The workers' compensation policy (Part One statutory benefits, Part Two employers liability, Part Three other-states coverage) and the general principles of no-fault benefits and exclusive remedy are covered in the national Workers' Compensation guide. This guide covers the New Jersey Workers' Compensation Act (N.J.S.A. 34:15): who must insure and how, how rates are set, the benefit amounts and deadlines, and the special funds.

Who must provide coverage

• Every employer must provide for payment of compensation, except the state, a municipality, a county or a school district (N.J.S.A. 34:15-71).
• Coverage is bought from a stock or mutual insurer authorized to write workers' compensation in New Jersey. An employer that proves its financial ability to the Commissioner of Banking and Insurance may be exempted by written order to self-insure (N.J.S.A. 34:15-71, -77).
• Employees include all people, corporate officers included, who work for pay. Federal longshore workers and casual employment are excluded (N.J.S.A. 34:15-36).
• Sole proprietors, partners and LLC members who actively work in the business are covered only if the business elects to cover them when it buys or renews the policy (N.J.S.A. 34:15-36).
• Household employees: homeowners and comprehensive personal liability policies must cover the policyholder's workers' compensation obligations to domestic servants and household employees (N.J.S.A. 17:36-5.29).
• No coverage: failing to insure is a disorderly persons offense, a fourth-degree crime if done knowingly, and can bring a stop-work order. A contractor that hires an uninsured subcontractor becomes liable for the subcontractor's employees' benefits (N.J.S.A. 34:15-79a).
• Employers pay the whole cost. Employees don't contribute.

How rates are set: CRIB

New Jersey workers' compensation is not a deregulated, competitively rated line.

• No insurer may write workers' compensation or employers liability in New Jersey unless it is a member of the Compensation Rating and Inspection Bureau (CRIB) (N.J.S.A. 34:15-90.1).
• CRIB sets the rules and premium rates (N.J.S.A. 34:15-90.2f), uses credits and debits to encourage safety (34:15-90.2h), and sets standards for payroll audits (34:15-90.2g).
• Workers' compensation is excluded from the commercial lines deregulation law (N.J.S.A. 17:29AA-3).
• Residual market: CRIB administers the New Jersey Workers' Compensation Insurance Plan. The Plan doesn't issue policies. It assigns employers who can't buy coverage normally to CRIB member insurers.
• The insurer files the first report of injury electronically with the Division through CRIB within three weeks of learning of the accident (N.J.S.A. 34:15-96).
• Cancellation: the insurer gives at least 10 days' written notice by registered mail and files a similar notice with the Commissioner. Cancellation takes effect 10 days after that filing (N.J.S.A. 34:15-81).

What's covered and what isn't

• Injuries must arise out of and in the course of employment (N.J.S.A. 34:15-1).
• Excluded: intentionally self-inflicted injury, injury caused by intoxication or unlawful drug use, willful failure to use required safety devices, and recreational activities that aren't a regular part of the job (N.J.S.A. 34:15-7).
• The old defenses of fellow-employee negligence and assumption of risk are abolished (N.J.S.A. 34:15-2).
• Exclusive remedy: when an injury is compensable, a co-worker can't be sued at common law except for an intentional wrong (N.J.S.A. 34:15-8). The worker can still sue a negligent third party, and the employer or insurer is reimbursed from that recovery (N.J.S.A. 34:15-40).
• Illegally employed minors receive double compensation. The employer pays the extra amount itself, and the insurer doesn't (N.J.S.A. 34:15-10).

Benefits

Deadlines

• Notice to the employer: within 14 days to keep full rights. Late notice can be excused up to 30 or 90 days, but no compensation is payable without notice or knowledge within 90 days (N.J.S.A. 34:15-17).
• Claim petition: within two years after the accident, or two years after the last compensation payment (N.J.S.A. 34:15-51).
• A worker who refuses an employer-requested medical exam loses compensation while the refusal continues (N.J.S.A. 34:15-19).
• A judge of compensation may approve a settlement as fair and just with the parties' consent (N.J.S.A. 34:15-20).

Special funds

• The Second Injury Fund pays a worker who becomes totally disabled from a work injury on top of an earlier, separate permanent partial disability (N.J.S.A. 34:15-95).
• The Workers' Compensation Security Fund pays claims when an insurer is insolvent. PLIGA administers it (N.J.S.A. 34:15-105). Workers' compensation claims aren't subject to PLIGA's $300,000 cap (N.J.S.A. 17:30A-8a(1)).

Interaction with temporary disability benefits

New Jersey's Temporary Disability Benefits program covers non-work disabilities. If a workers' compensation claim for temporary disability is contested and delayed, the worker can collect temporary disability benefits until compensation is paid. The fund or private plan is then reimbursed from the compensation (N.J.S.A. 43:21-30(b)(1)).

Common exam traps

• Rates come from CRIB, not from competitive filings. Every workers' compensation insurer must be a CRIB member.
• Public employers (the state, municipalities, counties and school districts) are the statutory exceptions to the duty to insure.
• Corporate officers are employees. Sole proprietors, partners and LLC members are covered only if the business elects it.
• 7-day waiting period, paid back if disability lasts more than 7 days. Medical care has no waiting period.
• 14 days to give notice to keep full rights, 90 days as the outside limit, and 2 years to file a claim.
• Minors employed illegally get double compensation, and the employer, not the insurer, pays the extra half.