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What happens if I am denied workers' comp benefits?

Bergen County workers may file claims for injury-related benefits without the help of an attorney, but sometimes there are good reasons to engage a lawyer. Some workers assume New Jersey workers' compensation claims approvals are automatic. That's not the case.

Before a claim is validated, a determination is made to ensure an injury occurred "out of the course of employment." An eligible benefits recipient must be classified as an employee. The time, place and details surrounding an accident must support the claim an injury occurred while the employee was fulfilling duties associated with a job.

Let's say you're injured in a car accident on your way home from work. Your job classification as an independent contractor -- not an employee -- and the fact the crash occurred off the clock work against you. You don't meet the criteria for workers' comp eligibility, so what do you do?

The denial of a workers' compensation claim may occur for several reasons, outlined in complicated state laws. A lawyer helps workplace accident victims challenge benefit denials, oppose the stoppage of benefits and seek compensation from other sources, like the Division of Temporary Disability Insurance.

If a workers' compensation insurer rejects an injury claim or ceases to pay benefits, an employee may be eligible for compensation under this alternate program. The state Temporary Disability Benefits Law forbids payments for injury claims related to work. But, since workers' compensation rejected or ended the case, TDI benefits may be available.

Workers' compensation benefits may resume, if an appeal on a denied claim later favors an injured worker. In that case, any TDI benefits you've received would have to be repaid.

This example shows how complicated a workers' compensation claim can get and why an attorney's advice can be very helpful. Lawyers also are aware of alternate and supplemental benefits, like TDI, that may not be apparent to accident victims.

Source: New Jersey Department of Labor and Workforce Development, "Work Related Disabilities" accessed Jan. 29, 2015

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