Attorneys Joe Jones and Karen Vincent of the Lois Law Firm discuss appeals and reopeners of New Jersey workers’ compensation cases from the defense perspective.
Attorney Greg Lois discusses the availability of a lump-sum dismissal settlement in New Jersey Workers’ Compensation cases. The presentation looks at the limitations on this type of compromise in the statute (N.J.S.A. 34:15-20), the rules (N.J.A.C. 12:235-13.1) and the case law. Attorney Lois reviews the barriers to Section 20 settlements and presents practical advice and opinion on obtaining the dismissal in court. The discussion also include an overview of the Medicare Secondary Payer Act as a barrier to full compromise settlements in New Jersey, with practical tips for resolving cases quickly.
Subject: New Jersey, Workers’ Compensation Law, Exposure, Permanency, MMI
Date Presented: January 22, 2018
Presenter: Greg Lois
Run time: 34:34
Attorneys Karen Vincent and Greg Lois discuss the role of defense counsel in providing timely and accurate exposure analysis to clients. The attorneys discuss the “when” of providing an exposure analysis – when during the litigation lifecycle the attorney should be providing estimates of exposure and likelihood of prevailing at trial. The attorneys also discuss the “how” of exposure – how estimates of permanent disability are made. This webinar presentation is a must-watch for risk professionals and adjusters relying on outside counsel to provide exposure analysis.
Title: “Evaluating Claims for Exposure in New Jersey (Permanency).”
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The presentation is in two parts: first, a fifteen-minute introduction to a specific topic in New Jersey workers’ compensation (focusing on practical claims-handling), and then an open “question and answer session” (Q&A is not limited to the topic). These webinars are perfect for your team members who need state-specific training or a refresher course for these jurisdictions. Participants can join by computer or can call in and listen on the conference line (no computer needed).
About one-in-five of the new cases filed in the New Jersey Division of Workers’ Compensation this year will be a “re-opener” claim. Formally called an “Application to Review or Modify a Formal Award” or “Application for Modification of Agreement” as per N.J.S.A. 34:15-27, these claims are brought by petitioners who allege that they have a need for treatment, have new lost time, or have an increase in the amount of permanent partial disability.
What types of cases are eligible for “Re-Opener?”
Compensable workers’ compensation claims are often resolved by way of an “Order Approving Settlement.” Such a settlement requires the employer/respondent to continue providing medical treatment for the injuries described on the Order Approving Settlement. In addition, a claimant has the right to “re-open” her claim for a period of two years from last compensation paid. Additionally, claims resolved by way of Judgment (award following litigation) are subject to re-opening by the petitioner.
As per the statute:
A formal award, determination and rule for judgment or order approving settlement may be reviewed within 2 years from the date when the injured person last received a payment upon the application of either party on the ground that the incapacity of the injured employee has subsequently increased. Continue reading “Re-Opener” Awards in New Jersey
What does the petitioner have to pay back when a settlement is reached in a New Jersey workers’ compensation case?
Has to be paid back: State Disability
Any petitioner’s award is offset by any amounts paid to the petitioner by State Disability as provided by N.J.S.A. 34:15-57.1. Temporary disability paid by the state for injuries later deemed compensable or settled via Section 20 must be reimbursed to the state. Before settling a case, counsel should be expected to investigate all outstanding liens. The New Jersey workers’ compensation law judge can provide the parties with the amount of the State temporary disability lien at the time of settlement.
Has to be paid back: Health Insurance
By the very terms of the Act, workers’ compensation insurance is primary to medical insurance. Therefore, any amounts paid on behalf of the petitioner for treatment deemed by a judge “reasonable and necessary” to cure the petitioner of the effects of the work-related accident, can be collected by the health insurer at the time of settlement, or later. Recent case law instructs that even matters disposed of pursuant to Section 20 may not extinguish a health insurer’s lien. Continue reading Settlements in New Jersey: What gets deducted?