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What you should know about appealing a workers' comp denial

Following a workplace injury or illness, you may be unable to immediately return to work. This could leave you unsure of how you will cover the costs that arise while recovering. The good news is workers' compensation benefits may be available. Unfortunately, these benefits are not always easy to secure or they may end prematurely. Not getting the benefits you need can be frustrating and you may not know what to do.

If you find yourself in this situation you do have options. You can file either a formal or informal claim to appeal the decision. Regardless of which route you take, it is important that action is commenced within the two year statute of limitations, which begins to run on either the date of the last compensation payment or the date of the injury, whichever is later.

Filing a Formal Claim

A formal claim petition will be filed with the Division of Workers' Compensation. Under this approach it is possible the injured worker will go to trial where he or she, along with medical and lay witnesses, will provide testimony. Once a formal claim petition is filed with the Division it generally takes six months before a hearing with a judge of compensation will take place. Based on the information provided, that judge will make a decision. Any appeals to that decision must go to the Appellate Division of the Superior Court.

In some cases things will start happening before the hearing. For example, if you need temporary benefits and medical treatment, a "Motion for Medical and Temporary Benefits" may be filed, followed by an initial hearing with a Judge of Compensation. Other times, the claim petition could settle during the pretrial stage.

Filing an Informal Claim

In situations where workers want to avoid formal litigation and try to resolve matters more quickly, an informal claim may be filed. Though any suggestions provided by the judge are not binding, this may be a good way to resolve matters such as:

  • Permanency benefits
  • Medical treatment
  • Temporary benefit amounts

When it works, these matters are usually resolved in much less time than formal claims. If it doesn't however, there is always an opportunity to file a formal claim.

Though it is not required that parties navigate either of these appeal options with the assistance of a workers' compensation attorney, since most injured workers are not familiar with the process, it is usually beneficial to do so.

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