Workers’ compensation is a “no-fault” insurance employers are required to carry to protect their employees in the event they’re injured on the job or they develop an occupation-related illness. It covers medical costs, wages lost, permanent partial or permanent total disability compensation and death benefits to dependents if the employee sustains a job-related death.
Workers’ comp also disallows an employee from suing their employer for pain and suffering and other damages, unless there has been an intentional wrong.
How does workers’ comp work?
The timeline with a workers’ comp case begins typically with the injury which must be reported promptly. Medical support is rendered, and the accident investigated and documented by the employer. Then the employer files a claim with the insurer.
If the claim is approved, benefits are processed. If it’s denied, the employee can appeal.
Claim denial is one issue among others that might have to be litigated. Other issues include the kind of medical treatment needed and the amount of temporary benefits and permanency benefits being sought.
If the parties in dispute cannot arrive at a settlement, the Division of Workers’ Compensation provides a number of forums within which issues can be mediated or adjudicated.
A worker can file an Application for an Informal Hearing to do mediation, that is, an informal hearing before a judge of compensation which is less involved and less costly than a full tilt litigation. The judge’s recommendations aren’t binding, and the employee doesn’t forfeit the right to pursue a formal hearing if an agreement isn’t reached, but the clock is ticking.
Two-year statute of limitations
Filing a formal claim petition – going to trial, doing the Workers’ Comp Hearing – must be done within two years of either the date of injury or the last provision of benefits. In New Jersey, an employee may represent themselves, that is, go pro se, but if a case has gone this far without resolution, representation by counsel is recommended. A worker is one person against powerful entities who are incentivized to reduce costs. The law is complicated, and trials are highly adversarial. You do the math.