You have been injured on the job and are unable to work. You follow the steps to immediately file a Workers’ Compensation claim for medical and disability benefits, but what happens if the insurance company denies your claim?
Most employees are aware that Workers’ Compensation laws cover injuries while at work. Claims can include one-time injury, disease, stress or repetitive injury, or even injury that occurs while at a company event. Loss of function or ability to return to work due to a workplace injury is a serious event with financial and emotional implications for the injured worker. When a claim is denied in full or in part, not only are payments of necessary medical bills at risk, but also your ability to stay financially afloat.
Denial and the Appeals Process
Insurance carriers employ claims adjusters who assess the circumstances and documentation of your work injury. Often, claim denials result when the insurance carrier does not believe your injury was the result of a workplace activity, or if it falls under one of the categories of fault or negligence. Typically, workers injured while under the influence of alcohol or drugs, or while engaging in physical horseplay, are not covered. However, other cases can occur where the insurance company determines it was not the result of a work activity.
In New Jersey, there are two options for appeals; an informal hearing or a formal hearing. An informal hearing can speed up the process and still offers the opportunity to present your case before a Workers’ Compensation judge. The judge will review information that you and the insurance company present, and will issue a recommendation, not a formal decision. If you are not satisfied with the result, you can then file a formal claim petition.
A formal claim petition is the other option and you can choose this without first filing an informal claim. The petition is submitted to the New Jersey Division of Workers’ Compensation. Note that key dates apply in a formal petition and you must file within two years after you were injured. You will be scheduled for a hearing within six months of filing your petition. At this hearing you will present testimony and witnesses that typically include medical professionals and co-workers. At a formal hearing, the judge issues a decision, which, if unsatisfactory, can also be appealed. In New Jersey, appeals are filed with the Appellate Division of the Superior Court. Finally, if you need time-sensitive medical care or disability and cannot wait, you can also file a motion for medical and temporary benefits separately, which is expedited and scheduled within 30 days. This process may become complicated, which is why an attorney familiar with New Jersey Workers’ Compensation laws can help safeguard your rights.
Cherry Hill Workers’ Compensation Lawyers at DiTomaso Law Help Injured Workers Claim Compensation
If you have been injured on the job, our Cherry Hill Workers’ Compensation lawyers at DiTomaso Law are experienced in this field and will review your case and guide you through the appeals process. We will help claim the compensation you deserve so that you can focus on your recovery. For a free initial consultation, please complete our online form or call us at 856-414-0010 today. Located in Cherry Hill, New Jersey, we proudly serve clients throughout the state.