Workplace injuries can lead to unexpected challenges, especially when an employer’s workers' compensation insurance denies your claim. For many injured workers, workers' compensation benefits represent a lifeline—covering medical expenses and lost wages while recovering. However, the denial of a claim can turn an already stressful situation into a daunting legal battle.
If you are a worker in New Jersey who has had a claim denied, understanding your rights and available legal options is essential. The Law Offices of Harold J. Gerr have decades of experience in helping workers navigate the complexities of workers' compensation claims. In this post, we will explore the steps you should take when your claim is denied and the legal routes available for securing the compensation you may be entitled to under New Jersey workers’ compensation law.
Understanding Workers' Compensation in New Jersey
Workers' compensation is designed to be a no-fault insurance system. This means that if you're injured at work, you do not have to prove fault to receive benefits. The law requires employers in New Jersey to carry workers' compensation insurance to provide coverage for injured employees. This includes benefits such as medical treatment, temporary or permanent disability payments, and compensation for any long-term impairments caused by the injury.
While the system is intended to protect workers, there are numerous reasons why claims can be denied. Insurance companies often reject claims to minimize costs, and sometimes they misinterpret the facts of the injury. If you find yourself facing a denial, you need to act quickly and decisively to challenge it.
Common Reasons for Workers' Compensation Claim Denials
Before we dive into the actions you can take following a denial, it’s important to understand the common reasons why your claim might have been denied:
- Lack of sufficient evidence: The insurance company may claim that there isn't enough documentation to prove that your injury is work-related.
- Missed deadlines: Failing to report the injury to your employer in a timely manner or missing deadlines for filing the claim can lead to automatic denials.
- Disputes over the cause of the injury: The insurer may argue that your injury didn’t happen at work or was caused by a pre-existing condition.
- Failure to seek appropriate medical treatment: Not seeing a doctor right away or refusing a medical evaluation by an employer-approved physician can hurt your case.
- Employment status issues: The insurance company may claim that you are not covered by workers’ compensation because of your classification as an independent contractor rather than an employee.
Steps to Take After a Denied Workers' Compensation Claim
Carefully Review the Denial Letter
When your claim is denied, you will receive a letter from the workers' compensation insurance company explaining the reasons for the denial. Read the letter thoroughly and identify the specific reasons for the rejection. Sometimes, the issues can be as simple as missing paperwork or documentation, which can be resolved relatively easily. Understanding the grounds for denial is the first step toward building a successful appeal.
Seek Legal Assistance Right Away
If your workers' compensation claim is denied, time is of the essence. Consulting an experienced workers' compensation attorney, like those at The Law Offices of Harold J. Gerr, can make a significant difference in the outcome of your case. An attorney will help you gather evidence, file the necessary appeals, and represent you during hearings or negotiations.
It’s important to act quickly because New Jersey has strict deadlines for filing appeals. Failing to meet these deadlines could result in forfeiting your right to challenge the denial.
File a Formal Claim Petition or Application for Informal Hearing
New Jersey law provides two main paths for appealing a workers’ compensation denial:
- Informal Hearing: An informal hearing involves a relatively quick and non-adversarial process where the worker, employer, and insurance company attempt to resolve the dispute with the help of a workers' compensation judge. This can be a good option if there is a chance for an agreement without a lengthy litigation process.
- Formal Claim Petition: If the informal hearing does not resolve the dispute, or if you prefer a more structured approach from the start, you can file a formal claim petition with the Division of Workers’ Compensation. A formal hearing is much like a trial, where both sides present evidence, witness testimony, and arguments before a judge.
Both options have deadlines. You must file an informal hearing request within two years from the date of injury or from the date of your last compensation payment. For a formal claim petition, you also have two years from the date of injury to file.
Gather Additional Evidence
Often, the reason for a denial is a lack of clear evidence linking your injury to your job. Work with your attorney to gather the following documents that can support your case:
- Medical records showing your diagnosis, treatment, and the relationship of the injury to your work duties.
- Witness statements from coworkers who saw the accident or can confirm the hazardous conditions that led to your injury.
- Incident reports filed with your employer immediately after the injury.
- Expert testimony from medical professionals who can testify to the nature of your injury and how it occurred.
Attend the Workers’ Compensation Hearing
Once a formal claim is filed, you will likely need to attend a hearing before a workers' compensation judge. At this hearing, both you and the insurance company will present evidence supporting your respective positions. Your attorney will play a critical role in presenting a strong case on your behalf, using evidence and witness testimony to prove your entitlement to benefits.
After reviewing the evidence, the judge will make a decision regarding your claim. If the judge rules in your favor, you will begin receiving the benefits that were initially denied.
Additional Legal Options: Third-Party Lawsuits
In some cases, workers injured on the job may have the option of filing a third-party lawsuit in addition to their workers’ compensation claim. For example, if your injury was caused by defective equipment, you may be eligible to explore additional legal avenues, such as filing a product liability claim against the manufacturer, depending on the circumstances of your case. Similarly, if another party (such as a subcontractor) was responsible for your injury, you might have grounds to sue them for negligence.
Unlike workers' compensation, which limits your recovery to medical expenses and lost wages, third-party lawsuits can provide additional compensation for pain and suffering, emotional distress, and punitive damages.
Don’t Accept a Denial Without a Fight
A denied workers' compensation claim can feel overwhelming, but it’s not the end of the road. By understanding your rights and taking the appropriate steps, you can challenge the denial and secure the benefits you could be entitled to. The Law Offices of Harold J. Gerr are committed to guiding injured workers through every stage of the claims process, working diligently to protect your rights and help you pursue the benefits you may be entitled to.
Need Help with a Workers' Comp Appeal in New Jersey? Contact The Law Offices of Harold J. Gerr Today
If you've been injured at work and your workers' compensation claim has been denied, don’t navigate this challenging situation alone. The Law Offices of Harold J. Gerr has over 40 years of experience representing injured workers throughout New Jersey, including Highland Park, Edison, New Brunswick, and nearby areas. Our team provides personalized legal representation to help you secure the benefits you may be entitled to under New Jersey workers' compensation law.
Whether you’re dealing with a complex workplace injury claim or need assistance with a workers’ compensation appeal, we are here to fight for your rights. Schedule your free consultation today by filling out our online contact form or calling us directly at (732) 537-8570. Let us help you take the next step toward your recovery.
Disclaimer: The information provided is not legal advice and does not establish an attorney-client relationship.
