Dorthea Simmons, Acting Bureau Chief
Main Reception Line: (609) 292-3475
Fax: (609) 292-2437
The State of New Jersey is self insured for Workers’ Compensation pursuant to N.J.S.A. 34:15 and all such matters are handled by the Division of Risk Management.
What is Workers’ Compensation?
Workers’ Compensation is remedial social legislation to insure that employees injured on the job will be paid without regard to fault. The effect of the compensation statute on the covered “employee” is to take away his or her common-law remedies against the “employer” and to substitute in their place a remedy that requires the employer to pay the compensation benefits stipulated in the statute. The right to pay the compensation is the covered employee’s exclusive remedy against the employer. In understanding this rule, the State of New Jersey is self insured for Workers’ Compensation pursuant to N.J.S.A. 34:15-1 et seq.; there is no other insurance involvement. All matters regarding case management and investigations are handled by the Division of Risk Management. The New Jersey State Department of Law and Public Safety, Division of Law, provides legal advice pertaining to claims and litigation support. The Division of Risk Management (DRM) is responsible for the budgeting of workers’ compensation obligations. All workers’ compensation obligations, including payments for medical treatment, temporary and permanent disability, are approved and processed by the Division to the dictates of N.J.S.A.34:15-7 and N.J.S.A.34:15-43.
Workers’ Compensation: What are the “Eligibility Requirements”?
In order to be eligible for worker’s compensation, we must first determine if the injury, in question, is arising out of and in the course of the employment. The Division of Risk Management oversees this decision process. If the injury is deemed compensable in nature, the injured worker is entitled to the full benefits of worker’s compensation. When medical treatment is warranted, the treatment is fully governed by the State of New Jersey, through our medical management facility, Horizon Casualty Services, Inc. If the injury results in lost time from work, the employee could receive monetary benefits through worker’s compensation, as well. The benefit is based on 70% of the employee’s base salary at the time the injury occurred, however, cannot exceed the rate that is allotted for the year, in question. Pursuant to medical findings which support an accredited record of permanent disability, monetary awards could be granted, as well. The amount of the award is based on the percentage of disability that governs the injured body part(s) in question.
What is a “Work Related” Injury?
In determining if a reported injury is covered under workers’ compensation, one must first determine if the injury is a direct result of the employee’s employment. The cause for injury must fall under the guidelines pursuant to N.J.S.A. 34:15-1 et.seq.
A work related injury is an injury which occurs out of and in the course of State employment. “In the course of employment” is defined as when employees are at their place of work, during the hours that they are expected to be there and engaged in doing the task that they were employed to do. This does not necessarily mean that the employee would have to be at the employer’s office or premises at the time. The employee could be traveling to or from appointments or doing work at other places designated by the employer. Overtime is included in the equation, as well. In order to be compensable, the accident must result in bodily injury. No compensation is payable for property damage which is the result of the accident. The injury for which a compensable claim is made must be the proximate result of the accident the employee sustained. If there is no such causal relationship, then the employee may not recover benefits.
What are the reporting time line/requirements for Workers’ Compensation?
Under the Workers’ Compensation Statute (34:15-17), unless the employer shall have actual knowledge of the occurrence of the injury, or unless the employee, or someone on his behalf, or some of the dependents, or someone on their behalf, shall give notice thereof to the employer within fourteen (14) days of the occurrence of the injury, then no compensation shall be due until such notice is given or knowledge obtained.
When to notify Division of Risk Management?
You must notify the Division of Risk Management with your report of incident/accident within 24 hours of such knowledge, especially if there is a direct need for medical treatment. If no medical treatment is warranted, you are required to keep the report on file; the DRM will contact the employer directly if the report is needed for litigation.
Horizon Casualty Services/Role of the Nurse Case Manager
Horizon Casualty Services is the State of New Jersey’s medical management care provider. Initially contracted for service in January, 1966, Horizon’s primary function is to authorize the medical treatment which is rendered to the injured state worker.
Understand that the Respondent (SNJ/DRM) has the right to control the choice of physician. The employee does not have freedom to choose a doctor while under state care and we seldom give the employee the choice to go to whomever they want to for medical treatment. If the employee chooses to go to a doctor, other than that which was chosen by the respondent, then, the treatment is unauthorized and will be deemed the sole expense of the employee. In as such, the nurse case manager of Horizon Casualty Services are authorized to assign the appropriate treating facility, authorizes all doctor’s visits, physical therapy, x-rays, diagnostic tests, surgical authorizations, rehab and recover, etc. The nurse case managers assigned to each case has the direct contact with the employee during the treatment process of the claim. They are required to follow the medical treatment protocol, making sure that all appropriate guidelines are followed to insure adequate medical treatment for the injured body part(s).