What if my employer disputes my workers’ compensation claim?

If you have a work-related injury or illness, you know you should file for workers’ compensation. However, you may not know what benefits you can receive. Or, you may be fearful that your employer could dispute your claim. 

Your first step is notifying your employer about your accident or injury. Next, see a medical professional approved by your employer’s workers’ compensation program. New Jersey law states that workers’ compensation benefits should cover “all necessary and reasonable medical treatment, prescriptions and hospitalization services” stemming from your injury. Depending on the severity of your injury and the nature of your job, you may also receive disability. Do not give up if your employer disputes your claim. You still have rights, though you may have to follow a few more steps. 

Claim petition 

If your employer denies your initial claim in full or in part, you have a right to request a hearing. Your employer may oppose your claim for one of several reasons. Sometimes, employers contend that certain injuries are not related to work. Second, they may disagree with treatment plans or other medical decisions. Third, they may want to deny disability benefits. In any of these cases, you can file a claim petition to open a claim in district court. 

Informal claim 

During an informal hearing, a judge of compensation hears from all parties involved. You, your employer and the workers’ compensation insurance carrier meet at the hearing. This meeting is an informal attempt to resolve the issues. The judge may make suggestions but will not make a binding decision. 

Formal claim 

If you and your employer cannot reach an agreement during the informal claim process, the next step begins. At this point, you may file a formal claim petition. If the pretrial hearing results in an impasse, a trial starts. Each side presents a case, and you will likely testify during this phase. The judge’s decision at the end of the trail is binding and subject to reversal only by a complex and lengthy appeals process.