This articles provides a basic overview of the wage replacement benefit – temporary disability – in New York workers’ compensation claims. A workers’ compensation claimant is entitled to medical care and wage replacement. If the worker is killed by the accident, his dependents may be eligible for death benefits.
As set forth more completely in my book, when an employee sustains are injury medical benefits must be provided immediately. WCL § 13. There is no waiting period before medical benefits must be provided. Wage replacement (as discussed below) has a waiting period before benefits must be provided. WCL § 12.
Simply stated, a commutation is the legal term for a petitioner asking the court to accelerate the payment of an award to answer some pressing need of the claimant.
Commutation reduces exposure in two ways:
Any commuted payment made is discounted 5%. Therefore, payments of compensation which are made under Order For Commutation save the insured money. (So, a commutation reduces the amount the respondent has to pay).
The payment of commutation is deemed to shorten the period of overall benefits. A claimant, under the New Jersey Workers’ Compensation Act, has two years to re-open a claim from the time the last payment was paid. By commuting payments, the period for re-opener is shortened.
Pursuant to Workers’ Compensation Law (WCL) § 21, injuries that occur at a claimant’s place of employment are presumed to be compensable work-related injuries for the purposes of awarding indemnity and medical benefits unless substantial evidence to the contrary is produced. In essence what this means is that if an employee suffers an injury during work hours and/or on the premises of his or her place of employment, the claimant will be entitled to indemnity benefits for any causally related lost time from their employment as long as they are able to produce medical reports evidencing a disability resulting from the injury.
However, according to WCL § 10, New York law dictates that for a workers’ compensation claim to be compensable the associated accident must have arose out of and in the course of employment, meaning there must be a causal nexus between the injury and the claimant’s employment. Idiopathic injuries, or personal injuries, may create a defense to a Workers’ Compensation claim if the employer can rebut the presumption that accidents arising in the course of employment arise out of the employment with “substantial evidence to the contrary.” See WCL §21.
In New Jersey, petitioners’ attorneys will often attempt to improperly “stack” injuries to multiple body parts in order to obtain greater settlements for their clients. However, “stacking” is subject to numerous longstanding limitations. One of such limitations is that in order to “stack” injuries to multiple body parts, said injuries must have resulted from a single underlying accident.
The concept of “stacking” injuries has long-existed in New Jersey workers’ compensation law. Stacking’s inception dates to the 1984 case of Poswiatowski v. Standard Chlorine Chemical Co., 96 N.J. 32,1475 A.2d 1257 (1984). In that case, the Supreme Court of New Jersey indicated that in instances where a worker has suffered injuries to multiple body parts, Judges of Compensation must “treat the individual as a whole.” This means that the Supreme Court of New Jersey determined that when affixing the extent of disability suffered by a given worker, workers’ compensation courts must determine the cumulative impact that each of the injuries had upon said worker. Continue reading The Limit To “Stacking” Injuries To Multiple Body Parts in New Jersey→
In New York, when an individual suffers an accident or illness arising out of and in the course of employment, workers’ compensation becomes the primary source of wage replacement and medical benefits. It is important to understand how workers’ compensation benefits affect or are affected by other available benefit programs. Some of these additional benefit programs duplicate workers’ compensation benefits, some supplement workers’ compensation benefits, and others are paid instead of workers’ compensation benefits.
Private Long Term Disability Benefits: Some employers voluntarily provide employees with long term disability benefits. Individuals can also obtain these policies on their own. Long term disability benefits are typically available for periods of disability which extend beyond an ‘elimination period.’ These policies issue indemnity benefits to policyholders who are disabled and unable to work beyond a set period of time, i.e. six months, 26 weeks, or another set period of time specified in the long term disability policy.
The Workers’ Compensation Board does not have jurisdiction over private long term disability benefit plans. As there is no jurisdiction, the Board has no legal authority to direct reimbursement for a duplication of benefits. Therefore, a claimant can receive both workers’ compensation indemnity benefits and benefits from their long term disability policy at the same time and even receive more from the two than their normal weekly wage while working. However, most long term disability policies contain provisions that require reimbursement to the long term disability carrier or take an offset for any workers’ compensation benefits. These reimbursements and offsets are to be determined in accordance with the terms of the long term disability policy. Continue reading How an Award of Workers’ Compensation Benefits Impacts Other Disability Benefits→
When an employer knows (with certainty) that an employee has been injured and will suffer some degree of permanent injury (for example, when there has been loss of a limb), a voluntary tender, made at the appropriate time, may be offered to reduce exposure for attorney’s fees when the underlying claim is disposed of. N.J.S.A. 34:15-64 provides (in part):
When, however, at a reasonable time, prior to any hearing compensation has been offered and the amount then due has been tendered in good faith or paid within 26 weeks from the date of the notification to the employer of an accident or an occupational disease or the employee’s final active medical treatment or within 26 weeks after the employee’s return to work whichever is later or within 26 weeks after employer’s notification of the employee’s death, the reasonable allowance for attorney fee shall be based upon only that part of the judgment or award in excess of the amount of compensation, theretofore offered, tendered in good faith or paid.