Appealing a workers’ compensation claim denial in New Jersey

Sustaining an injury in the workplace can be a challenging experience. Aside from the physical and emotional distress associated with any injury, workplace injuries can have significant financial consequences. In order to mitigate the risk of these potentially devastating financial consequences, the state of New Jersey operates a workers' compensation program.

Specifically, New Jersey law requires all employers, who are not covered by federal programs or qualified for self-insurance, to carry workers' compensation insurance. Through these insurance policies, injured workers may be able to obtain benefits for the following costs associated with a workplace injury:

  • Medical costs to cover treatment of the injury, including psychiatric and neuropsychiatric injuries
  • Lost wages associated with temporary total disability
  • Lost wages associated with permanent partial disability
  • Lost wages associated with permanent total disability

Workers' compensation insurance may also cover benefits to dependents of workers who died in consequence of their employment.

Appeal options

The state's workers' compensation law is limited to injuries that arose out of and in the course of employment. In some cases, employers and their insurers may dispute the source or nature of the injury in question and, consequently, deny benefits to the injured worker. In fact, employers and insurers may be financially motivated to avoid funding workers' compensation benefits, if possible. If a worker's benefits are denied, there are steps that may be taken.

According to the State of New Jersey's Department of Labor and Workforce Development, one option is to file an Application for an Informal Hearing with the Division of Workers' Compensation. In this case, a judge of compensation will offer non-binding suggestions to the parties. These suggestions may facilitate a mutual resolution out of court.

Another option, which may be utilized independent of, or subsequent to, an informal hearing, is to file a formal Claim Petition. This process features a trial, in which testimony and other evidence is presented, whereupon the judge will render a decision. Unlike the informal hearings, this decision is binding and appealable to the Appellate Division of the Superior Court.

Legal representation

Issues that may be in dispute include not only the compensability of the claim, the nature of medical treatment and the appropriate category of disability. There are also timetables that may influence compensability. Formal claim petitions must be filed within two years of the date of the injury in question or the last payment of compensation, whichever is later. Navigating these issues can be complex and challenging. For this reason, injured workers whose benefits have been denied may wish to consult with a workers' compensation attorney.