Denied Workers’ Compensation Claims

If you were injured in a workplace accident or developed an occupational illness, Workers’ Compensation benefits can help you recover or live with a disability. It also provides death benefits to dependents of a worker who suffered a fatality. It is a no-fault system of insurance, so when your Workers’ Compensation claim is denied, it may come as a shock to learn you will not be receiving the benefits you were counting on.

Common Reasons for Denial

While most injuries are covered under Workers’ Compensation, there are deadlines for filing a claim. If you are injured in a workplace accident, you should inform your employer immediately. In New Jersey, the window for reporting an injury is 90 days and after this, you lose your right to Workers’ Compensation benefits. Other reasons why your claim might be denied include:

  • Your injury happened while you were under the influence of drugs or alcohol
  • Your injury happened as the result of horseplay with coworkers
  • Your injury or illness happened because you did not use your employer-provided personal protection equipment, even after being told it is essential for your safety
  • Your injury did not occur within the scope and course of your employment
  • Your injury is not severe enough to prevent you from doing your work
  • Your claim is for medical care deemed unnecessary and unrelated to your work injury

When your claim is denied, you have a right to appeal the denial. It could be that the insurance company made a mistake in their reasoning or application of the law. An experienced Workers’ Compensation lawyer can evaluate the reasons for the denial and help you craft your appeal.

Appealing Your Denial

In New Jersey, there are two appeal processes at the Division of Workers’ Compensation: the Application for an Informal Hearing and the Claim Petition, which involves a formal hearing. The informal hearing is a quicker route to appeal the denial of your claim. After submitting your completed Application for an Informal Hearing to the Division of Workers’ Compensation, you will receive a written notice of the date and time of your first hearing. More than one hearing may be necessary to allow you, your lawyer, and the insurance company to gather and present the issues involved in your case. After assessing everything, the judge will make a recommendation for settling the dispute, which may be rejected by either side. If you do not agree with the recommendation, you may request a formal hearing.

Petitioning for a Formal Hearing

To request a formal hearing, you must submit a Claim Petition to the Division of Workers’ Compensation within two years of the date of your injury or the last date you received compensation from the insurance company. The time is calculated from whichever date is later. A Claim Petition relating to an occupational illness must be filed no later than two years from the date you were first aware of your illness. It is important to note that filing for an informal hearing does not interrupt the running of the two-year statute of limitations.

Formal hearings are typically scheduled around six months after your petition is received. At the hearing, both sides may present witnesses, as well as evidence to support their case. The judge will issue a written decision that could include specific benefits. If the judge does not find the case in your favor, you can appeal the decision in the New Jersey Appellate Division of the Superior Court.

Navigating the Appeals Process

While you certainly can appeal a denied Workers’ Compensation claim on your own, an experienced Workers’ Compensation lawyer will know how to file the proper forms by their deadlines, gather evidence, and interview witnesses to support your claim. Instead of having to deal with the insurance company, your attorney can handle those communications, as well as represent you at the hearings so you to concentrate on your recovery.

Cherry Hill Workers’ Compensation Lawyers at DiTomaso Law Help Injured Workers Receive the Benefits They Deserve

If your claim for Workers’ Compensation benefits has been denied, talk to the experienced Cherry Hill Workers’ Compensation lawyers at DiTomaso Law. We will fight to obtain the maximum allowable benefits for your case so that you can make a full recovery. Call us at 856-414-0010 today or contact us online to schedule a free consultation. Located in Cherry Hill, New Jersey, we assist injured workers throughout South Jersey, including Mt. Holly and Camden County.