Workers’ Compensation - FAQ
GENERAL
I was injured at work. Who do I notify?
Notify your employer immediately. The notification can be either written
or verbal. Before seeking medical treatment, speak to your employer
first. NJ workers’ compensation law provides that the employer
and/or their insurance carrier has the right to choose the health
care provider(s) for you to be examined and treated by.
What are my responsibilities for complying with my employer’s
insurance company?
- Provide a statement regarding how the accident occurred
- Agree to an examination by a doctor other than your treating physician
- Change treating physicians to one they authorize
- Provide information regarding other employment, your salary overtime,
etc.
- Provide them with any other information necessary to properly investigate
your claim
Who pays for my medical treatment?
As an injured worker, your employer’s insurance company (or
employer directly is self insured) is required to pay for any medical
treatment deemed necessary to improve your medical status. All treatment
must be approved by your employer’s insurance company (except
for emergency treatment). They reserve the right to switch treatment
or have you examined by a doctor of their choice. Always obtain proper
authorization for all medical treatment before beginning treatment.
Failure to obtain proper authorization will most likely result in
your having to pay for this treatment as your individual health insurance
WILL NOT pay for it.
What is Palliative treatment?
Palliative treatment is a term used to describe treatment that relieves
pain but does not improve your medical condition. The costs incurred
for this type of treatment are your responsibility; however, these
costs may be covered by your own insurance company. Always check with
your insurance company before seeking palliative treatment.
My employer’s insurance company will no longer authorize
medical treatment. I strongly feel that I still need treatment. What
do I do?
Contact this office immediately before incurring additional medical
bills.
I was fired after taking
time off from work due to a work-related injury. Is this legal?
Pursuant to NJSA 34:15-39.1, the Workers’ Compensation statute,
an employer cannot terminate you for filing a workers’ compensation
claim or testifying at a workers’ compensation hearing. If you
feel you were terminated for one of these reasons, your attorney may
file a discrimination complaint against your employer with the Division
of Workers’ Compensation. Under this law, you are entitled to
your former position and payment of lost wages ONLY if you able to
perform the essential duties of the position. You should contact your
attorney to begin this process.
How is the degree of my disability decided?
Your attorney will have you examined by a doctor who performs Workers’
Compensation examinations. The doctor will evaluate your disability
as a percentage of the loss of use of your injured body part(s) or
as a percentage of total disability. The doctor will charge a fee
for the exam which will be paid for by this office at the time of
the examination and later deducted from your settlement. Your employer’s
doctor will also send you to their doctor for an evaluation. You will
never be responsible to pay for this exam. The doctor will also evaluate
the percentage of your disability. The judge will make a decision
based on both doctor reports as well as your testimony. He will then
decide on an award in dollar amount based on the percentage of your
disability and altered earning power of the average worker. In rare
cases, we will be required to bring either a treating or evaluating
physician or both into Court to testify as to the extent of your injuries
and disability. The doctors will charge a fee to testify. You will
not be responsible to pay for testimony fees incurred by the respondent’s
doctor. The respondent may pay for half of our doctor’s testimony
fees. The remaining balance will be taken from your settlement.
Can my employer’s insurance company investigate me?
Yes. In some cases, the insurance company will employ an investigator
to verify the validity of your claim. They may interview co-workers,
neighbors, family, and/or friends. They reserve the right to photograph
or videotape you performing activities that challenge the severity
of your injury. Activities include, but are not limited to, performing
chores around the home or performing work related activities on the
side. Please note that any type of unauthorized employment while you
are collecting temporary disability benefits will cause those benefits
to be terminated and may constitute criminal fraud.
Can I sue for pain and suffering?
No award can be granted for pain and suffering. The amount of the
award does not take into account your inability to continue the same
type of work or your decreased earning power.
The workers’ compensation doctor has released me for
light duty but my employer informed me that there is no light duty
work. What is my next course of action?
If you haven't returned to work and continue to receive authorized
medical care for your injuries, you may continue to receive temporary
disability benefits. You can use the maximum allowable time for medical
improvement which is determined by a date provided by the authorized
health care provider.
I have a part time and a
full time job. I was injured on my part time job and I am now unable
to work my full time job. Can I collect workers’ compensation
benefits from my full time job?
No. You may only receive workers’ compensation benefits for
the job you were injured on.
I am disabled and out of work. Does the Department of Labor and
Workforce Development provide training services to help me find a
new job?
The New Jersey Division of Vocational Rehabilitation Services helps
disabled individuals find a means of employment based on their skills,
strengths, and needs. If your disability is preventing you from working
or complicates your current job, you may submit a referral for services.
Does the Workers' Compensation Law give special compensation
to minors?
A minor who was inured at work is treated the same as an adult. If
the minor was employed in violation of child labor laws; however,
benefits for temporary disability, permanent disability or death double
the normal amounts awarded.
BENEFITS
What kind of benefits am I entitled to?
An employee or his/her dependents can receive workers' compensation
benefits for an injury or death arising out of and in the course of
employment. The employer or its insurance carrier pays for the necessary
and reasonable medical treatment and temporary disability benefits
in place of wages lost during the period of disability.
How much are the benefits for loss of wages?
If you are disabled for a period of more than seven days, you will
be eligible to receive temporary disability benefits at a rate of
70% of your average weekly wage, not to exceed the maximum rate or
fall below the minimum rate set by statute in effect during the year
of accident. These benefits are provided during the period when a
worker is unable to work and is under active medical care. Benefits
are usually terminated when the worker is released to return to work
in some capacity and/or if he or she has reached maximum medical improvement
(MMI). MMI is a term that is used when additional treatment will no
longer improve the medical condition of the injured worker.
Can I recover money from a third party as a result of my injury?
The New Jersey Workers’ Compensation Law entitles the employer
and/or their insurance carrier to receive a credit for amounts recovered
from a third party causing a compensable work related injury (N.J.S.A.
34:15-40). This provision is intended to prevent the recovery of duplicate
benefits for the same injury and disability.
When the gross third party settlement amount is equal to or greater
than the total award of compensation benefits, the amount of the credit
is generally two-thirds of the amount payable by or on behalf of the
employer less $200.00.
When the gross third party settlement amount is less than the total
award of compensation benefits, the credit is generally two-thirds
of the gross third party settlement amount less $200.00.
Where benefits have not been paid, the amount owed to you by or on
behalf of the employer will be reduced by the credit amounts.
Are cost of living increases provided for under workers’
compensation?
The statute allows that only totally and permanently disabled workers
and dependents of deceased workers whose date of injury or death occurred
prior to January 1, 1980 may be eligible for supplemental benefits
or cost of living increases. In some cases, dependents of deceased
workers may be eligible where the death of the worker occurred after
1979 but was directly and causally attributable to the injury resulting
in total and permanent disability prior to 1980.
However, for those receiving temporary total or partial total disability
benefits, there is no provision in the statute for cost of living
adjustments.
What are Supplemental benefits?
Supplemental benefits are paid in addition to the basic awarded weekly
workers’ compensation benefit rates to address changes in the
cost of living. Calculated annually, they are based upon the current
maximum weekly workers’ compensation rates as well as your basic
and maximum benefit rates. Supplemental benefits are reduced for receipt
of Social Security, Black Lung and/or employer disability pension
benefits and are also subject to reduction for employment in cases
of total and permanent disability.
Are workers’ compensation
benefits taxable?
Workers' compensation benefits are not taxable as per the NJ Gross
Income Tax law NJSA 54A:6-6.
My employer’s insurance company is ceasing to pay for
temporary disability benefits and I disagree with this decision. What
should I do?
Contact this office immediately.
SECOND INJURY FUND
What is the Second Injury Fund?
The Fund assumes payment of permanent disability benefits after an
initial period during which the employer or his insurance carrier
makes these payments.
To be eligible, an individual must be totally and permanently disabled
as the direct result of a work-related injury in combination with
a pre-existing permanent partial disability. It is not necessary that
the pre-existing permanent partial disability be work-related.
Are Second Injury Fund benefits paid in addition to regular
compensation benefits?
No. Fund benefit payments are in the same amount as those previously
received from the employer or the employer’s insurance carrier.
The Second Injury Fund begins only when the employer or the employer’s
insurance company is no longer obligated to make payments.
How long are Second Injury Fund benefits payable?
Fund benefits are received as long as the injured worker remains totally
and permanently disabled and unemployed. Benefits will cease upon
the death of the worker. The Fund will not cover funeral and dependents’
benefits.
Can I work and collect Second Injury Fund benefits?
Yes; however, any wages received after 450 weeks of benefits will
be used to reduce the amount of benefits received. The reduction is
based on the comparison of your current earnings to those received
at the time you were declared totally and permanently disabled.
Your new employer is entitled to reevaluate your medical condition
and can possibly remove benefits.
TIMELINES
How long must I be out of work before I am eligible to receive
workers’ compensation benefits?
By law, you must be unable to work for seven days (including weekends
and holidays) before you are eligible for temporary disability benefits.
Benefits are retroactive to the first day. The seven days do not need
to be consecutive.
There is no similar waiting period to receive medical benefits or
permanent disability benefits. Those benefits are due, if warranted,
regardless of the number of lost workdays.
What is the deadline for filing a claim with the Division?
A formal claim petition must be filed within two years of the date
of injury or the date of last payment of compensation, whichever is
later. Medical treatment authorized by the employer is considered
a payment of compensation. In cases of occupational illness, for example
- asbestosis, lead poisoning or hearing loss, the claim petition must
be filed within two years from the date the worker first became aware
of the condition and its relationship to employment. Please note that
the filing of an application for an informal hearing does not stop
the two-year statute of limitations from running.
What is the wait period for receiving disability benefits?
It generally takes two weeks to receive disability benefits. If your
employer or their insurance carrier unreasonably and negligently delays
denial of a claim, they may be liable to you for an additional amount
of 25% of the amounts due plus any reasonable legal fees incurred
in relation to the delay. A delay of 30 days or more is considered
unreasonable.
THE LITIGATION PROCESS
I was awarded Disability Benefits by a Workers’ Compensation
Judge. When will I receive my benefits?
By law, the Workers’ Compensation Insurance carrier has 90 days
to process the payment. If not processed after 90 days, you may be
entitled to receive simple interest. Initial payment can be expected
within 6 to 8 weeks from the date of the execution of the judge’s
order.
I do not like the doctor to whom I was referred by my employer’s
insurance company. What recourse is available to me?
If the employer refuses or neglects to provide reasonable and necessary
medical services, you may take action by filing a Motion for Medical
and/or Temporary Disability Benefits. These proceedings are given
a very high priority and are scheduled before a judge within 30 days
of the proper filing of the motion.
What is the date of my next workers’ compensation hearing?
You should contact your attorney to determine the tentative date of
your next workers’ compensation hearing.
When should I contact my attorney?
- You return to work with your present or new employer
- Your doctor discharges you from treatment
- The insurance company notifies you that they are terminsting temporary
disbility payments and/or authorization for medical treatment
- Your doctor refers you to another doctor
- Your doctor schedules physical therapy, x-rays, or specialized tests
of any kind that will be performed outside of his office
- The insurance company makes a payment to you for permanent disability
benefits
- The insurance company requests that you be examined by a doctor
other than your treating physician
- An investigator, co-worker, or neighbor contacts you regarding your
disability.
