Potential challenges that may arise if a workers’ compensation claim is denied and what can be done to overturn a rejected claim in New Jersey.
Not only painful and sometimes debilitating, on-the-job injuries often are overwhelming events producing many diverse consequences. The stress of these events can worsen tenfold if the worker’s compensation benefits you count on to cover related medical bills and lost wages get denied. For many workers in New Jersey, a worker’s comp denial can be a devastating blow to your day-to-day security and financial stability and a major setback. However, it must be highlighted that denial doesn’t mark the end of the road for obtaining coverage and access to benefits. There are steps you can and should consider pursuing to challenge the decision and secure the benefits you deserve. Contact the seasoned New Jersey workers’ compensation attorneys at Cohen & Riechelson to discuss your rights and options today. Call us at (609) 528-2596 for a free consultation.
Frequent Justifications for Denying Workers’ Comp Claims
One of the first things you’ll want to understand is why your claim was denied. There are several common reasons for denials, each with its own set of complications.
Providing Inadequate Medical Evidence
One of the most frequent reasons for denial is insufficient medical evidence. Workers’ compensation claims require documentation that clearly links your injury to your job. If the documentation is vague or incomplete, the insurance company might argue that your injury isn’t really as serious as you claimed. Alternatively, they might not see how it’s connected to your job or even argue that it is entirely unrelated to your work. Following your injury, getting medical attention following the accident or as soon as any symptoms from a potentially work-related injury arise is critical. Follow up with your doctor on a regular basis, consider seeking a second opinion if necessary, and obey your treatment plans and care instructions. All of these steps also create medical records that are translated into evidence for your worker’s compensation claim. Therefore, keeping records organized is a vital part of a successful worker’s compensation claim.
Insurers Contesting Your Injury’s Link to Work
Another reason for denials in worker’s compensation cases is the insurance company’s assertion that your injury is not associated with your work. If your employer or their insurance provider can argue that your injury happened outside of work or was pre-existing, they may deny your claim. Such impasses can be resolved by detailed accounts from coworkers, supervisors, and medical professionals who can verify the circumstances surrounding your injury. These witnesses, statements, and reports can be essential to your claim and pivotal during an appeal.
Failure to Follow Strict Timing Requirements
In New Jersey, workers’ compensation claims have a timeline to follow. Your claim must be filed within the set time limits. Missing any of the related deadlines can be detrimental to your claims process, resulting in an automatic denial. The state requires that you notify your employee within 14 days of an injury, and failure to meet this timeframe could jeopardize your ability to access benefits. Additionally, all forms and claims need to be filed within two years of the date of your injury, the day you became aware of the injury, or the last payment of compensation. Staying organized, aware, and in compliance with all deadlines is key to maintaining your eligibility for benefits.
Disagreements of the Scope and Impact of Your Injury
Another reason behind denials can be disputes over the extent of your injury. Sometimes, claims get denied because of disagreements over the scope and impact of an injury. Insurance companies can argue that your injury isn’t severe enough to warrant compensation or that you could still work in some capacity. In these cases, gathering comprehensive medical evidence and seeking testimonials from medical experts can help amplify your position and the overall outlook of your claim.
Absence of Support for Your Claim from Witnesses
Lastly, a lack of witnesses can create a window for the insurance company to question whether the incident happened the way you described in your claim. Witness statements from coworkers or supervisors who were present when the injury occurred can be invaluable in supporting your claim. If you have no witness reports, you can try to pull any camera footage from the day and time of your accident. If your injury occurred over a long period due to repetitive motions, you could rely more on medical expert testimony or see if another worker with the same duties as you may have experienced the same symptoms and injury.
Other Possible Causes of Workers’ Compensation Claim Denials to be Aware Of
While the reasons we’ve reviewed above are more common, there are also less frequent causes for denial that you should be aware of.
For instance, intoxication or drug use at the time of injury. If any evidence is obtained demonstrating you were under the influence of drugs or alcohol when the injury was sustained, you could be looking at a denial. Typically, worker’s compensation coverage excludes injuries that occur when an employee is under the influence or intoxicated.
Another issue that can get in the way of your worker’s compensation benefits is willful misconduct. If your injury was a result of any sort of willful misconduct, like roughhousing or goofing on the job and intentional violations of safety rules, then your claim could get rejected. It’s imperative to understand worker’s comp was designed to cover accidents and injuries that happen in the course of your average work activities or a direct command of your boss but not those resulting from reckless behavior you choose to participate in.
Navigating the Process to Overcome a Denied Workers’ Compensation Claim in New Jersey
If your claim has been denied, you have the right to seek an appeal of this decision. The appeals process in New Jersey involves several steps, each with its own set of deadlines. The first step in appealing a denied claim is to file a Notice of Motion to Reopen the Clean. You will want to take care of this step promptly, as failing to meet the deadline could forfeit your right to appeal. Once your motion is filed, you may be scheduled for an informal hearing. During this hearing, a judge will try to mediate between you and the insurance company to reach a settlement. Although informal, this hearing is a significant opportunity to present your case, so having an attorney by your side is crucial.
If an agreement is not reached during the informal hearing process, then the next step will be a formalized hearing. It’s a much more structured legal proceeding where both sides present their evidence and can make arguments. A judge will then make a binding decision on your claim. The evidence you present at this stage is paramount to your claim, and thus, a thorough preparation is a necessity. If the formal hearing does not go in your favor, you could appeal the judge’s decision to a higher court. However, it should be noted that this route is both lengthy and complex. Deadlines are stringent, and ensuring you have appropriate and experienced legal representation is highly advisable.
Essential Elements to Successfully Appeal a Denied Workers’ Compensation Claim in NJ
Comprehensive Medical Documentation
Throughout the appeals proceedings, the quality of the evidence you present will play a significant role in the outcome of your case. Many contributors can influence the result, such as comprehensive medical documentation. Ensure that all of your medical treatments and their relation to your workplace injury are carefully documented. From doctor’s notes to test results and any records of surgeries or treatments you may have undergone or need to undergo due to the injury should be tracked and documented.
Witness Substantiation
Another factor that will impact the outcome of your claim or appeal is witness records, such as statements from coworkers or higher-ups. Lining up any medical experts who could testify on your behalf will strengthen your case’s perspective.
Avoid Costly Mistakes and Challenge a Denied Claim with Assistance from our NJ Workers’ Compensation Attorneys
In life, we often hear mistakes are a part of life, and they are meant to happen so you can learn from them and grow. However, there is also a saying that the wisest man learns from the mistakes of others and not his own. With worker’s compensation benefits hanging in the balance, it’s best to try and avoid mistakes altogether, as they can be painstaking to try and recover from. Missing deadlines can cost you. Another mistake is representing yourself. While it might be tempting to handle your own case, the complexities of workers’ compensation laws make it difficult to do so effectively. Another huge mistake is not working to gather sufficient evidence or assuming your case is cut and dry.
At Cohen & Riechelson, our experienced attorneys can help you avoid costly mistakes and help you present your case accurately, comprehensively, and in the best possible light. Of course, a denied workers’ comp claim is disheartening, but it does not have to be the final verdict. By understanding why they turned you down, you can, with appropriate legal counsel, pursue the benefits you deserve to get through this trying time. Contact our team of trusted New Jersey workers’ compensation lawyers for a free consultation at (609) 528-2596. We help workers in your situation throughout Robbinsville, Princeton, Hamilton, Trenton, Ewing, East Windsor, Lawrence, Lambertville, including in other towns in Mercer County and around New Jersey.
