News

Disability Pension Denied as a Public Employee of the State?

For public employees in New Jersey—including firefighters, police officers, teachers, and judges—a disability pension serves as a vital financial safeguard when injuries or illnesses make it impossible to continue working. Unfortunately, not every claim for a disability pension is approved, even when the need is undeniable. If your disability pension application has been denied, you’re not alone, and you may have legal recourse to challenge the decision.

At Feeley & LaRocca, LLC, we understand the challenges public employees face when fighting for their rightful benefits. Denials can be emotionally and financially devastating, but with the right legal strategy, you may secure the benefits you deserve. Here’s what you need to know if you’ve been denied a disability pension.

Disability Pensions in New Jersey

A disability pension is a financial benefit provided to public employees who are unable to perform their job duties due to an illness or injury. In New Jersey, disability pensions are governed by laws specific to various public employment sectors. These pensions are essential in offering financial stability to employees who can no longer work due to circumstances beyond their control. 

New Jersey offers two main types of disability pensions—ordinary and accidental. Ordinary disability pensions are granted when an employee is permanently disabled due to illness or injury, regardless of whether it is job-related. Accidental disability pensions, however, require proof that the disability resulted from a specific traumatic event at work.

Eligibility for these pensions varies depending on the type. For ordinary disability pensions, applicants must have at least four years of service and provide medical evidence of permanent disability. Accidental disability pensions require no minimum service but necessitate proof that the injury was work-related and accidental. These pensions are regulated under statutes such as N.J.S.A. 43:16A-7 for police and firefighters and N.J.S.A. 18A:66-39 for teachers. These laws outline eligibility criteria, calculation methods, and procedural requirements.

The financial benefits of these pensions can be substantial. Ordinary disability pensions typically provide 40% of the applicant’s final salary, while accidental disability pensions offer up to 66.67%. However, applicants must file for disability pensions within five years of the incident or diagnosis, as missing this deadline can result in an automatic disqualification. 

Medical evaluations play a critical role in the application process. Applicants must submit detailed medical documentation from treating physicians and undergo evaluations by independent medical examiners to verify the permanence and severity of their disability.

Denied applicants have the right to request a hearing before an administrative law judge or challenge the decision in the Superior Court of New Jersey. Given the complexity of these cases, applicants benefit significantly from working with experienced attorneys. Feeley & LaRocca, LLC focuses on advocating for public employees and securing the benefits they deserve. If you are struggling with a disability pension denial, our pension disability lawyer can help ensure your rights are protected.

Top 10 Common Reasons for Disability Pension Denials

Disability pension denials often stem from procedural errors or disputes over eligibility. Understanding why your application was denied is the first step toward appealing the decision. Here are the top ten most common reasons:

Top 1: Disputes Over Eligibility

To qualify for a disability pension, you must prove that your injury or illness directly prevents you from performing your job duties. For example, firefighters and police officers applying for an accidental disability pension must demonstrate that their condition resulted from a specific traumatic event during the course of their duties. 

New Jersey law governs accidental disability pensions for police and firefighters and requires that the disabling incident be identifiable, unexpected, and unrelated to pre-existing conditions.

Top 2: Insufficient Medical Evidence

Medical evidence is a cornerstone of any disability pension claim. A lack of detailed medical reports, failure to include statements from treating physicians, or conflicting opinions from independent medical examiners can lead to a denial. According to N.J.A.C. 17:4-6.7, the burden of proof lies with the applicant to provide compelling medical documentation.

Top 3: Missed Deadlines or Procedural Errors

Filing a disability pension application requires strict adherence to deadlines and procedural requirements. Applicants must file within five years of the disabling incident. Failure to meet these deadlines or to complete the required forms accurately can result in an automatic denial.

Top 4: Disagreement on the Severity of the Disability

Even if the reviewing board acknowledges your condition, they may argue that it doesn’t meet the threshold for permanent disability. This is particularly common for applicants with chronic but non-debilitating injuries. The pension board relies on standards to assess the severity and permanency of disabilities.

Top 5: Lack of Job-Related Connection

Disability pensions for public employees often require a direct link between the injury or illness and the applicant’s job duties. If the reviewing board determines that your condition was caused by non-work-related activities, your claim may be denied. This is especially critical for accidental disability pensions, where the law mandates that the injury result from a specific workplace incident.

Top 6: Pre-Existing Conditions

Claims may be denied if the pension board determines that your condition existed prior to your employment or prior to the incident cited in your application. N.J.S.A. 43:16A-7(b) requires applicants to demonstrate that their disability was caused or aggravated by their job duties and not solely due to a pre-existing issue.

Top 7: Inadequate Evidence of Permanency

A disability pension requires proof that the applicant’s condition is permanent. Temporary or partially disabling conditions, such as injuries expected to heal within a certain time frame, typically do not qualify. Providing thorough medical evidence that outlines the permanence of your condition is crucial.

Top 8: Errors in Application Documentation

Incomplete or improperly filled-out application forms are a common reason for initial denials. The disability pension process is governed by strict procedural requirements, and even minor errors can lead to a rejection. Applicants must ensure that all required sections are completed and supported by the appropriate documentation.

Top 9: Disputes Over Workplace Responsibilities

Sometimes, the pension board disputes whether the duties described in the application truly align with the applicant’s official job responsibilities. Providing detailed job descriptions and corroborating statements from supervisors or colleagues can help address this issue.

Top 10: Unfavorable Independent Medical Examiner (IME) Findings

Applicants are often required to undergo evaluations by an independent medical examiner (IME). If the IME’s findings contradict those of your treating physician, it can lead to a denial. Challenges to IME findings can include providing additional medical opinions and submitting detailed records that highlight discrepancies.

If you’ve received a denial letter, it will outline the reasons for the decision. Our disability attorney in Winfield Park, NJ can review your case, explain your options, and help you take the next steps toward a successful appeal.

Legal Options If Your Claim Is Denied

If your claim for a disability pension is denied, it can be a frustrating and overwhelming experience. However, there are several legal avenues available to contest the denial and secure the benefits you deserve. Understanding these options and acting promptly can make a significant difference in the outcome of your case.

Administrative Appeals

If your disability pension claim is denied, the first step is to file an administrative appeal. This involves requesting a hearing before an administrative law judge (ALJ). The ALJ reviews all aspects of the case, including medical evidence, witness testimony, and employer records. 

The ALJ will then make a recommendation to the pension board. This step is crucial as it allows for a comprehensive re-evaluation of your claim. Working with legal counsel ensures that your case is presented in the most effective way possible. 

Superior Court Appeals

If the administrative appeal does not result in a favorable outcome, you have the right to appeal the decision to the Superior Court of New Jersey. This step involves filing a lawsuit against the pension board. The court will review whether the board’s decision was arbitrary, capricious, or unreasonable under N.J.S.A. 52:14B-10. 

Superior Court appeals often focus on procedural errors or misinterpretations of the law. Experienced legal representation is critical at this stage to present a strong argument and challenge any inconsistencies in the pension board’s decision-making process.

Filing a New Application

In some cases, it may be strategic to file a new application instead of pursuing further appeals. This approach is particularly useful if new evidence or updated medical documentation has become available since the original denial. A new application allows you to address the reasons for the initial denial while presenting a stronger case. Legal counsel can help identify the best course of action based on the specifics of your situation and ensure that all procedural requirements are met to avoid further denials.

Requesting Reconsideration

Another option is to request reconsideration from the pension board. This involves submitting additional evidence or clarification regarding your original application. Reconsideration requests are most effective when you can present compelling new information, such as updated medical reports, that were not included in your initial submission.

Mediation or Settlement Negotiations

In some instances, mediation or settlement negotiations may provide a viable alternative to lengthy appeals. Mediation allows both parties to work with a neutral third party to resolve disputes amicably. While less common in disability pension cases, this approach can be effective in resolving specific issues or reaching an agreement without prolonged litigation.

Don’t Face a Denial Alone

A disability pension denial can feel like a significant setback, but it doesn’t have to be the end of your story. At Feeley & LaRocca, LLC, we understand the importance of these benefits for public employees and are committed to helping you fight for your rights. With our experienced Winfield Park, NJ state police pension attorney by your side, you can take the necessary steps to challenge a denial and secure the support you deserve.

Don’t let a denial keep you from the financial stability you need. Contact Feeley & LaRocca, LLC today and let us help you protect your future.