Workers’ compensation is a no-fault system of insurance that was set up to protect employees who are hurt (or become sick) on the job. With workers’ comp, you don’t have to prove that your employer was in the wrong to be entitled to benefits. It is enough to show that you suffered an injury or were diagnosed with an occupational disease that is related to your work.
If you don’t have experience with the system, you may be confused by what exactly you need to do to get workers’ comp or the benefits that you may be eligible for after filing. In its most basic terms, if you are hurt or develop an illness due to your job, then you can receive medical treatment and compensation for your lost wages and/or permanent disability. The exact amount that you receive is based on the type of injury or illness you suffer and how serious it is.
At Bross & Frankel, our practice is devoted to helping people with disabilities get the benefits that they are entitled to under the law. This includes the full range of workers’ compensation benefits for their injuries.
Eligibility for Workers’ Compensation Benefits
Under New Jersey law, all employers must either maintain a workers’ compensation insurance policy or be self-insured (subject to the approval of the Division of Workers’ Compensation). If an employee suffers an on-the-job injury or is diagnosed with an occupational disease, they may be entitled to a range of benefits. If a worker is killed due to a work-related illness or injury, their dependents may receive certain benefits.
Most physical injuries that occur during the scope of employment will be compensable under the New Jersey Workers’ Compensation Law. Occupational diseases — such as asbestosis or hearing loss — are also compensable. The key is to any workers’ compensation claim is that the injury or illness must have arisen in the course and scope of employment.
Additionally, there must be an employer-employee relationship for you to be eligible for workers’ comp benefits. If you are an independent contractor, volunteer, or otherwise not an employee, then you will probably not be eligible for benefits.
Finally, to qualify for workers’ compensation benefits, you must file a prompt notice of a work injury or illness. In most cases, notice should be provided within 14 days or up to 90 days after an accident or diagnosis. You have up to 2 years after the accident or when the employer stops paying benefits to file a workers’ compensation claim with the state.
Types of New Jersey Workers’ Compensation Benefits
There are five types of benefits that you or your loved ones may be eligible for if you suffer a workplace injury or illness. They include:
- Medical benefits;
- Temporary disability benefits;
- Permanent partial disability benefits;
- Permanent total disability benefits; and
- Death benefits
The value of a workers’ comp case will depend on the nature and severity of your injury or illness.
Medical benefits include all necessary and reasonable medical treatment, along with prescription medications and hospitalization services. These benefits are paid directly by the insurer (if self-insured) or by their insurance carrier.
Importantly, an employer has a right to designate an authorized treating physician for all work-related illnesses and injuries. However, if there is an emergency or if the employer refuses to provide medical treatment, then you may choose your own treating physician. In this situation, you should inform your employer as soon as possible that you are being treated for a work-related illness or injury.
Temporary Disability Benefits
After you have missed work for more than 7 days due to your injury or occupational disease, you will be eligible for temporary disability benefits. These benefits are only available when you are unable to work and are actively under medical care.
Temporary disability benefits are paid at a rate of 70% of your average weekly wage (AWW). This amount cannot exceed 75% of the statewide average weekly wage (SAWW), or be less than 20% of the SAWW. Currently, the temporary disability rate is set at a maximum of $945 per week, and a minimum of $252 per week.
These benefits usually end when you are released to return to work or when you have reached what is known as Maximum Medical Improvement (MMI). This means that further treatment will not improve your condition. If you are left with permanent injuries (partial or total), then you may be eligible for additional benefits.
Permanent Partial Disability Benefits
If you have a disability that is permanent due to a work-related illness or injury, then you may be entitled to permanent partial disability benefits. This compensation is based on a schedule of disabilities.
You may either have a “scheduled” or “non-scheduled” disability. A scheduled disability is one that involves a disability listed on the schedule, involving your arms, hands, fingers, legs, feet, toes, eyes, ears, or teeth. A “non-scheduled” disability is any loss involving a part or system of the body that isn’t specifically identified in the schedule (such as the brain, lungs, or the spine).
The amount of compensation that you receive is based on a percentage of your disability. For example, if you suffer a 30% disability (not amputation) to your thumb, then you are entitled to receive 24 weeks of permanent partial disability benefits at a rate of $6,048. These benefits will be paid weekly, due after your temporary disability benefits end.
Permanent Total Disability Benefits
If you are unable to return to any gainful employment after a workplace injury or occupational disease diagnosis, then you may be eligible for permanent total disability benefits. The initial benefit period is 450 weeks, which may be extended if you can demonstrate that you are still unable to work.
Permanent total disability benefits are paid on a weekly basis. Like temporary disability benefits, they are paid at a rate of 70% of your average weekly wage, with a maximum (75%) and minimum (20%) based on the statewide average weekly wage. After 450 weeks, any wages that you earn will offset the amount of permanent total disability benefits that you receive.
You may be considered to be permanently and totally disabled if you have an injury or multiple injuries that make you unable to work. Permanent total disability is also presumed in situations where a worker loses two major members (such as eyes, legs, feet, arms, or hands), or a combination of members of the body.
If a worker dies due to a work-related illness or injury, then their dependents may be able to receive death benefits. For purposes of workers’ compensation, a surviving spouse and children who were part of the worker’s household at the time of death are presumed to be dependents. Others who may be considered dependents must prove that they were actually dependents (such as parents, siblings, or grandchildren).
Death benefits include payments of 70% of the average weekly wage of the deceased employee. This amount cannot exceed the maximum amount set each year by the Labor Commissioner. If there is more than one dependent, then a judge will divide the benefit amount based on their needs.
Children who are considered dependents may continue to receive benefits up until the age or 18, or 23 if they continue to be a full-time student. If a dependent child has a disability, they may receive additional benefits.
In addition to weekly compensation, death benefits include up to $3,500 in funeral expenses. The employer or its insurer may pay this amount to whoever is responsible for paying these expenses associated with the job-related death.
I Was Hurt at Work. Am I Entitled to Compensation for My Pain and Suffering?
No. The New Jersey Workers’ Compensation Act allows for five types of benefits: medical, temporary disability, permanent partial disability, permanent total disability, and death benefits. Compensation for pain and suffering is not authorized under this Act.
Generally, damages for intangible losses, such as pain and suffering, are available through personal injury lawsuits. Because workers’ compensation is an exclusive remedy, injured workers are limited to obtaining benefits through the workers’ compensation system. There are some exceptions to this rule, including when an employer intentionally causes an injury or when the injury was caused by a third party.. A skilled New Jersey workers’ compensation attorney can evaluate your case and advise you of your options.
Who Determines If I Am Permanently Disabled?
If you are hurt at work or develop an occupational illness, you are entitled to receive medical benefits through the workers’ compensation system. After you have completed the course of treatment, you may be entitled to permanent disability benefits if you still have some degree of disability. Your eligibility for these benefits – and the amount of benefits that you receive – is determined through two permanency evaluations.
These evaluations are completed by a doctor of your choosing and by a doctor that is chosen by your employer or its insurance carrier. Each doctor will express your level of permanent disability as a percentage of functional loss of a particular body part and the impact on your ability to perform your job.
These two separate evaluations will then be reviewed by each side’s attorney and the Judge of Workers’ Compensation. From there, a settlement recommendation will be made with regards to permanent disability benefits.
What Type of Medical Treatment Can I Get for My Work Injury?
Under New Jersey law, employees who are hurt on the job or who develop an occupational illness are entitled to all necessary and reasonable medical treatment, including prescriptions and hospitalization. These costs are paid by the employer’s insurer or directly by the employer.
While each case is different, medical benefits may include appointments with a doctor or specialist, physical therapy, surgery, diagnostic tests, and/or medication. Importantly, your employer has the right to designate the treating physician for work-related injuries. If the treating doctor determines that a medical treatment is unnecessary or that you will not benefit from further treatment, you may file a motion with the Division of Workers’ Compensation.
Questions? We’re Here to Help.
If you have suffered an injury at work or have been diagnosed with an occupational illness, you may be entitled to workers’ compensation benefits. These benefits are designed to ensure that you get the treatment that you need — along with compensation for lost wages and any permanent disability that you may have suffered.
At Bross & Frankel, we are dedicated to helping people get the benefits that they are entitled to after a work-related illness or injury. We offer free claim reviews for all prospective clients. To learn more or to schedule a consultation with a New Jersey workers’ compensation attorney, call us today at 856-795-8880 or reach out online.