N.J. Admin. Code § 13:75-4.1

Current through Register Vol. 56, No. 21, November 4, 2024

Section 13:75-4.1 - General provisions

(a) The Office may order the payment of compensation for expenses actually and reasonably incurred as a result of the personal injury or death of the victim.

1. Reimbursable expenses include those unreimbursed and unreimbursable out-of-pocket expenses or indebtedness for medical care or other necessary services, loss of earnings, loss of support, pecuniary loss to the dependents of deceased victims, and other reasonable pecuniary loss resulting from the personal injury or death of the victim.

(b) Subject to the availability of funds, the Office may award payment for such allowable expenses that the Office determines to be reimbursable within the scope of this chapter, such as charges for reasonably needed products and services, medical care, rehabilitation, rehabilitative occupational training, and other remedial treatment and care.

(c) Where the Office determines that, because of the victim's conduct, the victim was the proximate cause of his or her injury, the Office may limit the amount of the award, reduce it, or deny compensation altogether.

1. Where an award is to be limited or reduced due to contribution or other circumstances relating to the victim's behavior or action, said award shall not exceed $ 12,500 in the aggregate. In homicide cases where the victim contributed to his or her death, the Office may make a limited award for funeral benefits, mental health counseling, loss of support for dependent children, and attorneys' fees.

(d) Every victim or claimant seeking compensation from the Office shall produce verification and provide evidence of all losses and injuries claimed as compensable items in his or her application. Only those losses and injuries for which verification and evidence is produced shall be considered for compensation.

(e) In making its award, the Office shall make no allowance for pain and suffering.

(f) Except as otherwise permitted by this chapter, no compensation shall be awarded for loss of personal property or property damage.

(g) Except for cases determined to be catastrophic in nature, no compensation shall be awarded in an amount in excess of $ 25,000.

1. The Office may, within its discretion, prioritize and attempt to compromise the various items of payment for any claim in the event it determines that the maximum amount of $ 25,000 payable is likely to be reached.

2. The maximum award of $ 25,000 shall remain in effect until statutory law provides otherwise.

(h) Claims for compensation shall expire based on the following dates:

1. For incidents occurring on or after June 26, 1995, and on or before November 29, 2010, any claim for compensation shall expire five years after the entry of an initial determination order. No further order is to be entered with regard to the claim, except for claims that are determined to be catastrophic in nature, or for requests for payment of specific out-of-pocket expenses received by the Office prior to the expiration of the five- year period, or for expenses for which the Office had notice or should reasonably have known existed prior to the expiration of the stated five-year limit;

2. For incidents occurring on or after November 30, 2010, and on or before July 15, 2012, payment for compensation shall expire after five years, except that compensation may be awarded after the expiration of the five-year period upon a determination by the Office that compelling circumstances exist justifying the payment of a claim beyond the five-year limit;

3. For incidents occurring on or after July 16, 2012, and before August 1, 2020, payment for compensation shall expire 10 years after the entry of an initial determination order, which shall not include administrative closures, and no further order is to be entered with regard to the claim, except:

i. For requests for payment of specific out-of-pocket expenses received by the Office prior to the expiration of the 10-year period;

ii. In those cases determined by the Office to be catastrophic in nature; and

iii. For requests for payments of expenses that were incurred only after the expiration of the 10-year period; and

4. For incidents occurring on or after August 1, 2020, eligible claims for compensation will not expire.

N.J. Admin. Code § 13:75-4.1

Amended by 53 N.J.R. 1852(c), effective 11/1/2021