How Does Workers Compensation Work in New Jersey | Part One

Scales of Justice

Scales of Justice

I have truly enjoyed the practice of workers’ compensation law during all these many years I have been practicing. Over that time I have appeared in all of South Jersey’s workers’ compensation vicinages, or districts. These include Camden, Bridgeton, Atlantic City, Burlington as well as Trenton.

The following may or may not come as a surprise to you. The system of delivering workers’ compensation benefits to injured workers in New Jersey has changed very little over the past 50 or more years. The process of having cases adjudicated is virtually the same now as it was in 1965.

Let’s assume a worker experiences a typical low back injury following a fall at work. The worker, now a client, engages an attorney.

But what happens next?

The employer’s insurer selects health care providers to supply the treatment for the injury. In New Jersey, the employee does not get to pick his orthopedic surgeon or physiotherapist or pharmacist or radiologist or any other physician. The selection process is controlled by the insurer.

Only the insurer is permitted to select these providers. This is intended to keep expenses down. It is also meant to control the possibility of unnecessary over-treatment for the benefit of the physician’s own lifestyle.

Injured workers are entitled to temporary disability benefits if they are unable to work for more than one week due to the injury. They then become entitled to temporary disability benefits. These benefits are generally based on 70% of their weekly wages.  Further, the benefits are payable for up to 450 weeks and until one is able to resume employment.

Temporary disability payments are also provided until the patient has “plateaued”. The authorized physician determines the patient has or reached MMI (maximum medical improvement). This is not synonymous with being cured – it merely means that he or she will not get better with additional “curative treatment.”

At this time a Claim Petition is generally filed on behalf of the client in the county of the petitioner’s residence. The case is listed initially and rather promptly along with about 50 other pending matters before a Judge of Workers’ Compensation.

The employer’s insurer files an “Answer”. The insurer is then obliged to furnish the petitioner’s attorney with copies of medical records which the carrier has obtained from the authorized medical providers.

These records are submitted by counsel for the petitioner to another physician. This physician specializes in providing disability evaluations based on a percentage of loss of bodily function attributable in case of a back injury, to “partial total” disability (unless the petitioner is deemed to be totally disabled) and likewise, if other parts of the body are involved the percentage may be to the hand, the foot, the leg, the arm, the hand, fingers, toes or even hearing loss.

Of course, in addition to reviewing medical records, the evaluating physician also examines the patient. The same process occurs with regard to an evaluation on behalf of the Respondent (i.e. the employer).

In a future blog article, I will explain the “Schedule of Disabilities and Maximum Benefits Exclusive of Amputation and Enucleation.” This chart is updated every year. It provides practitioners and the court with guideposts for determining permanent or (most frequently) partial permanent disability benefits in New Jersey, It depends, of course, on the nature and extent of residual disability.

No compensation is included under workers’ compensation for pain and suffering. In return, the employee is no longer required to provide proof that the employer’s negligence was the direct and proximate cause of the injury, as was the case under the common law.

You can learn more on our Workers’ Compensation page.

Our firm welcomes the opportunity to provide a confidential, no-obligation consultation to any worker injured while at work. Please call us at 856.235.1234 or use our contact form.

Uri Taenzer