Callagy Law Arizona: When is an Injury Covered by Workers’ Compensation?

New Jersey Workers’ Compensation and the New Jersey Division of Risk Management | Helpful Information from the Callagy Law Team

The following article was written by Callagy Law’s Legal Team, and will focus on many common questions and concerns surrounding new developments, legal matters, and other procedures within the field of healthcare law Medical Revenue Recovery, PIP, Workers Compensation, and Commercial Insurance. Our mission is to answer any questions and give knowledge to many different aspects of these matters.

The State of New Jersey is self insured for Workers’ Compensation pursuant to N.J.S.A. 34:15 and all such matters are handled by the “Division of Risk Management”. Workers’ Compensation is legislation to insure that employees injured on the job will be paid without regard to fault. The effect of the compensation statute on the covered “employee” is to take away the employee’s common-law remedies against the “employer” and to substitute in a remedy that requires the employer to pay the compensation benefits stipulated in the statute. The right to pay the compensation is the covered employee’s exclusive remedy against the employer.

In understanding this rule, the State of New Jersey is self-insured for Workers’ Compensation pursuant to N.J.S.A. 34:15-1, et. seq. All matters regarding case management and investigations are handled by the Division of Risk Management. All workers’ compensation obligations, including payments for medical treatment, temporary and permanent disability, are approved and processed by N.J.S.A.34:15-7 and N.J.S.A.34:15-43.

In order to be eligible for worker’s compensation, the first inquiry by the Division of Risk Management is whether the injury arose out of or in the course of the employee’s employment. If the injury is deemed compensable in nature, the injured worker is entitled to the full benefits of worker’s compensation. When medical treatment is warranted, the treatment is fully governed by the State of New Jersey, through the medical management facility, Horizon Casualty Services, Inc. If the injury results in lost time from work, the employee could receive monetary benefits through worker’s compensation, as well. The benefit is based on 70% of the employee’s base salary at the time the injury occurred, however, cannot exceed the rate that is allotted for the year, in question. The amount of the award is based on the percentage of disability that governs the injured body parts in question.

A reported injury is covered under workers’ compensation if the injury is a direct result of the employee’s employment and falls under the guidelines pursuant to N.J.S.A. 34:15-1, et. seq. A work related injury is an injury which occurs out of and in the course of State employment. “In the course of employment” is defined as when “employees are at their place of work, during the hours that they are expected to be there and engaged in doing the task that they were employed to do.” The employee could be traveling outside of the office. Overtime is also included. Moreover, the accident must result in “bodily injury.” Finally, the injury must be the proximate result of the accident the employee sustained. The employee may not recover benefits if there is no such causal relationship.

Under the Workers’ Compensation Statute (34:15-17), unless the employer shall have actual knowledge of the occurrence of the injury, or unless the employee, or someone on his behalf, or some of the dependents, or someone on their behalf, shall give notice thereof to the employer within fourteen (14) days of the occurrence of the injury, then no compensation shall be due until such notice is given or knowledge obtained.

You must notify the Division of Risk Management with your report of incident/accident within 24 hours of such knowledge, especially if there is a direct need for medical treatment. If no medical treatment is warranted, you are required to keep the report on file.

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When is an Injury Covered by Workers’ Compensation?