The Workers’ Compensation Fraud Act makes it a fourth-degree felony to “purposely or knowingly” make false or misleading claims, representations, or submissions concerning any fact “material” to a workers’ compensation claim for the purposes of wrongfully obtaining benefits. The Act has been in force in New Jersey since 1998. A “material fact” is any fact that a reasonable person would recognize as relevant to your workers’ compensation case, as distinguished from an insignificant or unimportant detail. Example Case For example, in the 2014 case Bellino v. Verizon Wireless, Verizon accused former employee Natalie Bellino of workers’ compensation fraud. Verizon maintained that several of her statements to both her treating and examining conditions were allegedly false, incomplete, or misleading and argued that she did not disclose every medication she’d been taking to each doctor she saw. They also argued that Bellino did not report all prior treatment of her injured back
Read MoreDuring your workers’ compensation case, you may be asked to undergo an “independent” medical examination, or IME. They are also known as Rule 4:19 exams or defense medical examinations. In reality, the doctors who perform these examinations serve insurance companies and are paid handsomely to downplay injuries, make a case for cheaper treatment, and make a report that’s as favorable to the insurance companies as humanly possible. It’s smart to wonder whether you may record these examinations to bolster your case. According to the 2023 New Jersey Supreme Court Case DiFiore v. Pezic, you may bring a neutral third-party observer to make an audio or video recording of the exam if your lawyer informs the defendant in advance. If the defense counsel opposes the third-party observation or recording, the parties should meet and confer to reach an agreement. The court also did not seem to hold the common view that
Read MoreIt would be nice to receive pain and suffering compensation when you are injured at work. Unfortunately, pain and suffering is not part of any workers’ compensation claim. The creation of workers’ compensation was meant to serve as a “grand bargain” between employers and employees. The idea is that employers would cover certain types of expenses for an injured employee without question, but in return, employees would lose the right to sue employers for negligence. The ability to sue a person for negligence leads to pain and suffering compensation, also known as a personal injury lawsuit. What Workers’ Compensation Covers Under workers’ compensation, your medical bills are covered for any visit relating specifically to your work-related injury. If you are temporarily or even permanently disabled, workers’ compensation replaces a portion of your lost wages, though it does not replace all of them. This is not to say there aren’t some
Read MoreIf 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
Read MoreWorkers’ 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
Read MoreIt 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: 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: Fortunately, you have recourse if your insurer refuses to authorize medical treatment. Your workers’ compensation lawyer can file a request for a hearing after gathering evidence that you
Read MoreNew 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
Read MoreMost 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
Read MoreIf 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: Many people feel utterly lost when considering what kind of work they can do now,
Read MoreSuicide 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
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