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Injured Workers Have Both Benefits and Responsibilities

By: Attorney Jeffrey S. Monaghan
The New Jersey Workers’ Compensation Act cushions the impact of workplace accidents by providing medical care, lost wages and, potentially, a monetary award for permanent injury through workers’ compensation insurance policies that must be carried by every employer for every employee in any occupation.

You can receive benefits for BOTH specific traumatic injuries and for what are called "occupational related diseases" – if proven to have arisen out of and in the course of your employment. Qualifying occupational related diseases, or conditions, may have been either caused by or aggravated by the kind of work you do or work environment in which you do it.

Many job related injuries or diseases and conditions can qualify for workers’ compensation benefits, such as: Asthma, emphysema & other breathing disorders, bone fractures or dislocations, burns, cancer, carpal tunnel syndrome & trigger finger, cuts & abrasions, joint diseases & replacement, disc herniation or fracture, infections & viruses, hearing loss, ligament & tendon injury, mental health trauma, poisoning, severe allergic reaction, skin diseases, spinal injury, and vision impairment.

New Jersey Workers’ Compensation laws require “no-fault” insurance policies. Employees suffering work related injury or disease should be compensated with a minimum of delay and without having to prove employer fault, regardless of any contributing negligence by the employee. However the employer’s workers’ compensation insurance company may raise some defenses to challenge the work-injury connection, question the injured workers’ conduct, or dispute the extent of the injury or disease in order to deny or minimize the employee’s benefits. Injured workers should take steps immediately to avoid or overcome these defenses.

WHAT TO DO IF YOU SUSTAIN IN A WORK RELATED INJURY

New Jersey Workers’ Compensation laws are subject to time constraints known as Statutes of Limitations. So it is important that employees notify the employer of any work related injury in a timely manner. Similarly, you must inform your employer or former employer of an occupational related disease, caused by or aggravated by the work you do, shortly after being diagnosed as such – even if the diagnosis occurs after significant time passes or after employment at that employer ends.

Timely employer notification helps avoid issues being raised as to the exact cause of an alleged workplace injury, as well as being required for all job related injuries.

Follow whatever notification procedure your employer has in place. This usually requires reporting the accident and how it occurred directly to a designated person such as the employee’s supervisor. You may be required to fill out an accident or injury report detailing how the accident happened and the particular injuries that have been sustained. If no procedure is in place, the injured employee should notify their direct supervisor.

No matter how insignificant the injury may initially appear notify your employer of the workplace injury. Symptoms associated with your injury may not manifest or become particularly noticeable for several days following the accident. A formal record describing the accident and the particular body parts affected can help avoid certain causal relationship issues from being raised by either employer or workers compensation insurance company.

When injured or upon recognizing that your injury may be significant, see a doctor.

MEDICAL TREATMENT BENEFIT

Under New Jersey Workers’ Compensation laws, your employer is required to furnish medical, surgical and other treatment and hospital services necessary to cure and relieve the effects of the injury. Included in the requirement is the employer’s obligation to cover the cost of medication that has been prescribed by an authorized doctor for the treatment of the injury sustained.

However, also under the New Jersey Worker’ Compensation laws, your employer is allowed to select the medical providers who will deliver and oversee the necessary and related treatment from a work related accident. Employees who obtain medical treatment on their own – after an employer or employer’s workers’ compensation insurance company has offered medical treatment through a designated treating doctor – will most likely be responsible for the cost of this unauthorized treatment.

LOST TIME WAGE REPLACEMENT BENEFIT

New Jersey Workers Compensation laws also mandate a wage replacement benefit – called temporary compensation – when a treating doctor, authorized by the employer or their workers’ compensation insurance company, has ordered the employee not to work for more than seven days following the accident while medical treatment is being provided for the job related injury. Once the eighth day of lost time from work has been reached, the employer or employer’s workers’ compensation insurance company must compensate the injured worker for lost wages from the first day you became unable to work continually until you either return to work or reach the maximum medical benefit from the treatments.

In cases when the treating doctor decides that an injured employee is capable of performing what is considered light duty work or some type of restricted work below the normal full job duties of the employment, the employer has the option of either providing the employee with work which meets these restrictions or continuing to pay temporary compensation benefits to the injured worker.

The temporary compensation is payable weekly at a rate equal to 70 percent of the injured worker’s normal weekly gross wages at the time of the accident and subject to a maximum of 75 percent of the statewide average weekly wages. These payments are tax-free.

PERMANENT DISABILITY BENEFIT

The Permanent Disability Benefit is a monetary award for work related injury, condition or disease resulting in some permanently disabling, or restricting, effects in the employee’s normal day-to-day life – on or off the job.

The determination regarding whether there has been a permanent disability and the extent of disability is made after the medical treatment has concluded. And, the injured employee has the burden of proof.

After medical treatment has concluded, both the attorney representing the injured worker and the attorney representing the workers’ compensation insurance company each have the employee undergo an examination, or examinations, by medical experts who specialize in the field of medicine covering the particular injuries sustained in the accident. These doctors, separately, review the medical records, then conduct their own a physical examinations of the worker. Each doctor prepares a report estimating the extent of disability, if any.

The injured worker’s attorney must demonstrate that the effects of the injury have resulted in a material lessening of your working ability or that the injury has resulted in disability that restricts you from carrying out the ordinary and regular activities of your day-to-day life away from work.

A successful workers compensation case may also entitle an injured worker to additional medical treatment and/or additional monetary benefits in the future if it can be proven that such additional benefits are warranted after the conclusion of the initial case. The time frame for either or both of these benefits is a two-year time period which commences from the workers final receipt of the monetary benefit awarded under the initial resolution of your case.

DEFENSES TO A WORK RELATED INJURY OR DISEASE

The concept of “negligence” is not part of the workers’ compensation system, in that you do not have to prove fault by your employer or co-employee in causing the accident. Nevertheless, an employer or their insurance company can raise certain defenses in response to your claim for workers’ compensation benefits.

For example, proving that instances of serious and willful misconduct by the injured employee led to the injuries could diminish or disqualify the injured worker from receiving the benefits.

Also, an employer or their workers’ compensation insurance company might assert that an injury did not arise out of or in the course of employment.

Finally an employer or their workers’ compensation insurance company may raise a Statute of Limitation defense, asserting that the accident, or resulting injury or disease diagnosis, were not reported in the required time period.

If the employer or their workers’ compensation insurance company raises any of these defenses in response to your claim, then the medical treatment and wage replacement benefits will not be automatically provided to the injured employee.

Timely legal representation is of critical importance in order to ensure that the injured worker’s claim is properly presented and the injured worker receives the benefits provided under our workers compensation laws as quickly and fully as possible.

THIRD PARTY INJURY CLAIM

When negligence by an entity other than your employer, or an employee of an entity other than your employer, contributes to your work related injury or condition, then you may file a personal injury negligence claim against that “third party” – or those multiple negligent “third parties” – in addition to, concurrent with, and separate from your workers’ compensation claim.

Such actions often result in significantly greater financial recovery for the injured worker and partial or complete recovery of benefits paid for the employer and their workers’ compensation insurance company.

Such actions often arise in multiple contractor projects, work done away from your employer’s premises, or from the use of defective products.

Legal representation by a law firm experienced in both workers’ compensation and personal injury can provide you with an informed evaluation of each aspect of your case.

SUMMARY

All employers are required by the New Jersey Workers’ Compensation Act by law to carry “no fault” workers’ compensation insurance for all of their employees in the state. Workers’ compensation laws mandate certain medical treatment, wage replacement and permanent disability benefits to be provided by the employer or employer’s insurance company.

The employer or employer’s workers’ compensation insurance company is allowed to select the providers who will deliver and oversee the medical treatment for work related injuries and conditions.

The employee maintains the burden of proof in determining permanent disability awards.

Workers’ compensation benefits are subject to reporting time limits, called Statues of Limitation, from the incident and/or diagnosis. Workers’ compensation claims can be challenged on the grounds of reporting time, the work-injury connection, the severity of injury, and employee’s contribution to injury by serious and willful misconduct.

When negligence by entities, or employees of entities, other than your employer contribute the injury, you may initiate third party injury claims against these parties in addition to your workers’ compensation claims.
 

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