Practice Areas

If you were hurt on the job in New Jersey, your case begins with the state workers’ compensation system. New Jersey is a no-fault system, which means you do not have to prove your employer did anything wrong in order to be entitled to benefits. This fact notwithstanding, the insurance companies that represent employers will fight to the last dollar to avoid paying what they owe you. These insurance companies have every incentive to authorize less treatment, to question whether the injury is truly work-related, and to end your checks as early as they can.

For example, consider a warehouse worker who tears a rotator cuff lifting freight off a loading dock, or a delivery driver rear-ended while driving. Under New Jersey law, that worker is entitled to:

• Medical treatment for the injury
• Temporary disability payments while out of work
• Permanent disability benefits if the injury leaves lasting damage
• Mileage reimbursement for travel to and from treatment
• Vocational rehabilitation if returning to the old job is no longer possible

Under New Jersey law, these payments and benefits must be paid to an injured employee. Unfortunately, getting the insurance company to pay them in full and on time is another matter entirely.

Timing is always a key factor when it comes to workers’ compensation cases. New Jersey requires an injured worker to notify the employer within 90 days of the injury. A formal claim petition must generally be filed within 2 years of the accident or the date of the last payment of benefits. Miss those deadlines and your entire case may be dismissed. Simply put, the sooner you involve an attorney, the less room the insurance company has to avoid paying money that is rightfully yours.

The injuries we handle reach across nearly every industry in the state:

• Construction site falls and scaffolding accidents
• Warehouse and forklift injuries
• Back injuries among healthcare workers caused by lifting patients or heavy equipment
• Repetitive stress conditions in office settings
• Motor vehicle accidents that happen during work duties
• Occupational illnesses that build up over years rather than in a single moment.

Employers and insurance companies have a usual bag of tricks that they use to avoid paying. Many times, an employer and its insurance company will argue that an injury occurred outside of the workplace, and thus is not subject to workers’ compensation. The insurance company will stretch out authorization through fee-schedule disputes or make a lowball settlement offer that arrives just as your bills are piling up.

Having Kotlar Cohen on your side can help change the result. We gather the medical proof, appeal the denials, negotiate the settlement, and argue the case at hearings so that the value of your claim reflects what actually happened to your body.

How much your workers’ compensation case is ultimately worth depends on several factors:

• How serious the injury is
• Whether it left permanent damage
• Whether you can return to the job you had
• The future medical care you will need
• Your age and occupation

New Jersey generally resolves these cases in one of two ways — a percentage-of-disability award that keeps your right to future medical treatment open, or a lump-sum settlement that closes the case for good in exchange for a single payment. Which option is right for you is an important decision with long-term consequences, and it is not one to make based on an insurance adjuster’s assurances. We make sure our clients understand those tradeoffs, in plain terms, before anything is signed.

When someone else’s negligence injures you, whether it be from a car or truck accident, slip and fall, or other injury, you may soon be faced with severe consequences – the medical bills, the lost income, the pain, and the parts of your life the injury took away. We have handled these cases throughout New Jersey since 1995, and our approach is direct: we put you first and take aggressive legal action to secure the treatment and the compensation you are owed.

Auto accidents are the primary cause of serious injuries. The insurance company will question whether you were really hurt, whether your treatment was necessary, and whether a pre-existing condition is the real cause. We handle the full range of auto accident cases, from rear-end and intersection collisions to the catastrophic crashes caused by drunk or distracted drivers.

Many insurance companies will point to the fact that an accident was minor and/or the plaintiff did not seek immediate medical treatment as a reason to make a low-ball settlement offer. However, even low-impact accidents can sometimes cause injuries. Frequently, these injuries do not manifest themselves until days or even weeks after an accident. The fact that you weren’t rushed to the hospital after an accident does not mean that you are not entitled to significant compensation for your injuries.

Truck accidents are a category of their own. A loaded tractor-trailer can weigh twenty to thirty times what a passenger vehicle does, so when one is involved, the injuries are often severe or even catastrophic. Conversely, because truck accidents can cause significant damage, trucking companies and their insurers fight claims vigorously, and the defense is well funded.

These cases reach beyond the driver to the trucking company, its insurer, and sometimes the party that loaded or maintained the rig, and they turn on evidence such as driver logs, maintenance records, and electronic control module data that has a way of disappearing if no one moves quickly to preserve it.

Slip-and-fall and other premises cases arise from hazards a property owner should have addressed: an unmarked wet floor, a broken stair, ice and snow left on a walkway, a poorly lit lot. Winning a slip and fall case means proving the owner knew or should have known about the danger and did nothing about it, which takes more than a photograph of the spot where you fell.

With regard to auto accident cases, one wrinkle under New Jersey law catches a lot of drivers off guard. When you bought your auto policy, you chose either the “limitation on lawsuit” (verbal threshold) option or the “no limitation” option, and that choice affects whether you can recover for pain and suffering or only for economic losses such as medical bills and lost wages.

It is worth having a lawyer read your policy before you assume a door is closed, because the threshold has exceptions and is frequently litigated. We usually work on a contingency, which means there is no fee unless we win, and we prepare every case as though it will be tried, because an insurance company that knows you are ready and able to go to trial is an insurance company that pays more.

In New Jersey, the deadlines for personal injury cases are strict. You generally have two years from the date of the accident to file a personal injury lawsuit, and claims against a public entity such as a city, a county, a transit authority can require written notice within just 90 days. Wait too long, and even a strong case can be lost before it begins. Second, the compensation you can pursue falls into two categories: economic damages, such as medical bills, lost wages, and the cost of future care, and non-economic damages for the pain, the disability, and the disruption the injury has caused. In serious cases, both can be significant, and building a credible, well-supported number for the non-economic side is a large part of what we do.

If your medical practice was underpaid, delayed, or outright denied reimbursement for services you have already provided, that money is often recoverable, and the path to recovering it depends on which framework the claim falls under: the federal No Surprises Act or New Jersey’s own surprise-billing law.

A surprise medical bill arises when an out-of-network specialist treats a patient at an in-network hospital or surgical center, very often without the patient ever choosing that provider. For example, an anesthesiologist who is out-of-network administering care during a surgery that the patient’s in-network surgeon performs at an in-network facility. In the past, the provider could bill the patient for the balance the insurer refused to pay. The No Surprises Act changed that. The patient now owes only their in-network cost-sharing, such as the copay, deductible, and coinsurance, and the dispute over the true value of the service is argued by the provider and the insurance company.

To settle that dispute, the No Surprises Act created a federal arbitration process known as Independent Dispute Resolution, or IDR. Under the NSA, an insurance company can pay the provider a Qualifying Payment Amount, or QPA, a figure the health plan itself calculates, and then bank on the fact that most providers will not challenge it in time. The reimbursement that results often bears little relationship to the billed charge; it is not unusual to see a substantial surgical or anesthesia claim paid back at a small fraction of what was billed.

Providers who let the arbitration deadline pass are left with no further recourse, which is precisely what the insurance companies are counting on. Medical providers have to be prepared to act quickly.

We handle No Surprises Act arbitration from the first eligibility review through the final award, often aggregating claims so that the economics make sense, and building evidence that places the provider’s training, the complexity of the case, and the true value of the service in front of the arbitrator. We know what these IDR entities look for when they decide the correct payment for an out-of-network service, and we handle each claim from beginning to end so that eligible claims are submitted on time.

Even prior to the No Surprises Act being enacted in 2022, New Jersey enacted the Out-of-Network Consumer Protection, Transparency, Cost Containment, and Accountability Act (the “NJ Act”), which took effect in 2018. Like the federal statute, it protects patients from balance bills for emergency, urgent, and inadvertent out-of-network care and limits them to their in-network cost-sharing. And like the federal statute, it takes the real dispute off the patient and moves it into arbitration between the provider and the insurance company.

The law applies to fully insured New Jersey plans, the State Health Benefits Program, and self-funded plans that have opted in, and it covers payment disputes of $1,000 or more, decided through a state-designated dispute-resolution organization. One significant difference from the federal system is timing. The New Jersey window to demand arbitration is short. A provider generally has only about 30 days after the insurance company’s final offer to reject it and file. Eligible claims are routinely lost simply because the deadline passed. Whether your out-of-network claim belongs in the federal IDR process, the New Jersey arbitration system, or both, the first step is the same — have it reviewed for eligibility before the clock runs out.