For many workers who are injured on the job, it is automatically assumed that if you put in a claim for workers’ compensation, your claim will be accepted and you will be compensated for time off the job and medical expenses that are incurred. While this may be how legitimate claims should be treated, it is not always how the process works.

In reality, workers’ compensation insurers often scrutinize workers’ compensation claims very closely, looking for any opportunity to deny a claim and save money. Where an injury may have another possible explanation or an insurer can argue that it is not as serious as it would appear, a worker may find his or her claim inexplicably denied.

A workers’ compensation denial can be overwhelming and devastating for an employee already struggling with the stress of an injury and time off work. After the initial shock of the denial wears off, it is important for all New Jersey workers to know their rights moving forward and how to effectively respond to a denial.

Getting a Denial in Cape May Court House

Denials of claims for workers’ compensation are not uncommon in New Jersey. In order to receive benefits, an employee must promptly notify his or her employer of the injury and must be able to show that the injury occurred on the job.

Prompt notification can go a long way to reducing suspicions that a worker is reporting an injury that is not actually workplace related. For example, if you claim to have been cut by equipment while on the job but do not report the cut for almost 30 days after the incident occurred, an insurer may question whether the injury is actually workplace related.

Even if you do notify your employer promptly, there are several common reasons that claims are denied in New Jersey.

  • The insurer may believe the injury is due to a recreational activity rather than work.
  • Your injury was a result of intentional misconduct.
  • Your injury was a preexisting condition not created or worsened by work.

If you receive a denial based on any of these arguments and the denial is incorrect, you must appeal the denial in order to prove you are entitled to benefits.

Appealing a Workers’ Compensation Denial

In New Jersey, you have two options for appealing an insurance company’s denial of your claim. For both options, it is in your best interest to have a qualified and experienced workers’ compensation represent you to ensure that you receive the benefits you rightly deserve.

With the first option, your attorney can file a formal claim petition with the New Jersey Division of Workers’ Compensation. This petition must be filed within two years of your injury. Within six months of filing, you will have a hearing with a New Jersey workers’ compensation judge to determine whether you are entitled to benefits.

In this formal process, the hearing is much like a mini trial. You will have the opportunity to present testimony from individuals such as a doctor who treated you or a colleague who saw your injury occur, and you will also be able to present evidence like medical records. After the hearing, the judge will decide if you are entitled to benefits.

If you do not want to go through the formal process, the alternative is to have your workers comp attorney request an informal hearing with a judge in the Division of Workers’ Compensation (DWC).  Informal hearings are often used to resolve smaller issues related to the scope of compensation, such as what medical treatments you should be entitled to receive.

In an informal hearing, the judge will consider the evidence and make suggestions or recommendations that can be used to facilitate negotiations between an employee and an insurance company. However, the judge will not issue a formal decision. If an informal hearing does not resolve the problem, then a request must be made for the formal claims process.

If you disagree with the outcome of the hearing process with a DWC judge, your attorney can also appeal that decision to the Appellate Division of the Superior Court in New Jersey to see if New Jersey’s state judges will find in your favor and reverse the DWC decision.

New Jersey Attorneys Helping You Navigate the Denial and Appeals Process

If you are facing a denial of your claim for workers’ compensation benefits, you are likely facing many different types of challenges, including ongoing medical needs, bills that may be piling up, difficulty supporting your family, and lack of work.  This can make properly responding to a denial and filing an appeal extremely difficult.

At Petro Cohen Petro Matarazzo, our workers’ compensation attorneys understand these stressors and how daunting it can be to consider the process of an appeal. We regularly work with employees who have had their claims denied and will do our best to take this burden off of your shoulders so that you can focus on what is most important to you.

The reality is that the outcome of your case will largely depend on the skill of your New Jersey work injury attorney and the quality of your legal representation. Your attorney’s level of education, experience, track record, legal abilities, and reputation matter.

Petro Cohen Petro Matarazzo has been consistently recognized as one of New Jersey’s leading firms in the area of workers’ comp. The firm received the highest rating by Martindale-Hubbell – the world’s foremost authority on law firm credentials – in Professional Excellence and Ethical Standards and Legal Ability.

In addition to the firm’s stellar reputation, the department head, Frank Petro, is respected locally, regionally, and nationally as a leading attorney in this specialized field. He has been recognized as an outstanding attorney by Best Lawyers® every year since 1995 and by Super Lawyers® every year since 2005. Moreover, he has achieved a rating of “Superb” on the leading lawyer-review website, Avvo®, the highest achievable rating.

Along with Stephen M. Matarazzo, Suzanne Holz Meola, Terri Hiles, Steven Lubcher, and Daniel Rosenthal, our New Jersey workers’ comp attorneys have more than 100 years of combined experience, having successfully handled thousands of litigated workers’ comp cases throughout New Jersey. This experience and winning track record means that you are going to have a skilled New Jersey work injury lawyer who will work for you.

To talk with us about your workers’ compensation case or a denial you may have received or to discuss the appeals process, contact our office online or at (888) 675-7607.