Name

Lancaster v. SD Warren

Insurance Company

CCMSI and Helmsman Management Services

Date Decided

May 13, 2020

Panel Members

David Hirtle

Sue Jerome

Tom Pelletier

Categories

Tags

Statute of Limitations Procedure §206 Paper Mill §354 Back Affirmative Defense

File Size

128 KB

Summary from the Troubh Heisler Attorneys

The Appellate Division affirmed ALJ Knopf’s refusal to adjudicate a statute of limitations defense to Lancaster’s Petition for Payment of Medical Services on a 1991 back injury, where the ALJ denied the petition on the merits.

Lancaster suffered work-related back injuries with S.D. Warren in 1991 (administered by CCMSI) and 1998 (Liberty Mutual). He filed Petitions for Payment of Medical Services (massage therapy) against CCMSI and Liberty. CCMSI maintained the affirmative defense that 10-year statute of limitations had run on the 1991 injury and offered uncontradicted evidence that its last payment was in 2006, more than 10 years before the petition was filed. Both CCMSI and Liberty maintained that Lancaster failed to prove that the massage therapy was reasonable treatment.

ALJ Knopf issued a decree denying both petitions on the grounds that the treatment was not proven to be reasonable. The ALJ did not address the affirmative defense raised by CCMSI. CCMSI moved for findings on its affirmative defense, pointing out that the ALJ failed to address the statute of limitations even though the parties had litigated the issue. In a Decree Amended the ALJ stated that “although though this is typically how I approach a case, CCMSI does not cite, nor do I find, any authority that requires this.” S.D. Warren and CCMSI appealed, arguing that where a party requests and submits proposed findings, the ALJ is under an affirmative duty to ensure the decision contains adequate findings.

The Appellate affirmed the ALJ’s decision, holding there is nothing in the Act, nor any other authority, that requires “prioritizing a statute of limitations defense” and it is not required that an affirmative defense be addressed before the merits of a claim. The finding that there was no evidence to support the reasonableness of the treatment was sufficient for appellate review of the claim on the merits.