Guide to Worker's Compensation in New Jersey

• What to do if you are injured at work or as a direct result of your job
• What kinds of injuries are covered by workers’ compensation
• What benefits are available
• Whether you need an attorney to help you pursue the benefits you deserve

Workers’ compensation is a type of insurance coverage. State law requires that most employers maintain this coverage for their employees. Nearly all employees working in New Jersey are eligible for workers’ compensation protection from the moment they begin their job.

Independent contractors are not protected by workers’ compensation policies or entitled to benefits unless they purchase their own policy of coverage. Many employers misclassify workers who should legally be considered employees. By declaring them to be independent contractors, they avoid paying mandatory benefits, including workers’ compensation. This is illegal. If you think you have been denied benefits because you may be misclassified as an independent contractor, you should consult with an experienced workers’ compensation attorney.

Employers buy a workers’ compensation insurance policy that covers all eligible employees. When an employee suffers an injury or other qualified medical issue, the employer submits a claim to their insurance carrier. The insurer is then responsible for paying medical expenses and costs related to the injury as well as compensation for lost wages.

To be eligible for worker’s compensation, an employee must suffer an injury or illness that arises out of and is sustained in the course of their employment. “In the course of employment” means that an employee is at their place or places of work, during the hours that they are expected to be there, engaged in the task(s) that they are employed to do. A worker’s injury or condition must be the direct and proximate result of something that happened in the course of employment.

Only bodily injuries are covered; workers’ compensation does not pay for psychological injuries or mental illnesses. However, in addition to specific, discrete injuries (such as cuts, burns, broken bones, herniated disks, amputations, concussions, etc.), it does cover injuries or diseases caused by repetitive motions or long-term workplace conditions (such as degenerative disk disorder, illness caused by lead or other hazards in the workplace, hearing loss, chemical sensitivity, carpal tunnel syndrome, etc.). Occupational diseases like black lung, asbestosis, mesothelioma, and many more job-specific ailments may also qualify for coverage.

Sometimes it can be challenging to determine whether a worker’s injury or illness was sufficiently work-related to qualify for compensation. In New Jersey, the Division of Risk Management (DRM) determines whether a worker’s reported injury is eligible for compensation under the workers’ compensation program. The DRM considers the facts and medical evidence and uses statutory guidelines to decide whether the injury “is a direct result of the employee’s employment.” [1] Like most interactions with government agencies, this process can be confusing, complicated, and slow. An attorney can help ensure that this process goes as smoothly as possible and make sure all relevant evidence is timely submitted on your behalf.

Generally, who is “at fault” for or caused your injuries or illness doesn’t matter when considering whether you are eligible for workers’ compensation benefits. Under the NJ Workers’ Compensation Act, employees are eligible for workers’ comp benefits as long as the injury or illness in question was sustained in the scope of their employment. However, your behavior may cause the DRM to determine you were not acting within the scope of your employment or that the injury was not actually the direct result of your employment. A bartender who drinks heavily while at work, for example, would most likely be unable to claim cirrhosis of the liver was a work-related occupational disease.

As more and more workers have “side hustles” that earn some income in addition to their primary employment, the answer to this question becomes less well-defined. If you have any source of income while you are receiving workers’ compensation payments, you must report it to the insurance carrier paying those benefits. If you do not, you may be guilty of criminal fraud. While having a side income is not likely to impact a carrier’s payment of your medical expenses, the insurer may refuse to pay temporary or permanent disability benefits. You should discuss your situation with an experienced attorney.

Sometimes employers attempt to bully employees into keeping quiet about on-the-job injuries. This can be motivated by a desire to keep the number of claims low because more claims can affect the amount the employer pays for the policy. Employers may attempt to make injured workers feel guilty or hesitant to report a claim to workers’ compensation or may refuse to do so on an employee’s behalf. Some may overtly or subtly threaten an employee with retribution or termination.

In New Jersey, the workers’ compensation law specifically prohibits employers from discriminating against or terminating employees because they have claimed or attempted to claim workers’ compensation benefits. Workers are also protected if they testified or are about to testify in another employee’s worker’s compensation matter. If you believe you have been terminated or discriminated against for participating in a workers’ compensation action, you should consult with an attorney.

As with other types of insurance claims, you only have a certain amount of time to submit a claim for a work-related injury.

First, you must report an injury to your employer within a reasonable period of time. What is reasonable depends on the nature of the injury or illness. In the case of an on-the-job accident, this could be a period of hours; in the case of a long-term occupational disease, this could be after obtaining a diagnosis—possibly years after the end of employment.

Usually, your employer will report the claim to the Department of Labor (DOL) as well as their workers’ compensation carrier. Sometimes, however, an employer will deny that an injury was work-related, refuse to respond to an employee’s notice, or otherwise fail to submit the claim properly. If your employer fails to accept or compensate you for a work-related injury, you may have to submit a claim directly to the DOL.

In order to timely file a workers’ compensation claim, an employee must submit a petition to the DOL within two years of the date of their injury (or discovery of injury). Once this time limit has passed, a worker is usually unable to pursue any claim for benefits.

Workers’ compensation claims can be complicated and uncertain. Sometimes injured workers are denied the benefits they deserve. An attorney can often help provide a workers’ compensation insurer with a fuller, more complete picture of a worker’s injuries and disabilities. Experienced legal counsel can help you prepare the best possible application for benefits, appeal a carrier’s decision to deny or terminate benefits, or increase the amount of your benefits or disability determination.

If you have been denied workers’ compensation benefits for an on-the-job injury, if your benefits have been wrongfully terminated, or if an insurer is seeking repayment for benefits you have already received, you need an attorney.

The experienced workers’ compensation team at The Mark Law Firm will help you with all aspects of pursuing your claim, including filing the initial Claim Petition, preparing for hearings before the Workers’ Compensation Board, undergoing an independent medical examination (IME), testifying in an examination under oath (EUO), evaluating medical testimony, participating in mediation or arbitration, and filing an appeal of the board’s decision if necessary.