Like most other states, New Jersey has a workers’ compensation system that provides benefits to employees who are injured at work. This system is generally an injured worker’s only recourse for getting compensation from an employer. (There are, however, a few exceptions. To learn more, see Workplace Injury: When You Can Sue Outside of Workers’ Compensation.) Below we explain how to start your workers’ compensation claim.
All private employers in New Jersey must have workers’ compensation coverage for their employees. Many employers fulfill this obligation by purchasing a policy from an insurance company. However, large and financially stable companies may also get the state’s approval to self-insure.
Workers’ compensation covers injuries that happen in the course of employment. Most injuries that occur at work, or while the employee is performing work-related tasks, are covered. For example, if you hurt your back carrying boxes at work or slip and fall while running a work errand off-site, your injury will likely be covered.
Workers’ comp is a no-fault system, meaning that the employee can usually collect compensation regardless of who was at fault for the injury. However, certain injuries—such as those caused by the employee’s participation in horseplay or practical jokes—are not covered.
The first step to making a workers’ comp claim is to report your injury to your employer. You have 14 days to give your employer notice. However, it’s best to give notice as soon as possible. Your employer and its insurance company might be skeptical of your claim if you wait more than a day or two to report it without good reason. If you fail to give notice within 90 days of your injury, you might lose your right to collect benefits.
Workers’ compensation should pay for all necessary medical treatment related to your work injury. If you need emergency treatment, you can go to the nearest emergency room or urgent care. Before getting any non-emergency treatment, though, you will need to check with your employer. In New Jersey, your employer is allowed to choose your treating doctor.
Once you give your employer notice of your injury, it should notify its insurance company. The insurance company will file a report of injury with the New Jersey Department of Labor and Workforce Development (DLWD). The insurance company will then review your claim and decide whether to accept it. If your claim is accepted, the insurance company will cover your medical treatment and begin paying wage loss benefits. If your claim is denied, you can challenge the decision through the New Jersey DLWD. (For common grounds for a denial, see Denied Workers’ Compensation Claims.)
The DLWD offers two options for resolving your dispute with the insurance company. The first option is to have an informal hearing before a workers’ comp judge, who will try to help you and the insurance company reach a settlement agreement. The second option is to go straight to a formal workers’ compensation hearing, where the judge will review evidence and make a decision in your case. Either way, you must file a claim petition with the DLWD within two years of the date of your injury or the date of last payment by the insurance company, whichever is later.
Most workers can handle the initial workers’ comp claim process on their own. If the insurance company readily accepts your claim and pays your benefits, you probably will not need to hire a lawyer. However, if the insurance company denies your claim or disputes the amount of benefits you are entitled to, you should consider hiring a lawyer. This is especially true if you need to attend a workers’ comp hearing, which follow complex procedural rules. For more information, see Should I Hire a Workers’ Comp Attorney or Can I Handle My Own Case?