The N.J. Workers’ Compensation Act provides injured employees with three types of benefits: (1) medical treatment related to the work injury; (2) temporary disability benefits of up to 70% of wages while out of work under the care of a doctor; and (3) an award of permanent partial or total disability benefits if there is objective evidence of a permanent loss of function.
The workers’ compensation insurance carrier must pay 100% of all related medical treatment. The injured employee does not owe any co-payment or deductible. However, that treatment must be pre-authorized by the employer’s workers’ compensation carrier. The drawback for injured workers is that the employer’s carrier chooses the doctor.
The Workers’ Compensation Act provides that an employee is entitled to receive 70% of his average weekly wage, up to the state maximum, for the period of time that the authorized treating physician indicates he is unable to work and needs active medical treatment. The average weekly wage is calculated based upon the employee’s gross wages before taxes, and it is generally although not always computed over the six-month period immediately prior to the date of the accident.
The average wage includes all overtime paid during that six-month period. For accidents which occurred in 2018, the state minimum temporary disability rate is $241 per week, and the maximum temporary disability rate is $903 per week. The maximum and minimum temporary disability rates change every year, based upon the state average weekly wage.
Once the injured worker has been discharged from medical treatment, the permanent disability phase of the workers’ compensation claim begins. In order to preserve the right to receive permanent disability benefits, a Claim Petition must be filed with the Division of Workers’ Compensation (hereinafter “DWC”) within two years of the date any benefits were paid by the workers’ compensation insurance carrier. See, sample Claim Petition at Appendix A.
The filing of the Claim Petition starts an adversarial proceeding in the DWC between the injured worker (known as the “petitioner” in the DWC) and the employer (known as the “respondent”). In order to evaluate the degree of permanent disability sustained by the petitioner, both the carrier and petitioner’s attorney will retain medical experts who are familiar with the New Jersey disability schedule. Both experts will provide exaggerated estimates of the disability for the purposes of negotiating a settlement of the claim. Most claims settle prior to trial, at a percentage of permanent partial disability benefits somewhere between the estimates of the medical experts.
The workers’ compensation system in New Jersey is far from perfect. Especially when the employer does not carry the required insurance coverage, injured employees often face long delays in treatment and benefits. For the majority of claimants with minor injuries, the system runs smoothly and fairly. However, if you sustained a serious injury, you may find that the treatment you receive from the workers’ compensation system is substandard since the care will be micromanaged by insurance bureaucrats, whose main goal is to patch you up quickly in order to stop your benefits. If you fall into this category, it is essential for you to retain competent legal counsel as early in the process as possible.
For more information on New Jersey Workers’ Compensation System, a free initial consultation is your next best step. Get the information and legal answers you are seeking by calling (908) 923-0020 today.