Denial of Application for Accidental Disability Retirement Benefits Upheld

On September 27, 2010, the Appellate Division decided Briane K. Washington v. Board of Trustees, Police and Firemen’s Retirement System, Docket No.: A-1857-08T1. In the case, Briane Washington (“Washington”), a former Essex County Correction Officer, applied for accidental disability retirement benefits as a result of an incident on February 21, 2005, when an inmate, who may have had HIV and/or AIDS, spit in his face on two separate occasions.

The Board of Trustees of the Police and Firemen’s Retirement System (“Board”) found that Washington was suffering post-traumatic stress disorder (“PTSD”) as a result of the incident and awarded him ordinary disability retirement benefits because he was permanently and totally disabled. However, the Board denied Washington’s application for accidental disability retirement benefits, concluding that he did not satisfy N.J.S.A. 43:16A-7, which requires an employee to be “permanently and totally disabled as a direct result of a traumatic event occurring during and as a result of the performance of his regular or assigned duties.”

Washington appealed the Board’s determination and was granted an administrative hearing. Based on the evidence presented, an Administrative Law Judge (“ALJ”) determined he was ineligible to receive an accidental disability pension. Specifically, the ALJ found there was no credible evidence that the inmate “was actually transmitting a life-threatening disease” and that Washington failed to satisfy the criteria set forth in Patterson for a disabling mental injury.

On appeal, Washington argued that he was entitled to an accidental disability pension because his disability resulted from “a traumatic event” on February 21, 2005. The Appellate Division rejected Washington’s contentions and affirmed the Board’s denial. Specifically, the Court found the Board correctly applied the law and its decision was supported by substantial credible evidence in the record. As such, the Court concluded that the Board’s denial was neither arbitrary, capricious, nor unreasonable.

This case illustrates the importance of a hiring an experienced attorney to assist in the filing of an application for accidental disability retirement benefits. As alluded to by the Court, the law regarding the grant of accidental disability benefits has been drastically altered over the past five (5) years. Consequently, it has become imperative for an applicant to hire an attorney who is familiar with these changes so as to ensure the application is properly considered and/or evaluated. Without doing so, one might fall short and never receive the benefits they are ultimately entitled to.

NEW ISSUES ARISE UNDER RICHARDSON

 Since the New Jersey Supreme Court’s decision in Richardson v. Board of Trustees, Police and Firemen’s Retirement System, 192 N.J. 189 (2007), we have witnessed more denials of accidental disability applications based on the premise that the member suffered from a pre-existing illness or injury which contributed to the overall disability that prevented the member from returning to employment. However, where the scenario gets particularly interesting is when the pre-existing injury or illness was the result of a work related traumatic event. One would think that such a denial does not make sense under the Richardson decision as a “traumatic event,” as redefined by the Supreme Court,  and the resulting injuries sustained therefrom should not qualify or be viewed as a pre-existing illness or injury. Such a scenario and situation has not been addressed by New Jersey courts and is ripe for review to further flush out this new and evolving area of the law. 

 While the last paragraph may sound like a tongue twister, we will try to explain it in plain english. New Jersey courts are currently grappling with scenarios revolving around multiple injuries caused by separate traumatic events which together cause a member to be permanently disabled from performing his or her job. However, the Police and Firemen’s Retirement System, Public Employees' Retirement System and Teachers' Pension and Annuity Fund do not believe that a person with multiple injuries that occurred as the result of multiple traumatic events should be entitled to receive accidental disability benefits. As a result, the various pension funds have been disqualifying applicants with multiple injuries caused by multiple traumatic events. 

          In Richardson, the New Jersey Supreme Court revisited the “traumatic event” standard under the accidental disability retirement provision of the Police and Firemen’s Retirement System, N.J.S.A. 43:16A-1. After conducting an exhausting analysis of conflicting court decisions which interpreted the traumatic event standard differently and the legislative history of the amendments to the accidental disability statutes, the Court opined that a “traumatic event” is essentially the same as what has been historically understood as an “accident” to be. An “accident” as defined under Richardson, is an unexpected, external happening that directly causes injury and is not the result of pre-existing disease alone or in combination with work. Based on establishing this baseline definition of “accident,” the Court held that in order to obtain accidental disability benefits, a member must prove amongst other things that he or she is totally and permanently disabled as a direct result of a traumatic event that is:

1.   Identifiable as to time and place;

2.   Undesigned and unexpected; and

3.   Caused by a circumstance external to the member (not the result of pre-existing disease that is aggravated or accelerated by the work).

          The Richardson Court also provided examples of situations that satisfy the newly enunciated traumatic event standard. The first example depicted a police officer who suffers a heart attack while chasing a suspect. The Court instructed that the police officer in such a situation has not experienced a traumatic event. In that case, the work effort, alone or in combination with a pre-existing disease, was the cause of the disabling injury. However, the Court stated if that the same police officer became permanently and totally disabled during the chase solely because of a fall, the officer has suffered a traumatic event that would give rise to an award of accidental disability benefits. Thereafter, the court provided another example. A gym teacher who develops arthritis from the repetitive effects of his work over the years has not suffered a traumatic event as defined and articulated under Richardson. Such a disability is the result of degenerative disease and is not related to an event that is identifiable as to time and place. On the contrary, the same gym teacher who trips over a riser, is injured and becomes permanently and totally disabled as a result of the fall, has satisfied the accidental disability standard. 

          In sum, the Court held that a member who is injured while performing his or her ordinary duties does not disqualify him or her from receiving accidental disability benefits; some injuries sustained during the ordinary work effort will pass muster and others will not. However, the polestar of the inquiry is whether, during the regular performance of his or her job, an unexpected happening, not the result of pre-existing disease alone or in combination with the work, has occurred and directly resulted in the permanent and total disability of the member. 

In our next post, we will look further into Richardson and whether members with multiple injuries resulting from multiple traumatic events should qualify for accidental disability benefits.

The Difference Between Accidental and Ordinary Disability Benefits Under PERS, TPAF, SPRS, and JRS

 

Following up on our previous entry, this article will help our readers understand the criteria that must be met in order for a public employee to qualify for an ordinary or accidental disability pension within one of the following State pension systems, the Public Employees Retirement System, the Teachers Pension and Annuity Fund, the State Police Retirement System, and the Judicial Retirement System. While these pension plans are similar in defined benefits and criteria for eligibility, each has their own specific nuances that are particular to the membership they serve. 

Accidental v. Ordinary Disability Benefits

Public Employees Retirement System and Teachers Pension and Annuity Fund

In accordance with the Public Employees Retirement System (“PERS”) and Teachers Pension and Annuity Fund (“TPAF”) handbooks, in order to qualify for an ordinary disability retirement, an employee must:

·         Have an active pension account;

·         Have 10 or more years of New Jersey service credit;

·         Be considered totally and permanently disabled; and

·         Submit medical reports certifying the disability.

In order to qualify for an accidental disability retirement, a member must:

·         Be an active member of PERS or TPAF on the date of the “traumatic event”;

·         Be considered totally and permanently disabled as a result of a “traumatic event” that happened during and as a direct result of carrying out the member’s regular or assigned job duties;

·         File an application for disability retirement within five (5) years of the date of the “traumatic event”; and

·         Be examined by physicians selected by the retirement system.

If an employee claiming membership to either one of these retirement funds qualified for accidental disability, his/her annual retirement allowance will be 72.7% of their salary at the time of the “traumatic event.”

Should the public employee be receiving periodic workers’ compensation benefits, the accidental disability retirement benefits will be reduced dollar for dollar by the periodic benefits paid after the retirement date. However, the retirement benefit is not reduced by any Social Security or private insurance benefits that may be payable.

The New Jersey Division of Pensions and Benefits reports accidental disability retirement benefits as exempt from federal income tax. The benefits are also

 

not subject to New Jersey state income tax until the employee reached the age of 65.

State Police Retirement System

In accordance with the State Police Retirement System (“SPRS”) handbook, in order to qualify for an ordinary disability retirement, an employee must:

·         Be a member in service at the time the application is filed with the Division of Pension and Benefits (an official leave of absence is considered in service);

·         Be under age 55 and have four or more years of service credit as a State Trooper;

·         Be considered totally and permanently disabled; and

·         Submit medical reports certifying the disability.

Should an employee qualify for ordinary disability retirement, the annual benefit is equal to 40% of your final compensation or 1.5% percent of your final compensation for each year of service credit, whichever is higher. 

An employee’s approval for workers’ compensation or Social Security has no bearing on his/her application for disability retirement from theSPRS .

In order to qualify for accidental disability retirement, the employee must:

·         Be enrolled in the SPRS on or before the date of the “traumatic event”;

·         Be a member in service at the time the application is filed with the Division of Pensions and Benefits (an official leave of absence is considered in service);

·         Be considered totally and permanently disabled as a result of a “traumatic event” that happened during and as a direct result of carrying out the member’s regular or assigned job duties;

·         Show that the disability was not a result of the member’s willful negligence;

·         File an application within five (5) years of the date of the “traumatic event”; and

·         Be examined by physicians selected by the retirement system.

If an employee qualifies for an accidental disability retirement, the annual benefit is equal to 2/3 of the member’s final compensation.

Should the public employee be receiving periodic workers’ compensation benefits, the accidental disability retirement benefits will be reduced dollar for dollar by the periodic benefits paid after the retirement date. However, the retirement benefit is not reduced by any Social Security or private insurance benefits that may be payable.

Judicial Retirement System

Unlike the other pension systems, the Judicial Retirement System (“JRS”) does not distinguish between accidental and ordinary disability retirement benefits. The JRS only provides disability retirement benefits is the following criteria is met:

·         The employee is physically or otherwise incapacitated for full and efficient service to the State in a judicial capacity as determined by three (3) physicians appointed by the Governor; and

·         The individual’s disability is certified by the Supreme Court and approved by the Governor.

If a JRS member is certified as disabled, they will receive disability retirement benefits calculated at 75% of their final salary. Moreover, approval for workers’ compensation or Social Security disability benefits has no bearing on a member’s application for JRS disability retirement.