How To “Appeal” a Denied Workers’ Compensation Claim In New Jersey
If you’ve been injured at work, it’s natural to have questions about your rights, medical care, and compensation. This workers’ compensation FAQ provides clear answers to the most common concerns employees face after a workplace accident. Learn what steps to take, how to protect your benefits, and when to seek legal help.
Q: Is A Lifting Injury Considered An Accident That I Should Report To My Employer?
A: Yes, an accident for workers’ compensation purposes is any traumatic event that causes immediate pain. Accordingly, if you experience pain when lifting, you should report it to your supervisor.
Q: Can I Choose My Own Doctor If I Am Hurt At Work?
A: No, the workers’ compensation carrier has the right to choose your doctor. If you believe that you are receiving substandard care from the workers’ compensation doctor, you should obtain a second opinion from your own doctor and seek the advice of an attorney.
Q: What If The Insurance Carrier Will Not Authorize Treatment Recommended By The Workers’ Compensation Doctor?
A: You should always request a copy of the office note or prescription from the workers’ compensation doctor regarding the recommended treatment. Bring that office note to an attorney, who may file a “Motion for Medical Treatment” on your behalf with the Court.
Q: Am I Entitled To Be Compensated For The Loss In Overtime Pay While I Am Out Of Work Following A Work Accident?
A: Yes, you are entitled to receive temporary disability benefits equaling 70% of your gross average weekly wages prior to the accident, including overtime pay. If the carrier is not including overtime pay in the calculation of your average wages, you should gather copies of your pay stubs for the six-month period prior to the accident and bring them to a workers’ compensation attorney. A Motion to change your temporary disability rate may be filed with the Division of Workers’ Compensation.
Q: Can My Employer Fire Me For Pursuing A Workers’ Compensation Claim?
A: No, it is illegal for an employer to retaliate against you for seeking benefits under the Workers’ Compensation Act. However, the Division of Workers’ Compensation currently does not have jurisdiction to adjudicate claims for wrongful termination. If you believe that you were fired due to your work injury, you may file a claim with the N.J. Department of Labor or the Superior Court of New Jersey.
Q: If I Was Already Paid Benefits For The Time I Lost From Work, And All Of My Medical Bills Were Paid, Is It Worthwhile To Formal Workers’ Compensation Claim?
A: Yes, because, besides medical and temporary disability benefits, you may also be entitled to receive an award for partial permanent disability benefits if your injury restricts the function of any part of your body, even if you returned to the same job.
Q: What Happens If My Doctor Releases Me To Return To Light Duty Work, And There Is No Light-Duty Work At My Job?
A: If your authorized physician recommends that you return to work with restrictions, and your employer does not provide “light duty work,” then the workers’ compensation carrier must continue paying you temporary disability benefits.
Q: The Workers’ Compensation Doctor Released Me To Return To Work, But I Can No Longer Perform The Same Job. What Should I Do?
A: Once the authorized physician determines that you have reached “maximum medical improvement” from treatment, then you are no longer entitled to receive temporary disability benefits, even if the treatment has not completely cured you and you cannot return to your prior occupation. You should seek the advice of an attorney in order to file a Claim Petition to obtain an award of partial or total permanent disability benefits in the Division of Workers’ Compensation. If you are disabled from all jobs, you should also apply for Social Security Disability. If you are able to perform another type of job, you should apply for unemployment benefits while you are looking for work.
Q: How Much Time Do I Have To File A Workers’ Compensation Claim?
A: A formal Claim Petition must be filed in the N.J. Division of Workers’ Compensation within two years of the date of the accident or two years from the date benefits were last paid through the workers’ compensation carrier, which is generally the last date you received medical treatment authorized through workers’ compensation.
Q: My Employer Did Not Cause The Accident. Am I Still Entitled To Receive Benefits?
A: Yes. If you are injured while performing work for an employer, you are entitled to receive workers’ compensation benefits, period. Fault or negligence is not a requirement for obtaining benefits. It does not even matter whether your own actions caused the accident; as long as the accident did not occur solely due to your intoxication or intentional harm to yourself, you would still be entitled to benefits if the accident occurred during the course of your employment.
Q: What Should I Do If I Am Hurt At Work?
A: If an accident occurs, you should immediately report it to a supervisor. Thereafter, your employer should notify its workers’ compensation insurance carrier of the accident. You should thereafter expect to receive a letter from the workers’ compensation carrier, providing a claim number, and the name and address of the physician who is authorized to treat you. If your employer does not notify the workers’ compensation carrier of the accident, you may do so. A poster should be posted in a common area of your workplace, with the name of the workers’ compensation carrier and policy number. Your attorney may also be able to identify the insurance carrier through the New Jersey Compensation Rating and Inspection Bureau.
Q: If My Employer Refuses To Provide Me With Medical Treatment Through Workers’ Compensation, Should I Use My Health Insurance To Obtain Treatment?
A: No, not for continued medical treatment. You may go to your own doctor initially to obtain an opinion on whether or not you need treatment related to the accident. If so, and if the workers’ compensation carrier refuses to provide this treatment, you should immediately contact an attorney. The attorney should then file a “Motion for Medical Treatment” with the Division of Workers’ Compensation. The health insurance carrier will be able to seek reimbursement from the workers’ compensation carrier for any medical bills it paid related to the work injury.
Q: What If I Do Use My Health Insurance To Treat An Injury Which Occurred At Work?
A: Your health insurance carrier will be able to assert a lien on your workers’ compensation claim in order to obtain reimbursement from the workers’ compensation insurance carrier for any benefits it paid on your behalf. However, if you fail to disclose the work accident at the time you obtain your medical treatment, in order to obtain the treatment coverage through your health insurance, then you are arguably committing insurance fraud. Accordingly, you must request treatment first through workers’ compensation. Once the workers’ compensation physician discharges you, or if you are unhappy with the treatment you are receiving through workers’ compensation, you may obtain a second opinion through your health insurance. Your attorney may then use the second medical opinion as a basis to file a Motion with the Court to force the workers’ compensation carrier to pay for further treatment.
Q: May I File A Workers’ Compensation Claim If My Injuries Were Not Caused By A Specific Event At Work, But Occurred As A Result Of My Work Over The Years?
A: Yes; some injuries occur over a period of time, from constant, repetitive, physical motions, and/or emotional stress, or exposure to chemicals and other irritants. Such injuries are considered “occupational,” rather than traumatic in nature. Occupational injuries are recognized under the NJ Workers’ Compensation Act, although they are more difficult to prove, and insurance carriers rarely accept such claims without litigation. Examples of occupational injuries include: carpal tunnel syndrome, obstructive pulmonary disease, asbestosis, degenerative disc disease, and post-traumatic stress disorder. If you have reason to believe that you suffer from such an occupational injury, you should immediately report it to your supervisor and request medical treatment. If the employer refuses to provide medical treatment, you may then seek a medical opinion outside of the workers’ compensation system and should thereafter contact an attorney.
Contact Pezzano Law Group (Warren County office of LCR Law) today to discuss your case and get the guidance you need to move forward confidently.
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