The workers’ compensation system in New Jersey was designed to provide injured workers with prompt medical attention and wage replacement benefits when they are disabled due to a work injury. There is no need for an employee to prove that the employer committed negligence in order to collect benefits. As long as the injury occurred during the course of employment, the injury is considered “compensable” under the New Jersey Workers’ Compensation Act, N.J.S.A. 34:15-1 et seq. In other words, even if the employee injures himself while tripping over his own two feet at work, he is potentially entitled to benefits. The workers’ compensation insurance carrier must pay 100% of all related medical treatment. During the time that the employee is unable to work while recovering from his injuries, he is entitled to be paid 70% of his average weekly wages, up to a maximum amount which changes every year. After he has been discharged from medical treatment, the employee may also be entitled to receive a percentage of permanent disability benefits. If the work injury leads to death, the employee’s dependents are entitled to receive benefits, based upon the employee’s average weekly wage. Unlike a negligence claim, a workers’ compensation claimant is not entitled to receive compensation for “pain and suffering,” and miscellaneous expenses. However, if the employee sustained a permanent injury as a result of the work accident, he is generally entitled to receive benefits for a certain number of weeks, based upon a schedule of disabilities set forth in the Workers’ Compensation Act.
The workers’ compensation insurance carrier must pay 100% of all related medical treatment. The injured employee does not owe any co-payment or deductible. However, that treatment must be pre-authorized by the employer’s workers’ compensation carrier. The difficulty for injured workers is that the employer (referred to as the “Respondent” in the Division of Workers’ Compensation, hereinafter “DWC”) chooses the doctor and has the right to “control” the treatment. Unfortunately, it is not uncommon for a carrier to hold up the worker’s treatment by failing to authorize it in a timely manner. The good news is that most Judges will order the carrier to pay for any treatment recommended by the authorized treating physicians. If an authorized physician recommends treatment which is denied by the workers’ compensation carrier, a “Motion for Medical Treatment” should be filed with the DWC, to compel the carrier to pay for the treatment.
If the carrier believes that the authorized physician is over-treating the patient, or is not returning him to work quickly enough, the carrier may choose to schedule an “independent” medical examination (known as an “IME”). The purpose of the IME may be to direct the treatment to a more appropriate medical expert. Sometimes though, the IME is specifically scheduled to create a basis for cutting off medical and/or temporary disability benefits to an injured worker. Unless there is a reason to question the competence of the authorized treating physician, many workers’ compensation attorneys refuse to allow their clients to attend an IME prior to being discharged from the authorized treating physicians. If the independent medical consultant finds that no further treatment is necessary or related to the accident, the carrier may terminate further benefits on that basis. However, the Courts will generally accept the opinion of the authorized treating physician, who followed the patient over a course of time, over the opinion of an “independent” expert who performed a cursory examination.
The Workers’ Compensation Act provides that an employee is entitled to receive 70% of his average weekly wage, up to the state maximum, for the period of time that the authorized treating physician indicates he is unable to work and needs treatment. The average weekly wage is calculated based upon the employee’s average wage over the six month period immediately prior to the date of the accident. The average weekly wage includes all overtime paid during that six month period. For accidents which occur in 2008, the state minimum temporary disability rate is $198 per week, and the maximum temporary disability rate is $742 per week.
If the authorized treating physician determines that the employee needs further treatment and is unable to return to work, he is entitled to receive temporary disability benefits. If the physician finds that the employee may return to work on a “light duty basis,” and the employer is willing to accommodate the specific work restriction set by the authorized physician, then temporary disability benefits will be suspended. On the other hand, if the physician recommends a return to work with a restriction (ie: lifting no more than 20 pounds), and the employer is unwilling to accommodate that restriction, then the carrier must continue paying temporary disability benefits.Continue Reading