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What do I do if my claim is denied?

Here at Parisi and Gerlanc, people often ask us about their rights after their workers' compensation claim is denied. Insurance companies find many reasons to deny a claim for benefits. There are typically two main categories for the denial: either your injury or illness is not work-related or it was due to inappropriate behavior that you allegedly engaged in.

In New Jersey, there is a standard procedure to follow if you find yourself with a workers' compensation claim denied by your employer's insurer. This is known as an appeal, in which you formally contest the decision and ask for it to be reviewed a second time. According to the Department of Labor and Workforce Development, if you disagree with the ruling from your employers' insurer, you can submit an application for an informal hearing or a formal claim petition or to dispute the decision.  

You can submit an informal claim to have your dispute heard before a judge of compensation. It is similar to a formal hearing, but nothing the judge says is binding and does not include litigation and other formal legal proceedings that can increase the time and cost of a hearing.

A formal claim is held before a judge of compensation and requires you file your petition within two years of the injury. If you also disagree with the judge of compensation's decision, you have the right to appeal it in the Appellate Division of the Superior Court.

An initial denial of your claim does not have to be the end of the process. Some insurance companies try to blame employees for the injury, stating there was willful misconduct, a previous injury or failure to follow safety guidelines. If you feel that your claim is justified, it is your right to have the decision reviewed by an objective judge. For more information on this subject, please visit our page on claim denial.

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