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What happens if my workers’ comp claim gets denied?

No one plans to suffer an injury at work, but sometimes accidents happen. Thankfully, New Jersey law requires businesses to offer workers’ compensation insurance to help keep employees financially afloat while they recover.

But what happens if your workers’ comp claim gets denied? The appeals process for a denied claim can leave you frustrated and confused, but there’s still hope.

Why did they deny your claim?

Your notice of denial should contain specific information on why your claim did not receive approval. Some common reasons for a denial include:

  • You did not make your employer aware of your injury within two weeks of the incident.
  • Your injury resulted from misconduct on your part and therefore does not receive coverage.
  • Your employer’s insurance carrier believes the injury was not work-related and should not be eligible for compensation.

After developing a better understanding of the reason for your claim denial, you can begin the next stage of the process.

Filing an appeal

Employees who receive a denial can still file an appeal in the hopes of receiving the financial compensation they need. In New Jersey, workers can choose to move forward with either an application for an informal hearing or file a formal claim petition.

A Judge of Compensation will preside over your informal hearing and issue a non-legally binding verdict. Any decisions made by the judge regarding your eligibility for benefits or the amount of compensation you should receive serve only as suggestions. If you and your employer’s insurance carrier cannot settle on an agreement, you may still file a formal claim petition.

If you choose to file a formal claim petition with the Division of Workers’ Compensation, you must do so within two years of the date of your incident. Then, your appeal will move forward with a hearing before a judge. This will usually happen within six months of your filing date. Most formal appeals settle out of court during this stage of the process, but your case may also move to a formal trial if you cannot reach an agreement.

Being out of work can create immense financial stress, especially if you have a family relying on your income. On top of that, medical bills can pile up and make an already difficult situation quickly feel overwhelming. If you have suffered an injury in the workplace, a workers’ compensation attorney can help you receive the compensation and care you deserve.

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