How To “Appeal” a Denied Workers’ Compensation Claim In New Jersey

In this article, you can discover…

• Common reasons a workers’ comp claim is denied.
• The documents needed to fight an insurance carrier’s denial of your claim.
• How a seasoned attorney can help successfully guide you through the process of filing a Claim Petition in the Division of Workers’ Compensation.

What Are The Common Reasons For A Workers’ Compensation Claim Denial In New Jersey?

There are many reasons why insurance carriers choose to reject workers’ compensation claims. The employer may deny that an accident even occurred, that it resulted in an injury, or that it occurred within the course of employment. If you have preexisting disabilities or injuries, your claim could be denied on that basis, with the carrier arguing that your condition is unrelated to your employment.

The statute of limitations is another basis for denying a claim. A formal Claim Petition must be filed within two years of the date that treatment was last authorized by the workers’ compensation carrier, or it will be denied as untimely. 

What Steps Should I Take Immediately After Receiving a Denial Notice?

If you are ignored by your employer or denied medical treatment by the insurance carrier after an accident, it is wise to immediately contact a workers’ compensation attorney. Practically speaking, you cannot appeal an insurance carrier’s denial. Your only remedy in the face of receiving a denial by an insurance carrier is to file a Claim Petition with the Division of Workers’ Compensation through an attorney. If you attempt to file an “appeal” on your own by informally reaching out to the Division of Workers’ Compensation, you will be wasting precious time. Moreover, the filing of an “informal” claim by a pro se petitioner does not stop the statute of limitations clock from running. A formal Claim Petition must be filed to avoid a dismissal of your claim on the basis that it was not filed within the two year deadline.

What Evidence Do I Need to Gather for My Claim

To move the process along quickly, it is a good idea to download all your medical records and provide them to a workers’ compensation attorney. That attorney may then analyze your records to present your claim in the most persuasive way. Obtain complete copies of medical records from any urgent care center, hospital, family physician, or specialty physician who examined you following a work accident.

If the basis of the denial is that no injury occurred or that your employer was not notified, be sure to get a copy of communications between you and your employer/supervisor indicating that you reported the injury.

If your employer denies that an accident or injury occurred at the workplace, while memories are fresh, request statements from witnesses. Co-workers may be afraid to provide a formal statement or speak with an attorney. Instead, ask them to simply text or email you a statement about what they remember. Then turn the statement over to your attorney.

Attorney Lisa Pezzano is a veteran, skilled workers’ comp attorney serving New Jersey. For over 30 years, she’s helped clients just like you pursue denied workers’ comp benefits and get the legal help and answers they need.

Has your workers’ comp claim been denied? Unsure of your rights or options? Reach out to the Pezzano Law Group at (908) 923-0020 for a free initial consultation today.

Why Is It Important to Hire A Lawyer To Help With My Workers’ Compensation Claim?

Without a lawyer, delays will compound, too much time will have passed, and evidence can become stale. What’s more, with the passage of time, another event in your life can be pointed to as the reason for your symptoms, ie, such as a subsequent accident, which an insurance adjuster can then claim is the true cause of your injury. 

Getting legal help immediately, to assist in gathering evidence and presenting it to the Court in a persuasive fashion is crucial to successfully pursuing a workers’ compensation claim.

What Are the Stages of the Workers’ Compensation Litigation Process?

First, your attorney will file a Claim Petition electronically with the Division of Workers’ Compensation. This filing triggers an adversarial process between your attorney and the insurance carrier’s attorney, wherein your case is periodically listed for a conference with a Judge of Compensation. 

If the insurance carrier is not voluntarily authorizing medical treatment, your attorney may file a “Motion for Medical Benefits,” to force the carrier to pay for your treatment. A “Motion for Temporary Disability Benefits” may also be filed if the carrier fails to pay you 70% of your gross average weekly wages while you are disabled from working.

Once you have been discharged from active medical treatment and have reached “maximum medical improvement,” your attorney will gather your updated medical records. Upon receipt of all of the medical evidence, your attorney will schedule you for an independent medical evaluation to estimate your permanent partial or total disability as a result of the work accident. The insurance carrier will also schedule such an examination.

Many settlements are negotiated after the resulting “permanency reports” have been received by the parties. The respective attorneys will attempt to negotiate a settlement in the range which is between the permanency estimates provided by the two medical experts.

If the parties are unable to reach an amicable settlement, the Judge of Compensation may then schedule the case for Trial. At a Trial, you would testify about the nature and extent of your injuries and how they effect your daily life. Thereafter, each medical expert would testify about the objective medical evidence which supports or refutes your claim. The Judge of Compensation will then issue a ruling about whether you are entitled to receive additional benefits, including a percentage of permanent disability benefits.

If the Judge issues a decision following Trial, the only appropriate basis for filing an appeal would be if the Judge made a mistake in the interpretation of the law. If the Court’s decision is based on weighing the credibility of witnesses, there is little basis to file an appeal with the NJ Appellate Division.

How Long Does the Workers’ Compensation Claims Process Typically Take?

The time varies greatly depending on the details of your case. Motions for medical and temporary disability benefits must be listed for a hearing within 30 days of being filed, though getting a decision from a judge may take much longer since cases are often adjourned for a multitude of reasons. Missing evidence, incomplete medical records, or a witness being unavailable may cause motions to be adjourned, and cases delayed.

It generally takes one year from the date on which you are discharged from active medical treatment to negotiate a settlement of the entire claim. If a trial is necessary, it will take longer to obtain an award. A seasoned workers’ comp attorney can review the details of your case and give you a better sense of what to expect in light of your injuries, available evidence, and evidence that may have been overlooked. 

Still Have Questions? Ready To Get Started?

For more information on How To Pursue A Denied Workers’ Compensation Claim In New Jersey, a free initial consultation is your next best step. Get the information and legal answers you are seeking by calling (908) 923-0020 today.