Navigating Disputes

Welcome to our Orthopedics Practice Workers’ Compensation Guide! This resource is designed to offer a helpful overview of workers’ compensation in the context of orthopedic injuries. It’s essential to recognize that this guide is not a replacement for professional advice.

To obtain more detailed and personalized information, we recommend visiting the official workers’ compensation portal. This portal provides access to the latest regulations, forms, and additional resources, ensuring you receive the most current and accurate information.

Your well-being is our primary concern, and we trust that this guide serves as a valuable starting point for understanding workers’ compensation in the field of orthopedic care.

Navigating Disputes

Filing Disputes and Seeking Resolution:

Formal Claim Petition and Informal Hearing Application: In situations where there is a disagreement between an injured worker and the employer or insurance carrier regarding entitlement to benefits, the worker can initiate either a formal Claim Petition or an Application for an Informal Hearing with the Division of Workers’ Compensation. Upon filing, the case gets assigned to a judge and a district office based on the injured worker’s residence county or, if out of state, the county where the employer is located.

Key Issues and Representation: The raised concerns may involve the compensability of the claim (whether the injury/illness is considered work-related), the type and extent of medical treatment, and/or the payment of temporary disability benefits. Additionally, a claim petition may seek permanent disability benefits and, in cases of alleged job-related death, dependency benefits. While workers are generally represented by an attorney, they also have the option to file a claim petition personally (pro se). An insurance carrier typically provides legal defense for a covered employer, and if it’s a self-insured corporation, obtaining legal representation is mandatory.

Informal Hearings for Swift Resolution: In situations of dispute, an employee, employer, and insurance carrier can file an application for an informal hearing before a judge of compensation. These proceedings serve as a quicker means of resolving issues without resorting to more intricate and lengthy formal litigation. Matters such as the amount of temporary benefits, medical treatment, and permanency benefits can be addressed during these hearings.

Non-Binding Suggestions and Statutory Time Limits: The suggestions made by the judge during an informal hearing are not binding on either party. The employee retains the right to file a formal claim petition within the statutory time period. While legal representation isn’t obligatory, it is recommended, particularly in more complicated cases where serious substantial permanent injury is alleged.

Scheduling and Time Limitations: Upon filing an application for an informal hearing, the worker, the employer, and/or their insurance company receive scheduling information from the Division within a few weeks. Informal claims are typically resolved within the initial or second hearing. It’s crucial to note that filing an application for an informal hearing does not pause the two-year statute of limitations.

Formal Claim Petition Process: Alternatively, the injured worker can file a formal claim petition with the Division within the statutory time frame. The first hearing before a judge of compensation usually occurs within six months from the filing date. Cases are typically assigned to a district office based on the injured worker’s residence or, if out of state, the county where the employer is located.

Settlements and Trial Proceedings: Most claim petitions are settled by mutual agreement on the amount of benefits due and the extent of disability. If issues cannot be resolved during the pretrial stage, trial commences, involving testimony from the injured worker, medical, and lay witnesses. After trial, the judge makes a decision based on the relevant evidence, and these rulings are binding, with appeal options limited to the Appellate Division of the Superior Court.

Accessing Claim Petition Forms: Claim petition forms are available for download for those wishing to initiate the formal claim petition process.

Immediate Recourse for Medical Treatment: The law facilitates immediate relief for workers in urgent need of medical treatment and temporary benefits. In such instances, the worker can file a “Motion for Medical and Temporary Benefits,” assigned an initial hearing date before a Judge of Compensation within 30 days of filing.

Accessing Motion for Medical and Temporary Benefits Form: For those seeking immediate recourse, the Motion for Medical and Temporary Benefits form is available for download.


Legal Representation and Fee Structure:

Recommendation for Legal Representation: While legal representation is not obligatory in such instances, it is recommended. Attorneys are legally prohibited from charging fees in advance for their services. Legal fees can only be awarded by a judge of compensation, contingent upon the approval of a compensation award. Typically, these fees are limited to 20% of the awarded judgment and are payable by the injured worker and the employer and/or insurance carrier.

Filing Formal Claim Petition without an Attorney: In the event you wish to file a formal claim petition without legal representation, you can seek a referral from your local Bar Association Lawyer Referral Service.

Statute of Limitations: There is a two-year statute of limitations for Workers’ Compensation cases. The formal claim petition must be filed within two years from the date of injury or the date of the last payment of compensation, depending on which is later. Medical treatment authorized by the employer is considered a form of compensation. For cases of occupational illness, like asbestosis, lead poisoning, or hearing loss, the claim petition must be filed within two years from the date the worker first became aware of the condition and its connection to employment. Importantly, the filing of an application for an informal hearing does not halt the running of the two-year statute of limitations.