In re Dykas
In re Dykas
Opinion of the Court
The opinion of the court was delivered by
In October, 1989, petitioner, Naoma Dykas, was diagnosed as suffering from carpal tunnel syndrome in both wrists, more severe on the left than on the right. On November 14, 1989, she underwent surgery to correct the condition in her left wrist and received sick leave injury (SLI) benefits pursuant to N.J.S.A. 11A:6-8 and N.J.A.C. 4A:6-1.6 for her two-month recovery period. Petitioner underwent a second surgical procedure on August 31, 1990 to correct the condition in her right wrist. The recovery period for this operation was IV2 months. Sick leave injury benefits for this latter period of disability were denied by her employing agency, the Division of Motor Vehicles (DMV).
Petitioner appealed and the Merit System Board (Board) upheld the denial on two grounds. One was that an “accident date” of “approx. 06-01-89” was specified in the “Employer’s First Report of Accidental Injury or Occupational Disease” submitted by petitioner on October 30, 1989; and that the time period between the specified date of injury, June 1, 1989, and the date of the second surgery, August 31, 1990, exceeded a one-year limitation established in N.J.A.C. 4A:6-1.6(b)3, which provides:
Benefits are limited to a one year period from the initial date of the injury or illness.
The report had described the injury as “Carpol (sic) Tunnel Syndrome — Both Wrists (Surgery on left).” In a submission to the Board, the DMV asserted its wish to waive the one-year limitation, but indicated that it was uncertain whether the type of injury suffered by petitioner qualified for the benefit sought. That caveat was articulated notwithstanding the DMV’s grant
In its other ground for denying petitioner’s application, the Board held that she had “allege[d] that her condition was caused by the repetitive sorting of cards rather than a single incident. This type of injury does not meet SLI criteria----” The Board at the time, therefore, appears to have rejected occupational diseases for SLI coverage, recognizing only traumatic injuries as being covered.
Petitioner argues that the one-year limitation contained in N.J.A.C. 4A:6-1.6(b)3 does not relate to the time within which an employee may file a claim, but rather establishes a one-year maximum for the receipt of benefits. The meaning of that provision is obscure and ambiguous. While the words admit of the interpretation advanced by the petitioner they also support the interpretation made by the Board. One way of resolving such a dilemma would be to give substantial weight to the agency’s interpretation of its rules and regulations. Simon v. Board of Trustees, 233 N.J.Super. 186, 195, 558 A.2d 490 (App.Div. 1989). Yet, a rule which does not contain a clear or objectively ascertainable standard may not be upheld. New Jersey Ass’n of Health Care Facilities v. Finley, 83 N.J. 67, 82, 415 A.2d 1147 (1980). In this instance, however,
In order to determine when a time period expires, one must first know when it began. The premise of the Board’s denial of benefits is that petitioner’s eligibility period commenced on June 1,1989, the date which she indicated on her report form as marking the onset of her carpal tunnel syndrome. Yet, as of June 1, 1989, petitioner had not become disabled. The purpose of the SLI benefit seems clear. It is to provide a continuation of salary to any covered State employee “who is disabled due to a work-related injury or illness [by granting] a leave of absence with pay.” N.J.A.C. 4A:6-1.6(b). It is clear that SLI benefits are designed only for the purpose of providing income stabilization and continuation for a designated period of time to employees with work-related injuries or illnesses; the benefits are not intended to compensate employees for their injuries or illnesses. Payments are to be reduced not only by any other temporary disability benefits received, N.J.A.C. 4A:6-1.6(b)2, but also by any compensation earned on a part-time return to work pending full recovery, N.J.A.C. 4A:6-1.6(b)l. When viewed in this light it is evident that “the initial date of the injury or illness”, N.J.A.C. 4A:6-1.6(b)3, must refer to the date the disability began, not to some prior date when an injury or illness was suffered or became manifest, but which did not disable the employee initially even though it did so ultimately.
With this understanding, if N.J.A.C. 4A:6-1.6(b)3 is seen as a one-year time limitation provision related to notice, it is clear that the petitioner provided timely notice in her October 30, 1989 report. In filing that report, petitioner stated that she suffered carpal tunnel syndrome in both wrists as a result of
If, on the other hand, N.J.A.C. 4A:6-1.6(b)3 is to be taken as imposing a one-year time limitation from the “initial date of the injury or illness”, the initial disabling event was the date of petitioner’s first surgery November 14, 1989. Petitioner’s second sick leave was occasioned by the surgery of August 31, 1990, well within the one-year limitation.
The basis of the Board’s decision accords undue emphasis to petitioner’s statement in her October 30, 1989 report that the accident date was June 1,1989. There was no “accident” here. N.J.A.C. 4A:6-1.6(c)l does not require an accident if the injury or illness was caused by a specific condition of employment.. Petitioner’s statement can be seen simply as an honest effort to comply with parameters established by her employer, guided by the language of the form provided by the employer. The statement should not be held against her to the extent of denying benefits for an occupational disease which, by its nature, except for the symptoms experienced, cannot be assigned a definite date of onset.
Sick leave injury benefits, just like any other remedial legislative program, may be attended by reasonable limitations. See Hutton Park Gardens v. West Orange, 68 N.J. 543, 564-65, 350 A.2d 1 (1975). The Legislature, in N.J.S.A. 11A:6-8, has seen fit to delegate to the Board the responsibility of establishing the criteria and procedures governing the program. It may be that this delegation of legislative power lacks adequate standards to guide the agency, Ward v. Scott, 11 N.J. 117, 122-28, 93 A.2d 385 (1952), but that issue has not been raised by either party. Narrower grounds of decision are available, which have been addressed by the parties and go to the merits of this case.
Neither a one-year limitation on benefits nor a one-year notice requirement is facially unreasonable. No valid public purpose is served, however, by denying benefits, other
In reaching this conclusion, we have not taken into account the fact that the Board, from time to time, has waived the one-year limitation on a case by case basis. We are unable, on the record before us, to evaluate petitioner’s contention that the refusal to extend the limitation in this case is arbitrary when compared to the Board’s action in other cases. While uniformity for its own sake cannot properly be expected in matters such as this, see generally Barone v. Dep’t. of Human Services, 107 N.J. 355, 526 A.2d 1055 (1987), the Board is clearly required to make its decisions on a rational, qualitative, and non-arbitrary basis. See Campbell v. Dept. of Civil Service, 39 N.J. 556, 562, 189 A.2d 712 (1963).
As regards the alternate ground for the Board’s decision, the only medical evidence before the Board were several reports of petitioner’s treating physician, Dr. Moskowitz. The Board reached its conclusion to deny benefits on the ground that SLI criteria had not been met, despite repeated statements of opinion in these reports that petitioner’s conditions were caused by her work duties, which were described with specificity sufficient to satisfy the requirement of N.J.A.C. 4A:6-1.6(c)1. Although a finder of fact may disbelieve uncontroverted evidence, Amaru v. Stratton, 209 N.J.Super. 1, 20, 506 A.2d 1225
Reversed and remanded for a calculation and award of sick leave injury benefits to the petitioner.
The Board’s denial was based upon N.J.A.C. 4A:6-1.6(c)l:
Injuries or illnesses which would not have occurred but for a specific work-related accident or condition of employment are compensable.
In 1992, N.J.A.C. 4A:6-1.6(c)4 was added to the rules governing this area:
Progressive, degenerative or repetitive motion disorders, such as asbestosis or carpal tunnel syndrome, are compensable only when the claim is supported by medical documentation clearly establishing that the disorder would not háve occurred but for the performance of specific work duties.
Reference
- Full Case Name
- IN THE MATTER OF NAOMA DYKAS
- Cited By
- 3 cases
- Status
- Published