Workers’ Compensation is a no-fault system of insurance that provides benefits for workers who experience an injury or illness on the job. Benefits help cover medical expenses and wages lost because of the injury. The majority of work injuries are minor and recovery time is minimal, but a serious work injury or illness can be devastating. Someone who suffers such an injury may have trouble managing simple daily tasks, and continuing to work may be out of the question. When a work injury or illness results in a disability, there are Workers’ Compensation benefits available to help.
What are the Types of Disability Benefits?
Disability benefits fall into two categories:
- Permanent total disability. Permanent total disability benefits are available when a catastrophic work injury such as spinal cord injury, head, neck, or back injury leaves an employee unable to ever work again. In New Jersey, the loss of both eyes, hands, arms, feet, legs, or a combination of any two are automatically considered a permanent total disability.
- Permanent partial disability. This is a benefit paid when an employee suffers a work injury or illness that causes a permanent disability that does not result in the employee being totally disabled. These types of injuries are referred to as scheduled or unscheduled losses. Most states keep a schedule of injuries and how they are compensated, such as the loss of a leg, ankle, foot, toes, and other body parts. For injuries that cannot be scheduled, a medical evaluation is performed and a percentage rating is given. For instance, a doctor may assign the injured worker a 10 percent disability rating, and benefits are based on this percentage rate.
How Do I Qualify for Disability Benefits?
Severely injured workers must go through a process of legal and medical checks to prove their disability and receive benefits. There are employers and insurers who will dispute the severity of a work injury and try to avoid paying total disability benefits because they are long term and very expensive.
To be eligible for any kind of Workers’ Compensation benefits, a person must be an eligible employee of a business that has Workers’ Compensation insurance; the injury or illness must be work related and covered by Workers’ Compensation; and the claim for Workers’ Compensation benefits must be submitted according to the laws and procedures of the state. Lastly, it is important that the worker follow state rules for getting treatment from a Workers’ Compensation treating doctor.
The next step is proving that an injury is permanent, which can take a long time depending on the nature of the injury or illness. When a worker’s doctor deems them to have reached a point at which their condition will likely not improve further, even with additional treatment, this is known as maximum medical improvement (MMI). The process to determine whether a disability is permanent can begin only after the worker has reached MMI. This is usually done through an independent medical examination (IME) requested by the insurance company or by a worker who disagrees with the doctor’s opinion. The medical professional performing the examination will assign a disability rating. If it is not 100 percent, the worker may be eligible for permanent partial disability benefits, or the worker may have a combination of permanent impairments that add up to a 100 percent disability rating.
When Will I Get My Disability Payments, and How Much Will I Receive?
A doctor must first notify the insurance company that a worker’s disability is considered permanent before the insurer can start sending payments for disability benefits. This process may be delayed if there are any disputes regarding the amount and extent of impairment. Workers whose injury results in a total and permanent disability are usually entitled to a lifetime pension; however, those with partial permanent disabilities receive benefits up to a certain limit set by the state.
Calculating disability payments is notoriously complex, and it is advisable that anyone unsure of their situation consult with an experienced Workers’ Compensation lawyer to ensure that they are receiving payments in the correct amount. The current maximum benefit for a permanent disability in New Jersey is 70 percent of the average weekly wage the employee was earning at the time of the accident, not to exceed 75 percent of the Statewide Average Weekly Wage (SAWW) or less than 20 percent of the SAWW. Benefits are paid weekly for an initial 450 weeks and then can continue after it has been proved that the worker remains unable to earn wages.
Often employers or their insurers will offer to settle a claim for Workers’ Compensation benefits with a lump-sum payment. Again, calculating the accurate value of a claim for permanent disability is extremely difficult, and a worker must be fully aware of the terms of what they are signing and what they are giving up in return for the lump sum of money. Only an experienced Workers’ Compensation lawyer can determine if the amount being offered is fair. Usually taking a settlement means the worker is giving up the right to future medical benefits, so the nature of the disability and the worker’s medical condition must be thoroughly considered before accepting any kind of offer.
A good Workers’ Compensation lawyer will never charge a fee for a consultation, and there is no risk to workers in asking for advice about getting the benefits for which they are entitled. When a work injury or illness causes a permanent disability, there should be no hesitation to enlist help to make sure the worker will be taken care of when they are unable to earn a living.
Mount Holly Workers’ Compensation Lawyers at Kotlar, Hernandez & Cohen, LLC Help Workers Obtain Disability Benefits
If you or someone you love has suffered a serious work injury, you may be eligible for disability benefits. The experienced Mount Holly workers’ compensation lawyers at Kotlar, Hernandez & Cohen, LLC can help you ensure you receive all the benefits for which you are entitled now and in the future. Call us at 856-751-7676 or contact us online for a free consultation. Our offices are in Mount Laurel, Cherry Hill, Trenton, and Vineland, New Jersey; and Trevose, Pennsylvania. We serve clients throughout New Jersey and Pennsylvania.
