New Jersey, NJ, Workers Compensation Questions and Answers
I have been hurt on the job. What do I do?
You should notify your employer as soon as possible. The notice may be given to the foreman, supervisor, personnel office, or anyone in authority at the employer’s place of business. Notice does not have to be in writing.
If you are in need of medical treatment, a request should be made to the employer as soon as possible so that they can file a claim with their workers compensation insurance carrier. Please note that under the NJ workers’ compensation law, the employer and/or their insurance carrier can select the health care provider(s) to treat injured workers for work related injuries. Contact NJ Dept. of Labor
My employer will not report my accident to the workers’ compensation insurance carrier. What can I do?
You should consider contacting the insurance carrier directly or alternatively, you may want to consider filing a claim with the Division in this instance. Proof of insurance coverage should be displayed in a prominent location at the place of business. If this information is not posted, you can obtain this information by writing to the Compensation Rating & Inspection Bureau at 60 Park Place, Newark, NJ 07102 or by visiting their web site at www.njcrib.com. If you choose to file a claim, you may wish to contact an attorney for assistance. If you do not know of an attorney, you should contact the Lawyer Referral Service of your County Bar Association or click here for a complete listing of NJ’s Lawyer Referral Services.
Who decides my entitlement to receive workers’ compensation benefits?
Your employer’s workers’ compensation insurance carrier or your employer, if they are self-insured, will investigate your claim and make a determination as to your eligibility to receive workers’ compensation benefits. If you disagree with their determination, you have a right to file a claim with the Division of Workers’ Compensation. This can be done by either filing an application for an informal hearing or by filing a formal claim petition. For more information on this process, please visit the “How to File a Claim” page.
While I was out of work as a result of a work-related injury my employer terminated me. Is such termination permissible?
The Workers’ Compensation statute, NJSA 34:15-39.1 only prohibits the termination of an employee in retaliation for filing a workers compensation claim or for testifying at a workers’ compensation hearing. If you feel you were terminated for these reasons, one alternative is the filing of a discrimination complaint against your employer with the Division of Workers’ Compensation. While the provisions of the law provide for restoration to your former position and payment of lost wages, you must be able to perform the essential duties of that position to avail yourself of any remedy under this portion of the statute. The applicable procedural rules may be found in the Rules of the Division of Workers’ Compensation, N.J.A.C. 12:235 – 9.1 et seq.
If your employer’s actions are not based upon your efforts to secure workers’ compensation benefits for yourself or others, but because of your disabling condition, you may have recourse to claim a violation of the Americans with Disabilities Act (ADA). Information concerning the ADA or complaints may be filed by writing or calling the Equal Employment Opportunity Commission at 1801 L. Street. NW., Washington, D.C. 20507, (202) 663-4900; Fax (202) 663-4912.
The EEOC may also be reached from Mercer County (except Monmouth) and South by calling 215-451-5800 or from Monmouth County (except Mercer) and North by calling 1(800) 669-4000 (T.D.D. 973-645-3004)
The workers’ compensation doctor has released me for light duty work, but my employer advises that there is no such work available. What can I do?
In this situation, if you haven’t returned to work and continue to receive authorized medical care for your injuries, you should continue to receive temporary disability benefits for the period of time up to and including the date the authorized health care provider indicates as the date of maximum medical improvement.
I have two jobs, one full time and the other part time job. I was injured on the part time job, and because of the injury I am also unable to work at the full time job. Can I collect workers’ compensation benefits from my full time job?
No. Since you were injured on your part time job, any workers compensation benefits will be based on that employment.
Are workers’ compensation benefits taxable?
Workers’ compensation benefits are not taxable as per the NJ Gross Income Tax law NJSA 54A:6-6. For further information, please visit the IRS website at: Government Publications
What if I recover money from a third party as a result of my injury?
The New Jersey Workers’ Compensation Law entitles the employer and/or their insurance carrier to receive a credit for amounts recovered from a third party causing a compensable work related injury (N.J.S.A. 34:15-40). This provision is intended to prevent the recovery of duplicate benefits for the same injury and disability.
When the gross third party settlement amount is equal to or greater than the total award of compensation benefits, the amount of the credit is generally two-thirds of the amount payable by or on behalf of the employer less $750.00.
When the gross third party settlement amount is less than the total award of compensation benefits, the credit is generally two-thirds of the gross third party settlement amount less $750.00.
Where benefits have not been paid, the amount owed to you by or on behalf of the employer will be reduced by the credit amounts.
I have a disability that is preventing me from working. Are there any services offered through the Department of Labor and Workforce Development, such as retraining services, that can help me in this situation?
The mission of the New Jersey Division of Vocational Rehabilitation Services is to enable individuals with disabilities to achieve employment outcomes consistent with their strengths, priorities, needs, abilities and capabilities. The Division of Vocational Rehabilitation Services is here to help individuals with disabilities that are having trouble finding or holding a job because of their disability. If you have a disability that is preventing you from working, or which is endangering your present employment, you may wish to submit a referral for services. For more information, visit their NJ Division of Disabilities website.
Does the Workers’ Compensation Law give special compensation to minors?
A minor who suffers a disability because of a work-related injury or illness is entitled to all of the same benefits as any other employee. However, if the minor was employed in violation of child labor laws, benefits for temporary disability, permanent disability or death are double the amount normally awarded.
What kind of benefits am I entitled to receive?
An employee or his/her dependents can receive workers’ compensation benefits for an injury or death arising out of and in the course of employment. The employer or its insurance carrier pays for the necessary and reasonable medical treatment, temporary disability benefits in place of wages lost during the period of disability and when documented, benefits for permanent disability.
How much are the benefits for loss of wages?
If an injured worker is disabled for a period of more than seven days, he or she will be eligible to receive temporary disability benefits at a rate of 70% their average weekly wage, not to exceed the maximum rate or fall below the minimum rate set by statute in effect during the year of accident. These benefits are provided during the period when a worker is unable to work and is under active medical care. Click here to obtain temporary benefit maximum & minimum rates in effect for the past several years.
Benefits are usually terminated when the worker is released to return to work in some capacity and/or if he or she has reached maximum medical improvement (MMI). MMI is a term that is used when additional treatment will no longer improve the medical condition of the injured worker.
While unable to work and collecting temporary workers’ compensation disability benefits, my employer discontinued my health care coverage. Is this discontinuation of coverage permissible under the law?
There is nothing in the New Jersey Workers’ Compensation law that prevents an employer from discontinuing an employee’s health benefits coverage while they are unable to work as a result of a job related injury. However, some protections are available under the Federal Family Medical Leave Act. These laws do not come within the jurisdiction of the workers’ compensation court and a judge of compensation does not have the authority to enforce them.
For further information in this regard, you may wish to contact the US Department of Labor, Employment Standards Administration at 1-866-4-USA-DOL or visit their web site at US Dept. of LaborUS Dept. of Labor
Are cost of living increases provided for under workers’ compensation?
The statute allows that only totally and permanently disabled workers and dependents of deceased workers whose date of injury or death occurred prior to January 1, 1980 may be eligible for supplemental benefits or cost of living increases. Dependents of deceased workers may, in some cases, be eligible where the death of the worker occurred after 1979 but was directly and causally attributable to the injury resulting in total and permanent disability prior to 1980.
However, for those receiving temporary total or partial total disability benefits, there is no provision in the statute for cost of living adjustments.
May a worker collect Temporary Disability Insurance (TDI) benefits if he/she is injured on the job ?
Work-Related injuries or illnesses are not compensable under the NJ Temporary Disability Benefits Law. However, if an individual claims workers’ compensation benefits and the claim is contested by the Workers’ Compensation insurance carrier, temporary disability benefits may be paid by TDI pending resolution of a a formal WC claim petition. A lien is filed by the Disability Insurance Service to protect its subrogation rights against any subsequent WC award. For more information, you can visit the Division of Temporary Disability Insurance’s website or call them directly at (609) 292-7060.
How long must I be out of work before I am eligible to receive workers’ compensation benefits?
By law, you must be unable to work for seven days (including weekends and holidays) before you are eligible for temporary disability benefits. Benefits are retroactive to the first day. The seven days need not be consecutive.
Please note that there is no similar waiting period to receive medical benefits or permanent disability benefits. Those benefits are due, if warranted, regardless of the number of lost workdays.
What are the time limits for filing a claim with the Division?
There is two-year statute of limitations that applies to workers’ compensation cases. A formal claim petition must be filed within two years of the date of injury or the date of last payment of compensation, whichever is later. Medical treatment authorized by the employer is considered a payment of compensation. In cases of occupational illness, for example – asbestosis, lead poisoning or hearing loss, the claim petition must be filed within two years from the date the worker first became aware of the condition and its relationship to employment. Please note that the filing of an application for an informal hearing does not stop the two-year statute of limitations from running.
How long do I have to wait before I receive benefits from my employer or their insurance carrier?
Generally, you can expect to wait two weeks before receiving temporary disability benefits. If your employer or their insurance carrier unreasonably and negligently delays denial of a claim, they may be liable to you for an additional amount of 25% of the amounts due plus any reasonable legal fees incurred in relation to the delay. A delay of 30 days or more is presumed to be unreasonable.
EMPLOYER/INSURANCE CARRIER ACCIDENT REPORTING REQUIREMENTS
One of my employees just reported a work-related injury to me. Do I have to report this to the State?
You should report all work related injuries/illnesses directly to your WC carrier or Third Party Administrator who in turn must file the necessary forms with the Compensation Rating & Inspection Bureau (CRIB) in an electronic format. CRIB will then forward the accident data to the Division for oversight and compliance enforcement responsibilities.
For insurance carriers/third party administrators and self-administered self-insurers, what forms to they have to submit to the State?
The following two forms are now required:
First Report of Accident must be filed within three weeks after learning of an accident, or obtaining knowledge of the occurrence of a compensable occupational disease. A copy of this report is sent to the employer;
LITIGATION AND THE ADJUDICATION PROCESS
I was awarded Disability Benefits by a Workers’ Compensation Judge. When will I receive my benefits?
The Workers’ Compensation Insurance carrier has by law, 60 days in which to process the payment after which time you may be entitled to receive simple interest on the delayed payments. However, it is more realistic to expect receipt of your initial payment within 6 to 8 weeks from the date of the execution of the judge’s order.
I do not like the doctor to whom I was referred by my employer’s insurance company. What recourse is available to me?
The statute, N.J.S.A. 34:15-15 does give the employer the authority to select the health service professionals to provide care to an injured worker. However, if the employer refuses or neglects to provide services reasonable and necessary to cure and relieve the worker of the effect of the injury or restore function where possible, the employee may take action by filing a Motion for Medical and/or Temporary Disability Benefits. The filing procedures are outlined in the Rules of the Division of Workers’ Compensation, N.J.A.C. 12:235-3.2. These proceedings are given a very high priority and are scheduled before a judge within 30 days of the proper filing of the motion.
What is the date of my next workers’ compensation hearing?
You should contact your attorney to determine the tentative date of your next workers’ compensation hearing. If you are representing yourself, the Division will provide written notice through the mail approximately two (2) weeks before the scheduled hearing.
TOTAL DISABILITY AND SECOND INJURY FUND
What is the Second Injury Fund and who is eligible?
First established in the 1920’s, the Second Injury Fund is intended to promote the hiring of disabled individuals and to reduce the potential costs of WC awards for employers for injuries or conditions pre-existing the last compensable work related accident. This is done by the Fund assuming payment of permanent disability benefits after an initial period during which the employer or his insurance carrier makes these payments.
To be eligible for Fund benefits, an individual must be totally and permanently disabled as the direct result of a work-related injury in combination with a pre-existing permanent partial disability. It is not necessary that the pre-existing permanent partial disability be work-related.
Are Second Injury Fund benefits paid in addition to regular compensation benefits?
How long are Second Injury Fund benefits payable?
Fund benefits are potentially paid during the lifetime of the injured worker so long as the injured worker remains totally and permanently disabled and unemployed. Benefits cease upon the death of the worker. Death, funeral and dependents’ benefits are not payable from the Fund.
Can I work and collect Second Injury Fund benefits?
In very limited circumstances you may earn wages while collecting Second Injury Fund benefits. However, any wages from employment will be used to reduce your benefit amount. This reduction is based upon the percentage that your current earnings bear to those at the time of your being declared permanently and totally disabled. Please note that benefits after the first 450 weeks are payable only if you (1) had submitted to the physical and/or educational rehabilitation as may be prescribed by the Division of Vocational Rehabilitation Services, and (2) can show, that because of your continuing disability, you are unable to earn wages equal to those earned at the time of your permanent and total disability.
Please be aware that you are responsible for notifying the Office of Special Compensation Funds immediately when you begin earning wages. Failure to do so may result in reductions or removal of benefits to recover some or all benefits paid during employment.
You should also note that employment which calls into question your continuing permanent and total disability may give rise to a reevaluation of your medical condition and possible removal of benefits.
What are Supplemental benefits?
Supplemental benefits are amounts paid in addition to the basic awarded weekly workers’ compensation benefit rate to address changes in the cost of living. Calculated annually, these benefits are based upon the current maximum weekly workers’ compensation rate in relation to the percentage of your basic benefit rate to the maximum rate in effect at the time of your injury. Supplemental benefits are reduced for receipt of Social Security, Black Lung and/or employer disability pension benefits and are also subject to reduction for employment in cases of total and permanent disability.
Who is eligible for Supplemental Benefits or cost of living increases?
The statute allows that only totally and permanently disabled workers and dependents of deceased workers whose date of injury or, as the case may be, death occurred prior to January 1, 1980 may be eligible for supplemental benefits. Dependents of deceased workers may, in some cases, be eligible where the death of the worker occurred after 1979 but was directly and causally attributable to the injury resulting in total and permanent disability prior to 1980.
UNINSURED EMPLOYERS FUND AND INSURANCE COVERAGE REQUIREMENTS
What is the Uninsured Employers Fund?
The Uninsured Employers Fund was established to make payments of medical expenses and temporary disability benefits to injured workers whose employers failed to provide the required workers’ compensation insurance coverage and who fail or refuse to make workers’ compensation benefit payments as awarded. Payments for permanent disability are not made by the Fund.
Who is eligible to receive benefits from the Uninsured Employers Fund?
When a formal workers’ compensation claim is filed with the Division of Workers’ Compensation and the employer is found to be uninsured, a motion to join the Uninsured Employers Fund is submitted by the worker or his/her attorney. If an award is made for temporary disability benefits and/or medical expenses, the Uninsured Employers Fund will make payment of the temporary disability benefits and reasonable and customary medical expenses included in the Judge’s Order.
What happens to the uninsured employer?
Before any payments are made from the Fund, liens in the amounts of any payments that may be made from the Fund are docketed against the employer in the Superior Court. Although not payable by the Fund, any permanent disability benefits awarded and unpaid by the employer are also docketed on behalf of the injured worker. In addition, the employer is subject to a penalty of up to $6,000 after an award has been unpaid. This amount is also docketed against the employer in the Superior Court.
What about permanent disability benefits in Uninsured Employers Fund cases?
While the Fund does not pay permanent disability benefits, any such award is docketed with the Superior Court as a lien against the employer. This lien may be prosecuted by the injured worker or his/her attorney for collection should the employer assets be located.
How soon after an award are benefits paid from the Uninsured Employers Fund?
In general, it takes 90 to 120 days after the date of an award for payments to be made from the Fund. This is necessary and includes a 45-day period during which the employer is allowed to make full payment of awarded amounts, docketing of liens in the Superior Court, as well as the approval and payment voucher process required to make payments. No payments may be made prior to an award by the courts of the Division of Workers’ Compensation and the docketing of amounts owed.
Is there anything that the worker can do to speed up the payment process?
While the greatest time is required by the statute or regulation, the worker and his/her attorney can ensure the quickest payment if complete documentation of medical expenses are included in the case file forwarded to the Office of Special Compensation Funds. Copies of all bills and receipts should be forwarded to UEF counsel as soon as possible. The originals of all billing statements should be provided to UEF counsel at trial or immediately after an award is made.
What if my employer doesn’t have workers’ compensation insurance?
With the exception of public employers and employers of domestic workers, the law requires that employers operating in New Jersey provide for the payment of workers’ compensation benefits through an insurance policy or an approved plan of self-insurance. If you suspect that your employer is in violation of this requirement, you should immediately notify the Office of Special Compensation Funds at (609) 292-0165 or at P.O. Box 399, Trenton, NJ 08625-0399 of your suspicion. You may also provide this information to us by completing a “Report of Non-Compliance” form. You need not identify yourself but you should be prepared to provide the name and exact address of the employer and, if possible, the names of the principle operators of the business.
Additionally, proof of coverage should be displayed in a prominent location at the place of business. If you would like to verify the coverage status of an employer, you can obtain this information by writing to the Compensation Rating & Inspection Bureau at 60 Park Place, Newark, NJ 07102 or by visiting their website at www.njcrib.com.
What are the penalties for failing to have workers’ compensation insurance?
Failure to provide the required insurance is a disorderly persons offense and, if the failure was willful, a crime of the fourth degree. In addition, penalties for failure are assessed at up to $1,000 for the first twenty days and up to $1,000 for each ten-day period thereafter. Penalties are docketed as liens against the employer in the Superior Court and collection action is taken to prosecute those liens through seizure of property.
How will you know if an employer fails to provide workers’ compensation insurance?
Our sources of noncompliance with the compulsory insurance requirements of the law include reports from employees, other employers, community and union organizations, other governmental agencies, and, unfortunately, claims filed by injured workers. Beginning in 1998, we will also be performing a periodic cross-match of employer data maintained by the Department of Labor and Workforce Development and the Department of Banking and Insurance to identify employers appearing to have failed to provide the required insurance. To obtain coverage information, please write to the Compensation Rating & Inspection Bureau at 60 Park Place, Newark N.J. 07102 or visit their web-site at www.njcrib.com.
Who determines the workers’ compensation insurance rates for employers?
The Compensation Rating & Inspection Bureau of the Department of Banking & Insurance is responsible for rate setting matters for workers’ compensation. They can be reached by calling (973) 622-6014 or by visiting their web-site at www.njcrib.com.
Can my business be self-insured for workers’ compensation?
Possibly. That decision is made by the Department of Banking & Insurance. Approval generally depends upon the ability of the entity seeking self-insured status to demonstrate assets sufficient to cover all potential claims for work related injuries. For more information in this regard, please refer to NJSA 34:15-77 of the NJ Workers’ Compensation Statute or contact the Department of Banking & Insurance at (609) 292-5350 ext. 50099.