1. Question: What benefits are available in a Workers Comp case?

Answer:
A) Temporary Disability.
B) Reasonable and Necessary Medical Care & Attention.
C) Permanent Functional Disability Benefits on a Partial Basis.

A) Temporary Disability

Under the compensation law of the State of New Jersey, as of 2007, the maximum amount of temporary disability that you can receive is $711.00. This is calculated by taking 70% of your gross average weekly wage. If 70% of your gross wage is less than $711.00 then that 70% figure is your temporary disability amount. If the 70% figure of your gross weekly average wage is more than $711.00 the maximum temporary amount that you will receive is $711.00. You will receive that as long as you are under the active medical care and attention of the authorized treating doctor, and the doctor then determines that you are temporarily totally disabled.

B) Reasonable and Necessary Medical Care & Attention
Medical care will be given to you pursuant to statute, by the insurance company, through their authorized treating physician. The doctor is paid for by the company and he works essentially for the company; however, he has an obligation to treat you. The obligation is between a physician and a patient.

C) Permanent Functional Disability Benefits - Partial Basis
Permanent functional disability is that which the Court assigns to you after reviewing all of the documents in the matter; hearing testimony concerning your condition; and hearing from the doctors, if necessary. This is more fully described in the initial letter that we have sent to you.


2. Question: If I am successful, what will I receive?

Answer: Compensation does not pay a lump sum. There is no jury trial. You receive the statutory benefits for the percentage of disability of whole man impairment or by the limb, that the Court finds you are partially disabled. The schedule of benefits begins at 0 and terminates at 100%. Generally, it is divided by the hand, arm, fingers, leg, foot, hearing (deafness), eyes, and whole man impairment. If you have an injury to any other portion of your body other than the specific portions listed, then it is determined by whole man impairment. Once the Judge finds a percentage of disability, that percentage of disability is equivalent to the weeks as determined by the Statute of Benefits. Each week is paid at the rate authorized by the statute for the year of the accident. If the accident happened in 2006, the rate per week begins at $184.00 per week, and after 180 weeks it begins to increase dramatically. The lump sum, if any, will be the number of weeks that the Court awards from the last period of temporary disability to the date of the Judgment, less whatever assessments the Court makes.


3. Question: Am I guaranteed to get temporary disability, medical benefits, and permanent functional disability?

Answer: No. In order to get temporary disability benefits, you must be temporarily totally disabled, and that decision is not yours to make, but that of the authorized treating doctor. In order to get medical attention, that medical attention must be curative in nature which is designed to cure the underlying problem, as opposed to palliative in nature which is designed only to allow you to live with the pain. As an example, in simple back cases, the insurance company will not approve a chiropractor because the treatment is designed to remove the pain and not cure the underlying condition. You only get permanent functional partial disability if the Court finds that you meet the standards and criteria for permanent functional partial disability.

Currently, the standards and criteria for permanent functional partial disability require the following:

1. Proof of disability by demonstrative objective medical evidence of loss of function of the body, its members or organs. This does not mean subjective evidence such as complaints of pain. It requires diagnostic testing such as X-rays, MRI, EMG, myelogram, etc. Generally, if there is a soft tissue claim, the Judge will not award permanent partial disability. The Court would then dismiss the workers' compensation petition without any award or reimbursement of costs to you.

2. Proof that claimant has suffered a lessening to a material degree of his/her working ability or that the disability is serious enough that it significantly interferes with other aspects of his/her life. This means even if you have some objective medical evidence of an injury but return to the same job without any decrease in ability to do the job, it is not compensable unless it interferes with your non-work activities. Generally, under these standards, soft tissue injuries such as muscle sprains or strains will not be considered eligible for permanent functional disability compensation.


4. Question: If the authorized treating doctor releases me to go back to work and I cannot do the job or the employer will not allow me to come back with restrictions, what happens?

Answer: If the authorized doctor tells you to go back to work, you must attempt to go back to work. If your work aggravates your condition, you have a right to ask your employer for additional medical care and attention or, in the alternative, file a claim for the aggravation of the underlying condition. In any event, unless you can demonstrate that you are temporarily totally disabled, you cannot continue with temporary disability. Report back to work and advise your supervisor or foreman if your condition stops you from doing any type of work in the nature of your employment. In the event that you are terminated, you may have a right to assert a claim under The Americans with Disabilities Act of 1990. To do so you must file a Complaint with the U.S. Equal Employment Opportunity Commission. The toll free number for the office near you is: (800) 800-3302. Generally, that claim must be filed within six months of the act of discrimination against you.


5. Question: What happens to my case after I go back to work?

Answer: As soon as you go back to work, please call us. We will then schedule permanency evaluations by a doctor who is going to examine you, not treat you, and send me a written report as to the permanent partial functional disability that you sustain as a result of the accident. Generally, the report fee is $400.00. We will send you a letter asking you to contact the doctor of our choice. We will send him a copy of the letter and enclose whatever medical or history we feel is relevant and make arrangements to come in at a convenient time. It is your obligation to set up the exam. No examination; no trial. No trial; no money. If you have problems, please contact us and we will attempt to straighten them out. Generally, the doctors may require a portion of their fee to be paid at the time of the examination. This is your responsibility.


6. Question: How long will it take for my case to come to Court?

Answer: Each day the Court lists approximately 70 cases. The first listing is a pre-trial listing and it enables the Court to conference the cases between the two lawyers and the judge. The judge only reaches approximately 3 or 4 cases for pre-trial conference. Therefore, it will take several listings before your case is actually called for conference and reached. If a settlement offer is made, this is communicated to you and a decision is made by you as to whether you wish to accept the settlement. We will give you our opinion as to whether or not the settlement offer is a good one or a bad one.

If an offer of settlement is not made, or the settlement is rejected, then the case is pre-tried and placed on the trial list. It may take between 18 to 24 months from the date of the filing of your claim to the date that your case is reached for trial.


7. Question: What will my lawyer's fee be?

Answer: The workers' compensation statute provides that a lawyer can receive a fee up to 20% of all of those benefits which the lawyer's efforts have obtained for you. If the Judge finds that your case is compensable, then 60% of that fee will be paid by the insurance company, and only 40% of the statutory counsel fee will be deducted from your award. If the Judge finds that your case is not compensable, then no fees are earned by your attorney.

In some cases, where the compensability of an injury or the employer's liability is at issue, the employer will offer you a lump sum to dismiss your claim petition. This is referred to as a Section 20. In a Section 20 Dismissal you are responsible for paying the entire portion of the attorney fee by yourself. The employer will not be responsible for any of the attorney's fees or any of the other costs of the trial. If you accept the Section 20 Dismissal, that means that you are giving up all of your rights against the employer and the insurance company including rights for re-opener, rights for additional medical treatment, temporary disability, and permanency.


8. Question: When the Judge makes his decision - is this the end of the case?

Answer: No. Assuming that the Court finds that your condition is as a direct result of an injury, which arose out of and in the course of your employment, you will have two years from the date on which you received the last payment under the Judge's Decision to reopen your case. You may only reopen your case if your permanent disability has substantially increased within those two years, or if you are in need of further curative medical treatment which is directly related to the work injury. In either such event you must contact an attorney so that they may file the appropriate pleadings before the expiration of two years from the date of the Judgment, or the last benefit received by you from the carrier.


9. Question: When will I receive my checks?

Answer: After the entry of a Judgment, Order Approving Settlement or Section 20 Dismissal, the carrier is obliged to send you the drafts in compliance with the Orders of the Court. Each carrier is different. The law requires them to pay upon their processing of the Judgment but no later than twelve weeks from its entry. Some carriers will send the drafts directly to you; others will send them to our office directly on your behalf. We cannot control that.


10. Question: How long do I have to wait until I get temporary disability after I report the injury and the doctor says that I am not able to work?

Answer: It depends on the carrier. Some carriers take up to four weeks to process temporary disability checks. If you have a problem, please call us or you may call the Dept. of Insurance, of the State of N.J., in their Trenton Office.