Frequently Asked Questions About Denied Workers’ Compensation Claims And Appeals
Workers’ compensation is supposed to provide financial support and medical care for employees who sustain injuries on the job. Despite this intention, not all claims get approved, leaving many injured workers uncertain about their next steps. Here are answers to some of the most frequently asked questions we hear:
What are some common reasons for a claim getting denied?
Several factors can lead to the denial of a workers’ compensation claim, including:
- Incomplete or inaccurate paperwork;
- Reporting the injury after the required timeframe;
- Insufficient medical documentation about the injury;
- Inability to connect the injury to the work; or
- Preexisting conditions.
Understanding these common reasons for denial can help you prepare a stronger initial claim or identify areas to address in your appeal.
Are there any other benefits or resources available to me if my claim is denied?
If your workers’ compensation claim is denied, you may still have access to other benefits and resources, such as:
- Health insurance: Your personal health insurance may cover medical expenses related to your injury.
- Disability benefits: Depending on your situation, you may qualify for short-term or long-term disability benefits through your employer or a private insurance policy.
- State assistance programs: There may be additional support for injured workers who cannot receive workers’ compensation benefits.
Exploring these alternatives can provide much-needed support while you work on appealing your denied claim.
Can I appeal the denial of my workers’ compensation claim?
Yes, you can appeal a denied workers’ compensation claim. The appeals process allows you to present additional evidence and arguments to support your case, increasing the chances of a favorable outcome.
Appealing a denial can be complex, but knowing that you do not have to navigate it alone is important.
What is the process for appealing a denied claim? How long do I have to file an appeal?
The appeals process for a denied workers’ compensation claim involves several steps:
- File a written appeal: Submit a formal appeal to your New Jersey’s workers’ compensation board or commission. This involves filling out specific forms and providing additional documentation.
- Attend a hearing: You may be required to attend a hearing where you can present evidence and testify about your injury and the circumstances surrounding it.
- Wait on the review board’s decision: The review board will decide based on the evidence presented after the hearing.
The timeframe for filing an appeal is typically 30 days from the date of the denial. It is crucial to act quickly to help ensure you meet the applicable deadline.
What evidence or documentation do I need to support my appeal?
To support your appeal, you should gather the following evidence and documentation:
- Medical records;
- Witness statements;
- Accident reports; and
- Employment records.
Having thorough and accurate documentation can significantly strengthen your appeal and improve your chances of success.
What are my options if my appeal is unsuccessful?
If your appeal is unsuccessful, you still have several options:
- Request a reconsideration: You can ask the review board to reconsider their decision based on new evidence or legal arguments.
- File a lawsuit: In some cases, you can file a lawsuit against your employer or the insurance company in civil court.
- Seek other benefits: Explore other potential benefits and resources, such as disability benefits or state assistance programs.
Knowing your options can help you plan your next steps and continue seeking the support you need.
How can I ensure that my new claim or refiled claim is not denied again?
To improve the chances of your new or refiled claim being approved:
- Submit complete and accurate information;
- Report the injury promptly;
- Provide comprehensive medical evidence; and
- Obtain experienced legal assistance.
Taking these steps can help you avoid common mistakes and increase the likelihood of a successful claim. At Jacobs, Schwalbe & Petruzzelli, P.C., we work hard to help our clients overcome unfair denials.
Do I need an attorney to appeal a denied claim?
While having an attorney to appeal a denied workers’ compensation claim is not mandatory, having legal representation can increase your chances of success.
An experienced attorney can help you gather the necessary evidence, navigate the appeals process and present a compelling case on your behalf.
Secure Your Benefits Today
Do not let a denied workers’ compensation claim leave you without the support you need. Our Jacobs, Schwalbe & Petruzzelli, P.C., attorneys in Cherry Hill are here to help you navigate the appeals process and secure the benefits you deserve. Call 856-528-7991 or contact us online today to schedule a free consultation.