SOME FACTS ABOUT YOUR WORKERS COMPENSATION CASE
Once you have signed your Claim Petition there are several procedures which are started and activities that will occur. Some of these procedures and activities are required by the compensation law. Some are required by this office so that we may better obtain the best possible outcome for you. Each has been explained to you in the office, but I realize that you may want to review the same information during your free time. Please keep in mind that these are general answers for general common questions. If you have the need to have more specific information regarding your case, please call or write.
Questions are noted in the bold and underlined print. Click on the question and you will be taken to the question and its answer.
- How long do I have to file a compensation case?
- How does a compensation case get filed?
- How is it decided where a case is assigned?
- How will I know when my case is actually filed?
- Is there a fee or cost to be paid the State for filing my compensation case?
- What is the difference between an accident case and an occupational case?
- Can I have both an accident case and an occupational case?
- What is a contested compensation case?
- Must I speak to the employer (or insurance company employees) about matters related to my case or benefits?
- When should I call your office?
- What is the difference between a treating doctor and an examining doctor?
- Who is responsible for the doctor's bills?
- How many doctors must I see?
- When must I go to doctors for evaluation or examination?
- Why might I have to go to the same doctor more than one time?
- What happens if I miss a doctor's examination appointment?
- Who pays for me to go to the insurance company doctors?
- How fast will my case be finished?
- What information must I call your office to provide?
- Who can give me information about my case?
- What are interrogatories?
- Why must I answer interrogatories?
- What happens if I don't answer the interrogatories?
- When will I go to court?
- How can I be paid less than someone else for the same type of injury and the same award of disability?
- Why are some cases finished before others?
- How is the lawyer's fee decided?
- What is "Section 20"?
- Why must my spouse also be involved in any Section 20 settlement decision?
- When can I expect to get my check?
- Is my money taxable?
- Can I re-open my case?
- How do I re-open my case?
* The law generally provides that you have two (2) years from the last happening of a number of events.
* For accident cases, you have two years from the date of an accident, the payment of the last medical bill by the carrier or employer, or the last date of payment for temporary disability.
* For occupational cases, you have two years from the date that you were made aware of the disability and its relationship to your employment.
* A Claim Petition is filed with the Division of Workers Compensation in Trenton. The Division is part of the New Jersey Department of Labor.
* Cases are normally assigned by the Trenton office to the County where you live. There are occasions and circumstances where the case may be assigned to a different County. One situation could be where it is more convenient to you to have the matter listed in the County in which you work rather than the County where you live.
* This office sends you a copy of the Claim Petition and the cover letter which is sent to Trenton. This is for your information only. You do not need to send anything back to this office.
*Mistakes are occasionally made on the information in the Claim Petition. If there is any mistake in the information on the Claim Petition, please call and tell the compensation secretary. Not every mistake must be corrected by filing an Amended Claim Petition. Many mistakes are correctable when you go to court.
* There is no fee or cost charged by the State of New Jersey to file a Workers Compensation Claim Petition.
* An accident case is filed where there is a specific happening or event and a specific immediate physical result or injury.
* An occupational case is filed where there is a physical disability which results from gradual or repeated exposures associated with your employment.
* Yes. You may have a specific injury which resulted from a specific event. After return to work and being subjected to repeated exposures, whether repeated body movements or repeated exposures to dust or fumes, you may have increased the injury or disability you would have otherwise had.
* A contested compensation case occurs when the insurance company or employer denies the happening of the accident, denies the exposures exist, or denies that your injuries are related to your employment.
* If you have a contested compensation case, you may be able to receive state temporary disability benefits (TDB) provided that a compensation case is filed and you inform the State that your medical condition may possibly be related to your employment.
* You must speak to your employer or the insurance company adjuster only to give information regarding the fact that you have an injury related to your employment and the date when it occurred. I do not recommend any other conversations or statements occurring between you and the employer or insurance company regarding your compensation matter. All communications regarding your case should go through this office in order to best represent and protect you.
* Although your telephone calls are welcomed at any time to this office in order to obtain or provide information, you should be aware that most mornings require that the attorney be in court and out of the office. Telephone calls to ask about the status of your case can be made to and answered by the compensation secretary between 8:30 A.M. to 2:30 P.M.. Of course, messages left with her for my return regarding matters she cannot handle for you will be returned at the earliest available time.
* A treating doctor is a doctor who has provided medical treatment to you for a disability or injury, whether in the past or currently.
* An examining doctor is a doctor selected by either this office or the insurance company who will examine you for the purposes of rendering a report to be used in your compensation case. The examining doctor will provide an estimate of disability to be used in your case.
* In an admitted accident where the insurance company or employer has admitted responsibility for the injury and the accident, the bills are the responsibility of the employer/insurance company.
* The law states that it is the employer who has the right to select the treating doctors for compensation injuries. If the insurance company designates a doctor to treat you for your injury, any other doctors will not be authorized and their bills will be your responsibility. It is very important that you inform this office if there is any dispute regarding the treatment or the doctors treating you.
* Evaluating or examining doctors' fees for their reports are set by the compensation court at the time your case is heard. This office will normally advance monies for these examinations.
* You should expect to see two doctors for each type of disability noted on your Claim Petition. One doctor will be for your side of the case and one doctor will be for the employer's side of the case.
* As an example, an orthopedic, neurologic/neuropsychiatric claim will require four doctors' examinations. We try to have you examined by as many of our doctors at one location and time as possible so that your time is as minimally spent as possible.
* We normally schedule our doctors' appointments for you and will send you a letter with the doctor's name, address, and telephone number as well as the time and date of the appointment. You should call here to confirm that you have received the letter and will go. If there is any problem with the time or date, please call the doctor and make another appointment which is more convenient, and then inform this office of the new arrangements.
* We normally are sent a pre-scheduled time and date of appointment for the employers examining doctors. If you must make changes for those doctors, follow the procedure outlined in the paragraph above. Not all appointments will be able to be changed.
* One of the reasons for getting these additional reports is that there is case law which indicates a judge may not base an opinion upon medical testimony that is itself more than two years old.
* In the event that you miss one of our doctors' examinations appointments, we will attempt to reschedule that appointment. However, in the event that the doctor requires an advance payment for the missed appointment, you will be requested to pay that rescheduled fee.
* If you miss an insurance company/employer's doctor examination appointment, your case is subject to being dismissed by the court for your failure to cooperate.
* You should be aware that an appointment that is missed results in your case not being able to go forward and delays any completion of the matter.
* Generally, it is the Petitioner's responsibility to get to the insurance company doctors. There are exceptions, however, in situations where the doctors are out of state or are a lengthy distance from your home.
* Appointments cannot be scheduled with any doctors until all past medical information has been obtained and treatment for any current injury has been completed. Once scheduled, failure to attend doctors' examinations will further delay the case. If you are mailed interrogatories, and they are not answered by you and returned to this office, the insurance company/employer will normally wait to schedule its examinations actions. That will further delay your case.
* After all examinations are complete on both sides, this office then waits for assignment of a court date from the county compensation court where your case has been assigned.
* Call the office immediately upon the happening of any of the following:
- A change of your address.
- A change of phone number.
- The happening of another accident, whether at work or elsewhere.
- A return to work.
- To confirm receipt of scheduled doctor's appointment.
- To tell us of any change by you of the scheduled doctor's appointments.
- To inform us of any problems with your medical treatment.
- To inform this office of any communications from employer or insurance company if you do not see the office copied on the letter you receive from employer or insurance company.
- To inform this office when you have completed your treatment.
* Information regarding the status of your case, the scheduling of appointments, confirmation of appointments, and general information regarding procedure may be obtained from the compensation secretary. She is the most informed person regarding scheduling of doctors' appointments and court dates regarding your case. Other questions that cannot be answered by her, can certainly be discussed with me. If I am not in the office or available at the time of your call, please discuss with the compensation secretary the nature of your question and leave a telephone number and/or time when you may be reached. Often, your question may require that I make a phone call to the insurance company and/or attorney on the other side prior to speaking with you. As the different law firms and insurance companies have various hours when they can be reached, your discussion with the compensation secretary regarding your problem can help you receive a quicker answer if a reply telephone call is required.
* Interrogatories are questions asked by the insurance company/employer for the purpose of obtaining information as to the nature of your disability, the nature of your job and how those job functions would have exposed you to conditions which could result in injury. The questions are also designed to have you disclose your employment or subsequent employment which may affect the legal responsibility of the employer/insurance carrier that has had the Claim Petition filed against it. Interrogatories must normally be answered in all occupational compensation cases.
* Only you can provide the answers to interrogatories because it is you who swears under oath that these answers are true. Although this office will have obtained information from our examining doctors as to the nature of your disability, only you can provide detailed information regarding your job function.
* When you receive interrogatories, answer them in the best manner you can. After reviewing your answers, if I find that I do not have the necessary information available in your file, my office will contact you and an appointment will be arranged so that I may personally go over the interrogatories with you. In most cases, however, you will not need to have an appointment to answer the interrogatories.
* The Court rules state that in occupational cases either party may be required to answer written questions under oath. The rule applies equally to the Petitioner (you) and to the employer. In limited cases, interrogatories may be required to be answered by the Petitioner in an accident case.
* Failure to answer the written questions could lead to the court dismissing your case.
* The cases are scheduled for court by a computer in Trenton. The listings and notice that the case is to be heard in a particular court is sent out from the local office based upon the Trenton, computer-based information. If it appears that all examinations have been completed for both sides and they have each received their doctors' reports, I will go to court on your behalf to discuss the matter first with the other side. You will receive a letter and/or a telephone call from this office regarding when you must appear in court. This office wishes to minimize the amount of time you must take off from your employment or otherwise inconvenience yourself and I will attempt to have you scheduled to be in court only if I believe your case can be disposed of or otherwise proceed with a trial.
* Our compensation law provides that the amount to be paid for a percentage of disability differs with each calendar year. The rate to be paid for a percentage of disability is by law related to the New Jersey Average Weekly Wage. As an example, a 1992 accident which results in five percent of disability would result in your receiving more money than a 1991 accident with five percent of disability. It should also be remembered, that negotiations with different attorneys and employers will result in different possible results. Each case presents its own special facts.
* Compensation cases are scheduled by Trenton according to "cycles." Currently, cycles are three week periods of time. Within the three week period of time, each county compensation court assigns a particular employer or insurance carrier law firm to appear before a specified judge. For example, Firemen's Fund or the City of Jersey City could be assigned to the second Tuesday occurring in a cycle.
* Within each day's assigned cases, only a limited number of cases can be assigned for Pretrial and/or Trial by that Judge. The age and/or filing date of that case is a factor in Trenton making its assignment of a hearing date for a case. The oldest filed cases and cases that involve Motions for Medical and/or Temporary Disability Benefits are normally listed sooner.
* Therefore, the date of filing, the completion of the medical and legal information-gathering parts of the case [such as answering the interrogatory questions], and the assignment of a court date by Trenton, will all play a factor determining when a case can be listed and subsequently completed.
* By statute, the Judge of compensation must set the fee. The maximum which the Judge may allow for the attorney's fee is 20 percent of what is paid to the Petitioner.
* In the event that the matter is settled as a Judgment or Order Approving Settlement, the Judge of Compensation will normally require a substantial portion of the fee to be paid by the employer or insurance carrier.
* In the event that the matter is settled under "Section 20" of the Compensation Act, the entire amount of the fee set by the Judge will be deducted from the amount payable by the employer or the insurance company.
* "Section 20" is a shorthand reference by the Court of Compensation or the attorneys to the Section of the Compensation Act that enables an employer or insurance carrier to pay money to a Petitioner in return for a dismissal of the Claim Petition.
* By your accepting money paid under Section 20 of the statute, you waive the right to a trial by the Judge of Compensation. You also eliminate the right to request any further medical payments or other monetary payments from the employer or insurance carrier for the disabilities set forth in the filed Claim Petition.
* By accepting the Section 20 money, you give up the right to have the Judge of Compensation hear all the evidence in your case after which he or she may have awarded you possibly the same amount of money, an equal amount of money, or less money than you will receive under Section 20.
* The New Jersey Supreme Court has determined that when a Petitioner gives up the right to a trial or judgment for a claimed work-related disability and the right to return to Court for any additional treatment or payments related to that claim, the Petitioner also affects the rights of the spouse. The spouse must be given the opportunity to object to having his or her rights affected by that decision, and to be informed as to the effects of his or her providing consent to that determination as the spouse will not be able to come back and make any more claims related to the employment and the disability if the Petitioner has agreed to a Section 20 settlement disposition of the claim. If the spouse has not agreed to waive his or her rights, a Section 20 settlement does not affect the spouse's future rights. This is a matter that must be discussed with the attorney before the disposition is finalized because more than just the Petitioner's rights are affected.
* Generally speaking, checks are paid by employers and/or insurance carriers between six to eight weeks following your appearance in court.
* Although it may change in the future, monies paid for workers compensation benefits are not currently considered income for taxable purposes under either New Jersey or federal law. It is not taxable.
* Once you have received a Judgment or had a Judge approve an Order Approving Settlement of your case, you may re-open your case within two years of the last date of the employer or insurance carrier's payment of monies to you. "Monies" would include the payment of permanent disability monies, temporary disability monies, and/or payment of medical bills on your behalf.
* In order to re-open your case, you would need to be able to show through medical reports that your disability had increased since the time you were in court. You would also need to show that you had more complaints regarding the disabilities for which you were in court
* If you were paid money pursuant to a "Section 20", you may not re-open the Claim Petition for a disability for which the "Section 20" money was paid. This, however, does not stop an individual from filing a new claim petition for new or additional exposures which occurred after the filing of the claim petition, or for accidents that occurred after the filing of the Claim Petition.
* Call this office to reschedule an appointment.