Even Though Employers May Argue Some Qualified Reasons To Deny A Workers’ Compensation Claim, in Some Cases, There May Be Grounds For Refuting the Rejection
Believe it or not, the mere act of filing a workers’ compensation claim doesn’t guarantee that your benefits will be given to you. Yes, an employer in New Jersey can deny a workers’ compensation claim if they believe it is unjustified or if the injury is not covered under the state’s workers’ compensation law. However, if the employer denies the claim, the worker can challenge the denial by filing a claim with the New Jersey Division of Workers’ Compensation. An administrative law judge will then review the case and decide the outcome of the workers’ compensation claim.
It’s important to note that in New Jersey, workers’ compensation is a no-fault system, meaning that an employee does not need to prove that the employer was at fault for the injury to receive benefits. However, the damage must have occurred during employment and must be covered under the state’s workers’ compensation law. If the workers’ compensation claim is accepted, the employee may be eligible for medical expenses, temporary disability benefits and permanent disability benefits.
Valid Grounds For Denying a Workers’ Compensation Claim in NJ
It is crucial to note that certain injuries may not be covered under the state’s worker’s compensation law. For instance, injuries that do not occur during work hours can lead employers to deny workers’ compensation claims. Moreover, there is a time limit for reporting any injuries sustained on the job within this system and failing to do so within 90 days in New Jersey could make it difficult for employees because companies legally deny claims based on such delays.
In addition, workers with pre-existing conditions could have trouble if they are injured because they did not follow their doctor’s instructions. For example, if George has a herniated disc and has been told not to lift or carry heavy boxes and he does it anyway, the resulting injury may not qualify him for workers’ compensation because he knew it was risky behavior.
Willful negligence is another claim used to deem a worker’s claim as ineligible. For a worker to have been willfully negligent, they must have used a controlled substance, be intoxicated, show reckless behavior, or commit deliberate acts or omissions.
Sometimes, it is possible for the injured worker to come back to work part-time or to be trained in another position, at least for the duration of their treatment. When workers refuse to do this, they are at risk of having their benefits denied.
Alternatives if There is Bad Faith in the Denial
Instead of submitting a formal claim, you can request an informal hearing with a Division of Workers’ Compensation judge. After reviewing evidence and medical records, they will recommend how to proceed. The result of this process is non-binding. It is similar to mediation; the goal is to decide on a settlement between you and the insurance company.
The New Jersey Division of Workers’ Compensation will receive your formal claim and accompanying evidence to review your situation. Your workers’ compensation attorney can meet with you to discuss your claim and help you to submit it. A formal hearing is akin to a trial. You and your attorney will submit evidence from experts, witnesses, medical reports, physical therapists, and cross-examination. If you win, your employer’s insurance must pay your claim.
What are the Employer’s Options If a Claim Is Denied?
If an employee’s workers’ compensation claim is denied, the employer’s attitude should be empathetic and understanding toward the employee. The employer should also make sure to follow the proper procedures for appealing the denied claim and provide the necessary support to the employee throughout the process.
It’s important to remember that the employee is likely in a difficult situation, potentially dealing with an injury or illness that has affected their ability to work. The employer should take steps to ensure that the employee is aware of their rights and options and provide any resources or information that may be helpful. Additionally, the employer should maintain a professional and neutral stance throughout the process, avoiding any actions that could be interpreted as retaliation against the employee for filing the claim.
Is There Room For an Appeal in the Process?
Yes, you can appeal a workers’ compensation decision in New Jersey. The New Jersey Division of Workers’ Compensation provides a process for appealing a decision related to workers’ compensation benefits. If you disagree with a decision made by a workers’ compensation judge or the New Jersey Division of Workers’ Compensation, you have the right to file an appeal. The appeal must be filed within 20 days of the date of the decision and must include a written statement explaining the reasons for the appeal. This hearing is different in that no new evidence or testimony is presented. This trial is designed to review the previous hearing and ensure that the decision was lawful, legitimate, and unbiased.
Employee Tips to Avoid a Denial of Your Workers’ Compensation Claim in New Jersey
Injured employees who want to ensure that their workers’ compensation claim is not denied should take the following steps. Injured employees should report their injury to their employer immediately after it occurs. This can be done in writing or orally, but it is best to provide a written report to ensure that the injury is documented. Seeking prompt medical attention is a must. This is important for their health and establishing a clear connection between the injury and the workplace. They must use the healthcare providers given to them by their employer.
Employees should complete and submit a Workers’ Compensation Claim Form to the New Jersey Division of Workers’ Compensation as soon as possible after their injury. This form can be obtained from the employer, the Division of Workers’ Compensation, or an attorney.
Cooperating with their employer and the insurance carrier in processing their claim can make the process easier. This includes attending medical exams and providing any requested information. It does not include accepting the denial of your benefits. You have a right to receive the benefits to which you are entitled. Cooperating does not mean receiving substandard medical support.
It is a good idea to keep detailed records of all medical appointments, expenses related to the injury, and other relevant information. This can be helpful if an appeal is necessary.
Talk to Our Workers’ Compensation Team to Protect Your Rights After a Claim Denial in Monmouth County NJ
An attorney can help you navigate the workers’ compensation claim process and ensure that your claim is filed correctly and on time while helping you negotiate a fair settlement. Your attorney can help you obtain the medical treatment you need to recover from your injury, including referrals to specialists and rehabilitation services. You don’t want to do this on your own, especially when you are injured and need to focus on your recovery. If your claim is denied, they can help you appeal the decision and present your case to a judge.
Our clients are our greatest motivation at Chamlin, Uliano, & Walsh. We want to ensure your rights are upheld and will work with you to make that happen in Holmdel, Middletown, Howell, Long Branch, Freehold, and throughout Southern New Jersey. Being injured or ill is stressful. You have concerns about costly healthcare, and piling bills can hinder your much-needed recovery. Our job is to put our experience to work and get you the best possible outcome.
To learn more, please call us at (732) 440-3950 or complete our online form for your free initial consultation. Time is of the essence and we look forward to helping you today.