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What to do after a workers' compensation claim gets denied?

Workers' compensation is a program created in order to protect those who work for a living from ending up disabled and in poverty as a result of a work injury. Employers in New Jersey must generally carry a policy to protect workers who sustain injuries or develop an illness in the course of their work. That means that it can feel frustrating and unfair when you receive notice that your claim for these critical benefits got denied for some reason.

You likely took all the proper steps at first, including immediately reporting the injury or illness to your employer and submitting to onsite evaluation if your employer provides direct medical care. Then, you likely sought additional evaluation and treatment from your physician or a hospital and proceeded to file a claim for benefits as soon as possible.

New Jersey requires that you file a claim within two years of the accident or of learning about the illness. Even if you try to do everything right, you may end up facing a denial of benefits.

There are many reasons why a valid claim gets denied

Sometimes, a simple error on one or more of the forms required for your claim can result in a denial. The potential for small mistakes causing a major delay and a lot of frustration is why many people seek the help of an attorney when filling out the claim forms. Inadequate medical records or the use of the wrong words by your doctor can also impact your approval or denial for benefits.

Sometimes, the issue with your denial stems from actions taken by your employer. Even if you reported the accident in a timely manner, your employer could dispute the details of the incident. Perhaps they hope to avoid an increase in their premium for the insurance or maybe a mistake was made and a report didn't get submitted by your manager or human resources. Whatever the cause of your denial, the good news is that New Jersey law allows you to appeal that denial.

Act quickly but remain calm when appealing a denial

It's only natural to feel frustrated and let down when you don't receive the benefits you deserve after a workplace injury or acquired illness. However, getting angry or letting despair overtake you won't remedy the situation. You need to remain calm, educate yourself about your options and take steps to appeal the decision as soon as possible.

Seeking additional medical evaluation may help in some cases. In others, correcting issues on forms or obtaining corroborating testimony from co-workers about your injury or illness can remedy the situation. You will likely need to go before a Judge of Compensation to resolve the issue.

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