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My workers’ compensation claim was denied. what should i do?

No one files a Workers’ Compensation claim for the fun of it. You’re filing a claim because it’s necessary to continue supporting you and your family while you’re unable to work. Life doesn’t pause after you’ve been injured at work; the mortgage still needs to be paid, bills are still coming in, as are any costs associated with your injury such as medical bills and copays. When you’re unable to work and collect a paycheck, filing a Workers’ Compensation claim is one of the most important steps you can take to find financial relief. But what if your claim was denied? What do you do then?

Why Was My Workers’ Comp Claim Denied?

If you sustain an injury while on the clock, the situation seems pretty cut and dry. However, that is not always the case. In New Jersey, injured workers are required to notify their supervisor of the injury within 14 days otherwise you could forfeit your right to receive full Workers’ Comp benefits. While you may have had a substantial reason for the delay, insurers will typically be skeptical of the severity of your injuries if you wait to file a claim. 

In many cases, the insurance company may try to argue that your injury wasn’t sustained during the course of employment. This can sometimes be a tricky area. If an employee was injured outside of the workplace  on his or her lunch break, that injury is not considered work-related because they weren’t performing work-related tasks at the time of the accident, and they were not on property under the control of the employer. However, if an employee was injured while running an errand for their supervisor on their lunch break, their Workers’ Compensation claim would be valid. Likewise, any injuries sustained on the company’s premises, regardless of whether or not the employee was on lunch, are considered work-related because of where the incident took place. The major exception to this rule is whether or not the employee was doing something that wasn’t in the employer’s best interest. A common example of this would be exercising on a lunch break. While the injury may have been sustained on company property, it wouldn’t be the basis for a valid Workers’ Compensation claim because the employee was not performing any function that was for the benefit of the employer. 

In New Jersey, a Workers’ Compensation claim will typically be denied if any of the following are applicable to the employee’s circumstances:

  • The employee was hurt by their own “willful negligence” or through “horseplay”
  • The employee was injured while partaking in voluntary recreational activities
  • The employee suffered a heart attack, stroke or other medical condition that can not be associated directly with work-related tasks
  • The employee was drinking or under the influence of drugs and the drinking or drug usage was the sole reason for the occurrence of the accident

If none of these situations pertain to you and your Workers’ Compensation claim was still denied, you have recourse. 

How Do I Challenge My Denied Workers’ Comp Claim?

If a Workers’ Compensation claim is denied, injured workers must file a formal Claim Petition with the New Jersey Division of Workers’ Compensation. This petition must be filed within two years, either from the date of your initial injury or within two years from the last date you received any Workers’ Compensation benefits. In cases of occupational diseases like carpal tunnel syndrome, repetitive stress injuries or lead poisoning, the two year window to file a petition starts when the employee knows or should have known that the injury was related to the employment. This is because occupational diseases like those mentioned above may take time to develop and not be noticeable right away. Individuals who file their petition will have an opportunity to have a hearing with a Workers’ Compensation judge to present your evidence and testify. There is often a pretrial conference that takes place before the hearing in an effort to try and negotiate a settlement. If a settlement cannot be reached and you proceed with the hearing, it’s important to collect all necessary documentation including medical records, doctors’ reports and unpaid bills to present as evidence. 

As you can see, there are a lot of complexities when dealing with a Worker’s Compensation claim that benefit from the experience of a Workers’ Compensation lawyer. At Team Law, our attorneys have decades of experience handling these complex claims. We understand that when a work-related injury prevents you from supporting your family, the necessity to file a Workers’ Compensation claim is all the more urgent. If your claim was denied, we can help. Schedule a consultation today. 

Contact a Clark Workers’ Compensation Lawyer to Discuss Your New Jersey Workplace Injury Case

A workplace injury can be devastating, particularly if it prevents you from returning to work for an extended period of time. Although New Jersey’s Workers’ Compensation laws are supposed to provide you with all necessary medical care and replacement pay for missed time at work, it is not always easy to get the Workers’ Compensation benefits you deserve. That is why you should speak with a knowledgeable Workers’ Compensation lawyer about your situation and get guidance throughout the claims process. The experienced Workers’ Compensation attorneys at Team Law represent clients in Perth Amboy, Newark, Jersey City, Summit and all across New Jersey. Call (732) 388-5454 or fill out our online contact form today to schedule a free consultation about your work injury case. Our main office is located at 136 Central Avenue, Clark, NJ 07066 and we also have offices in West New York, New Brunswick, Union City and Orange. 

The articles on this blog are for informative purposes only and are no substitute for legal advice or an attorney-client relationship. If you are seeking legal advice, please contact our law firm directly.

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