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What are the Different Types of Workers’ Compensation Benefits?

A workplace injury or illness can have a significant impact on anyone’s life. The Workers’ Compensation system in New Jersey is established to help injured workers get needed medical treatment and temporary wages while they recover. However, claims can be disputed and even denied. The process can be complicated by supervisors who do not do their due diligence, or insurance companies might take steps to avoid payment.

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Understanding a worker’s rights on the job is paramount because employees cannot keep working and supporting their families if they are not compensated after an injury. There are a few different forms of Workers’ Compensation that are available depending on the nature of the accident, the length of the victim’s recovery, and special losses the victim might incur.

Employees are encouraged to reach out to a Mount Laurel Workers’ Compensation Lawyer to learn more about the rights of injured workers. There are several things that victims can do to improve their position, and in each of those actions, it helps to work alongside a lawyer. Lawyers can guide the legal process and help victims understand what they must do to recover and move forward.

What is Workers’ Compensation?

Mount Laurel Workers’ Compensation LawyersWorkers’ Compensation is an insurance plan that employers must carry to help pay for the recovery of an injured employee after an accident. The insurance plan covers everything pertaining to the accident, and it comes into effect the moment the victim must receive medical treatment.

The employer is responsible for providing employees with reasonable medical treatment for injuries received in the course and scope of employment. Along with this obligation, the employer has the right to choose which medical care providers are authorized to provide medical services for the worker’s injuries. The obligation to pay for medical treatment rests with the employer until the authorized doctor believes the employee will not get any better through further treatment.

It is important to keep in mind that the employer is obligated only to pay for care provided by approved medical care providers. If injured workers seek medical treatment with a care provider who is not authorized by the employer, the workers may bear the responsibility for payment of any related medical expenses. The only exception is when the victim requires emergency medical treatment or lifesaving care just after an accident. In a situation such as this, the victim requires care so that they can survive, and the employer does not have time to select a medical provider.

Because there is a network of doctors that Workers’ Compensation insurance providers use, a list of those doctors are typically posted in the office or somewhere on the worksite. If the employer does not have a preference, the injured worker may choose from that list.

Workers’ Compensation also pays wage loss and disability benefits. These benefits stretch beyond medical care because they pay for the time that the victim cannot go to work. The insurance company ensures that all bills are paid, and victims do not need to file claims on their own. Additionally, when the insurance company takes over the claim, the employer cannot do anything about that claim other than direct the employee to a doctor.

When Should I Report Accidents?Mount Laurel Workers’ Compensation Lawyers

Workers injured on the job should report their injuries as soon as possible. Every company has a chain of command that it generally shares with its employees. This chain of command dictates that people injured on the job go to their direct supervisor to report accidents. This is important because the supervisor must initiate an insurance claim.

Exempt and nonexempt workers should report their injuries immediately because the employer needs to know that an accident occurred. The employer can create an accident report, and the victim can seek medical attention as soon as possible. Nonexempt employees start receiving benefits because their employer’s insurance plan covers their injuries. If an employee is exempt from receiving Workers’ Compensation coverage because they are a subcontractor or otherwise do not have an employee-employer relationship with the business, they may file suit against the parties responsible for the accident.

It is important to note that all those receiving Workers’ Compensation enter a no-fault system. This system does not allow employees to sue their employers. They may file suit only against third-party companies that may have played a part in the accident. Speaking to a Workers’ Compensation lawyer is a simpler way to manage the situation when employees are hurt, confused, and worried about supporting their families.

Whereas employers may create guidelines that require injured workers to report their accidents within a timeframe such as 24 hours, the state of New Jersey allows injured employees 90 days to report accidents. After that, injured workers may have issues recovering the compensation they deserve.

When the report is submitted, the insurance company may try to prove that the victim should not receive compensation. The insurance company may reach out for more information, but they often ask questions that are intended to confuse accident victims. Injured workers should speak to a lawyer about how to respond to the insurance company. Victims might also request assistance when reporting the accident. At times, the situation may make it difficult to report accidents or injuries and working with a lawyer ensures that the report is accurate, complete, and makes it into the right hands.

What can I Do to Ensure I Receive Workers’ Compensation Benefits?

Although the scene of a work accident might be a chaotic and terrible place to be, injured workers and their colleagues can take steps that will make it easier to recover compensation in the future. Anyone who is involved in a worker accident should receive medical attention as soon as possible. If that person is not able to see a doctor on their own, their colleagues should call 911 and wait for an ambulance to arrive.

Injured workers or their colleagues should try to take pictures or videos of the area where the accident occurred. This is important because the business will often clean up and go back to work as usual right after the accident. Even if the police arrive on the scene of, for example, a vehicle accident, there is no guarantee that a police report will include important details.

Anyone who was present during the accident should be asked to come forward and explain what they saw that day. Work accidents might include several other people who saw what occurred or understand how the accident occurred. For example, the victim may be injured when a forklift tips over, but someone else in the facility can state that the forklift has been malfunctioning, implicating the manufacturer.

When workers report their accidents, they do not need to offer too many details. An injured worker should merely let a supervisor know that an accident has occurred, and treatment is being sought. There is no need to give a supervisor information that might lead them to think the worker was not performing their job duties or acting inappropriately at the time of the accident.

What are Wage Loss Benefits?

Under the Workers’ Compensation Act, the employer is obligated to pay 70 percent of the employee’s average weekly wage while they are recovering. In the event that a work-related injury keeps them from working for seven days or more, benefits begin. These benefits pay for medical treatment immediately, but victims must remain out of work for those seven days without an approval to go back to work. Some accidents are minor and require very little treatment, meaning that the victim can use sick days, have their medical bills paid, and return to work.

Wage loss benefits are managed by state law and not employers. This amount is subject to a statewide maximum benefit amount per week, which is established on an annual basis. In New Jersey, benefits cannot be more than 75 percent of the statewide average. Additionally, these benefits cannot be less than 20 percent of the statewide average. The state publishes these charts online, and it is easy for workers to find the amount that they would make if they reached that year’s maximum allowable wage.

Wage loss benefits break down into several categories, and it is important that victims know what type of compensation they are receiving based on their injuries. Because levels of compensation can change, workers should apprise themselves of their rights or speak to a lawyer who can better explain their options in these circumstances.

What is Temporary Disability?Mount Laurel Workers’ Compensation Lawyers

Temporary disability is a payment offered to injured employees while they are recovering. This is intended to help victims pay their bills and recover at home instead of returning to work. These benefits are offered until the victim is cleared to return to work by the doctor who was chosen by the employer. Workers cannot receive this clearance until they submit to a full examination and the doctor believes they can work again.

Victims who reach their maximum medical improvement (MMI) may find that they require permanent benefits because they cannot return to work. In other cases, these benefits include special losses because the worker can train in another field or may be partially disabled.

What is a Specific Loss Benefit?

Specific loss benefits are more comprehensive than partial disability by providing victims with benefits specific to their injuries. For example, an injured employee may have suffered an amputation or the loss of use of a limb or extremity. They may have lost their hearing or vision, or they might have suffered from disfigurement or scarring that makes it difficult to maintain gainful employment.

The chart published by the state is used to determine how much injured workers will receive, as the victim will receive a percentage of the maximum benefit allowable. For example, someone who loses 75 percent of their mobility in their arm can receive 75 percent of the maximum award allowed under the law. In New Jersey, the maximum benefit is a total of 600 weeks of pay based on 70 percent of the worker’s average weekly wage. Therefore, someone who is determined to have 75 percent disability in their arm will receive 450 weeks of coverage as a lump sum.

When workers have so many injuries that they are, in effect, totally disabled, they may receive permanent disability benefits.

What is a Permanent Disability Award?

After injured employees have completed medical care for their injuries and there is evidence of a permanent impairment to a part of the body, they may be entitled to an award for permanent disability. Permanent disability can continue in perpetuity if the worker cannot obtain gainful employment and cannot work again.

Victims who are partially disabled may receive a specific loss payment and receive permanent disability benefits because they cannot work to support their families. When the worker can retrain in a new field, they may recover a portion of their earning capacity. The worker, however, rarely makes as much money as they did before the accident. Permanent disability benefits in these cases pay for the difference between the worker’s former and current earnings.

Are Death Benefits Available?

Death benefits are available under Workers’ Compensation law, and families of victims may reach out to the employer and insurance company to request these benefits. Death benefits start with $3500, which helps pay for burial and final expenses.

The worker’s dependents receive 70 percent of the deceased worker’s weekly wages after the accident. The spouse and children are common dependents, and the spouse receives these benefits in perpetuity, whereas children receive benefits until they turn 18. If the child is a full-time college student, they receive benefits until they are 23. If the victim and their spouse cared for a disabled child, that child may be entitled to additional benefits.

Other dependents might include parents, grandparents, aunts or uncles, and disabled adult siblings. A hearing allows a judge to hear arguments from both sides to determine who is dependent on the victim.

When Do Disability Payments Stop?Mount Laurel Workers’ Compensation Lawyers

When workers recover and receive clearance to go back to work, their benefits stop. Wage loss benefits stop because the victim is working again, and their medical benefits stop only when the attending doctor has no more treatment to order. If the victim must take medications over a long period, the insurance plan will pay for medication or some type of therapy while the other major medical bills are already paid.

When the victim lingers for some time without recovering fully, they may be subjected to a medical examination to determine their level of disability. The medical examination will be conducted by a doctor chosen by the insurance provider, hoping to prove that the worker can go back to work, and payments may stop. Because insurance companies are trying to save money, victims must prepare for these examinations by bringing all their medical documents, being forthcoming about their condition, and allowing their current quality of life to speak for itself.

These examinations generally occur after the victim receives temporary benefits for 450 weeks. At this time, the insurance company can convert the benefits to permanent benefits, settle with the victim, or offer payment through a specific loss settlement.

Can I Settle with the Insurance Carrier?

Injured employees can settle with the insurance company through what is known as a Section 20 or Section 22 settlement. Under Section 20 of the Workers’ Compensation Act, workers and the insurance company may come to an agreement on a lump-sum payment instead of making payments every month, potentially for decades after the accident.

A Section 20 settlement includes a few stipulations:

  • The employer does not admit any liability.
  • The case cannot be reviewed in the future.
  • A judge must approve the settlement after both the employer and employee sign off.
  • There must be a problem with how the accident occurred, the jurisdiction of the case, or the true nature of the worker’s injuries.

A Section 20 settlement helps close the case quickly, and the employer can move on while the victim receives compensation. However, victims cannot come back with new evidence in the future to receive more compensation.

A Section 22 settlement is slightly different. In this situation, the victim receives a lump-sum settlement, and both parties must sign off on the settlement, but the settlement includes slightly different stipulations, such as the following:

  • The case can be reopened in the next two years if more information comes to light.
  • If the worker is reinjured in exactly the same way, the employer gets a credit for what it has already paid.

Because these settlements are slightly different, lawyers will work with their clients to better explain their options for compensation. For example, a lawyer may argue for a Section 22 settlement because their client needs compensation right now. While the lawyer completes a full investigation, they may uncover more information that allows them to reopen the case. If the lawyer believes that closing the case is the best option for their client, they may petition for a Section 20 settlement.

Can I Sue Because I Did Not Receive Workers’ Compensation?Mount Laurel Workers’ Compensation Lawyers

Workers are not allowed to sue their employers under Workers’ Compensation law. There are rare exceptions, and it is wise to discuss those exceptions with a lawyer. For example, the court must find that the employer was deliberate and malicious in its actions and was certain that the worker would be injured. Anything short of that does not allow for a lawsuit against the employer.

The insurance company takes the liability from the employer because it is handling the case and paying claims. The insurance company might deny the worker benefits and make it more difficult for them to recover the compensation they deserve. When that is the case, the worker may sue the insurance company for wrongly denying benefits, stopping payment, or otherwise mischaracterizing the accident. Lawsuits such as these often result in Section 20 or 22 settlements.

If the worker was injured due to the negligence of a third party, a lawyer can file suit to recover damages. Third parties in these lawsuits can include the following:

  • Part or tool manufacturers
  • Construction companies
  • Vehicle manufacturers
  • Malicious colleagues who caused the accident

Because work injuries can occur in so many ways, workers might find that a third party did not install a gas line properly or toxic substances were not stored properly. Any small mistake by another business is compensable under the law, and it should be investigated by the victim’s lawyer as soon as possible.

When Should I Hire a Workers’ Compensation Lawyer?Mount Laurel Workers’ Compensation Lawyers

Injured workers have the right to hire representation at any time. The injury may have just occurred, but the worker may believe that they require legal representation because of the way their employer approaches accidents and/or insurance. A lawyer may need to get involved if a claim is never filed, and a lawyer can file suit against anyone else who is responsible for the accident.

When a lawyer takes the case, they investigate every aspect of the accident to ensure their client is receiving the coverage and compensation they deserve. Lawyers can negotiate settlements, or they can take the claim to court when required.

Victims who do not qualify for Workers’ Compensation should hire a lawyer who can file suit against their employer and anyone else who factored into the accident. The lawyer also helps victims when they encounter other legal issues during the recovery process.

Injured workers should send all the letters they receive to their lawyer, and phone calls should be forwarded to the lawyer’s office. Victims should focus on recovering while their lawyer shields them from all the machinations of the legal system.

Mount Laurel Workers’ Compensation Lawyers at Kotlar, Hernandez & Cohen, LLC Advocate for Injured Workers

If you were injured in a work-related accident, you are likely eligible for Workers’ Compensation coverage. When you do not receive coverage or you are fighting for your rights, reach out to the Mount Laurel Workers’ Compensation lawyers at Kotlar, Hernandez & Cohen, LLC for help building a case and recovering compensation. Call us at 856-751-7676 or contact us online for a free consultation. Located in Mount Laurel, Cherry Hill, Trenton, and Vineland, New Jersey; as well as Trevose, Pennsylvania, we serve clients throughout New Jersey and Pennsylvania.

856-751-7676 16000 Commerce Parkway
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