Workers’ compensation provides benefits to employees who suffer injuries or illnesses they get from work. It covers medical expenses, lost wages, and rehabilitation costs. However, not all claims receive approval. Understanding common reasons for denial can help you avoid pitfalls.
1. Failure to report the injury promptly
New Jersey law requires you to report a workplace injury to your employer within 90 days. Delaying this step can lead to suspicion about the claim’s validity. Employers may question whether the injury occurred at work or elsewhere. Always inform your employer immediately to strengthen your claim.
2. Lack of medical evidence
Insufficient medical documentation often leads to a claim denial. You need comprehensive medical records that clearly link your injury to your job. Visiting a doctor promptly and following all medical advice ensures you have the necessary evidence. Make sure the medical reports detail the nature of your injury.
3. Disputes over employment status
Workers’ comp only covers employees, not independent contractors or volunteers. Employers might dispute your employment status to deny a claim. Ensure your role as an employee is clearly defined and documented. Keep records of your employment contract and any communication regarding your job duties with your employer.
4. Injury happened outside work duties
If an injury occurs while you are not performing work-related tasks, your claim may face denial. Insurance companies scrutinize whether the injury happened within the scope of your employment. Always clarify that the injury occurred while performing job duties and gather witness statements if possible.
Is an appeal possible?
Filing for an appeal after a claim denial can feel daunting, but understanding your rights is crucial. In New Jersey, you have the right to appeal a denied claim. Due to the complicated nature of the issue, you may want to seek help from a legal professional who can guide you through the appeals process.
They can also help gather necessary evidence, effectively represent your interests, and increase your chances of receiving the benefits you deserve.