CE2

Question 2

What is the Accident Year?

Answer 2

__________

Question 3

What is the Case/Docket?

Answer 3

______________________

Question 4

What is the Date of the accident?

Answer 4

__________

Question 5

What is the Body Part / Category?

Answer 5

____________________________

Question 6

What are the options for Body Part / Category?

Answer 6

☐ Scheduled ☐ Partial Total (600‑week scale)

Question 7

What are the weeks at 100% for common body parts?

Answer 7

Common: Arm 330 • Hand 245 • Leg 315 • Foot 230 • Eye 200 • Ear 60 • Great Toe 40 • Other Toe 15 • Partial Total 600

Question 8

What is the formula for Net Weeks?

Answer 8

Net Weeks = (Incremental % ÷ 100) × Weeks @ 100% = __________ weeks

Question 9

What is the Average Weekly Wage (AWW)?

Answer 9

$ __________

Question 10

What is 70% of AWW?

Answer 10

$ __________

Question 11

What is the Accident-Year Minimum Weekly?

Answer 11

$ __________

Question 12

What is the Accident-Year Maximum Weekly?

Answer 12

$ __________

Question 13

What is the Final Weekly Rate?

Answer 13

$ __________

Question 14

What is the formula for Final Award?

Answer 14

Final Award = Net Weeks × Final Weekly Rate = $ ______________________

Question 15

What is needed to have a witness?

Answer 15

To testify about a prior accident or medical condition.

Question 16

What is a proffer?

Answer 16

A good faith offer to substantiate their position.

Question 17

What is required for evidence of a prior medical problem?

Answer 17

A witness is needed to provide evidence.

Question 18

What is the significance of Wang v Allstate?

Answer 18

A cert from attorney is not evidence.

Question 19

What does Murray v Allstate establish?

Answer 19

An attorney cert is not a factual basis for prior-disability.

Question 20

What is required for video evidence?

Answer 20

A videographer needs to come to court to testify.

Question 21

What is the adverse inference rule?

Answer 21

Can negatively impact a party who doesn’t call a witness who should be called.

Question 22

What is the four-part test for adverse inference?

Answer 22

1) Witness had to be within control of the party. 2) Testimony would be relevant and superior. 3) Must provide names of the witness. 4) Must schedule the witnesses.

Question 23

What is a WCMSA?

Answer 23

A Workers’ Compensation Medicare Set-Aside arrangement is a portion of a settlement reserved for future medical care that Medicare would cover.

Question 24

When will CMS review a WCMSA proposal?

Answer 24

When the injured person has Medicare and the total settlement is more than $25,000, or when the person is expected to become entitled to Medicare within 30 months and the total settlement is more than $250,000.

Question 25

How is a WCMSA amount calculated?

Answer 25

CMS projects the lifetime cost of Medicare-covered, injury-related care and prescriptions, then sets that aside.

Question 26

What is the funding style for WCMSA?

Answer 26

Lump sum or structured WCMSA.

Question 27

What is required for WCMSA administration?

Answer 27

Funds must be held in a separate, interest-bearing account and used only for injury-related, Medicare-covered expenses.

Question 28

What are the practical steps for WCMSA in New Jersey?

Answer 28

1) Confirm Medicare status. 2) Gather medical records. 3) Project Medicare-covered services. 4) Price care using actual charges. 5) Choose funding style. 6) Set up a separate account.

Question 29

What triggers the Second Injury Fund (SIF) payments?

Answer 29

The Judge decides the worker is totally and permanently disabled due to the combined effects of the last work injury plus pre-existing disability.

Question 30

When do SIF payments start?

Answer 30

When the employer's obligation ends, and not earlier than the date the SIF petition was filed.

Question 31

How to compute the hand-off for SIF?

Answer 31

PTD rate = 70% of AWW, subject to the PTD max/min for the accident year.

Question 32

What percentage of total accidents is found to be employer-paid?

Answer 32

40% of the total accidents is found to be employer-paid.

Question 33

How many weeks does the employer pay at the PTD rate?

Answer 33

The employer pays 180 weeks at the PTD rate.

Question 34

When does the SIF take over payments?

Answer 34

The SIF takes over after week 180 or the SIF-petition filing date, if later.

Question 35

What should you look for in the Order for Total Disability w/ Second Injury Fund (WC-376i)?

Answer 35

Look for the lines that specify (a) the weeks due from respondent, (d) the 'payment to begin' clause, and the blank that sets the 'Commencement date for Fund benefits.'

Question 36

What is a key issue in settlement regarding lost wages?

Answer 36

A key issue is whether temporary payments have been made.

Question 37

What is the significance of the contract of hire rate?

Answer 37

The contract of hire rate is important for determining wage statements.

Question 38

What should be considered before making a demand in a settlement?

Answer 38

Look at issues that will be paid in addition to permanency.

Question 39

What often causes denied cases in settlements?

Answer 39

Denied cases often arise from rate issues.

Question 40

What is reconstruction of wages?

Answer 40

Reconstruction of wages applies to part-time employees or those who worked under 40 hours a week.

Question 41

What is the main case regarding reconstruction of wages?

Answer 41

The main case is Katsourus v South Jersey, 131 NJ 535.

Question 42

When does reconstruction of wages come into play?

Answer 42

It comes into play when the petitioner wasn’t working in a 'normal' pattern at the time of injury.

Question 43

What are the triggering situations for wage reconstruction?

Answer 43

Triggering situations include seasonal workers, part-time workers, students, and multiple jobs.

Question 44

What is the legal basis for wage reconstruction in NJ?

Answer 44

NJ courts allow reconstruction where failing to do so would unfairly undervalue benefits.

Question 45

What is the goal of wage reconstruction?

Answer 45

The goal is to put the petitioner in the same position as if they were earning their expected normal wage.

Question 46

What method is used for wage reconstruction?

Answer 46

Look at what the worker would reasonably have earned if employed in the usual or full pattern.

Question 47

What role does defense counsel play in wage reconstruction claims?

Answer 47

Defense counsel scrutinizes the claim and argues against reconstruction if the petitioner never had a history of full-time work.

Question 48

What is a conditional payment lien?

Answer 48

A conditional payment lien involves parties agreeing on the amount paid and returning to court for further negotiation.

Question 49

What must be done if a settlement amount is $25,000 or above?

Answer 49

Approval from Medicare must be obtained.

Question 50

What happens if a petitioner is not on Medicare but has a settlement over $250,000?

Answer 50

They might become a recipient in 30 months and require Social Security Medicare approval.

Question 51

What is the Medicare set-aside requirement?

Answer 51

Medicare's interests need to be protected in Section 20 settlements.