New Jerseys Workers Compensation Basics

In New Jersey, every employer who has any employees is required to carry workers compensation insurance. New Jerseys Workers Compensation Act requires coverage for corporate officers. Employees of sole proprietors (other than the principal owner) and employees of partnerships (except for the partners) must have workers compensation coverage. Employers of domestic labors and farm workers must provide workers’ compensation coverage.

New Jersey has a very liberal definition of employee. While the workers compensation statute does not require an employer to provide work comp insurance for independent contractors, many individual independent contractors who would not be considered employees in other states will be considered an employee in New Jersey. If the employer retains the right to determine what should be done and how it will be done, or if the work that is done by the independent contractor is an integral part of the activities of the business, New Jersey will consider the individual an employee.

To obtain workers compensation coverage in New Jersey, the employer has two options which are:

1. purchasing a workers compensation insurance policy from an insurance company authorized to do business in New Jersey

2. obtaining approval from the New Jersey Commissioner of the Department of Banking and Insurance to act as an independent self-insurer, along with the posting of security if requested

Governmental agencies in New Jersey are required to carry workers compensation insurance, but are not required to purchase it from an authorized insurance company or to be self-insured. They can participate in a governmental insurance pool, or they can maintain a separate appropriation for workers compensation.

The employee must report the injury to the employer within 90 days of the injury. The notice can be given the employees supervisor, personnel department or anyone in a position of authority for the employer. The employer upon learning of the accident is required to report the workers compensation claim to the insurer immediately. The insurer is required to file the First Report of Injury form with the New Jersey Division of Workers Compensation within 21 days of the claim being reported to them.

The employer selects the medical provider. If the employer refuses to provide medical treatment, the employee is free to select the medical provider. In an emergency situation, the employee may be treated at any emergency care facility or the emergency room of a hospital without the employers approval. After the initial emergency care, the employee must treat with the employer’s chosen medical provider. All reasonable and necessary medical treatment including prescriptions and hospitalization are covered under New Jersey’s workers compensation statutes for as long as the employee needs medical care.

The temporary total disability (TTD) benefits are calculated as seventy percent of the employees average weekly wage, not to exceed the statutory maximum rate or to fall below the statutory minimum rate. There is no annual cost of living adjustment for accidents after January 1, 1980. The maximum amount and minimum amount of TTD benefits is changed annually by the Commissioner of Labor and Workforce Development. The maximum TTD benefits per week for injuries in 2011 are $792.00 per week. The state minimum weekly benefit for 2011 is $211.00.

The first 7 days of disability (the waiting period) is not paid to the injured employee unless the employee is disabled for more than 7 days. TTD benefits can be paid until the employee returns to work, or reaches maximum medical improvement, or for a maximum of 400 weeks.

New Jersey employees are paid permanent partial disability (PPD) benefits for any permanent loss of body function suffered as the result of an on-the-job injury. Once the employee has reached “permanent and stationary” (maximum medical improvement), the employee is paid PPD weekly and PPD is paid after TTD benefits have ended. In 2011, the weekly maximum for PPD is $792 and the weekly minimum is $35. The maximum amount of time for PPD is 600 weeks.

New Jersey uses a Schedule of Disabilities for injuries for arms, legs, hands, feet, fingers, toes, vision and hearing. The loss of an arm is worth 330 weeks of indemnity benefits. The number of weeks of indemnity benefits decreases down to the loss of a small toe being worth 15 weeks of indemnity benefits (with a week calculated the same as TTD). For example, if the treating doctor gives the employee a 15% disability rating to the arm, and the employee’s TTD rate was $400 per week, the employee will receive $19,800 ($400 X 330 X 15%). When a member is amputated, an additional 30% is added to the schedule amount. New Jersey does not have any provisions for compensation for disfigurement.

Injuries to the back, heart and lungs are not scheduled injuries. When a New Jersey employee has a non-scheduled injury, they will continue to collect TTD benefits, up to 600 weeks or until they are able to return to work.

New Jersey permits the employee to collect 450 weeks of indemnity benefits when the employee can not return to any type of gainful employment. Benefits can be continued conditionally beyond the 450 weeks provided the employee has accepted the prescribed rehabilitation and can show that she/he remains totally disabled. The permanent total disability benefits are paid weekly, based upon 70% of the employees average weekly wage, not to exceed the state maximum ($792 for 2011) or to fall below the state minimum ($211 for 2011).

The burial expenses in New Jersey are covered for a work-related death up to $3,500. If there is one beneficiary, the death benefits equal 50% of the deceased employee’s average weekly wage. For each additional beneficiary, an additional 5% is added up a maximum of 70%, but not to exceed the maximum weekly benefit rate. The death benefits are payable to a surviving spouse, or spouse and children, or any other family member who can prove dependency upon the deceased employee. A judge for the Department of Labor and Workforce Development hold a hearing to determine how the death benefits are divided by the dependents. Children are defined as being under the age of 18, or under the age of 23 if enrolled full time in an accredited educational institution. A surviving spouse receives the death benefit for life until the surviving spouse remarries.

New Jersey employees who are receiving permanent total disability benefits are referred to the New Jersey Division of Vocational Rehabilitation at the 450 week mark. Permanent total disability benefits may be stopped unless the employee has participated in physical or educational retraining as required by the Division of Vocational Rehabilitation. Permanent total disability benefits continue if the Division of Vocational Rehabilitation certifies the employee is still totally disabled.

NOTE: State laws change frequently. Nothing in this article is meant as legal guidance.

For legal advise on a particular states most current law, please consult with you legal adviser.

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Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact [email protected].