Information About Worker's Compensation

Temporary Disability:

The Compensation law of the State of New Jersey, as of 1985, for example, permitted the maximum of temporary disability that an employee could receive as $269.00 dollars. This is calculated by taking 70% of the gross average weekly wages of the employee. Thus, if 70% of the gross wages of the employee is less than $269.00 then the 70% figure was the temporary disability amount. If the 70% figure was over the $269.00 figure, then the maximum amount that the employee would receive was the $269.00. The law would permit the receipt of these funds, in order to permit a more humane treatment of employees during the period of disfunction and recuperation, as long as he/she is under active medical care and attention concomitant with the disability being authorized.

Reasonable and necessary medical care and attention:

Medical care will be given to the employee pursuant to statute, by the insurance company of the employer but only through the employer's authorized physician. The treating physician is paid by the employer and he/she works for the employer, in essence. Nevertheless, the obligation is between the physician and the patient/employee. Of course, the employee may obtain an additional physician but this would be at an additional expense not covered by the employer's worker's compensation insurance benefits.

Permanent Functional Disability Benefits - Partial Basis:

Permanent functional disability is that which the Court assigns to the employee after reviewing all the documents, medical reports and treatment notes regarding the injuries and after hearing testimony concerning the employees condition.

2. Can the Employee Go to His Own Family Doctor or a Physician of His own Choice?

Under the New Jersey Worker's Compensation Act, the Employer has the sole right to select on who becomes the treating physician for the employee. The employee must go to that particular physician designated by the Employer unless otherwise clearly informed. If the injured employee opts to also see another doctor or treating facility then he/she is personally responsible for any additional bills incurred with the other physician. The Court will generally not enforce or otherwise compel the employer's insurance company to pay for the outside physician's bills incurred.

3. Can a Second Opinion Help in Determining the Seriousness of the Injuries?

Not usually. The reason for this is that these secondary reports are usually from physician's who are unwilling to testify or will be too expensive to compel their appearance in court and testify. They may, however, aid the employee in determining whether surgery is necessary in serious cases.

4. If The Employee Wins an Award/Settlement, What Occurs?

Compensation does not involve a jury trial. The employee only receives the statutory benefits for the percentage of disability of a whole person impairment ratings or by the limb that the court determines to be disabled. The entire matter depends upon the particular judge's experience, expertise, the physician's reports, the length of treatment, the employees testimony and other related factors. The schedule of benefits begins at 0 and ends at the 100% range. Generally, it is divided by the hand, arm, leg, fingers, ears (deafness), eye and leg injuries and the whole person impairment.

If the employee has an injury to any other portion of his body other than the specific pritions listed, than it is determined by whole impairment.

When the judge determines a percentage of disability, then this rating is translated under the statute for the year of the injury into a number of weeks. Each week is then paid at the rate permitted by the statute for the year of the accident. If the accident on the job occurred in 1985, the rate per week began at $68.00 per week and after 180 weeks the same increases upwards. The lump sum, if any, will be the number of weeks that the Court awards from the last period of temporary disability to the date of the judgment, less whatever assessments the court decides.

5. Is the Employee/Injured Person Entitled to a Jury Trial?

No.

6. Is the Employee Guaranteed to Receive Temporary Disability, Medical Benefits and/or Permanent Functional Disability?

No. The employee must be temporarily totally disabled in order to qualify for temporary disability benefits. This decision is determined by the treating physician. In order to receive medical attention, the medical treatment must be curative in nature so as to be designed to cure the underlying disability or problem, as opposed to simply being palliative in nature. For example, in simple back injury cases, the insurance company will not approve a chiropractor, in many cases, because such treatment is viewed as aimed to relieve the pain and not actually cure the underlying condition. The employee only receives permanent functional partial disability if the court finds that he/seh meets the standards and criteria for permanent functional partial disability.

7. If the Authorized (employer's) Treating Physician Releases the Employee to go back to Work and the Employee can not do the work, or the Employer will Not allow the Employee to return with restrictions, What occurs?

If the authorized physician informs the injured employee to return to employment then the employee must make the attempt of returning to work. If the employment then aggravates the employees' condition, the injured person has a right to apply for continued additional medical care from the employer or, alternatively, to file a new claim for the aggravation of the underlying condition.

In any event, unless the injured person can demonstrate that he/she is temporarily totally disabled, he/seh can not continue with the temporary disability. The injured person must then report back to work and advise the supervisor or foreman of the continuing injured status condition and inform that the condition does not permit him/her to work.

8. If the employee is compelled to return to work by the authorized treating physician, can the employee find another credible physician who will determine the injured person temporarily totally disabled?

The injured employee or his attorney can file a Motion for a continuation of disability. The motion must have an affidavit attached explaining the subjective disabilities as well as a doctor's report stating the need for continued medical care and that the employee is temporarily totally disabled.

The effect is that even after the authorized treating doctor returns the employee to work, and the employee attempts to work, the employee is behooved to be evaluated again by his own private physician. This second consultation and report may take weeks to receive. Afterwards, a motion is filed immediately so as to get on the Worker's Compensation list of pending cases (about 4-6 weeks) while the employee is not receiving any income.

The other alternative to this waiting stage is to file for a State Temporary Disability Lien ( a different application ) for certain matters, under State law. This other process generally takes 4-5 weeks to process and the moneys from this source will be paid for a maximum of 26 weeeks, depending upon the medical reports that are submitted.

Nevertheless, this other lien will have to be repaid at the conclusion of the compensation claim, and will be deducted form the additional or accumulated temporary disability. All that this additional funds do is permit the employee to receive some State moneys while his/her primary case is pending and then the temporary disability petition is determined at the conclusion of the case.

9. What can occur to the employee's petition after returning to work?

As soon as the employee returns to work, it is advisable that the attorney be contacted. At that point, a permanency evaluation will be scheduled wherein a doctor will examine the employee and submit a written report as to the degree of permanent partial functional disability sustained. The costs of this report varies. This physician must be paid at the time of the consultation.

10. What are the lawyer's fees?

The worker's compensation statute permits an attorney(s) to only receive the amount of up to 20% of all those benefits which the lawyer's efforts has obtained for the injured employee. If the judge finds that the case is not compensable, then the attorney earns no fees. Costs are deducted from the award or settlement.

11. Once the Judge determines the value of the injuries, does this conclude the matter once and for all?