Peralta v. Silver Line Building Products
(NJ Appellate Division, Argued 9/18/25, Decided 9/24/25)
In this decision, the court affirmed a workers’ compensation judge’s ruling requiring the employer to authorize and pay for a third spinal surgery, despite a prior determination that a second surgery was not compensable. The case highlights the risks employers and carriers face in high exposure cases when medical causation is the crux of the case. These issues are fully dependent upon the Judge’s view of the evidence and not reversible on appeal. While the Workers’ Compensation Act is designed to be liberally construed in favor of injured workers, this case demonstrates how that deference can place employers in risky situations, particularly when unauthorized treatment and questionable causation is involved.
In this case, Norberto Peralta, a 20-year window fabricator, was injured on the job in July 2020 while lifting an 80-pound piece of glass. He subsequently underwent two spinal surgeries without authorization from the employer, Silver Line Building Products. The employer denied responsibility, arguing causation. The Judge originally found that the first surgery (completed in October 2020) was compensable and causally related to the work injury. However, the Judge found that the second surgery (completed in April 2021) was not compensable, as it addressed pre-existing degenerative spinal conditions. Temporary total disability benefits were only paid for the period following the first surgery, not the second.
In a subsequent motion, petitioner sought authorization for a third cervical spine surgery to correct failed fusions and remove broken hardware. The treating physician in this case, who performed the earlier surgeries, argued that the third surgery was necessary due to stress caused by the prior fusions. Respondent opposed, arguing that the third surgery was the direct result of the non-compensable second surgery and therefore should not be covered. The defense further raised res judicata and collateral estoppel arguments, emphasizing that the second surgery’s lack of compensability had already been adjudicated.
Both parties’ experts testified. The court’s decision ultimately turned on the credibility of the medical testimony. Petitioner’s expert treated the petitioner thoroughly and emphasized the connection of the anterior and posterior spinal fusions. He testified that the third surgery stemmed from mechanical stress caused by the initial (compensable) fusion. Respondent’s expert opined that the third surgery was unrelated to the workplace accident and addressed ongoing degeneration. However, under cross-examination, he accepted that anterior and posterior fusions do influence each other biomechanically. The judge gave substantial weight to the treating physician’s testimony. The Judge also discounted the respondent’s expert’s opinion, noting both his limited exposure to the patient and potential bias, including undisclosed authorship of a book for insurance professionals and significant income from defense-side referrals.
The Appellate Division affirmed the trial court’s decision in full, rejecting all of the respondent’s arguments. It should be noted that this decision found that res judicata and collateral estoppel did not apply because the issue of the third surgery was deemed distinct from the second surgery. The court held that a new factual and medical question was presented: whether the relationship between the first and second surgeries necessitated the third procedure. The appellate division deferred to the workers’ compensation Judge’s expertise in evaluating medical evidence and credibility.
From a defense standpoint, the Peralta decision presents several challenges and lessons. Although the surgeries were initially unauthorized, the employer was still held responsible for treatment costs and associated benefits. This erodes the employer’s statutory right to direct care, raising concerns about future claimants sidestepping established procedures. Additionally, the credibility of respondent’s expert was heavily scrutinized, and his cross-examination exposed vulnerabilities, including allegations of undisclosed bias. The objectivity of the employer’s expert in a high exposure complicated surgical fact pattern is essential for credibility purposes.
This ruling illustrates the difficulty of applying collateral estoppel or res judicata in evolving medical cases. Even where an issue (like the non-compensability of a surgery) appears settled, courts may allow reconsiderations and relitigating if new facts or treatment recommendations surface.
While the Appellate Division highlighted the overall goals of the Workers’ Compensation Act, this case demonstrates how expansive readings of causation can lead to significant exposure for employers and carriers. The court will continue to liberally interpret the evidence to achieve the remedial purpose of the Act and the Appellate Division will not reverse credibility calls of the Judge absent an abuse of discretion.
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