Have you been injured at work or been diagnosed with a work related illness? If you have, you should be able to claim compensation from your employer’s insurer. New Jersey ensures that nearly all employers take out workers’ compensation insurance to cover their employees in the event that there is a workplace accident or injury. The claim process is not always straightforward as one might expect. The insurer may deny the claim for a number of different reasons. An unjustified denial of a claim can still be successfully appealed with the help of an attorney who specializes in workers’ compensation law. Workers Compensation Law in New Jersey The Division of Workers’ Compensation (DWC) administers Workers’ Compensation in New Jersey. Most employers are required to take out insurance with certain exceptions, principally farm workers and domestic workers. Workers’ compensation in New Jersey is intended to cover medical bills and lost wages as well as permanent disability. Employees are expected to inform their employers if they are involved in an accident or are diagnosed with an industrial sickness. The time limit is normally 14 days to inform and 2 years to make a claim. Compensation for mental illness is not always approved. It depends on the exact individual circumstances. 70% of the average wage that would have been earned is provided in compensation if the employee is unable to go back to work temporarily because of the injury or illness. How a New Jersey WC Claim Could be Denied There are usually a range of reasons why a workers’ comp. claim might be denied by an insurer. Insurers do not usually like to pay out compensation unless a claim is clearly justified. Some claims are denied because of a mistake in the work details. An insurer maybe told that you were not at work when you claimed to have the injury, even if you were. This could be a simple mistake and easy to clear up. Insurers may try and deny a claim if time limits have been exceeded as well. More seriously, a claim can be denied if the insurer alleges that: you were drunk or on drugs at the time an accident happened; suffering from a pre-existing illness; you did not need medical attention; caused your own injuries in order to obtain compensation; failed to use safety equipment provided or failed to follow safety rules. If these allegations are incorrect, you have the right to appeal the decision. The New Jersey WC Appeals Process The New Jersey Division of Workers’ Compensation handles all disputes in New Jersey. You will need to file a petition with them at first for an informal hearing to hear your complaint. The informal hearing is normally arranged fairly quickly. Both you and the insurer’s representative will have a chance to resolve the dispute before a judge. Sometimes there may be more than one hearing called. The judge will make a recommendation for resolution, but this is not binding and you may decide to request a formal hearing. The formal hearing may take several months before being heard. It is more like a trial and both you and the insurer will be called to answer questions and provide evidence that backs up the claim and the denial. The judge will make a final decision from the DWC’s point of view of the law. The only further appeal that can be made is to the state’s Appellate Court. Why a WC Attorney May be of Help Even though New Jersey’s workers’ comp. laws seem to favor you when it comes to making a claim, you can still have your claim denied and be forced to make an appeal. This can be a long winded process and you are advised to get the help of a workers’ comp. attorney. The attorney can provide legal advice, ensure you obtain sufficient evidence to back up your claim and represent you at any adminsitrative hearings and court appearances.
