This page provides answers to the following questions:
- I had an accident at work. How do I file a workers compensation claim in my state?
- Should my employer have workers compensation insurance? How do I know I am covered?
- What are the conditions that enable me or prevent me from claiming benefits under my state's law?
- What benefits might I be eligible to receive?
- How much time do I have to file my claim? What are the stages of the claim process? What should I expect?
- If I'm not happy with the determination, how do I appeal?
1. I had an accident at work. How do I file a workers compensation claim in my state?
If you are injured during the course of your employment, notify your employer or supervisor as soon as possible. This may be in the form of a written or verbal notice. If you are in need of medical treatment, you should make a request to your employer as soon as possible.
Once your employer receives notice of your injury, the employer should notify the employer's insurance provider. This step is essential in the claims process; the insurance provider is expected to file a First Report of Injury with the state in regards to the events surrounding your injury.
The employer's insurance provider must evaluate your claim and determine whether it will accept liability. The insurance provider is expected to follow up and maintain information regarding the status of the claim, with regards to payment and your condition while awarding you benefits.
2. Should my employer have workers compensation insurance? How do I know if I am covered?
New Jersey state law expects a majority of employers to provide coverage for workers' compensation benefits by either purchasing an insurance policy or becoming self-insured.
3. What are the conditions that enable me or prevent me from claiming benefits under my state's law?
By filing a workers' compensation claim that leads to you receiving benefits, you forfeit the opportunity to bring any potential civil actions against your employer for damages like pain or suffering. Civil action will be permitted in the event your employer commits intentional acts.
Your employer should place information regarding what kind of insurance coverage the employer partakes in somewhere readily visible at your place of work.
4. What benefits might I be eligible to receive?
An injured employee is entitled to benefits regardless of who was at fault. Depending on the circumstance of your claim, you may be entitled to one or more of the following benefits:
- Medical Benefits: Payments and compensation made to you relating to all necessary and reasonable medical treatment and care for your work related injury.
- Temporary Total Benefits: You may be entitled to this benefit if your injury disables you for more than seven days. Temporary total benefits provide you with payments for lost earnings as a result of the disability. You should expect to receive approximately seventy percent (70%) of your average weekly wages. In the event you return to work or you have reached maximum medical improvement, as deemed by your doctor, these benefits will be discontinued.
- Permanent Partial Benefits: Weekly payments made to you for the loss of function or disability to a body part. The state has pre-calculated the amounts due for various body parts.
- Permanent Total Benefits: In the event that your work-related injury or illness prevents you from returning to work in your field or seeking any form of employment, you may be entitled to receive permanent total benefits. These benefits are wage replacement benefits calculated and paid to you as approximately seventy percent (70%) of your average weekly wage. If your injury or illness qualifies you for Permanent Total Disability, this mean you have either lost two major members or a combination of members of the body (eyes, arms, hands, legs, or feet).
- Death Benefits: If your work related injury or illness results in your death, your dependents may be entitled to these benefits. Death benefits are essentially wage replacement, also calculated at roughly seventy percent (70%) of your average weekly wages. The dependent may be a surviving spouse and/or children. Your employer's insurance provider may also compensate your survivors with $3,500 for funeral expenses.
5. How much time do I have to file my claim? What are the stages of the claims process? What should I expect?
If a dispute arises between you and your employer and/or employer's insurance provider, you may file a formal claim Petition or an Application for a Formal Hearing with the Division of Workers' Compensation. You have two (2) years from the date of your injury to file a petition with the division. When you file a claim, your case is assigned to a judge. Informal claims are often recommended as an alternative to formal litigation, which can be costly and lengthy in time.
You may file an informal petition and a formal petition. After filing a formal petition, a hearing is scheduled before a judge of compensation within six months. The goal is to arrive at a mutual settlement at some point during the pre-trial stage; however, if a settlement cannot be reached, a trial takes place. At the end of the trial, the judge of compensation makes a determination based on the case presented.
6. If I am not happy with the determination, how do I appeal?
If you are unhappy with the determination made at the formal claim hearing, you may appeal the decision to the appellate division of the Superior Court of New Jersey.