Many injured workers are shocked to learn that their workers’ compensation claim has been denied, especially when the injury clearly occurred on the job. Unfortunately, denials are common in New Jersey, and they often have little to do with whether an employee was truly hurt at work. Employers and insurance companies closely scrutinize every claim and frequently look for reasons to avoid paying benefits.
At Mallon and Tranger, we regularly assist injured workers throughout New Jersey who are facing denied claims. Understanding why denials happen and knowing how to respond can make a significant difference in whether you ultimately receive compensation for medical care and lost wages.
Workers’ compensation insurers often rely on technical arguments to justify denying claims. Even small mistakes or delays can be used to challenge eligibility, regardless of how serious the injury may be.
Some of the most common reasons for claim denials include:
Employers may also argue that the injury happened outside of work hours or resulted from conduct that disqualifies coverage. These arguments often require strong evidence to overcome.
A workers’ compensation denial is not the end of the process. New Jersey law provides injured workers with the right to challenge denied claims through the workers’ compensation court system. Many valid claims are initially denied but later approved through the appeals process.
Appealing a denial involves presenting evidence that supports your injury claim, including medical records, testimony, and employment documentation. Because insurance companies are often represented by experienced defense attorneys, having your own legal representation can greatly improve your chances of success.
If your workers’ compensation claim has been denied, acting quickly is critical. Delays can result in missed deadlines or lost evidence that may weaken your appeal.
Key steps to take after receiving a denial include:
Taking these steps helps protect your rights and strengthens your position during the appeals process.
New Jersey provides two main avenues for resolving denied workers’ compensation claims: informal hearings and formal hearings. Informal hearings allow a judge to review the dispute and offer guidance without issuing a binding decision. These hearings can sometimes lead to voluntary resolutions.
Formal hearings involve a more structured legal process. Evidence is presented, witnesses may testify, and medical experts may be called to support or challenge the claim. Formal hearings can take time, but they provide an opportunity to fully present your case and challenge the insurer’s position.
Workers’ compensation insurers are motivated to limit payouts whenever possible. Approving claims can be expensive, especially when injuries require ongoing treatment or result in long-term disability. As a result, insurers often question the severity of injuries or attempt to shift responsibility away from the workplace.
Common tactics used by insurers include requesting repeated medical evaluations, delaying approval for treatment, and pressuring injured workers to return to work before they are ready. Legal representation helps counter these strategies and ensures that insurers follow the law.
If your appeal is successful, you may be entitled to a range of workers’ compensation benefits designed to support your recovery and financial stability. These benefits can be essential when injuries prevent you from working or require ongoing medical care.
Workers’ compensation benefits in New Jersey may include:
Securing these benefits can ease financial stress and allow you to focus on healing.
Workers’ compensation law involves strict rules, deadlines, and procedures. Insurance companies and employers often rely on these complexities to their advantage. An experienced attorney understands how to present evidence, respond to insurer arguments, and meet all procedural requirements.
Our workers’ compensation attorneys at Mallon and Tranger work closely with medical providers and experts to build strong cases for injured workers. We understand how to challenge denials based on pre-existing conditions, delayed reporting, and disputed medical treatment.
A denied workers’ compensation claim can place tremendous financial strain on injured workers and their families. Medical bills, lost income, and uncertainty about the future can quickly become overwhelming. You do not have to accept a denial without a fight.
Mallon and Tranger represents injured workers throughout New Jersey who are facing denied workers’ compensation claims. We are committed to helping clients pursue the benefits they deserve and holding insurers accountable. Contact us today to discuss your case and learn how we can help you move forward with confidence.
