Understanding Your New Jersey Workers’ Compensation Denial Letter

North Jersey law firm handles appeals of rejected claims for injured employees

When you receive a letter denying your workers’ compensation benefits in whole or in part, you still have options under New Jersey’s Workers’ Compensation Law. Unfortunately, many injured workers in New Jersey receive this type of notice, putting their financial well-being at risk. If an employer or insurer has denied your claim, you have the right to appeal, and Hollander, Strelzik, Pasculli, Vandenberg, Hontz & Associates, LLC is ready to help. For more than 60 years, our Sussex County law firm has provided consistently excellent service for our injured clients in cases involving denied New Jersey workers’ compensation claims. If you believe you received an unfair result, we’ll make every legal effort to see that your denial letter is not the last word. 

Common reasons workers’ compensation claims are denied

Along with basic personal and policy information, your workers’ compensation denial letter must note the reason(s) for the decision, such as:

• Lack of timely reporting — If you report an accident/injury within 14 days, the law grants your claim the greatest protection. If you report in 15 to 90 days, your employer or insurer can challenge the claim, arguing that the delay caused prejudice or casts doubt on whether the injury occurred in the course of your job duties. After 90 days, you risk being barred from benefits entirely, unless you present a valid excuse for the delay or an exception to the rule.
• Disputed injury or causation — Your employer or insurer asserts that your injury did not occur at work or isn’t a job-related injury.
• Insufficient medical evidence — In some cases, an insurer or employer alleges that the medical documentation does not prove the existence of the medical condition for which you seek benefits.
• Pre-existing conditions — The insurer says your injury stems from a prior medical condition, not your current employment.
• Failure to seek approved medical care — In New Jersey, your employer has the right to choose the treating physician. Visiting an unapproved doctor without prior permission can jeopardize your claim.

When you consult with one of our attorneys, we will thoroughly examine the stated reason for the denial and get to work immediately on finding ways to challenge the decision.  

What to look for in a workers’ compensation denial letter

In some cases, adverse workers’ compensation rulings are based on insurance company errors. If the notice includes a mistake regarding your job or medical condition, it is important to correct those problems immediately. Some decisions reflect inconsistent reasoning or explanations that defy logic. Schedule an appointment with a NJ workers’ comp attorney who can review the reasons for the denial and advise you of the pertinent deadlines based on the latter. You should also notify your employer and their insurance company that you intend to dispute the decision. 

Common tactics employers and insurance companies use to deny benefits

Your denial letter includes key information, but the real reason for the decision of an insurance company or employer might not be apparent. An adjuster or claims reviewer could be disputing whether the injury-causing accident actually happened or whether you’re accurately reporting your condition. Specious allegations of fraud can lead a carrier to reject a valid claim or intimidate a workplace injury victim into accepting a lowball settlement offer. Without a strong advocate, it could be difficult to get at the truth, so you should not delay to reach out to an experienced attorney once you are notified that you are not being given the benefits you seek. 

The appeals process for a denied claim in New Jersey

New Jersey has a formal appeals process conducted by the Division of Workers’ Compensation, which includes two options:

• Informal hearing — This is a non-binding meeting before a Judge of Compensation. It is often used to resolve disputes more quickly and amicably.
• Formal claim petition — You must file this within two years of the injury or last compensation payment. This initiates a more structured legal process, potentially leading to a trial if a settlement cannot be reached. A judge will review evidence, hear testimony and issue a binding decision. 

If you disagree with the outcome, you can appeal to the Appellate Division of the New Jersey Superior Court.

How an attorney can help with a denied workers’ compensation claim

You can rely on our experienced workers’ compensation attorneys for strong legal counsel after a claim denial. We understand the legal process, can compile evidentiary support for a reversal and ensure you meet all deadlines. Our firm can also negotiate with insurance companies on your behalf and represent you at hearings.

Contact our North Jersey lawyers if you receive a workers’ comp denial letter

Hollander, Strelzik, Pasculli, Vandenberg, Hontz & Associates, LLC handles appeals of denied workers’ compensation claims for injured employees throughout New Jersey. Please call 973-737-1023 or contact us online to schedule a consultation at our Newton or Succasunna office.