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NJ Workers Comp Question
(12-03-2017, 08:37 PM)bugmann Wrote: [quote pid='166224' dateline='1511790237']
[i]Hi MCATS,[/i]
TO take a break from the seriousness of this discussion please visit 


for a smile as Im sure you can appreciate this cats adventurous take on getting fed ASAP in the AM along with some loving. I've been a kitty guy all my life, sadly I just lost my 19 yr old Russian Blue who was a gift to me when I learned I woul be disabled for a long while. I have never had a kitty so dedicated to being with me than "ACHOO" I miss him very much. I have a rescued Russian Blue from a house fire. The people whose house was totaled just picked up and left. "GARTH VADER" aka "BOB" was living on garbage for several weeks until I found him, and got him to my Vet to be sure he would not get my British short hair "Blue" sick. So I now have 2 BLUE'S but both are rescues and have been through many terrible events and will take much love to get them back in the saddle, and Chumly has been to 5 homes in his 1st four years of his life and the old lady whom I got him from kept him locked in the bathroom as she preferred her dog more. But my wife was helping her with some private issues and one day, her kitty came right to me and he laid on my chest and when they were done I told the old lady I would take himnif she ever needed to find him a good home. At that time I new Achoo was on borrowed time but was assured he was not suffering. Dont you know it about 3 weeks passed and we got call to come get him. He has been a great addition to  my home and he knows when I am upset over some thing as he comes and lays on my chest and puts me to sleep and I wake feeling better?. He is Alfa male now that Achoo is gone.
Well I'd love to hear your kitty story, if you want to share.
OK now lets get to the point on your Hubby's pending WC case
1) No Union contract on point is bad luck and poor economy and the aftershock of Reaganomics by breaking the Cal Air Traffic Control Union agreement, as this set the ball rolling to destroy most of the powerful unions ( Steelworkers, mine workers, auto workers etc... Having a contract on point would have set the rules in black and white with no grey area as in NJWC Law/  Rules. Then it wouldn't be so bad dealing with the carrier.  
 2) These IME's where most likely at the carriers request so they can pick and chose from each report what thy will use as evidence in the final hearing ( should it go that far) Most JUDGES of WC Court encourage settlements over trial, but like anything every profession has their good and bad employees, I imagine this includes JUDGES. Certainly  the expert Drs are all paid millions of $$ each year to minimize the liability of the carrier, these Drs are WELL EDUCATED, top of their class and field, of expertise.  Its shocking to read their written reports when you know how hurt your Hubby is and how he was prior to this injury. The only expert Drs you have are the ones you had to pay for in advance b4 your exam. Also any FCE exams, that display no inappropriate illness behavior that is in line with your Dr reports will be very valueable            
3) The 9538.00 of Temporary Disability monies receives must be from the State Temporary Fund it is set up for non work injuries  but  must be paid back to avoid whats called double dipping. Which means Hubby was paid by 2 insurances for the same time period and same injury, because when when the smoke clears NJM will have also paid Hubby for the same time period in which he got NJ State Temp Disability. Nj is 1 of less then 10 states with such a benefit!! For this reason there is a lien on your award for repayment of this amount. I doubt the ins co will be repaying this lien as you received it and the ins co will be liable for all payments owed to you of your ACE amount ( the amount equal to the TTD benefits you received in the very beginning)  the ins will pick up from the day after you where deemed MMI. With this said you will have been paid 2x for same injury and time period and thats double dipping and is a NoNo in Nj ☹.  I cant imagine what your lawyer was thinking to say that, unless you miss understood his words which is easy as everyone is trying hard to absorb what is being said and your both "pumped up"
Its more likely your lawyer was referring to his service fees as it is common for Judges to make carrier's pay all or most of your lawyers fees?? 
Should your Husband be found totally disabled not 100% impaired as he would need to be a vegetable for a 100% impairment. The employer will only be responsible for the impairment rating due to the injury sustained at work.
In order to get SIF it is imperative that you be open and honest with your lawyer about Hubbys past medical issues, including mental disorders like anxiety, depression, personality orders etc as this is the easily tied together with failed back syndrome.
I dont have any information of Hubby's back condition but if he has limited prolong sit/stand/walking & no pushing pulling or climbing then I would say his work injury is a major contribute  to his total disability. Nor do I have his medical history where I may evaluate how his past conditions effect his back today?? 
Honestly your lawyer has been seeing the carriers lawyer and the JUDGE about every 3-4 weeks as this case has been in rotation since MMI. Rotation is the cycle of which every pending WC claim goes through so the JUDGE knows where the case is going and insists on settlement over trials.
Any payments ordered are only until your hubby can return to work not for te rest of his life. He will have reveiws from SSDI and it tells you on the Award Letter when to expect this review. SSA's reviews go from 2- 7 yrs depending on the likely hood of improvement. Also the ins co is permitted to give hubby exams whenever they feel one is going to show improvement. They can do this yearly if they want to be a pain in your a___.
My best advice is to move out of nj IF ITS POSSIBLE. I say this because once in a different State that States rules applies.  I moved to PA where  IW are protected from jerks like in NJ who send you to job training because your Dr didnt write you are permanently and totally disabled in his requested report. Many Drs dont like to predict the future by stating in writing permanently and totally as some claimants think because they moved no one is watching them, this is UNTRUE!! Then the investigator gets the IW on video moving a piano and take the tape to the dr who then feels like he has been taken. IT         HAPPENS TO ALL Dr's for IW. So when you get the request for an exam the form you give 2 the Dr has all required information the ins co wants. So when it comes to are your totally and permanently disabled ask him to put at this time you conclude the patient is totally and permanently disabled at this time. This works well as it protects the Dr and gives the ins what they asked for, If you remain in NJ any flaw in your Drs report  can send you to job retraining      to see if you qualify.  If your in PA all you need is to be under the care of a Dr for work injury and that ends that.
AS said dont worry about the acting lawyer playing dumb in court your last hearing. The JUDGE has seen this act b4, and it works to help you.  remember its CREDIBILITY  THAT MATTERS MOST AT THIS POINT OF THE GAME.
Yes the carrier can change their position on total disability, but the JUDGE reserves his decision till the very end.
The ins co is getting you all uptight thus leaving you open for mistakes dont fall for their tricks

 Please don't worry just prepare yourself for each step and 4 sure I'll be here to here 2 help u all the way.;


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!

(12-04-2017, 11:26 AM)mcats Wrote: MCATS.

Please 4give me for not answering all your questions directly, I had a long BAD day and I let my personal side get the better of me, but its also important to know you have moral support as well as the world is much to light on that these days.

Its very hard to say why your Hubby must be present on the next hearing date. YES it seems appropriate at this point for your Hubby to tell the court how devastating this work injury has effected all aspects of his life more so his ability to work,but the Judge needs to hear how it effects your relationship with your husband, DO NOT HOLD ANYTHING BACK!!!! I know its hard to swallow ones pride but just look how the carriers has handled their end, they have no shame all you need to do is put it aside for that day. If you are getting my entire drift please PM me and I will explain clearly   You must always believe you are being watched each and every time you exit your home.As one reason to be summoned is the insurance carrier has footage in conflict with your reports of pain and lack of activity  or restrictions??? That would be the worst case scenario the best would be this is your final hearing and he must be present to understand his award.

If you ever need help with meds get a Good RX,com card and go to the site for right now coupons until your card arrives. Also AAA membership card has med discounts worth mentioning.  Cobra cost are ridiculous.

I hope this is more on point as to what you were asking. You are a very friendly considerate woman who loves her husband. I really admire this in you. Its sickening how many females walk away from their marriage 

The SIF structure is a solid payment plan. You guys will not be wealthy but you should be able to get by fairly well as long as your work provides health ins.  For some reason it appears your lawyer doesnt feel comfortable going for SIF??? Due to past hearings. Well if the insurance is liable its up to the JUDGE  as to the extent. The law is fairly "Grey" when the SIF is not involved with the total disability of the IW. You may get just the impairment rating that was caused by the work injury less any additional damage done by the car accident, however if the agreement b4 the JUDGE was made for total disability (which is the most you may receive) B4 the accident then the accident is moot as there is no more than total disability available in "WC Court," and if your lawyer is shrewd, and if lawful, after the WC ruling is made then the accident may be another avenue, in a circuit court  possible 4 u.

The part I disliked about my lawyer, whom was a well known expert, to every lawyer I spoke to, was he never returned calls, not until I began asking his secretary to get the answers to my carefully worded questions did I begin to get any ideas what was up. What I did learn was dont do anything involving your case if it will not advance it, these are words to live by

The only way I see you not committing double dipping is if you pay the lien in full out of your award, but the JUDGE may force the carrier to pay all of your legal fees, which will be much more than that lien. Smile 

Why its so important to tell your lawyer of ALL INJURIES and/or conditions is thats how they can establish why your hubby had failed back Syndrome after all his care.  For example many mental health conditions can and do prevent the spine from healing such as severe anxiety as how can anyone heal when as each day passes all they do is get more uptight over what happened to his livelihood, his ability to take care of you, I can go on and on but I think you see my point so there is NO SHAME in any personality disorders either as this aggravates any back/ neck injury. I got SIF from

You both are in my prayers and Im sure all will workout fairly as I feel you deserve that and I have been involved in 100's of total disability NJWC cases. Always be honest and truthful as CREDIBILITY IS ALL YOU HAVE IN COURT and now the seated JUDGE wants to see your sincerity.

Always here 4 u,


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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