In some accident and injury cases it is necessary to prove the other party was negligent before you can recover any form of compensation. This is not the case in a New Jersey workers compensation case.
Instead, it is only necessary to prove that the injury or illness arose as a result of your activities and presence in the workplace.
This is part of the bargain that was made between New Jersey workers and employers when the workers compensation system first came into existence. Workers would lose the right to sue employers for negligence and employers would pay for injuries and illnesses sustained at work regardless of whether or not the employee played a role in causing those injuries.
As always when the law is involved, there are of course both complications and exceptions that you should be aware of.
Exception #1 – You Were in Violation of Certain Policies
Employers may deny workers compensation when the employee was found to be in violation of clearly established safety policies that would have prevented the injury.
This includes policies about horseplay and assault. If an employee is engaged in unsafe behavior, is engaged in workplace violence, or is playing around in a way that causes an injury the employer will often have a case for denying workers compensation.
Exception #2 – You Need to Prove a Third Party Contributed to Your Injury
When a third party contributes to your injury you will often be able to launch a personal injury …Read More
A Section 20 is one of two types of settlements that may be awarded in a New Jersey worker’s compensation case. The other type is called a Section 22.
Here’s what you need to know about both types of settlement.
Section 22 Settlements
A Section 22 settlement is a settlement wherein the employer pays for a portion of your disability. The percentage would be a percentage of what would be paid out for a body part over time, i.e., 30% of the knee, with amounts set by the New Jersey body part schedule.
In a Section 22 settlement the employer does admit that the injury to that body part happened on the job. A Section 22 does allow for the modification of claims as necessary
Section 20 Settlements
A Section 20 is a one-time lump sum payment and is considered a full and final dismissal of the claim. You accept one dollar amount that ends your case forever. The employer accepts no liability for your accident. They’re essentially saying, “We don’t agree this is a work injury, but we’ll pay you to avoid arguing about it or litigating it.”
A Section 20 is only allowed in cases where there is a “genuine issue of dispute.” This means there may be a dispute as to whether there was a real link between your work and the injury, which is the most common type of dispute. Other genuine issues could include issues as to whether you are classified as …Read More
A “reopener” is an informal term for a modification of a workers compensation claim. Either party can request a modification after a workers compensation claim settles.
No party has an unlimited right to reopen a workers compensation claim. The modification may only be requested up to two years after the last time compensation was paid, or from the date of an awarded Judgement.
When may an employee reopen a workers compensation claim?
An employee may reopen a workers compensation claim when one of the following is true:
- They need additional treatment for the same work-related injury.
- They have lost additional time as a result of the same work-related injury.
- They need an increase to the amount of permanent partial disability that they’re receiving.
In other words, somewhere along the way your condition got worse. This can happen even if you’ve reached maximum minimal improvement (MMI) as MMI is a measure as how much your condition will ever improve, not a guarantee that your condition will never deteriorate.
When may an employer reopen a workers compensation claim?
An employer might seek to modify the workers compensation claim when they have reason to believe your disability has diminished. They may also do so in cases where they believe that you are working for another employer while continuing to receive benefits.
How can an employee prove they need a modification of a workers compensation claim?
You will have to provide medical evidence that your condition has gotten worse. This can include:
Your doctor has restricted you to limited work hours, or has given you specific work restrictions which indicate how much lifting, walking, or other actions you may take on the job. In many cases an employer will offer you “light duty” work while you continue to recover.
In most cases you have no choice but to accept a light duty post. Yet that does not mean you do not have rights when you go on light duty. Here’s what you need to know.
#1) You may be entitled to vocational training.
If an employer tries to assign you to a light duty role that you are not qualified for you may have to take it, but your employer may also be obligated to train you for it so that you can do the job.
The employer can not put you into a job you have no idea how to do and then fire you for being unable to do the work.
#2) Your employer may not assign you part-time work for less pay than your temporary disability rate.
Some employers have used light duty as an excuse to drastically cut an employee’s pay. They turn the light duty position into a part time role for a lower rate than the employee used to receive.
New Jersey courts have ruled that your employer may not pay you less than the temporary disability rate for this work.
#3) If your employer does not accommodate you then you can receive temporary disability benefits.…Read More
Don’t feel like you can trust your employer’s chosen doctor or the workers compensation insurance company doctor?
You’re smart to suspect there’s a conflict of interest. Yet New Jersey Law gives employers and insurance companies the right to choose the doctor who will evaluate you and offer medical treatment, if any.
If you go to your own doctor while the workers compensation claim is still open, then the medical bills will become your responsibility.
However, there is a moment in a workers compensation case where going to your own doctor will be both appropriate and necessary. In the event the insurance company denies your claim, you now have the option to go to the doctor on your own.
Going to Your Own Doctor After a Denied Claim
To make sure that doing so will strengthen your case rather than weakening it, you’re going to need to inform your employer and the insurance company in writing that you dispute the denial of their claim. You also need to inform them that you’re going to see your own doctor to get your own assessment.
At that point you’ll have the doctor submit the bill to your own private health insurance company. That company is immediately going to say wait, this was a workplace injury, we’re not responsible for this. They will try to kick it back to workers compensation and then will end up paying if workers compensation continues to deny your case.
At that point they can then seek compensation …Read More
For the majority of the population, the idea that you may be surveilled at any point in your life sounds ludicrous. That’s the kind of thing that typically happens to spies and movie heroes, not to everyday people.
Yet if you’re involved in a workers compensation case, surveillance is a likely outcome. It’s important to understand this, and to account for it.
When is surveillance likely to start?
It could start at any point during your case, but the time when it most often happens is when you’ve reached maximum medical improvement and have been given a set of permanent restrictions by your doctor. This is especially true if you haven’t been able to go back on the job because they don’t have light duty available for you.
In many workers compensation cases this is the point where the case is about to be settled, and it becomes the point where the insurance companies want to do whatever they can to pull the plug on paying you anything at all. They are going to want to find reasons to gut the case. Often, documenting the worker’s own behavior is the best way to do this. If they can catch you doing something that is prohibited by your doctor’s list of restrictions then their position becomes very powerful.
What should you do if you know you’re being surveilled? Can anything be done about it?
The only thing you should worry about doing is complying with the restrictions given to you by …Read More
At some point, many people who end up with an NJ Workers Compensation claim will end up having to make a decision about whether or not to settle that claim.
When you settle, a number of things can happen. Sometimes the insurance company will send money directly to your medical providers while sending your lost wages directly to you in a lump sum. Sometimes all the money will come to you in a lump sum and you will be responsible for reimbursing your medical provider. Sometimes you’ll end up with a structured payment plan.
Either way, you’re agreeing to a specific amount, and once that amount is paid, that’s it. The workers compensation insurance company no longer owes you any money. Yet receiving a settlement can often be a better option than constantly fighting to keep the workers compensation benefits flowing, or fighting to get the company to agree to treatments you should have.
Here’s what you need to know.
Both your attorney and your insurance company will be assessing “exposure.”
The main thing the insurance company wants to know, prior to offering a settle, is how much they will end up having to pay if they refuse to settle. If it makes sense for them to do so then they will then try to settle the claim for something under that number.
That means they’re going to try to estimate all of your projected medical expenses, along with the number of weeks they’re going to have to pay …Read More
One reason that people get hurt on the jobs is because employers fail to follow appropriate health and safety standards. Some employers will do anything to keep violations from getting reported, including intimidating employees or claiming they can’t get workers compensation benefits if they report the violation.
Yet the law is very clear. Employers may not retaliate against you for reporting an OSHA violation, nor may they deny your workers compensation claim. This doesn’t mean that they won’t try, but it’s not legal and it could open them up to sanctions by the court.
Of course, if you are going to find yourself in the position of having to report an OSHA violation on top of everything else you might want to retain an attorney so you can protect yourself as you do so.
Filing an OSHA violation won’t render you ineligible for benefits either. There is no link between whether you can get benefits and whether you file a complaint. If you were injured on the job and you yourself weren’t violating any laws or company policies then you should be able to make your workers compensation claim.
In fact, if you are seriously injured and your employer was violating the law then you may even be able to pursue additional compensation. Speak to your attorney about whether this may be true in your case.
Note that employers themselves are supposed to be reporting injuries. These are used to help investigate occupational health and safety claims. If …Read More
Employer-sponsored events are a pervasive part of corporate culture. Employers either ask or strongly encourage their employees to participate in various events.
Such was the case in a recent New Jersey case recently decided by the State Supreme Court.
Here are are the facts of the case:
“On September 23., 2017 [Jersey Friendship House] hosted a ‘Family Fun Day’ event for clients and families, and asked employees if they would volunteer. Mrs. Goulding offered to cook, and while she was preparing to grill she stepped into a small pothole on the grounds and fell, injuring her right foot and ankle. She applied for workers compensation, which was denied by a workers comp judge.” –Business Insurance.
The judge in the case used the standard that volunteering for the company did not produce a “benefit to the employer” beyond boosting employee health and morale. The Supreme Court disagreed.
Thus, yes, in some cases you can be covered by worker’s compensation while volunteering at an employer-run event. However, you should be aware of a few key facts which can impact whether you would be covered or not.
Were family and friends invited to the event?
One of the major deciding factors for the judge in this case was the fact that family and friends were not invited to the event. Instead, it was mostly the regular clients of the employer, which meant it provided a benefit to the employer in the form of community goodwill and PR.
The purpose of the …Read More
An IME, or Independent Medical Examination, is what happens when the workers compensation insurance company demands that you go to a doctor of their choice so that your injuries may be evaluated. Naturally many workers are nervous about this process because the doctor doesn’t seem entirely objective.
What happens if the doctor lies about the extent of your injuries, claims they were the result of a preexisting condition, or otherwise spins a story that benefits the insurance company at your expense? And who is paying for this anyway?
Here’s everything you need to know about IMEs in New Jersey.
The insurance company must pay for the IME.
If the insurance company wants you to get an independent medical examination they must pay for it. In most cases they must choose a doctor that’s a reasonable distance from your home or workplace.
These arrangements are very lucrative for doctors. There is a clear conflict of interest and most have every incentive to side with the defense wherever possible. Nevertheless, you’re still going to want to go. You want to show that you’re complying with the insurance company’s investigation of your injuries.
You have the right to a second opinion.
You should think about getting a second opinion even if you trusted the IME doctor. In many cases you won’t: it’s not that uncommon for these doctors to spend less than 5 minutes with patients before finding in favor of the insurance company.
The insurance company will not necessarily pay for …Read More