If you’ve been injured on the job, you may wonder what you should do next. Should you call your own health insurance? Are you eligible for workers’ compensation? If you are, what does that mean? Learning the basics of workers’ compensation coverage can help ease some of the stress and uncertainty you may feel if you’ve suffered a work-related injury.
What Is Workers’ Compensation?
Workers’ compensation is a kind of insurance that is paid for by your employer. It compensates employees who sustain injuries on the job for direct expenses like medical bills and indirect expenses like lost wages and disability related to those injuries. Like other insurance policies, the policyholder pays a set amount (the “premium”) for a certain amount of coverage. How much your employer pays depends on a number of considerations, including the type of business activity, the claims and accident history, and the total amount of payroll. If an employee is injured, the insurance carrier is responsible for paying the expenses covered by the policy and paying any compensation for wage loss to the injured worker.
Am I Covered by Workers’ Compensation?
Most employers are required to carry workers’ compensation coverage. State law sets out the requirements for workers’ compensation programs, which means that many aspects of coverage and policy regulations can vary from state to state.
Generally, workers who are considered “employees” are eligible for workers’ compensation, while workers who are classified as “independent contractors” are not. (Check out our blog post “Workers Comp FAQ: Are You an Employee or an Independent Contractor?” if you have questions about whether you are eligible for New Jersey workers’ compensation coverage.) If you are an employee acting within the scope of your job-related duties when you are injured, you are probably eligible to file a workers’ compensation claim.
What Injuries Are Covered by Workers’ Compensation?
In order to be covered by your employer’s worker’s compensation coverage, an injury must “arise out of” and be sustained “in the course of” a worker’s employment. In New Jersey, the Division of Risk Management (DRM) oversees the process of deciding whether a worker’s reported injury is eligible for compensation under the workers’ compensation program. One of the things the DRM evaluates is whether the injury “is a direct result of the employee’s employment” under statutory guidelines.
Note that workers’ compensation may not cover injuries if you are engaged in behavior that is outside the scope of your job duties, even if you are at work. For example, if you are a pizza delivery driver making an unauthorized detour to the grocery store for personal use, a slip-and-fall injury sustained in the store parking lot may not be a work-related injury for purposes of workers’ compensation coverage.
“In the course of employment” means that an employee is at their place of work, during the hours that they are expected to be there, engaged in the task(s) that they are employed to do.
“Place of work” doesn’t have to be the employer’s office or company premises, so long as the employee is directly involved in actual work. For example, a delivery person is at their place of work while traveling to or from deliveries; remote workers or those working from home are also considered to be at their place of work.
To qualify for workers’ compensation coverage, an injury must be the direct and proximate result of something that happened in the course of employment. Further, it must be a bodily injury (not a psychological injury or property damage).
The requirement that it be “direct” does not mean that it must be immediately apparent. Cumulative injuries—those that develop over a period of years, like diseases caused by years of exposure to hazardous conditions—may qualify under this requirement.
What Benefits Does Workers’ Compensation Provide?
If you are a covered employee and suffer a qualified injury, you are entitled to receive a number of different kinds of benefits from the worker’s compensation system.
You are entitled to payment for necessary and reasonable medical treatment, prescriptions, and hospital services related to your work injury; however, the state and your employer have the right to designate which medical providers you use to receive treatment for your work-related injuries.
If your injury means you are unable to work, you may receive compensation for lost wages.
If you are disabled for a period of more than seven days related to an eligible workers’ comp claim, you may 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. 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.
Permanent Partial or Total Benefits
When a job-related injury or illness results in a permanent bodily impairment, benefits are based on the individual’s functional loss (partial or total inability to continue working at any type of gainful employment). These benefits are paid weekly, beginning when temporary disability benefits end. The amount of benefits depends on the severity and permanence of your disability or impairment.
Your dependents may be eligible to recover 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, if you suffer a fatal on-the-job injury.
Pursuing Workers’ Compensation Claims
Generally, your statutory right to receive workers’ compensation is your only remedy for injuries you sustain while working. This means you can’t sue your employer for work-related injuries in civil court. However, there are exceptions. If you have been injured in the workplace, you should consult with an experienced attorney to evaluate your options and ensure you recover the compensation you deserve.
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 Kathleen Hobson, Workers’ Compensation, OFFICIAL SITE OF THE STATE OF NEW JERSEY (July 25, 2019), http://www.state.nj.us/treasury/riskmgt/workers-comp.shtml
 A Worker’s Guide to Workers’ Compensation in New Jersey, NJ.GOV http://lwd.dol.state.nj.us/labor/forms_pdfs/wc/pdf/wc(g)-338.pdf (last visited Nov. 18, 2020).