Welcome to our Workers’ Compensation Guide specifically tailored for our Orthopedics Practice! This guide aims to provide you with a comprehensive overview of workers’ compensation concerning orthopedic injuries. While we offer valuable insights, it’s crucial to understand that this guide doesn’t replace professional advice. For more precise and personalized information, we recommend visiting the official workers’ compensation portal.
This portal is your go-to resource for the latest regulations, forms, and additional details, ensuring you have access to the most current and accurate information. Your well-being is our utmost concern, and we trust that this guide serves as a helpful starting point in navigating workers’ compensation in the context of orthopedic care.
Requirements for Employers
According to New Jersey law, all employers within the state, not covered by Federal programs, must either possess Workers’ Compensation coverage or be sanctioned for self-insurance. Even out-of-state employers might necessitate Workers’ Compensation coverage if they engage in a contract of employment in New Jersey or perform work within the state.
The following categories of employers must maintain Workers’ Compensation insurance:
- Corporations: Every corporation operating in New Jersey must either hold Workers’ Compensation insurance or gain approval for self-insurance, as long as any individuals, including corporate officers, render services for the corporation for previous, ongoing, or anticipated financial compensation*.
- Partnerships/LLC’s: All partnerships and limited liability companies (LLC’s) in New Jersey must maintain Workers’ Compensation insurance or be approved for self-insurance, given that any individuals, excluding partners or LLC members, perform services for the partnership or LLC, for prior, current, or anticipated financial consideration*.
- Sole Proprietorship: All sole proprietorships in New Jersey must maintain Workers’ Compensation insurance or be approved for self-insurance, as long as any individuals, excluding the principal owner, provide services for the business for previous, current, or anticipated financial consideration*.
- Financial consideration encompasses any remuneration for services and includes cash or non-cash remuneration like products, services, shares of corporate stock, or options to buy stock, meals, lodging, etc.
Governmental agencies must offer Workers’ Compensation benefits to their employees but are not obligated to purchase insurance or receive approval as self-insurers. They generally acquire an insurance policy, participate in an insurance pool, or maintain a separate appropriation for Workers’ Compensation.
Insurance coverage can be procured in two ways:
- Obtain a Workers’ Compensation Insurance Policy from a mutual or stock carrier authorized to write insurance in New Jersey. Premiums are based on work classifications, employer claims experience, and payroll.
- Pursue Self-Insurance through application to and approval by the Commissioner of the Department of Banking and Insurance. Approval depends on the employer’s financial capability to meet obligations and the permanence of the business. Posting security for such obligations may be necessary.
Self-insured employers can either manage their Workers’ Compensation claims or enlist a third-party administrator (TPA) for these services. Refer to N.J.S.A. 34:15-77 of the New Jersey Workers’ Compensation statute or contact the Department of Banking and Insurance at (609) 292-5350 ext. 50099 for additional details on self-insurance.
Workers’ compensation insurance coverage is obtainable from over 400 licensed insurance companies in New Jersey. Policies can be purchased directly from an insurance carrier, agent, or broker. For further assistance, contact the NJ Compensation Rating and Inspection Bureau at:
60 Park Place Newark, NJ 07102 Phone: (973) 622-6014 Fax: (973) 622-6110 www.njcrib.com
Guidelines for employers
The repercussions for not providing Workers’ Compensation coverage can be severe, even in the absence of a work-related injury. Specifically, the law deems failure to insure as a disorderly persons offense, and if deemed willful, it becomes a crime of the fourth degree. Additionally, penalties for such failure can be imposed up to $5,000 for the initial ten days and up to $5,000 for each subsequent ten-day period of failure to insure. In the case of a corporation, liability for failure to insure can extend to the individual corporate officers. Penalties levied for failure to insure are not dischargeable in bankruptcy.
In cases of work-related injuries or fatalities, the employer, including individual corporate officers, partners, or LLC members, is directly responsible for medical expenses, temporary disability, and permanent disability or dependency benefits. Besides awards for medical expenses and other benefits, New Jersey law also allows for civil penalties against the employer and its officers when failure to insure is established. Awards and penalties from these claims can become liens against the uninsured employer and its officers, typically enforceable in the New Jersey Superior Court against any assets owned by the uninsured employer and its officers.
If you are aware of an employer without insurance coverage, you can report this information to the Office of Special Compensation Funds by completing an online Report of Non-Compliance form. Anonymity is preserved, but you should be ready to provide the employer’s name, precise address, and, if possible, the names of the principal operators of the business.
The Office of Special Compensation Funds conducts regular cross-matches with the Department of Banking and Insurance’s Compensation Rating and Inspection Bureau (NJ CRIB) to identify uninsured employers. Upon identifying a potentially uninsured employer through this cross-match, a letter and cross-match response form are issued. Immediate insurance procurement is mandated if an employer is found to be uninsured, and verification of insurance must be supplied. Penalties may still be imposed for the lack of insurance at the cross-match time.
If you are an insured employer and have received this form, it is crucial to promptly provide the requested information about your workers’ compensation coverage to prevent improper penalties from being assessed. For inquiries regarding the Cross-Match Program, you can contact:
Office of Special Compensation Funds Cross-Match Program P.O. Box 399 Trenton, NJ 08625-0399 Fax: (609) 633-7783 Email: oscf@dol.nj.gov
The law mandates that each employer prominently display, in and around the workplace, a form provided by the Commissioner of the Department of Banking and Insurance. This form must declare that the employer has either obtained Workers’ Compensation insurance coverage or has been approved as a self-insured employer by the Department of Banking and Insurance.
For insured employers, the notice must contain details such as the name of the insurance carrier and other information specified by the Department of Banking and Insurance. Employers seeking copies of this notice should contact their insurer
Upon hiring and at regular intervals, employees should receive the following information:
- An overview of their Workers’ Compensation coverage and benefits
- Instructions on how, when, and to whom to report an injury
- Guidance on where to seek medical treatment if injured while working
Upon receiving notification of a work-related accident or occupational exposure, employers should promptly inform their insurance carrier or third-party administrator (TPA) to file a First Report of Injury form electronically with the State of New Jersey.
Within 26 weeks of the worker reaching maximum medical improvement or returning to work, a second report, known as a Subsequent Report of Injury, must be electronically submitted to the State.
In cases where disputes arise regarding entitlement to benefits, a worker has the option to file either a formal Claim Petition or an Application for an Informal Hearing with the Division of Workers’ Compensation. Disputed matters may include the compensability of the claim, the nature and extent of medical treatment, and/or the payment of temporary and permanent disability benefits.
