N.J. Admin. Code § 13:75-6.3

Current through Register Vol. 56, No. 24, December 18, 2024

Section 13:75-6.3 - Compensation benefits

(a) Subject to the individual monetary caps established by the Office in this chapter, compensation awarded to catastrophically injured crime victims shall not exceed a supplemental amount of $ 35,000 in out-of-pocket aggregate expenses.

1. The award of compensation for catastrophic injury related services shall be entered by the Office in addition to any award of compensation for which a crime victim may be found eligible if the victim had filed an application for non-catastrophic crime related injuries.

(b) The benefits and services listed in this section shall be compensated solely for the benefit of catastrophically injured crime victims.

(c) Compensation may be awarded to catastrophically injured crime victims where it is determined that the rehabilitative services are reasonable and medically necessary as evidenced by written prescription for the service issued by a licensed provider of medical services.

(d) Compensation for loss of earnings, loss of support, property damage, living expenses such as food, shelter, and clothing necessitated by the victim's medical condition, expenses incurred for vocational training services and continuing education in educational institutions, and pain and suffering are excluded.

(e) Services for which compensation may be awarded include, but are not limited to, the following:

1. Surgical and therapeutic procedures;

2. Rehabilitative physical and occupational therapy designed to restore an optimum function level, including chiropractic services;

3. Prescription and over-the-counter drugs and medical supplies that are physician-authorized and Federal Drug Administration-approved for injury or incapacity related to the crime that formed the basis for the victim's application for compensation;

4. Cognitive and psychological therapy;

5. Home health assistance;

6. Vehicle modifications upon submission of a medical prescription or other medical proof indicating the need for such modifications.

i. Reimbursement or compensation for the purchase or lease of a vehicle, insurance payments, and replacement and repair of parts, service, and maintenance of the vehicle and modification are excluded.

ii. Compensation for vehicle modification shall be limited to the one vehicle that serves as the victim's principle conveyance.

iii. The victim and/or claimant shall maintain motor vehicle insurance including, but not limited to, collision insurance in an amount that is sufficient to cover the cost of replacement or repair of the vehicle modification features for which the Office has previously awarded compensation;

7. Driver training;

8. Wheelchair, braces, splints, crutches, walkers, shower, commode chair, and any other personal adaptive equipment required to meet individual disability needs;

9. Structural modifications to living environment solely to the victim's proven principle place of residence, designed to provide accessibility and to maximize independence.

i. Modifications to vacation and secondary homes are excluded unless the victim/claimant can show that the vacation or secondary home has become the claimant's principal place of residence, that ownership of the original primary residence, the modification of which the Office had previously awarded compensation under this section has been sold to a party other than a member of the victim/claimant's family, and that the original primary residence is no longer available for the use of the victim/claimant or his or her family.

ii. Structural modifications to the physical plant and/or equipment owned by an employer are excluded.

iii. The vendor and the victim/claimant are responsible for all permits, licenses, insurance, and inspections as required by Federal, State, and/or municipal statutes and codes for the premises to be modified.

iv. The maximum compensation for a structure where modifications are made to a building not owned by a victim shall not exceed $ 15,000;

10. Subject to medical prescription, as needed dependent care and domestic help as set forth in this chapter;

11. Speech therapy;

12. Subject to the review and approval of the Office, experimental medical treatment/experimental drugs that have been recognized by Federal or State agencies and provided by licensed health care providers; and

13. Upon a showing that the service provided is a rehabilitative service as defined in this section, telecommunications, sensory, and other technological aids and devices and interpreter services.

(f) Every claimant seeking compensation for catastrophic injury is required to produce verification for and provide evidence of all out-of-pocket expenses and injuries claimed as compensable items and the Office shall consider only those expenses and injuries for which such verification and evidence has been produced. Verification must be provided that the services for which compensation is sought are related to the date of the incident and/or the recovery period in question.

1. The victim or claimant may seek prior approval from the Office for the services for which he or she intends to seek compensation.

2. The Office's prior approval and/or payment of the expense incurred shall not be considered as a warranty of the services provided or fitness for use of any of the products and materials provided or improvements made, the workmanship performed, or the capability and license of the provider to perform said service.

3. Although prior approval for a particular service may have been granted, compensation shall only be awarded upon notice from the claimant that the service for which compensation is sought has been completed.

(g) The Office shall annually set aside an amount of funds it determines to be reasonable for the purposes of compensation of catastrophic claims out of the funds appropriated for the administration of the Criminal Injuries Compensation Act of 1971, N.J.S.A. 52:4B-1 et seq., and subject to the provisions of N.J.S.A. 52:4B-9. Additional funds may be set aside, as the Office determines reasonable and necessary.

N.J. Admin. Code § 13:75-6.3