Sussex County Attorneys Favorably Resolve Workers’ Compensation Cases

The vast majority of workers’ compensation cases settle out of court. In a few cases, the insurance company pays the entire claim quickly and the matter is completely resolved. If the victim has already partnered with an experienced attorney by this time, the insurance adjuster is sometimes more likely to approve the claim in full.

In most cases, the insurance adjuster denies the claim, either in whole or in part. Many victims get discouraged at this point, especially if they are unable to work for a significant period. The insurance company knows this, which is why so many claims are denied.

To improve the chances of fair compensation, reach out to an experienced lawyer like the ones at Hollander, Strelzik, Pasculli, Hinkes, Vandenberg & Hontz, L.L.C. as soon as you file your initial claim. We give solid advice to victims so that they can plan for the future. We also advocate aggressively for our clients because a tenacious attorney is the best way to ensure a fair outcome for both sides.

Pre-Claim Procedure

Many injured victims wait to go to the doctor. They erroneously believe that the insurance company will reward them for not rushing to the doctor by paying their medical expenses. The insurance company usually sees a delay in seeking medical treatment as a weakness in the victim’s case. Insurance adjusters and lawyers reason that the victims’ injuries must not have been very severe. Otherwise, they would have sought treatment straightaway.

It is important to see a doctor immediately after a work-related trauma injury like a fall or electric shock. The same rule applies in the case of an occupational disease, such as respiratory issues or hearing loss. At the first sign of trouble, see a doctor. After all, a victim can always withdraw a claim later, and it is illegal for employers or potential employers to discriminate against workers based on their workers’ comp claims history.

Additionally, be sure that the doctor knows that your claim is work-related, and be sure and keep copies of all diagnostic reports, medical prescriptions, and so on.

The Claim

Typically, injured workers have 90 days to file workers’ compensation claims. Courts almost never grant exceptions or extensions, so if the claim is not filed properly, the victim may lose the right to obtain compensation. Furthermore, the claim must also be complete in every way and completed in the proper format, or it may be subsequently denied.

Be sure the claim includes the names and complete contact information of any witnesses, so that they can be easily located later, if needed.

Claim Evaluation

At this point, either an employer’s representative or an insurance company adjuster evaluates the claim based on the injury report and the currently available medical information. Not surprisingly, most claims are denied at this point, at least in part.

If the dispute continues, the injured victim may either file a claim petition or an application for a reconsideration hearing. If the claim was only denied in part, a reconsideration hearing may be a good idea because the two sides are already somewhat close to a favorable resolution. Another advantage of a reconsideration hearing is that it usually takes place only a few weeks after the request is made.

In most cases, the next step is a claim petition. The wait for a formal hearing may be several months partially because medical treatment must be complete before the hearing and partially due to bureaucratic delays. Furthermore, because of the way these matters are structured in New Jersey, the hearing itself may take several weeks. The wait for a resolution is normally worthwhile because at a formal hearing, an attorney may call witnesses, introduce other evidence, and make legal arguments. So, the hearing officer is fully informed about the victim’s case.

Once the case is resolved either by agreed settlement or a judge’s decision, it is imperative that it make provisions for all the victim’s economic losses, including:

• Lost Wages: If the victim can return to work, the victim is entitled to 70% of his/her average weekly wage for up to 400 weeks. If the victim is unable to return to work, a lump sum payout is generally in order.
• Medical Bills: Workers’ compensation is designed to get injured victims back to work quickly. So, all medical expenses through physical rehabilitation are paid, to ensure that victims are completely healed.

Benefits are usually retroactive to the date of injury.

Appeals

The judge of compensation does not have the last word in the matter. At least in most cases, victims may appeal unfavorable decisions to the Superior Court Appellate Division. Typically, the appellate judge may only review clear errors on the record and may not re-try the case, underscoring the need for an effective attorney during the claims process.

Count on Experienced Attorneys

The workers’ compensation process is sometimes difficult to navigate. For a free consultation with an experienced workers’ compensation lawyer in Sussex County, contact Hollander, Strelzik, Pasculli, Hinkes, Vandenberg & Hontz, L.L.C. After-hours appointments are available.