Can You Be Denied Workers’ Compensation if You Contributed to Your Own Injury?

Every state, including New Jersey, has workers’ compensation laws, designed to provide benefits to people who have been hurt on the job. Workers’ compensation programs are designed to be a compromise for both employees and employers, eliminating the need for an injured worker to incur the time and expense of a lawsuit, and simultaneously shielding employers from exorbitant jury awards. Worker’s compensation benefits are typically designed to address instances where the employer was careless or negligent in some respect. But what if you are an injured worker, and the accident was caused in part by your own negligence? Can you be denied benefits?

As a general rule, the worker’s compensation system is a no-fault system. This means that, in most instances, eligibility for benefits does not depend on who was at fault. There are exceptions, however. Many states bar or limit claims that result from the employee’s wrongful acts, including injuries that are intentionally self-inflicted, or injuries resulting from a fight or “horseplay” unrelated to the employee’s job. As a general rule, workers who injure themselves while drunk or under the influence of controlled substances will find it difficult to get workers’ compensation benefits.

In most instances, when the employee’s actions or behavior contributed to the injury, the court will look at whether there were other factors as well that caused the accident. Typically, courts will allow a worker to receive benefits unless the employer can show that the worker’s wrongful conduct was the sole cause of the injury.

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At Taylor & Boguski, we bring more than 70 years of combined legal experience to injured people throughout New Jersey. For a free initial consultation, contact our office online or call us at 856-234-2233.

Worker’s Comp and Disability

Mount Laurel NJ Worker’s Comp Attorney

Serious, catastrophic job-related injuries may qualify you for temporary total, temporary partial, permanent total, or partial disability benefits. If your injuries prevent you from returning to work, you may be eligible to receive one of the following kinds of worker’s compensation benefits:

• Temporary total benefits: Weekly benefits you are eligible to receive until your doctor indicates you are ready to carry out your full duties at work.
• Temporary partial benefits: Weekly benefits you are eligible to receive until your doctor indicates you are ready to return to light duty at work.
• Permanent partial benefits: If you are unable to return to work, you are eligible to receive some kind of worker’s compensation benefits on an ongoing basis.
• Total benefits: If you are unable to return to work and prefer a single, one-time only lump payment of benefits, you can elect a total benefit payout. Typically, this option is reserved for injured workers suffering from catastrophic injuries that involve permanent disability.

If I’m Disabled, can I still Qualify for Social Security?

In the event your injuries are permanently disabling, you can qualify for Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI). However, the amount of SSDI or SSI you are eligible to receive will be affected by the amount of worker’s compensation you receive as well. Here, it’s also important to keep in mind that additional medical exams may be required in order to qualify for SSDI or SSI. In some cases, this process can be complicated by the fact that not all employers maintain or provide accurate information regarding injured workers.

Contact Mount Laurel Worker’s Comp Attorneys at Taylor & Boguski

Disability and worker’s compensation often involve a number of legal issues that require the direction of an experienced worker’s comp attorney. At Taylor & Boguski, we have helped numerous workers navigate the sometimes confusing area of temporary, permanent, and total benefits. We also assist injured workers in matters related to SSDI and SSI when permanent disability prevents them from working in the future.

To learn how we can help you, contact Mount Laurel worker’s compensation attorneys at Taylor & Boguski today.

What if I can’t work anymore due to an on-the-job injury?

An employee left unable to work due to a workplace injury is in a difficult situation, but may still have options to collect an income to support him or herself. We offer complete services to those injured on the job, including those facing a future with a complete disability.

Who is considered to have a permanent total disability?

After a workplace injury, you will go through treatment and rehabilitation to improve your condition. You will reach your Maximum Medical Improvement, and a doctor will determine whether the injury will totally disable you and prevent future work.

If a catastrophic work-related injury or occupational disease causes a complete inability to return to work, the employee may collect benefits for a permanent total disability. This total disability is presumed when a worker loses the use of two or more major body parts (such as eyes, arms, hands, legs or feet). It can also be proven with facts concerning other types of conditions that establish a complete inability to resume gainful employment.

Permanent total disability benefits can be paid for up to 450 weeks. These payments can be like a pension with a regular disbursement or a lump sum. The amount is usually 70 percent of the average weekly wage, subject to certain caps and minimums. These payments can be extended past the 450 weeks if the claimant can prove the disabling condition continues to prevent a return to work.

Other sources of income

Workers’ compensation may not be the only benefit a totally disabled employee could tap into. Through the employer, or purchased by the worker, there may be a private disability insurance policy that could be used. Many of our clients can also receive Social Security Disability Insurance (SSDI) benefits.

If you become totally disabled, SSDI can provide income if you have been paying into Social Security for a sufficient time (that amount changes each year) and it’s been determined you are disabled.

• In 2014, you earn one credit for each $1,200 of wages. When you’ve earned $4,800, you’ve earned your four credits for the year. How many work credits you need to qualify depends on your age when you become disabled. Generally, you need 40 credits, 20 of which were earned in the last 10 years ending with the year you become disabled. Younger workers may qualify with fewer credits.
• To be considered “disabled” you must show you are unable to perform “substantial gainful employment.” If someone qualifies for SSDI two years after the “disability onset date,” they will also be eligible for Social Security Disability Medicare, which provides free medical care.

If you have suffered a serious work-related injury and want to learn more about your rights and legal options, contact our office.

Do I have a right to workers’ compensation if I injured myself on the job?

Getting worker’s compensation benefits generally does not require a showing of fault by one party or another. If the injury took place in the course of your employment, you should be covered. But all cases are unique and very fact-specific.

Unlike with personal injury law, workers’ compensation does not normally involve fault issues. If the employer caused the accident, you won’t collect more money and if you caused the accident, you normally won’t be denied benefits.

Self-injury and intent

A self-inflicted injury may be intentional or unintentional. If a self-inflicted injury is intentional, it means the worker deliberately did harm to him or herself. If it is unintentional, it was the result of a mistake and there was no intent to self-harm. That unintentional type of injury would be covered by workers’ compensation.

If the injury was intentional, however, and the worker did something in order to harm him or herself, the injury would not be covered. But the burden would be on the employer to show that the self-injury was intentional. Another possible route for the employee in this case could be to show a mental illness was caused or worsened by work to the point where the worker was a danger to him or herself (which may be a difficult case to prove).

In very unusual cases, it could be found that the sole cause of the injury was the employee’s fault because the worker ignored a well-known safety rule or policy. In that case, a workers’ compensation claim could be denied. Normally, though, when an employee makes a mistake or doesn’t pay attention in the course of doing a job, there’s a work component, like a tool or piece of equipment that hits you.

Workers’ compensation benefits

As a practical matter, if you find yourself injured at work, don’t spend time wondering about legal issues. Report your injury to your employer. Your medical treatment will be chosen and paid for by the workers’ compensation insurance company. You may qualify for temporary disability benefits (70 percent of your gross weekly salary) if you are unable to work for at least seven days. You would return to work, and your benefits would end, when you are medically cleared to come back to work. If you suffer a permanent disability, you are entitled to a monetary award.

If you have any questions about workers’ compensation laws and how they may apply to your situation, contact our office for a free consultation.

How do injuries get valued in workers’ compensation payouts?

We work with our workers’ compensation clients to get them the maximum recovery for their work-related injuries. Some of the values of those injuries are clearer cut than others.

If we and the compensation carrier can’t work out a settlement agreement, the value of your case will be decided by the New Jersey Department of Labor and Workforce Development Division of Workers’ Compensation, an administrative court that determines the value of an injured New Jersey worker’s claim.

Partial permanent disability

When a job-related injury or illness results in a partial permanent disability, benefits are based upon a percentage of certain “scheduled” or “nonscheduled” losses.

• A “scheduled” loss is one involving arms, hands, fingers, legs, feet, toes, eyes, ears or teeth. The schedule lists the body parts, the percentage of loss and value of each.
• A “nonscheduled” loss is one involving any area or system of the body not specifically identified in the schedule, such as the back, heart or lungs.

These benefits are paid weekly and are due after the date temporary disability ends.

Temporary total disability

If an injured worker is disabled for more than seven days, he or she will be eligible to receive temporary total benefits at a rate of 70 percent of their average weekly wage, with a maximum and minimum rate set by the State based on the year of the accident. For example, for an accident occurring in the year 2013 the maximum rate is $843.00 and the minimum is $225.00. These benefits are provided during the period when a worker is unable to work and is under active medical care.

Benefits usually end when the worker is released to return to work in some capacity or if the worker has reached maximum medical improvement, when additional treatment will no longer improve their medical condition.

Permanent total disability

If a work-related injury or illness prevents a worker from returning to any type of gainful employment, that person may receive permanent total disability benefits. Permanent total disability is presumed when the worker has lost two major body parts or a combination of parts of the body, such as eyes, arms, hands, legs or feet. However, permanent total disability can also result from a combination of other injuries that render the worker unemployable.

These weekly benefits are provided initially for 450 weeks. These benefits may continue if the injured worker can show that he or she remains unable to earn wages.

Contact us

If you or a loved one has been injured on the job and want to get answers to questions about workers’ compensation, contact our office.

Can I Go to My Own Doctor for a Workers’ Compensation Claim?

Mount Laurel Workers’ Compensation Attorneys

If you file a workers’ compensation claim with your employer after an accident or job-related injury, your employer’s insurance company doctor will likely examine you to determine the extent and nature of your injuries. Under New Jersey’s workers’ compensation laws, employers can choose the doctor you must see.

In certain situations, however, your employer (or your employer’s insurance company) may agree to let you choose your own doctor. On the other hand, if your doctor is not authorized by your employer (or employer’s insurance provider), or you have been specifically instructed to see the insurance provider’s doctor, you can’t see a doctor of your choosing for your workers’ compensation claim.

Denial of a Workers’ Compensation Claim — Getting a Second Opinion

If your employer insists on choosing your doctor, you may want to get a second opinion. Keep in mind, however, that the doctor you choose is subject to your employer’s approval. Here, workers’ compensation claims can be a bit tricky — since the doctor works for your employer’s insurer, he or she may have an unspoken incentive to minimize costs to your employer. As a result, insurance company doctors downplaying injuries or claiming workers are ready to return to work before they really are is not unheard of.

In these kinds of cases, it’s best to talk to an experienced workers’ compensation attorney who can help you navigate the workers’ compensation appeals process while protecting your rights and financial interests.

A Difference of Opinion: the Insurer’s Doctor and Yours

Suppose you suffer from what you believe is carpal tunnel syndrome and are experiencing tingling and weakness in your arm. You’ve developed these symptoms due to the repetitive motion required by your work. After you file a workers’ compensation claim, your employer instructs you to see a doctor it has chosen for you. The doctor examines you and decides you need physical therapy and are able to return to work.

You then decide to see your own doctor, who takes some x-rays of your spine and neck. He discovers that you have retrolisthesis and endplate spurring. He suggests surgery may be necessary, but can be avoided if you take a month off from work and use physical therapy. In this situation, your employer is not obligated to accept your doctor’s finding. If this happens, your only alternative is to hire a workers’ compensation attorney and take your employer to court.

Problems with Your Employer’s Doctor? Contact Taylor & Boguski

If you’re being told you’re ready to return to work even though you know you aren’t, contact Mount Laurel workers’ compensation attorneys at Taylor & Boguski today. We can evaluate your case, discuss the best options available to you and ensure that your rights and interests are protected.