New Jersey workers' compensation provides various benefits to workers who are injured while on the job or who develop an occupational illness as a result of their work duties or environment. Like all states, New Jersey does not require proof of any fault on behalf of the employer in causing the injury or disease. As long as your injury or illness was caused by your work, you will typically be covered by workers' comp.
When you are injured at work or discover you have a job-related illness, you should report it to your employer as soon as possible. If you fail to report your injury within 90 days, you may lose your right to collect benefits.
Your employer will then notify its workers' compensation insurance carrier. The insurance company will complete a First Report of Injury form and submit it to the New Jersey Division of Workers' Compensation, which begins your workers' compensation claim.
The insurance company will notify you whether your claim is allowed. If your claim is allowed, your medical bills will be paid and you will begin receiving disability benefits (if you need time of work). If your claim is denied, you may appeal that determination (see Appealing a Workers' Compensation Denial, below).
Once your claim is accepted, you are eligible for workers' compensation benefits. Your employer or its insurance carrier pays the workers' compensation benefits. You may receive medical coverage, benefits for time off work, and benefits for any permanent impairment you have suffered.
Workers' comp pays for all proper, necessary, and reasonable medical treatment for conditions related to your work-related injury or disease. This covers doctors' visits, physical therapy, prescriptions, surgery, medical equipment, and other treatment if necessary. The insurance company will pay your medical providers directly.
You may seek medical treatment for your injury or illness at any time. However, under New Jersey law, your employer or its insurance carrier has the right to select your treating doctor. If you treat with another doctor without permission, your medical bills may not be covered.
Another workers' compensation benefit is temporary total disability benefits, which are meant to compensate for lost wages if you are unable to work while you recover from your injury or illness. You are eligible to receive these benefits if you are out of work for seven or more days. In New Jersey, you will receive 70% of your average wages, subject to a maximum set by state law. (The maximum is $896 per week in 2017 and $903 per week in 2018.)
Temporary total disability benefits end when your doctor releases you to work or when your doctor finds that you are at maximum medical improvement, meaning there is no additional medical treatment that will cure your disease or injury.
If you sustained a permanent impairment as a result of your workplace injury or disease, but you are still able to work in some capacity, you may receive permanent partial disability (PPD) benefits. PPD payments begin once you have reached maximum medical improvement. At that time, your doctor will assess the level of your permanent impairment and give you a permanent disability rating.
The amount of your PPD benefits depends on what body part you injured and the disability rating assigned by your doctor. New Jersey has a schedule of injuries, which lists the amount and duration of benefits for certain types of injuries. A scheduled injury is one involving eyes, ears, teeth, arms, hands, legs, and feet. A nonscheduled injury is one involving other body parts and internal organs, such as the heart, lungs, and back. PPD benefits are subject to the same weekly maximum as temporary disability benefits. (To learn more, see How Are Permanent Partial Disability Benefits Calculated?)
If you are permanently disabled, and cannot return to work due to your workplace injury or illness, you are eligible for permanent total disability benefits. These are like a pension—you will receive a weekly payment. The amount of the payment is 70% of your gross average weekly wage, subject to the same weekly cap as permanent partial disability benefits.
In New Jersey, permanent total disability (PTD) benefits are paid for at least a period of 450 weeks. If you are still unable to work at that point, the PTD benefits can be continued.
You have a right to appeal a denial of your workers' compensation claim. The Division of Workers' Compensation in New Jersey has two appeal processes: a formal hearing through a Claim Petition or an informal hearing through an Application for an Informal Hearing.
The benefit of an informal hearing is a more expedited and informal route to addressing your appeal. To obtain an informal hearing, you must complete an Application for an Informal Hearing and submit it to the Division of Workers' Compensation.
Your case will be assigned to a judge, and you will receive written notice of the date and time of your first hearing. Sometimes multiple hearings are necessary to allow the insurance company (and your lawyer, if you have one) time to assess all of the issues and gather relevant evidence. The judge will ultimately make a recommendation for settling the dispute, but either side is free to reject it. If you aren't able to resolve the dispute at the informal hearing, you may request a formal hearing.
You can request a formal hearing by filing a Claim Petition form with the Division of Workers' Compensation. You must file your petition within two years of the date of your injury or the last date you received compensation from the insurance company, whichever is later. If you have an occupational disease, you must report the illness within two years from the date you became aware of the illness and its possible connection to employment conditions. It's important to note that requesting an informal hearing does not affect this two-year deadline.
Once you submit your petition, your case will be assigned to a judge in the workers' comp district office in the county in which you live. If you live out of state, the hearing will take place in the county where your employer is located. Unlike informal hearings, which usually occur in a matter of weeks, the formal hearing takes place around six months after the date of filing the petition.
The formal hearing is much like a trial, in that both parties present evidence and witnesses to testify. You should plan to have witnesses testify on your behalf, including yourself, your doctor, and family members and coworkers with knowledge of your injury.
After all of the evidence has been presented, the judge will issue a written decision. If the judge allows your claim, the judge will likely award specific benefits and may assess penalties. If the judge does not rule in your favor, you may appeal the decision to the state courts of New Jersey in the Appellate Division of the Superior Court.
After you file a claim petition, your employer might approach you with a settlement offer. You are under no obligation to accept a settlement offer, but it can often be a positive resolution to your claim. Many disputes are settled prior to the formal hearing. Unless your injury was very minor, you should discuss any settlement offer with an attorney before accepting. An attorney can tell you how much your case is worth and whether the settlement offer is a good one.
If you are considering appealing a claim denial, you should strongly consider talking to an attorney experienced in New Jersey workers' compensation law. Appeals are legal proceedings involving complex rules of procedure and evidence that you will be expected to know if you represent yourself. An attorney will almost certainly represent your employer or its insurance carrier, so you will likely be at an unfair advantage without an attorney. (For more information, see Do I Need a Lawyer to Get Workers' Compensation Benefits?)