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Getting hurt on the job is stressful enough without the additional trauma of having your workers’ compensation claim denied. Sadly, claim denials occur more frequently than most people would expect. If you were injured on a construction site in Trenton, suffered a repetitive injury while working in an office in Cherry Hill, or have been injured on the job anywhere else in New Jersey and have had your workers’ comp claim denied, it is helpful to know the reasons why and what legal options are available to you.
At Pellettieri Rabstein & Altman, our Supreme Court certified workers’ compensation attorneys have decades of experience assisting workers who have suffered on-the-job injuries all over New Jersey who have had their workers’ compensation claim denied. Below are some of the most common reasons for a claim denial and what to do after your workers’ compensation claim has been denied.
Why Do Workers’ Compensation Claims Get Denied in New Jersey?
Insurance carriers and self-insured employers in New Jersey are in the business of making money and every approved workers’ compensation claim has a negative impact on their bottom line. Thus, employers and their insurance carriers look for any reason to cut benefits or deny a workers’ compensation claim. There are a number of common reasons for a New Jersey workers’ compensation claim to be denied.
- Delay in reporting the work-related injury – New Jersey law requires a worker to give his or her employer prompt notice of a work-related injury. Failure to give such notice in a timely manner can negatively impact a worker’s right to receive workers’ compensation benefits for that work-related injury, since the insurance company can argue that the injury occurred as a result of an outside activity and was not work-related in nature.
- Disputes as to whether an injury is work-related – This can often include situations where an employer or insurance company will contend that an employee’s injury was in fact caused by a pre-existing condition or by an event that occurred outside of work. Often they will also contend that the cause of an injury is unrelated to the tasks that the employee is required to perform as part of their job.
- Missed deadlines – New Jersey workers’ compensation claims are generally subject to a two year statute of limitations which begins on the date of the work injury or on the date of the last payment of workers’ compensation benefits.
- Lack of sufficient medical documentation – If the medical records from your treating physician fail to establish a connection between your injury and work activities, the insurance company can deny your claim.
- Independent Medical Examination (IME) findings can be unfavorable to the injured worker – It is common practice for the insurer of an injured worker to send that worker for an Independent Medical Examination (IME) by a physician chosen by the insurer. The report of that physician can be used by the insurer to contend that the worker’s injury is not as serious as the worker claims, or that the worker’s injury has already healed.
What Happens Immediately After a Denial?
When a workers’ compensation claim is denied by an insurance carrier in New Jersey, a written notification of the reason(s) for the denial of benefits is given to the denied claimant. The content of the written notification will specify the reason(s) for denial and that is what will need to be refuted by the approved claims department of the workers’ compensation insurance carrier as well as by the attorneys for the denied workers’ compensation claimant. There are two common methods for handling a denied New Jersey workers’ compensation claim.
- File a Claim Petition with the New Jersey Division of Workers’ Compensation. This formally opens your case before a workers’ compensation judge and starts the litigation process.
- File a Motion for Medical and Temporary Benefits if you need immediate medical treatment or wage replacement while the underlying dispute is resolved.
Once a Claim Petition is filed the case proceeds to Mediation, Discovery and possibly a hearing before a judge of compensation. Most disputes are resolved prior to trial when the insurance carrier realizes that the injured worker has good legal representation and proper medical evidence to support their claim.
Steps to Take If Your Claim Was Denied
Many people receive a denial letter at some point during the process. While a denial letter can be a source of worry for many of our clients, we recommend that they not lose any sleep. In fact, we tell all of our clients with offices in Lawrenceville, Cherry Hill, Nutley, Morristown and Trenton to keep their chins up because things will likely work out in the end.
- Read the denial letter carefully to understand the stated reason for denial.
- Gather your medical records from every provider who treated you, including emergency room visits, primary care follow-ups, and any specialists.
- Document the incident with photos, witness names, and a written account of exactly how and when the injury occurred.
- Avoid recorded statements to the insurance adjuster without speaking to an attorney first, these statements are often used against injured workers later.
- Contact an experienced workers’ compensation lawyer as soon as possible. New Jersey’s system is procedurally complex, and missing a deadline can permanently bar your claim.
Why Local Experience Matters
As stated above, the laws of Workers’ Compensation vary from state to state. In New Jersey, there are specific rules, time frames and Judges located throughout the state at the Division of Workers’ Compensation offices. Attorneys that appear regularly before these Judges located in Mercer County, Camden County, Essex County and Morris County and are familiar with the practices of regional insurance companies can make a huge difference in how a claim is ultimately decided.
Since 1929, PR&A Law has represented workers injured on the job throughout New Jersey, including workers from Lawrence Township, Cherry Hill, Nutley, Morristown, and Trenton. Our workers’ compensation attorneys are Supreme Court certified, with many years of experience representing workers in workers’ compensation proceedings. We are very familiar with the manner in which the insurance companies develop a denial of responsibility argument and how to effectively counter such arguments.
Frequently Asked Questions
Q: How long do I have to file an appeal for a workers’ denied workers’ compensation claim in New Jersey?
A: Typically, a Claim Petition must be filed with the New Jersey Division of Workers’ Compensation within 2 years of the date of an employee’s work-related injury or within 2 years from the date of the last payment of workers’ compensation benefits or medical treatment. However, there are several exceptions which can affect the time in which a Claim Petition must be filed as well as certain time limits for proceeding within the Division of Workers’ Compensation after a claim has been filed. It is therefore advisable to consult with an experienced workers’ compensation attorney as soon as possible after a denial of a workers’ compensation claim.
Q: What about medical treatment while the claim is on appeal?
A: Although the workers’ compensation claim has been denied, an individual can request emergency medical treatment or temporary benefits by filing a Motion through a Motion with the Division of Workers’ Compensation. An experienced workers’ compensation attorney can prepare and file such a Motion on your behalf within days, if not hours, to obtain needed medical treatment.
Q: What if the employer disputes that the worker actually suffered an injury at work?
A: This is one of the most common disputes that are raised in denied claims for workers’ compensation claims. We can assist you in gathering strong medical evidence, witness statements, as well as an incident report that details the circumstances of the work-related injury. We can also depose all of the relevant witnesses, including any medical experts hired by the insurance company to dispute the worker’s disability or the cause of the work-related injury.
Q: Do I have to go to court if my workers’ compensation claim has been denied?
A: In most instances, denied workers’ compensation claims are resolved by way of negotiation with the workers’ compensation carrier and its lawyers prior to reaching a fair and reasonable settlement of the disputed claim. In some instances, mediation also can be used to attempt to resolve a disputed workers’ compensation claim. However, if necessary, we are prepared to try any case before a Workers’ Compensation Judge to protect our clients’ rights to workers’ compensation benefits.
Q: Is there a cost to hire a Workers Compensation lawyer in NJ?
A: No. PR&A Law workers compensation attorneys represent workers on a contingency basis. This means there is no up front charge to retain our services, and we only get to collect a percentage of the workers compensation benefits recovered, subject to court approval.
Contact PR&A Law About Your Denied Workers’ Compensation Claim
When a workers’ compensation claim is denied anywhere in New Jersey, it is in the best interest of the injured worker to have qualified legal representation to assist in the appeals process. The experienced lawyers at Pellettieri Rabstein & Altman have obtained hundreds of millions of dollars in verdicts and settlements for their clients throughout New Jersey and have two Supreme Court certified workers’ compensation attorneys on staff to assist in the defense of workers’ compensation claims to ensure that injured workers receive all of the benefits that they are entitled to.
To speak with a lawyer representing workers’ compensation claimants in New Jersey regarding denied workers’ compensation benefits, contact one of our offices in Lawrenceville, Cherry Hill, Nutley, Morristown or Trenton for a free consultation.
