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New Jersey lawyer webmaster article synopsis: Information on the benefits under the Workers Compensation Act.

BENEFITS UNDER THE
WORKER'S COMPENSATION ACT

by
Matthew Noyes

 

MEDICAL BENEFITS

Under the Worker’s Compensation Law, the employer is required to furnish to the injured employee " such medically necessary remedial treatment, care, and attendance for such period as the nature of the injury or process of recovery may require, including medicines, medical supplies, durable medical equipment, orthoses, prostheses, and other medically necessary apparatus.

Managed Care as of 1997--Treatment received outside the worker’s compensation managed care arrangement is not compensable unless authorized by the carrier prior to the treatment date. 440.134(17)

No health care provider can render service to an injured employee ( except for in emergency care situations ) without prior authorization from the employer or worker’s compensation insurance carrier.

Under the 1994 Worker’s Compensation Law, chiropractic care has been significantly limited. The Law states that chiropractic services in excess of 18 treatments or rendered eight weeks beyond the date of the initial chiropractic treatment, whichever comes first, shall be considered not medically necessary. However, the carrier may authorize additional treatment.

ATTENDANT CARE: The employer shall provide appropriate professional or nonprofessional attendant care performed only at the direction and control of a physician when such care is medically necessary. This care is beyond the scope of household duties. Family members may provide nonprofessional attendant care, but may not be paid for care that falls within the scope of household duties and other services normally and gratuitously provided by family members.

INDEPENDENT MEDICAL EXAMINATION: In any dispute concerning medical benefits, compensability or disability relating to a work-related injury, the carrier or the employee may select an independent medical examiner.

INDEMNITY BENEFITS

CATASTROPHIC TEMPORARY
TOTAL DISABILITY

-- Doctor must say that the employee cannot work at all due to the loss of an arm, leg, hand or foot or employee is paraplegic or quadriplegic

--Injured employee is entitled to 80% of Average Weekly Wage up to $700.00

--Cannot be received if employee is receiving Unemployment Compensation

--Can receive Social Security Disability Income, but benefits are subject to offset.

--Can be received for 26 weeks and then becomes Temporary Total Disability

PERMANENT TOTAL DISABILITY (PTD)

--Doctor must say that injured employee is unable to return to work because of a catastrophic injury or an injury that would qualify the injured employee for Social Security benefits.

--Injured employee receives just two-thirds (66%) of Average Weekly Wage up to maximum allowable (presently $465.00)

--Injured employee must apply for Social Security benefits and cannot be receiving Unemployment Compensation.

--Payable until employee is no longer permanently and totally disabled or dies.


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TEMPORARY TOTAL DISABILITY (TTD)

--Doctor must say that injured employee cannot work at all.

--Injured employee receives just two-thirds (66%) of Average Weekly Wage up to maximum allowable (presently $465.00).

--Cannot be received if employee is receiving Unemployment Compensation.

--Can receive Social Security Disability Income, but benefits are subject to offset.

--Payable for a total of 104 weeks in combination with Temporary Partial Disability benefits OR until injured employee reaches Maximum Medical Improvement ("MMI").

TEMPORARY PARTIAL DISABILITY (TTD)

--Doctor must say that injured employee is able to return to work on a modified basis (light duty) and injured employee is earning less than 80% of Average Weekly Wage.

--Injured employees only receive 80% of (80% of Average Weekly Wage on Date of Accident minus current employee income) not to exceed two-thirds of Average Weekly Wage

--Payable for a total of 104 weeks in combination with Temporary Total Disability benefits OR until injured employee reaches Maximum Medical Improvement ("MMI")

PERMANENT IMPAIRMENT BENEFITS

--Doctor must opines that injured employee has reached maximum medical improvement (MMI) with an impairment rating or 104 weeks from the date of injury has expired.

--Injured employee only receives 50% of average weekly TTD benefits.

--Injured employee is only paid three weeks of benefits for every percentage point the doctor determines he/she is impaired.

--Return to work or not-no more benefits

SUPPLEMENTAL BENEFITS

--Payable after Permanent Impairment Benefits end

--Injured employee is only entitled to these benefits if the impairment rating is 20% or greater and employee is unable to return to work or is earning less than 80% of his Average Weekly Wage.

--Injured employee only receives 80% of (80% of Average Weekly Wage on Date of Accident minus current employee income) not to exceed two-thirds of Average Weekly Wage.

--Payable only until 401 weeks have passed since the date of the accident.


 

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