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Who determines if I receive workers’ compensation benefits?

| May 5, 2021 | Workers' Compensation |

Workers’ compensation provides benefits if you suffer an injury at work through insurance your employer must carry. The state oversees the program but does not provide any benefits.

If you make a workers’ compensation claim, the New Jersey Department of Labor and Workforce Development explains you do it with your employer’s insurer. It is the insurer who makes the decision on whether or not you receive benefits.

Insurer rules

There are rules and regulations passed by the state that helps ensure the insurer fairly reviews your claim. The decision the insurer makes must follow the workers’ compensation law. The insurer will investigate your claim and look over the facts of your case. You should get a decision quickly on your claim.

The insurer can award you medical and monetary benefits. What you receive depends on the insurer’s decision and the state laws regarding the availability of benefits.

Appeals

If you get a decision from the insurer that you do not agree with, then you can appeal. When you appeal, it is to the state. You need to file a formal claim petition or for an informal hearing with the Division of Workers’ Compensation.

The DWC will then review your claim and make a ruling. It might rule in your favor or in the favor of the insurer. If the insurer did not follow the law when reviewing your claim and determining your benefits, then there is a likely chance the DWC will rule in your favor and you will get the benefits you deserve.

While the state makes laws and rules for the workers’ compensation system, it is your employer’s insurer who will usually make the decision about your benefits.