What to Expect During a Workers’ Compensation Appeal in New Jersey

Navigating a workers’ compensation claim can be stressful, particularly when the claim is denied. In New Jersey, workers injured on the job are entitled to compensation for medical expenses and lost wages, but it’s not uncommon for valid claims to face obstacles along the way. When this happens, the appeals process is the injured worker’s best course of action to secure the benefits they deserve.

This blog will explore what to expect during a workers’ compensation appeal in New Jersey, providing guidance for workers who have had their claims denied.

Why Workers’ Compensation Claims Get Denied

Understanding the reasons for a denied workers’ compensation claim is crucial. Common reasons include:

• Lack of Medical Evidence: Insufficient documentation of your injury can lead to a denial.
• Missed Deadlines: New Jersey requires injured workers to file claims within two years of the injury or the last compensation payment. Missing this deadline can result in a denied claim.
• Disputed Employment Relationship: If there’s uncertainty about whether the injury occurred within the scope of employment, the claim may be denied.
• Pre-Existing Conditions: Insurers may argue that a pre-existing condition, not a work-related accident, caused the injury.

If your claim is denied, don’t lose hope. Many valid claims can be approved through the appeals process.

Step 1: Understanding the Denial

After receiving a denial, the first step is to carefully review the Notice of Denial provided by the insurance company. This document outlines the reasons for the rejection. It is critical to consult with an experienced workers’ compensation attorney to determine whether the denial was justified and whether you have grounds to pursue an appeal.

Step 2: Filing an Appeal

In New Jersey, there are two main routes for workers’ compensation appeals:

• Informal Hearing with the Division of Workers’ Compensation (DWC): The informal hearing is a quick way to resolve disputes without entering into a full-blown trial. An attorney and the insurance company present arguments to a judge, who makes non-binding recommendations. Keep in mind that this process doesn’t stop the statute of limitations, so you still need to be mindful of filing deadlines.
• Formal Hearing with the DWC: If the informal hearing fails, a formal hearing is the next step. This hearing functions like a trial where both sides present evidence, witness testimonies, and arguments before a workers’ compensation judge. The judge’s decision is legally binding, and if unfavorable, can be appealed to the New Jersey Superior Court’s Appellate Division.

Step 3: Preparing for a Formal Appeal

When preparing for a formal appeal, your attorney plays a vital role in gathering evidence and managing legal deadlines. Here’s how they’ll help:

• Gathering Medical Evidence: Your attorney will work with medical experts to establish a direct connection between your injury and your employment.
• Deposition of Witnesses: Witnesses such as co-workers, supervisors, or treating doctors may provide crucial testimony supporting your claim.
• Reviewing Employment Records: Accurate documentation of the injury, work duties, and medical history will help counter the insurance company’s defense.
• Filing a Claim Petition: A formal claim petition must be filed with the DWC to initiate the appeal process. Keep in mind the two-year statute of limitations for this filing.

Step 4: The Hearing

A formal hearing allows both you and the insurance company to present your case before a judge. Here’s what to expect:

• Opening Statements: Both sides present an overview of their arguments.
• Presentation of Evidence: Medical records, employment documents, and witness testimonies are presented to support each side.
• Questioning and Cross-Examination: Both parties will have the chance to question witnesses, which may include you, your co-workers, or medical experts.
• Closing Arguments: Final statements summarize why the judge should rule in favor of either the worker or the insurance company.

The judge will review all the evidence and issue a binding decision. If the ruling is in your favor, you’ll receive the compensation and benefits you’re entitled to.

Step 5: Appealing the Judge’s Decision

If you disagree with the judge’s decision, you can appeal to the New Jersey Superior Court’s Appellate Division. This is a more formal and complex process, where the higher court will review the workers’ compensation judge’s ruling to ensure it was fair and legally sound.

It’s important to act quickly if you plan to file an appeal, as strict deadlines apply. Your attorney will help prepare and file the necessary paperwork.

Step 6: Motion for Medical and Temporary Benefits

If you are facing severe medical issues or need financial assistance during the appeal, you may be eligible to file a Motion for Medical and Temporary Benefits. This motion can help provide financial support while the appeal is being processed.

Step 7: Returning to Work

If you successfully appeal your claim and receive workers’ compensation benefits, the next step may involve returning to work. Depending on the severity of your injury, you may be cleared to return to your previous position, or you may need to pursue temporary or permanent disability benefits if you are unable to work in the same capacity.

Returning to work is often a delicate process, and it’s important to communicate with your employer about your abilities and any restrictions your doctor has placed on your work activities. Your workers’ compensation attorney can assist in negotiating a reasonable return-to-work plan if needed.

Navigating the NJ Workers’ Compensation Appeals Process

The workers’ compensation appeals process in New Jersey is designed to help injured workers secure the benefits they deserve, even after a denial. Partnering with an experienced attorney can be crucial for improving your chances of success. At Rudnick, Addonizio, Pappa & Casazza PC, we guide you through every step, ensuring your rights are fully protected.

Need Help with a Workers’ Comp Appeal in NJ? Reach Out to Us Now

If you’ve had your workers’ compensation claim denied in New Jersey, don’t navigate the appeals process alone. Rudnick, Addonizio, Pappa & Casazza PC serves injured workers across Monmouth, Ocean, and Middlesex counties, including Hazlet, Red Bank, and East Brunswick. Our experienced team is ready to fight for the compensation you deserve. Contact us today for a free consultation and let us help you secure your rightful benefits.