An Overview of New Jersey Workers' Compensation
What is Workers' Compensation?Workers' compensation is a "no fault" insurance program that provides the following benefits to employees who suffer job-related injuries or illnesses:
Medical (treatment) Benefits;
Temporary Total Disability Benefits;
Permanent Partial Disability Benefits;
Permanent Total Disability Benefits.
It also provides death benefits to dependents of workers who have died as a result of their employment.
An injured employee will receive benefits regardless of who was at fault. In exchange for these benefits, the worker cannot bring a civil action against the employer for pain and suffering or other damages, except in cases of intentional acts.
Medical BenefitsAll necessary and reasonable medical treatment, prescriptions and hospitalization services related to the work injury are paid by the employer's insurance carrier or directly by the employer if they are self-insured.
The employer has the right to designate the authorized treating physician for all work related injuries. Only in the situations where the employer inappropriately refuses to provide medical treatment or if an emergency exists, may the injured worker choose the treating physician. In the case of the latter, the injured worker should notify the employer as soon as possible concerning the treatment being received.
Temporary Disability BenefitsIf an injured worker is disabled for a period of more than seven days, he or she will be eligible to receive temporary total benefits at a rate of 70% their average weekly wage, not to exceed 75% of the Statewide Average Weekly Wage or fall below the minimum rate of 20% of the Statewide Average Weekly Wage. 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 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. The worker, in some cases, may be left with either partial permanent injuries or total permanent injuries.
Partial Permanent Disability BenefitsWhen a job related injury or illness results in a partial permanent disability, benefits are based upon a percentage of certain "scheduled" or "non-scheduled" losses. A "scheduled" loss is one involving arms, hands, fingers, legs, feet, toes, eyes, ears or teeth. A "non-scheduled" loss is one involving any area or system of the body not specifically identified in the schedule, such as the back, the heart, the lungs. These benefits are paid weekly and are due after the date temporary disability ends.
Permanent Disability BenefitsWhen a work injury or illness prevents a worker from returning to any type of gainful employment, he or she may be entitled to receive permanent total disability benefits. These weekly benefits are provided initially for a period of 450 weeks. These benefits continue beyond the initial 450 weeks provided that the injured worker is able to show that he or she remains unable to earn wages.
Wages earned after 450 weeks offset the weekly computation in proportion to the income at the time of the injury. Permanent Total benefits are paid weekly and are based upon 70% of the average weekly wage, not to exceed 75% of the Statewide Average Weekly Wage (SAWW) or fall below the minimum rate of 20% of the SAWW.
Permanent Total Disability is also presumed when the worker has lost two major members or a combination of members of the body. However, permanent total disability can also result from a combination of injuries that render the worker unemployable.
What to do if you are injured on the jobYou should notify your employer as soon as possible. Notice may be given to your supervisor, personnel office, or anyone in authority at your place of business. Notice does not have to be in writing. If you need medical treatment, a request should be made to your employer as soon as possible. Under the NJ workers' compensation law, the employer and/or their insurance carrier can select the physician(s) to treat injured workers for work related injuries.
What happens if there is a dispute?When there is a dispute between an injured worker and the employer and/or insurance carrier over entitlement to benefits, the worker may file either a formal Claim Petition or an Application for an Informal Hearing with the Division of Workers' Compensation. Upon filing, the case will be assigned to a judge and a district office based upon the county of residence of the injured worker, or if the worker lives out of state, the county where the employer is located.
Issues may include compensability of the claim (whether the injury/illness is considered work-related), the type and extent of medical treatment, and/or the payment of temporary disability benefits. Further, a claim petition may seek permanent disability benefits and in cases of alleged job-related death, dependency benefits. Workers are generally represented by an attorney but they may file a claim petition on their own (pro se). An insurance carrier will usually provide a legal defense on behalf of an insured employer.
Time Limits for Filing ClaimsImportant: There is a two year statute of limitations that applies to workers' compensation cases. 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, such as 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.