Why Was My Workers’ Compensation Claim Denied?

October 9, 2020

New Jersey’s workers’ compensation system offers injured employees benefits after suffering work-related injuries and illnesses. Even though you or a loved one may suffer a work injury or an occupational illness, you may find that your workers’ compensation claim is denied by your employer or its workers’ compensation insurer.

If you’ve had a workers’ compensation claim denied, you should understand why claims get denied and what your rights are for appealing a denied workers’ compensation claim. A workers’ compensation attorney can help you if you are having trouble getting benefits you need and deserve for your work injury or illness.

What is the Timeline for Pursuing a Workers’ Comp Claim?

In New Jersey, you normally must report a work-related injury or onset of an occupational illness to your employer within 90 days of a work accident or onset of an occupational illness. If you fail to timely report your injury or illness, you may end up losing your right to workers’ compensation benefits.

Once you report your workers’ comp claim, your insurer will forward your claim to its workers’ compensation insurer (unless your employer is self-insured). Your employer or its insurer will then send you notice within 30 days of receiving your claim telling you that your claim is either accepted or denied.

Reasons Why Your Workers’ Comp Claim May Have Been Denied

If your employer or its workers’ compensation insurer denies your claim, your notice of denial will give the reasons for the denial. Some of the most common reasons why workers’ compensation claims are denied include:

Your injury or illness is not work-related
You had a pre-existing condition that was not aggravated by your job
Your injury or illness is not as severe as claimed and you are capable of returning to work
The medical treatment you are requesting is not reasonable or necessary to treating your injury or illness

If you wish to appeal the denial of your workers’ compensation claim, you need to fully understand the reasons for your employer’s or its insurer’s denial of your claim.

What to Do If Your Claim Has Been Denied

If you have a workers’ compensation claim denied, you should contact a workers’ compensation attorney as soon as possible. A lawyer can review the facts of your case, such as the circumstances of your work accident or occupational exposure, the injuries you have suffered, and the reasons given for the denial of your claim.

You may have the option to appeal the denial of your claim with your employer or its workers’ compensation insurer. This option can be effective if you have additional information to submit to substantiate your claim.

Alternatively, you may choose to file a claim with the state to seek either an informal hearing or a formal claim petition. An informal hearing is similar to mediation, in which a workers’ compensation judge will attempt to help you and your employer or its insurer reach a settlement of your claim.

If you choose to pursue a formal claim petition, you will receive a formal hearing, which functions more like a traditional trial in which you and your employer or its insurer get to present evidence and witnesses and cross-examine each other’s case. The workers’ compensation judge presiding over the hearing will issue a decision in either your or your employer’s favor. If you don’t agree with the judge’s decision, you can appeal to the courts. If you choose to pursue that route, a workers’ compensation judge will almost certainly be critical to your success.

Contact a Scotch Plains Workers’ Compensation Lawyer to Discuss Your New Jersey Workplace Injury Case

A workplace injury can be devastating, particularly if it prevents you from returning to work for an extended period of time. Although New Jersey Workers’ Compensation laws are supposed to provide you with reimbursement for medical expenses and replacement pay for missed time at work, it is not always easy to get the Workers’ Comp benefits you deserve. That is why you should speak with a knowledgeable Workers’ Compensation lawyer about your situation and get guidance throughout the claims process. The experienced Workers’ Compensation attorneys at Bramnick, Rodriguez, Grabas, Arnold & Mangan, LLC represent clients in Paterson, Clifton, Passaic, Wayne, and all across New Jersey. Call (908) 325-5571 or fill out our online contact form today to schedule a free consultation about your work injury case. Our main office is located at 1827 E. 2nd St., Scotch Plains, NJ 07076, and we also have offices in Westfield, Newark, East Brunswick, Clifton, Cherry Hill, and Elizabeth.

The articles on this blog are for informative purposes only and are no substitute for legal advice or an attorney-client relationship. If you are seeking legal advice, please contact our law firm directly.