You reported your injury, filed your claim, and waited for approval. Then the letter arrived — your workers’ comp claim was denied. Now you are left wondering how you will pay medical bills or replace income while you recover.
A denial does not always mean the end of your case. Many denied claims in New Jersey can be challenged or corrected through the proper review process. Below, our denied workers’ compensation claim attorneys at Petro Cohen, P.C. explain what happens next, why claims get denied, and how to appeal a workers’ comp denial successfully.
Why Workers’ Comp Claims Get Denied
Once you file a workers’ compensation claim, the insurance carrier reviews your report, medical records, and employer statements before deciding whether to pay benefits. A denial means something in that review did not meet New Jersey’s requirements.
Common reasons for workers’ comp claim denials include:
- The employer disputes the injury. An employer may argue your injury didn’t occur at work or is not related to your job duties. For example, if you report a shoulder strain several days later, your employer might question when and where it happened.
- Missed reporting deadlines. New Jersey law requires employees who are injured to notify their employer as soon as possible, ideally within 14 (and no later than 90) days of the incident. If that report is delayed or incomplete, the insurer may deny coverage on procedural grounds.
- Insufficient medical proof. When medical records do not show how your injury connects to your job, the insurer may reject your benefits. This is common when you start treatment before reporting a workplace injury or when the employer has not authorized the treating provider.
- Pre-existing conditions. If you have had prior injuries or similar symptoms, the insurer may claim your current condition isn’t work-related.
When you receive a denial letter, review it carefully. Compare the insurer’s explanation with your medical records, claim forms, and communications with your employer. This helps identify what needs correction before you file an appeal.
What Happens If Workers’ Comp Is Denied?
If your workers’ comp claim is denied, benefit payments typically stop — but you still have legal options. New Jersey law gives injured workers the right to appeal through the Division of Workers’ Compensation.
Act quickly. You generally have two years from the date of injury or your last benefit payment to appeal. Missing this deadline can permanently forfeit your right to benefits.
How to Appeal a Workers’ Comp Denial in New Jersey
There are two main ways to appeal a workers’ compensation denial which an experienced workers’ compensation firm can file on your behalf:
Application for an Informal Hearing
File an Application for an informal hearing with the New Jersey Division of Workers’ Compensation. During this meeting, you will appear before a judge to discuss the dispute, present supporting evidence, and clarify any errors in your claim. Many cases involving unpaid medical bills or delayed wage benefits are resolved at this stage without the need for a full trial.
Claim Petition
If the informal route does not settle your case, you can file a formal claim petition. This initiates a structured legal proceeding in which testimony and medical evidence are presented, and a judge issues a binding decision. Hearings may take several months, and the judge’s ruling will determine whether benefits resume or continue.
Throughout the appeal process, continue following your doctor’s treatment plan and keep all records related to your injury, medical visits, and correspondence. Consistent documentation supports your case and reduces the chance of further disputes.
5 Smart Steps After a Workers’ Comp Denial
- Verify you filed properly and on time. Report your injury promptly and double-check that your claim meets New Jersey’s filing deadlines.
- Keep getting medical care. Maintain consistent treatment. If your employer’s insurer wrongfully denied your claim, those costs may still be reimbursed later.
- Follow your doctor’s advice. Do not return to work before you are cleared — doing so can worsen your injury and weaken your case.
- Learn your rights. Appeals and hearings involve complex legal rules. Understanding the process helps you make informed choices.
- Talk to a lawyer. A denied workers’ compensation claim attorney can determine why your claim was denied, fix any errors, and represent you before the Division of Workers’ Compensation.
Your Rights Under New Jersey Workers’ Compensation Law
Even after a denial, you still have rights:
- Medical benefits: Reasonable and necessary care from an authorized provider.
- Temporary disability benefits: Generally, 70% of your average weekly wage (within state limits).
- Permanent or total benefits: Compensation for lasting impairment or disability.
- Death benefits: Weekly payments and funeral costs for dependents of a deceased worker.
If your employer lacks valid coverage, the Uninsured Employers Fund (UEF) can step in to provide payments while the State seeks reimbursement.
Frequently Asked Questions About Denied Workers’ Comp Claims in New Jersey
Why would a workers’ comp claim be denied?
A workers’ comp claim may be denied if the insurer disputes that the injury happened at work, questions the medical evidence, or finds the report was filed late. Other common reasons include pre-existing conditions, incomplete documentation, or treatment with an unauthorized doctor. Each denial must explain the specific reason in writing.
When would a worker expect to be denied compensation?
Workers can expect a denial when New Jersey’s filing or notice deadlines are not met, or when there is uncertainty that the injury is job-related. Denials are also common if an employer believes the injury was caused off duty or if the medical provider’s report does not link the condition to work activities.
What happens if my workers’ comp claim is denied?
If your workers’ comp claim is denied, you still have options. You may file an Application for an Informal Hearing or a formal Claim Petition with the New Jersey Division of Workers’ Compensation to appeal the denial. With guidance from a denied workers’ compensation claim attorney, many workers successfully overturn denials through evidence and hearings.
What percentage of workers’ comp claims are denied?
Nationwide studies estimate that around 7% to 10% of workers’ compensation claims are initially denied. However, many of those cases are later resolved through appeals or corrected paperwork. In New Jersey, experienced representation greatly increases the chance of approval or reversal on review.
Why Choose Petro Cohen, P.C. for a Denied Workers’ Comp Claim
Insurance companies deny valid claims every day — but with experienced legal support, you can fight back.
At Petro Cohen, P.C., our attorneys have decades of combined experience helping injured workers in New Jersey appeal denied claims and recover the benefits they deserve.
We understand how critical these benefits are to your recovery and financial stability. Let our firm handle the legal process while you focus on healing.
Speak with a New Jersey Denied Workers’ Compensation Claim Attorney
If your workers’ comp claim was denied, keep trying. You may still be eligible for benefits through appeal or corrected documentation.
Contact Petro Cohen, P.C. today for a free, confidential consultation. With offices in Northfield, Cape May Court House, Cherry Hill, and Hamilton Township, we proudly serve clients throughout South Jersey and across the state.
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