The New Jersey workers’ compensation laws are different from many other types of state programs. A worker will most likely not have to appear in a traditional court with a jury or judge in order to seek workers’ compensation benefits for an injury. In fact, the worker may not have to appear in any type of court at all. The majority of workers’ compensation claims are settled between the employer’s insurance company and the worker’s lawyer. This is the ideal way to handle a claim because it is quick, simple, and requires limited involvement from the state.
The main reason workers’ compensation cases do not go through the traditional court system is efficiency. If this was required, an injured worker could wait months or even years for their case to finally appear in front of a judge, which would delay the settlement and benefits tremendously. Since the worker is unable to take employment due to an injury, their family will remain unprovided for. As a solution, a separate negotiation and legal process was established to move workers’ compensation cases along at a much more steady and efficient pace.
However, just because a workers’ compensation case will not go through the traditional court system does not mean the injured worker should not seek legal representation. In fact, it is quite the opposite, since the worker will need someone knowledgeable and skilled to negotiate with the insurance company for a fair settlement. Insurance companies can be strategic and may try to give an injured worker the least compensation possible. A successful lawyer will know how to quickly and efficiently win a fair amount for the worker.
When an injured worker files a workers’ compensation claim with their employer, the insurance company will first investigate the claim to determinate if the worker is eligible to receive benefits. Next, during a meeting, the worker’s lawyer will enter into negotiations to win the maximum amount of benefits. The vast majority of claims are settled among the worker and employer without any outside involvement. However, if the insurance company is unwilling to give grant a fair settlement, or disputes the claim altogether, further involvement becomes necessary.
When an injured worker and their lawyer disagree with the decisions made by the insurance company, they have the right to either file a formal claim petition or an application for an informal hearing with the New Jersey Division of Workers’ Compensation. At this point, the state will become involved in the case to help resolve the issues that keep the parties from agreement.
Issues that a judge may assist with include:
- Compensability of the claim (whether the injury/illness is considered work-related)
- The type and extent of medical treatment required
- Amount of benefits
- The payment of temporary or permanent disability benefits
- Dependency benefits in cases of death
In the case of dispute between the injured worker and employer, the first step is to file an application for an informal hearing before a judge of compensation. The informal hearing is a third party mediation with a judge who is very familiar with workers’ compensation laws. The purpose of the hearing is to attempt to resolve the conflicts without the need for extended formal proceedings, and the judge’s suggestions are not legally binding.
An injured worker can expect the informal hearing to be scheduled within weeks of filing the application. The vast majority of cases that go to informal hearing are resolved after one or two sessions.
The worker is not required to hire an attorney for informal or formal hearings, but it is highly recommended. The insurance company will provide legal defense on behalf of the employer and self-insured companies are required to hire an attorney. It would be unfair for the worker to be the only party without proper legal representation.
In the chance that the conflict can not be resolved after a few informal hearings, the injured worker should then file a formal claim petition. At this point, the case will be assigned to a judge of compensation based on the county where the injured worker resides. If the worker lives out of state, it will be assigned based on the county where the employer is located. It can take up to six months to schedule a formal claim petition hearing after filing.
The vast majority of disputes that go to a formal hearing are settled by mutual agreement during the pretrial stage. If an agreement can not be reached, the judge will hear testimony from the injured worker, the treating physician and any other witnesses. The judge will then make a legally-binding decision based on relevant evidence surrounding the case.
Please note, a two year statute of limitations applies to formal hearings. A formal claim petition must be filed within two years of the date of injury or the date of last payment of compensation (whichever is later). Medical treatment agreed to by the employer’s insurance company is considered a payment of compensation. In cases of illnesses that develop over time, the claim petition must be filed within two years from the date the worker first became aware of the condition and its relationship to job duties
Motions for Medical and/or Temporary Benefits:
Because formal hearings can take an extended amount of time, the law also provides immediate medical treatment and temporary benefits to the injured worker if necessary. In such cases, the worker should file a Motion for Medical and Temporary Benefits, and a hearing date will be scheduled within thirty days.