When a Seemingly “Non-Work-Related” Injury Can Be Work-Related

Hurt hand and work injury claim form

In earlier blogs, we’ve talked about the requirements for qualifying for workers’ compensation benefits—you must have been hurt and the injury must have been “job-related.” In many instances, particularly if your injury stems from a work accident, it’s pretty easy to show that the injury was caused by your job. There are situations, too, where you can’t point to a single incident, but you can provide evidence that suggests that your work caused the injury—repetitive stress injuries or occupational illness fall into this category. There can also be instances where it doesn’t appear, at first blush, that your injury was work-related, but a careful investigation and analysis can lead to a causal connection.

Let’s look at an example. Suppose you suffer a stroke or a nervous breakdown while at home. You weren’t at your place of employment and you weren’t working on anything tied to your job, so it seems unlikely that you’d have any chance of securing workers’ compensation benefits.

But what if you could show that you’d been under an inordinate amount of stress at work? Maybe you’ve had unending production deadlines, or maybe it’s just the nature of your job…suppose you work as a paramedic, a firefighter or a police officer, and you are exposed to trauma on a daily basis. Could you make the argument that the stress caused by your job had a negative impact on your blood pressure, causing the stroke?

Successful workers’ compensation claims have been made by attorneys for clients who suffered heart attacks and other health problems because of work-related stress.

Contact the Law Offices of Voorhees Law, LLC

To arrange a private meeting, contact us by e-mail or call our office at 908-200-2297. Evening and weekend meetings are available upon request. We take all major credit cards.

We handle all workers’ compensation cases on a contingency basis. There will be no attorney fees unless we get compensation for your losses.

Can Your Employer Terminate Your Health Insurance Benefits If You Are Collecting Workers’ Compensation Payments?

Health Insurance Benefits

Under New Jersey’s workers’ compensation laws, you are entitled to payment of all “necessary and reasonable medical expenses” resulting from a work-related injury, including medication and hospitalization, as well as payment based on your disability. If you have job-related health insurance, can your employer terminate that insurance during any period when you are unable to work?

Unfortunately, there are no provisions in the New Jersey workers’ compensation laws that require your employer to keep your company health benefits in force while you are collecting workers’ compensation payments. That does not mean, however, that your employer won’t have to pay for any medical expenses that you have. But it can mean that any coverage provided to your dependents through the company-provided health insurance policy will be discontinued. Though surviving spouses and dependent children may be entitled to disability benefits in the event of your death from a work-related accident or illness, there is no provision for them to receive any medical benefits and no requirement that your health insurance covering them remain in effect.

You may be able to get some limited benefits or protection under the Family and Medical Leave Act (the FMLA), a federal statute that protects employees who need to take time off from work for health reasons. Under the FMLA, you can have up to 12 weeks unpaid leave with full benefits. You must, however, apply for leave and your benefits will only be available for that three month period.

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To arrange a private meeting, contact us by e-mail or call our office at 908-200-2297. Evening and weekend meetings are available upon request. We take all major credit cards.

We handle all personal injury cases on a contingency basis. There will be no attorney fees unless we get compensation for your losses.

What are “Supplemental Benefits” under the New Jersey Workers’ Compensation Laws?

Supplemental Benefits

If you suffered an injury in the workplace, and you are awarded permanent total disability benefits, will those benefits be fixed for the rest of your life? What happens as the cost of living increases? Is there any adjustment for inflation or other increases in the cost of care or living?

Fortunately, under New Jersey’s workers’ compensation system, there are “supplemental benefits” that may be paid in addition to the basic weekly disability payments. These supplemental benefits are designed to compensate disabled workers for any changes in the cost of living. An annual assessment of the cost of living is conducted and weekly benefits may increase if there’s an acknowledged increase in the cost of living. It’s also important, though, to understand that supplemental benefits may be reduced if a worker qualifies for Social Security, Black Lung or employer-provided disability pension payments.

Unfortunately, the right to supplemental benefits is extremely limited, though. Under the New Jersey law, supplemental benefits are available only to totally and permanently disabled workers whose date of injury was prior to January 1, 1980, and to dependents of individuals who have died in a work-related accident or from a work-related illness before that date. Surviving dependents of a person who died from a work related accident after 1979 may still have a claim to supplemental benefits if they can show that the death was caused by an injury suffered before January 1, 1980.

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To arrange a private meeting, contact us by e-mail or call our office at 908-200-2297. Evening and weekend meetings are available upon request. We take all major credit cards.

We handle all personal injury cases on a contingency basis. There will be no attorney fees unless we get compensation for your losses.

What is New Jersey’s Second Injury Fund?

work related injury

Suppose you have a disability from a prior work-related injury, but it doesn’t keep you from being gainfully employed. Then you suffer a new injury on the job, unrelated to your first injury, but the combination of both injuries renders you permanently unable to work. Are you eligible for permanent total disability payments under New Jersey’s workers’ compensation system?

Fortunately, the answer is yes. Under New Jersey’s “Second Injury Fund (SIF),” a worker who becomes permanently totally disabled because of the combination of a pre-existing condition and a new injury may be entitled to permanent benefits. Designed to encourage New Jersey employers to hire persons with disabilities, the Second Injury Fund was established in 1923. For an employer who hires a disabled worker, liability for any subsequent injury is limited to the second injury only. The employer is not liable for permanent total disability benefits. The Second Injury Fund pays all additional benefits.

To obtain benefits from the Second Injury Fund, you must obtain an Order for Total Disability with Second Injury Fund involvement. Typically, your employer or your employer’s workers’ compensation insurance provider will make payments for a specified period of time. When those benefits end, the benefits from the SIF will commence.

Before you actually start to receive benefits from the SIF, though, you will need to complete an initial certification. You can expect to receive the documentation for this within a month or two prior to the expiration of benefits from your employer or employer’s workers’ compensation insurance provider. The initial certification simply reconfirms that you are permanently totally disabled and cannot return to work.

It’s important to understand that the Second Injury Fund does not cover any medical expenses, but only provides benefits for your disability.

Contact Us

To arrange a private meeting, contact us by e-mail or call our office at 908-200-2297. Evening and weekend meetings are available upon request. We take all major credit cards.

We handle all personal injury cases on a contingency basis. There will be no attorney fees unless we get compensation for your losses.

Permanent Total Disability Benefits in a New Jersey Workers’ Compensation Claim

suffer-an-injury

If you suffer an injury in the workplace in New Jersey, and the nature of your injury is such that you’ll never be able to work again, you can pursue permanent total disability benefits under New Jersey’s workers’ compensation system. The determination that you cannot work must be made by a medical professional.

Customarily, in the aftermath of an injury, you’ll receive temporary total disability payments (assuming you cannot work at all). Once it’s determined that your medical condition will not improve to the point where you can work again, your temporary benefits will be terminated and replaced by permanent benefits. As a general rule, the permanent total disability award is for a period of 450 weeks. However, the benefits may continue to be paid after that period expires, provided you can demonstrate that you are still unable to engage in any gainful employment.

The amount of your benefits will be based on your average weekly wage (AWW) for the 26 week period immediately preceding your injury. The allocated percentage is 70%, but your benefits must be at least 20% of the statewide average weekly wage (SAWW) and cannot exceed 75% of the SAWW. To qualify for permanent total disability, though, you need not show that you can’t work at all. Instead, if you have lost two major members of your body—both arms or both feet, for example—or if you have lost a combination of two or more members—a leg and a hand, for example—you will be presumed to be permanently totally disabled.

Contact Our Office

To arrange a private meeting, contact us by e-mail or call our office at 908-200-2297. Evening and weekend meetings are available upon request. We take all major credit cards.

We handle all personal injury cases on a contingency basis. There will be no attorney fees unless we get compensation for your losses.

Permanent Partial Disability Benefits under New Jersey’s Workers’ Compensation System

Partial Disability

If you’ve sustained an injury on the job and company authorized medical professionals have determined that you will either be unable to ever work again, or will carry a partial disability with you for the rest of your life, you may be eligible for either permanent partial benefits or permanent total benefits under New Jersey’s workers’ compensation laws.

Permanent Partial Disability Benefits

If you’ve suffered an injury that doesn’t preclude you from working, but limits your ability to perform your job or leads to a permanent change in your health, you can pursue what are known as permanent partial disability benefits, also called “scheduled or non-scheduled” losses. A scheduled loss is a permanent injury to appendages, such as arms, legs, hands, feet, fingers and toes, as well as eyes, ears or teeth. An unscheduled loss is a permanent injury to any other part of the body, such as your neck, back, lungs or heart.

Permanent partial disability payments customarily start immediately after any temporary disability payments are terminated. The amount of your payment and the number of weeks you receive payments are based on the percentage of disability, as established by the Department of Workers’ Compensation and the schedule of disabilities.

According to the 2016 schedule, the New Jersey statewide average weekly wage is $1,161.04, so the maximum rate that can be paid on a permanent disability claim is $871, though an additional 30% will be added for any amputation. Some examples of the duration of payments include:

  • Disability involving hand—245 weeks
  • Disability involving arm—330 weeks
  • Disability involving fingers—anywhere from 20 weeks to 75 weeks
  • Disability involving leg—315 weeks
  • Disability involving foot—230 weeks
  • Disability involving eye—200 weeks

Contact Us

To arrange a private meeting, contact us by e-mail or call our office at 908-200-2297. Evening and weekend meetings are available upon request. We take all major credit cards.

We handle all personal injury cases on a contingency basis. There will be no attorney fees unless we get compensation for your losses.

Temporary Total Disability Benefits in a New Jersey Workers’ Compensation Claim

Disability Benefits

When you’ve been hurt on the job in New Jersey, your first course of action will likely be to file for workers’ compensation to cover lost wages. Technically, New Jersey is not a “wage loss” claim state for workers’ compensation purposes. Instead, injured workers are entitled to disability benefits, which can be partial or total, or temporary or permanent, based on the nature of the injury.

Temporary Total Disability Benefits

If you are unable to work at all because of your injury, you may be entitled to “total disability” payments for a specified period of time. You cannot start to recover total disability benefits, though, until you have been unable to work for a period of at least seven days. Once you meet that threshold, you may be eligible for payments, typically at a rate of 70% of your average weekly wage (AWW) for the 26 week period immediately prior to your injury. There’s both a minimum and a maximum that can be paid, though. Your benefits cannot exceed 75% of the New Jersey state average weekly wage, and must be at least 20% of the that amount.

Temporary total disability payments are only available if you are unable to work at all because of your injury. If your doctor clears you to return to work, your benefit payments will typically be discontinued. In addition, if you have reached what is known as “maximum medical improvement (MMI), where your doctor determines that you won’t get any better, the temporary benefits will be terminated and you may be eligible for some level of permanent benefits.

Contact Us

To arrange a private meeting, contact us by e-mail or call our office at 908-200-2297. Evening and weekend meetings are available upon request. We take all major credit cards.

We handle all workers’ compensation cases on a contingency basis. There will be no attorney fees unless we get compensation for your losses.

What Medical Benefits Are Available in a New Jersey Workers’ Compensation Claim?

Medical Benefits

If you have been hurt on the job in New Jersey, one of your first steps after an injury will be to seek medical care. You’ll also want to ensure that your workers’ compensation benefits pay for any treatment you need. But are there any limits to the medical care you can pursue? Will workers’ compensation cover any “alternative” forms of treatment, such as chiropractic care? What about any medications you might need?

Under New Jersey law, the workers’ compensation coverage provided by your employer must pay for all “necessary and reasonable” medical treatment, prescriptions and hospitalization required because of the injury (provided the injury was suffered at work or because of your work). Though the law does not specifically define “necessary and reasonable,” if a dispute arises, the workers’ compensation judge will likely gather testimony from medical professionals to determine whether the treatment, care or other medical services you requested meet the test.

It’s important to understand that, under the New Jersey workers’ compensation system, your employer has the discretion to determine who will be your authorized treating physician for all injuries suffered on the job. There are limited exceptions to this rule—for example, if you need emergency care and there’s no time to obtain authorization from your employer, or if your employer wrongfully refuses to authorize any medical treatment at all, you may choose your own caregiver. However, you must notify your employer as soon as practicable if you seek unauthorized medical treatment.

Contact Us

To arrange a private meeting, contact us by e-mail or call our office at 908-200-2297. Evening and weekend meetings are available upon request. We take all major credit cards.

We handle all workers’ compensation cases on a contingency basis. There will be no attorney fees unless we get compensation for your losses.

What Happens if Your Employer Has No Workers’ Compensation Coverage

Whistleblower

Under New Jersey law, all employers are required to either carry a valid policy of workers’ compensation insurance or qualify to be self-insured, which means they will pay any benefits directly out of company income. Unfortunately, one of the corners that employers often cut is paying for workers’ compensation coverage. So what happens if you are hurt at work and your employer is neither self-insured nor carrying a policy of workers’ compensation

Fortunately, the New Jersey legislature established the Uninsured Employer’s Fund (UEF) to cover such contingencies. The UEF provides temporary medical and disability benefits to workers whose employers cannot make workers’ compensation benefits payments and don’t have workers’ compensation insurance.

To recover benefits from the UEF, you must file a workers’ compensation petition, just as you would in any other circumstance. The formal claim petition asks for the name of your employer’s workers’ compensation insurance provider or for certification that your employer is self-insured. If neither of those conditions are indicated on the claim petition, the New Jersey workers’ compensation division will conduct a search through the state’s Compensation Rating and Inspection Bureau to verify your employer’s workers’ compensation insurance status.

If the search indicates there is no coverage, a hearing is scheduled to determine the actual status of your employer’s workers’ compensation benefits. If your employer is found to have violated New Jersey law, a financial penalty will be imposed and the workers’ compensation judge will enter an order allowing the UEF to make all disability and reasonable and necessary payments for medical expenses.

Contact Us

To arrange a private meeting, contact us by e-mail or call our office at 908-200-2297. Evening and weekend meetings are available upon request. We take all major credit cards.

We handle all personal injury cases on a contingency basis. There will be no attorney fees unless we get compensation for your losses.

What is an Employee for Purposes of a Workers’ Compensation Claim?

Compensation Claim

The workers’ compensation system in New Jersey is designed to provide benefits when someone is hurt on the job. Often, there’s no real issue as to whether the injured person was an employee. If you are on the company’s payroll, have submitted a W-4 and receive a W-2, then you’ll be considered an employee. But what if the employer alleges that you’re an independent contractor? Can you file a workers’ compensation claim against the company to whom you were providing services?

In New Jersey, the assumption is that anyone providing services to an employer is an employee for workers’ compensation purposes unless all of the following conditions can be shown:

  • The worker has been and will be free from direction or control of the performance of duties, both as agreed upon in any contract, and in fact,
  • The services provided are outside the usual course of business, or are performed outside all the places of business where such services are performed, and
  • The worker customarily performs these duties in an independently established trade, occupation, profession or business

If a dispute arises regarding whether a worker is an employee or an independent contractor, the New Jersey Department of Labor and Workforce Development will customarily complete a “worker classification questionnaire,” based on an interview with the worker. Among the questions asked to determine status are:

  • Type of business you operate—is it a sole proprietorship, partnership or other legal entity?
  • Are you required to work fixed hours?
  • Did you have other clients at the time you provided the services?
  • Approximately what percentage of your income was from the employer during the period you worked for them?

Contact Our Office

To arrange a private meeting, contact us by e-mail or call our office at 908-200-2297. Evening and weekend meetings are available upon request. We take all major credit cards.

We handle all workers’ compensation cases on a contingency basis. There will be no attorney fees unless we get compensation for your losses.

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