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How to File a Workers’ Compensation Claim

Workers’ compensation, also known as workman’s comp, is an insurance program that insures employees for job-related injuries and illnesses. The State of New Jersey passed the New Jersey Workers’ Compensation Act in 1911. This Act makes it mandatory for all employers,  including LLC and part-time and seasonal employers in New Jersey, to have a workers’ compensation insurance policy.

You can file a workers’ compensation claim in New Jersey if you sustained an injury or illness as a result of working on the job or engaging in a task related to the job. In case, you do get a work-related illness or injury, you are entitled to the following benefits:

  • Medical treatment, including physical therapy, medicines, surgeries, and any other treatment that you need to recover. New Jersey’s law allows employers or insurance payers to pick the healthcare provider for their medical treatment. If you consult a doctor without your employer’s permission, your medical bills may not be covered.
  • Lost wages if you are unable to return to work.
  • Ongoing care costs, including surgeries or physiotherapies.
  • Temporary total disability benefits if you cannot work for more than seven days. In New Jersey, you will receive 70% of your average wage.
  • Permanent partial disability benefits, which depend on the body part you injure and the severity and type of injury.
  • Permanent total disability benefits if you lose two major parts of their body. Here, you will receive 70% of your gross average weekly pay. These benefits last for at least 450 weeks. However, if you are unable to work after that, then these benefits can be continued.

Who can File a Workers’ Compensation Claim in New Jersey?

As per the law of New Jersey, most workers, including domestic workers and farm workers, can file a workers’ compensation claim. However, if you are an independent contractor, an unpaid volunteer or intern,or a sole proprietor with no employees, then you are not covered under this law.

When to File a Workers’ Compensation Claim

You can file a workers’ compensation claim if you sustain injuries on the job or by doing any task to fulfill any requirement of your job. These include occupational accidents, such as slip and fall accidents, diseases, trauma injuries such as traumatic brain injury, or illness caused by exposure to work activities or chemicals.

How to File a Workers’ Compensation Claim

Here are the steps you need to take to file a workers’ compensation claim in New Jersey.

Step 1. Notify Your Employer

The first step you need to take to file a workers’ compensation claim is to report your injury to your employer. If your condition requires immediate attention, then you will be taken to a hospital’s emergency room. Here, you will not need your employer’s authorization to receive necessary medical care. However, if the situation does not require emergency care, you can simply visit a clinic after getting authorization. This will ensure that your medical costs get covered through workers’ insurance.

In case that you are involved in a workplace accident but do not suspect any injury, you should still notify your employer. This is because, in some situations, injuries or illnesses, such as mesothelioma (caused by exposure to asbestos) surface over time. As per the New Jersey law, you only have 90 days from the date of the injury to inform your employer about your injury. Therefore, if you discover an injury or illness after the statutory deadline, you may not be able to file a workers’ compensation claim. 

As with any legal procedure, you must notify your employer regarding the accident in writing. Even if you do provide a verbal notification first, you must give a written notification as well to maintain an official record. It is a good idea to report accidents soon after they occur because you will be able to recall more details this way.

Step 2. Complete the Paperwork

Once you have reported the injury, your employer will hand you an official claim form as part of the process to file a workers’ compensation claim. You only need to fill in the “employee” section of the form, which generally requires the following pieces of information:

  1. Injury type and affected areas of the body
  2. What caused the accident
  3. Date, time and location of the accident
  4. Any other employee or person involved in the accident
  5. Record of any medical treatment that you have received

After filling in the details, you will have to submit the form to your employer. You can return the form in person or via email. If you opt to mail the claim form, then use certified mail and request for a return receipt. This will ensure that you have a complete record of the date on which you mailed the form and the date on which it was received. If you fail to submit the completed form to your employee on time, you may not be able to receive adequate benefits and compensation.

Step 3. Your Employer will File a Workers’ Compensation Claim

Your employer is responsible for submitting the documents to the insurance company. If you haven’t consulted any healthcare provider yet, the insurance company will pick a doctor to conduct am Internal Medical Examination. The results of this examination will be sent to the insurance company.

Once the insurance company has received the paperwork, they will fill in the First Report of Injury form and send it to the Division of Workers’ Compensation in New Jersey. If the insurer or employee has not completed the report within 21 days of your injury notice, you should follow-up. At this stage, you can also contact a workers’ compensation lawyer for assistance.

Step 4. The Insurance Company Processes your Claim

The insurance company will then begin to evaluate your claim. Based on the evidence, the insurer will decide to either accept or reject your claim.

If the insurer approves your claim, then you will be entitled to receive a payment that will cover the cost of your medical treatment, including physical therapy, medicine, surgery. You may also receive a portion of the wages you have lost as a result of the injury or illness. Moreover, you may also be entitled to travel reimbursements in accordance with your employer’s insurance plan. Once you have received your rightful compensation, you do not have to proceed to the next steps.

In case your employer or the insurance company declines your claim, you should get in touch with a worker’s compensation lawyer if you haven’t already. A legal professional will review your case and help you decide on the best way to move forward.

Step 5. File a Hearing

As per the law, if your workers’ compensation claim is denied, you have the right to challenge the insurance company’s decision through the New Jersey workers’ compensation claim process. If you have hired a workers’ compensation lawyer, they will guide you on whether you should file a formal or informal hearing with the New Jersey Division of Workers’ Compensation.

Informal Hearing

In case of a dispute, you can file an Informal Hearing application. This process allows you to reach a compromise situation or settlement agreement with the other parties involved. These proceedings offer a quicker way of settling issues without having to resort to more complex and time-consuming litigation procedures. An informal hearing usually addresses disagreements, such as medical treatment, the amount of permanent or temporary benefits, etc.

In an informal hearing, the judge’s suggestions are non-binding on you or any other party. If an informal hearing does not work out in your favor, you canproceed to a formal hearing. However, you need to keep the legal time frame in mind and make sure that all your claims are filed in the designated time window. The laws regarding workers’ compensation claim in New Jersey have a two-year statute of limitations that is appliedto cases of workers’ compensation. In simple terms, this means that a formal claim petition must be filed within 24 months of the injury date or the date on which the last compensatory payment was received, whichever comes later.

Once you file an informal hearing application, you, your employer, and their insurance company will get a schedule from the New Jersey Division of Workers’ Compensation in a couple of weeks. Informal claims can besettled by the second hearing. If you have legal representation at this stage, then you will have to pay 10% of the amount awarded to you as legal fees.

Formal Hearing

If you have sustained a job-related injury, you also have the option to file a formal claim petition with the New Jersey Division of Workers’ Compensation within the two-year time limit. The first formal court hearing usually takes place within a period of six months from the date on which it was filed. Cases are generally allocated to a regional office. This usually depends on the county where the employer is situated or the county of your residence.

A large number of formal claim petitions are resolved through a mutual decision regarding the benefits that are to be provided and the severity of the disability caused by the injury. If the disagreements still haven’t been settled during the pre-trial phase, the trial officially begins. Your testimony along with that of medical professionals and eyewitnesses is extremely crucial for the judge to decide. One the trial comes to an end,the judge will arrive at a decision. The judge’s ruling is considered binding for all the parties involved.

Note – Medical treatment that is authorized by your employer is counted as a compensatory payment. In case you have a work-related health issue, such as black lung disease, bursitis, visual loss, or cancer, the claim must be filed within 24 months from the date you first get to know about the medical condition. Furthermore, if you file for an informal hearing, remember that it does not interfere with the two-year statute of limitations. This means that the time limit of two years will be applicable even after you file an application for an informal hearing.

Step 6. Appeal

If you still do not agree with the judge’s ruling, the statute of workers’ compensation claims in New Jersey gives you the right to appeal the verdict to the Superior Court, Appellate Division.

Important Point to Remember

New Jersey’s Workers’ Compensation Act requires all employers to adequately compensate their employees for any injury or illness caused on the job or during a work-related task without proof of fault. This means that it is illegal for an employer to terminate or discriminate against you or any employee who has filed for a workers’ compensation claim or received compensatory benefits from the employer. Moreover, it is also unlawful for employers to discriminate against any employee who has attested or is going to attest in a matter involving workers’ compensation.

If you feel that you are being retaliated by your employee, you can file a complaint against the employer in the Civil Part of the Superior Court and seek punitive and compensatory damages. You can also opt for an administrative course of action to remedy the problem of discrimination. In the administrative course of action, the Office of Special Compensation Funds will investigate your claim and make a decision accordingly.

Parting Words

We hope that these steps have given you a clear understanding of how to file a workers’ compensation case in New Jersey.

If you or your loved ones need legal representation to file a workers’ compensation case in New Jersey, feel free to contact us. Our experienced team of professionals will ensure that your workers’ compensation claim is handled in the best possible way.

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