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Posts by Albert Talone

How Alcohol or Drugs Impact Your New Jersey Workers’ Compensation Claim

If your employer can prove you were drunk or high at work, you may lose your workers’ compensation benefits. 

However, in New Jersey, employers can only raise this defense to a workers’ compensation claim if they can prove “by a preponderance of the evidence” that your work-related injuries were caused solely by your intoxication. 

Mixed-Cause Injuries 

An example of how this law may work in your favor comes from the  2006 case Tlumac v. High Bridge Stone, decided in the New Jersey Supreme Court. 

The Thlumac case revolved around James Tlumac, who drove a tractor-trailer for High Bridge Stone. At the time of his accident, he had worked 12 days in a row and had logged a total of 230 hours. His wife had recently suffered a broken hip, increasing his family responsibilities and causing him to lose sleep. 

At 8:00 PM, he was up on the roof of his house, doing some repairs and drinking a beer. He was up at 2:15 AM for work. His wife made coffee and saw no signs of intoxication. But he was in an accident, and his blood alcohol level was slightly over the legal limit at 0.087. 

Tlumac’s attorney showed that his exhaustion, roadway conditions, mental state, and other factors had far more to do with the accident than his intoxication and awarded him workers’ compensation. 

Drug Testing After an Injury

In New Jersey, employers do not have the right to drug test you just because you’ve been injured unless you …

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How to Tell You’re Receiving a Good Workers’ Compensation Settlement Offer in New Jersey

Workers’ compensation insurance companies in New Jersey will often offer a settlement when you reach Maximum Medical Improvement (MMI). They usually do not wish to keep paying out for medical expenses or to keep issuing weekly checks indefinitely, especially if it doesn’t look like you’re going to be able to return to work anytime soon.

But how do you know when you are receiving a fair offer? After all, you know the insurance company is a lot more interested in saving money than in helping you. Lowball offers are common and should be expected early in the process.

While you should have a New Jersey workers’ compensation law firm like ours evaluate any settlement offer before accepting it, there are some general guidelines you can use to determine whether or not your settlement is fair. 

Ask yourself the following questions.

What does the offer include?

Your offer should include coverage for the following:

  • 100% of your past unpaid medical bills.
  • Compensation for your unpaid lost wages.
  • Compensation which addresses future medical bills, lost wages, and other expenses.

It is very common for insurance companies to ignore future needs on their first offer, or to offer a sum so paltry that it couldn’t even get you through a year. 

If you don’t think the money is going to meet your needs, reach out to our law firm ASAP so we can discuss your claim.

Does the offer take all of the evidence into account?

Are they paying attention to all of …

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How Do I Obtain Pre-Authorization for Workers’ Compensation Medical Treatment in New Jersey?

It usually isn’t hard to get workers’ compensation insurance to pay for routine medical check-ups and visits related to your injuries. 

A worker may also obtain emergency care without fear of insurance denial in most cases. Authorization is presumed in life-threatening situations.

Too bad most workers’ compensation cases involve extensive, often catastrophic injuries. Those injuries often require expensive tests and treatments like:

  • MRIs
  • CT scans
  • Specialist care
  • Surgery
  • Prosthetics
  • Physical therapy
  • Chemotherapy
  • Expensive medications

It is often much, much harder to get workers’ compensation insurance to pay for these treatments. 

Often, obtaining these treatments means getting those treatments authorized in advance. Often, obtaining authorization is your doctor’s job, but you will still receive notice if the insurance company denies your initial authorization. 

The company may deny the treatment, even in the authorization phase, because:

  • They disagree that the treatment is “medically necessary,” even if it clearly is. 
  • They want you to use a cheaper treatment. 
  • They are hoping to frustrate you until you give up.
  • They are claiming some administrative problems, such as a failure to meet certain deadlines.
  • They want to claim that the new treatment has nothing to do with your work-related injury. 
  • The employer’s doctor doesn’t think you need the treatment, but your own second-opinion doctor does. Obviously, the workers’ compensation insurance company wants to use the doctor’s opinion that favors them, even if that doctor ignores your health and needs. 
  • A human didn’t even look at your claim; an AI-bot or algorithm denied your
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What Happens if My Condition Gets Worse During My New Jersey Workers’ Compensation Case

New Jersey workers’ compensation law has provisions for when a condition worsens. Much will depend on which condition is worsening and when it is worsening.

Here are a few scenarios.

Condition Worsens While Your Case is Ongoing

If your case is open and ongoing, workers’ compensation insurance should still actively pay your medical bills. Your medical needs should be met, regardless of what they are.

You might expect questions about how and why the condition worsened, and you should be ready to answer them as best you can. 

Sometimes, of course, your doctor needs you to need specific medical care, and the workers’ compensation company rejects that care as “not medically necessary,” especially if the one advocating for a higher level of care is your second-opinion doctor. In such cases, working closely with a New Jersey workers’ compensation lawyer is useful. 

Condition Worsens After You Settle

If your condition gets worse after you settle, you may be able to reopen your workers’ compensation claim so long as you are asking for additional treatment for the same work-related injury. 

You must provide concrete, objective medical evidence that your condition has worsened. Unfortunately, “increased pain” is not enough—pain is subjective, and the medical industry isn’t very good at dealing with it as it is. 

The Initial Injury Exacerbates a Pre-Existing Condition

New Jersey law recognizes that an exacerbated pre-existing condition is a valid issue. Compensation may be pro-rated in some cases, but not all. In some cases, exacerbating a pre-existing condition could …

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7 Signs Your NJ Workers’ Compensation Insurance Company Is Acting in Bad Faith

Most workers’ compensation cases run smoothly and are very routine

Every now and then, we end up with a case where a workers’ compensation insurance company is acting in bad faith. When you see signs of this happening to you, it’s time to involve a New Jersey workers’ compensation attorney.

Here are seven signs to look out for. 

#1) Unreasonable Delays

There is a short delay period for temporary disability payouts known as the “waiting week.” That’s the first seven days of your disability period. The Department of Labor holds that first payment until your unpaid leave continues for a total of 22 days or more. Once you meet that 22-day cut-off, you receive a retroactive payout for the first seven days.

If you don’t get your benefits on the second week, or if your workers’ compensation insurer refuses to pay your doctor bills promptly, the insurer may delay your payments in the hopes of somehow undermining your claim. 

#2) Denying Legitimate Claims

Is your insurer making false accusations, trying to claim you weren’t injured at work, or spinning a story that has nothing to do with the incident report you submitted?

They may deny claims to see if they can make you give up and go away. This often happens in severe injury cases where the claim is especially expensive. 

#3) Denying Requests for Necessary Medical Care

We all know that a doctor’s definition of “medically necessary care” and an insurance company’s don’t always …

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What Types of Rehabilitation Services are Available Under NJ Workers’ Compensation?

If you can’t return to your old job because your injuries make it impossible, you may be eligible for vocational rehabilitation (VR) services. These services are designed to help you find and keep jobs so you don’t have to live on a meager workers’ compensation check for the rest of your life.

To do so, you must first find an organization to help you. Most people get VR services from one of the following organizations. 

Note that you must apply for any of these services; any organization may deny you. Fortunately, your workers’ compensation lawyer can help you with a VR denial like we would help you with a denied workers’ compensation claim. You have the right to appeal any denial.

The types of services you would receive depend on the organization but often include:

  • Career counseling 
  • Job placement services
  • One-on-one job coaching
  • Assistive technologies
  • Training, including vocational school, technology, trade, or business school training
  • Deaf or hard of hearing services
  • Mental health counseling
  • Vehicle or home modifications

Many people feel utterly lost when considering what kind of work they can do now, especially if they have been barred from a career they held for years or even decades. Vocational rehabilitation services can help you identify new opportunities you might enjoy or be good …

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Is Suicide Compensable Under Worker’s Compensation Death Benefits?

Suicide is a difficult subject, and we don’t discuss it lightly.

Nevertheless, suicide is a subject that can come up in New Jersey workers’ compensation cases. Under most circumstances, a self-inflicted injury or death is not compensable, but exceptions exist. 

It doesn’t come up often, but this workers’ compensation law provision is worth knowing about.

The 1945 case Konazewska v. Erie R.R. Co. established a 4-part test that said an employee’s suicide was not compensable unless:

1. It’s the direct result of a physical injury.

2. The worker was possessed of an uncontrollable impulse to commit suicide or is in a delirium of frenzy.

3. The worker did not consciously intend to kill themselves.

4. They do not recognize the consequences of self-destruction. 

The 1980 case Kahle v. Plochman involves a suicidal worker.  Rosalie Kahle was injured during her employment at a mustard plant. She sustained back and left leg injuries and suffered from chronic pain and depression. She was permanently partially disabled. She could never return to work and suffered complications from her accidents.

Eventually, she ended her own life. Her husband requested dependency death benefits for himself and his children, alleging that her suicide directly resulted from her work-related injuries. 

During this case, the court ruled that a chain-of-causation test is “a more realistic and reasonable standard” than the 4-part test. Kahle established that “an employee’s death by suicide is compensable where the original work-connected injuries result in the employee’s becoming dominated by a disturbance of mind …

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What is the Going and Coming Rule in NJ Workers’ Compensation Law?

Few, if any, employers will compensate an employee for the cost of commuting to and from work. By the same token, workers’ compensation law does not require employers to cover injuries sustained during routine travel to and from the workplace.

This is known as the “going and coming” rule. Yet there are many exceptions to this rule, and it’s important to understand when one of those exceptions may apply to you. 

Exception #1: The Special Mission Exception

Workers’ compensation covers any time the employer requires you to be away from the conventional place of employment, including work travel. It also covers any time you are actively engaged in the performance of employment duties while you are traveling. 

Exception #2: The Travel Time Exception

You receive coverage any time you are:

  • Paid for travel time to and from a distant job site
  • Are using an employer-authorized vehicle while on business authorized by the employer
  • Travel in employer-sponsored rideshare or vanpool.

You are covered if you work outside of the office and must travel throughout your day. Examples include home services professionals who visit homes and businesses to make repairs or outside salespeople who must visit prospective homes or offices to make sales. Employees in this circumstance can take normal work breaks without losing their ability to gain compensation but can’t run personal errands. 

Some employers offer employees compensation for gas, tolls, and wear and tear on the vehicle as a benefit. The 2008 case Scott v. Foodarama Supermarkets established …

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Job Retraining and Rehabilitation Under New Jersey Workers’ Compensation

Your doctor has discharged you to return to work with permanent restrictions, and your employer says those restrictions cannot be accommodated. Given your employer has no obligation to accommodate them or to hold your job, what are your options and next steps?

Here is everything you need to know about what you can do next.

Apply for Reasonable Accommodation

If you believe you can do your old job with reasonable accommodations, you can apply for them under the Americans With Disabilities Act. Employers are required to provide reasonable accommodations where necessary.

Of course, if your employer is already trying to send you packing, it may not be worthwhile to fight that fight with them. You may get more mileage out of a different option. 

Apply to a Vocational Rehabilitation Program

The New Jersey Department of Labor and Workforce Development offers vocational rehabilitation programs.  Anyone with a physical, mental, or cognitive disability may apply. They offer career counseling, training, and funding for college training, driver training, or skills training to eligible individuals. 

Many services are free.

The United States Department of Labor also offers vocational rehabilitation services. Anyone who is an injured worker in receipt of compensation payments may apply as long as they cannot return to their regular job. The DoL must also see that there are appropriate return-to-work opportunities within your commuting area. You are also eligible after a settlement, but you must be able to support yourself financially during the process. College assistance isn’t available at the …

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Does Workers’ Compensation Cover You if You Are Injured on a Work Trip in New Jersey?

Travel is often a special case in workers’ compensation law, and there are several definitions of a “work trip” to consider. 

Here are the different cases you might encounter and how workers’ compensation handles each one.

Injured on an Overnight Trip

If your employer requires you to go on an overnight trip of any kind, such as for a conference, for training, or to meet with clients, then in New Jersey, you should be covered under workers’ compensation for any injuries sustained for the entire duration of the trip.

It doesn’t matter that you won’t be working the entire time. They sent you out of your home city, so they have to cover you until the trip is over: from the time you get on the plane to the time you get off it. 

Driving is Part of Your Job

If your car or your company car serves as your workplace, then you are eligible for workers’ compensation so long as you are on the job. 

If you’re on break or lunch, you are still covered because the courts have ruled employees who travel most of the day for work have the same right to lunch and breaks that office employees would.

Yet you should be careful. If you travel very far out of your way, the courts may rule that your trip has transformed into a “personal errand” and deny benefits.

On Call

Sometimes you are eligible for workers’ compensation benefits if you are on-call, but the rules …

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The Law Office Of Albert J. Talone
The Law Office Of Albert J. Talone is committed to providing for those with Workers Compensation cases throughout New Jersey.
302 N Washington Ave #101
New Jersey
United States

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