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What Types Of Claims Are Covered By N.J. Workers’ Compensation?

  • By: Lisa J. Pezzano
  • Published: September 15, 2020

The simple answer is that if you were hurt during the course of your employment, you most likely have a valid workers’ compensation claim.

Do I Still Have A Claim If My Employer Did Not Cause The Accident?

In New Jersey, workers’ compensation is basically a no-fault system. In other words, an employee does not need to prove that an employer committed negligence in order to obtain workers’ compensation benefits. You can trip over your own two feet and still collect workers’ compensation as long as you weren’t engaging in behavior which could be construed as a major deviation from your employment.

What Industries Are Covered by N.J. Workers’ Compensation Laws?

All industries which perform work in the state are covered by the New Jersey Workers’ Compensation Act. Even out-of-state employers may need workers’ compensation coverage if a contract of employment was signed in New Jersey, or if the work is performed in New Jersey. Virtually all individuals who work in the state are covered by the Act, with the exception of longshoremen and employees of the United States government, who are protected by separate compensation systems.

Does The N.J. Workers’ Compensation Act Cover Only Accidents or Does It Also Cover Long Term Problems and Illnesses?

The Act applies to both traumatic injuries from specific accidents, as well as occupational injuries which occur over time as a result of the work effort. Examples of occupational injuries include carpal tunnel syndrome caused by repetitive typing, pulmonary disability of a fireman who repeatedly suffered from smoke inhalation, or a factory worker who experiences hearing loss due to constant loud noises. Back injuries may also be caused by years of heavy labor in the construction industry. Shoulder impingement may be caused by the repetitive use of tools. Any activity which requires the use of the same muscles repeatedly has the danger of causing an occupational injury.

Occupational claims are generally more difficult to prove than specific accident claims. Many insurance carriers in New Jersey automatically deny occupational claims as a matter of course. With all occupational claims, the personal risk factors of the injured worker, such as smoking, are always at issue. It is undoubtedly more difficult to prove that an employee with a 30-year smoking industry developed a pulmonary disability due to chemical exposure, than it is to prove causal relationship in a case involving a non-smoker.

How Can Someone Prove That An Injury Is Related to Their Current Occupation?

It is critical for the injured worker to be able to demonstrate that his activities on the job were more taxing than those outside of his employment, to successfully litigate an occupational claim. Therefore, it is important to have a very specific list of job duties at work, with a description of each duty (for example, how much is lifted, what tools/machines are utilized, and a log showing the length of time of each activity). The injured worker should be prepared to provide her doctors with a complete description of the activities which led to the symptoms, to enable the physician to document how the injury is related to her employment. Since litigation often takes years to conclude, and memories fade, it is advisable to write down the job duties while still employed or shortly after employment ends. If a formal job description from the employer is available, that document should also be obtained. If possible, it is helpful to save the names and contact information of co-workers who would be able to corroborate your testimony regarding the nature of the work.

What Injuries Might Not Be Covered By Workers’ Compensation?
  1. A heart attack or a stroke on the job will only be covered under certain circumstances. If the heart attack was not brought on by the work effort, it is not compensable. In other words, if the employee just happened to be at work at the time of the heart attack, and could have just as easily suffered a cardiac arrest if he had been relaxing at home at the time, then workers’ compensation benefits are not available. On the other hand, if you experience chest pain due to the strain of lifting a 200-pound box at work, then the injury would come under the purview of the Workers’ Compensation Act.
  2. Pre-existing injuries are not covered. However, pre-existing injuries which are exacerbated by the accident should be paid by workers’ compensation.
  3. Self-inflicted injuries are not compensable.
  4. Injuries which are caused solely due to the intoxication of the employee are not covered.
  5. While psychiatric disability may be covered by workers’ compensation, such claims are notoriously difficult to pursue. All jobs are stressful in some respect, so the Courts have held that the mere stress of performing one’s job duties and/or personality disputes with co-workers or supervisors is not enough to make an employer liable for a psychiatric condition, such as anxiety, depression, or a mental breakdown. There must be some unusual, objectively stressful work condition, peculiar to the workplace, which would have mentally affected any reasonable person. It is often very difficult for an employee with a pre-existing psychiatric problem to meet this burden. In addition, the employee must be prepared to disclose sensitive, personal information, such as the records of a therapist, to pursue a psychiatric claim.
What If A Work Accident Irritates Or Exacerbates A Preexisting Condition?

Insurance carriers are notorious for pointing to a pre-existing injury as the cause of an employee’s symptoms. However, if a pre-existing condition was asymptomatic prior to the work accident, it should not be used as a basis to deny workers’ compensation benefits. For example, if you were diagnosed with pre-existing arthritis which never caused any symptoms before the accident, the carrier should not use that condition as a basis to deny benefits, although they often try to do so. In short, while workers’ compensation insurance will not cover the arthritis which existed prior to the accident, it should cover any exacerbation or acceleration of the arthritis which became symptomatic because of the work injury.

The difficulty of proving that a pre-existing condition was aggravated by a work injury usually depends upon the severity of the trauma and a review of the medical reports. For example, it is undeniable that arthritis may be present yet asymptomatic for years. Whether or not medical treatment becomes necessary due to a traumatic event often boils down to the strength of the medical testimony and how persuasive the employee is in explaining how active he was prior to the accident. Employees must be prepared to release copies of all prior medical records which are relevant to the work injury in order to pursue a claim.

For more information on Claims Covered By NJ Workers’ Compensation, a free initial consultation is your next best step. Get the information and legal answers you are seeking by calling (908) 923-0020 today.

Lisa J. Pezzano

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