Can a Workers’ Compensation Claim be Denied?

Can a Workers’ Compensation Claim be Denied?

Missed deadline, insufficient job connection, and lack of coverage cause most final workers’ compensation denials in New Jersey.

The number of initial workers’ compensation denials has always been rather high. Many claims examiners reject most claims, at least in part. They often hope that the victim either settles the claim for less than full value or abandons the matter altogether. Sadly, this tactic often works.

Somewhat disturbingly, the number of final denials has also increased significantly in recent years. Workers’ compensation provides no-fault insurance benefits to injured workers. However, there are still some basic elements that a Freehold workers’ compensation attorney must establish. Most final denials involve one of the deficiencies listed below.

Missed Deadline

Time deadlines vary in different situations, but typically, injured workers must immediately report their situations to their supervisors in writing.

Email or text message usually, but not always, count as written notice. Once again, the rules vary in different insurance policies. The best practice is to immediately provide electronic notice and follow up with a “snail mail” letter. If the company has a designated claim form, be sure to use it.

Occupational disease claims, such as hearing loss, often present a special problem. Most victims do not run to the doctor as soon as they have trouble following a conversation in a noisy room or experience a bit of tinnitus (ringing in the ear). By the time they go to a doctor and the doctor diagnoses hearing loss, the initial claim deadline has long since passed.

A variation of the delayed discovery rule protects job injury victims in these situations. The clock does not begin ticking until victims discover the full extent of their injuries and the victim connects the injury to a workplace condition.

No Job Connection

This basis for denial is related to the untimely-claim justification. The insurance company claims that a non-job-related cause, such as a fall at home or a preexisting condition, created the injury or occupational disease. New Jersey’s res ipsa loquitur rule, which often creates a legal presumption in favor of the victim, usually does not apply in workers’ compensation cases.

For trauma injuries, like falls, a witness may be important. Any evidence the witness provides is usually enough. The witness did not need to see the entire incident, or even any of it.

Regarding occupational diseases, full workers’ compensation benefits are usually available, even if the victim had a preexisting condition. An attorney must simply prove that the workplace injury exacerbated the preexisting condition, and not the other way around.

Not a Compensable Injury

Workers’ compensation does not apply to all job injuries. That is especially true with regard to cancer, Post Traumatic Stress Disorder, and other occupational diseases. Many times, the law does not keep up with the latest scientific advances.

In these instances, victims may be able to file claims in civil court. The bad news is that the victim/plaintiff must prove negligence or some other cause, such as a defective product. The good news is that the victim may be entitled to additional noneconomic damages, such as compensation for pain and suffering.

Contact a Tenacious Attorney

No fault insurance does not necessarily mean an automatic win. For a confidential consultation with an experienced workers’ compensation attorney in Freehold, contact Lomurro, Munson, Comer, Brown & Schottland, LLC. We do not charge upfront legal fees in these cases.