Workers Compensation Benefits
Workers all over the country have a right to safe and healthy workplace, regardless of industry or job type. Unfortunately, inadequate safety measures and negligent behavior still contribute to nearly 3 million work-related injuries and illnesses nationwide every year. Workers in New Jersey filed a total of 148,791 workers’ compensation claims in 2011, an increase of nearly 12,000 from the previous year.
Workers’ compensation is an insurance program that compensates employees for medical treatment, lost wages, and disability if they suffer a work-related injury or illness. Workers’ compensation is a “no-fault” program, meaning benefits are provided regardless of who was at fault in the incident; in return for guaranteed benefits, workers forfeit the right to bring a civil lawsuit against the employer for additional damages (except in cases when the act was intentional).
However, workers still have the right to file a personal injury suit against a third party if the individual’s negligence contributed to the injury; a personal injury suit often allows an employee to recover damages not otherwise covered through workers’ compensation.
New Jersey Workers’ Compensation law requires employers and/or their insurance carrier to pay out five types of benefits, as described below:
The employer or employer’s insurance carrier is required to pay for all necessary and reasonable medical treatment, prescriptions, and hospitalization services caused by the work-related injury. When medical benefits are awarded, the employer has the right to choose the authorized medical provider for work-related injuries. The injured worker has the right to choose the physician only when an emergency arises or the employer inappropriately refuses to provide medical treatment. (If the employee seeks emergency medical treatment for a work-related injury, he or she must notify the employer as soon as possible regarding the treatment received.)
Temporary Total Disability Benefits
Temporary Total Disability Benefits kick in once an injured worker is unable to work for more than seven days. In order to receive Temporary Total Disability Benefits, the employee must be unable to work and undergoing active medical care.
Temporary Total Disability Benefits amount to 70 percent of the employee’s average weekly wage, but they may not exceed 75 percent of the Statewide Average Weekly Wage or fall below 20 percent of the Statewide Average Weekly Wage. The maximum weekly payout in 2014 is $843, with a minimum weekly payout of $225; this represents a Statewide Average Weekly Wage of approximately $1204.
Temporary Total Disability Benefits terminate when one of two events takes place:
- The employee is released to return to work in some capacity.
- The worker reaches maximum medical improvement, meaning additional treatment will no longer improve the medical condition. If the worker has reached maximum medical improvement and is left with partial permanent injuries or total permanent injuries, benefits switch from Temporary Total Disability to one of the following two sections.
Permanent Partial Benefits
For the purposes of evaluating permanent disability, losses are divided into “scheduled” and “non-scheduled” losses. A scheduled loss involves the arms, hands, fingers, legs, feet, toes, eyes, ears, or teeth. Based on the body part involved and the percentage of disability, benefits are paid in accordance with the Schedule of Disabilities and Maximum Benefits.
A non-scheduled loss involves an area of the body not covered in the schedule, including the back, heart, and lungs.
Permanent Partial Disability Benefits are paid weekly beginning at the termination of Temporary Total Benefits. The rate depends on the type and severity of the injury, but minimum and maximum payouts still apply, with a 2014 maximum of $843 per week and minimum of $35 per week.
Permanent Total Benefits
Permanent Total Benefits are paid to workers whose work-related injury prevents them from returning to any type of gainful employment. These benefits are paid for a starting period of 450 weeks, after which the injured worker has to prove that he or she is still unable to make a living.
The New Jersey Department of Labor and Workforce Development presumes Permanent Total Disability when the employee has lost two major members or a combination of members, which include the eyes, arms, legs, feet, or hands. But workers suffering from any combination of injuries that render him or her unemployable can qualify for Permanent Total Disability.
Permanent Total Benefits are paid weekly at a rate of 70 percent of the average weekly wage. However, the weekly payment cannot be greater than $843 or less than $225, according to the 2014 Statewide Average Weekly Wage.
Workers who are partially disabled and subsequently suffer a work-related injury can qualify for the Second Injury Fund if the combination of injuries renders him or her totally disabled. The Second Injury Fund was established in 1923 and is designed to encourage the hiring of partially disabled workers by limiting the payments employers have to make in the case of further injuries. Second Injury Fund benefits kick in once time runs out on benefit payments from the employer or insurer, and they continue until the employee’s death or return to the workforce.
If a worker suffers a fatal work-related injury or illness, his or her dependents can qualify to receive weekly death benefits.
A surviving spouse and natural children who were part of the employee’s household at the time of death are presumed to be dependents. All other alleged dependents—including parents, siblings, grandchildren, grandparents, and spouses or natural children not a part of the decedent’s household at the time of death—must prove actual dependency.
Children qualify as dependents until the age of 18 or, if a full-time student, 23. Children with physical or mental disabilities can also qualify for additional benefits through the workers’ compensation program. Families of workers killed on the job are also entitled to up to $3,500 in funeral expenses (payable to the estate or individual responsible for the funeral bill).
Benefits are set at 70 percent of the weekly wage of the decedent, not to exceed the maximum weekly amount. A hearing on extent of dependency is generally required to establish death benefits, and at that point a judge will determine how the benefits will be divided among dependents.
Background of the New Jersey Workers’ Compensation Program
The New Jersey workers’ compensation system was the first of its kind, enacted more than a century ago. Prior to 1911, injured workers’ only legal recourse was to sue their employers for negligence. This long and difficult process left workers without income or medical benefits for the months or even years that their cases spent winding their way through the legal system. The state of the law at that time also heavily favored employers, who could argue for assumption of risk and contributory negligence to avoid paying employees for work-related injuries and illnesses.
The workers’ compensation reforms of 1979 again put New Jersey at the forefront of worker protection and workers’ compensation programs. These reforms served to minimize permanent disability payouts for workers with subjective or minor complaints, and they worked to improve benefits for seriously disabled workers. The updated workers’ compensation program included improved provisions for totally and permanently disabled workers, cost-of-living increases, workers suffering from second injuries, and dependents of workers killed while on the job.
Contact a New Jersey Workers’ Compensation Lawyer
If you have suffered a work-related injury or illness that qualifies for workers’ compensation, hiring an experienced attorney can be invaluable. Maggiano, DiGirolamo & Lizzi have extensive experience with workers’ compensation and personal injury claims, and we can ensure you receive the benefits you are entitled to. Call (201) 585-9111 or fill out our online form to schedule a free and confidential consultation.