What Should I Do if My Workers’ Compensation Claim is Denied?

Posted on behalf of James Lynch on January 9, 2019  in Workers' Compensation News. Updated on February 24, 2022

arm in a castIn New Jersey, workers’ compensation claims may be denied for many reasons. However, a denial is not the end of the road – you have options for pursuing the benefits you may be entitled to.

Below, Lynch Law Firm, PC’s New Jersey workers’ compensation attorneys outline the steps you need to take following a workers’ compensation claim denial.

If your workers’ compensation claim has been denied, contact us to request a free, no obligation consultation. We will help you find out which legal options may be available to recover the benefits you need.

Reasons Why Workers’ Compensation Claims Are Denied

There are many reasons your workers’ compensation claim may have been denied by your employer’s workers’ compensation insurer. Some of the most common reasons include the following:

  • The injury happened outside of the scope of your employment, occurred while participating in recreational activities, or you intentionally hurt yourself.
  • You suffer from a pre-existing condition that may have contributed to or caused your injury or ailment.
  • Your medical records show that your injury is not as severe as you claim.
  • Your medical treatment was unnecessary or not related to a workplace injury.
  • Your occupational illness was caused by initially exposing yourself to a known workplace hazard.
  • Your injury occurred due to intoxication, controlled substance use, or horseplay with other employees.
  • Your injury resulted from misusing dangerous equipment, machinery or vehicles.
  • Your suffered an injury after being warned by your employer about your activities or behavior.
  • You missed the deadline for filing claim to receive workers’ compensation benefits.
  • You filed your workers’ compensation claim after your employment was terminated or you resigned from your position with your employer.

Appealing the Insurers Decision

After your workers’ compensation claim has been denied, you have the right to appeal the insurer’s decision. You will need to file a formal claim petition with the New Jersey Division of Workers’ Compensation (DWC) within two years of suffering a work-related injury. If you have been diagnosed with an occupational disease, the two-year statute of limitations begins when you were diagnosed with your illness.

Within six months of filing your petition, a hearing with a workers’ compensation judge will occur. You may testify and present supporting evidence to strengthen your claim. Once the heading has concluded, the judge will issue his or her decision to approve or deny your claim.

If you do not agree with the workers’ compensation judge’s decision, you may file another appeal with the Appellate Division of the Superior Court in New Jersey.

If you do not wish to file a formal claim petition, you may file an application for an informal hearing with the DWC. If you go this route, you will have an informal hearing in front of the workers’ compensation judge. The workers’ compensation judge will make suggestions, but will not issue a formal decision.

An informal hearing will also provide you the opportunity to address disputes with medical care and permanent disability benefits. If no resolution is found during this process, you may still file a formal claim petition and go through that process, though the two-year deadline for filing your appeal still applies.

How an Attorney Can Help You

Working with an attorney is extremely helpful when appealing a denied workers’ compensation claim. Your attorney will advise you on which route is best to take when filing an appeal and ensure your appeal is filed within New Jersey’s two-year deadline.

Additionally, an attorney will help you gather strong evidence to support your injury claim, including medical documents and expert witness testimony. Your attorney will also use the case he or she builds to represent you during your workers’ compensation hearing.

Schedule a Free Consultation with Lynch Law Firm, PC

If your workers’ compensation claim was denied, our New Jersey workers’ compensation lawyers can provide you the legal assistance you need to file an appeal. This may help you recover the benefits you need after suffering an occupational injury or disease.

To learn more about appealing a denied workers’ compensation claim, contact Lynch Law Firm, PC as soon as possible. We will provide you a free, no obligation consultation to review your claim and help you determine your options for recovering the benefits you need. We charge no upfront fees and payment is only due if we recover compensation on your behalf.

Call (800) 518-0508 today.

* Results may vary depending on your particular facts and legal circumstances.

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