What to Do if Your Workers’ Compensation Claim Is Denied in NJ
Although the New Jersey workers’ compensation system is designed to prevent injured workers from suffering financial hardship, insurance companies do not always make the claims process easy. If your workers’ compensation claim gets denied in New Jersey, don’t give up. You may still be eligible for financial benefits. Take the following steps to get your claim back on track with the help of a workers’ compensation attorney in New Jersey.
Contact a New Jersey Workers’ Compensation Attorney
The first step is to contact an experienced personal injury attorney in New Jersey near you for legal counsel. An attorney should review your case as soon as possible to find out whether you are being treated fairly by your employer or an insurance company.
A lawyer can give you tailored advice as to what to do next. If you are a victim of insurance bad faith, for example, your lawyer can file a lawsuit against the insurer. A lawyer can help you with the appeals process for a standard claim rejection. Meanwhile, you can relax and focus on healing from your injuries.
Learn the Reason for the Denial
Workers’ compensation insurance claim denials should be issued in writing. Carefully review the rejection letter to determine the reason behind the insurance company’s decision.
Common reasons for workers’ compensation claim denials in New Jersey include:
- Failure to notify the employer by the deadline (90 days)
- Lack of medical documentation proving injuries
- Allegations of an injury unrelated to work or “off the clock”
- Pre-existing injuries or medical conditions
- Horseplay, willful negligence or recklessness
- The influence of drugs or alcohol
The reason for the denial may be something that you can resolve on your own, such as by resubmitting your claim with further evidence or documentation of your injuries.
Request an Informal Hearing
If you cannot resolve the dispute through negotiations with the insurance company or your employer, the next step is to request a hearing. Your workers’ compensation attorney can make a recommendation as to whether you would benefit from an informal or formal hearing based on your situation.
An informal hearing is an out-of-court meeting with a judge. It can address issues such as your medical care, a contested amount of temporary benefits or the permanency of benefits. Any suggestions made by a judge at an informal hearing are not legally binding. Your lawyer can help you file your Application for an Informal Hearing and attend the hearing on your behalf.
Arrange a Formal Hearing
If the informal hearing process is unsuccessful or not the right fit for your case, you can file a formal Claim Petition with the New Jersey Division of Workers’ Compensation. You must do this within two years of the date of the work-related injury or the last date that you received any workers’ compensation benefits.
A formal hearing will be arranged with a judge or jury. You and your attorney will need to gather documentation to present at your hearing, such as witness statements, accident reports and records, photographs and videos, expert testimony, bills and receipts, and medical documentation. There may be pretrial conferences to attempt an out-of-court resolution at any time until the date of the hearing.
File an Appeal
The outcome of a formal hearing will be binding. However, if you are not happy with the result, you may be able to file an appeal to have the decision reversed by the Appellate Division of the Superior Court. However, you will need to have grounds for an appeal, such as an administrative error made during your formal hearing.
You have rights and multiple legal options if your workers’ compensation claim in New Jersey has been denied. Contact the Law Offices of Jeffrey S. Hasson, P.C. for a free consultation about your case to get started.