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When to Settle a NJ Workers’ Compensation Claim

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 …

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What to Expect at a New Jersey Workers’ Compensation Hearing

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 …

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How Occupational Disease Cases Work in New Jersey

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 …

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Updated Protections for New Jersey Temporary Workers

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 …

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What Are Presumption Laws in a New Jersey Workers’ Compensation Case

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 …

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What is the NJ Workers Compensation Fraud Act?

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 and hand to each doctor and failed to prevent that she had a substance abuse problem in the past or that she’d been taking Suboxone to prevent relapse. They also claimed that she failed to disclose her prior psychiatric treatment and issues fully.

Bellino argued she never purposefully or knowingly provided false or misleading information. She said she tried to answer all doctor questions truthfully but that she’d seen multiple doctors several times and wasn’t always sure of the times or dates of previous treatments. She also disagreed with the characterization of her statements contained in several doctor reports. …

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Do You Receive Pain and Suffering Damages in a New Jersey Workers Compensation Claim?

It 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 cases wherein injured workers could, theoretically, obtain pain and suffering compensation. 

If a third party was involved in your injury and that third party was not your employer, you could receive workers’ compensation and sue that third party. The third party would then be required to pay the portion of your lost wages not already covered by workers’ compensation and for pain and suffering damages.

Can you sue the workers’ compensation insurance company for delaying medical treatment payment or authorization?

The third-party lawsuit exemption does not include the insurance carrier. 

For example, in the 2012 case Stancil

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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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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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The Law Office of Albert J. Talone is a NJ Workers Compensation Law Firm committed to meeting the needs of every client. For more information - contact us today.

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
Moorestown
New Jersey
08057
United States

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