There are times when a New Jersey employer is permitted to deny your workers compensation claims. For example, they are not required to pay your claim when your injury is self-inflicted, or the result of horseplay or willful misconduct.
Some employers claim you’ve engaged in behavior that can result in a denial, and do so in bad faith. It’s important to know when they can, when they can’t, and what you can do about it if your claim is denied.
Valid Justifications for Denial
A New Jersey employer may deny your claim when any of the following are true:
- The injury is not job-related.
- You engaged in willful misconduct.
- You engaged in assault or horseplay.
- You were under the influence.
- You did not follow the proper procedures for filing your claim.
- You missed claims deadlines.
If you are certain you have a legitimate, job-related injury and are equally certain you filed the claim on time, then your employer may be denying the claim in bad faith. You’ll have to take some additional steps to protect your rights.
When You Are Denied in Bad Faith
You can turn to the New Jersey Division of Workers Compensation and form a formal claim petition. The DWC will review the facts of your case. If they side with you then the employer has to pay the claim. It may also be possible to request an informal hearing with a DWC judge so that the judge can look at the evidence you provide …Read More
One of the most common problems people face in a worker’s comp case is the tendency for employers to utterly violate or ignore the doctor’s light duty orders. They often figure that once they have you back at work that you’re at their mercy and they can make you do anything they want. They may even be trying to pressure you into quitting your job so that they can stop paying the workers comp claim.
When this happens it’s important to fight back, and it’s important to do it in the right way. Otherwise you could either exacerbate your injury or lose your job.
What are light duty restrictions?
You may be able to return to work before you have reached maximum medical improvement. Many employees prefer to do this when their disability award is much lower than the money they’d make at work.
In many cases you have to return to work as soon as you’re medically able to retain your other benefits.
Yet if you haven’t reached MMI then doctors may help you along by outlining restrictions on the kind of work you can do. Employers are supposed to honor these “light duty” restrictions. For example, your doctor may indicate you should not lift any object over 50 pounds.
How are employers supposed to handle light duty restrictions?
New Jersey law requires employers to accommodate these restrictions to the best of their ability and to allow a workers comp claimant to remain at work without termination as long …Read More
For many hourly workers, every day that an employee isn’t on the job is a day when that employee is not making money. For employees who live paycheck to paycheck, that money is vital.
Fortunately, in New Jersey you should receive back pay for the days that you missed if you missed more than 7 days of work. The first week is called the “waiting week.” As of right now if your disability is related to Covid-19 the seven-day waiting period has been eliminated.
You’ll be paid back pay for your temporary disability benefits once your benefits are awarded.
What is the maximum benefit for lost wages?
The benefit maxes out at 70% of your average weekly wages, or $945, whichever is smaller. You can receive these benefits for a total of 26 weeks. In some cases you may be able to extend the benefit, but you will need to speak to your workers compensation attorney to find out if it’s possible in your case.
You will usually receive money every week via direct deposit.
How long does it take to get workers compensation?
If you’re getting temporary disability benefits you should start receiving checks roughly two weeks after you become eligible for the benefit. While you’re waiting for money you might want to use your FMLA benefits, if you have them available. There’s no waiting period for FMLA, and it can provide some relief while you’re waiting.
Why does temporary disability get denied?
It’s not uncommon for insurers to …Read More
If you are planning to file for worker’s compensation protection after contracting Covid-19 at work, you probably need to plan on getting an attorney right away. Even workers at hospitals and nursing homes are struggling to get compensation after contracting the virus.
For example, in one New Jersey case the widow of a housekeeper at a nursing home is trying to get workers compensation death benefits. Her husband’s employer gave him no PPE. They refuse to cover her husband’s ICU bill or survivor’s pay.
The state senate recently has passed a bill that provides expanded protection to essential employees, creating a presumption that Covid-19 contracted by essential employees is a work-related injury for the purpose of receiving benefits. The bill has not yet been enacted into law. The bill is currently before the Assembly Labor Committee.
The bill would require employers of essential employees who wanted to fight employees on whether Covid is work related to prove, by a “preponderance of evidence,” that they did not contract the disease at work.
The bill includes other protections. For example, if the bill passes, “the amount of time an essential employee is incapacitated or unable to perform their duties as a result of contracting coronavirus disease 2019, or Covid-19, or exposure to the disease or infection and the required time of hospitalization, time of quarantine, or time of self-quarantine shall be considered as on-duty time, and an essential employee shall not be required to use paid leave or any other contractual time-off …Read More
Right now it’s theoretically possible to claim workers compensation if you contract Covid-19 on the job. The problem is proof…you would still have to prove you got Covid there, and not from your other activities. This isn’t impossible, but is really difficult.
A proposed bill, S2380, would change all that, at least for any worker deemed essential.
The bill would be retroactive to March 9 and would include a presumption that if an essential worker gets sick with Covid-19, it happened on the job.
What if my employer made me sign a waiver?
Employer waivers are gaining some popularity right now, but they’re not worth the paper they’re written on. Employers also can’t really make you sign such documents. Some employees feel forced to because they are aware some employers will find other ways to fire them if they don’t, but even those shouldn’t be too worried.
Employers can’t make employees waive their workers compensation rights. They’re protected, and those waivers will not hold water.
Workers fired for refusing to sign would have a case under the Conscientious Employee Protection Act, allowing them to sue their former employers.
What does the presumption mean?
It means instead of you having to prove that you contracted Covid at work, your employer would have to prove that you didn’t.
They would have to do this by a “preponderance of the evidence,” which would be a difficult standard for most employers to meet. At best they could point to safety …Read More
While New Jersey is working its way through a phased reopening, there are still plenty of employees who will continue to work from home until a vaccine is found and administered. This has led many who are able to perform their duties in this capacity to wonder whether workers compensation still covers them.
As with many legal questions, the answer is “it depends.” The employee will need to prove that the injury arose out of and in the course of employment.
For office workers, certain repetitive stress injury claims may not be at all impacted by working from home if they can be clearly tied to job duties requiring the employee to type or use a mouse for hours at a time.
You may also find it easier to file a claim if it can be proven that you were doing work at the time of your injury or accident. If you were on a Zoom call and fell out of your chair while reaching for a file then it would be hard to dispute that you were at work and that the injury arose from your employment.
If you paused to pick up one of your children and injured your back you’d have a harder time, even if due to the hour of the day you were technically “at work” at the time of your accident. Picking up your child has nothing to do with work even if you are on the clock, even if your employer is …Read More
Here in New Jersey you’re eligible for worker’s compensation benefits if you contract COVID-19 on the job. That’s the good news.
The bad news? This very sneaky virus doesn’t make it easy to prove transmission. Employers are no more eager to pay for claims than they ever were. Already, employer’s lawyers are advising them on how they can work around having to pay for these kinds of claims.
To keep your case strong, think about sharing certain facts with your attorney.
Precautions your employer too, or failed to take, in response to Covid-19.
It’s incredible, but plenty of employers are failing to protect their employees. Right now Whole Foods and Amazon provide fairly famous cases, but they aren’t the only ones who don’t seem to value their employees enough to take precautions.
Document every instance where employers force you to work without PPE, in conditions that place you less than 6 feet from fellow employees or customers, or in stores, shops, or offices where there has been a confirmed case of COVID-19. If employers try to force you to travel during this time or to take other risks, you should document these behaviors as well.
You won’t necessarily use this information unless you contract COVID-19 and your employer starts fighting you on worker’s compensation.
Confirmed cases in your workplace.
Make a note of every confirmed case in your workplace. You should also document any instance in which a customer came in who seemed visibly ill, especially if that customer was …Read More
Many workers compensation cases last for a few weeks or months. The worker gets injured, the worker gets care, and the worker returns to work.
When the injury is very minor workers compensation may simply be a matter of getting treatment, getting the insurance to pay for that treatment, and returning to work with some minor accommodations.
There are cases where the worker must be out for more than 7 days with the injury. This is called Temporary Total Disability, and can last up to 400 weeks.
However, there are two other forms of disability which can last longer. The first is Permanent Partial Disability, which can last up to 600 weeks. There’s also Permanent Total Disability, which can last for life.
The maximum amounts you can get to cover your lost income during these periods is capped in New Jersey. On Temporary Total Disability you can earn the lesser of 70% of the gross weekly amount that you normally earned, or $903 per week. Permanent Partial Disability and Permanent Total Disability depend on the scheduled loss chart.
A scheduled loss involves the loss of a limb like arms, hands, fingers, legs, feet, toes, eyes, ears, or teeth. They “schedule” the number of weeks you can receive wage loss compensation for the injury based on the state-approved schedule and the percentage of the body part you are determined to have lost.
For example, the court might determine you’ve lost 50% of your hand. If you’d lost 100% you would …Read More
A permanent partial disability status indicates you could do some work, but nevertheless suffer from some partial disability which reduces your quality of life. New Jersey workers compensation laws allow you to receive some compensation for your reduced work capacity.
The Judge of Compensation evaluates your loss of function across all aspects of your life based on medical proof of impairment and your own personal testimony. Your attorney can help you present your case in a clear, concise way which helps you describe exactly how your injuries have impacted your quality of life.
All of this is possible because New Jersey workers compensation law differs from the law in most other states.
Understanding “Scheduled” vs. “Non-Scheduled” Losses
Permanent partial disabilities get divided into two kinds of losses.
Scheduled losses involve:
Non-Scheduled Losses involve everything else. This could include back injuries, heart trouble, brain damage, or lung damage.
Compensating Permanent Partial Disability
You may continue to receive some compensation. The amount paid will depend on the type and severity of the injury. You’ll be paid a minimum of $35 a month and a maximum of $945 a month.
Your injury may be worth more if you received corrective surgery, or if it involved a complete or near-complete loss of function to the body part in question.
The Department of Labor puts out schedules which outline maximum benefits for different disabilities. These can be confusing to read. The bottom line is you can expect to …Read More
Employers aren’t allowed to retaliate against you for claiming workers compensation. The law also prevents them from discriminating against you on the basis of your new disability.
This does not mean you have air-tight protections against getting fired. Indeed, there are several mistakes you can make which will make it easy for your employer to terminate you.
Mistake #1: Failing to Comply With Employer Policies
For most workers compensation benefits the lack of compliance comes from a failure to follow bureaucratic process.
Some employees assume that their employer “already knows” they’re being treated for injuries and that they cannot return to work yet. In truth, you’re required to check in and provide doctor’s notes just as you would be required to check in for regular sick days.
If the doctor says you cannot work for three months you can bring that documentation to your employer and you should be safe. However, you have to bring a new doctor’s note if your doctor extends that time. Many employees make the mistake of assuming the employer knows they’ll be returning to work, or assume that their verbal notification of the doctor’s decision will be enough.
Protect yourself with every bit of documentation you can get. Make sure every doctor’s note that bars you from working is on file with your employer as soon as you receive it. Otherwise your employer will be able to fire you for being a no-show.