New Jersey Court Discusses Proving Workers’ Compensation Coverage

In New Jersey, employers are typically required to pay injured employees workers’ compensation benefits. In most instances, employers do not pay employees benefits directly but rely on their workers’ compensation insurers to pay them. Thus, even if an employer admits such benefits are owed, a claim may be denied due to an insurer’s refusal to provide coverage. If you were harmed at work and your claim for benefits was denied, it is in your best interest to speak to a skillful New Jersey workers’ compensation attorney to determine your options.

The Plaintiff’s Harm

Allegedly, the plaintiff was injured while working for the defendant employer. He submitted a claim for workers’ compensation benefits. The defendant insurer filed an answer in which it denied coverage, stating that the coverage it once provided to the defendant employer was canceled prior to the plaintiff’s accident. The defendant insurer then filed a motion to dismiss. A hearing was held on the matter, after which the workers’ compensation judge denied the defendant’s motion to dismiss. The insurer then appealed, arguing the judge erred in denying the motion.

Proving Coverage for a Workplace Injury

On appeal, the court noted that the trial court stated that the New Jersey statute governing the cancellation of workers’ compensation insurance policies was clear and unambiguous. Specifically, it stated that either an employer or insurer could cancel a policy within the time indicated by the contract, as long as at least ten days written notice was sent by mail from the party seeking cancellation to the other party.

The court went on to state that it was the insurer’s obligation to demonstrate that it complied with the terms of the statute. In the subject case, however, the defendant insurer failed to offer any witness who had personal knowledge of the mailing of the notice or of the receipt of the notice. Additionally, while the court recognized that evidence of a mailing could be proven via office customs, the defendant insurer did not offer that kind of evidence either.

Finally, the court stated the notice in question was insufficient to cancel the policy regardless of when it was mailed or received. The notice simply stated that the defendant insurer’s failure to pay its premium by July 24th might impact the defendant employer’s insurability. The court explained this was inadequate to effectuate a cancellation per the terms of the statute. The court stated that public policy required that continued coverage should be found unless an insurer strictly complies with all regulatory and statutory requirements. Thus, the court affirmed the trial court ruling.

Speak with a Trusted New Jersey Workers’ Compensation Attorney

Employees who are injured at work are typically owed benefits from their employers.  If you’ve been denied a workers compensation claim in New Jersey, you may be owed workers’ compensation benefits and should talk to an attorney as soon as possible. The trusted New Jersey workers’ compensation attorneys of The Law Offices of Jonathan F. Marshall can help you determine what benefits you may be owed and will fight to help you seek a just outcome. You can reach us via our online form or at 800-999-0897 to schedule a conference.

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