New Jersey Workers’ Compensation Benefits Explained

When you are injured at work, it can have a significant impact on your finances: you could be facing substantial medical bills while you are unable to work due to your injury or illness. Workers’ Compensation benefits are designed for this very scenario and can help keep you from financial ruin. Workers’ Compensation is a type of insurance purchased by your workplace, available to you mandated by the federal government, and administered by the state.

Workers’ Compensation is a no-fault insurance program that most companies are required to keep in the event that employees are injured at work or while performing duties as part of their job. The insurance will provide financial reimbursement for an injured person to prevent them from experiencing major financial difficulty.

Some companies may be reluctant to cooperate with employees because they fear developing a record of workplace accidents. When this occurs, a company may attempt to delay a claim, or their insurance will attempt to deny the claim. When this happens, you will need the services of an experienced Workers’ Compensation lawyer who will represent you.

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What Is Workers’ Compensation?

Workers’ Compensation is a type of insurance that covers an employee’s medical expenses and lost wages when they are hurt at work or develop an occupational illness. The insurance does not cover a full amount, and the specific amount varies state by state. The state requires that most companies cover their employees.

Workers’ Compensation is a no-fault insurance program, meaning that the injured or sick worker does not need to prove negligence to collect benefits. However, that coverage is not absolute, as if an employee was doing something that was beyond their traditional work responsibilities when they sustained the injury, they could be considered ineligible for Workers’ Compensation benefits. An example of an injury not covered by Workers’ Compensation would be an injury sustained while engaging in horseplay in a dangerous area on the premises of the job.

Not everyone who works at a company is eligible to receive Workers’ Compensation. Those individuals include:

  • Unpaid interns
  • Unpaid volunteers
  • Independent contractors
  • Sole proprietors with no employees

Most companies in New Jersey are required to carry Workers’ Compensation insurance. Government entities are exempt from carrying Workers’ Compensation, but that is because they usually carry their own version.

What Is Covered Under Workers’ Compensation?

In New Jersey, the law mandates that all employers who are not covered by federal programs must have Workers’ Compensation coverage or be approved for self-insurance. If you have suffered a workplace injury or illness, you should be covered by Workers’ Compensation benefits, which can include some or all the following:

  • Vocational rehabilitation: This is available if you are unable to continue the type of work you were doing pre-injury.
  • Medical benefits: All necessary medical care related to your injury should be covered, including hospital stays, prescription medication, and prosthetics. It is essential that you document all your treatment and report it to your employer.
  • Mileage reimbursement: Your mileage to and from your medical appointments is covered by Workers’ Compensation.
  • Death benefits: Death benefits are paid to surviving family members of a worker who suffered a fatal work injury and may include funeral and burial expenses.

Death Benefits

Who is Eligible for Death Benefits in New Jersey?

To collect Workers’ Compensation benefits, a worker’s injury or illness must be work-related. Workers whose conditions were not caused or worsened by their work activities or environment may not be entitled to benefits. Similarly, survivors of deceased workers whose conditions were not caused or worsened by their job may not be able to collect death benefits.

In New Jersey, only those who relied upon the deceased worker for financial support at the time of their death can receive these benefits. Dependents include:

  • Spouses
  • Parents
  • Stepparents
  • Grandparents
  • Children
  • Stepchildren
  • Grandchildren
  • Brothers/sisters
  • Half-brothers/half-sisters
  • Nieces/nephews

Dependents must be either under 18 or over 40 years old to collect death benefits, however, there are exceptions. Spouses, parents, grandparents, and physically or mentally disabled family members may collect death benefits regardless of age. Dependents between the ages of 18 and 23 may also collect benefits if they are full-time students. However, spouses may only collect death benefits until they remarry.

Death Benefit Rates in New Jersey

In New Jersey, dependents may receive death benefits equal to 70 percent of the deceased worker’s average weekly wages up to the cap, which is based on the statewide average weekly wages of all workers. The maximum allowable death benefit for 2020 is $945. The benefits are divided among dependents according to need as determined by the New Jersey Division of Workers’ Compensation.

Up to $3,500 in burial and funeral expenses are also available to the person who paid or will pay those costs. There are additional factors to consider when calculating death benefits, therefore those seeking compensation should contact a local Workers’ Compensation lawyer who can evaluate their case and help ensure that their rights are protected.

Wage loss benefits 

Wage loss benefits are available if you are unable to work for more than seven days. The way your benefits are calculated depends on your type of injury. The following are the different types of benefits for which you may be eligible:

Lump-sum settlement 

A lump-sum settlement may be issued to the injured employee in exchange for certain rights. Once the settlement is in place, the employee can no longer seek additional damages.

Under New Jersey law, Section 20 or Section 22 settlements are available, each with different benefits. Critical components of both payments include the following. 

Section 20 Settlements

A Section 20 settlement is a lump-sum, final payout settlement that can only be used in contested or denied cases. Section 20 features include:

  • Used when the insurance company disputes or denies a Workers’ Compensation claim.
  • Provides a one-time payment, as opposed to installments over time.
  • In entering into the settlement agreement, the employer does not admit liability.
  • Both the employee and the employer must agree to the terms of the agreement and submit it for approval by a judge. If all parties do not approve every time, the deal is invalid.
  • It is not a Workers’ Compensation payment except for insurance rating purposes.
  • Employee relinquishes all rights for future benefits about the claim; it cannot be reopened. This could be a potential negative if you relapse, aggravate the injury, or worsen your condition. 

Employers and insurers often prefer Section 20 settlements because they constitute a full and final settlement of the matter. The employer and insurer are essentially free from having to address the injury after the payment has been paid. 

A Section 20 settlement may not be the best choice from an employee’s perspective. If the insurance company is aggressively disputing your claim, it may be logical to take the Section 20 settlement. It would be helpful to discuss your options with a Cherry Hill Workers’ Compensation lawyer. 

Section 22 Settlements

A Section 22 settlement is an award that consists of a percentage of your total disability. In this sort of agreement, the following components would apply:

  • It can be used for approved Workers’ Compensation claims. 
  • The injured worker agrees with the insurer to a specific payment based on a percentage of their total disability based on a disability rating assigned by a physician. The insurance company then agrees to pay the permanent disability benefits in installments, based on the New Jersey schedule of benefits.
  • The injured employee will not give up their right to future medical care should they need it.
  • If the condition worsens in the future, the employee retains the right to reopen the Workers’ Compensation claim to seek additional disability benefits. This must occur within two years from the last payment under the claim.
  • The employer accepts specific medical conditions, such as a torn rotator cuff or herniated cervical disc.
  • If there is a re-injury to that body part in the future, increasing disability, the employer gets credit for the percentage paid.

Suppose you, as an injured worker, anticipate needing a good deal of future medical care or want the option to reopen your claim when necessary. In that case, a Section 22 settlement might be a good choice.

To reopen a Section 22 claim, the employee has two years after the last settlement payment was made. It is often recommended that employees wait until they have achieved maximum medical improvement (MMI). Holding off until the condition is stable can keep the employee’s future options open.

Should I Settle?

There are pros and cons to settling. A lawyer can help you understand your choices, and can take the case to court if a fair settlement cannot be reached. 

Temporary Total Disability Benefits

If an injured worker is disabled for more than seven days, they will be eligible to receive temporary total disability benefits, retroactive to the first day of lost time. These benefits are paid at 70 percent of the worker’s average weekly wage, not to exceed the statutory maximum rate or fall below the statutory minimum rate. These benefits are provided until the worker has returned to work or has reached maximum medical improvement (MMI) or the statutory 450-week maximum. 

Permanent Partial Disability Benefits

Once you reach MMI or return to work, a required evaluation will determine whether your injury or disease has permanently impacted your life. Partial disability benefits begin when the evaluation indicates you are partially disabled but can perform light-duty work and earn wages. Permanent partial disability benefits compensate you for your permanent loss of function.

In New Jersey, specific physical injuries automatically qualify for partial or total disability in amounts set by statute. These scheduled losses include limb amputation, including fingers, hands, arms, legs, feet, and toes, and losses of vision and hearing. Permanent partial disability benefits equal 70 percent of your pre-injury wages for the length of time determined by the schedule of disabilities. Work injuries that permanently damage the spine, internal organs, and head are non-scheduled disabilities and are compensated at 70 percent of pre-injury wages.

Permanent Total Disability Benefits

If your doctor determines you cannot return to work because of your work injury, you may be eligible for permanent total disability benefits after temporary total disability benefits have run out. These benefits are paid for a maximum of 450 weeks. 

At 450 weeks, you will undergo an evaluation to assess your capacity to work. If your permanent disability is confirmed and you cannot earn at a rate equal to what you earned pre-injury, your benefits can continue past 450 weeks. The benefits are paid weekly and are based upon 70 percent of the average weekly wage, not to exceed the statutory maximum or fall below the statutory minimum. 

To qualify for these benefits, you must be at least 50 percent impaired based on American Medical Association standards. If you are not at least 50 percent impaired, your employer can change your status to permanent partial disability.

Although there are significant benefits to the insurance, there is a trade-off. Since it is no fault, it should not take long for you to begin to receive your benefits. However, while you should receive your benefits although you were responsible for your own injury, you cannot then turn around and sue your employer. By offering Workers’ Compensation to employees, a company then shields itself from most liability. However, there is also an option to file a third-party liability claim.

How Do I Know if I Am Eligible for Workers’ Compensation Benefits?

It may seem like a simple thing to determine your eligibility for Workers’ Compensation, but there are certain instances when it is not. It can become even more complicated if you are dealing with a reluctant employer or insurance company. There are a few factors that should qualify you for Workers’ Compensation:

  • There must be an employer-employee relationship to qualify for Workers’ Compensation. A control test will determine this relationship or the relative nature of the work test.
  • Another factor pertains to the authority a supervisor has over you. If they have the right to supervise you, control your work, and how it is performed, or if you rely on the income from your employer and the work you do is an integral part of your employer’s business activities, you may qualify as an employee.
  • You must have sustained your injury or illness because of the work you were performing for your employer. In other words, it must have occurred during the scope of your employment with the company.
  • You have promptly provided notice to your employer about your injury. If you failed to notify them about the accident and attempt to file a claim about it, they will have every right to question that claim and even deny the claim. 
  • There is a specific limit on when a person can file a Workers’ Compensation claim in New Jersey. Employees have two years from the date of the injury or the last compensation payment, whichever is later, to file their claim.

Even if you are unsure about your eligibility, you should assume that you are eligible and act accordingly. That means go ahead and report the incident to your employer and seek medical assistance right away. Failing to do so could hurt your chances of collecting on this benefit if you are eligible.

What Steps Should I Take After Getting Hurt at Work?

When an accident takes place at work, the first step is to not to panic. There are a few steps you should take in the immediate aftermath of an accident. These will benefit you from a physical recovery standpoint as well as help with your Workers’ Compensation claim when you file one in the future.

The order in which you take the following steps will depend significantly on the severity of your injury. These steps include:

  • Get help: If your injury is severe enough, the first step you should do is go to the hospital to have yourself evaluated. If your injury is severe enough, you may be unable to do anything else until you are treated for your injuries. Even if your injuries are not that severe or if you believe that you were not hurt, you should still seek out a medical opinion to determine if you sustained an injury that has not manifested itself yet. The earlier you treat an injury, the more likely you can recover.
  • Follow medical advice: Once you see the doctor, be sure to explain to them what happened and how you sustained your injury. Describe any symptoms that you might be experiencing or any past problems that can factor into your current condition. Then follow the doctor’s instructions, including taking any medications, rehabilitation, or other treatments they prescribe. It may be difficult for you to collect on your benefits if you are not following the doctor’s advice.
  • Report your injury: If you do not need to go to the hospital immediately, you should report your accident to your immediate supervisor. In New Jersey, you have 90 days from the day of your accident to report the incident. Failing to do so will jeopardize your chances of being able to file a claim in the future. Finally, you should submit your incident report in writing, even though it is not required. The report should include the date and time of the incident, the details of what happened, and the injuries you believe you sustained at the time.
  • Collect evidence: As soon as you get the chance, collect evidence from your accident in case you get any resistance from your employer or their insurance. Be sure to get a copy of your timecard to prove that you were working at the time of your accident. In addition, take pictures of the scene of your accident, including any circumstances that led to the accident. You should also take pictures of any injuries you sustained as well. If you are physically unable to do this, you should have a coworker who you trust collect this evidence for you.
  • Speak to witnesses: Talk to any of your coworkers who might have seen the accident take place and will be able to corroborate your story. Take down their statements and, most importantly, get their name and contact information in case you or your lawyer needs to contact them later.

Taking these steps will help you in filing your claim should you encounter any resistance to your claim. If you find that your employer is unnecessary delaying your process or questioning the authenticity of your accident, you should immediately reach out to a Workers’ Compensation lawyer who will vigorously represent you to your employer and help you through what could turn into a long legal process.

How Do I File a Workers’ Compensation Claim?

The first step toward filing a Workers’ Compensation claim is the report to your employer, who will then report the accident to your employer’s Workers’ Compensation insurance carrier. From there, it is up to the insurance provider to complete a First Report of Injury form and submit it to the New Jersey Division of Workers’ Compensation. This notice must be submitted within 21 days of you informing your employer about the accident. Once the document is formally submitted, your Workers’ Compensation claim has commenced. 

After you have made your formal report to your employer, you should continually check on the status of your claim to make sure that the process is continuing, and they have not forgotten about it or ignored it deliberately. 

The insurance company will investigate your claim and after this investigation will decide about whether to accept or reject the claim. If they accept it, you will start receiving your payments for your medical bills and lost wages soon. However, if they deny your claim, you have several legal options available to you to overturn this decision. You have two appeals options through the Division of Workers’ Compensation in New Jersey. The first is a formal hearing through a Claim Petition, while the second is an informal hearing through an Application for an Informal Hearing.

To obtain a formal hearing, you must file your Claim Petition within two years of your accident or the last date you received compensation from the insurance company, whichever is later. If the claim was over an illness you contracted because of work conditions, you must report the illness within two years from the date when you were aware of the illness and its origination with your job.

During a formal hearing, you will be assigned a judge based on the county where you live. If you are from out of state, the judge will come from the county where your employer is based. The overall process will take about six months. 

The process plays out similar to a trial in that both sides present evidence and witnesses to advocate for their case. In your situation, your witnesses should include your doctor, family members, and coworkers with direct knowledge of the accident.

After both sides have presented their evidence, a judge will issue a written opinion that will either accept the Workers’ Compensation benefits claim, in which you will start to receive your benefits in the coming weeks, or the judge will deny the claim. If your claim is denied at this level, you can then appeal that decision to the state courts of New Jersey in the Appellate Division of the Superior Court.

If you want a quicker process than the formal hearing, you might wish to consider an informal hearing. This process only takes a few weeks. You will once again be assigned a judge and a written statement on when your hearing will take place. Over the course of multiple hearings, both sides will present their case. The judge will then issue their recommendation, which either side may feel free to reject. From there, you can then resolve your matter through a formal hearing. 

Cherry Hill Workers’ Compensation Lawyers at DiTomaso Law Will Help You With Benefits After a Workplace Accident

Getting injured at work does not have to cause a severe financial impact. Our Cherry Hill Workers’ Compensation lawyers at DiTomaso Law will stand up for your rights. Call us today at 856-414-0010 or contact us online for a free consultation. Located in Cherry Hill, New Jersey, we represent clients throughout South Jersey, including Mt. Holly, Camden County, and Vineland.