Workers' Comp FAQs

Workers' Compensation Insurance FAQs for Injured Workers

What is workers' compensation insurance?

Workers' compensation is a state-mandated insurance program provided by your employer. It ensures that workers injured on the job receive appropriate, approved medical treatment, and lost wages for time out of work. To be eligible for these benefits, the injury must occur during work and result directly from the job duties as outlined by state law.

By cooperating fully with your employer, NJM and the treating physicians, you can be assured of appropriate medical treatment and prompt payment of your disability benefits.

What benefits are available through workers' compensation?

Workers' compensation provides reimbursement for lost wages and medical treatment according to guidelines that vary by state. Your claim representative will be able to answer your specific questions as they pertain to your claim and guide you accordingly. For additional state specific information, you can visit the following websites:

New Jersey - State of New Jersey Department of Labor and Workforce Development
Pennsylvania - Pennsylvania Department of Labor and Industry
New York - New York State Workers' Compensation Board
Maryland - Maryland Workers' Compensation Commission
Delaware - State of Delaware Division of Industrial Affairs
Connecticut - State of Connecticut Workers' Compensation Commission

What should I do if I suffer a work-related injury and need medical treatment?

If you suffer a work-related injury, notify your employer immediately to establish a claim and initiate medical treatment. Following these recommendations will help expedite your treatment and other benefits.

If you experience any issues reporting a claim, please contact NJM at 1-800-HELP-NJM (1-800-435-7656).

What are my responsibilities if I am unable to work?

If you are unable to work:
  • Update your employer.
    Keeping your employer updated on your recovery and work status will assist in a smooth transition back to work. Give a copy of the work note provided at each physician visit to your employer. This will allow them to accurately assess when there is a return to work opportunity. Your employer may be able to provide modified duty or light work until you can return to your regular job.
  • Communicate with your claim representative.
    Active communication with your claim representative helps appropriately direct treatment as outlined by your state laws. Your claim representative will also be able to answer any questions or concerns regarding all aspects of your claim. It's important to advise your claim representative of any medical updates or changes to your work status.
  • Follow your treatment and return to work plans.
    It's important to attend all scheduled appointments and follow any work restrictions set forth by your doctor to insure benefit eligibility.

When am I eligible for temporary disability benefits?

The length of time you must be out of work until you are eligible to receive compensation benefits for lost wages varies depending on predefined state guidelines. For additional information on the predefined waiting period by state and how your lost wage replacement is calculated, contact your claim representative. You may also visit your state’s website for more details:

New Jersey - State of New Jersey Department of Labor and Workforce Development
Pennsylvania - Pennsylvania Department of Labor and Industry
New York - New York State Workers' Compensation Board
Maryland - Maryland Workers' Compensation Commission
Delaware - State of Delaware Division of Industrial Affairs
Connecticut - State of Connecticut Workers' Compensation Commission

Are workers' compensation benefits taxable?

Workers' compensation benefits are not taxable at the state level. However, a portion of workers' compensation benefits may be taxable at the federal level for anyone who also receives Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI). If you have any other tax-related questions, you should contact a tax professional.

Should I tell my physician about my job functions/duties?

Yes, providing a detailed job description will assist your physician in determining the best course of treatment and your ability to return to work. In many instances, you may be able to resume work in a modified duty or light work capacity during your recovery.

What should I do if my workers' compensation physician releases me to modified duty or light work?

Modified duty or light work are transitional responsibilities that allow you to work with restriction while recovering from your work-related injury. If your physician releases you to modified duty or light work and your employer is able to accommodate the restrictions, the expectation is that you return to work. Not returning to work could jeopardize the wage replacement portion of your benefits. If your employer cannot accommodate the restrictions, your wage replacement benefits will continue until you are released to full duty or from medical care by your workers' compensation physician. Please consult your claim representative if you have any questions regarding modified duty or light work.

What should I do if I receive a prescription for medication from my workers' compensation physician?

NJM has an agreement with a major pharmaceutical vendor for prescription medications. If NJM determines the medication prescribed is authorized, your pharmacist will bill our prescription vendor directly, eliminating an out of pocket expense for you. You will receive a prescription card in the mail that you can present to your pharmacy.

More information and instructions regarding our pharmacy program is available here.

You may also contact your assigned claim representative or 1-800-HELP-NJM (1-800-435-7656) for assistance.

What should I do if I receive a medical bill from my provider?

If you receive a bill from your authorized physician or provider, you can mail it to our Billing Department.

NJM Insurance Group
Attn: Workers' Comp Billing
PO Box 928
301 Sullivan Way
West Trenton, NJ 08628.

Please print your claim number on the bill before sending it. In most cases, you are NOT responsible for paying any balance that may be due to your authorized treating physician.