Articles Posted in Denial of Claims

People hurt on the job while working in New Jersey may be able to recover workers’ compensation benefits for their losses. They must meet certain requirements in order to be eligible for such benefits, however. For example, they have to establish that they suffered compensable injuries, which means, in part, the harm must be work-related. Recently, a New Jersey court discussed the review process in a matter in which an employee’s workers’ compensation claim was denied due to insufficient proof of work-related harm. If you sustained injuries while working in New Jersey, it is advisable to speak to a New Jersey workers’ compensation attorney to assess whether you may be owed benefits.

The Plaintiff’s Claims

It is alleged that the plaintiff worked at a manufacturing warehouse for the defendant. He was provided with protective eyewear and gloves but no equipment to protect his hearing. In July 2015, the defendant presented to the emergency room with complaints of dizziness. He was prescribed medication and directed to follow up with an ENT doctor. He was then evaluated in October and November 2015 by ENT doctors.

It is reported that the first doctor found the plaintiff’s hearing to be normal and did not diagnose any abnormalities, while the second diagnosed him with tinnitus and hearing loss. The plaintiff then filed a claim for workers’ compensation benefits, alleging his hearing issues were work-related. Following a hearing, his claim was denied, after which he appealed. Continue Reading ›

Many people in New Jersey work in maritime industries. Thus, if they suffer injuries at work, they may be able to recover workers’ compensation benefits under the Longshore and Harbor Workers’ Compensation Act (“the Act”). The Act only applies in certain circumstances, however, as discussed in a recent opinion in which a New Jersey employee’s denial of benefits under the Act was reversed. If you were hurt while working in New Jersey, you might be owed workers’ compensation benefits under the Act or other laws, and it is advisable to meet with a seasoned New Jersey workers’ compensation attorney to determine your rights.

Facts of the Case

It is alleged that the plaintiff, who was working on a marine construction project for the defendant, suffered hearing loss due to his work conditions. He then filed a claim for benefits under the Act, which was dismissed by an administrative law judge on the basis that his injury did not occur in navigable waters. The plaintiff appealed the decision, and on appeal, the court reversed and remanded for a determination of benefits.

Eligibility for Benefits Under the Act

On appeal, the plaintiff argued that the administrative law judge misinterpreted the definition of navigable waters, and therefore, the ruling was unjust. The court stated that the concept of navigability is vast. Because the Act was a federal maritime law, the court noted it must apply the definition that is used for determining admiralty jurisdiction under Article III. Continue Reading ›

People who suffer injuries in the workplace are frequently owed workers’ compensation benefits. They must comply with certain notice requirements, though, and if they fail to do so, their claims may be denied, regardless of the work-related nature of their injuries. The ramifications of the failure to give an employer proper notice of an injury was the topic of a recent New Jersey ruling, in a case in which the plaintiff appealed the denial of his workers’ compensation claim. If you sustained harm at work, you might be owed benefits from your employer, but it is critical to act promptly, and you should speak to a New Jersey workers’ compensation attorney as soon as possible.

The Plaintiff’s Harm

It is alleged that the plaintiff worked as a police officer for the defendant township from 1979 through 2004. In 2007, he filed a workers’ compensation claim, seeking benefits for orthopedic and psychiatric occupational injuries. Following a trial, both claims were dismissed. He appealed, and the decision was affirmed with regard to the psychiatric injury claims, but the court found that there was insufficient information to affirm the ruling as to his orthopedic injury claims, and the case was remanded for the judge to make specific findings. Following the remand, his orthopedic claim was dismissed as well, after which he appealed.

Notice Requirements in Workers’ Compensation Cases

On appeal, the plaintiff argued that he did not realize until 2007 that his orthopedic complaints were work-related. The court explained that the New Jersey Workers’ Compensation Act (the Act) requires an injured employee provide an employer with notice of the injury within ninety days of an injury. Further, the Act states that a claim petition must be filed within two years from the date the accident occurred. The statute of limitations does not begin to run, though, until an employee is, or reasonably should be, aware of the work-related nature of an injury. Continue Reading ›

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. Continue Reading ›

While under the New Jersey Workers’ Compensation Act, employers are required to provide eligible employees who suffer work injuries with medical and disability benefits, many employers will argue that such benefits are not warranted. As such, in some cases, a workers’ compensation judge will be called on to determine whether an injury is compensable, and if so, what benefits the employee is owed. A judge’s basis for making such determinations was recently discussed in a case in which an employer admitted an employee’s injury was work-related but denied that it prevented him from working. If you work in New Jersey and sustained a work-related injury, it is prudent to talk to a capable New Jersey workers’ compensation attorney to determine your rights.

History of the Case

It is alleged that the plaintiff worked for the defendant as a laborer. He was injured in a single-vehicle accident when he was driving a truck owned by the defendant after leaving the defendant’s concrete plant. He was terminated the day after the accident for failing to submit to a drug test following the accident. The plaintiff suffered substantial injuries because of the accident and filed a workers’ compensation petition.

It is reported that the defendant originally denied that the plaintiff suffered a work-related injury. It later admitted the injury was compensable and paid the plaintiff medical benefits but denied that the injury prevented the plaintiff from working. The plaintiff then filed a motion for disability benefits. Following a hearing, the judge granted the plaintiff disability benefits and delay damages, and the defendant appealed. Continue Reading ›

Employees that suffer injuries while working are often able to recover workers’ compensation medical benefits from their employers. However, in some instances, while an employer may not dispute that an employee suffered a work-related injury, it may nonetheless argue that the treatment the employee seeks is not reasonable or necessary. In such cases, the courts will typically resolve the dispute based on which party’s medical expert offers more compelling testimony, as demonstrated in a recent New Jersey case in which the employer argued its employee’s prescription was not compensable. If you were hurt at work, and your employer denied you workers’ compensation benefits for the treatment of your injuries, you should consult a skilled New Jersey workers’ compensation attorney to assess your rights.

Facts and Case History

Reportedly, the plaintiff suffered a back injury in a car accident in 2011, when he was working for the defendant. He subsequently filed a workers’ compensation claim and, in 2014, received a fifteen percent partial disability award for the injury to his lower back and aggravation of a pre-existing injury. He then filed a motion to compel the defendant to pay for his opioid painkiller prescription. The defendant opposed the motion, and a hearing was held during which the plaintiff’s treating physician and the defendant’s medical expert testified.

Allegedly, the plaintiff’s doctor testified that the plaintiff would never heal through the use of pain medication and that the only treatment that would address his symptoms was surgery. The defendant’s expert testified, though, it was reasonable for the plaintiff to be on opioid medication for long-term management of his pain. The court found in favor of the defendant, and the plaintiff appealed, arguing the court improperly granted greater weight to the testimony of his treating doctor. On appeal, the appellate court affirmed the trial court ruling. Continue Reading ›

While the work-related nature of some harm is clear, in other instances, an employer may deny that an employee suffered an illness or injury due to work conditions. Thus, the matter of whether an employer owes an employee workers’ compensation benefits will have to be decided in court. Recently, a New Jersey court addressed an issue where an appellate court overturns an initial ruling that an employee suffered work-related harm, if the employee may be compelled to repay any benefits he or she received. If you suffered an illness or injury due to conditions you encountered at work, it is advisable to confer with a dedicated New Jersey workers’ compensation attorney to assess your rights.

Facts and Procedural History

It is reported that the employee requested workers’ compensation benefits, alleging that he suffered harm due to exposure to toxic substances in the workplace. The employer denied that the employee suffered a work-related injury, and therefore the employee filed a claim against the employer. A trial was held, after which a judge of compensation awarded the employee temporary disability benefits, permanent disability benefits, and costs. The employee appealed and filed a motion to stay the case pending resolution of the appeal.

Allegedly, the judge of compensation denied the stay, but orally proscribed that if the decision was overturned, the employee might be required to repay the employer any benefits paid during the pendency of the appeal. While the parties were waiting for a ruling on the appeal, the employer paid the employee almost $117,000 in benefits. The appeal was subsequently granted, after which the employer filed a motion seeking reimbursement of the benefits paid. The judge of compensation denied the employer’s motion, stating that jurisdiction remained with the appellate court, after which the employer appealed. Continue Reading ›

It is well-known that in order for an employee to recover workers’ compensation benefits, the employee’s injury must be work-related. It may not be entirely clear, though, which party bears the burden of proving whether or not an employee sustained an injury at work. In a recent New Jersey workers’ compensation case, the court clarified which party bears the burden of proving the nature of an employee’s injury. If you sustained a work-related injury, you might be owed workers’ compensation benefits, and you should consult a skillful New Jersey workers’ compensation attorney as soon as possible.

The Plaintiff’s Injury

It is reported that the plaintiff suffered an injury to her shoulder while she was undergoing physical therapy for an injury to her right wrist that she sustained at work. As such, she filed a claim for workers’ compensation benefits, alleging that she either tore her rotator cuff or aggravated an existing tear, and that the injury was work-related. The defendant employer denied that the plaintiff’s shoulder injury was work-related. As such, the plaintiff filed a motion to recover benefits. The judge of compensation denied the plaintiff’s motion, finding that she had not sustained her burden of proving her injury was work-related and that her claim was compensable. The plaintiff appealed the denial of her motion, arguing that the judge improperly shifted the burden of proof from the defendant to the plaintiff.

The Burden of Proving the Nature of an Employee’s Injury

On appeal, the plaintiff argued that when a defendant claims an accident was caused by an employee’s physical condition, the employee bears the burden of establishing causation and that the defendant failed to show that the plaintiff’s injury was idiopathic. The appellate court disagreed, stating that while it is a fundamental truth that the language of the New Jersey Workers’ Compensation Act is to be liberally construed in favor of a claimant, a claimant nonetheless bears the burden of proving that an accident caused a compensable injury. Continue Reading ›

In New Jersey, a person that suffers an injury at work may be eligible to recover workers’ compensation benefits. However, there are certain factors that determine whether a person may be awarded benefits, such as whether the person is an employee or an independent contractor and whether the person was engaged in the scope and course of his or her work. As discussed in a recent New Jersey case, generally, an employee that suffers an injury while traveling to or from work is not considered to be engaged in work-related activity and cannot recover benefits. If you suffered an injury while working, it is prudent to meet with a knowledgeable New Jersey workers’ compensation attorney to discuss whether you may be owed benefits.

Facts Regarding the Plaintiff’s Injury

It is reported that the plaintiff, a nurse, parked her car in the parking lot across the street from the hospital in which she worked. She was crossing the street to go to work when she was struck by a vehicle. She suffered a concussion, multiple fractures, and other injuries. She subsequently filed a claim for workers’ compensation benefits. Her employer denied her claim, and a judge of compensation ultimately ruled that her injuries did not arise in the course and scope of her employment. The plaintiff appealed, but on appeal, the appellate court affirmed the dismissal of her claims.

Benefits for Injuries Suffered While Traveling To or From Work

Pursuant to New Jersey’s Workers’ Compensation Act (the Act), employees that suffer injuries while they are in the course of their employment have the right to recover workers’ compensation benefits. While the general law previously provided that injuries incurred while traveling to or from work were not compensable, there were numerous exceptions. Thus, the legislature enacted what is known as the premises rule. Continue Reading ›

In New Jersey, an employee that suffers an injury may be entitled to workers’ compensation benefits. There are specific things an employee must prove to recover such benefits, however, such as the work-related nature of the injury. In a recent New Jersey case in which the employer appealed an order granting an employee workers’ compensation benefits, the court discussed the burden of proving causation in workers’ compensation cases. If you were injured at work, you may be owed benefits from your employer, and it is in your best interest to speak to a dedicated New Jersey workers’ compensation attorney to assess your rights.

Facts of the Case

It is reported that the plaintiff injured his left foot and ankle while working as a roofer for the defendant. The plaintiff then filed a workers’ compensation petition, seeking benefits for his injuries. In its answer to the petition, the defendant denied that the plaintiff’s injuries were work-related, but provided benefits without an admission of liability. The plaintiff subsequently filed multiple motions seeking temporary disability benefits, which the defendant opposed on the grounds the injuries were not work-related. The majority of the motions were resolved without a hearing.

Allegedly, however, in 2019, a hearing was held on a pending motion in which the plaintiff sought benefits for a proposed surgery. The court entered an order continuing temporary disability benefits and requiring the defendant to authorize the surgery, but did not opine on the defendant’s continued argument that the plaintiff’s injuries were not work-related. The defendant then appealed. Continue Reading ›

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