Summary of New Jersey Workers Compensation

Transcription

1 Summary of New Jersey Workers Compensation

2 NEW JERSEY S COMPUTERIZED SYSTEM Most Comprehensive In The United States (

3 BENEFITS OF WORKERS COMPENSATION Temporary Total Disability Benefits Disabled For More Than 7 Days Under Active Medical Care Calculation Of Wage 26 Week Wage Statement

4 BENEFITS OF WORKERS COMPENSATION Temporary Total Disability Benefits Rate 70% of Gross Average Weekly Wage Minimum and Maximum Rate 400 Week Limit

5 BENEFITS OF WORKERS COMPENSATION Cessation Of Temporary Benefits Discharge From Active Medical Care Light Duty Restrictions And Still Treating Must be a job available RTW Loss in wages partial/temp?

6 BENEFITS OF WORKERS Medical Benefits COMPENSATION Cure And Relieve The Effects Of The Injury (NJSA 34:15-15) Emergency Medical Care Employer s Right To Authorize Providers

7 BENEFITS OF WORKERS COMPENSATION Medical Benefits Second Opinions Maximum Medical Improvement

8 BENEFITS OF WORKERS COMPENSATION Permanent Partial Disability Permanent Disability Defined (NJSA 34:15-36) Demonstrable Objective Medical Evidence Functional Restriction Of The Body, Member Or Organ

9 BENEFITS OF WORKERS COMPENSATION Permanent Partial Disability Lessening To A Material Degree Of Working Ability Ordinary Pursuits of Life

10

11

12 STATUTE OF LIMITATIONS Two Years From Injury Or Date Of Last Benefit Provided In Occupational Disease 2 Years From The Date Claimant Knew Of Condition And Its Relationship To The Job

13 RE-OPENER PETITION Re-Opener Rights 2 years to seek further ttd; medical; increase in permanency; 2 years runs from date of last payment of permanency or last benefit provided

14 TYPES OF SETTLEMENT OAS: Order Approving Settlement Section 20 Settlement (N.J.S.A. 34: 15-20)

15 ORDER APPROVING SETTLEMENT Order Approving Settlement The parties settle a compensable claim where all temporary total disability benefits and medical benefits have been provided and now the parties have tentatively settled permanency subject to approval by judge Requires testimony or Affidavit by petitioner supporting terms of settlement

16 SECTION 20 SETTLEMENT N.J.S.A. 34: Must Be Approved By A Judge And Must Have Counsel Dismisses The Claims With Prejudice No Re-opener Rights

17 SECTION 20 SETTLEMENT Must Be An Issue Of Jurisdiction, Liability, Causal Relationship Or Dependency State TDB Lien Must Be Paid Out Of Proceeds But Waives Balance Kibble: Dependents Rights Survive Unless Waived

18 Stroke Claim Renner vs. AT&T, (No. A ; App. Div. 11/29/2010) Facts: Petitioner worked for AT&T for 25 years salaried manager Sat at her computer for long hours to meet various deadlines On 9/24/2007, worked throughout the night in order to complete a project

19 Stroke Claim Renner vs. AT&T Facts: At 9:00 am, advised a co-worker she was not feeling well but would keep working to complete the project Finished the project and sent an at 10:30 am regarding same At 11:34 am called 911 but pronounced dead upon arrival at the hospital from a pulmonary embolism

20 Stroke Claim Renner vs. AT&T Issue: Was the employee s death compensable as a cardiovascular event pursuant to Section 7.2 of the Act? Holding: WCJ and Appellate Division both found compensability

21 Stroke Claim Renner vs. AT&T Reasoning: Although the employee lead a sedentary lifestyle in and out of work, credible evidence proved that her work inactivity was greater than her non-work activity Section 7.2 requires that in a cardiovascular claim that an employee prove that the injury or death was produced by work effort or strain involving a substantial condition, event or happening in excess of the wear and tear of the employee s daily living

22 Stroke Claim Renner vs. AT&T, New Jersey Supreme Court reverses Decision 7/31/2014 Holding: The petitioner did not meet the burden of proof required by Section 7.2 that the deceased s cardiovascular death is compensable. Reasoning: Section 7.2 enacted to prevent recovery from cardiac incidents that simply manifest at work Burden of proof requires work exposure of a greater risk than those faced in their daily life

23 Stroke Claim Renner vs. AT&T, New Jersey Supreme Court reverses Decision 7/31/2014 Reasoning: Petitioner not confined to a specific work space or instructed not to move from her work station Prolonged sitting, uninterrupted breaks to stand, walk or exercise not compelled by the employer Long work hours with extended periods of sitting do not constitute a work effort or strain involving a substantial condition, event or happening.

24 Stroke Claim Renner vs. AT&T, New Jersey Supreme Court reverses Decision 7/31/2014 Thoughts: Strengthens the heightened burden of proof for cardiovascular claims Supreme Court seems to touch upon a fault concept with respect to the employee s choice to sit uninterrupted.

25 Mark Setaro, Esquire