What to Do if Your Workers’ Compensation Claim is Denied
Getting a denial letter after filing a workers’ compensation claim can feel like a gut punch, especially when you are already dealing with pain and lost income. A denial does not mean your case is over. You have the right to appeal by filing a Formal Claim Petition with the Division of Workers’ Compensation within two years of the injury. With the help of our workers’ compensation attorneys, many denied claims are ultimately overturned.
Common Reasons for Denial
Insurance companies deny workers’ compensation claims for a variety of reasons, and some of those reasons have more to do with technicalities than the legitimacy of your injury. Common reasons include:
- Late reporting of the injury to your employer
- Insufficient medical documentation linking the injury to work
- Disputes over whether the injury occurred on the job
- Missed filing deadlines
- Pre-existing condition arguments
- Employer contesting the claim
Steps to Take Following a Denied Workers’ Comp Claim
A denial is a setback, but it is also a starting point for building a stronger case than the one you initially submitted. Taking the right steps in the right order can significantly improve your chances of a successful outcome.
Consult an Attorney
Sitting down with a workers’ compensation lawyer to review your denial letter is one of the smartest moves you can make at this stage. The letter contains specific reasons for the denial, and an attorney can identify whether those reasons are legally sound or whether the insurance company overstepped. A skilled lawyer will:
- Analyze the stated grounds for denial
- Identify errors or weaknesses in the insurer’s reasoning
- Advise on the strongest path forward for your appeal
- Handle all communication with the insurance carrier
- Represent you at hearings and proceedings
Request an Informal Hearing
Before moving to a formal petition, you can request an informal hearing through the Division of Workers’ Compensation. A judge will meet with both sides to explore whether the dispute can be resolved without the time and expense of a full trial.
File a Formal Claim Petition
If informal efforts do not result in a fair resolution, the next step is to file a Formal Claim Petition, which initiates the formal litigation process before a workers’ compensation judge. The petition outlines your injury, the circumstances surrounding it, and the benefits you are seeking.
Gather Documentation
Strong evidence is the backbone of a successful appeal, and the more organized your records are, the better positioned your case will be. The attorneys at Matarazzo & Lubcher help clients compile and present the documentation that matters most:
- Medical records and diagnostic test results
- Incident reports filed with your employer
- Witness statements from coworkers
- Pay stubs and proof of lost wages
- Photographs of the injury or hazardous work conditions
- Written correspondence with the insurance company
Speak to a New Jersey Workers’ Compensation Lawyer Now
A denied claim does not have to be the final answer when you have the right legal team in your corner. Contact Matarazzo & Lubcher at 856-460-5805 to schedule a free consultation with a workers’ compensation attorney in Cherry Hill, who will fight to get your claim back on track.