New Jersey Workers’ Compensation Appeals

Sussex County lawyers fight denied claims

Injured workers seeking medical care and wage replacement through workers’ compensation may encounter resistance from employers or insurance carriers. If your claim has been denied, delayed or reduced, New Jersey law provides a formal appeals process. For more than 60 years, Hollander, Strelzik, Pasculli, Vandenberg, Hontz & Associates LLC has guided applicants through the New Jersey workers’ compensation appeals process to help them get the benefits they deserve. 

Common reasons New Jersey workers’ compensation claims are denied 

The initial question in every workers’ compensation claim is whether the injury was work-related. An insurer might argue that the injury happened outside of work, did not arise out of employment or was related to a pre-existing condition. Since medical records must clearly link the injury to job duties, an employer’s insurer might refuse benefits for lack of medical documentation. Disputes can also arise over the injury’s severity, the need for ongoing treatment or the extent of disability. 

Filing a workers’ compensation appeal in Newton, New Jersey

Appeals are filed with the NJ Division of Workers’ Compensation. Injured workers in Sussex County can challenge denied workers’ comp claims in one of two ways:

  • Application for an Informal Hearing — A judge considers the case evidence and issues a non-binding recommendation.
  • Formal Claim Petition — A judge holds a full trial that allows for discovery and medical evaluations.

In most cases, you must file an appeal within two years of the date of the injury or the last payment of benefits. Missing this deadline can permanently bar your claim.

Appealing denied medical treatment and wage benefits

Insurance carriers sometimes authorize limited treatment but deny coverage for surgeries, therapy, diagnostic tests or pain management. When this happens, you can file a motion for medical and temporary benefits. Temporary total disability (TTD) benefits, which replace lost wages while you are unable to work, can be disputed. Insurance carriers may stop payments by claiming you have reached maximum medical improvement or can return to work.

A workers’ compensation judge can review the medical evidence and order the insurer to provide treatment or resume wage benefits when appropriate.

Workers’ compensation court hearings and trials

Many cases settle before trial, but thorough preparation strengthens your position in negotiations. If negotiation does not resolve your case, you proceed to a hearing or trial before a workers’ compensation judge. Both sides exchange medical records and you may request an independent medical examination. Medical expert testimony often plays a critical role. At trial, your NJ workers’ compensation lawyer presents evidence, questions witnesses, including your medical experts and challenges the employer’s experts. The judge then issues a written decision.

Challenging employer or insurance company defenses

Employers and insurers frequently argue that:

  • The injury did not occur during employment.
  • The condition is pre-existing.
  • The worker failed to report the injury.
  • The employee can return to light-duty work.

Overcoming these defenses requires strong medical documentation, credible expert testimony and strategic presentation of evidence. Skilled legal representation can make a meaningful difference in the outcome of your appeal. An experienced Sussex County workers’ compensation appeals attorney can gather records, coordinate expert opinions and advocate effectively on your behalf.

Contact our NJ workers’ compensation lawyers to discuss your denied claim

Hollander, Strelzik, Pasculli, Vandenberg, Hontz & Associates LLC, with offices in Newton and Succasunna, handles workers’ compensation appeals for New Jersey employees who have been hurt or have fallen ill on the job. Please call 973-737-1023 or contact us online to set up a consultation.