the injury is compensable under the WCA and, therefore, any TDB

for the same injury would duplicate those benefits. It was

within that factual context that we held in Sperling that an

individual who obtains workers' compensation benefits by

settlement "may not obtain temporary disability benefits for the

same injury." Sperling, supra, 301 N.J. Super. at 5 (emphasis

added). However, the interplay between the two statutes

requires closer scrutiny when, as here, the employee has more

than one job.

In 1999, we decided Scott, which, we recognized, was unlike

cases such as Janovsky and Sperling that dealt "with the

traditional situation of a worker who has one job and is injured

in circumstances not covered, or clearly covered, by workers'

compensation." Scott, supra, 321 N.J. Super. at 65. In Scott,

the employee held both full-time employment, with Konica

Business Machines, and a part-time job, with Holiday Bowl. He

was injured "in the course of his employment" at his part-time

job. Id. at 62-63. He obtained workers' compensation for the

injury calculated solely on his earnings from Holiday Bowl.

Ibid. As a result, the compensation benefits he received were

less than he would have received if the accident occurred at

7 A-3209-11T1
Konica. Id. at 64. His application for TDB based on his

inability to work at his full-time employment was denied by a

private plan hearing officer. Id. at 63. On appeal, Konica

argued that no TDB should be paid because "such benefits are

payable only for injuries 'not compensable under the workers'

compensation law,' N.J.S.A. 43:21-29," and argued further that,

because Scott obtained workers' compensation from Holiday Bowl,

N.J.S.A. 43:21-29 and -30 prohibited the payment of any TDB to

him. Scott, supra, 321 N.J. Super. at 63-64.

We acknowledged that the argument had "some literal appeal"

but rejected the notion that the Legislature intended a blanket

prohibition against the payment of any TDB:

[W]e do not interpret those provisions to
reflect a legislative intention to deny all
temporary disability benefits to a disabled
full-time worker, merely because he receives
a workers' compensation award as a result of
an accident "arising out and in the course
of" unrelated part-time employment, when the
workers' compensation benefits he receives
are calculated solely on the basis of his
earnings with that employer and are far less
than would have been payable had the
accident occurred on the full-time job.

[Id. at 64.]

Noting the remedial nature of the TDBL, N.J.S.A. 43:21-26,

we found

neither logical support nor empirical
evidence that the Legislature intended to
deprive a worker who pays deductions for

8 A-3209-11T1
temporary disability benefits from obtaining
those benefits to compensate him for the
loss of income at his full-time employment
merely because his injury occurred at a
second or part-time job taken to supplement
that income.

[Id. at 65.]

We observed, "The employee should not be worse off because the

accident, not related to his full-time or prime employment and

therefore otherwise entitling him to temporary disability

benefits through that employer, happened to occur at an

unrelated part-time work site." Id. at 66.

We remanded the case to the Department of Labor for further

proceedings consistent with our opinion. Citing Justice Stein's

concurring opinion in Sperling v. Bd. of Review, 156 N.J. 466,

468 (1998), we directed the Department of Labor to examine

"whether the disability carrier should be entitled to a set-off

'to the extent of the' temporary workers' benefits obtained

through workers' compensation . . . or in some other amount" and

the manner in which such a set-off would be undertaken. Scott,

supra, 321 N.J. Super. at 66-67 (emphasis added). Significantly

for the purposes of this appeal, both employers in Scott were

"covered employers" under the TDBL, and we did not establish any

procedure to be followed regarding a set-off. Rather, we stated

the set-off argument "must be examined in light of our

conclusion that the statutory interplay itself must be examined

9 A-3209-11T1
separately with respect to each job." Id. at 66 (emphasis

added). And, we explicitly adopted the point emphasized by

Justice O'Hern in his separate opinion in Sperling:

It is quite obvious to even the most casual
reader of its title that N.J.S.A. 43:21-30
intends to avoid double recovery, not full
recovery. Although no specific offset
provision exists, the purpose of the law
demonstrates that recovery for temporary
disability and workers' comp is not mutually
exclusive. The title to N.J.S.A. 43:21-30
is "Nonduplication of benefits," not
"Election of benefits."

[Sperling, supra, 156 N.J. at 473 (O'Hern,
J., concurring and dissenting).]

Our opinion thus moved the interpretation of the

nonduplication provisions of the TDBL away from a literal

approach that would permit language designed to preclude "double

recovery" to unfairly limit a worker's benefits based upon

chance circumstances when a worker has more than one job. As we

emphasized, the interplay between the WCA and the TDBL "must be

examined separately with respect to each job." Scott, supra,

321 N.J. Super. at 66. As part of that examination, due

consideration should be given to the employee's payments for TDB

and the principle that it is only double recovery, not full

recovery, of benefits that is prohibited. Our decision prompted

both legislative and regulatory action.

10 A-3209-11T1
N.J.S.A. 43:21-30(b)(3) was intended to codify Scott by

establishing a set-off procedure:

If there has been a settlement of a workers'
compensation claim pursuant to [N.J.S.A.]
34:15-20 in an amount less than that to
which the claimant would otherwise be
entitled as disability benefits under the
[TDBL] for the same illness or injury, the
claimant shall be entitled to disability
benefits for the period of disability,
reduced by the amount from the settlement
received by the claimant under [N.J.S.A.]
34:15-20.

The Department of Labor promulgated N.J.A.C. 12:18-1.5 to

"conform[] the regulations to the Scott decision which addressed

the issue of the offset by the Division of Temporary Disability

Insurance of temporary workers' compensation benefits." 33

N.J.R. 3622(a) (Oct. 15, 2001).1

The Department's statement regarding the proposed rule

explained that it had been "rewritten to ensure that the

Division or the private plan retains the right of subrogation"

to all aspects of workers' compensation awards, as upheld in

Janovsky, supra, "thereby insuring the integrity of the

Temporary Disability Trust Fund . . . . Specifically, to permit

a claimant to keep disability benefits and temporary workers'

1
The Division of Temporary Disability's right of subrogation of
duplicate workers' compensation benefits was previously
established by N.J.S.A. 34:15-57.1.

11 A-3209-11T1
compensation benefits would result in a windfall not

contemplated by law." Ibid. (emphasis added). Addressing the

concern we raised in Scott, the Department stated the rule would

ensure that an employee who works more than
one job, who is injured during the course of
his or her duties with one of his or her
employers, and who seeks to collect
disability benefits, is not worse off merely
because his or her injury or illness
occurred at a second job taken to supplement
his or her income. In other words, the
proposed new rule seeks to ensure that
injured workers in New Jersey receive all of
the benefits to which they are entitled by
law.

[Ibid. (emphasis added).]

N.J.A.C. 12:18-1.5 states,

(a) If a covered individual with more
than one employer receives temporary
workers' compensation benefits for an injury
or illness incurred at one place of
employment and that individual files a claim
for New Jersey temporary disability benefits
as a result of the same injury or illness on
the basis of his or her employment with the
other employer(s), those benefits are
payable under the New Jersey State plan or
an approved private plan provided that:

1. The claimant otherwise meets the
eligibility criteria for temporary
disability benefits in accordance with [the
TDBL];

2. Wages from all covered employers are
used to calculate the temporary disability
insurance weekly benefit rate . . . ;

3. The temporary disability insurance
weekly benefit rate is reduced by the

12 A-3209-11T1
temporary workers' compensation weekly
benefit rate;

4. The claimant receives the temporary
disability insurance benefits at the
adjusted rate; and

5. Any such reduction in the temporary
disability insurance weekly benefit rate
shall also reduce the maximum total benefits
payable during the period of disability.

II

We now turn to the facts of this case.

Appellant had two part-time jobs. At the time of her

injury, her major source of income was her part-time job with

Vinny's Pizza, where she earned $500 per week. She was also

employed, part-time, as a cafeteria worker by the Brick Township

Board of Education (BOE), earning approximately $215 per week.

She tore the rotator cuff on her right shoulder after picking up

a heavy tray at BOE and eventually required surgery. She was

unable to work for either employer for the period from January

20, 2009, through May 1, 2009.

The TDBL established an entitlement program funded out of

contributions paid by covered employers and employees, N.J.S.A.

43:21-46; N.J.S.A. 43:21-7(d)(1)(G); N.J.S.A. 43:21-7(e). Only

one of appellant's employers, Vinny's Pizza, was a "covered

employer" under the TDBL. N.J.S.A. 43:21-27(a)(1) defines a

"covered employer" as "any . . . employer subject to the

13 A-3209-11T1
'unemployment compensation law' . . . except the State, its

political subdivisions, and any instrumentality of the State

unless such governmental entity elects to become a covered

employer." Because BOE did not elect to participate in the TDB

program, it is not a "covered employer." It did not contribute

to the State Disability Benefits Fund and no contributions

toward the fund were taken from the wages appellant earned from

BOE.

Through her employment with Vinny's, appellant contributed

to the State Disability Benefits Fund as required by N.J.S.A.

43:21-46 and N.J.S.A. 43:21-7(d)(1)(G). Accordingly, when

appellant became unable to work due to her injury, she filed a

claim for TDB for the loss of her income from Vinny's Pizza in

January 2009.2 Following instructions given her by the

Division's customer service representative, appellant submitted

a claim form that stated she had not been injured during the

course of her employment at Vinny's. However, she also supplied

a certification from BOE, which stated her injury was work-

related and that a workers' compensation claim was anticipated.

N.J.S.A. 43:21-40 provides in pertinent part that the

amount of an individual's weekly TDB "shall be two-thirds of his

2
Appellant identified her employer as "Vinnie's Pizza" on her
claim form. Since all pleadings refer to the employer as
"Vinny's Pizza," we use that spelling.

14 A-3209-11T1
average weekly wage, subject to a maximum of 53% of the

Statewide average weekly remuneration paid to workers by

employers." The definition of "average weekly wage"3 contained

in N.J.S.A. 43:21-27(j) is explicitly linked to the amount of

3
As applied to appellant's claim for TDB, N.J.S.A. 43:21-27(j)
provides, in pertinent part:

(1) "Average weekly wage" means the amount
derived by dividing a covered individual's
total wages earned from the individual's
most recent covered employer during the base
weeks . . . by the number of such base
weeks.

(2) If the computation in paragraph (1)
. . . yields a result which is less than the
individual's average weekly earnings in
employment with all covered employers during
the base weeks . . . then the average weekly
wage shall be computed on the basis of
earnings from all covered employers during
the base weeks . . . .

(3) For periods of disability commencing on
or after July 1, 2009, if the computations
in paragraphs (1) and (2) . . . both yield a
result which is less than the individual's
average weekly earnings in employment with
all covered employers during the base weeks
in the 26 calendar weeks immediately
preceding the week in which the period of
disability commenced, then the average
weekly wage shall, upon a written request
. . . be computed by the department on the
basis of earnings from all covered employers
of the individual during the base weeks in
those 26 calendar weeks . . . .

[Emphasis added.]

15 A-3209-11T1
wages a "covered individual" earns from a "covered employer."

Similarly, the definition of "wages" to be used in interpreting

the TDBL is "all compensation payable by covered employers to

covered individuals for personal services . . . ." N.J.S.A.

43:21-27(h) (emphasis added).

Because BOE was not a "covered employer," only the wages

earned from Vinny's Pizza were used to calculate appellant's

weekly entitlement under the State Disability program.

Consistent with the weekly benefit rate authorized by N.J.S.A.

43:21-40, appellant received weekly TDB of $333 per week (minus

FICA), an amount equal to two-thirds of her average weekly wage

at Vinny's, for the period from January 20, 2009, to May 1,

2009.

In April 2009, appellant filed a claim petition with the

Division of Workers' Compensation for the injury she sustained

at BOE. Her claim for lost wages was based only on the gross

weekly wages she received from BOE, which she listed as $215.

BOE did not dispute her claim.

In September 2010, the Division of Temporary Disability

Insurance filed a Notice of Lien pursuant to N.J.A.C. 12:18-1.5

with the Division of Workers' Compensation in the amount of

$4,788.19 on the claim pending before the Division of Workers'

16 A-3209-11T1
Compensation. The amount of the lien represented the full

amount of TDB appellant had received.

That same month, appellant filed an appeal from the lien,

arguing she had not received a duplicate payment of benefits for

her injury. On April 5, 2011, the Division of Temporary

Disability reduced the lien to $2,848.23 to reflect the

difference between appellant's weekly benefit rate entitlement

to TDB and her weekly entitlement to TWCB. The net effect was

to reduce appellant's weekly TDB rate from $333, the equivalent

of two-thirds of her average weekly wage at Vinny's, to $135.

On March 31, 2011, an Order Approving Settlement was filed

in the Division of Workers' Compensation. Appellant and BOE

stipulated that appellant had "an admittedly compensable injury"

and agreed upon a 22 1/2% partial total permanent disability

award to appellant in the total amount of $23,271. The order

approving settlement listed her weekly wages as "$350

(reconstruct[)]" and the TWCB rate as "$198.00/$245.00." She

received $2,941.68 in TWCB. Appellant agreed to pay the revised

lien, reserving her right to appeal the assertion of the lien.

Appellant satisfied the lien before her appeal was

conducted telephonically by an Appeals Examiner in June 2011.

Testimony was taken from appellant and Robert Goyne, a

17 A-3209-11T1
supervisor in the Division of Temporary Disability Insurance's

claims intake section.

Goyne maintained that, pursuant to our decision in Scott,

and N.J.A.C. 12:18-1.5, a lien was required to reduce

appellant's TDB by the amount of workers' compensation paid.

According to Goyne, it was immaterial that BOE was not a covered

employer and that appellant's TDB was based solely upon her

wages from her only covered employer. He said that, "following

the Scott procedure," when there are two employers, one of whom

is paying workers' compensation benefits, "the [TDB] benefit

must be reduced by the amount of the workers' compensation if

the weekly benefit rate is higher." Goyne testified that the

lien of $2,848.23 represented the difference between the

benefits "exactly as the Scott procedure stated."

The Appeal Tribunal concluded that the lien was properly

imposed pursuant to N.J.A.C. 12:18-1.5, stating,

The evidence presented indicates that the
claimant received Workers' Compensation
benefits and State Plan Disability benefits
for the same disability for the same period
of time. In this case, the claimant's
monetary entitlement to State Plan
Disability benefits was based on her wages
earned solely with [Vinny's Pizza] since her
wages with [BOE] were not covered under the
State Plan Disability Law in accordance with
N.J.S.A. 43:21-27(a)(1). Her weekly benefit
rate of $333.00 is therefore considered
appropriate in accordance with N.J.A.C.

18 A-3209-11T1
12:18-1.5 since the calculation was based on
wages earned from all covered employers.

. . . [T]he claimant's entitlement to an
adjusted rate of $135.00 is also considered
appropriate under N.J.A.C. 12:18-1.5 since
she received Workers' Compensation benefits
in the amount of $198.00 per week as a
result of the same injury or illness.
Therefore, the claimant is liable for refund
in the amount of $2,848.23 for State Plan
Disability benefits paid from 1/20/2009
through 5/01/2009.

Appellant timely filed an appeal from the decision of the

Appeal Tribunal to the Board of Review, which affirmed the

decision of the Appeal Tribunal.

III

Appellant advances several arguments to support her

contention that the lien was improperly asserted here. She

argues that, because she was not entitled to receive workers'

compensation benefits for her loss of income from Vinny's, the

Division of Temporary Disability Insurance could not properly

assert a lien on her TWCB for the TDB she received based upon

her wages from Vinny's. She argues further that her TDB weekly

benefit should not have been reduced by the TWCB she received

based on her wages from BOE because those wages were not

included in calculating her TDB rate.4

4
In addition, appellant argues that her receipt of TWCB did not
disqualify her from receiving TDB for the income she lost from
(continued)

19 A-3209-11T1
The Board counters that, pursuant to N.J.S.A. 43:21-30 and

N.J.A.C. 12:18-1.5, appellant was paid TDB she was not entitled

to receive. Because both TDB and TWCB were paid for "the same

injury," the Board argues it correctly determined that a

reduction of appellant's TDB was required and that she is liable

for a partial refund of benefits pursuant to N.J.S.A. 43:21-

55.1.

We recognize that our review of administrative agency

decisions is "limited." Brady v. Bd. of Review, 152 N.J. 197,

210 (1997). An appellate court will not upset the ultimate

determination of an agency unless shown "that it was arbitrary,

capricious or unreasonable, that it lacked fair support in the

evidence, or that it violated legislative policies expressed or

implicit in the act" governing the agency. Campbell v. Dep't of

Civil Serv., 39 N.J. 556, 562 (1963); see also Brady, supra, 152

N.J. at 210. However, the central issue in this appeal concerns

the interpretation of our decision in Scott and the statute and

regulation that were intended to codify and implement it,

N.J.S.A. 43:21-30(b)(3) and N.J.A.C. 12:18-1.5. While we

(continued)
Vinny's. The Board does not contend that she was disqualified
from receiving TDB, only that the right to subrogation applied
to the TDB she received. Finally, she argues that the
Division's right to subrogation is limited to TDB payable under
the WCA, N.J.S.A. 34:15-12, and does not extend to permanency
benefits. We need not address this issue.

20 A-3209-11T1
respect an agency's expertise, the interpretation of statutes

and caselaw is ultimately a judicial, rather than an

administrative, function. We are therefore not bound by the

agency's interpretation. Mayflower Sec. Co. v. Bureau of Sec.,

64 N.J. 85, 93 (1973); see also Shim v. Rutgers, 191 N.J. 374,

384 (2007). "Although judicial review of administrative actions

is limited, courts will intervene when 'an agency action is

clearly inconsistent with its statutory mission or other state

policy.'" N.J. Ass'n of Realtors v. N.J. Dep't of Envtl. Prot.,

367 N.J. Super. 154, 160 (App. Div. 2004) (quoting In re Musick,

143 N.J. 206, 216 (1996)).

As we have noted, the Department expressly stated that

N.J.A.C. 12:18-1.5 was proposed to conform the regulations to

our decision in Scott. In its statement, the Department said

that the subrogation procedure set forth in the regulation would

preserve the integrity of the Fund and insure a full recovery of

benefits by the worker while precluding a windfall to the worker

that was not contemplated by the Legislature. These objectives

are fully compatible with Scott.

However, in Scott, we also stated that, when the injured

worker has more than one employer, the interplay of the TDBL and

WCA must be viewed separately with respect to each job. And,

the worker should not be worse off, i.e., denied full recovery

21 A-3209-11T1
of benefits, because the injury occurred at one workplace rather

than another.

Viewing each job separately here, the injury occurred "in

the course of employment when" appellant was "engaged in the

direct performance of duties assigned or directed by" BOE.

N.J.S.A. 34:15-36. Therefore, her claim for lost wages under

the WCA was limited to the wages earned at BOE.

The loss of appellant's substantially higher wages from

Vinny's was "not compensable under the [WCA]," N.J.S.A. 43:21-

26, and fell within the very gap the TDBL was designed to fill.

The only remedy available to cushion her against the loss of

those wages was the TDB for which she was eligible pursuant to

N.J.S.A. 43:21-29(a).5 Deductions were taken from the wages she

earned at Vinny's for the Fund, and her "full recovery" of TDB

5
Curiously, the Board does not dispute appellant's eligibility
for TDB under this statute, which provides:

In the case of the disability of a covered
individual, disability shall be compensable
. . . if the disability is the result of the
covered individual suffering an accident or
sickness not arising out of and in the
course of the individual's employment or if
so arising not compensable under the
workers' compensation law, . . . and
resulting in the individual's total
inability to perform the duties of
employment.

22 A-3209-11T1
was two-thirds of her wages from Vinny's, or $333 per week, in

accordance with N.J.S.A. 43:21-40.

The Board has failed to show that appellant's receipt of

the sum paid to compensate her for the wages she lost from

Vinny's was a "windfall" to appellant. Still, the Board

maintains that appellant's receipt of the full amount of TDB due

her based solely on her wages from Vinny's must be reduced

pursuant to N.J.S.A. 43:21-30(b)(3) and N.J.A.C. 12:18-1.5.

The authorities relied upon do not clearly support the

interpretation adopted by the Board, i.e., that the fact only

one of a worker's employers is a "covered employer" under the

TDBL has no impact on the Division's right to subrogation.

N.J.S.A. 43:21-30(b)(3) describes the worker's entitlement

to disability benefits and a subsequent reduction in benefits in

a specific scenario: when the workers' compensation claim has

been settled for less than the applicable TDB "for the same

illness or injury." Given the fact that this statute was

enacted in response to Scott, and its reference to the receipt

of both TDB and TWCB, it can be assumed that employment by

multiple employers was contemplated. Notably, Scott did not

concern a situation in which one employer was a "covered

employer" under the TDBL and the other was not and the statute

is silent on that point.

23 A-3209-11T1
On its face, N.J.A.C. 12:18-1.5 is similarly

undiscriminating on this issue. In the first instance, it

refers to

a covered individual with more than one
employer [who] receives temporary workers'
compensation benefits for an injury or
illness incurred at one place of employment
and . . . files a claim for New Jersey
temporary disability benefits as a result of
the same injury or illness on the basis of
his or her employment with the other
employer(s).

[N.J.A.C. 12:18-1.5(a) (emphasis added).]

The disparity between identifying the employee as a

"covered individual" and using the term "employer," rather than

"covered employer," suggests that the status of the employer as

"covered" or not, is immaterial to the application of the

subrogation provision. This is the interpretation applied by

the Board.

However, review of the definitions section for the TDBL

reveals that such an interpretation is erroneous. N.J.A.C.

12:18-1.1 states that "'Employer' means a covered employer as

defined in N.J.S.A. 43:21-27(a)." (Emphasis added). Therefore,

when the literal language of the subrogation provision is

altered to reflect the actual meaning of the words, the right to

24 A-3209-11T1
subrogation is clearly limited to circumstances where the

injured worker has more than one covered employer:6

(a) If a covered individual with more than
one [covered] employer receives temporary
workers' compensation benefits for an injury
or illness incurred at one place of
employment and that individual files a claim
for New Jersey temporary disability benefits
as a result of the same injury or illness on
the basis of his or her employment with the
other [covered] employer(s), those benefits
are payable under the New Jersey State plan
or an approved private plan provided that:

. . . .

2. Wages from all covered employers are
used to calculate the temporary disability
insurance weekly benefit rate . . . ;

3. The temporary disability insurance
weekly benefit rate is reduced by the
temporary workers' compensation weekly
benefit rate;

4. The claimant receives the temporary
disability insurance benefits at the
adjusted rate; and

5. Any such reduction in the temporary
disability insurance weekly benefit rate
shall also reduce the maximum total benefits
payable during the period of disability.

[N.J.A.C. 12:18-1.5]

In sum, we conclude that the Board's decision was based

upon an erroneous interpretation of N.J.S.A. 43:21-30(b)(3) and

6
This interpretation is consistent with the regulation
regarding "Concurrent coverage," N.J.A.C. 12:18-3.5.

25 A-3209-11T1
N.J.A.C. 12:18-1.5 that undermined the policy underlying the

TDBL by denying appellant the full recovery of benefits due her

when there was neither a duplication of benefits nor a windfall

to her. We discern no legislative mandate to penalize

appellant's diligence in holding two jobs by reducing the TDB

she was entitled to receive from Vinny's. The Board's decision

was therefore arbitrary, capricious, and unreasonable, requiring

reversal. See Russo v. Bd. of Trs., Police and Firemen's Ret.

Sys., 206 N.J. 14, 33 (2011) (reversing an administrative

decision where the board's interpretation of a legal standard

was held to be "inaccurate, . . . contrary to the legislative

objectives that standard embodies, and . . . clearly erroneous

as a matter of law").

Reversed and remanded for further proceedings consistent

with this opinion. We do not retain jurisdiction.

26 A-3209-11T1

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Source: Frix Law Library, https://www.frixlaw.com/law-library/cases/2675365. Public record. Not legal advice.
