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Steps to follow after a denied workers’ compensation claim

On Behalf of | Jun 20, 2023 | Workers' Compensation |

The Bureau of Labor Statistics reported over 75,000 work-related injuries in New Jersey in 2020. Suffering an injury at work can be a life-altering experience. Workers’ compensation insurance provides a crucial safety net, offering medical benefits and wage replacement. However, it can be disconcerting to receive a denied claim when counting on these benefits.

The denial of a workers’ compensation claim does not mark the end of the road. There are several steps to take upon receiving a denial: Challenge the decision and seek the benefits owed.

Understand the reason for the denial

The first step toward appealing the decision is understanding the reason behind it. Start by carefully reading the workers’ compensation denial letter. It should state the reason for the denial. Common reasons may include disputes about whether the injury occurred at work, missed reporting or filing deadlines or insufficient medical evidence to support the claim.

Collect additional evidence

Often, denial of a claim occurs due to insufficient evidence that the injury is work-related or severe enough to warrant benefits. If this is the case, gather more medical evidence. Visit a doctor, explain the situation and request detailed medical reports linking the injury to the workplace accident.

File an appeal with the Division of Workers’ Compensation

The next step is to file a formal appeal. In New Jersey, workers can file a Claim Petition or an Application for an Informal Hearing with the Division of Workers’ Compensation.

A Claim Petition is a formal legal action where the case goes to a judge and a series of hearings will occur. The Application for an Informal Hearing is a less formal process where a district office will schedule a meeting with a judge and the employer’s insurance carrier to discuss and possibly resolve the dispute.

Follow timelines and procedures

Be sure to carefully follow all procedures and meet all deadlines when appealing the denial. In New Jersey, workers generally have two years from the date of injury or the last payment of compensation, whichever is later, to file a Claim Petition.

Facing a denied workers’ compensation claim in New Jersey can be challenging, but there are ways to challenge this decision and protect your rights. Understanding what you need to do can help you have the best chance at a successful appeal.