How Workers' Compensation Works in New Jersey

Each stage has its own rules and its own ways to go wrong. Here is how the process generally works, in order.

What should you do first after a work injury in New Jersey?

Report the injury to your employer as soon as you can, in writing if possible. Tell a supervisor or whoever your workplace designates what happened, when, where, and which parts of your body are hurt. Do this even if the injury seems minor. A sore back can turn out to be a herniated disc, and the report made on day one is what ties it to work.

The notice rules in N.J.S.A. 34:15-17 and 34:15-18 reward speed. Notice within 14 days takes the issue off the table. Later notice gives the employer room to argue that the delay prejudiced it, and if the employer had neither notice nor knowledge of the injury within 90 days, compensation is generally barred. Those are outer limits, not a schedule to aim for.

A few other things matter early:

• Tell every doctor exactly how it happened. The first medical records get read closely. If an emergency room note says "back pain, unknown cause," expect a dispute later.
• Keep copies. Accident reports, doctor's notes, work restrictions, letters from the carrier, and a simple diary of symptoms and missed days.
• Don't let anyone route it through your health insurance. A work injury belongs on the employer's workers' compensation policy.

Are you covered?

Most New Jersey employees are covered from their first day, whether full time or part time. Employers must carry workers' compensation insurance or be approved to self-insure. If an employer has no coverage, the claim doesn't disappear; the state's Uninsured Employers Fund may become involved. Being called an "independent contractor" does not settle the question either, because the Division looks at how the work actually functions. Federal employees, longshore workers, and railroad workers fall under separate federal laws.

Coverage generally begins when you arrive at your employer's place of employment, so an ordinary commute usually isn't covered. There are exceptions, such as travel that is itself part of the job, and injuries in areas the employer controls.

Who pays for treatment, and who picks the doctor?

The employer's insurance carrier pays for authorized treatment of a work injury, with no copays or deductibles. In return, the carrier, not you, generally chooses the treating doctors. Emergency care is the main exception: get the care you need, then report it.

That control is behind many disputes. Carriers sometimes delay an MRI, decline a recommended surgery, or push a release back to work that the worker doesn't think is right. The remedy is a Motion for Medical and/or Temporary Disability Benefits, which the Division handles on an expedited basis. Our page on medical treatment and authorized doctors explains how those motions work and what your options are if you want a second opinion.

What do you get paid while you're out of work?

If an authorized doctor keeps you out of work, or restricts you to duties your employer can't accommodate, you are generally entitled to temporary disability benefits. The rate is 70 percent of your average weekly wage, subject to a statewide maximum and minimum that change each year. Nothing is paid for the first seven days unless the disability lasts longer than seven days, in which case benefits are paid back to the first day.

Temporary disability ends when you return to work, when the authorized doctor finds you've reached maximum medical improvement, or at the statute's 400-week cap. Disputes over how the wage was calculated, light-duty offers, and early cutoffs are common. See temporary disability benefits for how those play out.

What happens when treatment ends?

At some point the authorized doctor will say you have reached maximum medical improvement, or MMI. That doesn't mean you are healed. It means further treatment isn't expected to make you meaningfully better. Active treatment stops and, if you haven't already gone back, you are typically released to return to work.

This is where the permanency part of the case begins. If the injury left a lasting limitation, you may be entitled to permanent partial disability benefits even if you are back at your old job. In New Jersey, permanency has to rest on objective medical evidence that the injury restricts how your body functions, and it is measured as a percentage: either of a specific body part under the statutory schedule, or of the body as a whole.

Usually two doctors evaluate you, one retained by your lawyer and one by the carrier, and their estimates are often far apart. The case then becomes a negotiation informed by the medical findings, your account of how the injury affects your work and daily life, and the judge's assessment. If you can no longer work in any capacity, the claim may be for permanent total disability instead. Our page on permanent disability covers how percentages work and what drives a case's value.

How does a claim move through the Division of Workers' Compensation?

A carrier can pay benefits voluntarily without anything being filed. The formal case begins when you, usually through a lawyer, file a claim petition with the Division of Workers' Compensation, which is part of the New Jersey Department of Labor and Workforce Development. The carrier files an answer, and the case is assigned to a Judge of Compensation at one of the Division's regional offices.

Cases are then listed for periodic hearings. Many are short conferences where the lawyers report on treatment, exchange medical reports, and negotiate. When the parties can't agree, the judge hears testimony from you, from witnesses, and from the doctors, and decides. There is no jury. A party who believes the judge got the law wrong can appeal to the Appellate Division of the Superior Court.

Most cases end in one of two ways:

• Order Approving Settlement. An agreed percentage of permanent disability, approved by the judge. You keep the right to apply to reopen the case, generally within two years of the last payment, if your condition worsens or you need more treatment.
• Section 20 settlement. A lump sum that closes the case for good, approved only if the judge finds it fair. It is often used when there is a genuine dispute about whether the injury is covered at all.

Neither is automatically the right choice. It depends on your medical future, the strength of the evidence, and how other benefits interact with the money. Our page on settlements compares the two in detail. If the carrier has denied your claim outright, this same process is how a judge decides it.

Can you sue anyone, or be fired for filing?

Workers' compensation is generally the exclusive remedy against your employer. You can't sue your employer for pain and suffering, even if it was careless, except in the narrow case of an "intentional wrong," which New Jersey courts have limited to conduct the employer knew was substantially certain to cause injury or death.

You can often sue someone else, though. If a negligent driver, an equipment manufacturer, a property owner, or another contractor on a job site caused your injury, a third-party claim may run alongside your comp case. It can recover damages that comp never pays, including pain and suffering. The comp carrier is entitled to be repaid from that recovery under N.J.S.A. 34:15-40, which is why the two cases have to be coordinated.

Employers may not fire or discriminate against a worker for claiming, or trying to claim, workers' compensation (N.J.S.A. 34:15-39.1). If that has happened to you, there are remedies through the Division and, in some cases, in court; see our workers' compensation overview. Workers' comp does not hold your job open, however. Whether your position is protected while you are out depends on other laws, such as the federal Family and Medical Leave Act if you are eligible, and New Jersey's Law Against Discrimination when an injury becomes a disability that calls for reasonable accommodation.

What does a lawyer cost, and what are the deadlines?

There is no upfront fee in a New Jersey workers' compensation case. The Judge of Compensation sets the attorney's fee at the end of the case, and N.J.S.A. 34:15-64 caps it at 20 percent of the award. The judge often divides the fee between the carrier and the worker.

The key deadlines, in short:

• Notice to your employer: as soon as possible. Fourteen days is the safe target; 90 days is the general outer limit.
• Claim petition: generally within two years of the accident, or two years after the last payment of compensation.
• Occupational disease: generally within two years after you knew the nature of the disability and its relation to your work.
• Reopening an Order Approving Settlement: generally within two years of the last payment.

A related third-party lawsuit runs on its own, different clock. Our page on workers' comp deadlines explains how each one is measured and where workers get caught out.

Talking to a lawyer about your situation

Plenty of claims go smoothly: the carrier accepts the injury, treatment is authorized, and checks arrive on time. A lawyer matters most when that stops being true, when a claim is denied, treatment stalls, benefits are cut off, or you are asked to agree to a permanency figure without knowing whether it is fair. It also matters before you sign anything that closes a case.

Gray Law Group is in Jefferson, Morris County, and represents injured workers in Morris, Sussex, Warren and Passaic counties and throughout northern New Jersey. If you would like to talk through where your claim stands, bring your accident report, any letters from the carrier, and your medical paperwork to a consultation.