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Resolving workers’ compensation disputes through a formal claim petition

People who are injured on the job or who acquire an illness or disease through their work do not have to prove fault by their employers to receive compensation for their medical care and related expenses. Certain requirements still apply, though, and workers must demonstrate that the injury or illness was caused or aggravated by a work act, exposure or accident that occurred in the course of their employment.

Sometimes an employer or its workers’ compensation insurer disagrees with the employee’s claim for workers’ compensation benefits and attempts to deny it. Some common challenges to workers’ claims for benefits include disputes over whether:

  • The injury, illness or disease is work-related
  • The type and extent of medical care required
  • The extent of an injury or disability
  • The duration of an injury or disability and its impact on the worker’s ability to return to his or her regular work

The formal claim process for workers’ compensation disputes

In cases when an employer denies a claim for workers’ compensation, the worker is able to challenge the denial by filing a formal claim petition with the New Jersey Department of Labor and Workforce Development’s Division of Workers’ Compensation. The court proceedings will take place in the county where the worker lives or where the employer is located if the worker lives outside of New Jersey.

By filing a formal claim petition, the matter will be heard by a judge who will issue a ruling on the disputed workers’ compensation issue. For example, if the worker needs immediate and/or ongoing medical treatment during the formal claim process and it is not being provided, his or her lawyer can file a motion with the Court to attain a satisfactory result.

In addition, pursuing a formal claim with an attorney gives one the leverage of having a skilled representative negotiating with the employer or its insurer on their behalf for a settlement. If a resolution is not achieved, then they will prepare your case for a trial with the judge of compensation.

During the trial, the judge hears testimony from the injured worker, medical care providers and other witnesses who may be able to offer evidence as to how the worker was injured or how the injury, illness or disease affects the worker’s life. When all the evidence has been considered, the judge will make a decision.

If either the worker or the employer disagrees with the judge’s decision, it may be appealed to the Appellate Division of the Superior Court.

Certain time restrictions apply, and a formal claim petition may be denied if it is filed too late, even if the worker’s claim is meritorious. Therefore, if you have been injured at work or have acquired an illness or disease because of your work duties, it is important to begin the claim process without delay. Contact a workers’ compensation attorney for more information on filing a formal claim petition.