The Cintron Firm, LLC Blog

Workers’ Compensation Fraud in New Jersey

March 19, 2025 by The Cintron Firm

What Is It? How Can You Avoid the Risk of Allegations of Fraud?

Like all other states, New Jersey has workers’ compensation laws that provide benefits to individuals who are injured during the course of employment. There are only two requirements to qualify in New Jersey: you must be injured and your injury must be work-related. If there’s evidence that your injuries were suffered outside of the job, you face not only the denial of benefits, but you could be charged with workers’ compensation fraud. What is workers’ compensation fraud? What steps can you take to minimize the risk that you’ll be accused of fraud?

What Is Workers’ Compensation Fraud?

Both employees and employers can be guilty of workers’ comp fraud in New Jersey. A worker who makes a false statement or a misrepresentation of material fact in an attempt to collect workers’ compensation benefits may be committing fraud. In addition, an employer who either misclassifies employees or misrepresents payroll can be charged with fraud. In this blog, we’ll look only at the potential responsibility of employees.

In New Jersey, workers’ comp fraud is specifically addressed by statute. The New Jersey Workers’ Compensation Law makes it a fourth-degree criminal offense for a worker to make a “false or misleading statement, representation or submission concerning any fact that is material” to a workers’ compensation claim. Specifically, an employee may engage in fraud by:

Making false statements about prior injuries or treatment
Intentionally or knowingly making false statements about their medical condition in an attempt to get workers’ compensation benefits
Filing a workers’ compensation claim for an injury that is unrelated to their job
Making a false statement about their employment status while collecting workers’ compensation benefits (i.e., working for pay elsewhere while collecting workers’ comp payments)

How Can You Avoid Potential Allegations of Workers’ Comp Fraud?

In the aftermath of a work-related injury, you want to seek immediate medical attention, and you want doctors and nurses to fully document your injuries. In addition, you want to obtain statements from as many witnesses as possible, so you have ample evidence that your injury was work-related. Always answer any questions truthfully, even if you think doing so may jeopardize your claim. It’s better to have a claim rejected than to face charges of workers’ comp fraud.

Contact the Cintron Firm

At the Cintron Firm, LLC, we offer more than 14 years of experience to people in New Jersey facing a broad array of legal challenges. Attorney Mark Cintron has worked as a prosecutor and has extensive courtroom experience, so he’s always ready, willing, and able to protect your interests before a judge or jury. Contact our office online or call us at 201-791-1333 or 917-494-5695 to set up an appointment.

Workers’ Compensation for a Work-Related Illness

January 28, 2025 by The Cintron Firm

Can You Qualify for Benefits If You Get Sick Because of Your Job?

When you’ve been injured in an accident on the job, seeking workers’ compensation benefits may seem pretty straightforward. In New Jersey, as in all states, to qualify for benefits, you must only show that you were hurt and that your injury occurred in the course of your employment. But what happens if you become ill, and you believe that your disease or illness was caused or aggravated by conditions on the job? Can you still seek workers’ comp benefits? What must you show?

Will Workers’ Compensation Cover Lost Wages and Medical Expenses Resulting from an Occupational Illness in New Jersey?

Yes. The New Jersey workers’ compensation laws allow workers to recover benefits when they become ill because of exposure to conditions or substances in the workplace. To recover benefits for an occupational disease or illness, you must demonstrate that:

The conditions at your place of employment have been documented to cause the type of illness you suffer; for example, there is evidence that employees have contracted mesothelioma as the result of exposure to certain toxic substances on the job;
As a part of your required duties, you were exposed to the conditions and/or substances that have been shown to cause the illness you suffer;
You did not have a pre-existing condition; and
You were not exposed to conditions or substances outside of work that may have caused your illness.

Typical Workplace Illness Claims That Qualify for Workers’ Compensation

Workers in New Jersey have successfully recovered workers’ comp benefits for a wide range of illnesses arising out of the workplace, including:

Cancer
Lung and respiratory disease, including mesothelioma and asthma
Hearing or vision loss
Carpal tunnel syndrome or other repetitive stress disorders
Infectious diseases, including viruses

Contact the Cintron Firm

At the Cintron Firm, LLC, we offer more than 14 years of experience to people in New Jersey facing a broad array of legal challenges. Attorney Mark Cintron has worked as a prosecutor and has extensive courtroom experience, so he’s always ready, willing and able to protect your interests before a judge or jury. Contact our office online or call us at 201-791-1333 or 917-494-5695 to set up an appointment.

Wishing You And Yours A Merry Christmas & Happy New Year

December 24, 2024 by The Cintron Firm

Injuries Caused by Third Parties in the Workplace

December 23, 2024 by The Cintron Firm

Your Options When You’re Hurt by a Third Party on the Job

In New Jersey, as in all states, when you’re injured while working, your first course of action will typically be to notify your employer and file a workers’ compensation claim. The requirements to qualify for workers’ comp are pretty straightforward: you must have suffered an injury and it must have happened during the course of your employment.

But it’s important to understand that workers’ compensation is intended to address injuries caused by your employer or a co-worker. If you suffer injuries because of the carelessness or negligence of an unrelated third party, you may be able to file for workers’ compensation benefits, but you may also have the right to file a personal injury lawsuit in court. If your injuries are caused entirely by your employer or a co-worker, workers’ compensation is the only recourse available to you.

Why Might You Want to File a Personal Injury Lawsuit?

Workers’ compensation laws were enacted in an effort to simplify the process for both workers and employers. As a worker, if your claim is approved, you can start receiving payments within a couple of weeks. Furthermore, as stated above, you don’t have to prove that your employer acted negligently or carelessly. Your injury must simply be work-related.

In a personal injury lawsuit, you will have to establish that the defendant (your employer or another party) was legally negligent. In addition, when you file a personal injury lawsuit, you can expect that, unless you settle before trial, it will be months and possibly years before your case is resolved (and before you receive any type of damage award).

The primary reason for filing a personal injury lawsuit is that you won’t be limited to the benefits available through a workers’ comp claim. The amount you receive through workers’ compensation is based on a specific formula, taking your recent wages into account. As a general rule, if you are fully disabled by your injury, you have the right to recover up to 70% of your average weekly wage. In a personal injury lawsuit, though, the jury won’t be limited to that amount and could return a significantly higher damage award. Of course, the jury may also reject your claim.

Contact the Cintron Firm

At the Cintron Firm, LLC, we offer more than 14 years of experience to people in New Jersey facing a broad array of legal challenges. Attorney Mark Cintron has worked as a prosecutor and has extensive courtroom experience, so he’s always ready, willing, and able to protect your interests before a judge or jury. Contact our office online or call us at 201-791-1333 or 917-494-5695 to set up an appointment.

Happy Thanksgiving

November 27, 2024 by The Cintron Firm

Common Winter Workplace Injuries in New Jersey

November 21, 2024 by The Cintron Firm

Winter Conditions Contribute to Annual Rise in Job-Related Injuries

It’s winter in New Jersey, which means ice and snow. And if you work outside, it can mean a greater risk of injury on the job. But even if most of your work is inside, you might still be at risk. Statistics show that work-related injuries go up when the weather gets cold. What are the common causes of workplace injuries in the New Jersey winter? Can you seek workers’ compensation for winter work injuries?

What Are the Common Types of Winter Workplace Injuries?

Most winter workplace injuries fall into one of the following categories:

Slips and falls—These may occur outside or inside, caused by an accumulation of snow or ice, or by wet floors when workers track in moisture.
Hypothermia—Employees who are outside for extended periods of time, such as construction workers and delivery drivers, can be at risk of frostbite or hypothermia.
Motor vehicle collisions—Delivery people, outside salespeople, and others are at risk of having accidents on slippery roads in the winter in New Jersey.
Electrocutions—Ice and snow can take down and then obscure live power lines. The moisture caused by melting snow and ice can make the situation worse.

Can You Get Workers’ Comp Benefits for a Winter Workplace Injury?

Absolutely. In New Jersey, as in all states, there are only two requirements to qualify for workers’ compensation. You must show that you suffered an injury, and you must prove that the injury was work-related, i.e., sustained in the performance of your job. You can seek benefits for a slip and fall on icy steps, pavement, or other walkway, but you may also be able to get workers’ comp if your exposure to the weather causes pneumonia or other illness.

Contact the Cintron Firm

At the Cintron Firm, LLC, we offer more than 14 years of experience to people in New Jersey facing a broad array of legal challenges. Attorney Mark Cintron has worked as a prosecutor and has extensive courtroom experience, so he’s always ready, willing, and able to protect your interests before a judge or jury. Contact our office online, or call us at 201-791-1333 or 917-494-5695 to set up an appointment.

Can You Choose Your Own Doctor When You Have a New Jersey Workers’ Comp Claim?

October 23, 2024 by The Cintron Firm

What Rights Do You Have With Respect to Who Treats You?

You’ve been hurt on the job, and it’s either making it difficult for you to work, or it’s preventing you from being gainfully employed. Your first concern, after any injury, is about getting the care you need so that you maximize the likelihood of full recovery. Can you simply schedule an appointment with your primary care physician, or take yourself to the hospital or urgent care facility? How much control do you have over who treats your injuries?

New Jersey Law Generally Gives the Employer the Right to Choose the Caregiver

Unlike most other states, New Jersey does not give an injured worker the right to select a doctor or other caregiver, with a few exceptions. As a general rule, the employer or the workers’ compensation insurance provider gets to select who will provide initial treatment. In the immediate aftermath of an injury, once you’ve notified your employer (who will subsequently notify the workers’ comp insurance provider), your employer will designate who you must see for treatment. You must submit to treatment by the selected doctor, either for the first 10 visits or the first 30 days, whichever is completed first. Once you’ve completed 10 visits or 30 days, you can ask the New Jersey Division of Workers’ Compensation for a change of treating physician, but there’s no right to change your doctor. You can request a second opinion, but such a request must be approved by the insurer.

General Exceptions to the Rule

Under limited circumstances, you may have the right to treatment by someone other than the doctor selected by the insurance company:

Any care that is provided on an emergency basis
Care for a pre-existing condition by the doctor who previously treated you
Care by a physician approved by the workers’ compensation judge after a formal request

Contact the Cintron Firm

At the Cintron Firm, LLC, we offer more than 14 years of experience to people in New Jersey facing a broad array of legal challenges. Attorney Mark Cintron has worked as a prosecutor and has extensive courtroom experience, so he’s always ready, willing, and able to protect your interests before a judge or jury. Contact our office online, or call us at 917-494-5695 to set up an appointment.

Can You get Workers’ Compensation for a Pre-Existing Injury?

September 27, 2024 by The Cintron Firm

Can You Qualify for Benefits If You Aggravate an Old Injury?

You’ve suffered some type of injury that prevents you from working. Maybe it happened at your current job, or maybe it happened before you came to your current employer. Maybe it wasn’t even related to your job—suppose you hurt yourself playing sports when you were younger and you aggravate that injury on the job. Can your employer or the workers’ compensation insurance company attribute your inability to work to the old injury and reject your claim for workers’ comp benefits?

Qualifying for Workers’ Compensation Benefits

In New Jersey, as in all states, there are only two requirements to be eligible for workers’ comp benefits: (1) you must suffer an injury, and (2) the injury must have been sustained during the course of your employment. So how does that apply when you have a documented pre-existing injury? It all comes down to whether the original injury is currently preventing you from currently or “an aggravation” of that prior injury. The simple fact that you were previously injured will not automatically disqualify you from eligibility for workers’ compensation benefits.

Under New Jersey law, employers take employees as they find them, with all pre-existing injuries and illnesses. There is no affirmative duty to inform an employer of a prior injury; if the employer does not ask, the employee is under no duty to disclose a previous injury. But an employee may not misrepresent the occurrence of a prior injury.

An employee will be allowed to recover workers’ compensation benefits only if they can prove that the prior injury was aggravated by their job. If it can be established that the employee never fully recovered from the prior injury, workers’ comp benefits typically will not be available. However, if the employee was cleared by a doctor to return to work and then aggravated the prior injury, benefits typically will be available.

Contact the Cintron Firm

At the Cintron Firm, LLC, we offer more than 14 years of experience to people in New Jersey facing a broad array of legal challenges. Attorney Mark Cintron has worked as a prosecutor and has extensive courtroom experience, so he’s always ready, willing, and able to protect your interests before a judge or jury. Contact our office online, or call us at 201-791-1333 or 917-494-5695 to set up an appointment.

Actions to Avoid After a Workplace Injury

August 21, 2024 by The Cintron Firm

Mstakes That Will Put Your Claim at Risk

The New Jersey workers’ compensation laws are pretty straightforward. As in other states, you don’t have to prove that your employer’s negligence caused your workplace injury. You only need to show two things: that you were hurt and that your injury happened during the course of your employment.

It’s possible, though, for you to inadvertently put your legitimate claim in jeopardy. Here are some of the ways that you can complicate the workers’ compensation process:

Mistake #1—You Don’t Notify Your Employer in a Timely Manner

Under New Jersey law, you have 90 days to let your employer know you’ve been hurt or are suffering some work-related illness. It’s usually in your best interests to tell your employer as soon as possible, though. If you wait unnecessarily, you could suffer an injury unrelated to your employment, which could make it far more difficult to prove that your losses were related to the workplace injury.

Mistake #2—Trying to Do All the Things You Did Before Your Injury

It’s natural, after any type of injury, to want to return to normal as soon as possible. That can often lead you to do things that you shouldn’t, like mowing the lawn, shoveling sidewalks, or engaging in other physical activities. Don’t be surprised if the workers’ compensation insurance company sends a private investigator out to see what you’re doing. Pictures of you engaging in physical activity can be detrimental to your claim.

Mistake #3—Failing to Get Medical Attention

You might not want to see a doctor about your injury as part of an attempt to shake it off or prove your mettle. That won’t benefit you in a workers’ compensation case. If you don’t seek medical attention, it will look for all intents and purposes as if you weren’t injured.

Mistake #4—Trying to Handle Your Workers’ Comp Claim by Yourself

This may be the biggest mistake of all. Though a workers’ compensation claim may seem cut and dried, your employer and the workers’ comp insurer have a vested interest in paying you as little as possible. They’ll look for every opportunity to diminish or deny your claim, and they know a lot more about the workers’ comp process than you do.

Contact the Cintron Firm

At the Cintron Firm, LLC, we offer more than 14 years of experience to people in New Jersey facing a broad array of legal challenges. Attorney Mark Cintron has worked as a prosecutor and has extensive courtroom experience, so he’s always ready, willing, and able to protect your interests before a judge or jury. Contact our office online, or call us at 201-791-1333 or 917-494-5695 to set up an appointment.

Was Your Injury Work-Related?—Part 3

July 31, 2024 by The Cintron Firm

Work Outside Scope of Duties | Injuries Suffered During Horseplay or in a Work-Related Scuffle

Under the workers’ compensation law of New Jersey, an injured worker doesn’t need to establish that the employer was negligent in order to receive benefits. Because workers’ comp is essentially based on the concept of strict liability, a person needs to show only that they suffered an injury and that the injury was work-related.

In the first two blogs in this series, we looked at injuries that occur while a worker is on a break, injuries sustained while at a company social event, and injuries suffered while traveling for work. In this part, we’ll look at two more situations: injuries that occur when you’re doing something that’s not within your job description or while fooling around with a co-worker.

Injuries Suffered While Doing Something Outside Your Job Description

Suppose you’re a machine operator, but your boss asks you to climb a ladder to retrieve a tool or some materials. If you fall off the ladder, can you still recover workers’ comp benefits?

As a general rule, if your supervisor asks you to do something outside of the normal scope of your job, any injuries suffered will be covered by workers’ compensation. Conversely, if your employer has specifically instructed you not to do something outside your job description, but you do it anyway, your claim is likely to be denied. If you’re injured while doing something that your boss neither asked you to do nor specifically prohibited you from doing, you may or may not be eligible for benefits, depending on whether or not your actions were reasonable under the circumstances.

Injuries While Engaged in Horseplay

In most instances, if you’re injured during horseplay that you initiated, your claim will be denied. On the other hand, if you are somehow hurt by the horseplay of coworkers, even though you were not involved in the horseplay yourself, you should be able to recover benefits. ‘

In some instances, even though you initiated the horseplay, you may still be eligible for benefits. The workers’ compensation board will look at a number of factors:

How serious was the horseplay, and how long did it go on?
Was there a practice in the particular workplace of condoning or even encouraging horseplay? Was it an accepted part of the work environment?
Was the horseplay objectively dangerous, or well outside the scope of employment?
Did you stop what you were doing to participate in the horseplay?
Did the nature of the employment reasonably encourage or lead to horseplay? Did you have a lot of idle time, for example?

Contact the Cintron Firm

At the Cintron Firm, LLC, we offer more than 14 years of experience to people in New Jersey facing a broad array of legal challenges. Attorney Mark Cintron has worked as a prosecutor and has extensive courtroom experience, so he’s always ready, willing, and able to protect your interests before a judge or jury. Contact our office online, or call us at 201-791-1333 or 917-494-5695 to set up an appointment.