How Does Workers' Compensation Work?

Posted on Tue Nov 27 2012 by Vincent Jesuele

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When I’m speaking with a new client, they want to know: how does workers’ compensation work? In this post I’m going to briefly outline the steps a claim follows from injury to compensation and beyond.

Workers’ compensation begins when a worker is injured on the job. In New Jersey, where I practice, you can receive compensation no matter how you are hurt at work . The exceptions are for self-inflicted injury, or injury resulting from horseplay or intoxication.

When an injury occurs on the job, a first report of injury is made to the employer. This serves as a record of the circumstances of the injury.

It is at this point where both the workers’ compensation insurance carrier and a workers’ compensation attorney typically get involved. When the workers’ compensation carrier is notified of the injury, they will choose a doctor to provide any needed treatment.

While an injured worker is unable to work and is under active medical care, they are eligible to receive temporary disability benefits. These are payable at 70% of the worker’s average gross weekly wage and subject to a maximum. In 2012 the maximum was $810 per week.

When treatment ends, a claim petition is filed by the workers’ compensation attorney. This formally begins the claim for a permanency award.

Once the claim petition has been filed, the workers’ compensation attorney gathers the medical records from treatment. Once the records have been assembled, the attorney will schedule a medical examination. This is called a permanency exam and serves to estimate the degree of permanent injury resulting from the injury. The workers’ compensation carrier will also schedule a permanency exam for the worker to attend.

Typically, the doctor designated by the attorney will give a high estimate of disability, meaning more compensation for the worker. The doctor designated by the insurance company will give a low estimate, meaning less compensation.

After the reports from both permanency exams have been received, the attorney attempts to come to an agreement with the carrier about the amount of compensation to be paid. If the parties cannot reach an agreement (called a settlement), the case goes to court to be decided by a workers’ compensation judge.

If the worker’s condition worsens after the end of their workers’ compensation claim, the worker may re-open the case to seek additional medical benefits. The time limit for re-opening a claim is two years from the last payment of benefits.

To summarize: The workers’ compensation process begins with an injury. Next, a first report is made to the employer, who involves the workers’ compensation carrier. The WC carrier designates a treatment doctor and treatment ensues, during which time temporary disability benefits are paid if the worker is unable to work. After treatment ends, a claim petition is filed, medical records are assembled, and permanency exams are ordered. When the exam reports are received, either a settlement is negotiated or the case is decided by a judge. Finally, the worker retains the right to open their case if their condition worsens until two years from the date of the last compensation payment.

I hope that this post has helped answer some of your questions about the workers’ compensation process. If you have any questions, you should contact an experienced workers’ compensation attorney who can address your concerns in depth. If you or a loved one has been injured on the job, please email me, visit my firm’s website, or call me at (908) 232-2040; I have almost three decades of experience handling these sorts of claims and can help you get the compensation you deserve.

Filed under Workers' Comp