You were injured at work. You told your employer who started the workers’ compensation process. You thought you had coverage – but now you’re hearing different.

If you’re facing an unfair workers’ compensation determination, it may be time to challenge that determination. Here’s what injured employees need to know to challenge an unfair workers’ compensation determination in New Jersey. 

How to Know It’s Time To Challenge A Determination

You may need to challenge a determination if your employer or their workers’ compensation insurer denies or disputes your claim. Common issues in denials and disputes include:

• Was the injury or illness work-related?
• What kind of medical treatment is required, and for how long? 
• When can the injured person return to work? Should their duties be restricted, and if so, for how long? 
• Does the injured person qualify for temporary disability benefits?
• Does the injured person qualify for permanent disability benefits, and if so, how much should those benefits be? 
• If the worker dies as a result of their injury or illness, what benefits should the family receive?

Other issues may arise as well. Employers are typically represented by their insurers’ attorneys during this process. To fight back, you’ll need an experienced workers’ compensation attorney on your side as well. 

Challenge and Appeals Processes for Workers’ Comp in New Jersey

Workers can challenge or appeal workers’ compensation determinations in New Jersey. The challenge or appeal typically happens after the employer’s workers’ compensation insurer has been notified of the claim and has denied or disputed that claim. 

First, an injured worker can file an informal claim. An informal claim starts when an employee, their employer, or the insurance carrier files an Application for an Informal Hearing with the state’s Division of Workers Compensation. 

A judge of compensation hears the issue in an informal hearing and issues a decision. The judge of compensation can hear issues related to temporary benefits, medical treatment, and permanent benefits. The goal of informal hearings is to settle issues without the time and expense required for a complete court trial. 

Another option is to file a formal claim. Employees have two years to file a formal claim petition after the date of injury. 

Typically, a formal hearing is held within six months of filing the formal claim petition. The case will usually be assigned to be heard in the county where the injured employee lives. If the employee doesn’t live in New Jersey, the case may be assigned to the county where the employer is located. 

Most formal claims are settled through negotiation. If the parties cannot reach a settlement agreement, the case goes to a hearing. At the hearing, the judge of compensation will likely take testimony from the injured worker and other parties, like doctors who treated the injured person. After hearing evidence, the judge issues a ruling. 

A judge’s ruling in a formal workers’ compensation claim is binding – but it can also be appealed to the New Jersey Appellate Division of the Superior Court. 

What to Do If You Need to Challenge A Workers’ Compensation Determination

If you’re facing a denial or dispute of your workers’ comp claim, talk to an experienced attorney right away. A lawyer can:

• Answer your questions and explain your legal rights. The workers’ compensation process can be confusing, especially if you’ve never had to file before. An attorney can help you understand the process and make informed decisions.
• Handle negotiations and communications. A lawyer can deal with insurance companies, so you can focus on healing. 
• Ensure you don’t run out of time to file. Filing an informal claim doesn’t stop the two-year time limit on formal claims. For this reason, it’s valuable to talk to an experienced workers’ compensation attorney if you need help challenging a determination. 
• Help you get benefits more quickly. It’s also important to speak to a lawyer if you need help right away. New Jersey workers’ compensation law allows injured employees to file a “motion for medical and temporary benefits” if they need prompt medical treatment and support. This motion can affect your case, however, so it’s wise to work with a lawyer to prepare and file it. Most motions for medical and temporary benefits are assigned a hearing date within 30 days of filing. 

The New Jersey Department of Labor and Workforce Development doesn’t require injured workers to have an attorney, but the Department does recommend having a lawyer. If you have an attorney, you may be able to have a judge of compensation award legal fees as part of your case. The experienced New Jersey workers’ compensation lawyers at Petrillo & Goldberg can help.