Artificial Joint Replacements Do Not Constitute Prosthetics For Application of New Jersey Workers' Compensation Statute of Limitations

Insurance Law Alert

In a case of first impression, a New Jersey workers’ compensation judge has ruled that an artificial knee replacement does not constitute a “prosthetic device” for the purpose of applying a significant exception to the statute of limitations on workers’ compensation claims. In Schaeffer v. Best Foods, Inc. (CP No. 1999-7072), petitioner sought in 2014 to re-open a 1999 workers’ compensation case after it had been resolved by an order approving settlement in 2007, and a final compensation payment in 2008. Petitioner’s 2014 application for medical treatment sought to replace a damaged knee replacement apparatus that was initially provided in 2000. Petitioner’s argument as to why her 2014 claim for medical benefits should not be time-barred was based upon the novel theory that her knee replacement constitutes a “prosthetic device,” for which there is no limitation on seeking repair or replacement under applicable law. See N.J.S.A. 34:15-12.7.

New Jersey’s Workers’ Compensation Law places a two-year limitations period on both filing and re-opening claims. Where an injured employee seeks additional benefits related to a prior work-related injury (a “re-opener” claim), the employee is generally prohibited from seeking any additional benefits, including medical treatment, more than two years following the employer’s final payment of compensation. See N.J.S.A. 34:15-51. Here, Petitioner received her final medical treatment for a replaced knee in 2008. She asserted that her employer should be responsible to provide a new knee replacement in 2014, including the attendant surgery and post-operative care, on the basis that the re-opener claim constituted a request to replace a damaged prosthesis. Section 12.7 of the Workers’ Compensation Law allows an injured employee to seek repair or replacement of any “prosthetic device” any time following a compensable injury, if the workers’ need for such device emanates from a compensable injury.

Petitioner’s argument that a knee replacement constitutes a prosthetic device is not without support in medical literature, which frequently refers to joint replacements as “prosthetics;” though Section 12.7 primarily addresses external prosthetic devices which do not require costly accompanying medical treatment. In writing for the Court, Judge Allen noted the potential impact of Petitioner’s line of argument: “The effect would be to effectively remove the statute of limitations with respect to all replacement joints . . . the removal of the two-year statute of limitation with respect to cases such as these would effectively allow a petitioner to re-open their case throughout their entire life, alleging that the replaced body part is in need of repair.”

Ultimately, the Court concluded that Petitioner’s argument should be rejected for two reasons. First, the Court relied on a narrow definition of “prosthesis” provided by the 18th edition of the Merck Manual which includes only “artificial limbs designed to replace lower and upper extremities after amputation.” This conclusion, however, could potentially be impeached via citation to numerous other medical texts which refer to knee replacement apparatuses as “prosthetics.” The more persuasive second rationale for the Court’s decision stems from its analysis of legislative intent.

The Court noted that Section 12.7 was drafted in 1956 and last amended in 1963, i.e., before the first joint replacement procedure had ever been performed. Therefore, the Court concluded, the Legislature could not possibly have intended to except joint replacements from the statute of limitations.

Since their invention and widespread incorporation into modern medicine, joint replacements have become a common surgical treatment for workplace injuries, and employers and their insurance carriers are liable for the accompanying expense vis-à-vis state workers’ compensation systems. As the implanted devices are prone to eventual damage and failure requiring surgical revisions, the argument presented by Petitioner in this case had the potential to dramatically expand the scope of employer/ insurer liability in New Jersey. While the argument may have been defeated here, a single judge’s decision is not binding on other workers’ compensation judges. Until the Appellate Division issues an opinion on point, or the Legislature clarifies its intent via an amendment, employers and insurers must vigorously defend such efforts to expand the scope of workers’ compensation liability that would increase the costs of coverage in New Jersey.

N.B. – The Workers’ Compensation Practice Group at Bressler, Amery & Ross, P.C. defended respondent Best Foods, Inc. in the matter discussed above. A copy of the decision can be accessed by clicking here. For further information regarding this case, or to discuss the firm’s capabilities in workers’ compensation defense, please contact Samuel J. Thomas or Michael J. Morris.