Workers’ Compensation FAQ in New Jersey

In New Jersey, Workers’ Compensation is a “no fault” insurance plan that provides monetary and medical benefits to employees disabled by work-related injuries or illnesses. A “no fault” plan is one in which, with few exceptions, an employee can receive benefits regardless of who was responsible for a work-related injury or illness. In return for accepting the plan’s benefits, however, the employee may not sue their employer for related pain, suffering or other damages.

Your employer does. Most employers pay premiums to a private insurance company for this coverage.

There are NO UPFRONT LEGAL FEES to be paid to Rudnick, Addonizio, Pappa & Casazza. Further, when your case settles, you will not have to pay any out of pocket legal fees, either. Allowable legal fees are set by the judge and may not exceed 20 percent of the cash award you receive. The insurance company must pay the majority portion of the 20 percent fee. In a third party claim, Rudnick Law Firm’s one-third fee will come right out of the recovery of the case, as well.

Workers’ Compensation benefits include medical treatment for an employee’s work-related injury or illness and weekly monetary benefits for loss of wages during disability. In case of work-related death, benefits include payments to the employee’s family and a cash allowance toward funeral expenses.

A work-related illness, injury or death is one “arising out of, and in the course of” employment. If an accident, illness or death not connected to a person’s employment in some reasonable way, the application for Workers’ Compensation benefits will be denied. Whether a particular injury or illness is work-related is often a matter of interpretation.

You should notify your employer as soon as possible. The notice can be given to your foreman, supervisor, personnel office, or to anyone in authority at your place of business. It does not have to be in writing.

If you need medical treatment for your work-related injury or illness, you should request it from your employer as soon as possible. Under the New Jersey Workers’ Compensation Law, your employer or their insurance carrier can select the health care provider(s) who will treat you.

Your employer’s Workers’ Compensation insurance carrier (or your employer, if they are self-insured) investigates your claim and determine whether your injury makes you eligible to receive workers’ comp benefits. If you disagree with their determination, you have the right to appeal to the New Jersey Division of Workers’ Compensation. You can do this by either filing an application for an informal hearing or by filing a formal Claim Petition.

Temporary benefits are based on your average weekly wage and the State Average Weekly Wage (the SAWW). If your disability began on or after January 1, 2015, your benefit would be 70 percent of your average weekly wage, up to a maximum of 75 percent of the SAWW, or $855 per week. The minimum benefit payable for temporary disability is 20 percent of the SAWW, or $228 per week. Benefits end when you are either released to return to work, or reach Maximum Medical Improvement (MMI), the point at which further treatment will no longer improve your medical condition.

In 2015 the maximum benefit payable in New Jersey for permanent total disability is 70 percent of wages, up to a maximum of $855 per week. The minimum benefit payable is $228 per week. Benefits are payable for up to 450 weeks, but they may be continued beyond that point if you can show that you are still unable to earn wages. There may also be monetary payments for specific injuries. The Social Security Administration maintains a rate chart called a Schedule of Disabilities to determine the monetary values of different kinds of disabling injuries. The Schedule, updated annually, is also used by most insurance companies and Workers’ Compensation review boards to make their determinations.

In cases of permanent partial disability, the same Schedule of Disabilities is used – except that percentages of the various values are taken, depending on the extent of the disability. In 2015 New Jersey’s maximum weekly benefit for permanent partial disability is $855, while the minimum weekly benefit is $35. These benefits are payable for up to 450 weeks.

Workers’ Compensation law forbids terminating an employee because they filed a claim or testified at a Workers’ Compensation hearing. If your employer terminated you for either of those reasons, you may file a discrimination complaint against them with the Workers’ Compensation Division.

Your Workers’ Compensation benefits are totally tax-free except in certain circumstances where you may be eligible to receive Social Security Disability benefits at the same time. If the Social Security Disability benefits are partly reduced (“offset”) by your Workers’ Compensation benefits, then the portion of your Workers’ Compensation benefit that reduces them can be taxed.

Your claim can be denied if you waited too long to file it or if the accident or illness that caused your disability didn’t “arise out of” and “occur in the course of” your employment. Your claim may also be denied if you have inadequate or incomplete medical records, or if you are unable to show that the work-related injury or illness you experienced was the actual cause of your present disability.

If your claim is denied, you have the right to appeal by requesting a hearing before the Workers’ Compensation Board. You may request either a formal hearing or an informal hearing.

You should begin by requesting a hearing before the Workers’ Compensation Board as soon as possible after receiving notice that your claim has been denied.

Workers’ Compensation laws and regulations are complex and can involve legal procedures, rules of evidence and interpreting the applicability of appellate decisions in cases similar to yours—things that most people are unfamiliar with. There are no upfront legal fees nor out of pocket legal fees for you to pay.