If you sustain any injury on the job in New Jersey, you are likely entitled to workers’ compensation benefits. Because you need to focus on your healthy and recovery, it is important for the workers’ compensation claims process to be as stress-free as possible.
Knowing what to expect in a workers’ compensation claim can be helpful. It will allow you to be prepared to assert your right to benefits after you have been hurt on the job.
Hiring an experienced New Jersey workers’ compensation lawyer is always the best way to make your claim and get the benefits you deserve, but knowing what to expect could help to put your mind at ease as you navigate this complex worker protection system.
Davis, Saperstein & Salomon, P.C., has prepared a step-by-step guide for what to expect when you make a workers’ comp claim.
1. You will need to get medical help immediately.
If you need emergency medical assistance because your injury is serious or life-threatening, you can go to any doctor or hospital to get treatment even without prior authorization from your employer.For non-emergency treatment, your employer has the right to choose the physician you will go to in order for costs to be covered. The physician must be qualified, licensed and provide appropriate treatment.
2. Notify your employer of the injury within 90 days.
You should let your employer know of the injury as soon as you can, but 90 days is the maximum time limit for reporting a work injury and still being eligible for benefits.You can provide notice to the personnel office, to a supervisor or to anyone else in a position of authority at the workplace. The notice does not need to be in writing, by law, but you should provide written notice and keep copies of documentation you submit in case there is a dispute.In some cases, the work injury occurs not because of an accident, like a fall or a car accident while on the job, but because of exposure to toxins or chemicals or because of repetitive stress over time. These injuries are covered, but you will need to notify your employer as soon as you are diagnosed.These cases are more complicated since it can be a challenge to link your ailment to your job or to pinpoint a specific time when the injury happened. You should always speak with a lawyer if you are making these types of workers’ compensation claims.
3. After you provide notice to your employer about your injury:
Once you give proper notice to your employer, the employer or the employer’s insurer will investigate your work injury claim. If your employer determines your injuries are work-related, benefits should begin. Additionally:
- Within 21 days of receiving notice of a workplace injury, the workers’ compensation insurer must file a First Report of Injury form with the Division of Workers’ Compensation.
- All of your medical bills should be paid for all treatment costs related to your injury. Workers’ compensation benefits should also cover transportation to medical appointments.
- If you have missed at least seven days of work due to your injury, you should receive temporary disability benefits. These benefits are equal to up to 70 percent of your wages, within state maximum limits.
- The temporary disability benefits will continue until you are recovered enough to return to work or until you have reached maximum medical improvement (MMI). You have reached MMI when a treating physician declares that you have recovered to the extent possible based on the nature of your injuries.
- If you are still unable to work despite reaching MMI, permanent total disability benefits will begin. These can continue for 450 weeks after which another review will be conducted to determine if you remain disabled and eligible for benefits.
- Within 26 weeks of returning to work or reaching MMI, the workers’ compensation insurer must file a Subsequent Report of Injury with the Workers’ Compensation division and must send a letter to the worker explaining benefits paid to-date on the claim.
- In some cases, you are partially disabled, which means you are able to work light-duty or do some work but not return to the job you had prior to the injury. If you are partially disabled on a temporary or permanent basis, you can receive partial disability benefits.
4. If your claim is denied:
If you submit initial notice of your injury to your employer, and your workers’ compensation claim is denied, you can appeal the denial. There are several approaches to take to appeal your denial, including:
- Filing a formal claim with the Division of Workers’ Compensation. You have two years from the time when the injury or last payment of compensation is made to file a formal Claim Petition if your employer or the insurer fails to provide medical services or disability benefits.
- Filing for an informal hearing before a Judge of Compensation. Typically, an informal hearing is attended by a representative of the employer and/or the insurer. The judge will make non-binding suggestions about how to resolve the dispute. An informal hearing does not stop the two-year time clock from running on a formal appeal.
When you file a formal claim with the Division of Workers’ Compensation, both you and the employer/insurer can present evidence in support of your argument. A binding decision will be made that will determine the outcome of your claim, although it may be possible to appeal this decision to a federal appellate court under certain circumstances.
Contact Our New Jersey Workers’ Compensation Lawyers Today
With multiple options for appeal, the process of dealing with a denial can be complex. An experienced lawyer at Davis, Saperstein & Salomon, P.C., will provide the help you need to have the best chance of getting benefits.
Attorneys are prohibited by law from charging for legal services prior to the resolution of your work-injury claim. Any legal fees must come out of compensation your attorney obtains for you. If you do not receive workers’ compensation benefits, you will not pay legal fees for our representation.
To learn more about how an attorney can help guide you through the process of getting workers’ compensation benefits, contact Davis, Saperstein & Salomon, P.C. at (800) LAW-2000 or online today.
Sources / More Information
- Forms & Publications, New Jersey Department of Labor and Workforce Development (NJDLWD)
- Workers’ Compensation Benefits, NJDLWD