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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.
My husband's work/health history has shown that after all of his health issues he has always returned to or been able to work.
A lot of people work with diabetes, the heart issues have been more serious but he still always went back to work.

We must have the same lawyer - having the same communications problems and he's supposed to be one of the best in NJ WC

Lawyer did have a conference with Insurance Company on Monday. He feels we are in a very good position. They have scheduled court for mid January, unless insurance company decides to settle this before then.

Lawyer says we should get back pay and other moneys in lump sum and payments for the rest of his life. I understand how back pay is figured out but How do they figure out additional lump sum $$? Is it based on type of injury and body part? He's had 3 surgeries as a result of WC injury and Pulmonary Embolisms after surgeries.
You and your husband can read about permanent partial benefits here
Your husband will have his permanent impairment rated by a physcian to determine the amount.
There is also an online calculator to help compute payments based on the percentage of disability for various body parts.
Reminder :
........Each state has their own comp system; POST YOUR STATE to get accurate information. Use the search feature to find information from similar questions.
(12-12-2017, 04:24 PM)mcats Wrote:   MCats,
  How are my favorite cat folks 2day? WelI, I hope.  Yes I understand Your husbands health permitted him to return to work after all his prior injury/illness. Thats not the point, it is the "combination" of these injury/illness along with his last work injury that is the issue for SIF. If your husband had even a mild form of anxiety/depression that by itself can be argued it exasperated his back injury to not allow him to heal, as with most back injuries much of he healing is state of mind (so says many experts???) That  is what I meant by: be complete and total release  of all prior conditions no matter how trivial it may seem at the time, even if it is embarrassing you must trust your choice in lawyer.  It does seem to late in the game to convince your lawyer to try SIF, as all they can say is no to his appeal with any new medical evidence?  In any event I feel the award will be substantial and you will be happy with your lawyers work, he has done fantastic to date.

I had said b4 I was impressed with your lawyers accomplishments and he appears to be WELL seasoned in total disability in work injury.  Your lawyer is on top of the game he has been handed it is the NJWC system itself that hinders the injured party from settlement(s)

The only way the ins co will settle sooner than court is if your lawyer is willing plea bargain for less to make it worth it to the ins co. It does not make sense for the ins to settle for total liability less the 3rd party liability.  So if asked to drop any litigation in the future  that would be a good reason to listen and follow advice to his/her letter.

If his only claim to total disability is his back pain there are 2 types of claims  scheduled and unscheduled  and partial total/ and partial  the best way to explain this is from an earlier post
If the worker's skills are limited, and his job imposes significant physical demands, the worker's attorney should advise the examining physician to evaluate the worker in light of these circumstances. A computer programmer with a severe leg injury will be less disabled than a floor tile installer with the same injury who possesses a limited education. The floor tile installer has to use his legs more to perform his job than a programmer who sits in a chair for most of the day. And if the tile installer's injury prevents him from performing manual labor in the future, he will find it much more difficult to get an office job than the computer programmer or some other college-educated worker. Of course, if the programmer injures a hand or wrist, or is afflicted by carpal tunnel syndrome, her ability to earn a living may be affected in a way comparable to a floor tile installer with an identical injury. Unless instructed otherwise, Petitioners' examining doctors often fail to note factors such as the nature of the Petitioner's job, and the Petitioner's level of skill, which is relevant to ability to earn a living in other fields if a Petitioner is totally disabled in a given occupation. In addition, where the worker has limited skill and job options, his attorney must stress these factors to the insurance company and the judge as well. 

The Respondent will also send the worker to an examining doctor or doctors. These doctors conduct examinations and set forth numbers representing estimates of the worker's disability. Doctors used by the employer will always give an estimate lower than the estimate provided by the worker's doctors. For instance, in the case of an unoperated herniated disc with minor nerve impingement, the worker's orthopedic expert may fix the worker's disability at 45% of partial/total disability.*(8)* The employer's orthopedic specialist may find a partial/total disability of 5%. Ultimately the case will, in all probability, be resolved at a figure in between these two estimates. 

The numbers used by examining doctors refer to charts published yearly by the New Jersey Division of Workers' Compensation. These charts assign dollar values to percentages of disability ranging form 1% to 100%. In the example just used, if the accident occurred in the year 2000,*(9)*5% of partial/total disability translates in dollars to $4,530.00, and 45% of partial/total disability translates to $92,000.*(10)* Different rates apply to different categories of injuries. A back injury is classified as "partial/total." This classification mandates a greater figure in dollars for any given percentage of disability than, for example, an injury to an arm or a leg. Whereas an award of 20% of partial/total is worth $19,536.00, an award of 20% partial disability for a leg is worth $9,513.00; 20% for a hand is worth $7,399.00; and for an ear, $1,812.00.

 Sch[i]eduled  injuries are listed each year on the NJWorkforce website  @[/i]
the charts for scheduled  injuries is at the bottom.  Unscheduled injuries such as your husbands back injury must be settled between the parties or at trial.   

Unless the surgeon or expert witness  for you can tie together the back surgeries and the  Pulmonary Embolisms they may be no part of the settlement. An MD I am NOT!!   But have learned much about back injury as the pain from mine is why I am totally disabled since 1994. I dont even want to get into the illnesses I have come down with due to my jobs toxins nor did I want to be some Drs experiment.

I also feel you and your husband will do fine in this matter, just remember its not your lawyer making things difficult for you, even if it seems that way, IT IS THE NJWC system itself being the most employer friendly system in our Nation.  You are a very bright woman and your husband is fortunate to have you in his corner just pay attention to everything like whqat is said and mostly what is not said, be honest and sincere to your JUDGE and remember your credibility is your finest asset.

i have AOL GOLD and they took my favorite sites and put them in alphabetical order and Im sure it will make things easier in the future but doing so without notice was mean as it took me 3 days just to find this page, and if not for the email sent early in DEc I may still be looking for you.

Anyway you will not get wealthy and I hope his palliative care cost are reasonable as the carrier is no responsible for this cost you are. Also if you stay in NJ I can be 99% certain the ins. carrier will hound you after a while and use the return to work rules on your husband to send him to job retraining. You may fined it wise to pack up and chalk up NJ as a learning tool and move to a state that protects the injured like PA as there as long as he is under a Drs care for his work injury he cant be released to any work function, and all of this liability rest on the ins carrier its going to cost them alot and will be willing to play dirty till the end. My best advice is start looking for an injured worker friendly state like PA to move to after this concludes

Wishing you both only the very best,


Good luck   and we are only a click away.   

My husband's work/health history has shown that after all of his health issues he has always returned to or been able to work.  
A lot of people work with diabetes, the heart issues have been more serious but he still always went back to work.

We must have the same lawyer - having the same communications problems and he's supposed to be one of the best in NJ WC

Lawyer did have a conference with Insurance Company on Monday.  He feels we are in a very good position.  They have scheduled court for mid January, unless insurance company decides to settle this before then.  

Lawyer says we should get back pay and other moneys in lump sum and payments for the rest of his life.  I understand how back pay is figured out but How do they figure out additional lump sum $$?  Is it based on type of injury and body part? He's had 3 surgeries as a result of WC injury and Pulmonary Embolisms after surgeries.
(11-30-2017, 12:36 PM)mcats Wrote:
(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.
Update: My husband had a court appearance scheduled for 12/11. He sat there most of the day but They said they wouldn't get to him that day because of the amount of time needed so they Re-scheduled for Monday 1/22. Lawyer hasn't heard from Insurance company or court to confirm the date. Insurance company hasn't returned any of our lawyers calls. Says we need to just show up in court.

Is this normal? Is the Judge going to keep giving extensions? No action has been requested from my husband.
Yes, the court will give extensions when needed.
Either party can object to an extension.
Litigation often involves delays.
Reminder :
........Each state has their own comp system; POST YOUR STATE to get accurate information. Use the search feature to find information from similar questions.
(01-17-2018, 05:56 PM)1171 Wrote: Yes, the court will give extensions when needed.
Either party can object to an extension.
Litigation often involves delays.

Just wanted to update you on the latest fiasco.
Husband went to court yesterday. They pushed him back to 1:30. They get into court, my husbands ready to testify. At this time the insurance company lawyer says she has to take her son to the DMV at 2:45. She tried to get out of the appointment & couldn't. Our lawyer did not want to proceed and get partially thru it and have to come back another day. Seems the State attorneys were there as well and were arguing with the judge regarding the last minute notice of this appointment and the delay.
They had been there all day as well, for nothing.

The Judge granted the delay - now we go back in 3 weeks.
The State obviously is still involved, why would their lawyers be there? Why would the Judge grant this request to the attorney to delay yet again?

So frustrated.

if the judge allowed the testimony without opposing counsel present, it's likely the decision would be overturned on appeal.
there will be more delays before litigation is complete.
This is how the process works in every jurisdiction.
Reminder :
........Each state has their own comp system; POST YOUR STATE to get accurate information. Use the search feature to find information from similar questions.

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