The workers’ compensa­tion laws are designed to provide benefits to persons who are injured while in the scope of their employment, or suffer illnesses, diseases, or medical conditions due to their work environment or work require­ments. Virtually, every worker who performs services for wages is covered by law regardless of the number of workers employed by the employer. We have no-fault workers’ compensation law, which means regardless of whether the injured worker was partially or fully at fault in caus­ing the injury or illness, they are still entitled to workers’ compen­sation payments so long as it is proved that the injury or illness arose out of and in the scope of employment.

There are two basic types of workers’ compensation claims. First, is the traumatic accident claim. This is when the worker has a specific traumatic event at the job, and sustains immedi­ate injuries. An example of this would be a painter falling from scaffolding and fracturing his elbow, or a truck driver lifting heavy items and sustaining a back injury. The second type of clam is known as an occu­pational exposure or disease claim. This is not due to one specific traumatic event, but is due to worker’s exposure over a period of time due to certain items that are peculiar to his individual work environment or job requirements. When such exposure causes a new injury or disease or aggravates, accelerates, or make worse such an underly­ing condition that the worker had before he had the job, this is known as a compensable occupational exposure. A good example of this would be a black jack dealer who because of repeti­tive motion of his wrist, hand and forearm in the dealing of cards around the black jack table, aggravates an underlying arthritis in his wrist.

Assuming a work related, traumatic, or occupational expo­sure that is caused by or arises out of employment, the worker is entitled to three specific areas of benefits. First, he is entitled to have medical treatment at the expense of the workers’ com­pensation insurance carrier of his employer. In New Jersey, the employer controls the provision of the medical treatment. It is not the injured worker, but the insurance company that chooses the doctor, which it wishes to authorize for medical treatment. There is a requirement that the appropriate specialists must be provided. As long as the doctor feels that medical treatment is necessary that is directly related to the work-connected injury or disease, then the insurance com­pany must pay for treatment.

The second area of benefits is called temporary disabil­ity. This is the payment of the injured worker of 70% of his gross weekly wages up to a maxi­mum of 75% of the statewide average weekly wage for the year in which the injury occurs. These payments are made by the workers’ compensation insurance company as long as the autho­rized doctor feels that the injured worker is not able to return to work, and is need of ongoing curative medical treatment.

Once the medical condition has reached a plateau, and the doctor does not feel further cura­tive medical treatment is neces­sary, the claimant can be evalu­ated to determine whether or not there is any permanent func­tional disability related to the work connected injury. A doctor chosen by the claimant’s lawyer and a doctor chosen by the insur­ance company independently evaluates the issue of permanent functional disability.

Thereafter, an attempt is made to settle the issue of per­manent disability. If the issue cannot be settled, then a trial is conducted without a jury before a Judge of Compensation. Even if the case is settled the workers’ compensation system establishes safeguards to assure that the set­tlement is fair and just. A Judge of Compensation must approve all settlements of workers’ com­pensation cases in open court. If the Judge is not satisfied with the fairness or adequacy of the settle­ment, he will not approve it.

The injured worker also has future rights under the compen­sation laws of this sate. There is the so-called, “re-opener” right. For up to two (2) years from the receipt of the final payment of any workers’ compensation judg­ment or settlement, an injured worker may seek additional med­ical treatment if the need for the treatment is directly related to the original accident or disease, and the additional treatment will improve the function of the dis­ability. In addition, if the overall disability has increased within that two-year period, the claim can be re-opened for additional permanent disability.

The workers’ compensation law is fraught with complexities. Therefore, it is always best for the injured worker to be repre­sented by a competent and expe­rienced workers’ compensation attorney, preferably, one who is certified by the New Jersey Supreme Court as a Workers’ Compensation lawyer. The lawyer’s fee cannot, as a matter of law, exceed 20% of whatever the lawyer obtains for the claimant. The lawyer cannot charge a fee based upon any benefit that is voluntarily paid by the insurance company. In addition, in most cases, the insurance company is required to pay up to 60% of the injured workers’ lawyer’s fee. If the attorney is unsuccessful in obtaining benefits over and above that which have already been paid by the insurance com­pany, there is no fee charged.