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How Do New Jersey Workers’ Compensation Benefits Work?

Posted by Jamison Mark on Sep 12, 2015 1:24:00 PM

Most companies are required to have workers’ compensation insurance, which ensures that employees injured on the job will be compensated for their injuries and lost wages. Workers’ compensation is governed by state law, which means that many aspects of workers' comp requirements and regulations will vary from state to state. Generally, you can’t sue your employer for work-related injuries; your statutory right to receive workers’ compensation is your only remedy. 

Hazardous jobsites can lead to injury and workers compensation claims

What injuries are covered by workers’ compensation?

In order to be eligible for worker’s compensation, an injury must “arise out of” and be sustained “in the course of” a worker’s employment. In New Jersey, once a worker reports an injury, the Division of Risk Management (DRM) oversees the process of deciding whether it is compensable. You must report an injury to DRM within strict time limits. The DRM then determines whether the injury “is a direct result of the employee’s employment” under statutory guidelines.[1]

  • “In the course of employment” is defined as when employees are at their place of work during the hours that they are expected to be there and engaged in doing the task that they were employed to do.

An employee doesn’t have to be at the employer’s office or on company premises, just directly involved in actual work. (This can be while traveling to or from appointments, working at job sites, or even working remotely from a place of their own choosing.) 

  • The injury for which a compensable claim is made must be the direct and proximate result of something that happened in the course of employment, and it must be a bodily injury (not a psychological injury or property damage).

If the injury is deemed compensable in nature, the injured worker is entitled to the full benefits of worker’s compensation.

What benefits can I get from workers’ compensation?

If the injury results in lost time from work, the employee could receive monetary benefits through worker’s compensation. The benefit is based on 70% of the employee’s base salary at the time the injury occurred; however, it cannot exceed the rate that is allotted for the year in question. If a medical review shows that you have a permanent disability, you may receive a monetary settlement; the amount of this award will vary based on the type and extent of your disability.[2]

Medical Benefits:

You are entitled to necessary and reasonable medical treatment, prescriptions, and hospital services related to your work injury. However, the treatment is fully governed by the state of New Jersey, through our medical management facility, Horizon Casualty Services, Inc.; the state and your employer have the right to designate medical providers for all work-related injuries.

Temporary Total Benefits:

If an injured worker is disabled for a period of more than seven days related to an eligible workers’ comp claim, he or she will be eligible to receive compensation for lost wages. The benefit will be paid at a rate of 70% of the worker’s average weekly wage, not to exceed or fall below the statutory maximum rate or fall below the statutory minimum rate.

  • Your average weekly wage is generally based on the average weekly earnings in the eight calendar weeks immediately before the week in which the disability begins.
  • The maximum rate is 75% of the state average weekly wage. The minimum is 20% of the SAWW. For frame of reference, in 2013, the state average weekly wage for NJ was $1,140.02.[3]

Temporary benefits are provided retroactively (dating back to the date of the injury) until the day the worker returns to work, reaches maximum medical improvement (MMI), or has exhausted the statutory 400-week maximum.

When a worker reaches MMI, he is evaluated by one or more physicians and specialists and rated with a determination of how much lasting and permanent injury the worker will carry. If the injury is specific and relatively common, e.g., one that is in the common workers’ compensation tables, such as the loss of a finger or use of an arm, a specific number of weeks of compensation will be paid. If the injury is non-scheduled, then the attorneys for all parties generally try to settle on an amount. The percentage of the salary that gets paid, like the number of weeks of payment, varies based on severity.

Permanent Partial Benefits:

When a job-related injury or illness results in a permanent bodily impairment, benefits are based on the individual’s functional loss. These benefits are paid weekly, beginning when temporary disability benefits end. Permanent partial benefits in New Jersey are not to exceed $792/week and not to be lower than $35/week.

For example, a worker who is in a compensable accident loses a finger. He is out of work for three weeks, but then returns to his normal work schedule. He would receive temporary total benefits while he is off of work, and then begin to receive permanent partial benefits based on the amount of his permanent loss when he returns to work.

Permanent Total Benefits:

When a work injury or illness prevents a worker from returning to any type of gainful employment, he or she may be entitled to receive permanent total disability benefits. These weekly benefits are provided initially for a period of 450 weeks. Benefits can continue beyond the initial 450 weeks if the injured worker is able to show that he or she remains totally disabled. As with temporary benefits, the benefits are paid weekly and are based upon 70% of the average weekly wage, not to exceed or fall below the statutory limits.

Death Benefits:

Dependents of a worker who dies as a result of a compensable work-related injury or illness may be eligible to receive funeral expenses up to $3,500, as well as weekly death benefits of 70% of the wage of the deceased worker, not to exceed the statutory maximum. [4]

  • A surviving spouse or civil union partner and natural children who were a part of decedent’s household at the time of death are conclusively presumed to be dependents.
  • A surviving spouse or civil union partner and natural children who were not a part of decedent’s household at the time of death, and all other alleged dependents (such as parents, grandparents, grandchildren, brothers, sisters, etc.) must prove actual dependency.

Children who are deemed to be dependents remain so until the age of 18 years or, if a full-time student, until the age of 23 years. If a child is physically or mentally disabled he/she may be eligible for further benefits.

 

If you’ve been injured in a workplace accident or believe you have a claim related to your employment, such as a sexual harassment, discrimination, wrongful termination, or adverse employment action claim, call the Mark Law Firm today. An experienced New Jersey workers' compensation attorney can help protect your rights and ensure you receive the compensation you deserve for your injuries. We have three convenient locations – whether you’re closer to Newark and Jersey City or Bridgewater and Somerville.

Download our FREE guide to the 5 essential things you should know about workers’ compensation in New Jersey by clicking below, and contact us today for a consultation.

 

 Injured on the job?  Free Guide: 5 Things You Must Know


[1] http://www.state.nj.us/treasury/riskmgt/workers-comp.shtml

[2] http://lwd.dol.state.nj.us/labor/wc/workers/workers_index.html

[3] http://lwd.dol.state.nj.us/labor/wc/content/stats.html

[4] http://lwd.dol.state.nj.us/labor/forms_pdfs/wc/pdf/wc(g)-338.pdf

Topics: Employment Law, Workers' Compensation

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