Union County Workers’ Compensation Denials Lawyers

Nobody goes to work expecting that a normal day on the job will suddenly turn into an injury, followed by paperwork, doctor visits, and, in many cases, a frustrating denial letter from an insurance company. Unfortunately, this is something that happens to countless workers throughout New Jersey, and if you are currently dealing with a denied workers’ compensation claim, you are most likely feeling uncertain about what comes next and how you are supposed to support yourself in the meantime. Read on and reach out to the dedicated Union County workers’ compensation denials lawyers here at The Mark Law Firm to learn more about how we can help you get the benefits you deserve and need.

Why Are Workers’ Compensation Claims Denied?

Though New Jersey’s workers’ compensation system is designed to provide benefits regardless of fault, that does not mean every claim is automatically accepted without issue. In fact, it is not uncommon for employers or their insurance carriers to push back on claims, sometimes for legitimate reasons, and other times for reasons that can and should be challenged. Some of the most common reasons workers’ compensation claims are denied in New Jersey are as follows:

• You did not report your injury within the required timeframe: Generally speaking, you are expected to notify your employer within 90 days of your injury, and failing to do so can give the insurance company a reason to question the validity of your claim.
• Your employer disputes that the injury is work-related: In many cases, insurers will argue that your injury occurred outside of work, or that it is tied to a pre-existing condition rather than your job duties.
• There is not enough medical evidence supporting your claim: If your medical records do not clearly connect your injury to your employment, or if you did not treat with an authorized provider, your claim may be denied.
• You made an error in your paperwork or missed a filing deadline: Workers’ compensation claims involve a considerable amount of documentation, and even a small mistake can delay or derail the process.
• The insurance company claims misconduct or intoxication: If your employer alleges that your injury resulted from a violation of workplace rules or substance use, benefits may be denied.
• An independent medical examination contradicts your treating physician: Insurance companies often rely on their own doctors, who may downplay your injury or disagree with your diagnosis.

What Happens When a Workers’ Compensation Claim is Denied?

If your workers’ compensation claim is denied in New Jersey, it is important to understand that you still have options. While the process may seem overwhelming at first, it follows a fairly structured path through the New Jersey Division of Workers’ Compensation, and with the right approach, many denied claims are ultimately resolved in favor of the injured worker. Generally, the process of challenging a denial proceeds as follows:

1. First, you should review the denial notice carefully. The notice should explain why your claim was denied, and understanding this reasoning is critical, as it will guide how you move forward.
2. Next, you can file either a Claim Petition or request an Informal Hearing. A Claim Petition begins the formal litigation process, while an Informal Hearing is a more relaxed setting that may lead to a quicker resolution, though it is not binding.
3. You will then begin gathering medical evidence and documentation. This can include treatment records, diagnostic imaging, and medical opinions that clearly establish that your injury is work-related.
4. If your case proceeds formally, you will attend hearings before a judge. During these hearings, both sides will present evidence, question witnesses, and make arguments regarding your entitlement to benefits.
5. At various points, settlement discussions may take place. Many cases are resolved before a final decision is issued, often through negotiations that provide compensation without prolonged litigation.
6. Finally, a judge will issue a decision, which may be appealed if necessary. If the outcome is not favorable, you may have the option to pursue further legal action through the appellate system.

What Benefits Could You Still Be Entitled to After a Denial?

One of the most common misconceptions about workers’ compensation denials is that once a claim is denied, that is the end of the road. Fortunately, that is simply not the case. Even after a denial, you may still be eligible for various types of benefits, provided you successfully challenge the decision. Workers’ compensation benefits may include the following:

• Medical benefits: Coverage for all necessary and reasonable medical treatment related to your work injury.
• Temporary disability benefits: Wage replacement while you are unable to work during your recovery.
• Permanent partial or total disability benefits: Compensation for lasting impairments that affect your ability to work in the future.
• Dependency benefits in fatal accident cases: Financial support for surviving family members if a workplace injury results in death.

Contact Our Workers’ Compensation Benefits Denials Lawyers Today

Here at The Mark Law Firm, our lawyers have extensive experience handling workers’ compensation denials on behalf of our clients. If you need an attorney to effectively represent your interests, contact us today for a free initial consultation.