New Jersey Attorney Assisting Injured Workers With Complex Claims

When an employee is injured or becomes ill during the scope of employment, they may file a claim for benefits. While there must be some connection between the injury/illness and the employee’s job, the fact that the employee had a preexisting condition does not necessarily preclude receiving workers’ compensation benefits. 

Cases involving the aggravation of pre-existing conditions often fall into the category of “complex claims.” Their complexity stems, at least in part, from the detailed research that must be done to connect the pre-existing condition to the workplace injury. Daniel Santarsiero, Esq. is a complex claims lawyer with over 30 years of experience helping the people of New Jersey get the benefits that are rightfully due to them. 

Our office will be glad to explain your legal rights in such a situation if you have recently been injured on the job. Call (934) 200-5372 or contact us online today.

Claims Based on an Aggravation or Exacerbation of a Preexisting Condition

Workers’ compensation is a mandatory program covering almost all employees and employers in New Jersey. Unlike situations involving traditional health insurance coverage, in which a preexisting condition may be a legitimate reason for denial of a claim, employers are said to take employees “as they find them.” 

This means that if an employee has a preexisting condition and something happens at work that worsens this condition, the employer can be held responsible for paying workers’ compensation benefits to the employee. This is true even if a different worker who did not have a preexisting condition might have had a better outcome from the same accident or injury.

Having a preexisting condition such as back pain, an old knee injury from high school sports, or a respiratory illness can add layers of complexity to a workers’ compensation claim. However, that complexity need not prevent an injured worker from being eligible for benefits like paid medical care, temporary total disability benefits, or permanent total disability benefits. 

The employer and its workers’ compensation insurance carrier may argue that the employee’s preexisting condition is the sole source of the injury or illness from which he or she suffers. Still, it is ultimately up to an administrative law judge to determine whether a certain claim is compensable under New Jersey law. 

In order to pursue a claim for workers’ compensation benefits, the injured worker must give notice of his or her injury within a certain time period, or else his or her legal rights may be jeopardized. The employer should then fill out the necessary paperwork in order to report the injury to the state workers’ compensation department and make sure that the employee gets the medical treatment that is necessary under the circumstances. The employer’s workers’ compensation insurance company should be financially responsible for this medical care rather than the employee’s health insurance carrier.

If the employee is unable to work for a period of time, he or she may also receive temporary disability payments. If the worker is left with permanent vocational impairment as a result of aggravation or exacerbation of a preexisting condition, he or she may also be entitled to a monetary award for a permanent disability. The amount of compensation that an employee ultimately receives depends upon, among other things, the employee’s wage at the time of the injury, the part of his or her body that was injured, and the physical impairment rating assigned to him or her by the treating physician.