Do You Qualify for Workers' Compensation?

If you’re injured while working in New Jersey, you may be eligible for workers’ compensation. Workers’ compensation is available regardless of who (if anyone) is at fault for the injury. To determine whether and how much you may be able to receive from the program, the New Jersey Division of Risk Management takes several factors into consideration. Generally speaking, workers’ compensation is available to employees who suffer illness or injury arising “out of and in the course of employment.” Whether a particular injury fits this description, however, may not be immediately apparent.

Are you eligible?

Were you at work?

To qualify for workers’ compensation, the illness or injury that forms the basis of your claim must be the result of something that happened at work while you’re engaged in work-related tasks. What qualifies as at work and work related is also subject to interpretation. For example, many employees now perform a substantial amount of work from their homes, making this their usual place of work.

An injury sustained off the usual worksite could also be covered, such as one that occurs during work-related travel or while running errands for your employer. On the other hand, if you’re injured in the middle of the workday but you’re away from the worksite on personal business (for example, eating lunch at a restaurant during your break time), workers’ compensation would not provide coverage. Some situations may fall into grayer areas that require legal interpretation.

Is the injury related to your work?

In many cases, the answer to this question is obvious. If you suffer an acute injury from equipment you’re using at work, chemicals you’re exposed to, or slipping on the freshly mopped office floor, there may be little question of whether it’s work related. Other injuries and illnesses develop gradually over time, however, and may be more difficult to definitively connect to work activities. Additionally, when workers suffer cardiovascular and cerebrovascular events like heart attack, stroke, and pulmonary embolism, more substantial evidence is required to show they were caused “in a material degree” by the claimant’s work. If an employer or insurer disputes your claim, you can file a formal Claim Petition or an Application for an Informal Hearing with the Division of Workers’ Compensation.

What benefits can you receive?

Depending on the injury, workers’ compensation claimants may receive benefits for resulting medical treatment, lost wages, and disability.

Medical Benefits

Workers’ compensation covers medical treatment, such as prescriptions, doctor visits, and hospitalization, that is reasonably necessary to treat the work-related illness or injury. Medical treatment for New Jersey workers’ compensation is managed by Horizon Casualty Services, Inc. The employer or their insurer may select the treating physician, although there are exceptions for emergencies and when employers refuse to provide access to treatment. If you receive emergency treatment for a work-related injury, notify your employer of this as soon as possible to protect your benefits.

Lost Wages

If your work-related injury renders you unable to return to work for more than seven days while you’re under medical care, you may be eligible for compensation for lost wages. These temporary benefits are paid at a rate of 70% of your average weekly wage (although statutory minimums and maximum apply).

Permanent Disability

If you’ve received the maximum benefit from medical treatment (referred to as “maximum medical improvement or MMI) and the injury continues to impact your life, you may become eligible for partial or total permanent disability benefits. Partial disability applies to injuries that are permanent but don’t prevent the employee from being gainfully employed. Total disability benefits are available when the employee is no longer able to work due to the injury. You can find New Jersey’s minimum and maximum permanent disability benefit rates here. Additionally, certain “scheduled” losses, such as loss of function in limbs, sight, or hearing, entitle claimants to specific benefit amounts, determined by the body part affected and percentage of the disability related to that body part.

As you can see, many factors go into determining whether a worker is eligible for workers’ compensation and, if so, how much their entitled to receive. It’s not uncommon for employers or their insurers to deny benefits to claimants who deserve them. As a result, it can be useful to talk with an attorney about your claim. An experienced New Jersey workers’ compensation lawyer can help you understand your rights and how to effectively enforce them. To learn more about workers’ compensation in New Jersey, visit our workers’ comp page.

Resources

James P. Renner v. AT&T, NJ Sup. Ct. (A-71-11) (068744), 2014.

NJ Rev Stat §34:15 (2009).

Protection for Injured Workers. https://www.nj.gov/labor/workerscompensation/injured-worker-protections/. Accessed October 28, 2022.

Schedule of Disabilities and Maximum Benefits Exclusive of Amputation and Enucleation. NJ Department of Labor and Workforce Development. Effective January 1, 2022. Accessed October 28, 2022. https://www.nj.gov/labor/workerscompensation/assets/PDFs/Legal/2022_schedule.pdf.

Workers’ Compensation. Division of Risk Management. New Jersey Department of Treasury. Updated July 7, 2022. Accessed October 28, 2022. https://www.nj.gov/treasury/riskmgt/workers-comp.shtml

Workers’ Compensation Rates and Statistics. NJ Department of Labor and Workforce Development. Published January 30, 2022. Accessed October 28, 2022. https://www.nj.gov/labor/workerscompensation/tools-resources/rates-statistics/