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NJ Workers Comp Question
#1
My husband is nearing the end of his WC claim. Injured in 2013, he was an HVAC tech with pre-existing health issues (heart, diabetes). Fell, injured his lower back and had 3 surgeries for rotator cuff, and torn bicep muscles in each arm. Suffered a Pulmonary Embolism after 2nd surgery. (Never had a PE before) He reached his MMI in June 2015 and hasn't been paid since. He is collecting SSDI since Dec 2015. He was also in a car accident in July 2014, which aggravated his lower back issues requiring a partial Discectomy which resulted in drop foot, so that has complicated things.

Long story short (if that's possible) our Lawyer had a hearing with the judge 2 months ago where it was determined my husband will be getting 100% disability and NJM will be responsible to pay him for the rest of his life. No amounts were discussed regarding payments or back pay settlement and the insurance company was advised to get that authority at the end of the last hearing. All that was decided then is- who was going to pay. We were told that when they get in front of the judge at the next hearing, he will sort it out and it should be done then. We were told that the Insurance Carrier can agree, but hide behind the fact that they have to get authority and the Judge is used to that happening.

Fast forward to yesterday at the next hearing - NJM sends a different lawyer in who isn't aware of the decisions that were made at the last meeting and is now asking for an extension. Seems she had more questions regarding his PE history The judge granted extension for 3 weeks from now but now wants my husband to appear at that hearing

Is this normal? Can they reverse their decision regarding total disability after the next hearing?


So frustrated and worried.
If anyone can provide any other information please let me know. Thank you so much for any assistance!
 
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#2
Was it a decision of the court? Formally issued in writing to all parties? Or just an " off the record" opinion of the judge to the parties as part of a side conversation as to what they were thinking at the time?
Unless the prior opinion of the judge was a formal written decision issued by the court with time to appeal then yes, they can change their thinking any time- especially when there is new evidence.
They can also charge their decision when an appeals court sends it back down to them with specific instructions about how the law is to be applied.
"Footer/signature" used in all my posts:
........Each state has their own comp system. We need to know your state to provide accurate information.........
 
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#3
glad we were able to help.
thankx for posting.
"Footer/signature" used in all my posts:
........Each state has their own comp system. We need to know your state to provide accurate information.........
 
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#4
(11-27-2017, 12:24 PM)1171 Wrote: Was it a decision of the court? Formally issued in writing to all parties? Or just an " off the record" opinion of the judge to the parties as part of a side conversation as to what they were thinking at the time?
Unless the prior opinion of the judge was a formal written decision issued by the court with time to appeal then yes, they can change their thinking any time- especially when there is new evidence.
They can also charge their decision when an appeals court sends it back down to them with specific instructions about how the law is to be applied.

This was probably off the record because we have no formal written decision.
Our attorney needs to come back with additional medical records on the PE's and we're waiting for a court date for my husband to appear.
The medical records have been available all along and the PEs shouldn't be "new evidence" I don't know why this is coming up now or why my husband has to appear. Is the court appearance for my husband common?
Our attorney has a good reputation but is a lousy communicator.
 
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#5
They probably want his testimony on the record before issuing the formal award of benefits.
It's common to have the worker testify at the final hearing.
"Footer/signature" used in all my posts:
........Each state has their own comp system. We need to know your state to provide accurate information.........
 
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#6
(11-30-2017, 01:09 PM)1171 Wrote: They probably want his testimony on the record before issuing the formal award of benefits.
It's common to have the worker testify at the final hearing.

Thank you for your replies!
 
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#7
you're welcome.
P.S. attys seem to do a better job when they are in front of a client.
"Footer/signature" used in all my posts:
........Each state has their own comp system. We need to know your state to provide accurate information.........
 
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#8
(11-27-2017, 09:43 AM)mcats Wrote: Hello MCATS,

The 1st thing I need to know was your hubby working under a work agreement, ie.. Union contract that includes work injury? If so that contract supersedes the min. requirements under NJWC rules and Laws.

As long as your Hubby is receiving SSDI and your lawyer filed for 2nd Injury Benefits which he appears to be eligible due to his prior health disorders. NJM would be neglectful to their company to not force your hubby to file for 2nd Injury Funds if he didn't do so, as this saves NJM much of the liability and its pretty much the gold standard in NJ o total disability claims with prior heath conditions that equal at least 1% impairment in the ratings phase. 

The only hearing your hubby should need to be present for is the final hearing where is the JUDGE of WC will make sure he understands his benefits.  I will explain how the amount is figured.

Did your hubby see Drs for the State of NJ? Many are shrinks? They are seeking any kind of inappropriate illness behavior that may be displayed by your husband.

After seeing the rating's Drs for physical injury both the carrier and your lawyer's Dr's  and winning a determination of a period of Total Disability from the SSA which is a very high burden to prove total disability. Then the States 2nd Injury Drs begin their exams  and there can be many. I had about 12 of them myself.

The statement made that " We were told that the Insurance Carrier can agree, but hide behind the fact that they have to get authority and the Judge is used to that happening."   is a load of crap in any total disability hearing for 2nd Injury Benefits. It just doesnt work this way but it is true that the seated WC JUDGE does have the final word in all cases. This is why hiring a WC total disability expert as your lawyer is imperative!!!!

Yes its sad but true that carriers try to wear you down with delays and the law permits this as NJ is the most employer friendly State in our Nation. However considering how far you have gotten I am impressed. Yes I am aware of the countless weeks without income, but you did have options and I could have advised you where to seek help during this period.

If you hubby has not filed for 2nd Injury he MUST ask his lawyer WHY!!!!!  It is not advised to remain under the thumb of any NJWC carrier as they can and will stop paying just to make you  file motions then begin paying again its a cat and mouse or MICKEY MOUSE SHOW!!!

The different lawyer who went to court was well aware of all events but played dumb to get a postponement they are very good at this, as you have seen, and you will see again!

OK if Hubby filed for 2nd Injury Fund and gets approved which I see no issue stopping him other than an incompetent lawyer that you may have hired?  So if Hubby gets approved for the 2nd Injury Fund how this works is every week since he was deemed MMI by the treating Dr he will receive the amount = to what he received while out on TTD in the very beginning or his ACE amount as long as he made below the max amount allowed if he did make more then he gets the max allowed I can get figured for you if I knew what year he got hurt?So you add up all the past weeks that you stopped getting TTD and this is your 1st award check less the 20% of fees the lawyer takes from you off the top till Hubby turns 65. NJ is a reverse offset state meaning he gets all of his SS and WC/SIF make up the rest till they reach ACE amount. When he is 65 SSDI converts to SSR (retirement) at the same rate of pay but the SIF can no longer deduct his SS because it is no longer disability $$ so I understand he will get his retirement SS and his full ACE after 65 till death. It was just 62 but they change it recently here is the SS law on point///

 https://secure.ssa.gov/poms.nsf/lnx/0452120165

new law on payments

https://secure.ssa.gov/poms.nsf/lnx/0452101005

Im sorry for not checking in for so long but my health has been better and my wife lost her job and health ins. I had to get a Medicare plan and let me tell you they ALL stink!!! It takes alot of nerve for Trump to take $$ away from Medicare to give to himself and his wealthy buddies. I think he holds the record for company bankruptcy filings that we also paid for to make him the billionaire he is, and his arrogant remark is "thats why I'm smart". No that why he is an arrogant ugly to the bone person. A person is JUDGE by how he treats the weakest he meets, well since he NEVER comes into my neighborhood, he never will meet some hurting folks who are more considerate to others than he could ever be to his own wife.

Im sorry for a political opinion but its hard to avoid since WC is so political in nature. I will make it a point to check in 3-4 X a week to see how you are and if you have any questions you want answered. You may have seen me on other NJWC help sites if so you should be aware of the reputation I have earn in taking every case like it were my own. I have been through all NJWC hoops and have been studying NJWC law for years as its the only way I can keep sane after all NJWC did to me. You wont believe what some employers will do to avoid WC liability including crippling a worker by changing no work notes by non examining Drs!!! made 10mins after being examined by the treating WC DR who wrote NO WORK TILL FOLLOW UP. But my mgr again called a non examining DR to change my status   Then threaten my job if I dont comply with the changes she made. I need and loved my work so against my better Judgement I went thinking they are Drs so they know best? Never did I think they would take $$ to go against the oath they took but its MILLIONS!! So Im here trying to help the little guy as I needed what I am doing now to keep my sanity while I did the system with just my GF, whom is now my wife of 20 yrs.

I just take this subject very seriously and want you to know I treat your case as if it were mine.

Are you a kitty person if so I have some very cute for you. Please call me Bug for now.

I hope to hear from you in the very near future

BUG    



My husband is nearing the end of his WC claim. Injured in 2013, he was an HVAC tech with pre-existing health issues (heart, diabetes). Fell, injured his lower back and had 3 surgeries for rotator cuff, and torn bicep muscles in each arm. Suffered a Pulmonary Embolism after 2nd surgery. (Never had a PE before) He reached his MMI in June 2015 and hasn't been paid since. He is collecting SSDI since Dec 2015. He was also in a car accident in July 2014, which aggravated his lower back issues requiring a partial Discectomy which resulted in drop foot, so that has complicated things.

Long story short (if that's possible) our Lawyer had a hearing with the judge 2 months ago where it was determined my husband will be getting 100% disability and NJM will be responsible to pay him for the rest of his life. No amounts were discussed regarding payments or back pay settlement and the insurance company was advised to get that authority at the end of the last hearing. All that was decided then is- who was going to pay. We were told that when they get in front of the judge at the next hearing, he will sort it out and it should be done then. We were told that the Insurance Carrier can agree, but hide behind the fact that they have to get authority and the Judge is used to that happening.

Fast forward to yesterday at the next hearing - NJM sends a different lawyer in who isn't aware of the decisions that were made at the last meeting and is now asking for an extension. Seems she had more questions regarding his PE history The judge granted extension for 3 weeks from now but now wants my husband to appear at that hearing

Is this normal? Can they reverse their decision regarding total disability after the next hearing?


So frustrated and worried.
If anyone can provide any other information please let me know. Thank you so much for any assistance!
 
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#9
Thank you Bug! Yes I am a cat person. I have many in my life!!

#1 - My husband was not under a Union contract. He was injured June/2013
#2 - My husband has been to quite a few IMEs ( I assume they are the State drs you refer to. Whether they were shrinks as well I don't know)
#3 -My husband did receive Temporary Disability of $9538 after workers comp stopped paying in June 2015
Our lawyer did inform us that if it is found that my husband should have been getting Worker's comp instead, that we would have to get the insurer to pay a portion or all of this lien.

I actually understand the payment structure if he wins for SIF. My main concern is why he is appearing before the WC Judge and if we are going after the SIF. Wouldn't NJM make our lawyer go that route?


re. SIF: We did initially provide a list of all prior injuries and conditions and all his prior hospitals for records that was put into a petition over 1 year ago. Lawyer had a discussion with the Judge and the attorney from the state (on fund filing) about how much of my husband's past was involved in him now being totally disabled. They agreed that it was all due to the injuries he received from this worker’s compensation fall. At the last hearing the attorney from NJM backed out on the understanding and we now have to have my husband come in and testify about these injuries and how they have kept him from working into the future. The 2nd injury fund is taking the position that NONE of his prior conditions or injuries were contributory to his present state of total disability. If the Judge at his testimony decides differently, then the 2nd injury fund may be back in the case. So, my husband is protected either way, if the Judge decides against NJM totally or if she does not, then the 2nd injury fund will have to explain why any of his prior conditions are not disabling, but either way the lawyer feels the chances for my husband to be decreed totally disabled are promising.

Does this sound about right?
What if NJM is found responsible - are payments structured the same as SIF?

On another note, I totally sympathize with your personal situation. I too lost my job in June and went through all kinds of hoops trying to find a solution for health insurance. I found my Cobra was going to be the way to go, since I needed Prescription for my husband more than anything (since he has Medicare with SSD) We would have been in the "donut hole" the first month. Insulin and Blood thinner medications he's on alone would have been $5000/month. Disgusting. I was fortunate to have found a job in 2.5 months that offered me full health insurance immediately. Never ended up paying for Cobra, so I am sooo grateful.

I wish you well and look forward to any other information you can provide.

We have a meeting with our lawyer on 12/21 which I'm hoping means he has a court date soon after.
 
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#10
*Deleted* See previous post
 
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