New Jersey Workers’ Compensation Denials

You work hard for a living, but unfortunately, things don’t always go as planned. One moment you’re doing something you’ve done countless times before, and the next, you’re hurt, in pain, and wondering how you’ll pay your bills or even get back to work. You file a workers’ compensation claim, thinking this is exactly what the system is there for. Then the letter comes. You’ve been denied the benefits you need. This is disheartening to say the least, but the good news is that a denial doesn’t always mean you’re out of options. In fact, it’s often just the start of the process. Pezzano Law Group (Warren County office of LCR Law) has extensive experience handling workers’ compensation denials, and we’re here to put that experience to work for you. Contact us today.

Common Reasons for Workers’ Compensation Denials in New Jersey

First, it’s important to understand that many valid claims get turned down every year for reasons that can range from small clerical errors to flat-out disputes about the cause of the injury. That said, some of the most common reasons workers’ compensation claims are denied are as follows:

• Missed Deadlines: You have 90 days to report your injury to your employer and two years to file a formal claim petition. Miss either, and your claim could be rejected automatically.
• Disputed Cause of Injury: Your employer or their insurer might claim that your injury didn’t actually happen at work or wasn’t related to your job duties.
• Pre-Existing Conditions: Sometimes insurers blame your symptoms on a prior injury or medical issue, even when the job clearly made it worse.
• Insufficient Medical Evidence: If your doctor doesn’t clearly connect your injury to your work, or if there’s missing documentation, the insurer may deny benefits.
• Unauthorized Medical Treatment: Your employer or their insurance company chooses your treating doctor. If you see an outside provider without approval, that alone could trigger a denial.
• Delayed Reporting: Waiting too long to report what happened can make insurers suspicious, even if you had good reason for the delay.
• Lack of Witnesses: No one saw it happen? They might use that as an excuse to question your credibility.
• Clerical or Administrative Errors: Something as simple as a missing date, wrong code, or incomplete form can lead to rejection.
• Employment Status Disputes: If your employer tries to classify you as an independent contractor, you might be denied coverage, even if, by law, you should be considered an employee.
• Employer Disagreement or Retaliation: Sadly, some employers dispute claims to avoid insurance rate increases or because they simply don’t believe the injury is real.

What to Do After Receiving a Workers’ Compensation Denial

Getting that denial letter in the mail can make your heart drop, but you still have time to turn things around. There’s a process to follow, and every step matters. Take the following steps:

• Read the Denial Letter Carefully: Don’t skim it. The insurance company must explain why it denied your claim. Understanding the reason gives you and your attorney a roadmap for how to best challenge it.
• Gather Every Relevant Document: Accident reports, medical records, witness statements, and employer correspondence can all turn a denial into an approval later.
• Talk to Your Employer: Confirm that the claim was reported correctly and that no simple mistake caused the problem.
• Request Full Medical Documentation: Get detailed notes from every doctor or specialist you’ve seen. You’ll need these to show how the injury ties directly to your job.
• Contact a Warren County Workers’ Compensation Lawyer: This part is critical. An attorney can evaluate your claim, pinpoint the insurer’s weak arguments, and guide you through the legal process ahead.

How to “Appeal” a Workers’ Compensation Denial in New Jersey

Though you cannot technically “appeal” a workers’ compensation claim in New Jersey, you do have options. If your workers’ compensation claim is denied, take the following steps:

1. File a Formal Claim Petition: The petition goes to the New Jersey Division of Workers’ Compensation and must be filed within two years of the injury or last benefit payment.
2. Attend a Case Management Conference: A judge will be assigned to your case and will oversee preliminary discussions between your attorney and the insurance company’s lawyer to see if an early resolution is possible.
3. Participate in Informal Hearings: These are less formal sessions where both sides can present information and attempt to reach a settlement. Sometimes, this alone resolves the issue.
4. Move to Formal Hearings: If informal talks fail, your case proceeds to a formal hearing. This is similar to a trial. Both sides present evidence, medical records, and testimony. Your attorney can cross-examine witnesses and dispute the insurer’s claims.
5. Await the Judge’s Decision: After reviewing the evidence, the judge will issue a written decision.
6. Enforcement of Benefits: If you win, the court will issue an order requiring the insurance company to pay the benefits owed, including any past-due compensation.

What Happens if the “Appeal” is Successful?

Winning an “appeal” can change everything. Once your claim is approved, you’ll receive the benefits that were denied to you before. Depending on your injury, this could include the following:

• Medical Benefits: These cover all necessary and authorized treatment related to your injury.
• Temporary Total Disability Benefits: If you’re unable to work for more than seven days, you can receive weekly payments equal to 70 percent of your average weekly wage, up to the state’s set maximum.
• Permanent Partial or Total Disability Benefits: If your injury results in a lasting impairment, you may qualify for additional compensation based on the degree of disability.
• Death and Dependency Benefits: For families who have lost a loved one in a work-related accident, dependents may receive financial support and coverage for funeral costs.

Contact Our Firm for Assistance With Workers’ Compensation Denials

At Pezzano Law Group, our legal team takes workers’ compensation denials personally, because we know what’s at stake. If your workers’ compensation claim was denied, don’t give up. We’re here to help. Contact our firm for a free initial consultation today.