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What Does Workers’ Compensation Cover In New Jersey?

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An injury or illness suffered at the workplace can impact the lives of workers and their families in many ways. The workers’ compensation system in New Jersey can help ease financial stress by covering the cost of medical expenses, providing temporary disability payments while the authorized doctor imposes work restrictions, providing partial total or total disability compensation and providing death benefits for the families of workers who suffered a fatal injury or illness.

Workers’ compensation is a no-fault system, meaning that in almost all cases where someone is injured on the job, workers and/or their families can receive benefits no matter what caused the accident. However, the claims process is complicated, and insurance companies typically try to keep minimize treatment and payments.

What workers’ compensation covers

Medical Benefits

If you suffered a work-related injury or illness, your employer – usually through their workers’ compensation insurance company – is responsible for paying expenses for all necessary and reasonable medical treatment. This includes surgery, hospitalization, medications, medical devices, prescribed physical or occupational therapy, doctor’s appointments, and any other medical treatment. Note that in New Jersey, your employer has the right to choose the health care providers who will diagnose and treat your work injury, with few exceptions.

Temporary Disability Benefits

You are eligible for these benefits if your doctor says you are unable to work because of your injury or illness for more than 7 days. You would also be eligible if your doctor says you have work restrictions, and your company cannot provide a position that meets with those restrictions.

The amount of these benefits is typically 70 percent of your average weekly wages, subject to a minimum and maximum rate set by law. This could be different if you have a contract with terms that affect the percentage, or you fall into certain statutory categories that impact your temporary disability rate.  You are eligible to receive these benefits until you are able to return to work, have reached maximum medical improvement, or have reached the 400-week maximum.

Permanent Partial Disability Benefits

You are eligible for these benefits if you suffered a work-related injury or illness that resulted in a permanent partial disability. The amount you can receive depends on the body part that was injured, and the percentage of your disability to that body part.  It is typically evaluated by a doctor hired on behalf of you, and one for the insurance company, who evaluate you for the level of functional loss to the body part from this accident.

Benefits are based on a percentage of “scheduled” or “nonscheduled” loss. A “scheduled” loss involves the arms, hands, fingers, legs, feet, toes, eyes, ears, or teeth. A “nonscheduled” loss may involve the back, heart, or lungs.  A chart set by statute is available for review with your attorney which provides the value of the injury based on the percentage that applies.  Scheduled losses are those that have specific values based on the body part injured.  Non Scheduled means that they fall into the category of Partial Total loss. 

Permanent Total Disability Benefits

These benefits may apply if you were left with a permanent disability due to work-related injury or illness and are unable to return to any type of gainful employment. By law, losing both arms, hands, legs, feet, or eyes, or any combination of two of those parts, is automatically considered a permanent total disability. Other severe injuries may also qualify for total disability if you are told by the doctors that you are unable to work in any capacity.

Eligible workers can receive payments for the rest of their life based on the worker’s wage, and the state maximum rate. There is a maximum established each year by the Commissioner of Labor and Workforce Development which your attorney can review with you. There are also situations where if you had a preexisting injury that impacted your ability to work prior to this accident, you would be eligible for total disability. An experienced attorney can guide you on the overlap between pre-existing and new injuries, and can also explain how qualifying for Social Security Disability overlaps with total disability claims through Worker’s Compensation.

Death Benefits (Dependency Benefits)

When a worker dies as the result of a work-related injury or illness, there are dependency benefits are payable to dependents. These include surviving spouses, civil union partners, natural children of a certain age, and certain other family members. There are certain statutory categories of dependents that an attorney can explain to the family, and an attorney may also be able to argue in Court that another family member was dependent even if they don’t meet the statutory definition.  Dependents may receive payment for funeral expenses as well as weekly benefits equal to 70 percent of the workers’ wages, subject to statewide maximums.

Workers’ compensation claim process in New Jersey

To receive workers’ compensation benefits after a job-related injury or illness, there is a process that needs to be followed. These are the general steps that need to be followed:

  • Report your injury or illness

You need to immediately notify your employer that you were injured in an accident or developed an illness related to your job. Notification can simply be telling your boss, supervisor or foreman. However, it is a good idea to put your notification in writing to create documentation. The deadline to report the injury varies depending on the circumstances, but in any case, it’s best to report as soon as possible.

  • Your employer must file a report

By law, your employer is required to file a “First Report of Injury” report with the New Jersey Division of Workers’ Compensation within 21 days. You can follow up with your employer to find out if the form was filed.

  • Your claim is processed

Your employer and their insurance company will investigate your claim and make a decision on whether to accept or reject it. Insurance companies typically try to keep their payments down, so they may challenge the seriousness of your injury or illness. In some cases, they may also try to dispute whether the injury or illness was work-related.

Filing a workers’ compensation claim in New Jersey

You are eligible to file a Claim Petition, which is a document that is processed through the New Jersey Division of Labor – Worker’s Compensation Division. The Division of Labor has established Courts throughout New Jersey that are assigned the cases, typically based on where you live. You are eligible to file a Claim Petition regardless of whether or not your employer has admitted the claim or denied the claim.

Your employer and their insurance company may deny your initial claim for benefits, arguing it didn’t happen during work, or the injuries don’t need treatment. Your employer or their insurance company’s denial is not the end of the matter. You have the right to Petition the Court for benefits, and to challenge a decision denying your case through the following process:

  • Informal hearings

An “Application for Informal Hearing” is filed with the Division of Workers’ Compensation. In an informal hearing, the injured worker and the insurance company attempt to work out a settlement with a judge present. Each side can raise issues and present evidence. The judge may make a settlement recommendation. Informal hearings are typically reserved for minor injuries. 

  • Formal hearings

These hearings typically apply to more serious injuries. A “Claim Petition” is filed to request a formal hearing, and to notify the worker’s compensation insurance company and your employer that you have an attorney assisting you with the claim. A Claim Petition is not a lawsuit. This means you are not suing your company; you are petitioning the company for benefits available to you through workers’ compensation. Each side can present their case to a judge, which may include evidence and witness testimony. If a settlement can’t be reached, a hearing will be held and the judge will issue a decision either as to the compensability of the claim, the need for treatment, or the percentage of disability that applies.

  • State courts

If you are still denied benefits after a formal hearing, you have the option of appealing the decision to the Appellate Division of the Superior Court of New Jersey. If you still disagree with the decision, you may also be able to Petition the New Jersey Supreme Court to review the case.

While there is no requirement to have legal representation for a workers’ compensation claim, it is in your best interest. An experienced attorney can help you navigate the claims process and gather evidence to build a strong case to get you the maximum amount of benefits you are entitled to. Contact a workers’ compensation attorney for a free consultation right away to protect yourself.

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Founded in 1927, Shebell & Shebell, LLC fights for the rights of injury victims. We handle workers’ compensation, construction accidents and personal injury claims. We have office...