New Jersey Worker Injury: Workers Comp Claims, Denials and Appeals

New Jersey workers’ compensation provides various benefits to workers injured while on the job in New Jersey and workers that develop an occupationally related illness as a result of their work environment in the state. Like all states, New Jersey does not require proof of any fault of the employer in causing the injury or disease; rather, you have a workers’ compensation claim if your injury or illness was caused by your work.

First Steps After Injury or Onset of Illness

When you are injured or discover you are sick because of your job, report your workplace injury or illness to your employer at the earliest reasonable time. This notice does not have to be written, but it can be if you prefer. You must report your injury within two years of the date of injury or the date of the last paycheck you received from your employer, whichever is later. If you have an occupational disease, you must report the illness within two years from the date you became aware of the illness and its possible connection to employment conditions.

Your employer will then notify its workers’ compensation insurance carrier. The insurance company will complete the form “First Report of Injury” and submit it to the state, which begins your workers’ compensation claim. Note that the filing of this form does not mean you have an allowed, open workers’ compensation claim, it just means the state is notified of your claim.

You may seek medical treatment for your injury or illness at any time. Under New Jersey law, your employer or the insurance carrier may require that you obtain treatment from a specific physician.

Claim Allowance

The workers’ compensation insurance carrier will notify you if your claim is allowed, meaning that your claim meets the requirements under state law to be a compensable workers’ compensation claim. You will not be eligible for any workers’ compensation benefits and will not have a workers’ compensation claim if your claim is not allowed. If you already have received medical treatment related to your workplace injury, the insurance company will also notify your doctor of the decision to accept or deny your claim.

Claim Denial

If your claim is denied, you may appeal that determination (see below).

Workers’ Compensation Benefits

Once your claim is accepted, you are eligible for workers’ compensation benefits. Your employer or its workers’ compensation insurance carrier pays the workers’ compensation benefits. Your eligibility for the following workers' comp benefits depends on whether you are unable to work during your recovery and whether you sustain any permanent impairment.

Medical Treatment

First, your employer or the insurance carrier will pay for all proper, necessary, and reasonable medical treatment for conditions related to your work-related injury or disease. This does not include all medical treatment for any condition(s) you may have – it only covers treatment related to your workplace injury or occupational disease. However, workers' comp will pay for doctor visits, physical therapy, prescriptions, surgery, and other treatment if necessary.

Your employer or their insurance company will pay your doctor or the hospital/clinic directly.

Lost Wages

Another workers’ compensation benefit is “temporary total disability” benefits, which are meant to compensate for lost wages if you are unable to work while you recover from your injury or illness. You are eligible to receive these benefits if you cannot return to your job for seven or more days. In New Jersey, you receive approximately 70% of your average wages, subject to certain maximums and minimums. (In 2012, the maximum is $810 per week and the minimum is $35 per week.)

Temporary total disability benefits end when your doctor releases you to work or when your doctor finds that you are at maximum medical improvement, meaning there is no additional medical treatment that will cure your disease or injury.

Permanent Partial Disability

If you sustained a permanent impairment as a result of your workplace injury or disease, you may receive permanent partial disability benefits. These benefits are given to workers that have permanent impairment, but are able to return to work in some capacity. Permanent partial disability (PPD) benefits are monetary awards paid directly to you to compensate for your permanent impairment.

PPD payments begin once your temporary disability ends and you are determined to be at maximum medical improvement. At that time, your doctor will assess the level of your permanent impairment and give you a permanent disability rating. Your permanent disability rating will determine the amount of permanent partial disability benefits you will receive. In New Jersey, disability ratings are based on a schedule when the eyes, ears, arms, hands, legs, feet are injured. The schedule dictates how many weeks of PPD benefits you'll be paid. PPD benefits are paid weekly.

Permanent Total Disability

If you are permanently disabled, and cannot return to work due to your workplace injury or illness, you are eligible for permanent total disability benefits. These are like a pension – you will receive a weekly monetary payment. The amount of the payment is usually 70% of the average weekly wage, subject to certain caps and minimums.

In New Jersey, permanent total disability (PTD) benefits are paid for at least a period of 450 weeks. If you are still unable to work at that point, the PTD benefits can be continued.

Appealing a Workers' Comp Decision or Denial

To appeal a denial of your claim, you can file a formal Claim Petition with the Division of Workers’ Compensation. Alternatively, you may file an Application for an Informal Hearing, also with the Division of Workers’ Compensation. If your claim is denied again, you have the right to appeal a Division of Workers’ Compensation decision to the state courts of New Jersey. For more information, see our article on New Jersey workers' comp appeals.

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