Articles Posted in Denial of Claims

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 ›

While in some instances, the work-related nature of an injury is not disputed, in other cases, the employee and employer may disagree as to whether an injury was sustained at work. Thus, in some cases, a hearing may be held in front of a workers’ compensation judge who will ultimately make a determination as to whether an employee is entitled to benefits. Workers’ compensation judges have an obligation to weigh all pertinent information before rendering a decision. If they fail to do so, it may be grounds for dismissal of any issued order. This was demonstrated in a recent New Jersey case in which the denial of the employee’s workers’ compensation claim was reversed due to the fact the workers’ compensation judge did not let the employee testify. If you filed a claim for workers’ compensation benefits that was denied, it is in your best interest to confer with a diligent New Jersey workers’ compensation attorney to discuss your options for seeking recourse.

Factual and Procedural History

It is reported that the employee filed a petition for workers’ compensation benefits after he fractured his foot while working for the employer, a landscaping company. The employer disputed that the injury happened at work, arguing that the employee’s medical records included statements from the employee in which the employee stated the injury happened at home. Multiple hearings were held on the matter, during which the employer testified regarding the reasons for disputing the employee’s petition.

Allegedly, the judge advised he would allow the employee to testify but did not actually afford him the opportunity to do so, and issued an order denying the employee’s petition. The employee then appealed, arguing that the judge violated the employee’s right to due process by not allowing the employee to introduce evidence in support of his petition. Continue Reading ›

In many instances, even if an injured employee is awarded workers’ compensation benefits, the award may be inadequate to cover the employee’s income loss or the cost of medical treatment. Thus, the New Jersey Workers’ Compensation Law allows employees to seek modifications of benefits awards under certain circumstances. There are time limitations as to when a modification may be sought, though, and employees who seek a modification outside of the statutory period may be denied, as showing in a recent New Jersey workers’ compensation case. If you wish to seek a modification of your workers’ compensation award or your request for modification was denied, it is prudent to speak with a skillful New Jersey workers’ compensation attorney regarding your rights.

Factual History of the Case

It is alleged that, in 2000, the employee injured his right knee while working for a shipping company. He subsequently sought and obtained numerous awards of workers’ compensation benefits for that injury. He then began working for a school district. In 2012, the employee filed a petition for workers’ compensation benefits from the school district for injuries in both knees and filed a concurrent motion to open his prior petition against the shipping company. Following a hearing, the compensation court determined that the shipping company was responsible for the treatment for the employee’s right knee, while the school district was responsible for the treatment of the left knee.

It is reported that both petitions resolved in December 2015, when the employee was awarded permanent disability benefits for his left knee against the school district and for his right knee against the shipping company. In 2017, the employee requested an additional examination and treatment from both employers, but the shipping company did not respond. He then requested that the court re-open his petition against the shipping company in 2018, but the court denied his petition as untimely. The employee appealed. Continue Reading ›

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