All is not perfectly clear when it comes to covering work-related injuries under a Workers’ Compensation policy. Taking a closer look at what is and what might not be covered is something that both the Employer and Employee must take very seriously. One such injury that can pose a coverage issue are Hernias.
Hernias are a common medical problem but surprisingly complicated if it is caused by something you did at your job. New Jersey has a State Statute that specifically states an injured worker is required to give 48 hours notice to their employer after the occurrence of a hernia (NJSA 32:15-12( c )(23)). If that time limit is not met, the insurance carrier would be correct to deny compensability of the accident. However, there are other elements that come into play that can impact the overall coverage issue.
As respects the 48-hour notification requirement, courts typically allow an exception if the injury occurred on a Friday, Saturday, Sunday or holiday. This notice requirement can also be met if an employee notifies their employer within 48 hours after they had reason to know of the existence of the hernia. So, in this instance, if the employee didn’t obtain an appointment to see a doctor for several days after the incident, the notice requirement could still be met as long as notice is given to the employer within 48 hours of that Doctor’s appointment where a diagnosis was given of the existence of a hernia. It is important to note that if the employee received this diagnosis BUT waited more than the allowable 48 hours to notify their employer, the insurance carrier writing the Workers’ Compensation coverage can still deny the claim.
Employees must take all work-related injuries seriously and properly notify their employer to avoid complications in the settlement of their claims.