Workers Compensation Denial

Common Causes and More for Workers’ Compensation Claims Denials

In 2021, there were 131,734 reported workplace injury claims in New Jersey. Of those accidents, more than 30,000 led to a formal claim petition filed with the workers’ compensation court. Additionally, more than 6,000 previously resolved injury claims cases were re-opened with the court that year.

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Although any injured worker can file a claim, that does not mean that their claim will be automatically approved and benefits provided. Nearly half of all workers’ compensation claims in New Jersey are initially denied. The experienced workers’ compensation attorneys at the Law Firm of Garces, Grabler and LeBrocq are well-versed in helping injured workers receive the benefits and compensation they deserve for a workplace injury.

What Leads to a Worker's Compensation Claim?

Worker's compensation claims occur when someone is injured in the course and scope of their job. A work-related injury can be the result of an accident. Workers who are injured as the result of a work-related accident are entitled to receive benefits and compensation for their injuries, even if they are the cause of the accident. Work-related injuries can also result from occupational exposures, such as repetitive stress injuries, exposure to injury-causing substances, and exposure to illnesses in the workplace. This can include work-related exposures to and illness from COVID-19.

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Any injury or illness caused by the workplace or work environment can lead to a valid workers’ compensation claim. This entitles the injured worker to receive workers’ compensation benefits. Those benefits include medical treatment, temporary disability, and permanent disability.

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However, many valid claims for workers’ compensation benefits are incorrectly and improperly denied. When this occurs, additional help from experienced workers’ compensation attorneys at the Law Firm of Garces, Grabler and LeBrocq can help injured workers receive their due benefits and compensation.

What Does it Mean When a Claim is Denied?

Nearly half of all workers’ compensation claims are initially denied. When a claim is denied, the injured worker does not receive any medical treatment paid for by their employer for their work-related injury. If the injured worker is unable to work, the denial of their claim also means that they will not receive temporary disability benefits to help with their bills and expenses. It also means that they will not receive any compensation for how serious and permanent the injuries are. When a claim is improperly denied, the injured worker is left on their own to pay for their own medical treatment, deal with their loss of wages, and their permanent limitations from the injury.

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When a workers’ compensation claim is denied, it is important to reach out to an experienced and knowledgeable attorney who can get the denial reversed.

Top Reasons a Claim is Denied

Claims can be initially denied for many reasons. If the denial is correct and appropriate, the injured worker is not eligible for workers’ compensation benefits. However, many denials of workers’ compensation benefits are incorrect. While every case is different, it is a good idea to speak with a lawyer about your situation. You may find that your workers’ compensation benefits have been improperly denied.

Injuries Were Not Work-Related

An employer or their insurance company may deny a claim by stating that the injury was not work-related. Often, the excuse given is that the injury occurred during a worker’s commute to and from a job. The denial may also be because it is alleged that the injury occurred outside of work.

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Whether or not either of these are valid reasons to deny a workers’ compensation depends on the facts of your particular situation. If your claim is denied, you must reach out to an experienced workers’ compensation attorney to discuss your options. The Law Firm of Garces, Grabler and LeBrocq has a track record of helping injured workers with denied claims receive their due benefits and compensation.

Injuries are Minimal, and Compensation is Not Needed

When denying a claim, an employer or their insurance company may claim that the injury is very minor and does not require medical treatment or time off from work to recover. However, that may not always the case. Injuries that are serious in nature may be initially present as mild.

Worker Intentionally Caused the Accident

Employers may wrongfully deny work-related injury claims on the basis that the injured worker was the cause of the accident. In reality, fault of the worker is not a basis to deny workers’ compensation benefits in New Jersey. Unless the injury was caused by an intentional act or by fraud, which is very rare, an injured worker is entitled to receive workers’ compensation benefits and compensation.

Worker Was Under the Influence of Drugs or Alcohol

After a work-related accident, an injured worker may be required by their job to take a drug or alcohol test. A failed result may result in the workers’ termination. However, under New Jersey law, that injured worker may still be entitled to receive workers’ compensation benefits. An employer may only properly deny a workers’ compensation claim if the intoxication is the sole cause of the injury. New Jersey law makes it difficult for an employer to deny workers’ compensation benefits due to intoxication. A positive drug test, for instance, is not able to show when an illegal substance was last used.

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If there are issues involving a work-related injury and a positive drug or alcohol screening, it is vitally important that you speak with a knowledgeable attorney. The workers’ compensation attorneys at Garces, Grabler and LeBrocq know the law and science of navigating the issues of intoxication and work injuries.

Procedures to File a Claim Not Followed

An employer will sometimes refuse to report a work-related injury to their insurance company. The insurance company will then use that lack of a report as a basis to deny an otherwise valid workers’ compensation claim.

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An employer who is following the law will promptly take a report of a work-related injury. The injured worker should obtain a copy of that report when it is generated. If the employer refuses to make a report of a work-related injury, the injured worker should document how they’ve reported the claim to their employer. It is smart to independently notify the employer via written notice, such as a text message, email, or letter. A phone call or face-to-face conversation only is often not enough. The injured worker should also keep a copy of how they report the injury in case timely notice of a claim becomes an issue.

Deadline for Filing a Claim Missed

An employer or their insurance company may deny a workers’ compensation claim due to a lack of timely notice. In New Jersey, an employee must notify the employer about a traumatic injury within 90 days. There is a special rule for hernias, which must be reported to an employer within 48 hours. A claim petition must also be filed with the workers’ compensation court within 2 years of either date of the injury or the last date of medical treatment provided by the employer.

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The team at the Law Firm of Garces, Grabler and LeBrocq can help explain all of the deadlines for notifying an employer of a claim and filing with the court.

Can Claims Be Denied in Bad Faith?

Many denials of workers’ compensation claims are not correct. The employer’s insurance company may only take statements about the injury from the employer, which may not be true. There may be incorrect allegations of fraud or misconduct. The employer may even deny knowing or employing the injured worker, especially if he works on a cash basis. The employer may also threaten the injured worker and other witnesses with being demoted or fired if a claim is started, may fail to adequately investigate a claim, may misrepresent the rights of the injured worker, or unreasonably deny paying the benefits to the employee.

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When one or more of these situations is happening to you, it is important to immediately seek out representation from an experienced workers’ compensation attorney. The workers’ compensation attorneys at the Law Firm of Garces, Grabler and LeBrocq know how to properly investigate an accident, document injuries, and get injured workers the benefits and compensation they deserve.

When a Claim is Denied, is That Final?

The denial of a claim by an employer or their insurance company is not the final step. If a claim is improperly denied, an injured worker can appeal the denial by filing a claim petition with the New Jersey Workers’ Compensation Court. If your claim is denied, your matter must be correctly filed with the court. A small mistake may cost you significantly as to your ability to receive medical benefits, temporary disability, and permanent disability.

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The attorneys at the Law Firm of Garces, Grabler and LeBrocq routinely appear throughout all workers’ compensation courts in New Jersey. We help injured workers receive the benefits and compensation they deserve.

Stay On Top of Deadlines

In all traumatic injury claims, a formal claim petition must be filed with the workers’ compensation court within two years of either the date of the accident or when medical treatment authorized by the employer was last provided, whichever is later. For all occupational claims, the formal claim petition must be filed within two years of when the injured worker knew or should have known about the injury.

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While this might seem like a lot of time, it really isn’t. It can be very easy to miss the deadline to file. When a deadline to file a formal claim petition is missed, the injured worker is no longer entitled to receive any medical benefits, temporary disability, or permanent disability relating to their work-related injury.

FAQs About Worker's Compensation Denials

When someone is denied worker's compensation benefits, knowing what to do and who they can trust is crucial. A consultation with an attorney like those at the Law Firm of Garces, Grabler, and LeBrocq is necessary. While every case is different, please read through the following FAQs to get some answers to some common questions that might have.

What Happens if a Worker's Compensation Claim is Denied?

When a workers’ compensation claim is denied, the injured worker can choose to appeal that denial. The way to appeal a denial is by filing a formal claim petition with the New Jersey Division of Workers’ Compensation. Once your matter is filed with the court, our attorneys are able to request that you begin to receive workers’ compensation benefits.

Is a Lawyer Required to File a Formal Claim?

It is highly recommended that you retain an attorney to assist with the filing of a formal claim petition with the Division of Workers’ Compensation. The pleadings required by the court are highly technical, especially in matters where motions to require an employer to provide medical treatment and temporary disability are needed.

Do I Have to Pay Upfront for a Lawyer?

No. Under New Jersey law, attorneys in workers’ compensation cases do not charge any upfront fee or retainer fee. Legal fees can only be ordered by a judge of workers’ compensation. Fees in New Jersey workers’ compensation cases are typically capped at 20% of any awarded judgment of permanency benefits at the end of the case. Furthermore, attorney’s fees are paid by both the injured worker and the employer. In most cases, the injured worker is not paying for the whole attorney’s fee.

Can My Employer Fire me for Hiring a Lawyer?

No. It is illegal under New Jersey law for an employer to fire a worker because they have filed a workers’ compensation claim, for suffering an injury on the job, or for hiring a lawyer. Nevertheless, some employers will do it anyway, either as a form of retaliation or in the hopes that the injured worker does not know their rights. If this happens, an injured worker should speak with a lawyer immediately about their options. This may include bringing a separate employment law claim against the employer for retaliatory discharge.

Can My Employer Fire me for Being Out of Work for a Worker's Compensation Claim?

Employers who fall under the Family and Medical Leave Act (FMLA) can be required to hold an injured worker’s position open for an absence of up to 12 weeks. Additionally, an employer may be required to provide an extended leave of absence as an accommodation under the Americans with Disabilities Act (ADA).

What Happens if My Employer Doesn't Report the Injuries?

If an employer refuses to report a work-related injury to their insurance company, either the injured worker or our office can do this for you. Additionally, our office can provide notice to the employer’s workers’ compensation company by filing a formal claim petition.

How Do I Know If My Employer Has Workers’ Compensation Insurance?

New Jersey law requires every employer to post a notice in the workplace naming their workers’ compensation insurance company. If your employer doesn’t do that, you can search for your employer’s insurance coverage on the website of the New Jersey Compensation Rating and Inspection Bureau (https://www.njcrib.com/PolicyCoverage/Disclaimer). For employees of self-insured companies, a list of their self-insured contacts can be found here (https://www.nj.gov/labor/workerscompensation/assets/PDFs/Forms/carrier_SI_contact.pdf). For public sector employees, a list of their insurance contact information can be found here (https://www.nj.gov/labor/workerscompensation/assets/PDFs/Forms/public_contact.pdf)

Is There Help Available if I Cannot Return to the Same Position?

For workers who are permanently injured and cannot return to work in the same position, the New Jersey Division of Vocational Rehabilitation Services helps workers who have a disability and may need job retraining or other career assistance.

Are There Any Differences for a Worker Who is a Minor When They're Injured?

A minor injured on the job are entitled to the same benefits as an adult injured on the job. The claims process and court process are the same. However, an employer who does not follow New Jersey law as to the employment of minors is penalized. Minors who suffer a work-related injury and whose employment violates child labor laws are entitled to receive double the rate of permanency benefits they would otherwise be entitled to receive.

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These are just some of the most frequently asked questions about worker's compensation denials. If you have been denied worker's compensation benefits, contact the Law Firm of Garces, Grabler, and LeBrocq to schedule a consultation. We will be able to answer questions specific to your case and let you know the best options to maximize your benefits and compensation.

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Getting the right help from the beginning can make a huge difference. Call now to get started working with a lawyer on your case.