N.J.A.C.  13:75-1.32  Catastrophic claims back to beginning
  1. The Board may make one or more supplemental awards for the purpose of providing rehabilitative assistance and services to catastrophically injured crime victims determined eligible for compensation within provisions set by this   section, notwithstanding the fact that said payments may, in the aggregate,  exceed the statutory maximum award as provided by N.J.A.C. 13:75-1.7(g). 

    1. A catastrophically injured crime victim who received a compensation award prior to July 15, 1999  is eligible for supplemental compensation as provided in this section. 
    2. Compensation under this section may be awarded in lump sum or periodic payments, however, any compensation awarded shall not exceed the actual cost of the rehabilitative service(s) enumerated in (c) below.
    3. Compensation under this section shall be awarded solely for rehabilitative services which are those services restorative in nature commensurate with the medical needs of the victim and prescribed by a licensed medical provider to correct or substantially modify a crime related physical or mental condition which is a significant impediment to the victim's ability to interact with others and carry on the victim's normal functions of life.   

       i. The rehabilitative service must be reasonably expected to eliminate or reduce such impediment and to promote or facilitate the accomplishment of long term rehabilitation goals and intermediate rehabilitation objectives.  

      ii.  Expenses incurred in an Emergency Room or medical facility where remedial, acute and recuperative care is required immediately subsequent to or shortly after the crime victimization forming the basis of a claim for compensation before the Board, unless shown to be a rehabilitative service as defined in this section, are excluded from supplemental catastrophic compensation even though the victim may have been determined to be a catastrophically injured crime victim.  

  2. Compensation for rehabilitative services includes those services not covered by other sources as defined by N.J.A.C. 13:75-1.19. 
  3. A denial of an application for compensation made pursuant to this section shall not be subject to appeal. 
  4. The burden of proof is upon the victim and/or claimant to prove and establish, by a preponderance of the credible evidence, eligibility for compensation as a catastrophically injured crime victim.  Speculation and conjecture as to a potential increase in disability, mere loss of earnings, cumulative injuries minor in nature and, among other things, subjective statements of the victim without a demonstration of catastrophic injury by way of objective medical evidence and professional medical analysis is not sufficient to meet the burden of proof. 
    1. The Board may order the examination of an injured victim and a report, thereon, from an impartial medical expert, if necessary, prior to a determination of eligibility under this section and periodically, as it deems appropriate, for the continued award of compensation to a catastrophically injured crime victim. 
    2. In order to reaffirm and verify eligibility for compensation, the victim and/or claimant shall annually submit in writing a request to the Board for continuance of catastrophic compensation together with a report demonstrating objective medical evidence and professional medical analysis of catastrophic crime related injury.  The expense incurred in securing said report shall be reimbursed by the Board as if prepared by an impartial medical expert.
  5. A catastrophically injured crime victim is a person who has sustained a severe long term or life long personal injury as a direct result of the offenses specified as compensable pursuant to N.J.S.A 52:4B-11.  Supplemental catastrophic crime victim compensation to secondary victims as defined by N.J.A.C. 13:75-1.28 is excluded.  

    1. In determining whether the personal injury is catastrophic so as to be eligible for compensation under this section, the Board shall take into consideration all of the following factors: 
      1. whether the victim has suffered significant and sustained reduction in the former function of mental and physical  abilities which dramatically alters the victim's ability to interact with others and to carry on the normal functions of life; 
      2. whether there has been a lessening to a material degree of a victim's working ability; 
      3. whether there has been a physical or neurophysical impairment where no fundamental or marked improvement in the victim's crime related condition can be reasonably expected; 
      4. the severity and debilitating nature of the personal injury including, but not limited to, conditions such as quadraplegia, paraplegia, loss of sight in both eyes, loss of hearing in both ears and amputation of a major portion of an extremity;
      5. whether the injury is permanent or long term. 

        vi. whether an extreme medical risk exist which substantially increases functional impairment or risk of death if the medical services are not provided expeditiously. 

      6. Where a victim is receiving benefits as a result of being determined permanently disabled pursuant to the provisions of 42 U.S.C. 1381, et. seq. as a result of a crime forming the basis of an application for crime victim compensation before the Board, there will a presumption that said victim is a catastrophically injured crime victim.  However, the victim shall submit to the Board a copy of the determination of permanent disability of the Social Security Administration and supportive medical documentation.
    2. The Board shall award compensation not to exceed the monetary cap established in this section and in (e) below where it deems the rehabilitative service(s) to be reasonable and [necessary] medically necessary as evidenced by written prescription for the service by a provider of medical service(s) licensed in this state or in a foreign state where the victim might receive the service(s).  In determining the amounts of compensation the Board and the provider of medical service(s) shall be guided by the maximum rates and service limitations for reimbursement for medical and medical related expenses established by the Board pursuant to N.J.S.A. 52:4B-9.  Compensation for loss of earning, loss of support, property damage, living expenses such as food, shelter and clothing necessitated by the victim's medical condition, expenses incurred for vocational training services and continuing education in educational institutions and pain and suffering is excluded.  Services for which compensation may be awarded include, but are not limited to, the following: 

      1. Surgical and therapeutic procedures; 
      2. Rehabilitative physical and occupational therapy designed to restore an optimum function level; however, the Board shall award no compensation for chiropractic services for a period of greater than 90 visitations for treatments and visits.  Where a direct catastrophic victim has been compensated for or attended more than 90 such visitations as of the date that victim has been determined eligible for catastrophic compensation, the Board shall award no compensation for chiropractic services for an additional period greater than 30 sessions.