Workers’ compensation is intended to function as a sort of safety net for injured workers, ensuring they don’t face financial ruin while recovering from injuries that occurred on the job. Unfortunately, not every claim is approved. That said, if your initial workers’ compensation claim has been denied, it’s not the end of the road. Our team has extensive experience handling workers’ compensation denials on behalf of clients in New Jersey, and we’re ready to put that experience to work for you in your case. Contact the seasoned Jersey City workers’ compensation lawyers here at Lerner, Piermont, Riverol & Lawlor, P.A. for a free initial consultation today.
Common Reasons Workers’ Compensation Claims Are Denied
Workers’ compensation carriers frequently deny claims, but some of the most common reasons for denials are as follows:
- Late reporting of the injury: If the injury wasn’t reported to the employer within the required timeframe, the claim may be rejected.
- Disputed cause of injury: The insurer may argue that the injury did not occur at work or wasn’t related to job duties.
- Pre-existing conditions: Claims may be denied if the insurer claims the injury was due to a condition that existed before employment.
- Insufficient medical evidence: A lack of detailed medical documentation supporting the injury often leads to denial.
- Failure to seek timely medical treatment: Delays in receiving medical care can be used to suggest the injury was not serious or not work-related.
- Employer disputes: Sometimes an employer will argue that the injury did not occur on the job or did not happen as claimed.
- Independent contractor status: Workers who are classified as independent contractors rather than employees may be denied coverage.
The Consequences of a Denied Workers’ Compensation Claim
When a workers’ compensation claim is denied, the impact can be immediate and serious. Common consequences are as follows:
- Loss of wage replacement benefits that would normally cover a portion of your income while you are unable to work.
- Increased vulnerability to collection actions when medical providers pursue payment directly from the worker.
- Inability to obtain medical coverage.
- Delays in recovery because without coverage, some employees postpone or skip needed medical care.
- Financial hardship due to unpaid household expenses, mortgage payments, etc.
- Risk of job loss or workplace conflict if the employer disputes the claim aggressively.
Steps to Take After a Denial
If your workers’ compensation claim has been denied, do not assume the process is over. Instead, take the following steps.
- Read the denial letter carefully. The insurance carrier is required to state the reason for the denial, which will be the first step toward building a response.
- Gather medical records, such as treatment notes, diagnostic reports, and physician statements. These can help support your claim.
- Speak with your employer about the denial to clarify whether they submitted the proper paperwork and confirm their version of events.
- Hire a workers’ compensation attorney who can recommend the best path forward.
- Collect witness statements if any co-workers saw your accident or can confirm workplace conditions.
- Keep records of your injury, treatment, expenses, and communications with your employer and insurer.
- File your appeal timely.
Appealing a Workers’ Compensation Denial in New Jersey
The appeals process is document-heavy and can be complex, which is why you should always have a knowledgeable workers’ compensation attorney in your corner. A brief outline of the process is as follows:
- File a Claim Petition or Application for an Informal Hearing: After a denial, you may request an informal hearing before a workers’ compensation judge or file a formal Claim Petition with the New Jersey Division of Workers’ Compensation.
- Attend the informal hearing (if chosen): At this stage, the judge attempts to resolve the dispute between you and the insurance carrier without a full trial. Many cases settle at this point.
- Proceed with a formal Claim Petition if necessary: If the issue is not resolved informally, you must move forward with the formal process.
- Pre-trial conferences and discovery: Both sides exchange medical evidence and other documents. Depositions of doctors and witnesses may also take place.
- Trial before a workers’ compensation judge: The judge hears testimony, reviews medical evidence, and ultimately issues a decision.
- Appeal to the Appellate Division of the Superior Court: If the workers’ compensation judge rules against you, there is a right to appeal to a higher court.
Jersey City Lawyers Handling Workers’ Compensation Denials: Contact Us Today
At Lerner, Piermont, Riverol & Lawlor, P.A., our attorneys have extensive experience representing injured workers whose claims were unfairly denied. We know the tactics insurance companies use, and we know how to fight back. If your workers’ compensation claim has been denied, contact us today so we can talk about your options.
