Posts by Albert Talone

You don’t have a choice about attending an IME—if you want your benefits, you’ll have to go. 

Unfortunately, IMEs are a highly stressful situation. How can you maximize your chances of getting an honest, fair evaluation that helps your workers’ compensation case?

Understand the Function of an IME

Independent medical examinations aren’t meant to treat you. Instead, they’re meant to determine the extent and nature of your permanent disability and the effect your injuries have had on your life. 

In short, it’s an insurance company’s attempt to set the value of your case and your potential settlement. 

Of course, they choose the doctor, and they are hoping the doctor is going to rule primarily in their favor. Often, they do. One judge said that IME doctor reports are so predictable that “it’s almost a waste of time to read the report because you know what it’s going to say.” Whenever possible, an IME doctor wants to rule an injury is not work-related or that your pain and disabilities are psychological. 

Thus, you could also read the IME as an insurance company’s attempt to set your case’s value to “zero.” 

Be polite. This person isn’t on your side, but rudeness or sarcasm on your part can be used against you. 

Stay Honest

Because an IME feels like an adverse process, you may be tempted to lie or hide things from your doctor. Instead, it’s very important that you remain as honest as possible. 

You should also give details …

Your employer has 21 days to file a claim after you sustain an injury at work. You should always mark the date that you reported the injury.

Remember, you should inform your employer you’ve been injured on the job within 14 days of the injury. In reality, we recommend reporting the injury immediately unless there is some good reason why you can’t. For example, if you end up unconscious and spend three days in the hospital before you wake up, then it wouldn’t be reasonable to expect an immediate report…but you’d want to make the written report as soon as you are medically capable of doing so. 

Usually, the New Jersey Division of Worker’s Compensation will notify you directly when the claim is accepted, and you’ll receive notice long before it’s really necessary to start checking the status of your claim. 

If you feel like your workers’ compensation claim is moving too slowly, you can contact the Department of Labor to verify whether your employer filed the claim. It’s not unusual for some employers to try to avoid making the report, either because they dispute the injury that occurred at work or because the employer doesn’t really have workers’ compensation insurance.

If the employer has failed to meet its insurance obligations, you can access the New Jersey Uninsured Employer’s Fund, but you’ll need an attorney’s help. You can check the New Jersey Compensation Rating and Inspection Bureau to find out if your employer has an active policy. If they don’t, …

New Jersey gives employers the right to choose the doctor who handles most of their treatment and care after an accident rather than employees. 

Many employees believe that an apparent conflict of interest exists, and for the most part, they’re right. Doctors know where their bread is buttered and certainly, look for any excuse to help employers deny workers compensation claims.

None of this means you are helpless. There are steps you can take to help your case and to obtain better care from day one.

Report Every Ache and Pain

Bring a list to the doctor in writing, and make sure that everything makes it into the medical record. Don’t ignore anything. Even small pains can be an indicator of bigger problems later. 

You only get one chance to make this initial report. 

Remember, the doctor treating you is treating you like a legal case, not like a patient. You need to treat the visit like you’re building up a legal case, too. Don’t forget to obtain and keep copies of all your medical records.

Realize they’ll order tests to check for pre-existing conditions. Don’t panic. While a pre-existing condition can complicate your claim, it is not in itself a reason to deny it.

Attend Every Appointment

When you miss an appointment, you give the insurance company ammunition against you. They’ll claim you’re not doing everything you’re supposed to to contribute to your recovery and mitigate your losses.

You will also receive some treatment even if the doctor doesn’t …

With New Jersey facing an early summer this year and temperatures projected to be higher than ever, it’s a good time to discuss heat injuries and workers’ compensation. 

While heat injuries aren’t always weather-related, 50% to 70% of them are. A large percentage of heat injuries in the United States are even fatal.  

Hopefully, you will be able to protect yourself from heat while on the job, and your employer will provide some PPE and policies to help you do so. Nevertheless, it’s good to know that heat injuries are covered if you need them to be. 

Types of Heat Injury

While heat stroke is the most common and most serious heat-related illness, there are others.

• Heat exhaustion
• Dehydration
• Burn injuries
• Fainting
• Cramps

Heat may also cause secondary injuries. Sweaty hands, dizziness, and fogged glasses can cause slips, trips, and falls, for example. 

Heat Injuries Are Compensable

Heat injuries are like any other injuries in New Jersey. As long as you can show the injury arose from your employment, you can obtain compensation.

The causes should be characteristic of the trade, occupation, or place of employment and show that the work contributed significantly to the heat-related injury or illness.

For example, suppose your job requires you to work outdoors or exposes you to unusually hot locations such as hot manufacturing shops, attics, or even the pavement. In that case, you can generally show that the cause of your heat illness is characteristic of your trade, occupation, or place of employment. …

You already know that New Jersey workers’ compensation should be paying for your medical expenses after an accident. You also know that, in reality, insurance companies often deny or delay claims or attempt to wriggle out of paying for treatments your doctor recommends.

That’s why it’s important to understand what the law actually says. In this case, the employer must provide all medical treatment necessary to “cure and relieve” the effects of the work injury. They must pay 100% of the medical bills. You should not owe any co-pay.

This should include:

• Surgical treatment
• Hospital care
• Hospice care
• Prescriptions
• Prosthetics

However, there are caveats.

The insurance company can recommend cheaper treatments.

The treatment your doctor recommends isn’t always going to be the treatment your workers’ compensation company wants to give you. For example, if you need a prosthetic, they may suggest a cheaper “claw-style” prosthetic over a working hand.

They may also try to deny you treatments that work for you in favor of cheaper treatments that aren’t getting results.

Once you start having these sorts of disputes, it’s usually helpful to get a workers’ compensation lawyer involved with your case. 

Rejecting treatment can cause problems with your workers’ compensation claims. 

Sometimes, the worker’s compensation physician suggests a surgery you don’t want. You have the right to reject it, but doing so could mean losing temporary disability treatments. You do have some recourse, like asking for less invasive methods or asking for a second opinion. 

If …

When you settle your New Jersey workers’ compensation claim with a Section 20 settlement, you receive a lump sum, and you stop receiving regular benefits like lost wage payments and medical payments.

Thus, any settlement decision should be considered carefully, especially if you’ve been relying on those payments to pay your expenses as you recover. 

Here are a few signs that settlement might be advantageous.

When You Reach Maximum Medical Improvement (MMI)

Most people should wait until they reach MMI. Settling any earlier than MMI is risky because there’s always the chance you’ll need additional treatments or surgeries. 

Once you’ve settled, the insurance company stops paying your medical bills, which means you’ll have to pay them out of pocket.

The costs of any medical treatment in America today could mean wiping out your entire settlement amount on a single surgery. 

One alternative path would be to go for a Section 22 agreement. This type of settlement allows you and your employer’s insurer to agree on a permanent disability rating. You’ll receive your settlement in installments, and you won’t give up your right to future medical care. 

While a Section 22 is usually a stronger settlement, many factors influence which type of settlement you and your qualified New Jersey workers’ compensation attorney will attempt to pursue. 

When The Insurance Company is Fighting With You 

If you see that your insurance company is fighting hard to terminate your benefits, or you’re starting to become embroiled in dispute after dispute over …

You might go through multiple hearings during a New Jersey Workers’ Compensation case. The first hearing generally comes after you make a formal claim to dispute a denied workers’ compensation claim.

Here’s everything you need to know about these hearings.

Who runs the hearing, and who attends?

The hearing will be run by a judge of compensation in the county where you live or the county where the employer is located. 

You and your lawyer will attend, as will the insurance company’s lawyer. Witnesses will also attend. This could include your supervisor, co-workers, expert witnesses, or other relevant parties. 

Will the judge help me get aid right away?

Your attorney can ask the judge to grant you immediate aid with a Motion for Medical and Temporary Benefits.

This motion asks that the employer and the insurance company provide you with immediate benefits while the dispute takes place. 

Is the hearing the same as a trial?

No. If you and your employer are unable to resolve or settle your workers’ compensation claim out of court, you will eventually receive a formal workers’ compensation trial. The trial works like any trial, with both sides calling witnesses and presenting evidence to make their case. Each lawyer will get a chance to cross-examine the other party’s witnesses.

A good workers’ compensation lawyer starts preparing for trial as soon as you retain their services, even though many cases do not go to trial. Most will settle out of court. Often, you will go …

Repetitive stress injuries. Lung diseases caused by exposure to toxic fumes. Cancer caused by repeated exposure to carcinogens within the workplace. Deafness caused by repeated exposure to loud workplace environments.

There are a myriad of ways that our workplaces can erode our health and make us sick. When that happens, you have grounds for an occupational injury claim under N.J.S.A 34: 15-31. 

The law defines a compensable occupational disease as: “All diseases arising out of and in the course of employment, which are due in a material degree to causes and conditions which are or were characteristic of or peculiar to a particular trade, occupation, process, or place of employment.” It goes on to specify that deterioration of tissues, organs, or body parts due to the natural aging process are not compensable.

As you might expect, arguments over whether a given ailment is the result of aging or arising out of and in the course of employment form the basis for many occupational disease disputes here in the state of New Jersey. Employers also try to prove that the disease came from sources other than the workplace so they can avoid paying benefits.

Proving an Occupational Disease Arose From Employment

In most cases, you will have to prove that the illness was produced by causes characteristic of or peculiar to the trade, occupation, or place of employment.

For example, if you are an office worker with a repetitive stress injury to your wrist, you usually have a pretty solid …

As of February 6, 2023, temporary workers are protected by the Temporary Workers’ Bill of Rights. The Bill of Rights makes temporary agencies responsible for protecting their workers.

This Bill strengthens a temp worker’s ability to claim workers’ compensation. New hires should be provided with information on the temporary firm’s workers’ compensation carrier. 

It also specifies the responsibility that both the temp agency and the assignment employer have to provide workers with workers’ compensation insurance. 

What to Do If You are Injured on an Assignment in New Jersey

If you are hurt at work, you should inform both your assignment site supervisor and your temporary service. Both companies have equal responsibility for providing you with workers’ compensation insurance.

You should seek medical care and file for workers’ compensation as normal. 

When determining your wages for the purposes of providing temporary disability benefits, you’d calculate your average weekly wage by adding up your last six months of pay and then dividing by 26. This allows you to get the right number, as temp worker pay can fluctuate. You’ll receive 70% of that amount as a weekly wage replacement benefit if you can no longer work, up to a maximum of $921. 

Remember that there is no time limit on claiming workers’ compensation benefits. You are eligible even if you arrive on a job site on Day 1 and get hurt within the very first hour. 

The temporary agency can’t suddenly disavow you either. If you were still available and still …

You work in the insulation industry, and you come down with a case of mesothelioma, an asbestos-caused cancer closely linked with the insulation and construction injury.

While an employer might be very eager to assert that your cancer diagnosis could have arisen from any number of sources, New Jersey employers don’t have it that easy. Presumption laws cover many occupational diseases.

What is presumption? 

Presumption shifts the burden of proof from you, the employee, to the employer. If they want to avoid paying workers’ compensation, they will have to prove that their work environment didn’t cause cancer.

Presumption laws have existed since 1921. They were established in WWI, allowing veterans a clearer path to proving their tuberculosis and certain psychiatric disorders were related to their service. 

New Jersey Presumption Laws 

In New Jersey, the Canzanella Twenty-First Century First Responders Protection Act protects the right of employees to receive workers’ compensation when they contract certain occupational diseases unless the employer fails to make use of PPE provided by the employer for the purposes of protecting them from said diseases. 

It specifically creates a presumption that cancer arose as the result of employment any time a first responder falls victim to firefighting-linked cancer, as outlined by the International Agency for Research on Cancer. The Act then specifically lists other occupational diseases that gain automatic presumptive protection for first responders only. 

Note: presumption does not automatically ensure that you will “win” a workers’ compensation case. Employers still balk at paying long-term …